Public health experts say that the exploding COVID-19 outbreak in Maricopa County and Arizona at large is only going to get worse as infections accelerate.
Maricopa County is now seeing a daily average of over 1,800 cases, up from 200 a few weeks ago.
Researchers at the Arizona State University Biodesign Institute estimate that community transmission of the virus has increased 40 percent since May 11, and the percentage of COVID-19 tests administered across the state that are coming back positive is increasing, which epidemiologists say is a sign that cases are increasing.
Experts are concerned about other trends. Thirty-six percent of all known Maricopa County cases were in the last week, and more than half involved people aged 20 to 44. That means the virus is spreading among young people, said Dr. Rebecca Sunenshine, Maricopa County Disease Control Division medical director, in press statements on June 24. An estimated 40 percent of people with COVID-19 have no symptoms and might not know they’re infected, a statistic Sunenshine said she found alarming.
Arizona’s COVID-19 total of about 63,000 known cases isn't close to the number seen in some regions in the country's northeast: New York has logged around 390,000, for example. Arizona's per-capita number of cases is also low, compared to some areas. But it’s the rapid explosion of the state’s outbreak that has observers worried.
Arizona is among the states experiencing the most severe resurgence of COVID-19, along with Florida, California, and Texas, according to the Biodesign Institute. And while Arizona has logged a relatively low number of COVID-19 deaths so far — just under 1,500 people so far — that could change as cases continue to increase and hospitalized patients start to die, experts argue.
Arizona rode out the first few months of the pandemic with a fairly minimal cases, but the situation changed dramatically after Governor Doug Ducey lifted his stay-home order on May 15.
“The state of Arizona is headed currently in the wrong direction,” said Joshua LaBaer, the institute's executive director, at a press briefing on June 24. “Our numbers are rising and they’re rising day over day. We’re on an exponential curve which means things can go even faster.”
"The rate that Arizona is trending right now is similar to what New York had when it was accelerating in its growth,” he added. “Day over day increases are going up very quickly in Arizona. That’s an area of concern. We really need to turn that trend around.”
Health Care System Under Pressure
The surge is already straining the state’s healthcare system. The number of emergency beds, Intensive Care Unit (ICU) beds, and regular hospital beds occupied by COVID-19 patients has been steadily increasing over the month of June, according to estimates from the Biodesign Institute. (As of June 24, 88 percent of ICU beds in the state were occupied by a combination of COVID-19 patients and other hospitalized people.)
While Ducey and state officials have repeatedly stressed in the past that hospitals in Arizona have enough beds to deal with COVID-19 patients, epidemiological modeling suggests that, as cases grow exponentially and hospitalizations increase, hospitals will have few to no available beds in July.
“In the next few weeks, we may start to approach capacity,” LaBaer said, referring to ICU beds. “We know the number of [cases] are doubling every nine days. If that nine-day thing continues, it won’t take much for us to fill up those beds.”
On the frontlines in local hospitals, the data is borne out anecdotally.
Juan Morales, a critical care doctor at Sun City's Banner Boswell Medical Center, told Phoenix New Times Sunday that the number of COVID-19 patients in his ICU daily had nearly tripled in the last three weeks, from an average of five to around 15 to 20.
Additionally, the data on hospital capacity don’t necessarily reflect the realities in individual hospitals. Morales said that his ICU has been at 80 percent or more for a week, and he'd heard of other Banner facilities that were at capacity.
A Banner spokesperson told New Times on Monday that its hospitals had sufficient capacity to handle COVID-19 and non-COVID-19 patients.
Hospitals are tight-lipped about their bed numbers. Maricopa County hospital chains declined to offer numbers on their occupancy. County officials referred inquiries to the state, which collects that data from hospitals. A state Department of Health Services spokesperson declined to offer any data specific to Maricopa County.
HonorHealth and Dignity Health told New Times at the beginning of this week that they were seeing a spike, but had sufficient capacity and were continuing elective surgeries — a sign that the hospitals are both seemingly confident about their bed capacity and want to maintain revenue from elective surgeries. However, Phoenix NBC affiliate 12 News reported today that Dignity was suspending new elective surgeries for a week at two Phoenix hospitals.
