The leveling off in new cases of COVID-19 has eased fears the state’s hospitals will suffer a fatal overload of critically sick patients.
In the past week, the number of deaths per day has dropped from about 10 to about 3 — reflecting a decline in demand for the state’s precious ICU hospital beds and ventilators.
The state health department reported early this week that about half of the state’s intensive care hospital beds are currently filled.
Of the state’s 1,600 emergency department beds, 577 are occupied.
Of the state’s 7,500 in-patient beds, 4,500 are in use.
Moreover, only about 25% of the state’s 1,174 ventilators are in use, according to state figures released early this week.
At one time, state officials feared they might need 4,000 more ventilators, 13,000 more hospital beds and 1,300 more ICU beds.
Fortunately, protective measures and the public response slowed the spread of the virus, flattening the upward curve of new cases and reducing the load on the hospitals. The virus has also spread more slowly in the less densely populated western states than it has in the east or in many more densely populated countries worldwide.
New cases could still accelerate, but in most Arizona counties the rate of increase has slowed. Early figures suggest the death toll may have peaked in Arizona in the last two weeks of March — several weeks sooner than the early predictions.
The state may have also benefited from the relatively mild symptoms in most of those younger than about 45. Some 68% of the deaths so far have been among people older than 65, although the death rate has also been relatively high among Native Americans — particularly on the Navajo Reservation.
Some 76 million Americans over the age of 60 have underlying health conditions like lung disease, heart conditions, asthma and diabetes, which put them at greater risk of serious complication from COVID-19.
A national survey based on federal data by QuoteWizard found that Arizona ranked 17th nationally in risk factors for seniors. In Arizona, 19% of seniors suffer from diabetes, 9% from cardiovascular disease, 14% heart and lung disease and 9% from asthma.
Overall, the condition of the hospitals as of this week represents a triumph for the strategy of social distancing, which has so far helped prevent new cases from overwhelming hospitals.
Gov. Doug Ducey also ordered the cancellation of elective surgeries to preserve hospital capacity. Visits to emergency rooms for other causes have also declined. Perhaps people are avoiding hospitals for fear of adding to the load or ending up in the waiting room with COVID-19 patients. The shutdown has also resulted in a drop in violent crime, traffic accidents and other mishaps that send people to the hospital.
Several weeks ago, medical officials sounded the warning about a potential shortage of hospital beds, particularly ICU beds and ventilators. Arizona ranks 47th nationally in the supply of hospital beds per capita — with 2.45 physicians and 1.96 hospital beds per 1,000 population, according to a national survey by the Kaiser Family Foundation.
Only Nevada, Idaho and Utah have fewer hospital beds and doctors per 1,000.
Pennsylvania — the top-ranked state — has 3.99 doctors and 2.92 hospital beds per 1,000 population, according to the survey.
Surveys suggest that the shutdowns and protective measures may have reduced the peak number of cases by about 50%. The measures won’t reduce the total number of infections over time, but will keep the rush of cases from overwhelming the hospitals.
Locally, Banner Payson Medical Center quickly developed plans to bring unused rooms and facilities into use along with contingency plans to shift doctors, respirators and nurses from one Banner facility to another as needed. Fortunately, Gila County’s cases have remained at five for the week, while other counties have seen caseloads grow steadily.
The western states have been less hard-hit by the pandemic than the eastern states. California Gov. Gavin Newsom even sent 1,000 ventilators to New York, which has suffered more than 10,000 deaths and seen its hospital system come close to the breaking point. At one point, New York Gov. Mario Cuomo said the state could need 20,000 additional ventilators.
Rural areas in Arizona have less hospital capacity than the urban areas in Phoenix and Tucson.
A bipartisan group of senators last week urged the Department of Health and Human Services to speed money from the $2 trillion emergency relief bill to hundreds of rural hospitals across the country going broke even before the pandemic hit.
Prior to the pandemic, half of all rural hospitals were operating at a loss, according to the letter by Sen. Kyrsten Sinema (D-AZ) and 19 other senators from both parties. The CARES Act included $100 billion for hospitals and local providers like the Arizona Health Care Cost Containment System for expenses and lost revenues because of COVID-19.
An additional $250 billion aid package last week stalled after Democrats insisted on an extra $150 billion for health care providers and $100 billion for local governments.
“We share significant concerns that the $100 billion provider fund (in the CARES Act already passed) will not be equitably distributed to small, rural hospitals, critical access hospitals and other rural providers who are in need of help.”
The senators noted that 50% to 80% of rural hospitals will likely actually lose revenue, due to the elimination of many non-emergency services to prepare for the surge of COVID-19 patients. Facilities serving communities with many older patients and many Medicaid and Medicare patients need special consideration, they argued. This would presumably include hospitals like Banner Payson and Summit Regional Medical Center in counties with a large elderly population and heavy reliance on Medicare and AHCCCS.
“Last year rural hospital closures hit a record high and 2020 is on pace to be even higher. Some 60 million people — 1 in 5 Americans — live in rural areas and depend on their local hospitals for care,” concluded the 19 U.S. senators.
The state took advantage of full federal funding offered under the Affordable Care Act to expand the Arizona Health Care Cost Containment System from 100% to 138% of the federal poverty line. The expansion of AHCCCS and policies offered through the Affordable Care Act online markets cut the share of people without insurance in the state in half, from about 20% to about 10%. AHCCCS reduces the uncompensated care for hospitals that treat uninsured emergency room patients.
Arizona and other states have continued to press a lawsuit seeking to overturn the Affordable Care Act, which will likely go to the U.S. Supreme Court after the November election.