Colorado’s measles-tracking nightmare 

Hey there, Temperature readers, they say that hope springs eternal on baseball’s opening day. They, however, are obviously not Colorado Rockies fans.

As of this morning, our very own Blake Street Bumblers are tied for the worst record in baseball, on pace in the early going to lose 130 games this season, more than eclipsing the other most futile seasons in the team’s history. Which were last year and the year before.

Yes, in LoDo this April, hope springs infernal.

And yet! Somehow the Rockies are no longer the hottest of messes in the Denver sports reality show. The Nuggets bailed out their cross-downtown brethren yesterday by firing both their coach and their general manager — as the team is on pace to make the playoffs and just two years after winning a championship.

Why am I rambling on about sports idiocies? Because it’s a fun way to remind oneself that human beings are persistently, energetically fallible. And sometimes it’s good to revel in that when the stakes are low — because, as some of the items below show, our missteps and struggles aren’t always so inconsequential.

Like a torpedo bat angling toward a Frisbee slider, let’s hit it.

John Ingold

Reporter

TEMP CHECK

MEASLES

Why the Pueblo measles case is such a nightmare for public health workers

Unlike COVID or the flu, measles, while extremely infectious, is not exactly a disease that moves quickly.

On average, people don’t get the telltale splotchy red rash until two weeks after they were exposed to the virus. Their window for contagiousness starts roughly four days prior to the rash. So that means it’s 10 days on average from when you are exposed to when you might spread the virus to others.

That week-and-a-half provides a crucial opening for public health workers to track down people who may have subsequently been infected before they are infectious. But this didn’t happen in the recent case of an adult in Pueblo infected with measles.

Instead, just about everything that could go wrong in the early response to a measles case did:

• The patient didn’t seek treatment until after the rash had appeared, meaning they had spent the better part of a week walking around while potentially infectious.
• The clinic that saw the patient did not report the suspected measles case immediately, as required by state regulation. “Untimely reporting can lead to faster spread and more severe local impacts,” Colorado Department of Public Health and Environment spokesperson Kristin Richmann wrote in an email. “We have issued a statewide alert reminding providers and laboratories of their legal obligation to report suspected measles cases without delay.”
• The private lab that performed the test took nine days to return a result — on the longer side for testing turnaround times from commercial labs, a Pueblo Department of Public Health and Environment spokesperson said.
• State and local public health agencies didn’t learn about the case until the positive test came back March 31 — 14 days after the individual was potentially infectious. That means, by the time health workers started contact-tracing, the people who had been newly exposed to the virus could have been spreading it to others.

So far at least, the state appears to have lucked out. There have been no new measles cases reported that were connected to the Pueblo case.

Measles can have an incubation time of up to three weeks. It is also possible for patients with the disease not to develop a rash, meaning they may never suspect they have measles, though this happens most often in people with weakened immune systems who may still get very sick.

So it will likely be at least a couple more weeks before health folks in Pueblo unclench. But this incident also shows how quickly a single case of measles could get out of hand.

UPDATE: As we were writing up this item last night, a new measles case was reported that raises some of the same questions.

Based on the timeline provided by public health authorities, the person infected in Archuleta County visited a clinic March 31 and again April 2. But Richmann, the CDPHE spokesperson, said public health was not notified of a suspected case of measles until April 4.

It then took three more days before a lab test confirmed the measles infection, and state and local public health agencies didn’t tell the public until a day after that, which was yesterday. Given that CDPHE pegged the start day of when people may have been exposed as March 28, that would mean 11 days went by between when the patient was first contagious and when people who were exposed knew.

Richmann said the person in Archuleta County had “some symptoms common with measles but also some less typical symptoms,” without elaborating more. So it’s possible there was confusion about whether this actually was a suspected measles case until the lab test came back. We’re asking more questions and will update with a story when we know more.

MORE: Prepping for — and responding to — new cases of measles amid a nationwide surge in infections is probably the greatest disease-tracking challenge that Colorado’s public health system has faced since COVID. But figuring out how well the system has handled the challenge is difficult because officials have released so little information about any of the cases.

For instance, officials have identified three places in Pueblo where the infected person there may have exposed others — a Walmart, the clinic where they sought treatment and a deli.

