Arizona began the phased reopening of the economy this week, following White House Guidelines amidst ongoing debate about the risk involved.
This week the state cleared the reopening of restaurants and most “non-essential” businesses – providing they can adhere to social distancing guidelines. The stay-at-home order was loosened, although people are still urged to avoid non-essential travel. Moreover, people in risk groups like those over 65 and people with diabetes, breathing problems and immune system weakness were urged to stay home.
When people venture out, the guidelines bar groups of more than 10 and encourage wearing masks in public.
Gov. Doug Ducey chiefly cited continued capacity to handle more cases at hospitals, a decrease in the percentage of positive tests and a rise in the state’s testing capacity.
The state did not meet all the White House criteria, nor the more restrictive recommendations made by the federal Centers for Disease Control. Despite a big increase in daily testing, the state does not have the capacity to track down and test the close contacts of those who do test positive. Rather than test close contacts as South Korea and others have done, most counties in Arizona are asking people to identify and inform their own close contacts after they test positive.
Gila County has one of the lowest case rates – with 19 cases and one death as of Wednesday. Perhaps because of the low caseload, the county health department has undertaken a more robust contact tracing routine than most. The county offered testing for many close contacts of confirmed cases. Moreover, the MHA Foundation has funded testing for health care workers and paramedics and will shortly open up testing to a much broader audience.
Early this week, Gila County had performed 978 swab tests to detect an active infection and 267 antibody tests. On a per-100,000 population basis, so far Gila County has 34 cases and 2 deaths – about a quarter of the state’s rate of 163 cases and 8 deaths per 100,000.
Statewide, 7.5% of swab tests have come back positive compared to just 2% of tests in Gila County. Meanwhile, statewide 3.2% of the antibody tests have come back positive compared to 2% in Gila County.
So by all the criteria Gov. Ducey has relied on to move towards reopening, Gila County remains one of the safest corners of the state. Arizona has a relatively low infection rate compared to the national average – but also has one of the lowest test rates.
The national criteria call for a three-phased reopening, with a roughly two-week lag between each phase. In 14 days, someone who got infected at work, a restaurant or a store would have time to incubate, cause symptoms and end up in the official tracking data. So if the opening of restaurants and other businesses this week causes a surge in infections, we won’t see the spike for about two weeks.
So here’s how Arizona stacks up against the White House criteria for a phased reopening.
Criteria: Hospital cases of flu-like illnesses and COVID-like cases decline over a two-week period.
Hospitalization for respiratory diseases like COVID-19 and the flu have declined since peaking at 52 admissions on April 6. The number of daily new admissions dwindled to about 23 on May 3, according to the state tracking system. COVID-19 cases account for about 13% of all hospitalizations. The total number of COVID-19 patients in the hospital has actually remained pretty consistent, generally over 700. However, the percentage of ER and inpatient admissions due to COVID-19 and flu-like symptoms has declined from about 7 or 8% to 3 or 4% since the peak at the end of March. Some of that decline may reflect the end of the flu season, since the statistics included both flu and COVID-19 symptoms.
Criteria: Percentage of positive tests declining in the past two weeks.
Overall, 7.4% of the swab tests for an active infection have come back positive. That percentage peaked at 12% in March and declined to about 4% in May. For most of April, it hovered at around 7%. However, that decline’s hard to interpret since the state has only recently loosened up the criteria for who gets tested. Throughout April, the state did about 2,000 tests daily. In May, the number has risen to more like 9,000 daily. In April, mostly only people with active symptoms got tested. In May, anyone with a doctor’s order can get tested. This makes the percentage of positive tests hard to compare from April to May.
Criteria: Rate of increase in new cases declines over a two-week period.
The number of Arizona cases actually continues to rise steadily, but that’s not surprising considering the big increase in testing. The single-day peak of 456 new cases came on May 4 and has declined since. However, results typically straggle in, so the more recent daily toll will likely rise. The overall shape of the curve continues to slope upward.
Criteria: Hospitals can handle a fresh surge of cases.
The state’s hospital system has never approached the kind of overload that confronted New York, Italy and Wuhan China. Gov. Ducey ordered the cancellation of all elective surgeries and pressed hospitals to get as many beds ready as possible, when early projections suggested a big shortage of beds and ventilators. Hospitals actually ended up half empty and started laying off workers. The percentage of intensive care beds in use hit a low of 62% on April 7 and has remained between 75 and 80% since then. The percentage of ventilators in use has remained consistently below one third of those available since the onset of the pandemic. Gov. Ducey recently allowed hospitals to resume elective surgeries.
The White House also lists things the state responsibilities in the event of a reopening.
Can quickly test for the virus and trace contacts:
The state has ramped up testing, but most counties don't have the manpower or the tests needed to do more than ask people to get in touch with their own close contacts.
Screen high-risk sites for people infected but not showing symptoms:
The state doesn't yet provide test-based screen in high risk setting like prisons, schools and nursing homes, which account for more than 25 percent of the deaths statewide.
Maintain stocks of gloves, masks and gowns for medical personnel
The state has fewer shortages for healthcare workers, but doesn't have a big supply of stockpiled equipment in case of a fresh surge of cases.
Provide enough ICU hospital beds for a surge of cases
Some 20 or 30 percent of ICU beds are currently available.
Advise citizens as to the need for masks and social distancing
The state has repeatedly put out that message, but compliance varies hugely by area. Few people in Payson wear masks - especially weekend visitors.