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Bars have now opened across almost all of Arizona. There are just a few counties that haven’t yet met the moderate spread metrics- and over 90% of Arizonans now live in counties where bars are open. In order to open, bars are supposed to go to the ADHS website and attest that they will follow mitigation measures.

Following mitigation measures is critical in these businesses. As we saw between May 15 and June 26 bars and nightclubs create super-spreading environments without mitigation.

Over the last couple of weeks there has been some strong administrative advocacy urging the state to develop a meaningful compliance program to ensure that bars and nightclubs follow the required mitigation measures upon opening. ADHS had already been requiring bars and nightclubs to sign attestations that they’ll follow mitigation measures, but until late last week there wasn’t an organized active compliance system.

The advocacy worked and late last week the department announced that they would be sponsoring a COVID-19 Compliance Hotline at 1-844-410-2157.  They committed to investigating complaints by referring them to the county health departments or in some cases investigating the complaints themselves.

Editorial Note: Let’s hope that the plan is well organized and works. If the compliance program isn’t effective, we can expect broad non-compliance with mitigation as we say earlier this summer, creating an increase in cases. If that happens, students in the K-12 system will suffer if that happens because counties would no longer meet in person instruction benchmarks in short order. That lost opportunity would be directly attributable the lack of an effective compliance system for bars and nightclubs.

Last week the FDA issued an emergency use authorization to Yale School of Public Health for its SalivaDirect COVID-19 diagnostic test, which uses a new method of processing saliva samples when testing for COVID-19 infection. SalivaDirect does not require any special type of swab or collection device; a saliva sample can be collected in any sterile container.

As the nation continues to grapple with the ongoing COVID-19 pandemic, the Network has joined with public health law partners to produce a report that includes critical analyses and recommendations from 50 national experts convened to assess the U.S. policy response to the crisis to date.

This new report offers policy recommendations on 35 wide-ranging topics, including pandemic preparedness, access to health care, voter health and safety, protections for essential workers, food insecurity and immigration policy. Designed to advise leaders at the federal, state and local level, the report presents a timely examination of policy challenges and opportunities in light of the pandemic.

Read the full report here. 

Back on August 3, the CDC issued new guidance regarding people who are infected with the coronavirus. It flew under the radar until the New Your Times wrote a story about that change.  Following the NYT article, other media outlets improperly interpreted the new CDC guidance and wrote stories suggesting that immunity wanes after 3 months. That is not what the CDC guidance said.

What the CDC actually said was that “People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to three months as long as they do not develop symptoms again. People who develop symptoms again within three months of their first bout of Covid-19 may need to be tested again if there is no other cause identified for their symptoms.”

Last Friday the CDC issued a clarifying statement saying, “Contrary to media reporting today…  the latest data simply suggests that retesting someone in the 3 months following initial infection is not necessary unless that person is exhibiting the symptoms of COVID-19 and the symptoms cannot be associated with another illness.”

Some scientists have speculated that immunity from the virus might only last 3 months based on a study published in Nature back in June that showed many patients began to show decreasing levels of immunity 2–3 months after infection and that antibodies may not last very long among asymptomatic mildly ill persons.

But remember, antibodies are just one part of the immune system and it’s normal for antibodies to decrease once an infection recedes.  It also doesn’t mean that waning antibody titers mean waning immunity.  The memory B cells that first produced those antibodies are still around and stand ready to make more antibodies on demand. There is also good evidence that people infected with the SARS virus also generate a robust T-cell response- providing a longer lasting type of immunity.

Next week I’ll do a have a piece on the immune system and how it works with an eye toward the pandemic.

Will There be a Compliance System this Time?

As you recall from last week’s blog post, the ADHS has proposed benchmarks for when bars, nightclubs and gyms can re-open.  When a county reaches numeric benchmarks like a defined percent positivity rate the paused businesses are free to re-open if they implement safety protocols and guidelines and turn in an attestation form committing to stay in compliance.

The benchmarks for each county are posed on the ADHS’ Dashboard.  That dashboard shows whether the county meets the benchmarks. There’s a drop-down box that let’s you see each individual county’s metrics. The default is the statewide numbers.

Editorial Note: Several counties are coming close to meeting the metrics that will allow bars and nightclubs to open again. And while each business will be required to attest that they are implementing the mitigation guidelines, there is still no defined compliance and enforcement system to ensure that the businesses stay in compliance.

Without a rigorous and compliance system that is enforceable it’s highly likely that large numbers of bars and nightclubs will ignore the mitigation guidelines and behave exactly like they did from May 15 all the way until late June when the governor finally “paused” these businesses. If that happens we will again see a dramatic growth in cases and percent positives which will jeopardize the opportunity for in-person instruction in our K-12 system.

Such a compliance system isn’t rocket science. The state could require each of these businesses to post a number to a complaint hotline (perhaps even the smoke free Arizona hotline). Complaints could be distributed to the county health departments who could send out their Environmental Health Specialists (Sanitarians). Businesses that are out of compliance as determined by the county inspector would have their attestation canceled. Business closes. Compensation for that work could come via CARES Act money. Voila, compliance.