Yes, they’re up, but the media is rushing to deem the state’s reopening a catastrophe.
Yes, they’re up, but the media is rushing to deem the state’s reopening a catastrophe.
A rizona is the latest focus of the reopening debate, with national headlines about the state heading for a COVID disaster.
The state’s positivity rate — the percentage of tests that are positive — and hospitalizations are up, key metrics that are more meaningful than simply having more confirmed cases (which can be simply a function of more testing).
There’s no doubt that there’s increased community spread in Arizona, a trend that bears watching. But the rush to push the state into shutting down and deem it a cautionary tale of the perils of reopening is simplistic at best and skips over details crucial to understanding Arizona’s true situation.
“We’ve been pretty clear to everyone that we don’t think Arizona’s immune to COVID-19,” says an Arizona official. “We know that we will see cases just like we had elsewhere in the country.”
Arizona hasn’t been particularly hard hit by COVID. It sits between Indiana and Tennessee in total cases, at about 39,000.
On a per capita basis, it’s roughly in the same place as neighboring states. It has 538 confirmed cases per 100,000, while Colorado has 511, New Mexico has 474, and Utah 470. Colorado and New Mexico have slightly more deaths per 100,000.
The trend in serious cases in Arizona is up, although not catastrophically so.
Consider ventilators in use for COVID cases. From May 26 to June 4, the number hovered in the 230s or hit 240.
As of June 15, it was 340, after it had been in the low 300s the previous several days.
On June 15, there were 81 new intubations for respiratory distress. That’s higher than most days over the past two months, but not the highest. Some days it’s been in the 90s or, on one day, over 100. On May 8, it was 97, when a stay-at-home order was still in place.
The usage of ICU beds is also up from where it was a couple of months ago — about 80 percent usage from 60 percent at the beginning of April — but not all of that is from COVID. When states were locked down, the hospitals basically emptied out, but now that people are resuming normal activities, there are more hospitalizations, as well.
The state is still far away from getting anywhere close to using all the ventilators it currently has on hand. About 30 percent of its ventilators are in use.
A June 6 letter from the director of the Arizona Department of Health Services to the state’s hospitals has been widely misunderstood. The Arizona Republic ran a headline about the letter, “State health director tells Arizona hospitals to ‘fully activate’ emergency plans,” an interpretation that has been repeated elsewhere in the press.
What the director said in the June letter was:
Your facilities and staff are on the front line of this response and your continued ability to care for your patients in a safe manner is critical in Arizona’s success in overcoming COVID-19. For those reasons, I urge you to do or continue doing the following:
Fully activate your facility emergency plan as directed by Executive Order 2020-16. . . .
A key phrase is “continue doing the following,” because the letter recapitulated almost exactly a communication from March. In other words, it wasn’t anything new.
The March 25 letter said:
Your facilities and staff are on the front line of this response and your continued ability to care for your patients in a safe manner is critical in Arizona’s success in overcoming COVID-19. For those reasons, I urge you to do the following:
Activate your facility emergency plan. . . .
The context here is important. Arizona has been able to prepare while other parts of the country were hard hit, and learn from the experience of others.
One of the purposes of its stay-at-home order, stretching from April 1 to May 15, was to build hospital capacity. The state has a surge plan in place. If facilities are at any risk of being over-topped, elective surgeries can be scaled back or canceled again. Arizona has set up a surge line — an idea borrowed from New York, state officials say — to transfer patients from any overburdened hospitals to other facilities (such transfers would be covered by insurance). An idled hospital called St. Luke’s can be brought back online if necessary, and there are two other alternative care sites in both the north and south of the state that can be used as well, according to state officials.
Just the other day, leaders of Arizona’s hospitals put out a statement: “As representatives of the largest health systems representing 80% of care provided in this state, we would like to assure the public that we have available bed capacity and surge plans are in place to continue to serve the people of Arizona. We are well prepared to manage an increase in patient volume.”
Arizona officials say they have been watching the various models closely, and have paid particular attention to a FEMA model, which, an Arizona official notes, “said Arizona’s spike was going to be in June.”
Given that the coasts, and especially the East Coast, were going to get hit first, it makes sense that Arizona would project to have a later peak.
The Navajo Nation, which spans three states including Arizona, has had a major outbreak, although it is trending down.
And there are hot spots in the counties in the south of the state, where there is an influx of laborers across the border. Santa Cruz on the border had the highest positivity rate in Arizona over the past week, according to Arizona officials. The border county of Yuma has also had a high rate.
None of this is to say that Arizona shouldn’t proceed with all due care, only that many of the headlines don’t convey the entire picture, nor are they intended to.