Health officials: 'Catastrophic' levels of COVID-19 hospitalizations coming without state action

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An immediate effort is needed to fight the “relentless transmission” of COVID-19 across Tucson and the state, public-health officials say after another week of record-breaking numbers in virus cases and hospitalizations.

If no immediate action is taken by the state government, officials are projecting “catastrophic” levels of COVID-19 cases, hospitalizations and deaths. In a letter to the Arizona Department of Health Services this week, the University of Arizona’s COVID-19 modeling team urged Arizona leaders to implement a statewide mask mandate, issue a shelter-in-place ordinance for two weeks and pass additional economic relief measures.

“No matter what actions are taken, Arizona will experience a hospital crisis in the coming weeks,” the letter said. “However, if action is not immediately taken, then it risks a catastrophe on a scale of the worst natural disaster the state has ever experienced. It would be akin to facing a major forest fire without evacuation orders.”

Based on projections by scientists at Arizona State University, COVID-19 hospitalizations will exceed current ICU and general ward capacity by early December if interventions are not taken to slow the spread. They also predict that hospitalizations will exceed Arizona’s total hospital capacity by late December, leaving no availability for routine, urgent or emergent care not related to the virus.

“We’re going to see many more cases, and those cases are going to lead to hospitalizations, ICU visits and eventually deaths,” said Dr. Joe Gerald, an associate professor with the UA’s Zuckerman College of Public Health. “It’s shaping up to make this Christmas, the end of December, just a terrible time not only here in Pima County, but the state as well. If some meaningful action is not taken within the next two weeks, we’re going to overwhelm our hospitals’ capacity to care for patients.”

As of Friday, the Pima County Health Department has recorded over 9,800 cases in November, nearly quadrupling the number of cases in October and surpassing the county’s previous peak in the summer.

The county also recorded its highest weekly case count last week with over 3,600 cases, which is nearly 40% higher than the last record in July. New records for single-day infections have been reported as well, reaching 878 cases on Sunday, Nov. 22, and 691 cases the day after Thanksgiving.

An accelerated rate of transmission is also seen throughout the state. The Arizona Department of Health Services is reporting 71,000 positive cases in November so far, compared to 32,000 in October.

“We will break a record again this week for the number of cases that this county is experiencing. This is scary,” said Dr. Francisco Garcia, Pima County’s chief medical officer. “That’s why we’re doing things that are relatively unpopular.”

The Pima County Health Department issued a public-health advisory on Monday asking residents to adhere to a voluntary nightly curfew through the end of the year. While the county does not have the authority to mandate a curfew, officials said they are hoping residents will take the recommendation seriously.

“We’re sitting on top of a ticking time bomb right now. And we have our eyes winced tight, simply praying that it doesn’t go off in our face,” Gerald said. “We’re already at peak levels. And if Thanksgiving does what we think it’s going to do — based on what happened in Canada, for example — conditions are going to deteriorate even more quickly than they are now.”

Canadians saw a 45% rise in COVID-19 cases as a result of their Thanksgiving on Oct. 12. Officials expect a similar occurrence in the U.S., but they won’t see the impact for 10 to 14 days.

“People are assuming that there are safe ways that they can gather with people who are not part of their household, and there really are very few safe ways to do that right now.” said Pima County’s public-health director, Dr. Theresa Cullen. “It’s the wonder and the beauty of human beings that we want to show compassion and love and caring. And we do that through physical touching and through talking. That’s what people are craving and I think that’s what’s happening.”

Cullen said these in-home gatherings, as well as outings to bars and restaurants, are contributing to the county’s coronavirus numbers and are taking a toll on the county’s hospital system.

Hospitalizations continue to rise

New COVID-19 hospitalizations have increased from last month by 51% throughout the county and by 57% statewide, according to data as of Nov. 25.

On Thanksgiving Day, there were only eight ICU beds available at Pima County hospitals. In Arizona at one point this month, only 10% of ICU beds were available.

“What we’re hearing from providers and hospital administrators is that we’re in for a week of hurt here,” Garcia said. “We’re watching hospital capacity very, very carefully. And that’s not about beds, or about physical spaces; it’s about the staffing capacity. And we know that some of our hospital partners are starting to feel the pinch of the hospital capacity issue.”

