Arizona is slowly reopening, but hospitals in the state continue to see severely ill COVID-19 patients and providers are bracing for another surge.
Not only are health leaders preparing for a continuation of COVID-19 in Arizona and a possible surge of illness in the fall and winter, but they are also preparing for 2021, too.
Unless a vaccine is ready, more COVID-19 illnesses could show up next spring.
“My concern is that people might think that because the state is opening, that the virus has gone away. The virus is still here,” said Dr. Marjorie Bessel, the chief clinical officer for Banner Health, which is the state’s largest health system.
“We have more than 400 people hospitalized right now in our system who are either COVID positive or under suspicion. We have 100 people on ventilators in that same category. … The threat of the pandemic will not substantially go away for some time.”
As of Tuesday, Arizona’s total identified cases rose to 14,566, and its tally of known deaths was 704.
There were 792 people hospitalized for suspected or confirmed COVID-19 statewide and that number has not been going down.
Twice last week the number of hospitalizations in Arizona broke the 800 mark — the highest number since the state began publicly reporting hospitalizations April 9.
Some epidemiologists say the heat of summer could slow, though not stop the spread of the virus, only to have it come back in the fall.
Some predictions show a protracted first wave of illness, others show a secondary wave.
“There’s a lot of uncertainty about what’s going to happen. We’re not out of this yet,” said Dr. Keith Frey, chief medical officer for Dignity Health in Arizona, which operates six hospitals in the state.
“A worst-case scenario would be we still have a lot of COVID-19 and we next year also have a very bad flu season,” he said. “That can consume some of the same resources.”
As more residents return to normal lives, there could be a spike in hospitalizations in a month or two “if safe behaviors aren’t practiced,” says an op-ed signed this week by the chief medical officers for eight major hospital systems in Arizona.
“There will be a rise in cases because of relaxed social distancing,” said Felicia Goodrum, a virologist in the Department of Immunobiology at the University of Arizona. “It’s going to be interesting to see how the state responds to seeing that spike.”
Here’s what we know about a so-called “second wave” of COVID-19 in Arizona.
Plans call for a statewide COVID-19 hospital surge system to remain in effect for a year.
Arizona has a statewide surge line that aims to evenly distribute ill COVID-19 patients to hospitals across the state so that no single entity is overwhelmed and to ensure that equipment such as ventilators and intensive care beds are available to those who need them.
That means rival hospitals and hospital systems across the state that normally compete against one another are sharing patients.
The surge line has been in place since April 21, and has been funded for a year, said Frey who worked on developing the system with the state and other Arizona health leaders.
“This is going to run for weeks or months to get through this particular seasonal version of (COVID-19),” Frey said. “Depending on the timing and distribution of a vaccine sometime in 2021, we could have yet another round of this next winter and spring.”
It’s possible the surge line will go dormant for a period and reactivate if cases wane, he said.
A second wave of illness could coincide with flu season
A season of COVID-19 and flu could be “horrible,” the UA’s Goodrum said.
“They are two really bad respiratory pathogens,” she said. “Regular flu season killed about 0.1% of people infected and COVID is killing at least .2%, so about twice that. So it’s like a severe flu. Of course, we have no immunity to COVID. We don’t even have ready antivirals. … With COVID, there’s so much we don’t know, still.”
An influx of patients ill with flu and respiratory syncytial virus, typical during late fall and winter months, could come at the same time hospitals are treating a second wave of patients ill with COVID-19, the illness caused by the SARS-CoV-2 virus, Banner Health’s Bessel said.
“One of the things that’s of course on our radar screen now is the fall/winter season,” she said.
If the second wave of illness were to come with COVID and create a “surge on top of a surge” during flu season, it would be a huge stress on the health care system.
One of the ways to prevent that scenario is encouraging the public to get their flu shots early, Bessel said.
Banner Health is working with the Arizona Department of Health Services on the messaging, which Bessel hopes will be broad and consistent, she said.
“Sometimes people don’t always think about flu season until later, sometimes they put off getting their vaccine,” she said. “We’re going to be doing a big, early push on getting your influenza vaccine done.”
‘A balancing act as we reopen the state’
Predicting a second wave is guesswork because much of it will depend on human behavior. But careful social distancing does not necessarily mean shutting down the economy.
Many health care experts say there’s a need to balance health care strife with economic strife because a financial downturn can lead to bad health outcomes that go beyond the toll of COVID-19.
“People lose their jobs, they lose their health insurance and that absolutely has a negative effect on their health and therefore the health of our communities,” Bessel said. “It is a balancing act as we reopen the state.”
At the same time, it’s important that people maintain measures like physical distancing, frequent hand-washing, staying home when they are sick and wearing a mask, experts say. For how long? No one knows. But for now, it’s what Arizonans should be doing, said Dr. Tara Ostrom, associate medical director for OptumCare Primary Care in Arizona.
“Wearing of masks is a show of compassion for each other and to protect people whose health may not be as good as your own,” she said. “Not everybody is comfortable with doing that but it is an act of compassion toward senior citizens, toward that patient with cerebral palsy … .”
There’s no way to know whether any of us might be infected yet not showing symptoms. That’s why we need to protect others, Ostrom said.
“In Arizona, we have increasing cases. Overall we don’t have a cure and we don’t have a vaccine,” she said. “It’s not going to be good if no one is wearing cloth masks, if large crowds are getting together, if there is no social distancing. … A significant uptick of cases would be expected.”
Moving forward, it’s not just Arizonans who need to continue following safe hygiene practices, including social distancing, the UA’s Goodrum said.
“This patchwork we have of states doing their own thing is going to work as long as people aren’t traveling and, of course, that is not going to continue for all that much longer,” she said.
“What happens when people begin traveling between states and worse, internationally? That’s going to be interesting what happens then. That’s why we need a federal response and we really don’t have it.”
Arizona still isn’t doing enough testing
The U.S. as a whole has been behind many other countries in its level of testing and Arizona remains behind the national testing level — 3.61% of Americans had been tested as of Tuesday, according to the National Association of County and City Health Officials. In Arizona 2.3% of the population has been tested, the association’s data showed.
The Kaiser Family Foundation as of Tuesday placed Arizona 49th out of 50 states, the District of Columbia and Puerto Rico for its number of tests per 1,000 population. Arizona’s number is 21.5. The national average is 36.1 with Rhode Island leading the list at 108.9.
“The problem is we still aren’t doing enough testing to really address this in the way that we would typically address this type of public health crisis, which would be a lot of testing and contact tracing,” the UA’s Goodrum said.
“Without that, we don’t have data. … In order to re-enter our normal life, you’d want to see a sustained drop in cases for two weeks. And that has not happened,”
A vaccine or effective treatment will be a turning point to prevent future waves
A vaccine or significant treatment will change the trajectory of COVID-19, but we aren’t there yet, Bessel said.
“We are not going to be there for many months to come,” she said. “We may see a decrease in total cases as we go into summer. Perhaps with it being hot out and with Arizonans doing the right things, we can certainly try and reduce the burden of the virus.”
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