The deli is especially significant because the exposure window runs from Monday, March 17, all the way through Friday, March 21. And, unlike the other two locations, there are no time boundaries placed on those days. (Conversely, information for the clinic says exposure was limited to between 1:30 p.m. and 4:30 p.m. on Saturday, March 22.)

So that means anyone who was at the deli at any time on those days may have been exposed. When The Sun asked if this means the infected person worked at the deli, we were told local authorities didn’t ask.

“As part of the case investigation, the individual identified all locations they visited during the specific timeframe in which they were infectious,” PDPHE spokesperson Trysten Garcia wrote in an email. “Specifics beyond the dates and times of the locations they visited were not asked as part of the case investigation.”

Officials likewise did not provide an answer on how many people may have been exposed and how many are being monitored for symptoms or were referred for testing.

“The Communicable Disease Team at the Pueblo Department of Public Health and Environment communicates daily with a core group of individuals who were known to be exposed and unvaccinated,” Garcia wrote, without providing more information.

One thing we do know: The case appears to have sparked a modest uptick in vaccinations. Garcia said the department had administered 16 MMR vaccines between March 31 and April 7. In a typical seven-day span, the department would have administered around six.

Section by John Ingold | Reporter

OUTBREAKS

Are Colorado’s measles cases tied to the Texas outbreak after all?

State officials linked two of Colorado’s recent measles cases — the one from Pueblo discussed above and a second reported Monday in a baby from Denver — to travel to the Mexican state of Chihuahua, which is experiencing a measles outbreak.

On the surface, then, it doesn’t appear these cases are connected to the massive outbreak that originated in Texas and now counts more than 500 infections in that state, plus dozens more in others including three that border Colorado: New Mexico, Oklahoma and Kansas.

Because measles has until recently circulated more widely abroad, it isn’t uncommon historically for Colorado to see a measles case every year or two linked to international travel. But might these two new cases be linked to the Texas outbreak after all?

The World Health Organization says that infections tied to the Texas outbreak have spread to Mexico. Mexican health officials told the news outlet Mexico News Daily that cases in Chihuahua originated in Texas. Specifically, local authorities believe members of Chihuahua’s sizable Mennonite population may have brought the virus back when visiting relatives in the Texas Mennonite community where the outbreak is believed to have started.

Asked during a media briefing last week whether the measles case in Pueblo could be indirectly tied to the Texas outbreak, Dr. Rachel Herlihy, CDPHE’s state epidemiologist and deputy chief medical officer, said, “We do believe that it is certainly a possibility.”

To know for sure, Herlihy said there would need to be genetic sequencing of the virus that infected the person from Pueblo.

A CDPHE spokesperson said that work, being done in coordination with the federal Centers for Disease Control and Prevention, is ongoing.

Section by John Ingold | Reporter

INSURANCE

Colorado is trying to protect a key ACA provision — but it could backfire

Colorado lawmakers are trying to protect one of the most popular provisions of the federal Affordable Care Act in state law, in case the Republican-controlled Congress, the administration of President Donald Trump, or various legal challenges dismantle it.

The provision is the ACA’s preventive health services coverage mandate. It’s a mouthful to say, but what it does is simple: It requires health insurers to cover certain preventive health care stuff — things like cancer screenings or breastfeeding support to new mothers — at no additional cost to patients. In other words, you can receive these services, and your insurer will pick up 100% of the bill, no deductible required from you.

In Senate Bill 196, lawmakers are trying to recreate this requirement in state law. The protection would apply only to insurance plans regulated by the state — people with health coverage through employers who are self-insured or based out-of-state would not benefit from the requirement.

“It’s about ensuring Coloradans can continue to access preventive services to keep themselves healthy regardless of what may happen at the federal level,” state Sen. Iman Jodeh, a Democrat from Aurora and one of the bill’s prime sponsors, said during a committee hearing last month.

But, at that same hearing, the head of a local insurance trade group raised concerns that the bill could backfire for a significant slice of Coloradans: those with high-deductible health plans.

High-deductible plans are plans with a deductible of more than $1,650 for single coverage or $3,300 for family coverage. They typically provide access to health savings accounts, which allow people to stash pre-tax money to pay for future health bills. Because these plans usually come with lower up-front premiums, they are hugely popular.

