Judge Rules ADHS Can Withhold  Care Home Case Data

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 Says they had Encouraging Phase I Vaccine Safety Results (n=45)

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”

It’s Time for the Governor to Unlock City Government’s COVID-19 Toolbox

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.

Dr. Gerald’s Latest COVID Model Analysis

Dr. Joe Gerald did a new COVID model run analysis this week. Lots of interesting new graphs. You can check out the full 8 page report here. Below is his summary of the analysis for this week:

Now that social distancing restrictions have been lifted, a greater frequency and intensity of human interactions will tend to facilitate viral spread. If this scenario is realized, increases in newly reported cases, hospitalizations, and ICU utilization would be detectable by early June.

o Absolute levels of community-driven viral transmission remain high as evidenced by substantial numbers of newly reported cases.

o For many locales, social distancing restrictions are likely needed to prevent reported cases, hospitalizations, and ICU utilization from increasing. o Hospital utilization has slowly increased over the past 4 – 6 weeks for COVID and non-COVID related care with excess capacity declining from approximately 30% to 15%. While adequate capacity exists to care for some increase in severely ill patients, additional viral spread will narrow that safety margin.

COVID-19 testing capacity (PCR and serology) has meaningfully increased over the past several weeks; however, the PCR test positive rate remains above 3% indicating capacity is not adequate to meet clinical and public health demands. This 3% target reflects testing practices in countries that had a more robust public health response and were more effective in controlling viral spread.

Several important changes have occurred in the past week that still make it difficult to assess the underlying trends in viral transmission. First, testing capacity has expanded identifying milder disease that would have previously remained undiagnosed. Second, ADHS added COVID-relevant causes of death from death certificates to the case definition of COVID deaths. Lastly, Arizona’s “stay-at-home” order expired May 15 likely increasing social interactions with the potential to transmit infection.

Is Congregate Setting Testing Ramping Up?

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.

Remembering Pete Wertheim

Arizona, AzPHA, and so many of us lost a good friend and mentor this week. Pete Wertheim passed away yesterday after courageously facing brain cancer. We will all miss Pete, his smile, sense of humor, his easy way, and his dedication to good solid public policy.

Pete was a long-time sustaining member of AzPHA, served on the Board of Directors and as Board President in 2011. Pete worked really hard to improve AzPHA’s business and other processes – working closely with AzPHA Executive Director Jennifer Bonnet to build us into the organization that we are today. Here’s what Jennifer shared about Pete…

“I remember Pete for “how” he accomplished rather than “what.” He worked with such warmth and humor that everyone felt welcome and engaged around him. We worked together on many tough legislative issues, yet,  I am recalling our more casual exchanges at a pub with colleagues after a long day at work.”

Many of you worked with Pete professionally and personally…  and you know that Pete was just so authentic and just such an all around good guy. He was committed to good public policy and transparency and was always on the lookout to set policy that would work effectively in the long run. He called things out when he saw things that were sneaky, inefficient, or just plain wacky. He knew and taught us that the devil was in the details.

I got to know Pete really well when he was the Chief Legislative Liaison for the ADHS during the time when Susan Gerard was the Director. Pete was just so good at tracking all the bills and always keeping us informed. He taught us to dive into the details of bills to figure out what effect they might have on the people.

Pete and Susan worked hard to get the financing needed to build a new Forensic Unit at the Arizona State Hospital.  His work paid off in 2008 when the agency was able to get funding for the new facility just before the recession. The former ASH Wick Units were many decades old (built in the early 60s) and were just inconsistent with providing a safe and therapeutic environment.

It was challenging getting 10’s of millions of dollars from the legislature for a new forensic unit, but Pete didn’t give up- he just worked so hard to get that important facility funded. What did it was the way he could connect with legislators that made it happen.

Barb Fanning, a good friend of Pete and co-worker during his time at the ADHS put it this way… 

Pete was one of the most genuine people I have ever known. He loved his work and had an unrivaled work ethic. He also brought a refreshing sincerity to all of his relationships, both personal and professional – everyone who knew Pete adored him. The healthcare industry in Arizona is better because of him, but the people who work in it are missing a great advocate and a dear friend.”

Most recently Pete served for several years as the Executive Director for the Arizona Osteopathic Medical Association. Before that, he worked for a year as the Communication and Public Affairs chief for the City of Prescott. He started that job practically the same week as the devastating Yarnell fire.

His career also included working as the VP for Communications and the Arizona Hospital and Healthcare Association. His early career was as a Legislative Research Analyst and Policy Advisor for the Arizona House of Representatives. That’s where he really refined his policy chops.

But most of all…  Pete was just a really good person. Always there with an easy smile and an interesting story.  A good friend.  We’ll all miss him.

Lawsuit Urges ADHS to Release Care Home COVID Case Numbers & PPE Availability 

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.

ASU Biodesign Institute Posts Useful COVID Trends Website

You’ll want to bookmark it

The ASU Biodesign Institute team has developed and posted a nifty Critical COVID-19 Trends website. You should bookmark it.

There are so many interesting data trends on the site including: 1) case trends by county; 2) daily positive test trends; 2) the percent of PCR test that are positive by day; 3) the new vs. total cases by county; and 4) the total deaths vs. total cases by county. Most of the data on this ASU site is info that you won’t be able to find on the ADHS Data Dashboard.

The total deaths vs. total cases graph shows you which counties are suffering with more severe outcomes. The percent positive of PCR tests by day shows you the daily trend in percent positives- which is really important because a determining point for moving to the next Phase of opening is the 14-day trend in the number of positive PCR tests divided by the total number of PCR tests done.

For example, the ADHS data dashboard shows the percent positive of the laboratory test results by the week….  but the ASU has them by the day. With all the data lumped into a whole week it’s hard to get a sense of a trend. It’s a lot easier to see whether there is a trend or not with daily data. Accountability and transparency.

There is also a lot of other interesting COVID-related info on the Biodesign home page.

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