Today the Arizona Public Health Association joins with the Arizona Hospital and Healthcare Association (AzHHA), Arizona Medical Association (ArMA), Arizona Osteopathic Association (AOMA), Maricopa County Medical Society (MCMS), and the Arizona Organization of Nurse Leaders (AAONL) to urge the governor to issue executive orders to temporarily pause the operation of certain types of businesses or further limit their operations, to temporarily limit gatherings, and to additionally mandate statewide mask wearing.
We know there is deep-seated opposition to some of these recommendations. And there are negative economic consequences to others, which have a down-stream impact on public health. However, we believe urgent action is needed on a temporary basis to protect the immediate fragility of the healthcare delivery system.
In our letter, we urge the governor and health director to take the following steps for the next six to eight weeks—while vaccines are being administered to healthcare workers and long-term care residents under Phase 1a of the state’s COVID-19 Vaccine Plan:
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Close bars and nightclubs. These could be reopened earlier if the state returns to moderate community spread.
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Limit restaurant operations to outside dining and take-out service. These restrictions could be lifted earlier if the state returns to moderate community spread.
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Except for essential services, limit public gatherings to no more than 25 people. Encourage people to only socialize with members of the same household. With holiday celebrations continuing through the New Year, we are incredibly concerned about multi-household gatherings which will become super spreader events.
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Implement a statewide and enforceable face covering mandate that focuses on business compliance rather than individuals.
Arizona finds itself in a potentially catastrophic situation. The healthcare system is overwhelmed and on the brink of considering the need to implement crisis standards of care. We also face the reality that our hospital systems will likely run out of available staff to care for patients who need our help.
Editorial Note: Sadly, the recommendations above to close bars and have restaurants go back to take out service could have been avoided if mitigation measures like a statewide, uniform, and enforceable face covering mandate (placing the responsibility for compliance on businesses and organizations) and far better enforcement of mitigation measures in bars and restaurants had been implemented weeks ago.
If those less dramatic interventions been implemented in October when the case rate and trajectory began to increase, those interventions would have been able to slow down the spread enough to decrease the imminent hospital capacity crisis.
Many weeks of opportunities to benefit from better enforcement in bars and restaurants and a uniform and enforceable statewide mask mandate (with enforcement focused on businesses and organizations rather than individuals) have now been missed, necessitating the recommendations above.
Editorial Note II Regarding Bars & Restaurants: For the last many months I have been in favor of much better enforcement of the existing required mitigation measures. Sadly, the opportunities to put together an efficient compliance system (and benefit from it) have been lost.
We’ve learned a lot about this virus and we now know that the virus thrives in closed indoor environments where people typically don’t wear masks.
When these businesses started back up a couple of months ago, they were required to sign attestations that they’d follow required mitigation measures (restaurants at 50% capacity and bars operating like restaurants and also using capacity limits). While there is a complaint hotline and some follow up of those complaints (I’ve heard that many are simply phone calls) there is little if any proactive compliance checks and sporadic enforcement.
Any effective regulatory program requires routine proactive compliance checks that include enforcement when necessary. Had we been doing better proactive compliance checks, there would be far fewer bars, restaurants and nightclubs ignoring the existing mitigation requirements. Businesses that are complying are frustrated that their competitors are cheating and getting away with it. That causes more businesses to cheat.
But how could such a system have worked? There were at least 2 possibilities. The existing food safety workforce in AZ (called Sanitarians) could have been reassigned to COVID mitigation detail for the next few months. Alternatively, the National Guard (who is currently helping with the response on other areas like food banks and shelf stocking among other things) could have been put on mitigation compliance check detail at bars restaurants and nightclubs. An Executive Order could have given authority to nullify the Attestations made by those businesses that are not complying, suspending their individual operation.
If better compliance and enforcement had been in place several weeks ago, we would be in a different place. As it stands, we are now in exponential growth of the virus and at the brink of a hospital capacity crisis.
My point has been that shutting the bars again could have been avoidable if better compliance and enforcement of the existing required mitigation measures had been in place many weeks ago.
