When Dr. Matthew Daley began his term on a previously little-known advisory committee with the U.S. Centers for Disease Control and Prevention, he knew he had a bigger task before him than he had expected.

Daley is a pediatrician with Kaiser Permanente in Denver, but he also does research through KP’s Institute for Health Research. Daley’s work primarily focuses on vaccines — their safety and patients’ hesitancy to get them — and it had long been a goal of his to serve on that obscure committee, known as the Advisory Committee on Immunization Practices, or ACIP.

But while Daley waited for his chance, the COVID-19 pandemic swept into the nation. By the time Daley took his seat in January 2021, ACIP had become one of the most closely watched medical bodies in the country, responsible for reviewing safety and efficacy data on COVID vaccines and making recommendations about whether and how they should be given.

Daley’s term ended in June, and we recently caught up with him to talk about his experience. The following conversation has been condensed and lightly edited for clarity.

The Colorado Sun: How are you feeling now that your term has ended? Happy? Relieved?

Matthew Daley: I’m really going to miss it, so I’m kind of sad, frankly. It was such an incredible experience. It was so much more work than anybody anticipated, so now I can put back all that energy into my day job, which is being a pediatric health services researcher and a pediatrician. Certainly I’m excited to get back to the rest of my day job, but I’m going to miss it because it was such an interesting experience.

Sun: You joined the committee at such a tumultuous time for the nation’s health systems. Why did this volunteer job appeal to you?

Daley: I was really grateful to have an opportunity to serve. Often, we have the energy, we have the expertise, but we don’t always have the opportunity. If you remember early in the pandemic, we were under lockdown, everything was shut down. And kids could get quite sick from COVID, but it was just a whole lot less common versus adults. So as a practicing pediatrician, the first couple months of the pandemic were pretty quiet for us. It felt so odd to be a doctor in a public health crisis who was not very busy. So I really was grateful for the opportunity to serve in this very unusual and unprecedented circumstance.

Sun: There was, of course, a lot of public attention on your work, and there was also speculation about political pressure on institutions like ACIP. How did that feel from the inside?

Daley: The ACIP was allowed to independently follow its process for decision-making. We were aware of these different power centers, but I was never getting late-night calls from any of those groups saying, “This is what we need you to do,” or, “This is the decision we need you to make.” We adhered to our process, the process served us well, and we had independence to make vaccine policy decision-making. And so that was very encouraging to find because I think there was always suspicion out there that somebody had their finger on the scale. But really, the ACIP had a process, followed it and was independent.

Sun: But there was still some pretty intense criticism from parts of the public. Did that ever become uncomfortable?

Daley: Our emails are up on the ACIP website, and people could easily find our emails. So we would get emails from the public. And some of those were pretty negative. Some of those were pretty positive, you know, just thanks for the work that you’re doing. And sometimes it was a high volume, but what was interesting there was that it was sort of copied and pasted. So you get a bunch of emails, but it was verbatim from another email that you’d get. So it seemed like a small number of people who had an organized campaign. But, given the circumstances, it was totally understandable and just fine.

Sun: How did you incorporate that feedback?

Daley: I think it was helpful to hear what people were worried about. And to the extent I could, I would try to address that in the public meetings. I remember a meeting where there were some public commenters who were really worried about COVID vaccine side effects. And I remember saying, “We hear how great your concerns are about COVID vaccine side effects. We do factor that into our decision-making.” We know that no vaccine is 100% safe or effective. And then here’s what data we have about safety. We have good safety surveillance systems in the U.S. The safety monitoring was some of the most intensive — probably the most intensive — safety monitoring ever in the history of modern science in terms of how many eyes were on safety. And so I was reassured by that.

Sun: There were so many consequential decisions during your time on ACIP, in terms of recommending use of COVID vaccines and really being one of the final checks before vaccines started going into arms. Are there any decisions you regret now?

Daley: I don’t have decisions that I wish I could have had back. But I think one thing that I as a pediatrician would have appreciated is if there had been vaccines available for kids sooner. That’s out of our hands because we can’t approve something until the vaccine manufacturer has submitted their data to the FDA (Food and Drug Administration), and the FDA has made a decision about it. And I think the burden (of disease) was so great in older adults that we lost sight of the fact that there were still, in absolute terms, some significant burden in pediatrics. More kids were dying from COVID than were dying from flu. It’s because the relative burden on kids was so much less than the burden on adults that there was so much more focus on adults and getting those individuals vaccinated.

Sun: COVID, obviously, drew the most attention during your time on the committee, but was there anything else that happened that didn’t receive as much public attention as you thought it deserved?

Daley: There’s a product called nirsevimab, and what nirsevimab is is it’s a long-acting monoclonal antibody that prevents RSV (respiratory syncytial virus) in infants. So that is not technically a vaccine because it’s an antibody and a vaccine is different. But it was being used in a very vaccine kind of way. And and so there was this debate about whether the ACIP should consider it and should vote on its use. As a practicing pediatrician, I’ve admitted more babies with RSV to the hospital than anything else I’ve seen in my 25 years of practice. It’s really common, and it can be really severe. And then here we’re given this opportunity to prevent a lot of that illness including hospitalizations and ICU admissions and deaths from RSV. I remember at a meeting where I sort of realized that if we handled it very differently, we’re probably not going to achieve the public health goals that we wanted and not achieve the disease prevention that we wanted.

Sun: So this is an injection that provides protection against RSV, but it doesn’t do it in the same way as a vaccine would by creating an immune response within your body to produce your own antibodies — it takes a shortcut by just giving you the antibodies to start. And the debate was whether to treat it like a vaccine?

Daley:  It’s being used very vaccine-like, meaning it’s being given to everyone for prevention. And so I just remember saying we’ve achieved a lot in the national immunization program. And we have all of these systems in place to achieve high coverage for routine childhood vaccination. And because of that, we have prevented a tremendous amount of disease. And we have the same opportunity with nirsevimab, but we need to use all of our processes, all of our systems, to achieve the same thing with nirsevimab that we’ve achieved with infant vaccines. And after that, ACIP considered it.

Sun: What happened as a result?

