Stephanie Innes Alison Steinbach Arizona Republic
(CNT) City News And Talk #arizona
While it’s not at the epicenter of a recent surge in U.S. cases, Arizona’s COVID-19 metrics are worsening.
Dr. Cara Christ, Arizona Department of Health Services director,said Arizona is at a “pivotal” moment for COVID-19. She does not want to see another scenario like summer, when coronavirus cases exploded in the state.
“A lot of it is going to depend on the upcoming weeks,” Christ told The Arizona Republic on Wednesday. “This pandemic has been so hard to predict and watching what the other states are going through, it’s certainly a possibility, which is why I think right now I think is a pivotal point to remind everybody to keep doing those mitigation strategies.”
Arizona is not seeing the rapid surges spreading across many other states, including Wisconsin and other parts of the Midwest.
Comparatively, Arizona is doing much better than many.
But it doesn’t take much for case counts to escalate, which in turn leads to increased hospitalizations and deaths.
“Our sister states New Mexico and Utah are having very bad rounds of it right now, where their hospital capacity is getting stretched,” said Dr. Marjorie Bessel, chief clinical officer for Banner Health, which is Arizona’s largest health delivery system. “It’s not really practical to think some of that isn’t going to come into Arizona and we’re not going to have increased activity.”
Daily case counts, hospitalizations, ICU beds in use and ventilators in use have seen gradual increases. Arizona’s reproduction rate for the SARS-CoV-2 virus is at 1.16, around the same level as early June, according to rt.live, a tracking website created by Instagram co-founders Kevin Systrom and Mike Krieger, using data from the COVID Tracking Project.
The reproduction rate means the virus is spreading at about the same rate it was in early June, and at a faster rate than desired. The metric was below one, meaning infections slowed, from late June to early September, after which it’s gradually increased.
“It’s one of many metrics that we are watching. It’s an easy metric to direct Arizonans to,” Christ said. “Hopefully they can make changes in what they are doing to help bring that reproduction number down.
Arizona’s cases spiked in June and July to one of the worst surges in the world, causing a domino effect of hospitalizations, an increased need for ICU beds and a rise in deaths.
All of Arizona’s COVID-19 metrics remain far below the levels hit during the state’s summer peak for the virus, but experts caution that the increases seen in recent weeks could again quickly mushroom out of control.
“If you look at where we’re at now, it’s only a matter of time,” said Joshua LaBaer, director of the Arizona State University Biodesign Institute and leader of the university’s COVID-19 research efforts. LaBaer pointed to the upward-trending case increases since the end of September.
In a news briefing Wednesday, LaBaer said there’s no doubt in his mind that Arizona is in a COVID-19 surge right now.
“We are currently surging in Arizona, and my hope is that we can prevent it from getting to the level where it was in the summertime,” LaBaer said.
“In terms of whether we will go back to where we were previously, we want to do everything we can to avoid that,” said Daniel Ruiz, chief operating officer for Gov. Doug Ducey.
White House reports reflect worsening trends
Arizona’s percent of positive diagnostic COVID-19 tests in Arizona went from 4% for six consecutive weeks, to 5% for the week of Oct. 11, state data shows. The state calculates percent positivity differently from other trackers, like Johns Hopkins University, as the state only includes test results that are reported electronically.
Johns Hopkins University’s calculation for Arizona’s seven-day moving average of percent positive tests is higher than the state calculation — 9.4% as of Wednesday. The Johns Hopkins dashboard shows the Arizona’s percent positivity had reached a relative plateau and is now trending slightly upward.
A positivity rate of 5% is considered a good benchmark that the spread of the disease is under control.
“We know that places like Arizona did get in trouble earlier on in the summer and you don’t want a repeat of that,” said Dr. Amesh A. Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security.
“I think that any kind of uptick has to be taken seriously. The virus spreads very efficiently and there is a lot of the population that is still susceptible, so you really can’t allow cases to increase without taking some kind of action.”
The White House’s weekly coronavirus reports to Arizona leaders reflect the worsening trends, too.
On Oct. 4, the report placed Arizona in the “yellow zone” for new cases and said trends were stable. By the Oct. 18 report, Arizona had worsened to the “orange zone” because of increasing new cases. Test positivity and hospital admissions also increased. Arizona was 39th in the country for its new case rate over the previous week, and 29th in the country for test positivity rate, according to the most recent report.
