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Spike in COVID cases makes public health experts nervous

Gov. Doug Ducey waits to hear President Trump speak after a tour of a Honeywell International plant that manufactures personal protective equipment, Tuesday, May 5, 2020, in Phoenix. From left behind Ducey are U.S. Sen. Martha McSally U.S. Rep. Debbie Lesko. The event was the only time Ducey has worn a mask in public during the coronavirus pandemic, leading public health experts to say he’s serving as a bad role model. PHOTO BY EVAN VUCCI/ASSOCIATED PRESS

Gov. Doug Ducey waits to hear President Trump speak after a tour of a Honeywell International plant that manufactures personal protective equipment, Tuesday, May 5, 2020, in Phoenix. From left behind Ducey are U.S. Sen. Martha McSally U.S. Rep. Debbie Lesko. The event was the only time Ducey has worn a mask in public during the coronavirus pandemic, leading public health experts to say he’s serving as a bad role model. PHOTO BY EVAN VUCCI/ASSOCIATED PRESS

 

Arizona continues to see a spike in positive COVID-19 cases and health experts say Gov. Doug Ducey sets a bad example by not wearing a mask in public.

Arizona reached its second highest day of positive cases June 10, at 1,556 positive out of 7,770 new tests, a 20% positive result, which led one expert to say Arizona has two options to turn things around, but neither will be popular.

Dr. Joe Gerald, a professor and researcher at the University of Arizona, said it doesn’t appear the state is taking the virus seriously enough and he is worried about a resurgence, if you can call it that.

Joe Gerald (Photo by Kris Hanning/University of Arizona Health Sciences)

Joe Gerald (Photo by Kris Hanning/University of Arizona Health Sciences)

“Arizona was a state that intervened relatively early in the course of this outbreak before there were a large number of hospital cases and so we benefited from that early intervention, but we were never able to drive case counts down – they just kind of plateaued,” Gerald said.

He said Arizona has “less of a safety margin” to handle a second wave because the state never saw the first wave subside. Combating the spread now is going to “require some pretty urgent intervention … because there’s such a delay between when we act and when we can see the tangible benefits of that action,” he said.

Gerald said there are only “two tools in our toolbox to address this problem” – physical distancing in the form of another stay-at-home order, which Ducey has made clear isn’t an option, or requiring people to wear a mask.

“We’re missing an opportunity by not doing more to encourage mask wearing and physical distancing. And certainly the governor, by not modeling this behavior, is sending a message that these behaviors aren’t important,” he said. “The optics of it just look terrible.”

Gerald said Ducey and Department of Health Services Director Cara Christ refusing to wear a mask in public has “struck a chord” with public health officials because “we’re really looking to our leaders, both political and other, to model the behaviors that are so critical to trying to gain control of this outbreak.”

Rebecca Sunenshine,

Rebecca Sunenshine,

He said wearing a mask should not be a political issue and blames elected officials for turning it into one and for not modeling healthy behavior themselves.

“I’m really disappointed that our elected officials of all stripes haven’t done more to model and emphasize the message and communicate the importance of mask wearing to protect not only others, but to protect the economy.”

Masked

Health officials in Arizona’s largest county have taken the opposite approach of Ducey and Christ in their most recent press conference on June 10.

Sporting masks and slathering on hand sanitizer, Maricopa County health officials announced that county employees are now required to wear masks and hinted that Ducey will announce a statewide campaign next week to encourage people to wear masks.

While Ducey refuses to change his actions as cases spike, Maricopa County Public Health Director Rebecca Sunenshine said as the virus has progressed, her understanding of the importance of wearing a mask has, too.

“Anybody who has seen my interview a few months ago, I did not routinely wear masks in public and I want everyone to know that I have changed my position on wearing cloth masks, mostly because the data just wasn’t there to support them when the recommendation first came out,” she said. “Now, there is a mounting body of scientific evidence that shows that cloth face masks can actually prevent COVID-19 from spreading.”

Ducey has only worn a mask in public once – when visiting the Honeywell factory with President Donald Trump, who didn’t wear a mask – but don’t expect to see the governor throw one on just yet.

One top official from the Governor’s Office said Ducey won’t wear a mask at his future briefings because he is “socially distant.” Nobody from Ducey’s office has commented on if the governor will ever wear a mask in public to set a better example for Arizonans after countless photos have circulated of Ducey and his team violating his own recommendations.