So what’s the problem?

Kevin McFatridge, the executive director of the Colorado Association of Health Plans, said high-deductible plans are regulated under federal tax law. These regulations require the plans to cover certain preventive services recommended by the United States Preventive Services Task Force, which is the subject of a challenge the U.S. Supreme Court will hear this year. (The Trump administration has said it will work to protect the task force.)

This would create an issue if Colorado begins mandating coverage for a different set of preventive services than the federal task force does, McFatridge said. In that situation, McFatridge said the federal government could declare high-deductible plans in Colorado to be noncompliant. That could expose Coloradans covered by those plans to tax penalties, he said.

“Carriers cannot simply override federal law to comply with conflicting state mandates,” McFatridge said during a committee hearing for the bill.

The bill passed the Senate without any changes made to address the potential issue that McFatridge identified. He said in an interview that he is hopeful lawmakers will include amendments in the House to fix the problem.

Section by John Ingold | Reporter

MORE ENVIRONMENT AND HEALTH NEWS

• A specialized pharmacy keeps these kids alive. There’s only one left in Colorado. Kids whose medical condition requires liquid nutrition that can be fed through a port on their bodies will die without it. But there is only one pharmacy left in Colorado that can provide this form of nutrition and that also accepts Medicaid, the government insurance program that covers many of these children. Now, amid a difficult budget year, lawmakers are fighting to find the money to improve what Medicaid pays for the nutrition in the hopes it will encourage more pharmacies to join in, Jennifer Brown reports.
  — The Colorado Sun
• Trump funding cuts threaten HIV prevention as disease gains ground in Colorado. Wrestling HIV into a virus that can be controlled, allowing the people infected with it to live near-normal lives, is one of the greatest health care success stories of our time. But that success requires continued vigilance and prevention work. And one nonprofit in Denver that does that work worries federal layoffs and funding cuts will bring the story a dark new chapter.
  — The Colorado Sun
• A group of Colorado communities were awarded $25.6M for water projects. Then Trump took office. Water and environmental groups in southwestern Colorado are still waiting for their money that got caught up in a widespread funding freeze, Shannon Mullane reports.
  — The Colorado Sun
• Colorado utilities are trying to go green. Tariffs and geopolitical chaos are getting in the way. Colorado’s electricity utilities — from the largest investor-owned corporation to rural electric cooperatives — are straining to meet reliability standards and state clean energy mandates as they face cost-spiraling economics and the threat of tariffs, Mark Jaffe writes.
  — The Colorado Sun
• Denver Water asks judge to stay injunction against Gross Dam construction, calling the stop-work order “egregious” and “radical”. Denver Water came in hot against a judge’s order halting construction of its project to raise the Gross Reservoir dam in order to hold more water, Michael Booth reports.
  — The Colorado Sun
• Tiny zebra mussels forced Colorado to completely drain a lake. Now, it’s time to refill it. Water is flowing back into Highline Lake near Grand Junction after state officials drained it to save it, as Shannon Mullane writes.
  — The Colorado Sun

CHART OF THE WEEK

Colorado’s lagging kindergarten measles vax rate

The map above gives a national look at the kindergarten MMR vaccination rate, as reported by the federal Centers for Disease Control and Prevention.

Colorado isn’t the lowest — that distinction belongs to Idaho, with an estimated 79.6% of kindergarteners vaccinated against measles, mumps and rubella. But it’s also far from the best, which is West Virginia at 98.3%. Colorado’s estimated 88.3% rate ties it with Oklahoma for sixth-lowest.

The CDC has this and more data available on its website.

BONUS About virus names: Rubella is sometimes known as German measles and it also causes a rash, but it is an entirely different virus from an entirely different virus family.

So why does it often get mixed up with measles? Maybe it’s because measles is only the name of a disease, not the virus that causes the disease. What is the measles virus’s name, you ask? Rubeola.

Seriously, why can’t any of this be easy?

Section by John Ingold | Reporter

And that’s it for us this week. Thanks for sticking with us through a packed newsletter. Let’s do it again next week, shall we? The Rockies will have had to have won another game by then, right? Right?

— John & Parker

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