Daley: Coverage was really high in the fall. This product is incredibly successful at preventing RSV hospitalizations in kids. There’s also an RSV vaccine for pregnant women that prevents their babies from getting RSV. And the combination of the two prevented just a huge amount of disease this last season. It sort of goes against the argument that there’s so much hesitancy out there that any new product is viewed with great skepticism because probably as many as 50% of infants in the U.S. in this past respiratory season, either they got nirsevimab or their mom got the RSV vaccine during pregnancy.

Sun: You mentioned hesitancy, which is a research specialty of yours. How do you view vaccine hesitancy, post-pandemic, and how do you address it now that vaccines have become a much more polarizing topic?

Daley: It’s a challenge that’s going to stay with us, I think, forever. I think we’ll always have some degree of hesitancy. When I look at hesitancy in pediatrics, I start with the principle that parents want what’s best for their kid. So I try as hard as I can not to get judgmental when parents make a different decision than what I recommend. They want what’s best for their kid. Then in the context of COVID vaccines, that’s a little different because people are making decisions for themselves and not for their kids. But it’s the same thing they want. They don’t want to get COVID, but they’re worried about the safety of COVID vaccines and they’re worried about maybe there’s some things that we don’t know about vaccines. So I understand that. But I think if we have transparency, integrity, public airing of the data, that helps. And then I think what also helps is to continue to study vaccine safety and study what people are really worried about.

Sun: When your term ended on ACIP did you get a parting gift?

Daley: No, I mean not really. What happened is that we had a three-day meeting, and on that Friday, they took a few moments to make comments about each of us and then they gave us a few minutes to make a comment. There were four of us who started right around Jan. 1, 2021. We had the most meetings that anybody ever had in the history of the ACIP. So they said thank you for your service. And that meant a lot.

Sun: OK, but not even a cake?

Daley: We didn’t have a cake. We had a lot of work to do.

The art is hung. The toilets flush. The X-ray machines are (finally) assembled.

On Saturday, barring any last-minute hiccups, Intermountain Health’s Lutheran Medical Center in Wheat Ridge will shut down its current location and move 3 miles west to a brand new, $680 million campus. It’s the first major hospital relocation in Colorado in years, and the new facility showcases how the COVID-19 pandemic has forced health systems to rethink what a hospital must be able to do.

Take, for instance, the patient rooms. There’s 226 of them, and each one comes with a nifty sliding supply cabinet that nurses can pull out to restock from the hallway.

This means nurses won’t need to disturb patients as often. But the feature serves another purpose. If the patient inside the room has a contagious bug, it keeps staff from having to load up on protective gear just to refill the tissue boxes.

Here’s another COVID-inspired design choice, taken from a pandemic when hospitals often worried about running out of capacity: Every patient room can be converted into a critical care room if needed.

“An outcome of the pandemic is we need the flexibility to take care of really sick patients everywhere,” said Casey Bogenschutz, the executive who is overseeing Saturday’s move.

Orchestrating the move

Bogenschutz is Lutheran Medical Center’s director of strategic initiatives, but that title severely undersells both the strategy and initiative the job requires.

At 6 a.m. on Saturday, the current location — at West 38th Avenue and Wadsworth Boulevard, where it has stood in some form since 1905 — will stop accepting new patients. The new hospital, which is just off Interstate 70 near the interchange with Colorado 58 in a development known as Clear Creek Crossing, will begin accepting patients.

Then the dance begins.

Starting at 8 a.m., a fleet of about 20 ambulances will begin running loops transporting patients already in the hospital to the new campus. The hospital is expecting to move about 180 patients, in a precisely timed choreography, one patient moving every eight to 10 minutes.

“We will have a down-to-the-minute plan for each patient,” Bogenschutz said.

On a recent day, Bogenschutz led The Sun on a tour of the new hospital, weaving through a maze of corridors and rooms, some with signage still TBD. Outside each room hung a list, attached with blue painter’s tape, of all the items needing to be placed inside. Bed, check. Toilet paper, check.

There were large televisions and “digital whiteboards” — screens with information for both patients and staff — to be connected. Bathrooms in the patient rooms were built as prefabricated pods at a factory in Phoenix, then shipped to Colorado on a truck and lifted by crane into place.

The operating rooms were just days away from intensive cleaning to render them sterile and ready for surgery.

Why build a new hospital?

In addition to COVID, the facility has been designed with other modern afflictions in mind. Doors connect all the rooms for trauma patients, allowing a doctor treating people from a mass-casualty incident such as a mass shooting to move quickly from patient to patient.

Bogenschutz said the new hospital has been organized for efficiency. MRI and CT scanners are positioned nearby the patients who will need them. The room numbering is orderly and intuitive, allowing a nurse to know exactly where they are in the hospital at any time. There’s an organized flow as patients move from one treatment area to the next — no more long walks or elevator rides to connect commonly used areas.

This, Bogenschutz said, is the best argument for building a new hospital, instead of simply renovating the old one.

“It doesn’t have the adjacencies that are required in the industry,” she said of the current hospital. “You make it work, but when you upgrade you can build things the way you want them.”

Colorado stands out among the 10 states that have disenrolled the highest share of Medicaid beneficiaries since the U.S. government lifted a pandemic-era restriction on removing people from the health insurance program.

It’s the only blue state in a cluster of red states with high disenrollment rates — a group that includes Idaho, Montana, Texas, and Utah — in the Medicaid “unwinding” underway since spring 2023.

Colorado also is the only state that had all the policy ingredients in place to cushion the fallout from the unwinding, according to Medicaid policy analysts at KFF.

But it seems the cushion hasn’t been deployed.

“There’s really a divide in Colorado between our progressive policies and our underfunded and fragmented administration,” said Bethany Pray, chief legal and policy officer at the Colorado Center on Law and Policy, a Denver-based legal aid group.

According to KFF data, during the unwinding Colorado has seen a bigger net drop in enrollment in Medicaid and the Children’s Health Insurance Program than any state except Utah.

Advocates for health care access, researchers, and county administrators — the administrators handling the bulk of the Medicaid redeterminations in Colorado — say that the major issues involve outdated technology and low rates of automatic renewals. Both create obstacles to enrollment that undercut the state’s progressive policies.

