Ducey at Odds With White House Task Force, Medical Leaders on COVID-19 Policy

Governor Doug Ducey.
Governor Doug Ducey.
During the course of the COVID-19 pandemic, Governor Doug Ducey has repeatedly pointed to the White House Coronavirus Task Force as his gold standard for advice on how to respond to the coronavirus outbreak in Arizona.

He recently reiterated this view at a December 2 press briefing, stating "I focus on what the White House Coronavirus Task Force says."

He went on to note some of the task force's members, like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr. Deborah Birx, the White House's coronavirus response coordinator. Ducey also noted that he gets the "best recommendation" from Dr. Cara Christ, director of the Arizona Department of Health Services.

But Ducey is seemingly at odds with the White House Coronavirus Task Force when it comes to his own policy response to the current surge in COVID-19 cases and hospitalizations in Arizona.

In a report issued by the task force on November 29 containing state-by-state assessments and recommendations, the task force had a dire message when it comes to Arizona's situation and urged further mitigation measures be implemented. Arizona Mirror first reported on the document last week.

"Arizona is experiencing a full resurgence equal to the summer surge but without the needed aggressive mitigation across the state," the report reads.

Additionally, the report states, “New hospital admissions in Arizona are rapidly increasing and mitigation must be increased.”

"Arizona is experiencing a full resurgence equal to the summer surge but without the needed aggressive mitigation across the state." - White House Coronavirus Task Force

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The task force made no specific mention of targeted lockdowns or business closures, akin to what Ducey implemented back in June when he temporarily shut down bars and gyms in an effort to stem the summer COVID-19 surge. But it did call for a "significant reduction" in "public and private indoor spaces, including bars and restaurants."

"The silent community spread that precedes and continues to drive these surges can only be identified and interrupted through proactive, focused testing for both the identification of asymptomatic and pre-symptomatic individuals," the report reads. "This must be combined with significant behavior change of all Americans. Ensure masks at all times in public; increase physical distancing through significant reduction in public and private indoor spaces, including bars and restaurants; and ensure every American understands the clear risks of ANY family or friend interactions outside of their immediate household indoors without masks."

Now, just a few weeks into December, Arizona is witnessing record-breaking numbers of new COVID-19 cases reported every day, and the highest virus transmission rate in the nation, according to some metrics. Local public health experts have called for more drastic action, too. In a letter issued last week, chief medical officers at Arizona hospitals called for a ban on indoor dining and group gatherings larger than 25 people, and a 10 p.m. curfew, among other policy measures.

But Ducey has so far refrained from implementing any targeted lockdowns or more significant mitigation measures. Earlier this month, he issued an executive order allowing restaurants to expand seating on sidewalks and other public right-of-ways, as well as $60 million in funding to help staff local hospitals.

"I’m listening. I hear those requests. I hear the very loud calls from folks yelling 'lock down' and I just don’t think it’s the right policy," Ducey said at the December 2 briefing. "When you say the word 'lock down' you’re talking about shutting down entire industries, closing classrooms, bankrupting small businesses, you’re talking about putting hundreds of thousands of people out of work... I don’t think it would slow the spread."

click to enlarge CJ Karamargin - TWITTER
CJ Karamargin
In response to an earlier question from a reporter about whether more mitigation steps were needed, Ducey said that Arizona is "in for a tough several weeks" and that his administration is going to "keep talking about the mitigation steps that work [and] how we got out of the challenge that we were in in late June and early July." The statement seemingly ignored the fact that Ducey implemented a temporary shutdown of certain industries during the summer surge.

C.J. Karamargin, Ducey's new communications director, blamed the winter COVID-19 surge in Arizona on indoor gatherings of family and friends. He cited warnings from public health experts, including national figures like Dr. Fauci, that the holiday family gatherings would drive a surge in COVID-19 cases in the United States. Recent modeling produced by researchers at the University of Arizona also predicted that hundreds would die in the state due to holiday-related travel.

"Most of the spread that we’re seeing is not traced to businesses or restaurants, it’s a result of small gatherings, family and friends — what happened not too long ago with Halloween and Thanksgiving," he said. "There’s no closure that is going to fix that. This is an issue of human behavior."

