Dr. Gerald’s weekly epidemiology and hospital capacity is hot off the presses. No surprises in this week’s report. No good news again, as expected, given the dearth of policy and operational interventions under the governor and health director’s leadership. As always, several good Figures in this week’s report document the severity of this unmitigated crisis.

Arizona is now experiencing a public health crisis where access to critical care services is limited due to shortages of space, personnel, and critical supplies. We are undergoing a great “displacement”. Hospital services are being rationed so that patients with severe Covid-19 illness are displacing others who have slightly less severe non-Covid medical conditions.

As Covid-19 illness continues to increase, delaying others’ care will become ever more difficult. At some point, hospitals will have to expand their physical capacity and implement Crisis Standards of Care. The Covid-19 crisis is now placing a greater share of Arizonans’ at-risk, not just those unfortunate enough to contract Covid-19.

With 617 deaths, the week ending July 19th is still Arizona’s deadliest week, but not for long. Because cases have been increasing, deaths are also increasing. Sharper rises are expected over the coming weeks as deaths lag new cases by 14- days and are often only made known weeks later.

By Christmas, Arizona will be experiencing >500 deaths per week. However, this toll will not be apparent until mid-January once all deaths are accounted for. As a rule of thumb, multiply the number of weekly deaths by 1.5% (approximate case fatality rate) to estimate the number of expected deaths in 2–3 weeks time.

It is now clear that there will be no interventions from the governor or health director to mitigate this crisis. Their plan appears to be to slowly vaccinate persons with the highest risk of hospitalization and death. Such a strategy will be quite slow owing to: 1) the slow pace of vaccinations given the totality of the population at highest risk; and 2) the lag time between vaccination and the development of protective neutralizing antibodies and T cells.