Garcia said health-care workers have not only been inundated with COVID-19 patients, but people dealing with the flu and other seasonal illnesses. This combination, he said, is straining resources rapidly.

While hospitals have contingency plans to ensure that beds are available should they need them, staffing for those extra beds continues to be a concern. During the first case surge in June and July, the Health Department worked with federal partners to bring in nurses and doctors from all over the country. However, as hospitals everywhere start to deal with an influx of both COVID-19 and other seasonal illnesses, the county and state will likely have to wait before receiving additional staffing support.

“Right now, even though the numbers are up, we’ve been able to handle the amount of cases that we’re seeing that are becoming hospitalized,” Cullen said. “But the concern is that if we start seeing additional cases with sicker people, that we will be in trouble.”

An increase in hospitalizations also means an increase in deaths, but they are a lagging indicator and typically take longer to report. Of the 6,624 people who have died from COVID-19 in Arizona, it took an average of 21 days from the time of infection, so the county likely won’t see an increase in mortality until the end of December.

Grim projections without intervention

Based on current projections by ASU, Arizona is set to exceed ICU capacity as early as next week and will exceed total hospital capacity by Christmas Day if no statewide action is taken.

Public-health officials also warn that this situation would likely force hospitals to decide who gets care and who doesn’t, whether they have COVID-19 or not.

“The COVID-19 surge means hospitals will lack the physical resources and personnel to provide timely care, and more Arizonans will die of heart attacks, strokes and injuries from car accidents,” said the UA’s modeling team.

While local leaders continue to do what they can do to prevent the spread and encourage residents to follow mask mandates and social distancing protocols, they now say county-by-county mitigation measures are no longer sufficient.

“I really think that there needs to be some attention on a statewide level to look at appropriate interventions that we know have been effective in the past,” Cullen said. “Nobody wants another lockdown. But there are lessons that we’ve learned that could help us mitigate this transmission and the things we know that do that are decreasing social activity and masking.”

Given the current outbreak and how quickly the rate of transmission is accelerating, Gerald said only a resumption of shelter-in-place orders are going to pull the county and state off of its current trajectory and have a large enough impact to prevent the most dire projections from occurring.

Updated May 27, 2020

Tucson Medical Center, coronavirus drill

Updated Apr 16, 2020

Arizona governor touts COVID vaccine coming soon; spurns calls for curfews, other rules

Updated Jan 8, 2021

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PHOENIX — Arizona is expected to receive “hundreds of thousands” of COVID-19 vaccine doses by the end of this month, with priority for health-care workers, teachers, vulnerable populations and long-term-care residents, the state’s health chief said Wednesday.

The announcement came as Dr. Cara Christ also disclosed that 1 person out of every 7 who got tested for the virus last week in Arizona was infected. She also reported a new one-day record for cases.

But Gov. Doug Ducey, standing by her side, refused to put any new mitigation measures or restrictions in place to get the state to the point where a majority of Arizonans can be inoculated.

He specifically rejected a proposal by the chief medical officers of several Arizona hospitals to put in place a curfew, close restaurants to indoor dining and cancel group athletic activities. Instead, Ducey said he is relying on the idea that Arizona will have sufficient hospital beds to treat those who get ill in the interim.

However, that assumes hospitals can find the qualified medical personnel to staff these beds.

Earlier Wednesday, Marjorie Bessel, chief clinical officer for Banner Health, said the problem now, unlike this summer when virus cases peaked here, is that Arizona is no longer the state with the biggest surge. That makes it difficult to recruit help from elsewhere.

And while Banner is in the process of filling 1,500 positions, she said efforts are still underway to hire 900 more.

Ducey did agree Wednesday to provide an additional $60 million to Arizona hospitals to help them find the staff they need to handle the surge of people needing medical care. That is on top of a $25 million infusion less than a month ago.

“Grim” forecasts for this month and next

Bessel said the picture in Arizona is “grim,” predicting that Banner hospitals will hit 125% of bed capacity this month and exceed that, at least briefly, in January.

That trend is not unique to Banner.

