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The stay at home orders and other social distancing measures have been working to ‘flatten the curve’ of COVID-19 cases across the country (including in Arizona). But to be honest, ‘stay at home’ type orders aren’t sustainable over the long run because of the collateral damage that these interventions cause in the economy (especially among folks that work in the service sector).

A much more refined tool that has far fewer consequences for the economy is ‘contact tracing’. Over the longer term, case identification and contact tracing is the key to limiting the spread of COVID-19 (until we get a vaccine or reach herd-immunity). In a nutshell, contact tracing involves:

1) Quick and easy testing to identify folks that are infected with an agent (in this case SARS CoV2);

2) Quickly contacting that person and ensuring that they understand that they need to go into Isolation (and coaching them how);

3) Working with the infected person to identify their close contacts over the period in which they were communicable;

4) Finding those contacts and letting them know that they’re at risk for developing the disease; and

5) Helping the contacts to understand that they need to quarantine for a period of time to prevent the spread to others.

It’s a labor intensive process that will require lots of new public health staff, and those folks will need training.

Fortunately, new on-line training is now available. Today, the Association of State and Territorial Health Officials announced they have developed on-demand training for entry-level COVID-19 contact tracers. The course, called Making Contact: A Training for COVID-19 Contact Tracers supports ongoing public health agency efforts to prepare new contact tracers for their work of helping identify COVID-19 positive cases and those with whom they have been in close contact.

Folks that take the initiative and complete the training on their own will be very good candidates to be hired by local public health agencies as contact tracers. Here’s a link to that training! 

The FDA launched its Coronavirus Treatment Acceleration Program last week which aims to move new treatments to patients as soon as possible while also measuring the safety and effectiveness of these programs. Clinical trials on 72 potential therapies are underway.

CDC posted a new website that has a variety of resources for state, tribal, local, and territorial health agencies to help them think through intervention relaxation criteria. Topics include infection prevention and control, laboratory capacity, community mitigation, financial resources, surveillance and data analytics, contact tracing, and communication materials. It includes resources from CDC, other federal agencies, the private sector, academia, and non-profit organizations.

Encouraging Study Results for an Inactivated SARS-CoV-2 Vaccine

Link: Rapid Development of An Inactivated Vaccine for SARS-CoV-2

Researchers in the above study developed a pilot-scale production of a purified inactivated SARS-CoV-2 vaccine. Administration of the vaccine induced SARS-CoV-2-specific neutralizing antibodies in mice, rats and non-human primates.

The antibodies produced in the animals neutralized 10 different SARS-CoV-2 strains. Immunization with two different doses  provided partial or complete protection (in macaques).  Systematic evaluation of the vaccine that it’s safe in macaques.

Early data to be sure, but encouraging. 

The state activated the Arizona Surge Line this week to keep hospitals and regions of Arizona from being overwhelmed by facilitating COVID-19 patient admission, transfer, and discharge to appropriate levels of care. Read the note.

This week one of our members (Scott Turner) discovered an evidence review that makes a decent case for the efficacy of cloth masks in the community. While the evidence review doesn’t have a direct reference to the efficacy of wearing a mask in the community – they do a good job of looking at other aspects that support the policy.

Pay it a visit!

If it has been a few days since you’ve been to the ADHS’ data dashboard– make sure you make a new visit. There’s a lot more data there now including current trends and key healthcare facility metrics including hospital ICU capacity. There’s more detail on demographic data and a new feature looking at COVID-19 rates. One glance at those rates will give you newfound perspective on just how profound the health disparities are up in the northeast corner of the state. 

A shout out to the ADHS team of Laura Erhart, Teresa Jue, Susan Robinson, Wes Korteum, et.al. and the web design team led by Jesse Lewis for laying the data out in a consumable way.

All scenarios show adequate hospital capacity

The ADHS published a modeling report this week that provides state-specific projections of new cases and deaths based on the best available science and Arizona case data. The report produces daily counts for infected individuals, ICU use, and deaths for five different scenarios. 

It provides scenario-based estimates of resource needs for hospital beds, ICU beds, and ventilators but doesn’t include a capacity assessment.  A trip to the new ADHS Dashboard reveals that peak use in all of the AZ model scenarios are well below our existing capacity.

These modeling results build on the growing model results that suggest we are fine with our current hospital capacity.  Here’s Dr.Gerald’s latest model result summary, always a good source of information. Models that are well respected are included in Dr. Gerald’s work include the IHME Model developed by the University of Washington and the University of Texas Modeling Consortium which includes a GPS tool that quantifies the effectiveness of social distancing measures.  

Arizona’s hospitalization data and the predictive models have consistently shown that there is enough hospital bed and ICU capacity overall with a margin of safety (except for a hot spot in the northeast part of the state).  The overall safety margin for hospital capacity and the improving PPE situation means that hospitals should now be able to safely make their own decisions about what procedures to allow. 

Last week the governor declared that elective surgeries can resume if hospitals meet certain criteria starting May 1, 2020. We support this decision. 

This change will be a very good thing for many Arizonans who have been waiting for important procedures that have been canceled and or delayed. There is a common mis-perception that elective procedures are cosmetic procedures. That’s not the case, the vast majority of elective procedures are important surgeries like hip and knee replacements, and some kinds of cancer and cardiac surgeries etc.

Medical facilities can now ask the ADHS permission to proceed with elective procedures if they meet some criteria like:

• Having more than 14 days worth of personal protective equipment for medical staff on hand;

• Maintaining adequate staffing and bed capacity;

• Screening staff, patients and visitors for COVID-19 symptoms;

• Developing discharge plans for patients being transferred to nursing facilities that include COVID-19 testing; and 

• Implementing an “enhanced” cleaning process for waiting areas.

You can read the governor’s announcement here.