Will Humble

Will Humble

And whatever “campaign” Sunenshine hinted at coming from the state, seems to be nothing more than a public service announcement that won’t involve requiring people to wear a mask in public.

Some cities in other states require people to wear masks whenever they leave home, but the new effort won’t include mandates, and will instead be more like a PSA on healthy habits, like wearing a mask and staying home when sick.

Worrisome Trend

Ducey’s staff continues to post updates on Twitter downplaying the severity of the latest spike, but health officials remain concerned.

Specifically, they are freaked out about Arizona’s spiking rate of positive cases, and shrinking hospital capacity.

CovidExitStrategy.org, a website run by health and tech professionals to aggregate publicly available data on the pandemic that includes a state-by-state dashboard of key metrics, lists Arizona as “trending poorly.” That’s because in the last two weeks, the Grand Canyon State has had one of the highest trends of new cases (up 198%), the highest number of new cases per million in the nation and still isn’t meeting the target number of daily tests.

The latest trend, coupled with the state’s decreasing hospital capacity, is particularly concerning, according to the group, which held a conference call with reporters June 10.

Ducey’s office has repeatedly said that the spiking number of cases is because the state is doing more tests, though health experts said that that claim is misleading.

“If your positivity rate is increasing, that is a problem,” Marta Wosińska, deputy director of Duke-Margolis Center for Health Policy, said. “The fact that the positivity rate in Arizona is increasing suggests that there is more to it than testing more.”

Sunenshine said the rapid increase in the percentage of positive cases is likely to keep increasing.

“All of these numbers tell us that there is sustained community wide spread of COVID-19.”

The data shows cases began to spike right around the time Ducey lifted the stay-at-home order on May 15.

Gerald said he didn’t think stay-at-home did enough, whereas another health expert said it was working, but scientifically speaking there was no reason to end it so soon.

“It wasn’t restrictive enough, initially, and then we just didn’t keep it in place long enough,” Gerald said.

Will Humble, the Arizona Public Health Association executive director, said it was working, but now we are noticing a trend of higher positive cases.

He acknowledged elected officials must look at more than the pure science of the most effective way to slow the spread – Ducey is also taking into account the economic and psychological harm that a shutdown causes.

“If you looked solely through the lens of the spread of the virus, yes [Ducey lifted the order too soon]. But looked at it from a larger perspective, who knows?” Humble said.

Floyd Factor

Gerald and Humble said numbers will continue to climb as has been the recent trend, but things could get worse because of the nightly George Floyd protests throughout the state. However, any spike won’t come until after the incubation period. The protests began May 28 and have varied in size and intensity.

The incubation period is the time someone becomes infected to the time they recognize it, plus a day or two longer before the test results show up on the Department of Health Services dashboard. The estimate is between seven and 14 days total.

Humble, who served as Christ’s predecessor under Gov. Jan Brewer, also said Arizona is beginning to see how much, if at all, the hotter weather will affect COVID numbers.

“If the numbers begin to stabilize from here at 1,000 or so and don’t start edging towards 2,000 a day, then perhaps we’re looking at a seasonal effect where 110 degrees actually does some mitigation,” he said, adding that it doesn’t look promising.

Based on these numbers, Humble said Ducey “better not declare Phase Two,” but if he does, “[Ducey] can’t say ‘we’ve met the criteria and then therefore I’m moving forward.’”

Sunenshine said it’s also worrying that hospitals continue to fill up, which means elective surgeries, procedures she defined as ones that can be put off for more than 24 hours, might again be prohibited..

Hospitalization numbers are what is the most worrisome to Gerald, he said, and that the response to this “second surge” will be slow.

“We may substantially overshoot our capacity or ability to provide care to those who are most severely ill,” he said.

That doesn’t mean hospitals won’t be able to provide care at all, he said, but in “normal circumstances” the intensive care unit wouldn’t be overcrowded, there would be enough beds, medication, protocols and treatments.

Gerald said another issue is the severely ill may not be able to receive proper treatment.

“It’s not like we’re going to have people dying on the street, but rather, people may be cared for in an OR,

instead of an ICU, and the ventilator that they’re being used isn’t one of the normal ventilators, but it’s rather an anesthesia machine, and instead of being primarily cared for by pulmonary and critical care doctor, they may be getting their care from an anesthesiologist or a surgeon,” he said.

“And so the worry is more people would die than otherwise would die because our health care system is over its capacity to provide the expected care that we normally [provide] to everyone that needs it,” Gerald said.

 

 

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