State officials have a rosier view. They say the drop in enrollment is a sign that they did a good job enrolling people at the height of the COVID-19 pandemic. Secondly, they say Colorado’s economy is doing well, so more people can get insurance through their jobs.

“When we have a really stellar unemployment rate, not as many people need safety-net programs, and we’re proud of that. Our people are rising and thriving,” said Kim Bimestefer, who leads the Department of Health Care Policy and Financing and is the state’s top Medicaid official. Her department has also said that some people choose not to fill out their eligibility paperwork because they know their incomes are too high to qualify.

Bureau of Labor Statistics data shows that while it’s true Colorado’s unemployment rate is lower than the nation’s as a whole, it’s higher than it was before the pandemic.

State officials say they believe Medicaid enrollments dropped because many of those people found jobs, as reflected by the lower unemployment rates. But that scenario happened in fewer than half of the state’s counties, a KFF Health News analysis found. Notably, in 11 counties where unemployment stagnated or increased from January 2020 to April 2024, the share of the population covered by Medicaid shrank. A low unemployment rate does not necessarily mean there is less of a need for Medicaid coverage, because many employed people earn wages low enough to still qualify for the program.

Colorado increased enrollment in Medicaid and the related Children’s Health Insurance Program by 35% during the covid public health emergency, compared with about 30% nationally and among Medicaid expansion states.

“We grew more, which means, logically, we’re going to disenroll more,” said Bimestefer.“We went up higher, we’re going to come down lower, because our economy is stellar.”

Her department’s website initially claimed Colorado’s Medicaid enrollment grew more than any other Medicaid expansion state except Hawaii. But data from the Centers for Medicare & Medicaid Services shows pandemic enrollment growth in other states, including Indiana, North Dakota, Virginia, and Nevada, also exceeded that of Colorado.

Even if it had grown the most, the argument that what comes up must come down doesn’t hold water, Medicaid policy analysts said.

“A counterargument to that is we know that there was never a full participation in Medicaid prior to the pandemic,” said Jennifer Tolbert, deputy director of the KFF Program on Medicaid and the Uninsured.

Tolbert said she was surprised by the extent of Colorado’s Medicaid enrollment losses, given it was the one state in the nation that met all the criteria that KFF expected would cushion the effects of the unwinding. Those policies include adopting the Affordable Care Act’s Medicaid expansion and the automatic processing of renewals.

Tolbert was among several policy researchers who said that even if unemployment returned to pre-pandemic levels, they would expect a higher, not lower, share of Coloradans to be enrolled in safety-net coverage.

Ally Sullivan, a spokesperson for Gov. Jared Polis, a Democrat, said one complicating factor in Colorado’s system is that it’s among the handful of states where most of the eligibility verification work falls on counties, “which added complexity to the state’s unwind process.”

“Colorado is committed to ensuring that Coloradans who no longer qualify for Medicaid coverage are connected to other affordable sources of coverage as soon as possible, and the state is going to great lengths to do so,” the statement said.

Minnesota is another state where verifying eligibility is largely left to the counties. Yet it disenrolled just 26% of its Medicaid population in the unwinding, compared with Colorado’s 48%. Like Colorado, Minnesota is led by a Democratic governor. Minnesota also mirrors Colorado in its population, pandemic-era increase in enrollment, the percent of its residents living in prosperous areas, and its better-than-national unemployment rate. But Bimestefer dismissed any comparison.

“I don’t care about Minnesota,” Bimestefer said. “This is Colorado. I don’t care what Minnesota did.”

Advocates for health care access and researchers said a cluster of technological and administrative issues have contributed to Colorado’s high disenrollment rate.

First, Colorado’s eligibility database, the Colorado Benefits Management System, is outdated and clunky, according to people who use it or are familiar with systems in other states.

“It’s like still using the old flip phone where you’re trying to play Snake,” said Sarah Grusin, an attorney at the National Health Law Program. “We have better stuff.”

Grusin and Pray’s organizations filed a civil rights complaint with several federal agencies saying that the system issues that terminated disabled Coloradans’ coverage amounted to discrimination.

“It took many months to fix something that doesn’t sound that complicated,” Pray said.

Colorado had to pick between keeping kids covered and automatically renewing people

Bimestefer said her department is working on a plan to improve the system, which is managed by Deloitte under a $354.4 million contract that lasts until 2027. A recent KFF Health News investigation of eligibility systems managed by Deloitte found widespread problems. In Colorado, a state-commissioned audit in 2020 found that many Medicaid beneficiaries were sent incorrect notices and deadlines.

Kenneth Smith, a Deloitte executive who leads its national human services division, said that Deloitte is one player among many who together administer Medicaid benefits, and that the states own the technology and make the decisions about their implementation.

Colorado’s technology woes have also weakened its ability to use a powerful tool in enrollment: automatic renewal.

Last fall, Bimestefer said, her agency had to choose between fixing the system so that it would stop disenrolling children who shouldn’t lose coverage, or start automatically renewing people with no income or with income below the federal poverty level. It couldn’t do both, she said.

Experts such as Tricia Brooks, a research professor with the Center for Children and Families at Georgetown University, said it’s especially important to increase automatic renewals in states like Colorado where most of the renewal work falls on county government staff.

“What happens when you’re not getting a high rate of automated renewals? You’re sending out those renewal forms,” Brooks said — meaning more disenrollments. “They didn’t get the mail. The notice was confusing. They tried to get help through the call center. The list goes on as to why people don’t renew.”

Indeed, two-thirds of disenrolled Coloradans lost coverage for procedural reasons. That’s in line with the national average, according to KFF. But paired with Colorado having disenrolled so many people overall, that means more than 500,000 Coloradans, or about 9% of the state’s people, were disenrolled for procedural reasons — more than the population of its second-largest city, Colorado Springs.

At least a third of those disenrolled were later determined to be eligible for Medicaid.

Officials at Colorado community health centers and mental health centers say they’re seeing a rise in uninsured patients coming through their doors — a sign, they say, that Coloradans dropped from Medicaid aren’t necessarily moving on to greener health insurance pastures.