Intensive-care-unit bed use is already at 90% of capacity in the state, the most recent data from the Arizona Department of Health Services shows.

Hitting 125% is not necessarily a problem as hospitals are required to have plans in place for such a surge, including converting non-ICU beds and other facilities for intensive-care use.

But the Institute for Health Metrics Evaluation predicts the demand for ICU beds will hit 300% of capacity in Arizona by the middle of January unless there are additional steps taken to curb the spread of the virus.

It was for that reason that Bessel and medical officers from Mayo Clinic and Dignity Health specifically asked Christ this week to impose the additional restrictions.

Bessel specifically praised Tucson Mayor Regina Romero and the City Council for voting Tuesday to impose a 10 p.m. curfew for three weeks.

“A curfew is mitigation that absolutely can work,” Bessel said. “It can work and it will work if we deploy it.”

Ducey is not willing to take such steps, even as he conceded that the vaccines, which will only start to be available later this month — and only for those in the highest priority classes — won’t make any immediate dent in an increasing trend in cases.

“We are in for a tough several weeks here,” the governor said at his news conference Wednesday.

He said he was giving his “most sincere condolences” to the families of the 6,739 people in Arizona who have died so far from COVID-19.

“We grieve every death in Arizona and want to continue to do everything we can to contain the spread of this virus and protect lives,” Ducey said.

Ducey: Curfews “not the right approach”

But that won’t include the kind of new restrictions being urged by the hospital medical chiefs and others, and not the kind of curfew that takes effect Friday, Dec. 4, in Tucson.

“I don’t think it’s the right approach,” Ducey said. “We want to do things that will allow businesses to operate safely.”

He said the continuing restrictions imposed in late June, like occupancy limits on in-house restaurant dining, movie theaters and fitness centers, along with enforcement, “will be the best things we can do to continue to slow the spread.”

He brushed aside questions about the fact that the spread is not slowing, even as Christ acknowledged that 15% of the tests for the virus conducted last week are coming back positive.

“This week we’re trending higher,” she said.

The number of new cases reported per day hit a record on Nov. 23 in the state. Figures for more recent dates are still being updated.

For Ducey, the focus is on the economy.

“I don’t think the right answer is to throw hundreds of thousands of Arizonans out of work before the holidays to slow this spread because I don’t think it would slow the spread,” he said.

He said there are other complications of restrictions, “like suicide attempts, like depression, like emotional and social disconnection, like child abuse and like domestic violence.”

Safety measures for large events

The lone new regulation of sorts that Ducey did impose Wednesday is not anything the state would enforce.

His current executive orders prohibit gatherings of more than 50 unless local governments approve. Now, he said, these governments will have to have a written agreement with event organizers that they will require and enforce certain safety measures, like distancing and the use of masks.

Nothing in Ducey’s orders affects activities he said are protected by the First Amendment, like the rallies the governor attended this year during President Trump’s campaign.

That, then, leaves the vaccines.

More financial help for restaurants

Ducey said first priority will go to health-care and essential public-safety workers, residents of long-term-care facilities and other “vulnerable” populations.

He is specifically including teachers in that first group.

That dovetails with his often-repeated argument that he wants more in-classroom teaching and less online education. The premise is that once teachers have immunity, they will be more willing to return to work in classrooms.

The date for vaccines for all Arizonans has yet to be determined.

Ducey issued an executive order Wednesday spelling out that all residents will be able to get inoculated “without financial barriers.”

Ducey also set aside $1 million in grants to help restaurants and other dining facilities expand their outdoor dining operations.

There is a separate $100,000 going to the Arizona Restaurant Association for the same purpose, and another $100,000 to the Arizona Lodging and Tourism Association to aid hotels and their restaurants in strengthening their sanitation and mitigation practices to protect patrons and staff.

Not everything being done for restaurants is financial.

Ducey is suspending a provision in law that says restaurants can serve alcoholic beverages only to patrons dining in-house or at an outdoor patio directly connected to the business. That has proven to be a barrier for restaurants that have received local permission to operate in parking lots and on cordoned-off areas of the street where there is a sidewalk in between.

