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A couple of weeks ago several news outlets including The Arizona Republic sued the ADHS arguing that they have a duty to disclose the number of COVID-19 cases and the supply and use of PPE in Arizona nursing homes and assisted living centers. The plaintiffs  believe it’s of particular public interest because the majority of deaths in AZ have come from cases in these facilities.

The state has declined to disclose the information because they believe existing communicable disease confidentiality laws and language in ARS 36-783 (E) prevents them from disclosing the info. That exact language says:

… public health authorities shall maintain as confidential any information or a particular part of information provided under this section that, if made public, would divulge the trade secrets of a person or business or; other information likely to cause substantial harm to the person’s or business’ competitive position.

You can see the ADHS’ response to the suit here. Other arguments made by the agency include that disclosing the information will “Have deleterious effects in the community’s trust that the Department can prevent infectious disease.”

Friday the judge deferred to the Department and ruled that they can continue to not disclose which nursing homes and assisted living centers have cases and how many.  However, CMS has suggested that they will be releasing these data in the coming days

Biotech company Moderna put out a press release this week saying that the initial Phase I results for a small study of 45 volunteers found that their experimental vaccine worked and had minor side effects. On the efficacy side of the table, they found that:

“…Dose dependent increases in immunogenicity were seen across the three dose levels, and between prime and boost within the 25 µg and 100 µg dose levels. All participants ages 18-55 (n=15 per cohort) across all three dose levels seroconverted by day 15 after a single dose. At day 43, two weeks following the second dose, at the 25 µg dose level (n=15), levels of binding antibodies were at the levels seen in convalescent sera (blood samples from people who have recovered from COVID-19) tested in the same assay. At day 43, at the 100 µg dose level (n=10), levels of binding antibodies significantly exceeded the levels seen in convalescent sera. Samples are not yet available for remaining participants.”

“At this time, neutralizing antibody data are available only for the first four participants in each of the 25 µg and 100 µg dose level cohorts. Consistent with the binding antibody data, mRNA-1273 vaccination elicited neutralizing antibodies in all eight of these participants, as measured by plaque reduction neutralization (PRNT) assays against live SARS-CoV-2. The levels of neutralizing antibodies at day 43 were at or above levels generally seen in convalescent sera.”

In other words… among the small number of participants (n=12) for which data are available, there was an immune response that may be immunogenic (it works).

So, the DOW stock market index went up 700 points that day because of this news (traders said that’s why it went up at least). Seems like a pretty tenuous reason for such a rally (on an n of 12!).

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UK COVID-19 Vaccine Project Data Shows Efficacy

Six vaccinated macaques and three unvaccinated control macaques were exposed to the virus a month after receiving one dose of the vaccine. The team saw a significantly lower number of viral particles in liquid and fluid taken from the lungs of the animals in the study that had been vaccinated compared with the controls. Here’s more on that “study”

The governor’s Stay at Home Order fully expired a couple of weeks ago. So, what have we learned about how Arizonans and Arizona businesses behaved after this 2-week experiment under the new (largely voluntary) expectations? 

You’ve probably made your own observations in the community.  Many retail stores now have decent mitigation measures in place, but not all.  Many customers are paying attention to the social distancing recommendations including distancing and mask wearing in public.  

But, there are also many examples of large groups of people and businesses that are simply ignoring the expectations in Executive Order 36 (provision number 5) which include establishing and implementing best-practice mitigation measures recommended by the CDC and OSHA etc.  Just check out this short video of the goings on in Old Town Scottsdale last weekend.

So why are some places doing it right while some places (and groups of people) are behaving irresponsibly and jeopardizing the health of all of us?  

In a nutshell, I’d say it’s because there’s a lack of enforcement for the scofflaws.  So, what’s the answer?  How can we get the minority of people and businesses that are ignoring mitigation expectations to step it up and start behaving responsibly?

Actually, it’s pretty simple. City governments have the boots on the ground ability to put local ordinances in place and have the resources and the chain of command to make sure that everybody is playing by the rules.

The problem is that Executive Order 36 (provision 7) prohibits city governments from implementing and enforcing mitigation expectations within their jurisdictions.  A simple move that would make a big difference would be for the governor to eliminate the language that ties the hands of city government from doing anything about the scofflaws.

By the way, cities are great at handling local problems. They have extensive experience breaking up nuisance parties and providing local businesses with expectations in line with their zoning requirements.  They also have resources to responsibly get compliance by using city inspectors and even law enforcement if that becomes necessary.  Why not let them do their job- especially now when the stakes are so high?

Arizona is a super diverse state. Just think about the differences between places like Yuma, Chino Valley, Jerome and Old Town Scottsdale. Super different places, both in terms of the spread of COVID-19 and the kinds of behaviors that result in amplifying the virus. The problem is that right now (because of E.O. 36) we have a one-size fits-all statewide policy for a state that isn’t one size.

We urge the governor to tweak Executive Order 36 and give city governments the opportunity to implement and enforce reasonable measures that would allow them to put the brakes on the kinds of behavior in their communities that are jeopardizing the health of the rest of us.

We’ve all sacrificed too much to let our progress slip away because we’ve locked up the toolbox.

Up until now, the major initiative to increase testing in the community has focused on these Saturday testing events, many of them drive-up type setups. For many weeks now, many stakeholders including ourselves and AARP Arizona have been calling for increased and coordinated diagnostic testing in congregate settings like skilled nursing and assisted living facilities and withing the correctional system.

Looks like the message finally broke through, as the state health department is now prioritizing testing in those settings (although the timelines and pace of the testing effort are still unclear).

Nationwide and in Arizona death counts have been dominated by our fellow Arizonans that live in these kinds of congregate settings. It’s nice to see that testing in these facilities is a newfound priority. Perhaps next week I’ll be able to report some of those findings…  but probably not, because the state health department isn’t disclosing data that comes from those settings.

Perhaps you’ve heard about the lawsuit brought by several media outlets urging the court to force the ADHS to release data that they are receiving under the enhanced surveillance advisory for nursing homes and assisted living centers.

Here’s a link to the Agency’s response to court telling them that they should’t have to disclosure of the number of cases of COVID in the facility or even information about the quantity of PPE available and used by the facilities.

The primary arguments used by the agency include that disclosing PPE availability and use and facility specific case data would

“… be financially detrimental to the facility”; and “… have deleterious effects in the community’s trust that the Department can prevent infectious disease”.

You can read their full argument here. 

It’s easy to see why organizations like AARP Arizona and many Arizonans are interested in being able to see that information. After all, the majority of deaths that have occurred have been in assisted living and skilled nursing facilities.

In addition, Arizona remains dead last in testing and has been prioritizing drive through Saturday testing events over more refined and targeted testing among residents and staff in congregate settings where the majority of deaths have been occurring.

Hopefully we’ll soon see what Arizona law really says about disclosing information about PPE and case counts in these settings and how much discretion the ADHS Director really has in making that decision.

Note: HHS is distributing $4.9 billion in relief funds to skilled nursing facilities to help them combat the effects of the COVID-19 pandemic. The funding will be used to support nursing homes suffering from significant expenses or lost revenue attributable to COVID-19.