AzPHA Action Alert: Save the Arizona Corporation Commission’s New Clean Energy Rules

Please take action to help stop two identical bills that are a direct attack on clean energy. We are urging you to take a few minutes to express your opposition to these two damaging bills.

The bad bills are HB2248 corporation commission; electric generation resources (Griffin) and SB1175 corporation commission; electric generation resources (Kerr: Gowan, Gray)

The purpose of these 2 bills is to overturn the clean energy rules being considered by the Arizona Corporation Commission. Those rules, which are currently in public comment, have gone through nearly two years of development and vetting. The ACC Rules are good and have strong  public support. They will drive AZ toward clean energy over the next 30 years and will also save ratepayers dollars, reduce water use and pollution, and bolster Arizona’s economy.

The bills we’re asking you to take action against prohibit the Corporation Commission from doing anything without the permission of the state legislature… so it is also a big power grab by the Arizona Legislature. 

Please sign in on the Request to Speak system to oppose both HB2248 and SB1175. You do not have to speak, but you can register your position on bills while they are in committee. 

We’re also asking you to email members of the House and Senate Natural Resources, Energy, and Water Committees and ask them to oppose the bills.

For HB2248, contact the following:
Rep Burges
Rep Cano
Rep Carroll
Rep Dalessandro
Rep Dunn
Rep Finchem
Rep Griffin, Chair
Rep Lieberman
Rep Parker
Rep Stahl Hamilton

For SB1175 contact the following:
Senator Engel
Senator Gowan
Senator Gray
Senator Kerr, Chair
Senator Mendez
Senator Otondo
Senator Rogers
Senator Shope
Senator Steele

You can also support the clean energy rules at the Arizona Corporation Commission! Send a message and RSVP to provide public comment here.

Weekly COVID Epidemiology & Hospital Capacity Report

Below is a summary of Dr. Joe Gerald’s weekly epidemiology and hospital capacity update. You can view his full analysis including all the charts and graphs here. As has been the case for some weeks now, the report paints a dire picture of the pandemic in Arizona due to woefully inadequate mitigation measures.

We continue to urge Governor Ducey and Director Christ to implement evidence-based mitigation measures to slow the spread of the virus (similar to those that were implemented during the summer “pause”). However, at this point, we have no confidence that either of them support any new measures whatsoever despite the dire situation in Arizona hospitals. We expect the virus to continue to rifle through Arizona with reckless abandon until Arizona reaches herd immunity- primarily because of viral infections rather than vaccine induced immunity.

Excerpts from Dr Gerald’s weekly report below:

“The SARS-CoV-2 virus continues to rampage through Arizona. Daily cases and fatalities could double, or perhaps quadruple, before declining under the weight of natural and/or vaccine-induced immunity later this winter. However, the arrival of a more transmissible UK variant could change this calculus for the worse. Arizona’s outbreak remains appallingly bad. A bit of good fortune (or preferably policy action) is needed to gain additional time to vaccinate Arizona’s most vulnerable citizens.”

“As of January 8th, new cases were being diagnosed at a rate of 860 cases per 100,000 residents per week (Figure 11 in todays report). This rate is increasing by approximately 83 cases per 100,000 residents per week. According to the CDC, no other state is currently experiencing faster spread transmission.”

“Arizona is reporting >700 Covid-19 deaths per week (>100 per day) and this count may underestimate true fatalities by half (see Woolf, Woolf, or Weinberger). Many of these deaths were preventable if the state had more aggressively adopted evidenced-based public health practices. Arizona weekly tally of deaths ranks second behind Alabama. Last week’s leader, Rhode Island, has since dropped to 12th.”

“Hospital Covid-19 occupancy has at least temporarily plateaued at record levels this week in the ward and ICU. However, some of this could be attributable to coping mechanisms that are hidden from view.”

“Hospitals continue to postpone scheduled procedures to create additional capacity for Covid-19 patients at the expense of others with serious medical conditions. However, patients who would have been previously hospitalized are undoubtedly being treated in an outpatient setting.”

“Health professionals are being asked to work additional hours and assume duties outside their traditional scope of practice. Shortages and burn-out will degrade our capacity to provide critical care services over the coming weeks.”

“The test positivity rate for traditional nasopharyngeal PCR testing declined slightly this week, dropping from 35% to 33% positivity. This indicates viral transmission is growing more slowly than testing capacity is increasing. Nevertheless, our testing capacity is wholly inadequate to the scale of the problem and other regions.”