On Oct. 4, 33% of Arizona counties had moderate or high levels of community transmission and 7% of counties had high levels of community transmission. By Oct. 18, 60% of counties had moderate or high levels of community transmission and 13% of counties had high levels of community transmission.
“Aggressive communication and mitigation is critical,” the Oct. 18 report states. That should include mask wearing, physical distancing, hand washing, avoiding crowds and social gatherings, ensuring flu vaccinations and increasing testing.
Christ said state health officials are increasing their communications with Arizona businesses about the latest guidelines on safe practices, as well as the requirements that they comply.
Businesses are required to implement mitigation measures, such as reduced capacity and masking.
Ruiz noted the hotline to report those that aren’t following the guidelines: 1-844-542-8201.
‘Pandemic fatigue’ could be fueling the spike, experts say
Possible causes of the upward trend include what some experts describe as “pandemic fatigue,” as well as more people resuming in-person activities such as going to restaurants and attending school.
“We have people participating in activities that they might not have been participating in a couple of weeks ago. So, we knew as we opened up we expected to see a slight increase in the number of cases. That’s just how this virus spreads,” Christ said.
“Our observation is that people are getting tired. Nobody really, of course, loves to wear a mask and we are starting to see potentially a little bit of slippage on that,” Bessel added.
Banner officials are watching closely modeling from the University of Washington’s Institute for Health Metrics and Evaluation, which predicts COVID-19 deaths in Arizona will rise by 48% percent to 8,678 by Feb. 1, with current conditions in place.
If the state had a universal mask mandate, the IHME estimates the death toll by Feb. 1 would be lower — about 7,405 deaths. Arizona allows cities and towns to make their own mask laws, and while most do, some communities do not.
As of Wednesday, Arizona was reporting 233,912 confirmed COVID-19 cases and 5,854 known deaths.
While Banner is preparing for another surge, it doesn’t have to happen if everyone does their part to follow social distancing guidelines,” Bessel said.
“It’s such a good reminder that we need to get right back to those basics of our social distancing and our masking because this time around it’s going to be different from the summer because we’re going to have to deal with influenza and other respiratory viruses that circulate during this time of year,” Bessel said.
Social distancing and masking was not happening among many individuals who attended political rallies for President Donald Trump held in Prescott and Tucson earlier this week, which could exacerbate the upward trend in Arizona cases, said Dr. Susan Hughes, a Scottsdale family physician.
Hughes is part of the Committee to Protect Medicare, a national organization of front line doctors that advocates for a stronger U.S. health care system and is opposing Trump’s re-election.
In Prescott on Monday, Trump complained about the sustained coverage of COVID-19 by CNN and other news organizations, suggesting Americans are tuning it out.
“People aren’t buying it, CNN, you dumb bastards,” Trump said.
Arizona trends ‘like a loaded gun’
Weekly case counts in Arizona increased by about 40% from the week ending Oct. 3 to the week ending Oct. 17, outpacing a much smaller increase in testing during that period, according to data on COVID-19 cases and tests by test date from the health department’s dashboard.
Daily case reports are about the same as seen in late May and early June, four weeks before the peak of the outbreak.
Given that Arizona is at that level now, it’s possible rapid infection could take off, said Joe Gerald, an associate professor at University of Arizona’s Mel and Enid Zuckerman College of Public Health.
“It’s almost as if we have a loaded gun in our hand and if we’re not careful, it can go off and hurt someone,” he said of the case trends.
“Once this kind of exponential growth rate sets in, you can achieve extraordinary numbers very rapidly. … We only need to look back to what happened in June to recognize how close we are to much, much different and worse set of circumstances.”
LaBaer of ASU characterizes what’s happening in Arizona right now as a definite surge, but not an overwhelming one. The next two weeks to three weeks will be key in terms of whether the trend increases or slows down, he said.
LaBaer said he hopes Arizonans are now more experienced with COVID precautions and will look at the numbers and respond with smart actions to avoid a repeat of this summer.
Expert: State could see major COVID-19 resurgence around Thanksgiving if Arizonans drop their guards
Gerald said Arizona is not yet in the “red flag” environment, but more a “yellow caution” environment. He looks at other states and knows the same could happen in Arizona.
