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Is Arizona about to face another exponential increase in COVID-19 cases?

Joanna Allhands Arizona Republic (CNT) City News And Talk #arizona

Could Arizona be headed for another exponential increase in COVID-19 cases?

And if so, are we in better shape than we were in the summer to tamp it back down again?

Community spread is back to the levels we saw in late May, according to University of Arizona researcher Joe Gerald, with increases now in all age groups, not just college students. Though confirmed cases have long varied by a few hundred, depending on the day, the two-week average in late September was less than 500 a day. Now, it’s about 750 a day.

On Oct. 15, cases topped 1,100 – a place we haven’t been consistently since the end of the last spike. Testing positivity rates also are inching back up, as are hospital visits, with less capacity to absorb COVID-19 cases than before because more patients with other conditions are occupying beds.

All of this concerns Joshua LaBaer, the head of Arizona State University’s Biodesign Institute, who warns that the conditions are right to spiral quickly out of control, as they did in June and by July had made Arizona a global hotspot for the novel coronavirus.

We have more tools now than in June

It’s too early to say we’re on the same trajectory. And even if we are, few experts are confident about what might be causing it.

But now is as good a time as any to take stock of how we might respond, should the numbers continue to move the wrong way (and quickly).

We have more tools to react to an outbreak than we did in late May and June, including mask requirements in many cities, counties and businesses across the state, as well as metrics to help guide operational decisions at schools and higher-risk businesses, like bars.

But they aren’t fail-safes. Mask requirements have always varied depending on where you are, and some areas have loosened the requirements or become lax on enforcement. Most counties have not signed contracts with the state to enforce COVID-19 related orders on businesses, with some saying it would cost far more than they have cash to handle.

But few are following the metrics

And the metrics? They were formulated more for reopening than for clamping down. The state urges waiting for a two-week trend before moving from one set of operational criteria to the other, which makes sense – you don’t want to act on blips in the data.

But that does us few favors if we find ourselves with exponential case growth.

It also presumes most businesses and schools are making operational decisions that strictly follow the metrics (most aren’t). The state suggested schools hit all three metrics before reopening in-person, but many, under heavy pressure from parents, fully reopened well before then.

Gov. Doug Ducey also has said that barring a major increase, he won’t force businesses to close again even if the metrics suggest they should. Other state health officials have said there are enough mitigation efforts in place to get a subsequent outbreak under control without closing some businesses, even if state plans call for as much when spread is considered substantial.

If they are meaningless, what next?

I get that. I don’t want another shutdown, either, particularly after the last one unfairly lumped in gyms with bars for closures – based simply on the potential for gyms to become community spread epicenters. There was no evidence that Arizona gyms were driving the previous spike.

The best way to avoid closures is if patrons and business owners remain vigilant on mask and physical distancing measures. Personal responsibility matters, and now is not the time to become complacent on it.

But if we’ve largely neutered the measures that aimed to bring certainty to how we move forward as cases increase, what else should our leaders be doing?

At very least, they should be asking businesses – particularly those with a higher risk of transmission, like restaurants – to move more indoors activities outdoors, where ventilation is better and the risk of transmission generally lower, particularly with proper masking and distancing.

We also need to rethink how counties do contact tracing. I’ve said this for a while, but where people have been is as important as who was close to them. We need to do a lot more to ask people about places they went or events they may have attended – and share more of this information with the public.

Bob England, a former county health director, suggests in a blog that counties disemminate information about COVID-19 outbreaks similar to how they handle food-borne illnesses: “If you were at Restaurant/Bar X on Date Y, it appears that some persons there contracted COVID. You should … ,” he writes.

Tell us more about super-spreaders

This is particularly important given new research that suggests most people who test positive for COVID-19 do not spread it to others. Rather, the bulk of transmission appears to be occurring among a small group of super-spreading individuals. The more we know about where these people are spreading the coronavirus to others – and the behaviors that may have led to that spread – the better we can target policies to lower risk where it may be the highest.

We’d also have data to back this up, so it’s not willy-nilly, based on what we thinkmight be most problematic. Now is the time to make this switch, before cases grow to levels that we can no longer effectively trace.

We need a better understanding of where community spread is occurring, so we can respond more quickly with targeted mitigation measures to those places and behaviors.

And, with any luck, tamp down outbreaks before they grow out of control.