Recent AzPHA Media Contributions

Last week was a busy one media-wise for AzPHA- in part because the pandemic is having such a tragic impact in our state. In fact, we are now number one in the world when it comes to viral transmission per capita. Here are a few of the stories that we contributed to this week:

Arizona, Roiled by Covid in Summer, Faces Even Worse Outbreak Now – The New York Times (nytimes.com)

Only 136 intensive care unit beds are available out of nearly 1,800 statewide, according to state data, but beds are not the most pressing issue, Dr. Bessel said. Staff and resources are. Nurses are being quickly trained in new skills and hundreds of health care workers are being flown in from other states. Still, Dr. Bessel acknowledged, there comes a point when resources can be stretched no thinner and more drastic measures, such as rationing care, might have to be considered.”

As Arizona becomes world hot spot, focus put on governor– The Washington Post

“We have a governor and health director who don’t care. Their goal in my opinion is to vaccinate their way out of this,” said Will Humble, head of the Arizona Public Health Association “Eventually it will work. There’s just going to be a lot of dead people in the meantime.”

Health expert blames Arizona’s COVID crisis on lack of enforcement(ktar.com)

He said that even though thousands of businesses are subject to mitigation rules enacted by the state over the summer, the health department has done just 15 enforcement actions.

“You’re telling me that that’s meaningful enforcement of the mitigation measures? … I can’t say it plainly enough: If we had been doing better enforcement in those indoor environments, then I wouldn’t be sitting here talking on the radio about shutting those businesses,” he said.

“I think their attitude has been, ‘Look, we’re not going to try to mitigate this thing, we’re going to try to vaccinate our way out of it,’” he said.

Arizona has the highest rate of new COVID-19 cases in the US, CDC says(azcentral.com)

“I probably sound like a broken record- but I feel compelled to say again that the situation we now find ourselves in is not because of fate as the governor and state health director suggest,” Will Humble, Arizona Public Health Association director, wrote in a Jan. 3 policy update.

“It is largely because they have been unwilling to implement evidence-based interventions this fall including authentic enforcement of the existing ‘required’ mitigation measures for bars, restaurants and nightclubs. A requirement without enforcement is merely a suggestion.”

Vitalyst Spark Podcast– E57: COVID-19 Roundtable Update – 1/4 | Free Listening on Podbean App

Arizona Horizon | 1-4-21: Slow vaccine roll out 

Glitch in Arizona health’s website temporarily allowed anyone to register for COVID-19 vaccine | Coronavirus in Arizona | azfamily.com

Arizona Vaccine Rollout Delayed by Computer Glitches, County Says | Phoenix New Times

Dr. Christ addresses coronavirus vaccines in Arizona, refuses to take questions about rollout (abc15.com)

“With Arizona being the hardest spot in the world for COVID cases, ⁦@drcarachrist⁩ refuses to take questions after today’s public event.

Contingency v. Crisis Standards of Care

As we press through contingency standards of care toward crisis standards of care, I thought it would be good to provide a little summary in plain language about what those words mean.

Hospitals generally operate under conventional standards of care. That just really means that they’re providing patient care without any change in daily practice.  Every cold and flu season hospitals face surges in demand (like the week after Christmas and off and on during January and February in Arizona). But hospitals are still operating under conventional care standards.

They will juggle space and staffing and may temporarily ask ambulances to go to alternate facilities or accelerate the discharge of healthy patients.  Staff may be asked to work in a different part of the hospital than they’re used to (for example a surgeon might be asked to work in the ER) but everyone is still working in their bounds of expertise and they’re following standard protocols.

As hospitals transition to contingency standards of care (where AZ is operating right now) hospitals change their practices and do everything they can to maintain the standard level of care.  For example, under contingency care they will use rooms of the hospital for different kinds of clinical care than usual, like converting surgical rooms for emergency services or using recovery rooms as a makeshift intensive care unit. Doctors, nurses, and respiratory therapists make different decisions about what therapies to use because of resource shortages too.  For example, they may not provide oxygen to a patient that would normally receive it because it’s in short supply.

Under contingency standards of care they also change admitting and discharge protocols.  Patients that arrive in the ER who might normally be admitted will be observed for awhile and then sent home with a prescription for example.