Fifty-eight percent of those who were disenrolled have returned to Medicaid, or now have another form of insurance. But the state doesn’t yet know what happened to the remaining 42% of people who were dropped and said it would conduct a survey to find out.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Precautions such as shutdowns and social distancing, combined with the fast rollout of vaccines, saved 800,000 lives in the United States from the clutches of COVID-19, a new study co-authored by a University of Colorado professor estimates.

But the price of that prevention was also tremendous. Shuttered schools creating lasting learning loss and achievement gaps. Delayed routine medical care leading to bigger problems and deaths down the road. And, perhaps most serious of all, a newfound hostility to public health measures, which could leave us more vulnerable for the next pandemic.

“Our hope in the paper is not to downplay those things or say these measures saved 800,000 lives, period,” said Stephen Kissler, an assistant professor of computer science at CU Boulder.

“My concern,” Kissler’s co-author, UCLA economics professor Andrew Atkeson told CU Today, “is that the next pandemic will be deadlier, but people will ignore it, because they will say, ‘Oh, we overdid it during COVID.’”

Instead, Kissler and Atkeson intend the new study, which wades into some of the most controversial debates of the pandemic and was published in a Brookings Institution journal, as a call to intensify public health efforts. A better public health system, they argue, would allow authorities to better understand diseases earlier in outbreaks so that such broad, heavy-handed countermeasures won’t be necessary in the next pandemic.

“If we had been able to gather better information more quickly, we would have been able to reduce the burden of our countermeasures,” Kissler said in an interview with The Sun.

Kissler’s speciality is mathematical epidemiology — using data and computer models to track the spread of disease and its outcomes. He said the new study fits with a movement to look back on the lessons of COVID.

“We’re starting to do some retrospective thinking about the pandemic,” he said. “Thinking about what happened. What could we do better now.”

For the study, he and Atkeson relied largely on data from blood tests to determine how many people were vaccinated prior to being infected with COVID. From there, they ran modeling scenarios to estimate how many people would have been infected before vaccination — and how many would have died — had social isolation and distancing policies not been in place or had vaccines rolled out more slowly.

Their two models, one that was simpler and another more complex, ended up returning the same result: The U.S.’s COVID countermeasures, which slow-rolled the spread of infections across the country, saved between 800,000 and 850,000 lives.

The study was published last month. What happened next wasn’t entirely unexpected to Kissler, who worked on epidemiological studies about COVID throughout the pandemic. People started emailing him. And they were angry — about the toll of lockdowns, vaccine mandates and all sorts of other things related to COVID. 

“I was a little surprised how quickly and forcefully some of those responses arrived,” he said.

But Kissler doesn’t see this study as divisive. He sees it as attempting to chart a better path forward.

In his view, the study shows how much impact humans can have through their behavior on the course of a disease outbreak. Now comes the work of trying to make that impact more precise.

By learning more now about how different types of viruses spread, by doing a better job of tracking emerging outbreaks, and by developing even faster vaccine-development and distribution systems, we can manage pandemics with less social pain.

“Clearly we can have a huge impact,” he said. “And we just need to do what we can do now to make sure we can have a similar impact at a lower cost.”

Cancer reclaimed the top spot as Colorado’s No.1 killer last year, according to finalized numbers released last month by the Colorado Department of Public Health and Environment.

In 2023, 8,411 Coloradans died from what are known in vital statistics records as “malignant neoplasms.” Heart disease, the second-leading cause, claimed 8,071 lives.

Those two causes far exceed any other cause of death in Colorado. Cancer has been No. 1 for most recent years, but heart disease held the top spot in 2021 and 2022.

The chart below shows the top 20 causes of death from 2018 through 2023.

COVID falls down the list

For the first time since it appeared in Colorado, COVID-19 didn’t crack the top 10 causes of death last year, though it was close. With 626 deaths in 2023, COVID was the 12th-leading cause of death. (In 2020 and 2021, it was the third-leading cause.)

That reflects the waning severity of the pandemic. But, for comparison, influenza and pneumonia combined last year killed 371 people, ranking 18th, so COVID is still very much a threat, especially to older populations.

The causes and categories in this list follow the methodology of the National Center for Health Statistics, though some of the causes are a bit of a mashup. Accidents, for instance, encompass everything from car crashes to falls to unintentional drug overdoses. Lumping them together like that can obscure some of the underlying trends.

Accidental deaths declined last year, but drug overdose deaths were up — to 1,865, of which 1,097 involved fentanyl. Motor vehicle accidents (785 deaths) and falls (1,064 deaths) were down.

Other notable causes of death: Suicides (1,290 deaths) remained almost exactly the same as in 2022, while homicides (366) dropped by nearly 50.

Deaths dropped overall

Overall, 44,862 Coloradans died last year. (The figure includes people who lived here but died elsewhere and not people who died here but lived elsewhere.) That’s roughly 2,000 fewer deaths than in 2022, and it’s nearly 3,500 fewer deaths than in 2021, Colorado’s deadliest year on record.

Relative to population size, Colorado’s death rate fell to something closer to — but still higher than — pre-pandemic levels. The age-adjusted death rate was 681.7 deaths per every 100,000 population in 2023. The three years before that had seen age-adjusted death rates in the 700s. In 2019, the year before the pandemic, the age-adjusted rate was 635.9.

The state compiles these annual death numbers, as well as a host of other vital statistics data, in a system called the Colorado Health Information Dataset. The system has several easy-to-use data dashboards for members of the public interested in more specific information.

Relationship problems, family breakups, inability to pay rent or a mortgage, losing a job and inability to find work are the top contributing factors leading people into homelessness across metro Denver, according to the findings of an annual report released Thursday.

Far more people in the seven-county metro area are newly homeless as opposed to chronically homeless, according to the 2023 State of Homelessness Report compiled by Metro Denver Homeless Initiative, the regional system that coordinates services and housing for people who are homelessness.

Over 90% of the 11,779 people surveyed said they did not choose to become homeless, the report said, disproving a common notion that homelessness is a personal choice.

Of the 9,085 people who shared previous address information in the homeless management information system since 2015, 88% reported a last permanent address in Colorado, according to the report.

People also are not moving to Colorado because of the legalization of cannabis and becoming homeless, another common myth, the report states. 

Homelessness is caused by systemic failures and not personal shortcomings, according to the report, which uses four data sources and surveys from people with lived experience in Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties.

