Did Arizona reopen too soon?
The data that Gov. Doug Ducey says drive his coronavirus decisions are heading in the wrong direction.
Three weeks after the statewide stay-at-home order was phased out:
- Cases soaring: Arizona has one of the fastest-growing coronavirus caseloads in the country, up almost 70 percent since the order expired. The state was among the top 3 nationally with the most significant spikes
- 'Positive rate' climbing: The “positive rate” - the percentage of tests that confirm COVID-19 - has jumped since the end of the stay-at-home order, a sign the state isn’t controlling the infection’s spread. Ducey had pointed to a declining positive rate in late April and early May as evidence the state was meeting White House guidelines for ending the stay-at-home order.
- Infection spreading: The Public Health Department in Maricopa County, the state's largest county, acknowledged Thursday that confirmed coronavirus cases are "steadily increasing... because there is increased spread in the community."
- Hospitals filling up: Use of hospital beds and ventilators hit new highs this week, pointing to a potential strain on state resources. Almost nine of every 10 inpatient beds statewide are being used, according the Arizona Department of Health Services. But COVID patients account for just one in every 10 patients. Ducey and Health Services Director Dr. Cara Christ maintain the state’s hospitals are prepared for a coronavirus surge.
“The stay-at-home order and the behavior that resulted from the ... order was working,” said Will Humble, a former state health director who is now executive director of the Arizona Public Health Association.
The latest data, Humble said, show a rebound around Memorial Day weekend.
“That really coincides with exposures that happened right after the end of the stay-at-home order,” he said. “There’s no doubt about it.”
The surge in positive cases and hospitalizations confirms projections by an Arizona State University research team three weeks ago.
The team’s modeling was designed to help guide the governor’s decision-making when the state reopened.
Their advice for the governor back in May: “Watching closely and acting quickly if you see a bad trend,” said Joshua La Baer, executive director of ASU’s Biodesign Institute.
The institute has developed its own COVID-19 dashboard that shows a dip in positive cases during the order and then a spike after it ended.
A Ducey spokesman rejected the idea that the governor might ratchet back the reopening.
“No, he’s not,” communications director Patrick Ptak said via email.
“Throughout this pandemic, our actions have been guided by the recommendations of public health experts and the gating criteria set forth by the CDC, and that will continue to be the case.”
“As we continue to increase testing and slowly phase in reopening, we expect to see continued cases of COVID-19. We know our hospitals are well equipped and have the capacity to ensure anyone who needs health care has to access it.”
Testing Rate Flunks Guidelines
The governor’s stay-at-home order took effect on March 31. Beginning the week of May 4, Ducey allowed businesses to slowly reopen. The order expired on May 15.
At his updates on how the state is handling the coronavirus, Ducey presents the White House’s reopening criteria as his benchmarks.
The state is now failing to meet both criteria for showing declines in coronavirus cases:
- 14 days of declining positive coronavirus tests.
- 14 days of declining positive tests as a percentage of total tests done.
Only one of the two must be met.
Arizona has consistently failed to meet the first criteria. In recent days, the number of positive tests has soared.
But the governor has checked off the second criteria - a declining positive rate.
Arizona Department of Health Services data appeared to support that conclusion for a brief period.
The weekly percentage rate of positive tests rose for two weeks after the stay-at-home order, then fell from mid-April to early May. It bottomed out at about 5 percent.
In the weeks since the reopening, the trend has reversed: The rate of positive coronavirus tests has more than doubled in three weeks.
This week, 11.5 percent of all reported coronavirus tests on Monday were positive. On Tuesday, 14.5 percent were positive.
Ducey’s spokesman dismissed the conclusion that he state was falling short on the reopening guidelines.
“The guidance is clear: A 14-day trend with built-in flexibility for states,” Ptak said. “Arizona met the gating criteria to be in Phase one and we remain in Phase One.”
DHS spokeswoman Holly Poynter provided this response to the data:
“As we continue to increase testing and slowly phase in reopening, we expect to see continued cases of COVID-19.”
In a May 26 blog post, DHS director Christ said a federal model for Arizona dated May 7 "predicts, even with the mitigation strategies lifted, that our current resources, including inpatient beds, ICU beds, and ventilators, are sufficient to meet a healthcare surge due to COVID-19."
How high is the rebound?
Just how high COVID cases might rebound isn’t clear.
Humble says infections contracted over the Memorial Day weekend probably haven’t been reported yet, given an incubation period that can last two weeks.
“We’re going to start to see those cases from those infections here in the next couple of days,” he said.
Humble said the hospitalization trend indicates patients are "entering faster than they're leaving." In other words, hospital stays are longer, perhaps because patients are being kept on ventilators for longer periods.
One of the great unknowns is whether the virus can survive our hot, dry desert.
“We’re the experiment for that,” he said. “There’s just no data to show what really high temperatures and really low humidity might do to this virus.”
Humble, who served as state health director under Gov. Jan Brewer from 2009 to 2015, said it was up to the officials elected by voters, not the public health experts, to decide how to respond to a rebound in COVID cases.
"Real decisions should be made by the people we voted for. These are not easy calls," he said.
“Is it such a rebound that you would want to go back to another stay-at-home order?”