By Rich Lowry
Wednesday, June 17, 2020
Arizona is the latest focus of the reopening debate, with
national headlines about the state heading for a COVID disaster.
The state’s positivity rate — the percentage of tests
that are positive — and hospitalizations are up, key metrics that are more
meaningful than simply having more confirmed cases (which can be simply a
function of more testing).
There’s no doubt that there’s increased community spread
in Arizona, a trend that bears watching. But the rush to push the state into
shutting down and deem it a cautionary tale of the perils of reopening is
simplistic at best and skips over details crucial to understanding Arizona’s
true situation.
“We’ve been pretty clear to everyone that we don’t think
Arizona’s immune to COVID-19,” says an Arizona official. “We know that we will
see cases just like we had elsewhere in the country.”
Arizona hasn’t been particularly hard hit by COVID. It
sits between Indiana and Tennessee in total cases, at about 39,000.
On a per capita basis, it’s roughly in the same place as
neighboring states. It has 538 confirmed cases per 100,000, while Colorado has
511, New Mexico has 474, and Utah 470. Colorado and New Mexico have slightly
more deaths per 100,000.
The trend in serious cases in Arizona is up, although not
catastrophically so.
Consider ventilators in use for COVID cases. From May 26
to June 4, the number hovered in the 230s or hit 240.
As of June 15, it was 340, after it had been in the low
300s the previous several days.
On June 15, there were 81 new intubations for respiratory
distress. That’s higher than most days over the past two months, but not the
highest. Some days it’s been in the 90s or, on one day, over 100. On May 8, it
was 97, when a stay-at-home order was still in place.
The usage of ICU beds is also up from where it was a
couple of months ago — about 80 percent usage from 60 percent at the beginning
of April — but not all of that is from COVID. When states were locked down, the
hospitals basically emptied out, but now that people are resuming normal
activities, there are more hospitalizations, as well.
The state is still far away from getting anywhere close
to using all the ventilators it currently has on hand. About 30 percent of its
ventilators are in use.
A June 6 letter from the director of the Arizona
Department of Health Services to the state’s hospitals has been widely
misunderstood. The Arizona Republic ran a headline about the letter,
“State health director tells Arizona hospitals to ‘fully activate’ emergency
plans,” an interpretation that has been repeated elsewhere in the press.
What the director said in the June letter was:
Your facilities and staff are on
the front line of this response and your continued ability to care for your
patients in a safe manner is critical in Arizona’s success in overcoming
COVID-19. For those reasons, I urge you to do or continue doing the following:
Fully activate your facility
emergency plan as directed by Executive Order 2020-16. . . .
A key phrase is “continue doing the following,” because
the letter recapitulated almost exactly a communication from March. In other
words, it wasn’t anything new.
The March 25 letter said:
Your facilities and staff are on
the front line of this response and your continued ability to care for your
patients in a safe manner is critical in Arizona’s success in overcoming
COVID-19. For those reasons, I urge you to do the following:
Activate your facility emergency
plan. . . .
The context here is important. Arizona has been able to
prepare while other parts of the country were hard hit, and learn from the
experience of others.
One of the purposes of its stay-at-home order, stretching
from April 1 to May 15, was to build hospital capacity. The state has a surge
plan in place. If facilities are at any risk of being over-topped, elective
surgeries can be scaled back or canceled again. Arizona has set up a surge line
— an idea borrowed from New York, state officials say — to transfer patients
from any overburdened hospitals to other facilities (such transfers would be
covered by insurance). An idled hospital called St. Luke’s can be brought back
online if necessary, and there are two other alternative care sites in both the
north and south of the state that can be used as well, according to state
officials.
Just the other day, leaders of Arizona’s hospitals put
out a statement: “As representatives of the largest health systems representing
80% of care provided in this state, we would like to assure the public that we
have available bed capacity and surge plans are in place to continue to serve
the people of Arizona. We are well prepared to manage an increase in patient
volume.”
Arizona officials say they have been watching the various
models closely, and have paid particular attention to a FEMA model, which, an
Arizona official notes, “said Arizona’s spike was going to be in June.”
Given that the coasts, and especially the East Coast,
were going to get hit first, it makes sense that Arizona would project to have
a later peak.
The Navajo Nation, which spans three states including
Arizona, has had a major outbreak, although it is trending down.
And there are hot spots in the counties in the south of
the state, where there is an influx of laborers across the border. Santa Cruz
on the border had the highest positivity rate in Arizona over the past week,
according to Arizona officials. The border county of Yuma has also had a high
rate.
None of this is to say that Arizona shouldn’t proceed with all due care, only that many of the headlines don’t convey the entire picture, nor are they intended to.
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