Hospitalized COVID-19 patients aren’t quickly being discharged from Arizona hospitals either. Morales, the ICU doctor, said that while most patients leave intensive monitoring after around three to five days, he’s seen COVID-19 patients stay for up to two weeks without their condition improving.
Medical Staff Shortage
Then there’s the question of staffing hospital beds — a factor that’s overlooked in the talking points pushed out by state officials about Arizona hospitals’ capacity to deal with a surge in COVID-19 patients.
Morales told New Times the biggest issue they're dealing with is a staffing shortage. Under normal conditions, seeing more than 15 patients in a day is difficult for a doctor. This past weekend, he came in on his day off to assist a colleague dealing with over 25 patients. Additionally, ICU nurses are having to monitor three or four patients instead of the usual one or two, he said.
“We're stretched right now,” he said. “We're definitely stretching our human resources.”
A Banner spokesperson acknowledged that the spike in COVID-19 patients was causing staffing challenges. She said they were hiring more medical personnel, including some who had previously retired, as well as training more nurses in ICU care and bringing in nurses from out of state.
A Dignity Health spokesperson said that they are offering pay incentives to take shifts. One nursing assistant with Banner in Phoenix, who asked to remain anonymous to protect her job, said last week that nurses there were also receiving similar offers.
But additional compensation may not be enough to patch over staffing shortages. The nursing assistant said that she knew people who are not taking shifts, in spite of cash bonuses offered, because they were worried about contracting COVID-19 or transmitting it to their families.
“We’re tired,” she said. “We’re exhausted.”
She tested positive for COVID-19 — she believes she got it from her health care work — and said she's worried that as the amount of space taken up by COVID-19 patients expands, there won't be enough people to take care of them.
"It's increasing day-by-day and we're getting really nervous," she said.
Morales said that for now, they’re managing. But, if exponential growth in Arizona’s COVID-19 cases continue, the quality of care will suffer — and the number of patients who pass away could increase as a result.
Public Still Lax on Measures
While Governor Ducey recently opted to allow cities and counties to adopt mask requirements in response to the escalating COVID-19 threat, many people can still be seen around town hanging out in groups, often without masks, in bars, nightclubs, and restaurants.
“Even this last weekend, there were young people out and about at restaurants, engaging in activities as normal,” LaBaer said. “That’s certainly going to help spread the virus.”
Ali Mokdad, a professor with the University of Washington’s Institute of Health Metrics and Evaluation, said that with social distancing relaxed, it was easy for young people to get a false sense of security, especially because they may be asymptomatic carriers and not realize they know someone who has it.
"The virus hasn't changed. The way the virus passes from one to another hasn't changed. Our behavior has changed," Mokdad said.
He called relaxing social distancing measures premature as he said the state needs to be preserving its capacity for the spike in cases expected in the fall that will coincide with flu season. He said mandatory social distancing measures should have been ramped back up when hospital usage hit 80 percent.
Purnima Madhivanan, an associate professor at the University of Arizona’s Mel & Enid Zuckerman College of Public Health, criticized Arizona’s response to the COVID-19 outbreak — particularly when it comes to messaging on mask-wearing and physical distancing.
“We are repeating the same problems we had at the beginning of this epidemic,” she told New Times. “If we have to control the epidemic, anybody who has worked with infectious diseases will tell you that you need to have complete, consistent, control measures to be put in place. And here, when you mandate masks for some but not for others, for some situations but not for the other situations.”
Madihvanan laid some of the blame at Ducey’s feet for deferring to local public health departments on mask-wearing requirements.
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“We have to be preparing our communities, we have to be giving consistent, clear messages at all times. And it has to come from up above. It cannot be up to the communities and up to the local departments to manage it, it has to come from the top,” she said. “He can do a better job.”
Public health experts argue that more testing, contact tracing, and stringent physical distancing, hand-washing and mask-wearing behavior by the general public is needed to slow the outbreak.
“Arizona is going to have to be ready for a dramatic spike in COVID cases unless there is a more serious effort taken to control this and that should be done right now,” Madhivanan said.
UPDATE: This story was updated to include information about Ducey's press conference today.