Photos: April coronavirus patient drill at Tucson Medical Center

Tucson Medical Center and the Tucson Fire Department held a drill on April 10, 2020, to help establish procedures and solve problems when hand…

Pima County keeps voluntary curfew, enhances penalties for violating COVID-19 rules

Updated Jan 11, 2021

The Pima County supervisors voted Friday to strengthen penalties related to noncompliance with COVID-19 regulations, including the potential suspension of restaurant licenses and civil penalties for people not wearing a mask in public.

In addition to several new enforcement actions, the Board of Supervisors also endorsed a strengthened public-health advisory by the Pima County Health Department that now requires businesses to report any known coronavirus cases.

The county’s voluntary curfew, which began Nov. 24, will remain in place each night from 10 p.m. to 5 a.m. through Dec. 31. Even as other areas of the county are asked to adhere to the voluntary curfew, the city of Tucson voted to implement a mandatory curfew earlier this week, which will be in place from Friday, Dec. 4, to Wednesday, Dec. 23.

“The point of an advisory is to really ensure that people understand the severity of what we are dealing with,” said Dr. Theresa Cullen, the county’s public-health director. “We are in a crisis situation.”

The increased enforcement measures come as new coronavirus cases reach unprecedented levels throughout the county and state. In the first four days of December, there have been close to 2,900 new infections in the county, exceeding the total number of cases in March, April and May combined.

Hospitals also continue to deal with a record number of COVID-19 patients, reporting only one available ICU bed in the county on Dec. 3. Officials throughout the state continue to see an accelerated growth curve with no signs of slowing down without serious statewide intervention.

“We in the hospitals are being stretched to the limit, even as we speak,” said Dr. Clifford Martin, an infectious-disease specialist at Tucson Medical Center, when addressing the board. “I ask you and the community to do whatever you can to help us in the hospital at this point.”

Based on action taken by Gov. Doug Ducey earlier this week, the board decided to enhance enforcement on a number of coronavirus regulations already in place.

Here are the actions that were taken by the board, in 3-2 votes with Republican supervisors Steve Christy and Ally Miller voting no on them:

Business regulations

In July, supervisors adopted a number of temporary measures applicable to restaurants, public pools, gyms, fitness centers, hotels and resorts, such as employee temperature checks, masks and gloves, occupancy limits, social distancing and cleaning requirements.

Under an amended proclamation, the county will now enhance its enforcement of these measures, allowing only one incidence of noncompliance before facing repercussion by the county Health Department. A second violation by a business could result in the possible suspension or revocation of the establishment’s license or operating permit.

Mask compliance

While the county has had a mask mandate in place since June, there were previously no penalties in place for noncompliance. On Friday, the board asked that all county jurisdictions and law enforcement agencies assist in enforcement action, which includes a $50 civil fine for not wearing a mask in public areas.

In addition, the board made it mandatory for businesses to refuse service to anyone entering their establishments without a mask, unless specific exemptions apply. A business could be fined up to $500 if they do not comply.

Event regulations

Anyone wishing to hold an event with more than 50 people will now be required to pay a $1,000 or more compliance deposit, depending on the size of the proposed event. If mitigation strategies are followed during the event, organizers would be entitled to get their deposit back.

There will be on-site inspections of these events to determine compliance.

Curfew

The voluntary countywide curfew, intended to curb evening social gatherings at bars and other places, will remain in place through Dec. 31.

After two weeks, the board will review whether the voluntary curfew and other measures are working by analyzing the number of infections per 100,000 residents as well as the percent of positivity within the county. If the county is still over 100 cases per 100,000 people and over 10% positive, the board will consider moving to a mandatory curfew.

“We don’t know what the next two weeks will bring,” County Administrator Chuck Huckelberry said. “We are at over 350 infections per 100,000. If that continues to increase, we will be back with more measures within the next two weeks.”

Older adults asked to shelter in place

In addition to the curfew, the Health Department is also asking for older adults and people with underlying medical conditions to voluntarily shelter in place, except to seek medical care, purchase food, attend work or other essential activities.

The enhanced public-health advisory also requires businesses to report any confirmed COVID-19 cases within their establishment and further comply with any contact tracing efforts by the Health Department. A website will go live next week for businesses to report these cases to the county.