Health
Doctors, hospital leaders call for more action to slow COVID-19 in Arizona
Pressure and alarm over rising COVID-19 numbers mounted Friday, with multiple calls for Arizonans to take concrete steps to slow the spread of the virus.
Arizona’s infections have been escalating for weeks, with daily case counts exceeding those from the worst of the summer surge. The state has reported more than 4,000 new cases for 15 of the past 30 days.
The reproduction rate of the virus here is highest in the nation, at a rate of 1.22, according to rt.live. This means that a person with the virus, on average, is spreading it to 1.22 people. A rate above 1.0 means COVID-19 is quickly spreading in the community.
The calls for action come despite a ray of hope: Arizona expects a first delivery of vaccines to arrive next week. Arizona Department of Health Services Director Dr. Cara Christ detailed the state’s plans for rolling it out on Friday.
Gov. Doug Ducey did not address the public this week.
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As the state’s, and the nation’s, metrics have grown more dire, some states have acted to try to slow the spread by instituting lockdowns or stay-at-home orders, or measures such as indoor dining bans and mask mandates.
Arizona largely has not, instead tweaking restaurant regulations to encourage outdoor dining and implementing more serious consequences for restaurants, bars, gyms and theaters that repeatedly ignore COVID-19 guidelines.
On Friday, a group of doctors called on Ducey to mandate masks statewide and limit indoor and sporting events to maximize physical distancing.
Pima County hospital leaders said at a news briefing that their facilities are struggling, with just seven open ICU beds in Arizona’s second-most-populous county.
Ducey has relied on cities and counties to implement and enforce local mask rules.
The vaccine, a cause for optimism that the pandemic’s end may be in sight, will not cause a return to pre-pandemic life for many months, until the country achieves herd immunity. Experts say this could come by mid- to late-2021.
FAQ: Arizona plans to start COVID-19 vaccinations next week. Here is what you need to know
Arizona surpassed 7,000 known deaths due to COVID-19 this week, and with deaths a lagging metric, many more are likely to be reported.
The number of patients hospitalizations statewide for COVID-19 is close to surpassing the most patients hospitalized in a single day, which was 3,517 patients on July 13. More than 90% of all hospital beds in Arizona are in use, with 46% of ICU beds and 40% of non-ICU beds occupied by COVID-19 patients as of Thursday.
At the end of November, the White House Coronavirus Task Force said Arizona needed to do more to confront its growing caseload.
“Arizona is experiencing a full resurgence equal to the summer but without the needed aggressive mitigation across the state,” the Nov. 29 task force report said.
“It must be made clear that if you are over 65 or have significant health conditions, you should not enter any indoor public spaces where anyone is unmasked due to the immediate risk to your health; you should have groceries and medication delivered.”
Nationally, the daily death count is equivalent to the loss of life the country saw from the Sept. 11, 2001, terrorist attacks.
Doctors: More action is needed
During a press call put on by an advocacy group called the Committee to Protect Medicare, the doctors said Ducey should consider a stay-at-home order as a potential next step, if other measures don’t slow the spread.
They dinged Ducey for refusing to take meaningful actions as the state’s situation worsened, saying they’ve seen colleagues, family members and friends get seriously ill and die.
“Gov. Ducey keeps proposing half-measures that are nothing more than putting Band-Aids on a bursting dam,” said Dr. Susan Hughes, a family medicine specialist in Scottsdale.
Dr. Sheetal Chhaya, a rheumatology specialist in Phoenix, said front-line health workers and first responders need the governor’s help. They’re growing weary, getting sick and there simply aren’t enough of them to help patients with or without COVID-19, she said.
Dr. Cadey Harrel, a family medicine specialist in Tucson, said Ducey has had 10 months to battle the pandemic and is “still a deer caught in the headlights.” He needs to better listen to health care workers and the science to figure out how to slow COVID-19, she said.
“Many of our patients are seeing their lives devastated, and they truly deserve so much more than this,” Harrel said. “Gov. Ducey can’t act, or he chooses not to, either of which tells us that there is a colossal failure of leadership here in Arizona. And our communities are the ones that are paying the ultimate price.”
Ducey did not immediately address Friday’s renewed calls for action.
During a public briefing last week, he focused on beefing up hospital staffing, indicating he had no plans to impose a new shutdown and saying curfews were the wrong approach.
“I believe we should instead focus on accountability and enforcing the rules we have in place now,” he said, noting that officials “know a lot more today (about the virus) than we did back in June or July.”
The governor also stressed that many restrictions implemented earlier in the year — such as shuttering nightclubs unless they changed their business model to allow for additional spacing — remained in place.
“We never held a press conference and said, ‘We’re lifting all of these measures because we’re out of the woods,” he said.
Pima County health leaders urge vigilance
In Pima County, hospital leaders said without decreased community spread as a result of individual actions, hospitals will reach a breaking point and will have to triage care to those who need it most.
Less than 2% of ICU beds were available as of Friday morning, with just seven open ICU beds in the county, according to Dr. Theresa Cullen, the county health director.
That means patients who need ICU beds, either for COVID-19 or other things, may be transported to Maricopa County or elsewhere for care.