“When we use data collected throughout the year to measure the scope of this crisis, we can more effectively plan an equitable system response that is geared toward ending homelessness,” said Rebecca Mayer, interim executive director at Metro Denver Homeless Initiative.

The purpose of the report is to educate the public about homelessness in metro Denver, humanize people who are homeless, combat misconceptions about people living outside, in shelters or in cars and describe the work being done by human service providers to reduce the number of people staying in places not meant for human habitation.

Data used to produce the report was entered by about 100 agencies across the metro Denver region and shows an annual account of homelessness. 

Because the data is collected over time, it better represents the scope of homelessness than the region’s point in time count, when people who are homeless are counted on one night in January.

The 2023 State of Homelessness report shows 7,217 people stayed outdoors at some point during the year compared with 2,763 on the night of the 2023 point in time count, for example.

The 2022 State of Homelessness report showed 7,334 people stayed outdoors at some point during the year, compared with 2,078 on the evening of the point in time count that year. 

There were 9,065 people counted during the 2023 point in time count, up from 6,884 people counted during the 2022 point in time count. The point in time total includes people sleeping outdoors and those who are housed in some type of emergency shelter or transitional housing.

The State of Homelessness findings come just after Denver Mayor Mike Johnston’s office said it met its goal of sheltering 1,000 people by the end of 2023.

A surge of about 38,000 Central and South American migrants who have arrived by buses from the Texas border since December 2022 are also finding themselves included in the region’s homeless crisis. Not all of them stayed in metro Denver. But as of Thursday, there were more than 4,300 migrants living in emergency shelters and hotels.

The State of Homelessness report does not include data specifically about the number of migrants who are homeless.

“What we’ve seen for the last few years is these numbers are increasing and I think that that’s alarming because even with the mayor’s new initiative of bringing more people inside, more people are falling into the cycle of homelessness,” said Cathy Alderman, chief communications and public policy officer for the Colorado Coalition for the Homeless, which helps with the point in time count and enters data into the homeless management information system.

“And if we can’t slow that flow down, it will be really difficult for the system to respond and get people back onto stable pathways to housing,” she said. 

More than 30,000 people accessed homeless services between July 1, 2022, and June 30, 2023, in the metro area, the report found. About 45% were seeking services for the first time.

During the 2021-22 school year, public school districts in the metro area identified almost 10,000 students who were homeless, the report states.

Rising rents and low wages make it increasingly harder for people to find and keep stable housing in one of the most expensive metro areas in the country, according to the report.

A list of factors leading to homelessness

Housing is the solution to homelessness, yet Colorado has the seventh highest housing shortage in the country, with a gap of nearly 70,000 units, the report says. 

Renting or owning a home in the metro Denver area is becoming more and more out of reach for Coloradans.

Dwindling resources for financial assistance, the lack of affordable housing, domestic violence, employment challenges and issues with mental health or addiction are on a long list of factors contributing to homelessness, according to the report.

Homelessness is not limited to the people seen living outside. A less visible population of people who are homeless includes children, families and young people. 

In the metro region, 3 in 4 people who are homeless live in emergency shelters, transitional housing or other indoor areas.

A high number of families are newly homeless. The head of these households are typically women and most of those households have one to three children. Trauma contributes to homelessness for more than half of those families.

An unnamed woman included in the report said she was kicked out of their mother’s house at 17, after she was admitted to a psychiatric hospital.

“In between the moments of being kicked out, I spent time on the streets at night, often getting harassed and assaulted due to my physical appearance of being a girl,” she says in the report. “It took a year of this before I was old enough to be considered for housing. This shaped me as a person who grew to deal with extreme anxiety and learn to face it head-on with the help of my best friend.”

Average rent for a two-bedroom apartment in the seven-county Denver metro area is $1,864, according to the report. To afford that level of rent and utilities, a household would need to earn $74,554 per year, the report says.

Men and people of color are consistently overrepresented in homelessness in the State of Homelessness report and the point in time count.

For example, 64% of men were homeless between July 1, 2022, and June 30, 2023, compared with 34% of women who were homeless within that same time frame.

Native American and Pacific Islander people are five times more likely to be homeless in metro Denver compared with their makeup in the general population. Black people are 3.7 times more likely to be overrepresented, Native Americans and Alaska Natives are 3.6 times more likely to be homeless and multiracial people are 1.6 times more likely to be overrepresented, according to the report. 

In metro Denver and across the country, people of color are overrepresented in homelessness because of the country’s racist history and inequitable policy decisions in health care, criminal justice, education, housing, child welfare and income, according to the report.

More than 20% of white and Asian households fell into the upper-income category in Colorado, compared with less than 10% of Black, Native American and Alaska Native households. 

Almost 5% of Coloradans are Black, but nearly half of all Colorado households were considered lower income, making it harder for them to rent or purchase housing.

The homelessness crisis, made worse by the pandemic, is becoming harder to adequately address but local service providers say one hopeful trend shows homelessness can be reduced.

In 2023, the number of homeless veterans in metro Denver dropped to 391 from 468, down 16%. According to the report, 415 veterans were housed in 2023.

“Our goal for 2024 is to functionally end veteran homelessness in 4 out of 9 subregions,” the report says. “This means homelessness for veterans becomes rare, brief and nonrecurring.”

Metro Denver Homeless Initiative will share monthly updates on progress toward reducing homelessness among veterans.

As Colorado slogs through its fourth winter of the COVID-19 pandemic, a curious trend has emerged.

This season — at least so far — the state reached its peak for hospitalizations of people with COVID in the second-to-last week of November. That’s almost exactly when a peak happened last year. And the year before that. And the year before that.

Four years, four different predominant variants of the virus, four different levels of vaccination and immunity in the population. And four times that COVID hospitalizations began rising in late summer or early fall and, more notably, began to decline in Colorado right around Thanksgiving.

“Fascinating and beguiling,” is how Elizabeth Carlton, a professor of epidemiology at the Colorado School of Public Health, described the phenomenon.

“I think, by now, there probably is something happening driving this pattern,” she said — instead of the trend being a statistical fluke.

What that something is, though, no one knows.