When asked whether Ducey is out of step with the White House Coronavirus Task Force given its calls for "increased" mitigation, Karamargin said, "No, not at all. We are working closely with the task force, we’re in constant communication with the task force."

"He [Ducey] keeps saying that he’s in coordination with the White House Coronavirus Task Force but that’s inconsistent with his actions," said Will Humble, executive director of the Arizona Public Health Association and a former state DHS director.

Humble also disputed the notion that small indoor gatherings are the primary driver of the COVID-19 surge in Arizona. He pointed to a study recently published in Nature (a weekly science journal) that found that restaurants are among the small number of locations causing the bulk of COVID-19 infections. Another study, published last month in the Journal of Korean Medical Science, found that the coronavirus can travel faster indoors and infect people quicker than previously believed — findings that would make settings like indoor dining more risky for virus transmission.

"If you look at the literature, it tells you where the dominant spread happens. It’s in restaurants and bars," Humble said. "Is there intra-family spread? Absolutely. If you were to have a large Thanksgiving gathering is there an increased chance of indoor spread? Of course. It’s not one or the other, it’s both. Where you have regulatory control, which is bars, restaurants, and night clubs, you should maximize that. There’s no regulatory control over families."

When asked for specific data informing the governor's assertion that restaurants are not a major sources of COVID-19 transmission, Karamargin referred New Times to the Arizona Department of Health Services.

"We’re relying on Dr. Christ’s expertise here as well as others," he said. "The data, the information you’re looking for may well exist. We don’t have it here."

Steve Elliot, a spokesperson for the Department of Health Services, wrote in an email that the agency has "600 people working on contact tracing" and that "transmission at small household gatherings is a clear and worrying trend, hence our repeated warnings and entreaties of late." He also cited new data released by state officials in New York showing that private indoor gatherings are driving the COVID-19 spike. Notably, on December 11, New York Governor Andrew Cuomo announced a new ban on indoor dining to slow virus transmission in the state.

Elliot wrote that their data from contact tracers "doesn't currently allow for an analysis like New York state's" when New Times requested any available data or analysis showing that social gatherings are driving Arizona's case surge. But he defended the notion that transmission stemming from small household gatherings are a major factor in the current crisis.

Will Humble
University of Arizona
"Our epidemiologists see a clear and significant trend in small social and household gatherings where people don't follow the precautions they are required to take at businesses covered by the executive order," he wrote.
"The example is someone who has to mask up and distance to pick up takeout then dropping precautions after taking the food home to share with people not from their household."

Karamargin also cited a recent statement from Dr. Christ, who attended a December 11 media briefing. A reporter asked her how she's certain that restaurants are not driving Arizona's COVID-19 surge. Christ responded by detailing ADHS' new contact tracing efforts and stating, "We are identifying some of those smaller household gatherings; we’re identifying sports as a potential source of transmission."

Currently, statewide restrictions on restaurant capacity are technically in effect, which were authorized by an earlier executive order issued by Ducey. For instance, liquor-licensed restaurants, bars and night clubs providing "dine-in services" in counties that have a "moderate" level of transmission can operate at 50 percent capacity, while restaurants in counties that have a "substantial" transmission rate should be closed. But several counties, including Maricopa County, have already crossed into the "substantial" community spread red-zone and restaurants are still operational, according to the Arizona Daily Star.

Karamargin said the state is conducting enforcement efforts and that businesses have a simple "two strikes and you're out" policy for compliance with pandemic-era guidelines. The Department of Health Services operates a phone line and website form for complaints about out-of-compliance businesses. But as the Arizona Republic reported, less than 15 businesses have been issued closure notices for violating the rules.

"Arizona businesses have done an excellent job in following the mitigation requirements," Karamargin said.

Not so, in Humble's estimation: "There’s been 11 enforcement actions by the state among tens of thousands of businesses over the last three months... It’s one thing to say you have requirements in place, it’s another to enforce it."

Even if Ducey had closed in-person dining in restaurants back in November, Arizona would still have experienced a grim December with a "hospital crisis," he said. But it would have gotten the outbreak under control sooner. Now, because of the inaction, the crisis-level spread will drag on, he argued.

"They’re making value judgements," he said. "They’ve decided that bars, restaurants, and night clubs are more important than hospital capacity."