Trends in COVID-19 Incidence After Implementation of Mitigation Measures – Arizona, January 22 – August 7, 2020 Early Release / October 6, 2020 / 69
The CDC released this new Morbidity and Mortality Weekly Report Tuesday that dives into the details of the Arizona experience with the pandemic this summer. It’s great that the folks at the ADHS put together this MMWR because it builds the evidence base for what kinds of interventions are effective at slowing the spread of COVID-19.
The piece discusses the fact that the average COVID-19 cases increased more than 150% between June 1 and June 15 following the end of the Stay at Home Order in mid-May. The report documents the fact that after face covering mandates were put in place and bars and nightclubs were shut in late June, the cases stabilized (July 3 and July 12) and daily new cases declined by 75% between July 13 and August 7.
Again, it’s great that the agency published this work because it builds the evidence base and can now serve to help other states (and even countries) as they think through interventions.
But it’s also important to tell the story the way it really happened.
For example, the MMWR write up states that… “Updated guidance from state officials provided local governments the authority to implement mask policies (June 17) and enforcement measures tailored to local public health needs“. The reality is that Executive Order 2020-36 Provision #7 prohibited local jurisdictions from implementing face covering ordinances or other mitigating measures stronger than the Governor’s orders.
Following intensive lobbying from local officials Executive Order 2020-40 (June 17) finally removed the prohibition against face mask ordinances (although not other measures). It was not updated guidance from state officials that prompted local jurisdictions to implement face covering ordinances, it was a result of rescinding an Executive Order that had been prohibiting county and state governments from implementing this evidence-based intervention.
The report further states that… “Before June 17, mask wearing had not been widely mandated or enforced.” This statement is true but misleading. In fact, local or county mask wearing mandates had been specifically forbidden by the governor’s executive orders prior to June 17, so of course mask wearing had not been widely mandated or enforced.
Further, the report neglects to mention a highlight of the epidemic in Arizona, the fact that the state authorized Crisis Standards of Care in July because the hospital system had reached saturation.
Editorial note: You might be wondering why I’m making such a big deal about the way that this MMWR is wordsmithed with respect to the face coverings. Quite simply, it’s because courageous elected officials in county and local government across the state had stridently asked the Governor and health director for their authority back and then immediately implemented face covering ordinances as soon as the Governor’s restriction was rescinded. Many of those officials faced backlash from elements of their electorate for that decision.
The MMWR piece implies that counties and cities implemented face covering requirements simply because of a change in guidance. This is misleading. As we look towards managing the pandemic through the crucial winter months ahead, it is important that we understand the actual dynamics of implementing such a public health intervention, beyond what may be stated in a publication such as the MMWR. Unfortunately, it seems that much about our pandemic response has become political. This is an example of how that politics at first prohibited local response, and how politics was then used to lift the restriction and allow local officials to do the right thing.
Local jurisdictions need the flexibility to continue to impose mask mandates, and other mitigation measures, depending upon local circumstances. For example, had the Governor not pre-empted local control of such matters, some local jurisdictions would not have waited so long to impose mask mandates. This would have decreased the peak of wave of infection, which has an impact on the number of cases occurring even months later. Some jurisdictions might also choose other measures. For example, prohibiting indoor bars and nightclubs in certain areas (such as adjacent to college campuses) which would limit the number of super-spreading events that continue to drive the epidemic.
We will likely experience another surge in cases during the coming winter months. The more we can limit this through modest mitigation measures such as mask mandates, the more we will be able to allow most aspects of the economy to remain open and viable. If we don’t moderate the coming surge, we risk being forced into another partial lock-down, with perhaps even worse economic outcomes than we’ve already felt.