“It is an interesting pattern,” said Dr. Rachel Herlihy, the state epidemiologist at the Colorado Department of Public Health and Environment. “I don’t think we can fully explain it.”

What’s happening with COVID now

As it seems like everyone you know is sniffling or coughing or otherwise testing positive for something, here is what we know about Colorado’s current COVID trends:

• The late-November peak came with 280 people in the hospital with COVID.
• As of last week, there were 246 people in the hospital with COVID. (Carlton said hospitalizations have become the key metric to watch for COVID trends because they tell you how much serious illness there is; data on infections has become less reliable as more people test at home and don’t report the results.)
• After declining through December, hospitalizations began rising again after the new year, likely caused in part by the arrival of a new variant, dubbed JN.1. The variant is sweeping across the country, pushing infections higher nationally. Herlihy said the variant appears to be more transmissible and better at escaping prior immunity than others.
• It is unclear if infections are continuing to increase in Colorado, though. Up until last week, various measures used to predict the virus’ spread — things like what percentage of tests at the state’s network of “sentinel” labs are coming back positive and what percentage of emergency room visits resulted in a COVID diagnosis — were trending higher. Both of those backed off slightly last week. 
• One measure used to track how widespread infections are — how much of the virus can be detected in wastewater — continues to show high levels. But both Carlton and Herlihy said it’s possible this is because JN.1 may be better at infecting cells in the gut, meaning it is shed more frequently in poop, skewing the analysis.
• The situation remains much more controlled than any previous year of the pandemic. Last year’s peak for hospitalizations was 440. The years before that saw peaks of more than 1,600 people in the hospital at one time.

Carlton said it’s important to remember that even if COVID levels are falling or aren’t as severe as in prior years, we are still in the middle of the high season for all kinds of respiratory illnesses — such as flu, RSV and that weird hacky-cough virus going around this year that no one can quite seem to identify.

That means people should continue to take precautions, such as staying home if they’re not feeling well, seeking treatment when sick and considering wearing a mask in crowded places. It’s also not too late to get vaccinated with an annual flu shot, an updated COVID booster or, if eligible, an RSV vaccine.

Colorado’s perplexing peak

Colorado’s late-November COVID peaks are unusual because they tend to happen earlier than peaks across the rest of the country. Last year, hospitalizations peaked nationally in January, same as the year before.

They have also sometimes had the effect of blunting the arrival of a new variant. When a new variant called XBB.1.5 swept across the country last year, it had little impact in Colorado, perhaps because our earlier-breaking wave had built up a layer of fresh immunity in the state.

This is not always the case. In early 2022, Colorado saw a significant rebound in infections and hospitalizations in January, driven by the arrival of the original omicron variant. This year’s trends may prove to be a smaller-scale version of that.

But the November peak has remained a COVID constant in Colorado, sticking to a much tighter turnaround schedule than other respiratory viruses like the flu, which sometimes hits early and sometimes later in winter. It is also intriguing because, with holiday travel in late November and December, one would normally expect to see cases increasing as a result.

Carlton said she’s thought of a few theories that might help explain the peaks. One possibility is weather patterns — viral transmission changes as temperature and especially humidity levels do, with drier air more favorable to infection.

“We’re just a drier state and we know this virus seems to spread under dry conditions,” she said.

The school calendar may have an impact. Colorado’s school year tends to start earlier than in some other states. Mobility and travel habits may also play a role — say, more people heading to the mountains to go skiing or spending more time indoors.

But none of these quite fits either, she said. Some falls have been wetter than others over the past four years. And, in order for hospitalizations from COVID to start falling in late November, infections would need to begin slowing at least a couple weeks prior, before ski season and school breaks really start.

Four winters in and there is still so much left to learn about this virus.

“I think what COVID has taught us is that it evolves incredibly rapidly,” Carlton said. “So what we think we know today may change by tomorrow.”

Dead men tell no tales, but their bones sure do. Even more than 100 years later.

And now a pair of researchers — one from the University of Colorado Boulder and another from McMaster University in Canada — are using those skeletal stories to question a conventional wisdom about the 1918 flu pandemic.

In a new peer-reviewed study published this week in the journal PNAS, the researchers take on the notion that the 1918 flu was unusually dangerous to the young and healthy. This is a common theme in stories about the pandemic, that it viciously struck down robust people in the prime of life. And this threat of an indiscriminately lethal pathogen has informed pandemic planning ever since.

But when the researchers, CU anthropology professor Sharon DeWitte and McMaster anthropology professor Amanda Wissler, studied the bones of people who died in the 1918 pandemic, they found that people exposed to stresses like poor nutrition, pre-existing illness or physical hardship were more likely to die from the pandemic flu than those whose bones showed fewer signs of stress. The most frail, based on an analysis of bone lesions, were 2.7 times more likely to die from the flu.

“Honestly, it shouldn’t be surprising because of what we see routinely from various causes of death,” DeWitte said in an interview with The Colorado Sun.

DeWitte is a well-known expert in a field called bioarchaeology — that is, the study of human life in the past through the examination of people’s skeletons. Much of her work has focused on the Black Death and skeletons exhumed from medieval London cemeteries. In that pandemic, too, she found evidence that society’s most frail and vulnerable were disproportionately affected.

The work inspired Wissler to work with DeWitte on a study on deaths in the 1918 pandemic and whether this notion of a plague that cut down healthy young people was true.

To answer the question, the researchers looked to the Hamann-Todd Human Osteological Collection, a collection of more than 3,000 human skeletons kept in the basement of the Cleveland Museum of Natural History, each with detailed notes on age and cause of death. The on-site work fell to Wissler, who spent hours in the basement looking for evidence of bone lesions in 369 skeletons that fit their study parameters. (While the research coincidentally took place during the height of the COVID pandemic, it had been thought up well before that virus began circulating.)

DeWitte said they were looking specifically for what are called periosteal lesions on people’s shin bones. The lesions can be caused by physical trauma, but also by illness, some nutritional deficiencies and other causes. In bioarchaeology, DeWitte said, such lesions are “often viewed as a nonspecific stress indicator.”