There are enough cases now that if people let their guards down, transmission will flare up very quickly, he said. The state could see a major resurgence of infections around Thanksgiving, the holidays and the New Year if current trends are not reversed, per Gerald.
“Continuing to do the things that we’ve been doing well — wearing a face mask, staying physically distanced, avoiding crowds, staying outdoors when possible — we need to keep doing those things or we’ll end up looking like the rest of the country,” Gerald said.
Bessel of Banner Health said she’s concerned about Thanksgiving, too. She pointed to a family outbreak of 11 COVID-19 cases across four states that was published Oct. 9 by the CDC’s Morbidity and Mortality Weekly Report and was traced to a 13-year-old girl who had tested negative for the virus.
The girl knew she’d been exposed but tested negative for the virus prior to the family gathering via a rapid antigen test, which are known to be not as sensitive as PCR (polymerase chain reaction) tests. Her only symptom was nasal congestion.
The case shows that children and adolescents can serve as the source for COVID-19 outbreaks within families, even when their symptoms are mild, the CDC report says.
Authors of the report say the case illustrates that that regardless of negative test results, people should self-quarantine for 14 days after a known exposure.
LaBaer said an important guideline is avoiding groups of people or large events that could be “superspreader events.” Recent research suggests that as few 10% of infected cases may be causing up to 80% of all the spread, meaning that a few people are giving the virus to a lot of people, primarily at large group events, he said.
Gerald also recommended avoiding things like indoor dining, which combines many risks: an indoor environment, no masks while eating, prolonged contact with others and possibly inadequate social distancing. The main driver of Arizona’s transmission is likely those types of small-scale activities or social gatherings, he said, as larger events are more rare.
Ideally all Arizonans will have a flu shot by Halloween, which will help protect people from getting sick from at least one of the respiratory illnesses in circulation, Bessel said.
“It’s really important to get a flu shot this year because influenza with COVID in our community is not a good equation,” she said. “It’s obviously not good for people when they get sick. It’s not good for the health care system that could potentially get overwhelmed if both of those come at the same time and come in significant numbers.”
State health officials say Arizonans should continue diligently following the precautions that have helped dramatically reduce the spread of COVID-19 in recent months, including:
Wear a face mask.
Maintain at least 6 feet of physical distance from those not in your household.
Wash hands thoroughly and often.
Stay home if you feel ill.
Keep any gatherings small, and hold them outside if possible.
Remember that home is the safest place to be with COVID-19 in the community.
Will Arizona have more closures?
The way for Arizona to keep an upward trend of cases at a manageable level is to test, trace and isolate, said Adalja of Johns Hopkins.
“You have to look and see what is driving the uptick in cases and can you take targeted public health action to try and get a handle on it before these cases start transmission chains and land on multiple populations,” he said.
“If percent positivity is increasing, you really should direct resources to what is driving those cases by looking at your case investigation and contact trace data to see what kinds of activities are responsible and then try and get some handle on it.”
If percent positivity is increasing, it says the outbreak is intensifying in the community, Adalja said.
“There clearly are people who are not getting tested who need to be tested,” he said. “You want to have a lot of messaging out there to get people tested.”
Adalja said he does not think the United States is doing a good enough job at preventing chains of transmission from reaching vulnerable populations, and that is what’s key to preventing more deaths.
“It’s still us making the same mistakes over and over again and not having the public health infrastructure needed to keep those cases to a manageable level,” he said.
The virus responds to policy, LaBaer said. When Ducey allowed municipalities to implement mask mandates, case counts dropped, for example. LaBaer said Arizona proved this summer the efficacy of mitigation strategies as they helped turn around what was one of the biggest surges in the world.
Ducey recently said that barring a dramatic increase, he does not expect to implement more business restrictions. He does not want another shutdown, he said.
“It’s worth pointing out that much of the country, and the world, is experiencing a resurgence of the virus,” Ducey spokesman Patrick Ptak wrote in an email. “Arizona remains in the bottom half of states for cases per 100,00 residents and percent positivity. We also find ourselves in a much different position than just a few months ago.”
Other approaches such as messaging and clear public information can make a difference, Gerald said.
He added that for state and local level policy, it’s time for leaders to open up the playbook again and think about what policies could be needed if trends reach a certain threshold.
“Preventing it from getting wildly out of control will be easier and less painful than trying to address it once it’s set into motion and we’re in trouble,” Gerald said.