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CDC has released guidance to support the needs of people with disabilities during the pandemic, including resources for direct service providers, group homes for individuals with disabilities,people with developmental and behavioral disorders, as well as additional information for direct service providers, caregivers, parents, and people with developmental and behavioral disorders.

Arizona State University has a PPE Response Network for supply chain leaders at hospitals and clinics to discuss best practices, share information on vendors and local manufacturers, and better understand and address evolving clinical shortages in PPE, testing supplies, and other equipment due to COVID-19.

As part of this effort, ASU has also been working closely with supply chain and leaders and clinicians to rapidly design, prototype, 3-D print, and test innovative solutions on an ad-hoc basis (e.g., UV and H202 sterilization chambers and intubation boxes). 

• Learn more about the PPE Response Network here: https://asunow.asu.edu/20200416-arizona-impact-luminosity-lab-3d-printing-health-care-ppe

• Enroll and submit requests for PPE and other supplies here: https://pperesponsenetwork.asu.edu/  

• Watch this video to guide you through the enrollment process: https://vimeo.com/408869037)

All the county health departments are ramping up their contact tracing capabilities. This week I’ll focus on what Maricopa County has been doing. They have a 2 pronged approach- staffing up internally and contracting with AZ 211 for extra help.  Here’s a previous blog post on the what contact tracing entails. 

Maricopa has 52 new people who now work in their Epidemiology program to support the contact tracing investigations teams. There are an additional 27 folks in the hiring process.  Every week, new investigators begin training and become independent. Once training is complete, all investigators go full force into interviewing cases, which includes identifying every close contact while they were infectious. The detailed contact tracing is handled by Maricopa County staff while following up with close contacts is handled by the team at AZ 211, who are hiring an additional 50 tracers.  

The folks who work for AZ 211 don’t require as much training because they don’t perform an extensive investigation requiring medical knowledge nor do they have confidential information related to cases. They provide the contacts with standardized information about what symptoms to watch for, what to do if they get symptoms and how to avoid spreading disease to others.  They also answer any questions the contact has and determine if additional services are needed. 

Maricopa is also implementing a plan to load case and contact information into a secure automated system which will monitor contacts for symptoms and alert staff.  That system (when it comes on-line) will also inform cases when they no longer require isolation.

When the automated system is implemented it’ll take a big workload off both the investigators and contact tracers, who can then focus on enhanced tracing.

Once the remaining new 27 in-house, Maricopa county employees are trained, they’ll have 76 new investigator team members interviewing cases and contacts 7 days per week. At this staffing level, they’ll be able to interview roughly 500 cases per day with the goal of completing the interview within 24 hours of receipt.

Editorial Note: Effective contact tracing requires robust testing in the community as well as fast turn around times from the laboratories. If the labs fall behind (as I have anecdotally heard) case data gets to the investigators after the horse has already left the barn and the case investigations and contact tracing efforts are a lot less effective. Lab turn-around time matters!

This week’s journal article addresses the question whether outdoor environments are as bad as indoor environments for spreading the virus. An important question given the outdoor protesting that has been going on- as well as the prolific indoor clubbing that happens in AZ.  

The study below found that indoor SARS CoV2 transmission in indoor environments is 19 times greater than outdoor environments. 

Closed Environments Facilitate Secondary Transmission of Coronavirus Disease

https://doi.org/10.1101/2020.02.28.20029272 

Dr. Gerald updated his modeling analysis today with some concerning (but not surprising) results, given the run-up in all of the dashboard indicators in the last 10 days.. One such conclusion in today’s report is that “… current trends in hospitalizations suggest excess capacity could be depleted by July.”

Hopefully executive branch officials will carefully read the report and implement interventions while there’s still time (see previous blog post). Below are some excerpts from today’s analysis.

Increasing hospital utilization strongly suggests that increasing case counts are attributable to increases in community transmission. If current trends are sustained, excess capacity could be exhausted by July. Banner Health recently reported some of its Maricopa ICUs were already at or near capacity. Because interventions take weeks to take effect, immediate action is needed to avoid exceeding our hospitals’ capacity to provide care.

It is worth revisiting the work of the Arizona State University Covid-19 modeling group (see their preprint). Using an SEIR epidemiological model, they examined various scenarios of physical distancing policies including a comparison of a May 15 (early) versus June 1 (late) re-opening (Figure 10). Dividing their daily estimate of new cases by 4X to derive PCR confirmed cases, they estimated that by the time of this update Arizona would see roughly 1500 confirmed cases per day versus about 7500 per day with early reopening which is roughly tracking current conditions. More worrisome is the future trajectory showing even faster growth without action.

Covid-related hospital utilization continues to increase with excess capacity declining from approximately 30% to <15% over the past two months. While adequate capacity exists, current trends in hospitalizations suggest excess capacity could be depleted by July.

We have good evidence that the Stay at Home Order had been effective at slowing the spread of the SARS CoV2 virus. In each county you’ll see that there had been a slow decline in the ratio of new cases over total cases up until May 26. In pretty much every county that ratio rebounds starting on May 26 and continues today.

The sizable increase in cases, percent positives, ratio of new to total cases, and COVID hospital census in the last 10 days coincides with a week’s incubation period with some time for lab testing since the end of the Stay at Home Order. 

There’s still a little room to spare within most hospitals, but the safety margin continues to decrease. Some hospitals are very close to their ICU bed capacity right now. It’ll continue to be very important to keep an eye on the capacity. When the warning bells go off there won’t be much time to make policy adjustments to increase capacity.

In my opinion there are 5 key interventions that, if implemented immediately, could stem the tide of new cases and hospitalizations:

1. More focus on testing and infection control in assisted living and skilled nursing;

2. Enhance contact tracing;

3. Allow cities to implement mitigation strategies;

4. Require wearing cloth masks in public; and

5. Stronger compliance incentives.

Failing to do the above effectively could result in either a need to implement the hospital surge capacity plan, another Stay at Home Order, or both. 

Note: Saturday night the ADHS changed the way that they calculate available hospital capacity on Hospital Bed and Availability dashboard. Their former approach added theoretical surge beds to both the numerator and denominator (available beds and occupied beds). That approach provided an inaccurate view of what’s really available. The new approach is a better way to portray the data. 

You can see a host of data including several interesting charts on the ASU Biodesign site. There’s more background info in this Horizon clip too.

This week’s journal article addresses the question whether outdoor environments are as bad as indoor environments for spreading the virus. An important question given the outdoor protesting that has been going on- as well as the prolific indoor clubbing that happens in AZ.  

The study below found that indoor SARS CoV2 transmission in indoor environments is 19 times greater than outdoor environments. 

Closed Environments Facilitate Secondary Transmission of Coronavirus Disease

https://doi.org/10.1101/2020.02.28.20029272