Their findings — which the anthropologists caution are ultimately limited by their small sample size — suggest the 1918 pandemic actually worked like a lot of other pandemics, including COVID-19: It was most devastating to the most medically and socially vulnerable. Even though the 1918 pandemic was unusual in having a higher death rate among young adults than typically seen in flu outbreaks, the disparities in who was dying remained. It largely wasn’t people who were otherwise healthy.

“The results contradict prior assumptions about selective mortality during the 1918 influenza pandemic,” the two anthropologists wrote in their study.

DeWitte said she hopes this knowledge will help public health leaders better prepare for future pandemics. If a narrative were to persist that there are some pandemics that kill indiscriminately, she said, “it sort of fosters complacency about doing anything to prevent horrible outcomes.”

Her research, she said, shows there are things that can be done, namely working to improve public health for society’s most vulnerable and better targeting resources to those groups when a pandemic does hit.

But, as historic and more recent events have shown, those aren’t policies that are adopted easily.

“The COVID-19 pandemic really highlighted for me how the work that I do has relevance to people today,” DeWitte said. “But it’s also depressing because we have these recent pandemics that people are experiencing firsthand and we’re not learning the lessons of the past.”

Coronavirus infections appear to be on the march in Colorado.

In numbers that the Colorado Department of Public Health and Environment reported this week, 112 people are hospitalized with a COVID infection, up from 99 last week. Last week’s increase in hospitalizations — to 99 from 77 — was the largest one-week jump in months.

The number of people newly admitted to the hospital with COVID-19 increased by 11 this week compared with last. The percentage of COVID tests coming back positive from the state’s sentinel lab network is rising, now at 13%, as are signals from wastewater surveillance.

“The trends are very similar to what we’re seeing nationally,” said Dr. Rachel Herlihy, the state epidemiologist, referencing rising numbers of COVID infections across the country.

The number of infections reported are also increasing but likely do not tell a complete tale. The state reported 1,920 new cases this week, up from last week’s 1,754. At-home testing — or people choosing not to test at all — means we are probably missing a whole bunch of cases.

But there’s another reason this COVID surge is different from those in the past and might be flying under the radar.

It’s not about the virus, it’s about the virulence

Even with 112 people in the hospital — the most since early May — Colorado remains near pandemic lows for hospitalizations. At this time last year, there were 195 people hospitalized. In late August 2021, there were more than 800. And at the all-time peak, in early December 2020, there were more than 1,800.

Among those hospitalized, roughly 45% are there for a reason other than COVID. In other words, their COVID infections aren’t believed to be causing their hospitalization.

Herlihy said the lower effective severity seen so far in this wave is likely due to stronger levels of population immunity, both through vaccination and through prior infection. Even as the virus continues to mutate and spit out new variants, it is a much more familiar foe to our immune system.

Some of those variants may do a better job at evading that existing immunity and make us sick. But, overall, the effective virulence of the virus — i.e., how vicious it is — is diminished.

Herlihy said the EG.5 variant is most common in Colorado right now, and the state has yet to see the BA.2.86 variant that has some epidemiologists a bit concerned due to traits in its genetic code that could make it better at evading pre-existing immunity. Both of those, though, live within the omicron variant family tree, which has been around for a while.

“Omicron has been with us for a very long time now,” Herlihy said.

Do you need a fall COVID vaccine booster?

So far, the federal government has not issued a broad call for people to get a COVID booster, but that could soon change. (People who are over 65 or who are immunocompromised are eligible for a booster as needed, though.)

An updated vaccine formula could be approved as soon as next month. Herlihy said that formula will be based on a specific omicron subvariant known as XBB.1.5 that was prominent in the U.S. this summer. (The EG.5 subvariant is closely related; the BA.2.86 subvariant is less closely related.)

Herlihy said the new formula’s ability to better target more recent versions of coronavirus mean that people should be patient when it comes to seeking a booster shot.

“At this point, most people should probably wait until that new vaccine comes out in September or October,” she said.

Do you need to start wearing a mask again?

In the meantime, the 112 people in the hospital right now battling COVID stand as a testament to the virus’ continued ability to do harm.

Herlihy said people should be mindful of the COVID upswing and be extra-vigilant, and those who are older or have underlying medical conditions should be especially so. Stay home if you’re sick. Get tested. Seek out antiviral treatments to help manage the infection.

Herlihy did not specifically call for people to begin wearing masks in public but has previously said it’s a good idea if people want extra protection. In areas where hospital admissions levels are low, as they are in all but five Colorado counties currently, the federal Centers for Disease Control and Prevention recommends masks be worn only on public transportation. Otherwise, the agency advises, “People may choose to mask at any time.”

Chaffee, Lake, Logan, Phillips and Sedgwick counties are all currently listed in the “medium” category for hospital admissions — though those designations can change quickly in counties with small populations. In areas with medium-level hospital admissions, the CDC recommends that people who are at increased risk from COVID to wear masks in public.

Colorado often sees COVID infections increase in late summer, with now through November typically the state’s busiest COVID season. But Herlihy said it’s unclear whether the state will follow a similar pattern this year or whether the current wave will fizzle out quickly.

COVID may still be a pandemic, but it’s one that looks a lot different than it did just a few months ago. 

“I think it’s challenging to predict what the next couple of months are going to look like,” Herlihy said.

The number of people who became homeless in metro Denver for the first time sharply rose to 3,996 people this year from 2,634 last year, a 51.7% increase, according to data from the annual point in time count led by the Metro Denver Homeless Initiative.

The number of families who were homeless for the first time also significantly increased to 1,316 this year from 597 last year, a 120.4% increase, according to the data released Monday morning.

The number of families experiencing homelessness for more than a year also drastically rose across the metro Denver region, according to the results. This year, 2,101 families were homeless again compared with 1,277 last year, a 64.5% increase.

The annual count, which quantifies homelessness in the seven-county metro Denver area, showed 9,065 people were homeless on Monday, Jan. 30, the night local volunteers, municipal and county leaders, outreach teams and people who were formerly homeless scattered across the metro Denver region to conduct the annual survey. That’s a 31.7% increase in homelessness compared with the survey’s findings in 2022, which counted 6,884 people. Preliminary numbers released after the 2022 count were slightly higher, at 6,888 people.

