On Wednesday, December 22, the state of Arizona reported 2,806 new cases of COVID-19 and 74 new deaths. There have now been 23,816 deaths related to the COVID-19 pandemic. Only 64.5% of the state is vaccinated at this time. Statewide, 6% of intensive care unit beds and 6% of inpatient hospital beds remain available at this time. Over 40% of ICU beds are currently occupied by COVID-19 patients.
This information comes from the Arizona Department of Health Services (ADHS) COVID-19 data dashboard.
Dr. Joe Gerald, MD, PhD, Associate Professor with the Zuckerman College of Public Health at the University of Arizona reported in his weekly COVID-19 Disease Outbreak Outlook for Arizona and Pima County that Arizona dropped to 23rd nationwide for new cases. Between December 12 and December 17 there was a decrease in cases which indicates that spread is “at least temporarily slowing.” Rates of spread are currently highest between those 25-64 years of age and the lowest rates are occurring among those older than 65.
Northern Arizona Healthcare (NAH) gave an update Monday on the effect of COVID-19 at its locations. According to Chief Medical Officer Dr. Derek Feuquay, slightly more than 20% of the Flagstaff Medical Center’s total inpatients are receiving treatment for symptoms related to COVID-19. The percentage at Verde Valley Medical Center was higher, nearly 40% of the total, according to the Arizona Daily Sun. Emergency wait times are currently elevated due to the high volume of COVID-19 patients. From Dr. Feuquay:
The ER normally operates with, let’s say, 20 beds. In Cottonwood last week, 10 or more of those beds had inpatients in them that were already admitted, so they have to operate with only 10 beds available, which makes wait times much worse… That’s happening across the country, where people come into the emergency room and triage If it’s a minor issue, still an issue they need to be seen for, we just can’t get them in as quickly as we normally would be able to.
Omicron in Arizona
According to the Arizona Public Health Association’s (AzPHA) executive director Will Humble, the early assessment of the clinical severity of the Omicron variant of SARS-CoV-2 from researchers in South Africa where the variant was first identified, is somewhat heartening. According to their study, people diagnosed with Omicron in South Africa in October and November were 80% less likely to be admitted to the hospital than those diagnosed with Delta infection at the same time.
Humble notes that the levels of immunity in the population from previous infections and vaccinations could be an important indicator in the reduced severity observed by the South African research team. From the report:
It is difficult to disentangle the relative contribution of high levels of previous population immunity versus intrinsic lower virulence to the observed lower disease severity.
According to Humble, an estimated 60% to 70% of people in South Africa have had a prior COVID-19 infection and Omicron also remains at least twice as contagious as Delta. It also evades some immunity provided by prior infection and the vaccine.
The Omicron variant of the virus was identified on the Tucson campus of the University of Arizona on Tuesday. According to Tucson.com, scientists in the UA department of ecology and evolutionary biology discovered the result from test samples sent to them via the university’s voluntary resting program. From Michael Worobey, a virologist and director of the lab:
This is a fast-moving variant: safe to assume it is already spreading quickly. Let us all do what we can now to slow its spread.
Death Calculations in Arizona
Throughout the pandemic, the ways in which deaths are classified as COVID-19 or non-COVID deaths has remained somewhat obscured. AZCentral spoke to officials with ADHS to clear up some of the misconceptions about who is and isn’t calculated as a “COVID-19 death” in Arizona. Ultimately, it depends on the disease process when the medical certifier looks at what the actual cause of death was and whether or not the virus was at play in that cause. From Jessica Rigler, assistant director for the division of public health services at ADHS:
So if it’s completely unrelated to COVID but they have COVID, then it would not be classified. If COVID took over and there’s significant respiratory involvement that led to death then it may be classified as COVID.
It is possible that excess deaths in 2020 that were not part of the COVID-19 calculus could be from an undercount of COVID-19 deaths. Between 2019 and 2020, overall deaths increased by 26% or 15,539 deaths. But COVID-19 only accounted for 10,395 of those deaths, leaving a highly unusual increase of 8% in non-COVID-19 deaths between 2019 and 2020.
Humble told AZFamily that he expects January 2022 will be the worst month of the entire pandemic. City-level responses are also proving to be inadequate as concerns about spread during the holidays increases among Arizona residents. For example, the City of Tempe had an allotment of 1,500 at-home testing kits that were gone within three hours on Tuesday. From Tempe spokesperson Melissa Quillard:
We did expect they would go quickly. We weren’t quite sure how quickly, but this was certainly an indication that there’s a demand for this, and people really want to be safe.
On Monday, the City of Mesa offered 1,200 rapid COVID-19 test kits for city residents. They were gone in less than two hours, according to AZFamily. Dr. Ross Goldberg of Valleywise Health told AZFamily that Arizonans should take into account the vaccination status of their family, the health issues of their family members and their overall level of concern before seeking out tests prior to holiday gatherings.
