The AzPHA and many faculty and staff from the University of Arizona sent this open letter to the Governor and ADHS Director this week. It provides our evidence-based recommendations for improving the COVID-response in Arizona.

July 28, 2020

Governor Douglas A. Ducey

Office of the Governor

1700 West Washington

Phoenix, Arizona 85007

Dr. Cara Christ

Director, Arizona Department of Health Services

150 N. 18th Avenue

Phoenix, Arizona, 85007

Dear Governor Ducey and Dr. Christ,

Arizona’s COVID-19 cases have grown exponentially, increasing from 400 cases a day in May to 5000 daily cases in July. The use of evidence-based, proven strategies could curb the spread of the virus, allowing businesses and schools to re-open safely and preventing further harm.

On behalf of the researchers and professors at the University of Arizona’s Mel and Enid Zuckerman College of Public Health and the Arizona Public Health Association, we respectfully request an enhanced government response to Arizona’s COVID-19 pandemic that would include the following: 

Address testing shortages and delays

Inadequate test availability and delays in delivering test results make it harder to identify and treat those currently infected.  Currently, test results may not be received for 7-14 days, making it more difficult to isolate infected individuals and track the people they contacted. Test shortages could be addressed, and we could be kept safer by:

  • Committing to achieving laboratory turn-around times of less than 72 hours for 90% of samples and placing this metric on the ADHS COVID dashboard.

  • Dramatically improving testing within assisted living and skilled nursing facilities.

  • Increasing use of antigen testing, which is more rapid and has a higher negative predictive value than the existing PCR and antibody tests in use in our state.

  • Expediting testing for individuals with symptoms and expanding testing for asymptomatic individuals, who may be unaware they are spreading the disease.

  • Allowing for testing without a doctor’s order.

  • Processing tests more efficiently using sample pooling techniques currently under development.

  • Expanding test availability to all communities, mobilizing walk-through testing in communities with limited transportation and renewing targeted “blitz” testing in high prevalence areas.

Expand use of masks

To keep us safe, robust government action is needed to promote mask wearing. Mask wearing also should be required and enforceable statewide, since the failure of individuals to act responsibly ultimately affects us all. Messaging about mask wearing should include education on its proper use (e.g. masks must cover both the nose and mouth, avoid contact with the outside of the mask, and techniques to avoid self-inoculation). Masks should also be made available to those who can least afford it, including those experiencing homelessness.

Develop compliance and enforcement system for CDC mitigation measures

Implementation and compliance with CDC mitigation measures in retail stores, restaurants, bars, and other public places is inconsistent.  We urge you to develop a workable compliance and enforcement system that includes a hotline for community complaints to ensure compliance with CDC mitigation measures. Arizona has a successful model in the Smoke Free Arizona Act.  We urge you to build and implement a similar model to improve mitigation measure compliance.

Curb the spread among those most at risk

This moment makes clear that the health of every person in our state is intertwined. We can’t afford to leave anyone out of efforts to stop the spread of disease.  This includes people in institutional settings that care for older adults or persons with disabilities who are at risk due to their proximity. It also includes those close-quarter settings where farm workers, prisoners, and meat packers work or reside.

Enhance community-level data collection and response

Strategies should be developed to prevent, rapidly identify and swiftly address outbreaks in local communities. For example, to better identify where the virus is spreading, randomized testing could be conducted locally so that communities needing added resources could be identified. Such data and related information should be transparently shared statewide, allowing resources to be better targeted to communities or populations in need. To ensure effective partnership in COVID-19 mitigation efforts with tribes in Arizona, tribal sovereignty must be recognized to protect and promote data rights and interests.

Strategies should also be developed to address emerging the needs of various local communities. For example, community-based teams should be deployed to help local businesses better assess and modify their work environment to minimize infection risk. 

To effectively educate the public about COVID-19 and how we can each play a role is stopping its spread, it is important to engage trusted, local partners using linguistically-appropriate messages and materials.  Culturally-responsive partners such as tribal community health representatives and promotoras can connect with those who are hard to reach.

Increase treatment capacity

Since intensive care units are nearly full currently, elective surgeries should be scaled back to provide hospitals an opportunity to safely serve the community, protect health care personnel, and ensure adequate supply of hospital beds, personal protective equipment (PPE). Additional action is also needed to address continued shortages of PPE and health care workers.

Help people isolate or quarantine

While each of us bears responsibility for stopping the spread of the virus, it is important to recognize that many who become sick may face challenges isolating. This includes those who care for children or elders; individuals lacking or residing in inadequate housing where self-isolation is impossible; those who feel a need to continue to work due to their job or financial situation; and those experiencing mental illness.  Strategies should be developed to ensure everyone has a safe, supportive environment for quarantine, isolation, and recovery. 

Better leverage technology

Technology could play a role in allowing individuals to receive and submit health information. However, limited access to technology and privacy concerns and misperceptions may limit its use.  Existing platforms, such as AZCOVIDTXT, could be expanded and efforts could be made to address privacy concerns and misconceptions. Public-private partnerships could also expand use of technology in addressing public information and information exchange.

Use comprehensive metrics for decisions regarding re-opening our education

Decisions to open K-12 schools and Universities should be data-driven measured, scaled and responsive approaches to resumption of in-person activities. Clear phases should be guided by metrics that include epidemiological indicators of transmission, and public health, testing and medical capacities. Educational institutions should further demonstrate their ability to monitor and respond to adherence to mitigation strategies and changes in internal transmission and broader community impacts of their re-opening. Mitigation strategies should be clear, public and follow public health guidelines. Community health workers could be trained to periodically assess institutional adherence. 

Now is the time for government to act to stop further spread of COVID-19. We’re at a critical juncture, demanding robust government action based on what we know works.


Aimee Sitzler, MSW


Arizona Public Health Association

University of Arizona Faculty and Staff:

Kacey C. Ernst, PhD, MPH

Katherine Ellingson, PhD

Kristen Pogreba-Brown PhD, MPH

Leslie V. Farland, ScD

Elizabeth T. Jacobs, PhD, MS

Sydney Pettygrove, PhD

Purnima Madhivanan, MBBS, MPH, PhD

Megan Jehn, PhD, MHS

Pamela Garcia, PhD, MPH

Bonnie LaFleur, PhD, MPH

Paloma I. Beamer, PhD

Joe K. Gerald, MD, PhD

Mark Nichter, PhD, MPH

Saskia Popescu, PhD, MPH, MA

Erika Austhof, MPH

Lindsay Kohler, PhD, MPH

Jill de Zapien, BA

Aminata Kilungo, MPH, PhD

Joshua Hunsaker, BS

Collin Catalfamo, MPH

Kelly M. Heslin, MPH, CHES

Stephanie Carroll, DrPH, MPH

Yann Klimentidis, PhD

Maia Ingram, MPH

Felina Cordova-Marks DrPH, MPH

Elizabeth Hall-Lipsy, JD, MPH

Cecilia Rosales, MD, MS

Kelly A. Reynolds, PhD, MS