Arizona COVID-19 spread called ‘alarming’
Hospitals urged to fully activate emergency plans
PHOENIX – Experts around the country and in Arizona are raising alarms about the state’s COVID-19 situation because cases and hospitalizations have increased for the past two weeks.
The increase in cases can’t solely be attributed to increased testing in Arizona, experts say.
Instead, it looks like the state is trending upward in a way that is concerning and could need another stay-athome order to curb the spread.
“I would go so far as to say alarming,” said Dr. William Hanage, an epidemiology professor at Harvard University’s T.H. Chan School of Public Health. “The only sort of crumb of comfort that I can find is that I think, in general, it’s sort of easier to social distance in Arizona than it is in some places.”
State ‘may need to gear up’
Arizona’s largest hospital system warned over the past week that its intensive care units are filling up, ventilator use was on the rise and capacity was reached for extracorporeal membrane oxygenation treatment.
“We have seen a steady climb of COVID-19 cases in Arizona over the last two weeks,” Banner Health tweeted Monday. “This trend is concerning to us, and also correlates with a rise in cases that we are seeing in our hospital ICUs.”
The state health director sent a letter on June 6 to hospitals urging them to “fully activate” their emergency plans.
But Arizona Gov. Doug Ducey and Dr. Cara Christ, the director of the Arizona Department of Health Services, said last week that the rise in cases was expected as Arizona started reopening.
Ducey’s office has repeatedly pointed to an increase in testing as the cause of case numbers increasing.
Jessica Rigler, the state health department’s assistant director, said the
department is trying to spread the message that people can take precautions such as wearing a mask in public and staying home while sick.
“We don’t want people to be in crisis mode, thinking that everything is all bad in Arizona with the cases,” Rigler said. “We are certainly monitoring what’s going on and trying to ensure that people understand where we are with COVID-19 in our communities.”
Dr. Kacey Ernst, an infectious disease epidemiologist at the University of Arizona, said all signs seem to point to the increasing transmission of the disease. Increased testing could explain increased cases, but not increased hospitalizations, she said. Arizona does appear to be increasing more than other states, she said.
The situation is “very concerning,” she said.
“If we continue on this trajectory and it is not just due to one or two localized outbreaks, then we may need to gear up for increasing action,” Ernst said in an email. “The director of ADHS has declared all hospitals should activate their emergency plans. That should tell us all something.”
Ducey spokesman Patrick Ptak said the governor’s office is working with public health officials and community leaders to provide more guidance on reopening,
“ensuring businesses return smarter and work to mitigate the spread.”
Ptak said in an email that the increase in cases was anticipated, and the state is working on ways to increase hospital capacity. The old St. Luke’s hospital is “ready for activation” though not yet needed, he said.
Ptak also pointed to increased testing as a reason cases are increasing, saying testing has doubled since the stay at home order ended May 15.
What are numbers showing?
Most indicators in Arizona show an increase in the disease’s spread that goes beyond just increased testing, experts say. For example, since the day after the stay-at-home order expired May 16 to Tuesday, cases increased by 108% while testing increased by 100%.
Last week, several days saw more than 1,000 newly reported cases. Prior to the past week’s dramatic case increases, new cases reported daily have typically been several hundreds daily.
Hospitalizations have steadily risen. Statewide hospitalizations as of Sunday were at 1,266 inpatients in Arizona with suspected and confirmed COVID-19, which was the second-highest number, behind Friday, since the state began reporting the data on April 9. The past eight days have seen inpatient hospitalizations statewide for suspected and confirmed COVID-19 eclipse 1,000.
The percentage of positive tests per week increased from 5% a month ago to 6% three weeks ago to 9% two weeks ago, and 12% last week.
With increasing testing, the percent of positive tests out of all tests would ideally decrease, Hanage said. Who is being tested can affect this percentage, he said.
Statewide, Arizona didn’t see a decrease in COVID-19 at any point, said Dr. Joe Gerald, an associate professor at UA’s Mel & Enid Zuckerman College of Public Health. Some places did begin to plateau or level off, he said. But since social distancing restrictions were lifted in early- to mid-May, the disease has taken off, he said.
What could stop the trend?
It’s clear now to experts that the state is in a concerning position. But acting immediately to take measures to curb the spread won’t have an immediate effect on case increases because people are already infected and spreading it to their close contacts, they said.
Hanage said if he were advising the governor, he would say the least that can be done is to halt reopening and see if the increase continues.
“Even if you were to be able to take pretty effective measures now, you’d still be having a month or so of difficulty with cases at least this level, if not somewhat more,” Hanage said.
Still, experts say the state needs to act quickly to get the situation under control.
The public needs to continue following public health recommendations, such as physically distancing, wearing masks and washing hands, Ernst, of the University of Arizona, said. It’s also important for state leaders to follow these guidelines, she said.
Gerald said it’s hard to see how the state could avoid another shutdown at the rate cases and hospitalizations are increasing right now.