“While the world is no longer in a pandemic, we are beginning to feel the full economic fallout of the COVID-19 era,” Jamie Rife, executive director of the Metro Denver Homeless Initiative, said in a news release.

“With COVID-19 relief funds for the prevention of homelessness coming to an end, as well as many other COVID-era protections, we’ve seen a sharp increase in the number of eviction filings as more households struggle to pay rent,” she said. “This, paired with inflation and the increased cost of housing, is resulting in many people falling into homelessness and many being unable to obtain housing.”

The pandemic showed that when municipalities have funding to help prevent homelessness, that mechanism works, she said in an interview on Monday afternoon. The number of people who are homeless this year would have been even higher without rental assistance and prevention funding, Rife added. “Instead of waiting for homelessness to happen, let’s prevent it before it starts.”

Last Tuesday, before he was even mayor for 24 hours, Mike Johnston’s office declared a state of emergency on homelessness so that he could access funding to help house 1,000 unsheltered people by the end of this year. Johnston said he wants to build additional tiny homes on city-owned property for people who are homeless.

Needed demographic data

The count, required by the Department of Housing and Urban Development, assesses the number of people living in a place not meant for human habitation on a single night. Surveyors also count people living in emergency shelters and transitional housing programs. Communities typically conduct their counts each year during the last 10 days of January.

People at risk of becoming homeless, such as those staying in a motel or with friends and family, are not included in the count.

The survey helps local human service organizations determine the scope of homelessness so they can help people find housing. 

The survey also provides needed demographic data, raises public awareness about homelessness and helps nearby service providers apply for increased and needed housing funds. Numerous variables, such as weather, the number of volunteers available to count and other factors can influence the results or lead to an undercount.

“While the region continues to improve our count and was able to locate 9,065 individuals on a single night experiencing homelessness, the Homelessness Management Information System (HMIS) used by our providers allows us to see this number is closer to 28,000 throughout the course of the year,” Rife said in the news release. “We need to keep moving towards understanding who is experiencing homelessness in real-time and by name, so our response is as effective as possible.”

It’s much more accurate to examine the number of people who are homeless throughout the year than on a single night in January, said Cathy Alderman, chief communications and public policy officer for the Colorado Coalition for the Homeless.

Most federal funding programs to address homelessness are based on the annual point in time count, even though data consistently shows that the survey is a significant undercount, she said.

“How can we truly design and implement programs for a crisis that is more than three times what the data point we choose to use shows?” she wrote in an email Monday evening. “If we looked more comprehensively at all of the data, and funded and brought to scale solutions that aligned with the true need, we would be making much more progress on resolving homelessness.”

Surveyors counted 6,495 adults who were homeless, 2,101 families who were homeless and 469 youth who were homeless this year. Denver, Adams and Boulder counties had the highest numbers of people who were homeless, respectively.

About 70% of people were living in an emergency shelter, transitional housing or a safe haven (supportive housing for people with severe mental illness) while about 30% of people were living outdoors, including in safe outdoor spaces or safe parking spaces.

Every year, people of color are overrepresented in the local homeless population. 

For example, Native Hawaiians or Pacific Islanders in metro Denver are 15 times more overrepresented in homelessness when compared with their makeup in the general population. Native American or Alaska Native people are 3.7 times more overrepresented in homelessness compared to their makeup in the general population. Black people are 3.4 times more overrepresented and multiracial people are 1.8 times more overrepresented, according to the results. 

Traditionally, adults and single men are also overrepresented in homelessness, Rife said. For example, 62% of men were homeless compared with 36.7% of women in this year’s survey. 

Less than 1% of people counted (0.6%) identified as transgender and the same percentage of people identified as gender-nonconforming. 

A systemic failure

Examining how factors such as child welfare, criminal justice, and health care systems contribute to the increasing number of people who are homeless is crucial, Rife said, and it’s important communities have access to the resources needed to provide support to address homelessness such as by offering housing options and wraparound services.

“We need to address the inflow into homelessness,” Rife said. “Homelessness is a failure of many systems, largely due to economics, or things like familial breakup and fleeing domestic violence. And yes, there are people that do have mental health issues or substance use disorders, but that is not the largest cause of homelessness and we need to recognize this is economic and systemic and be taking steps to address those.”

She encouraged people to be open to having housing solutions such as safe outdoor spaces, tiny homes and affordable housing nearby in their communities. 

“We are all impacted by homelessness,” Alderman said in the email. “Whether it’s the sorrow we feel when we see the toll of homelessness on friends, family members, and neighbors or the concern we have for our parks and public spaces where people are forced to survive. There is a significant financial toll to the community when we don’t invest in interventions like housing and services and instead rely on expensive emergency services for people experiencing homelessness. As individuals and communities, we are stronger, better, safer, more effective, and successful when we provide meaningful solutions to homelessness and ensure everyone has a safe place to call home.”

The number of families included in this year’s survey is likely a significant undercount, she said, because families can be reluctant to disclose homelessness when they are fearful of being separated.

The best way to stabilize a family that has entered homelessness is to rehouse them as quickly as possible, Alderman said, but a severe housing shortage for families with low incomes makes that difficult.

“The enormous toll that this will take on the kids in our community cannot be underestimated,” she said. “We need to invest in housing for fixed and low income families and more resources like vouchers, rental assistance, and eviction prevention to stop this flood into homelessness that families are experiencing.”

She encouraged people to support the organizations working to resolve and prevent homelessness, ask elected officials to invest in meaningful solutions such as housing and wraparound services, talk to people who are homeless to learn from their firsthand experiences and give directly to unhoused people who need help. “Speak up and against stigmatizing language, cruelty, and attempts to criminalize people simply because they are unhoused,” she wrote in the email.

Information about how to volunteer during the 2024 count will be released in October, Rife said.

The survey results were announced the same day Mayor Johnston’s office said it would begin a series of town halls Tuesday to engage community members in Denver neighborhoods to help find strategies to address the homelessness crisis.

On Tuesday at 6 p.m., Mayor Johnston and Councilmember Darrell Watson will host the first town hall at The Savoy Denver at 2700 Arapahoe St. 

Metro Denver Homeless Initiative leaders are encouraging people to read the organization’s latest State of Homelessness Report to gain a more comprehensive picture of homelessness in the region.