Judy Rich, president and CEO of Tucson Medical Center, said the hospital has been compromised over the past few weeks and has had to cancel surgeries and radiology procedures to make sure everyone in the emergency room who needs a bed or ICU care can get it.
Dr. Gordon Carr, chief medical officer at Banner University Medical Center Tucson, said hospitals are stressed like never before.
“We are facing ongoing, uncontrolled spread of the virus in our community. If we are not able to slow the spread soon, the strain on the health care system could become too great. At this critical moment, public health interventions have never been more important. So our message is simple: wear a mask, and shrink your circle of social contacts. We need your help to avoid reaching the breaking point.”
Carr said if current trends continue, hospitals may need to turn to crisis standards of care, meaning more patients per caregivers, delays in getting needed care and long ER waits.
“We are not invoking triage today,” Carr said, but added that hospital systems are “perilously close to a point where we would not be able to deliver a normal standard of care, and we would only be able to meet the most life-threatening needs under conditions of crisis.”
Pima County health care, emergency response and public health leaders wrote a letter to county residents dated Thursday urging them to stay home as much as possible, wear masks for work or essential activities in public and “avoid altogether any social gatherings, including among non-household family,” over the holidays.
“Our acute healthcare system is experiencing heavy stress and is near the breaking point. If our community does not take immediate action to slow or stop the spread of COVID-19 in Pima County, the results for the healthcare delivery system could be catastrophic,” the letter from more than two dozen county health, hospital and fire district leaders reads.
The letter says that emergency departments and hospitals are full and facing staff and supply shortages. Without “significant changes in community behavior,” cases and hospitalizations will increase through December, according to the letter.
“We know that’s a lot to ask this time of year, but the holidays will come again; sit this one out,” their letter read.
State’s top doc: It’s the small gatherings
Christ, the state health department director, said people will need to continue wearing masks and physically distancing for months. They remain safer at home than engaging with people outside their households.
The state’s contact tracing has shown people spreading the virus through small gatherings in their homes, Christ said. Arizona has 600 contact tracers at the state level, plus many at the county level, she said. She also mentioned sports as a potential spreader.
They’re finding that people aren’t engaging with strangers but with loved ones, indoors, without masks, she said.
“That is a very, very difficult place to either regulate or enforce, in people’s homes,” Christ said.
EXPLORE: As COVID-19 worsens, life in Arizona remains more normal than during the first pandemic wave
Some epidemiologists have expressed skepticism, or at least have not seen evidence to support, that small gatherings are a major driver nationwide, according to the New York Times.
The state requires establishments like restaurants to reduce capacity and wear masks, she noted. If they violate these guidelines, there’s a two-strike system for enforcement, where businesses are shut down after the second strike, she said. This week, four establishments were given a first strike, she said.
Christ said the state is considering more efforts to slow the spread of COVID-19, such as enforcing existing mitigation measures and limiting places where people could congregate. She mentioned a measure to require any events allowed by cities to publicly post what efforts are taken to minimize potential spread.
Calls for more mitigation continue
Calls for action from the state have been ramping up since November as trends continued to worsen.
A report released Nov. 19 by Arizona State University predicted that hospital capacity in Arizona will be exceeded in December and that, without additional public health measures, holiday gatherings are likely to cause 600 to 1,200 additional deaths from COVID-19 in Arizona by Feb. 1 beyond current-scenario death projections.
A group of eight Arizona health leaders asked the state last week for immediate actions on the worsening COVID-19 crisis, including a statewide curfew, no indoor dining at restaurants and a pause on group sports.
A team of University of Arizona researchers wrote in a memo to the state Health Department that a statewide shelter-in-place order could help avert a “catastrophe” in Arizona hospitals. The modelers said without additional public health interventions, Arizona “risks a catastrophe on a scale of the worst natural disaster the state has ever experienced. It would be akin to facing a major forest fire without evacuation orders.”
Dr. Marjorie Bessel, chief clinical officer for Phoenix-based Banner Health, said that the state’s largest health care system already is having two patients share rooms in several of its ICUs, and could reach 150% of its licensed bed capacity in January. “We’re on the cusp of a really terrible surge. It’s going to be the worst surge, I believe, of the entire pandemic,” she said.
Without any interventions or new policies, Arizona’s peak in cases may not happen until February, according to Joshua LaBaer, director of the Arizona State University Biodesign Institute and leader of the university’s COVID-19 research efforts.
LaBaer said it’s clear from Arizona’s summer experience that the virus responds to policy. He said a complete shutdown is likely not necessary but targeted interventions would be very helpful. Evidence shows that certain activities are much more likely to spread the virus, he said.
“When people are indoors and not wearing masks, they are going to spread the virus,” he said during a news briefing this week.
“Limiting those sorts of activities would put a huge limit on the spread of the virus. Right now, you still see people in bars, you still see people indoors at restaurants, from what I can tell, there’s not a lot of enforcement ensuring mask-wearing … What ends up happening is the virus spreads in those circumstances.”
Reach reporter Rachel Leingang by email at [email protected] or by phone at 602-444-8157, or find her on Twitter and Facebook.
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