The number of positive tests for COVID-19 speak for themselves, as far as Dr. Bernadette Albanese is concerned.

On March 17, Colorado had 160 positive tests. A week later, that number was 4.5 times higher — 720 cases.

“A day later, it had increased from 720 to 912 cases,” said Albanese, an epidemiologist with the Tri-County Health Department, which covers Adams, Arapahoe and Douglas counties. “This is a rapid rise in the number of positive tests that we are getting reported.”

It's that kind of rise, and the fear that those positive tests represent the very tip of the iceberg, that led Tri-County Health to join with Jefferson and Boulder counties to announce an emergency stay-at-home order, set to begin at 8 a.m. March 26 and last until the end of the day April 17.

The Tri-County order requires residents to stay at home except for what were identified as essential activities — getting food and supplies, receiving medical care and participating in outdoor exercise, for example. The order allows people in what were deemed essential businesses to continue to go to work, including those in the fields of health care, infrastructure, utilities, groceries, news media and liquor and marijuana retail.

State and local officials have been encouraging residents to practice social distancing, avoiding large groups and staying at least 6 feet away from everyone else since the disease was first identified in Colorado in early March.

“But yet, despite those efforts, the iceberg keeps pushing up,” Albanese said during a Tri-County Health media conference March 25. “We are starting to see more sick people, more hospitalizations, providers seeing more patients with illness that could be consistent with COVID. We've observed what's going on in other states and a lot of lessons learned about what might happen.”

Colorado needs to step up efforts to keep people home to try to curtail the disease, at least as much as possible, she said.

“The disease is still spreading despite our best efforts, we are having issues with non-compliance with people not heeding our advice, so we need a more widespread and more strict measure to break the chain of spread,” she said.

Albanese joined Dr. John Douglas, Tri-County's executive director, and county officials in the media conference, which was handled entirely remotely. The Tri-County team was in offices and rooms around the Denver metro area, taking questions from similarly sequestered journalists. Douglas said he's keeping himself in home quarantine because he's suffering from a chest cold.

Tri-County's stay-at-home order is similar to one enacted by Denver on March 23. To read Tri-County's order go to https://www.tchd.org/CivicAlerts.aspx?AID=373

Douglas said he worries the number of cases Colorado is seeing represents the conditions present two weeks ago, what he called the “cracked rearview mirror.”

“A test that's positive today represents an event that happened probably 14 to 17 days ago, in terms of transmission,” he said. “It takes you a while, seven to 10 days after you are exposed, to get sick. And then it takes you a while after you get sick to get into a place and get tested. And then it takes a while to learn the test results. So, we are working right now with what we know has only partially, in retrospect, been measured. Combined with what I'm hearing from hospital partners, we are weeks away from getting overloaded. That's what led me, and our other public health partners, to take these actions today.”

Enforcement

Everyone, whether they are considered essential or not, is being asked to limit social contact, maintaining a 6-foot buffer.

“In a nutshell, the order allows people to leave home — they are not locked down — for essential purposes,” Douglas said during the press conference.

The order carries a potential for fines and other penalties — $5,000 and up to 18 months in jail — for those that ignore it. But Douglas said he does not expect punishment will be necessary.

“There are 1.5 million people in our three counties and it would be beyond imaginable possibility to surveil 1.5 million. That's not our goal,” he said. “What we are looking for is hopefully greater cooperation created by the fact that this is not an encouragement. It's a public health order. If you don't comply, you are actually breaking the law.”

Douglas said the intent is not to fine people or to jail them.

“We will, however be responding to citizen complaints and trying to survey areas where gatherings have been reported before,” Douglas said. “The response to any complaint is to have the health department, not law enforcement, respond to it. The big goal is to say 'Hey, you may not be aware, this is really concerning and this sort of gathering can spread infection. It's not actually not allowed under the law.”

People can rely on local police as a last resort, he said.

Arapahoe County Sheriff Tyler Brown said his deputies will try to educate people first.

“But the big thing I'm relying on is social peer pressure, that people will say 'Hey, this is the right thing to do? We are listening to medical experts and trying to make sure our community stays safe and healthy',” Brown said. “There are fines, there is the ability to enforce these. But that is not our goal.”

George Brauchler, district attorney for Arapahoe, Douglas, Elbert and Lincoln counties, concurred.

"These rules and laws need to be complied with, but the fear should not be that you will be drug into court to face criminal charges. That is a matter of last, last, last resort," he said in a news release.

While some have questioned Tri-County's authority on social media, Douglas said the agency is well within its rights to issue a public health stay-at-home order for the three counties. He noted that the agency was not declaring an emergency. That's been done, on every level of government.

“It's not an emergency declaration,” Douglas said. “That's not our job, but issuing public health orders to reduce a public health problem — in this case, stemming a pandemic — we do have the authority as the health department of record for these three counties.”