As Arizona approaches the two-year mark from Governor Doug Ducey’s March 30, 2020 executive order mandating the closure of certain businesses and a stay-at-home advisory for all Arizonans, the Arizona Republic reflects on what has happened in those two years of the public health emergency. Following three major surges of COVID-19 in just over a year, Arizona has ended the surge related to the Omicron variant with the second-highest COVID death rate in the country and depletion of healthcare workers.
According to a retrospective by The Arizona Republic, those two years have revealed a number of systemic issues with Arizona’s healthcare system. Public health recommendations that Arizonans contact a trusted family doctor to discuss symptoms, testing and vaccinations fell flat for the large number of Arizonans without insurance or primary care. In fact, according to a physician workforce analysis by the American Association of Medical Colleges, Arizona ranks in the bottom 10 for active primary care physicians by population, illustrating the dire concern that the healthcare worker shortage brings to the state.
It’s clear in the timeline of COVID-19 statewide events provided by the Republic, that after June 2020, Governor Ducey expressed limited interest in addressing the concerns brought by healthcare providers prior to each of the three major surges that occurred in 2021. While he celebrated and publicly advocated for COVID-19 vaccines at the beginning of their rollout in the winter of 2021, during the summer of 2020 Arizona experienced rising cases and testing backlogs, and in December Ducey ignored warnings from Arizona University researchers and an urgent request from the chief medical officers of Banner Health, Dignity Health Arizona, Arizona’s Mayo Clinic, Tucson Medical Center, Valleywise Health, Yavapai Regional Medical Center and HonorHealth to issue a statewide curfew, end indoor dining in restaurants and prohibit group athletics, among other safeguards.
Arizona health system leaders wrote,
Strong messaging from the Governor’s office and ADHS will create a sense of urgency. Please help us, as the healthcare leaders of your state, to bridge this gap until the vaccine can be widely available to the public. This has been a long road for us all, but there is hope on the horizon.
Aside from patchwork additions of COVID-19 funding assistance, the Arizona State Legislature has also shown little interest in addressing the state of Arizona’s public health, choosing instead to curb the governor’s executive powers in times of emergency, ban vaccine mandates and prohibit other measures that might mitigate future waves of COVID-19 and any future contagion outbreaks that have yet to be realized.
Just last week, the governor turned his attention back to healthcare and signed legislation that strengthens background checks for individuals that apply for work at Arizona’s nursing facilities. The law will require anyone applying for assisted living facility certificates or nursing care administrator licenses through the independent Board of Nursing Care Institution Administrators and Assisted Living Facility Managers (NCIA). From Governor Ducey:
Our nursing homes and assisted living facilities deserve accountability and leadership from their supervisors. SB 1242 accomplishes this. Our seniors — grandmothers, grandfathers and family members — deserve nothing less to ensure their safety, happiness and health.
Months earlier, AARP took a different approach. In the four weeks ending on September 19, 2021, an alarmed AARP reported that the daily number of nursing home resident deaths from COVID-19 jumped from two to 11 per day as Arizona nursing homes reported staffing shortages of 29%.
In response to these striking numbers and concern that the vaccine would fail to adequately protect workers and residents alike, AARP called on the Arizona State Legislature to consider a bill that would place spending requirements on nursing homes for direct care, ensuring quality metrics and staffing levels, combatting persistent isolation by allowing virtual visitation, holding nursing homes legally accountable for providing care and addressing the workforce shortage. The AARP proposed legislation was designed to work to ensure the safety, happiness and health of Arizona seniors amid a pandemic that disproportionately affects their community.
Vaccines and Mandates
Pfizer and Moderna have submitted emergency use authorization applications to the Food and Drug Administration (FDA) for the authorization of an additional booster dose for individuals 65 years or older who have already received a primary booster of the vaccine. According to the Arizona Medical Association, the effectiveness of boosters is based on real-world data collected during the surge related to the Omicron variant.
The Occupational Safety and Health Administration held a hearing on its emergency temporary standard to protect healthcare workers from COVID-19 exposure. Modern Healthcare reports that the temporary standard was published last June, but its non-recordkeeping provisions were allowed to expire in December. The comment period will also be open for another 30 days, and the American Hospital Association (AHA) has called the standard “unnecessary” because they already have implemented safety precautions. The nation’s largest nurse’s union, National Nurses United, is in favor of the permanent policy.
The Associated Press reports that U.S. District Judge Donald Molloy of Missoula issued a preliminary injunction against a Montana state law that prevents health care facilities from mandating vaccines. Judge Molloy qualified the injunction by saying that it would only apply while the the Centers for Medicare and Medicaid Services (CMS) interim rule is in effect, because the federal rule takes precedence over state law. The rule was upheld by the U.S. Supreme Court in January.
Gerald Harmon, MD, president of the American Medical Association is joining American Academy of Pediatrics President Moira Szilagyi, MD, PhD, American Nurses Association president Ernest Grant, RN, PhD and Ada Steward, MD, chair of the board of the American Academy of Family Physicians to begin an advertising campaign aimed at parents to get their children vaccinated. According to Becker’s the ads called Oath and Trust are 60-second spots that will run on social media and television this week and are part of the Biden administration’s vaccination improvement efforts.
This ad campaign comes as scientists investigate the connectio between mild cases of COVID-19 and diagnosis of Type 1 diabetes in children. Modern Healthcare reports that a Center for Disease Control and Prevention (CDC) report looked at two large U.S. insurance databases and found a correlation between diabetes in children and COVID-19 infection, although it did not distinguish between Type 1 and Type 2.
COVID-19 tests are suddenly in very abundant supply following several months of shortages and difficulties with distributing the tests to Americans through federal programs. According to the New York Times, the nine different at-home rapid tests on the U.S. market are available at public libraries, through local government agencies, workplaces, insurance companies, pharmacies and on request from federal government programs. From Dr. Michael Mina, a pathologist and chief science officer at eMed, a digital health care company:
It’s unfortunate that we didn’t have these tests earlier, before the Omicron wave, before the Delta wave and, frankly, before 2020. It feels too little too late. But it’s much better to have them available.
Northern Arizona Healthcare announced on Tuesday that it would move it’s COVID-19 testing clinic from the Elk’s Lodge #499 in Flagstaff to the Flagstaff Medical Center’s West Campus. Testing will be available in the parking lot at the south end of the medical center building and entry to the building will not be required.