I am not advocating any lockdowns. I am not advocating for saying you can’t do things. I just think you need to be safe and smart about it.
According to ABC15, Embry Health says they have 90 to 100 locations across the Valley to get tested. Dr. Carmen Hill-Mekoba, chief nursing officer at the health system suggest getting a PCR test:
In terms of the level of specificity and sensitivity of testing, you will probably want to get a PCR test and you want to do that in the next day or two to be sure that you’re well ahead of Christmas.
The Health Systems Alliance of Arizona took out a full-page ad in local newspapers to clarify how serious the threat of COVID-19 spread during the holiday season could get. The ad is unusual for the medical nonprofit according to AZFamily. Health System Alliance CEO Brittney Kaufmann said the alliance is hoping the increased threat level during the holidays and a desire for family safety will encourage people to seek out vaccination and booster shots.
Our goal is really, predictive modeling shows that if we stay with current hospitalization rates and current transmission rates of COVID, we will have a peak in mid-January. So the timing is important, with the Christmas holiday and New Year’s holiday to avoid that.
In an appeal to Governor Doug Ducey, Interim ADHS Director Don Herrington, Dr. Richard Carmona and other Arizona healthcare leaders, AzPHA published an open letter sponsored by Right 2 Safe Schools for assistance during the current wave.
If Arizona continues on its current course in the face of combined Delta + Omicron surges, we will face collapse of our healthcare system, including the need to triage hospital resources, accelerated loss of life and long-term disability in our highly vulnerable state, and worsening of severe healthcare workforce shortages. To minimize the impending catastrophes, Arizona leaders must act swiftly to implement multiple measures that will slow the spread of COVID-19 and protect the health of all Arizonans.
Federal Response in Arizona
Last week, officials at ADHS told Capitol Media Services that it had appealed to the Federal Emergency Management Agency (FEMA) to provide staff who can administer monoclonal antibodies, nursing support and other staffing requests at 14 hospitals across the state. In total, seven rural hospitals were seeking a total of 133 staffers to assist.
This request came as Governor Ducey released another $35.2 million to extend the contracts of 300 nursing staff at Arizona hospitals. An aide to the governor said that without the additional cash, the funding for the extra staff would run dry by the New Year.
On Tuesday morning, the White House announced it would send an emergency response team to Arizona in addition to Michigan, Indiana, Wisconsin, New Hampshire and Vermont. According to ABC15, each team will be comprised of 100 paramedics and clinical workers “on top of the 200 federal medical personnel that we have deployed since we learned about Omicron.”
Dr. Michael White, Chief Clinical Officer with Valleywise Health was enthusiastic about the news:
This will allow us to get those patients to a more appropriate location to be able to do this. Utilize this extra personnel and have the personnel we have dedicated back to their own department to service additional patients and the volumes we’re seeing in the emergency room.
According to 12News, this falls short of the numbers requested by the seven rural hospitals that had delivered specific requests. From Anne-Marie Alameddin, president and CEO of the Arizona Hospital and Healthcare Association (AzHHA)”
It’s not at the level that we need. As facts change and things become more dire, hopefully the feds will take another look.
FEMA also dispatched 10 nurses, nine respiratory therapists and medical equipment to the Navajo Nation.
Mandates and Challenges
State Senator Kelly Townsend (R-Mesa) asked Attorney General Mark Brnovich to review a section of the state Health Code that gives state and county health officials certain powers during states of emergency. In a new formal legal opinion, AG Brnovich said that Arizona law requires health officials to seek a court order within 10 days after imposing a quarantine, and the agency is required to prove that isolation or quarantine is “reasonably necessary to protect the public health.” Brnovich said that anyone who is ordered isolated or quarantined can go to court to demand release from the restrictions and the court must hold a hearing within 24 hours and issue a decision within 48 hours.
Townsend pursued this review specifically to challenge the authority of school districts to require student quarantine following exposure to COVID-19. Under the current public health emergency, county health departments have delegated the authority to impose quarantine on students to school boards themselves. According to the Arizona Capitol Times, the AG’s opinion would entitle anyone who seeks judicial relief to have a lawyer appointed by the state and that the legal representation “continues throughout the duration of the isolation or the quarantine of the person.”
The Arizona Conference of Police and Sheriffs filed a lawsuit challenging a $45 health insurance surcharge imposed each pay period on Pima County employees who haven’t received vaccination against COVID-19. According to the Associated Press, the surcharge, which took effect on November 1 would cost an unvaccinated employee close to $1,200 per year. The association alleges the charge violates federal law by failing to offer a reasonable alternative to vaccination.