Archives

The state activated the Arizona Surge Line this week to keep hospitals and regions of Arizona from being overwhelmed by facilitating COVID-19 patient admission, transfer, and discharge to appropriate levels of care. Read the note.

This week one of our members (Scott Turner) discovered an evidence review that makes a decent case for the efficacy of cloth masks in the community. While the evidence review doesn’t have a direct reference to the efficacy of wearing a mask in the community – they do a good job of looking at other aspects that support the policy.

Pay it a visit!

If it has been a few days since you’ve been to the ADHS’ data dashboard– make sure you make a new visit. There’s a lot more data there now including current trends and key healthcare facility metrics including hospital ICU capacity. There’s more detail on demographic data and a new feature looking at COVID-19 rates. One glance at those rates will give you newfound perspective on just how profound the health disparities are up in the northeast corner of the state. 

A shout out to the ADHS team of Laura Erhart, Teresa Jue, Susan Robinson, Wes Korteum, et.al. and the web design team led by Jesse Lewis for laying the data out in a consumable way.

All scenarios show adequate hospital capacity

The ADHS published a modeling report this week that provides state-specific projections of new cases and deaths based on the best available science and Arizona case data. The report produces daily counts for infected individuals, ICU use, and deaths for five different scenarios. 

It provides scenario-based estimates of resource needs for hospital beds, ICU beds, and ventilators but doesn’t include a capacity assessment.  A trip to the new ADHS Dashboard reveals that peak use in all of the AZ model scenarios are well below our existing capacity.

These modeling results build on the growing model results that suggest we are fine with our current hospital capacity.  Here’s Dr.Gerald’s latest model result summary, always a good source of information. Models that are well respected are included in Dr. Gerald’s work include the IHME Model developed by the University of Washington and the University of Texas Modeling Consortium which includes a GPS tool that quantifies the effectiveness of social distancing measures.  

Arizona’s hospitalization data and the predictive models have consistently shown that there is enough hospital bed and ICU capacity overall with a margin of safety (except for a hot spot in the northeast part of the state).  The overall safety margin for hospital capacity and the improving PPE situation means that hospitals should now be able to safely make their own decisions about what procedures to allow. 

Last week the governor declared that elective surgeries can resume if hospitals meet certain criteria starting May 1, 2020. We support this decision. 

This change will be a very good thing for many Arizonans who have been waiting for important procedures that have been canceled and or delayed. There is a common mis-perception that elective procedures are cosmetic procedures. That’s not the case, the vast majority of elective procedures are important surgeries like hip and knee replacements, and some kinds of cancer and cardiac surgeries etc.

Medical facilities can now ask the ADHS permission to proceed with elective procedures if they meet some criteria like:

• Having more than 14 days worth of personal protective equipment for medical staff on hand;

• Maintaining adequate staffing and bed capacity;

• Screening staff, patients and visitors for COVID-19 symptoms;

• Developing discharge plans for patients being transferred to nursing facilities that include COVID-19 testing; and 

• Implementing an “enhanced” cleaning process for waiting areas.

You can read the governor’s announcement here.

The FDA has a very streamlined process for authorizing the emergency use of a host of testing kits for the novel coronavirus (2019-nCoV).  Some are the classic PCR tests and some are antibody tests (IgM and IgG).

So far there are 30 different tests on the Emergency Use Authorization list.  Here is a link to the FDA’s  Test Kit Manufacturers Table which includes the manufacturer and their contact information, fact sheets for providers and patients and instructions.  

The Association of State and Territorial Health Officials collaborated with Johns Hopkins University to produce A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US. The report calls for a robust and comprehensive system to identify all COVID-19 cases and trace all close contacts of each identified case, and outlines a vision—complete with resources and specific action steps—to accomplish this goal. Here’s the media release.

Also, the Singapore Ministry of Health has built a Contact Tracing App that conducts scaled contract tracing and involves public engagement in the process. They recently announced they’re making it open source.  The advantage of something like this is its value in identifying pre-symptomatic contacts, while maintaining confidentiality. 

I downloaded the App to test it out but couldn’t activate it because on the verification screen they have Singapore’s country code hard wired.

The federal government issued new guidelines to help state and local government officials with decision criteria to consider to relax some of the interventions currently in place without jeopardizing public health from exceeding hospital treatment capacity.

It’s a three-phase set of guidelines for governors and others to consider with the goal of mitigating the risk of resurgence and protect the most vulnerable. The guidelines specify symptoms, cases, and hospital capacity criteria that must be satisfied before proceeding to a phased comeback.

Take a look at the guidelines for yourself.  My take was that it is reasonably well thought out but there wasn’t any gating criteria emphasis (page 1) regarding diagnostic and antibody testing availability. 

That seems like a pretty big oversight to me- as testing availability is important for contact tracing (once community spread wanes).  Widespread accurate antibody testing is also important information for businesses to have access to as they plan their individual re-openings.

The guidelines don’t even mention predictive modeling as a gating criteria component.  Predictive modeling can provide important information for decision makers- arguably more important than the information provided by looking at simple trends in case counts (gating criteria number 2).

There’s also a big emphasis on syndromic survieillance in the gating criteria that (in my opinion) is given too high of a priority. I would have replaced the syndromic surveillance gating criteria with predictive modeling outcomes.

A new serology (antibody) study conducted in Santa Clara County suggests that COVID infections are 25 to 50 times higher than the number of confirmed cases.  During the study period, SC county had 1870 cases and 73 deaths reported among its 1.7 million residents. The serology study estimated that 2.5% – 4.2% of county residents have been infected – which converts to between 48,000 – 81,000 total infections…  exceeding the number of known cases by a factor of 25–50.

If confirmed, this would suggest the overall infection fatality ratio would be approximately 0.1 – 0.2%, much lower than the current overall estimate.

Note:

The University of Arizona will begin providing antibody tests for 250,000 health care professionals and first responders who are on the front lines in the battle against COVID-19.  The UA will administer the antibody tests to check for antibodies through an individual’s blood sample to determine if they were exposed to COVID-19, had the virus and recovered.

I didn’t see when this actual work will begin, but that’s probably because there will be some type of approval that needs to happen first. These results will be the first good look we have into where we really are when it comes to herd immunity here in AZ.