Published in The World Journal
Frustrated with the impact that COVID-19 has had on local economies, many Colorado counties are looking to an experimental program run out of Mesa County called the "Five Star Program" for a solution that would allow for indoor dining and increased business capacity. Currently, the Colorado Department of Public Health and Environment is preparing administrative regulations to address implementing this program statewide. However, two questions are raised by this: (1) does this program work safely, and (2) how will the state vary from the Mesa County program?
The Mesa County Five Star Program
Mesa County unveiled the final version of its Five Star Program on July 31, 2020, after briefly suspending the program due to the involvement of the CDPHE. Under this program, businesses interested in participating in the Five Star Program would have to submit a safety plan to the county and agree in writing to follow best practices for implementing its safety plan. Mesa County rates businesses based on a 45-point scale that addresses
- 100% mask use;
- the increased distance between patrons (from six feet to ten feet);
- use of no more than 50% of the business' capacity;
- frequent cleaning;
- documented contact tracing of employees and patrons;
- having a posted written schedule for cleaning; and,
- active monitoring of symptoms for employees
Those businesses that succeed at meeting the Five Star Program standards are given a window cling and monitored for continued compliance via telephone only. In exchange for participation, businesses would be allowed to operate one level below the current one on the state COVID-19 dial, provided certain epidemiological conditions occurred.
CDPHE's Proposed Version of the Five Star Program
Colorado Department of Public Health and Environment (CDPHE) released its proposed version of the Five Star Program on November 27, 2020 (the text of the proposed regulation can be found here: http://bit.ly/5starproposed. While the time for public comment was short (just one week), there are some indicators that this proposed regulation will be enacted. First, Governor Jared Polis has expressed his enthusiasm for the Five Star Program. Second, multiple counties - including Pueblo County, Huerfano County, and Las Animas County - have expressed interest in participating in the program.
The proposed regulations require businesses seeking Five Star Certification to submit a written plan detailing how they will meet or exceed state COVID-19 prevention guidelines. Businesses would also be required to
- ensure 100% mask-wearing by both staff and customers;
- conduct daily symptom checks;
- engage in regular outreach to employees and customers for exposure notifications;
- develop a contact tracing log by the businesses;
- follow expanded social distancing guidelines for indoor dining; and,
- utilize a reservation system if the businesses are in the fitness and personal services industries.
Under the CDPHE's proposed regulations, county governments would have to create an administrative committee responsible for implementing the Five Star program. Counties would need to ensure the committee met two standards:
- it included members of the local public health agency, and
- it would have the capacity to run a Five Star program without diminishing public health capabilities like contact tracing, COVID-19 testing, and enforcement investigations.
CDPHE's proposed version of the Five Star program would be suspended if the county reached "Red level metrics" on the state COVID-19 Dial for more than two weeks or if the county exceeded 90% of its regional healthcare system's hospital capacity.
CDPHE plans to finalize its regulations concerning Five Star eligibility and operations on December 14, 2020. Eligible counties would need to train staff on the program before standing it up. Counties would have permission to stand up their Five Star programs on or after December 18, 2020. CDPHE did not detail the nature of the training required for businesses or county governments.
Criticisms of Both Programs
District 35 State Senator Larry Crowder has expressed concern regarding the CDPHE proposed regulation. Crowder cited the regulation's provisions concerning the management of the Five Star Program as the reason for his criticism. "This takes rule-making powers away from the counties," Crowder said. Sen. Crowder also stated that he was concerned about how the CDPHE's proposed regulations were far stricter than the current statewide regulations. Sen. Crowder said he believed the state should be moving toward more freedom for businesses, not less. The current laws, Crowder said, do not target big box stores and pot shops the same way they do small businesses. Crowder noted that this was fundamentally unfair. "You've heard the expression 'we're all in this together'?" Crowder remarked, "Well, right now [with the current regulations] we aren't."
Douglas County Commissioner Lora Thomas has stated that the state's allowance of Mesa County's program is unfair. Thomas wanted businesses in Douglas County to be able to participate in the pilot program. In a more rebellious way, Weld County has expressed its criticisms by refusing to enforce the state's restrictions.
Public health experts have stated that they believe the Five Star program is contrary to residents' best interests. In an interview with Colorado Public Radio, Dr. Thomas Tsai of Harvard University's T.H. Chan School of Public Health, said, "This partial opening with the five stars [program] is just treading water going against the riptide, and being pulled further away from suppressing the pandemic." Kuhr responded to this criticism on behalf of Mesa County by stating he believed economic health is a component of public health.
Tsai cited an unpublished and non-peer-reviewed paper he drafted with 27 other scientists that found banning indoor dining reduced the infection rate of COVID-19 in the community (interestingly, this study used Google's cellphone contact tracing data). Conversely, in a study published in PLOS ONE, Easton R. White and Laurent Hébert-Dufresne found that there was only a half-day reduction in the doubling rate of COVID-19 due to restaurant closures. Interested readers can find this study, Easton R. White & Laurent Hébert-Dufresne, State-level variation of initial COVID-19 dynamics in the United States, PLOS ONE (October 13, 2020), at http://bit.ly/covid19whiteplos. White and Hébert-Dufresne stated there was no "causal evidence for government actions as a key factor in controlling the disease spread, only an association." They determined that US states with harsher restrictions on behavior due to the pandemic saw faster doubling rates of the disease than US states with looser restrictions on conduct.
What About The Results?
There is no data yet about how well the Five Star Program has benefitted Mesa County's economy. On the other hand, the data about how the Five Star Program has influenced the infection rate in Mesa County is less than favorable.
Mesa County, with its reduced restrictions, has an overall per capita infection rate of 4.4%. Both Las Animas and Huerfano Counties have far lower rates. Las Animas County has a per capita infection rate of 2.0%. Huerfano County has a 2.9% rate. With a population that is 10.7 times greater than that of Las Animas County and 22.6 times greater than that of Huerfano County, Mesa County has an infection rate that is roughly twice that of the other two counties. It remains to be seen how Colorado's statewide per capita infection rate would change after implementing a version of the Mesa County Five Star Program.