Practitioners may start conserving supplies by, for example, not providing precautionary oxygen to patients who under normal circumstances would receive it, but who can survive and recover without it.

Patients are transferred between hospitals as they try to level out patient loads when they have periods of time. Some hospital systems like Banner are large enough to do interfacility transfers using their own resources and data. Others will need to contact the ADHS Surge Line, where transfers can be facilitated. I’ve been told that in recent days the Surge Line has been activated to facilitate patient transfers.

Hospitals restrict non emergency procedures. This isn’t something hospitals like to do because patients really need these important procedures and because general surgery and elective procedures contribute much to the financial bottom-line. Nevertheless, these procedures will begin to be postponed or canceled. This is probably already happening.

Hospitals change their admission decisions. For example, persons presenting in the emergency department may be sent home when, under normal circumstances, they would be admitted. Likewise, a patient that would normally be admitted to an Intensive Care Unit (with robust staffing rations) might instead be placed on a general ward bed.

Hospitals change their discharge decisions. People that have been admitted and who would normally stay for a couple more days will be discharged rather than observed. In some cases, persons that are in the ICU may be discharged directly to home rather than admitted to a general ward bed. Others will be discharged to a skilled nursing facility rather than a general ward hospital bed.

When the system becomes totally saturated, as will be the case in the next 2 weeks, hospitals will ask the ADHS to allow them to operate under Crisis Standards of Care. 

“Crisis Standards of Care” is basically a protocol for making healthcare decisions when the system can’t provide all of the care that everybody needs because the needs outstrip the resources. Ethics panel discussions will be held to make difficult decisions regarding who will get care and who will not.

Under Crisis standards hospitals need to make even more substantial changes to the way they provide care. For example, staff are asked to practice outside of the scope of their usual expertise. Supplies are reused and recycled. In some circumstances, resources may become completely exhausted.

Core strategies that get used under Crisis standards include substitution, adaptation, conservation, reuse, and reallocation in the areas of for oxygen, medication administration, IV fluids, mechanical ventilation, nutrition, and staffing.

The Crisis Standards of Care also provides a protocol to help healthcare providers objectively decide who gets care when resources don’t allow everyone to get treatment.  This blog post fleshes it out How Will Patients Be Prioritized Under the New “Crisis Standards of Care”

Here’s a link to the ADHS Crisis Standards of Care Planning Document. It’s 141 pages, but the real heady stuff is on pages 29 through 38 where it discusses the scoring system to prioritize which patients will get treatment and which will not and how to ration care to all patients when resources are outstripped by demand.

The ADHS also has an Addendum to the report called Allocation of Scarce Resources in Acute Care Facilities Recommended for Approval by State Disaster Medical Advisory Committee.

This Week’s Grim Epidemiology and Hospital Capacity Report

Below is an excerpt from Joe Gerald’s Weekly Arizona Epidemiology and Hospital Capacity Report. Far more detailed charts and graphs are available in the full report.

The SARS-CoV-2 virus is mowing through Arizona like a sharpened scythe. Fatalities are stacking up like cordwood in advance of a long winter. Barring intervention, daily cases and fatalities will double or perhaps quadruple before the outbreak collapses under the weight of natural, not vaccine-induced, immunity later this spring.

While Arizonans’ poor individual decisions are undoubtedly contributing to viral spread, the Governor’s inaction in the face of a clear and present danger is of greater concern. Most recently, he has performed more poorly than other governors, but more importantly, he has performed more poorly compared to his prior success this summer. This latter point highlights the calculated indifference of his current response.

As of January 3rd, new cases were being diagnosed at a rate of 780 cases per 100,000 residents per week (Figure 11 below). This rate is increasing by approximately 220 cases per 100,000 residents per week although this brisk pace is partly an artifact of last week’s under-counting. According to the CDC, no other state is experiencing faster spread transmission.

Arizona is now reporting >700 Covid-19 deaths per week (>100 per day) and this count may underestimate true fatalities by half (see Woolf, Woolf, or Weinberger). Many of these deaths were preventable if the state had more aggressively adopted evidenced-based public health practices. Arizona weekly tally of deaths ranks second behind that of Rhode Island.

Emerging evidence from New Zealand suggests that strict Covid-19 control measures are not associated with excess mortality from other causes. In fact, New Zealand experienced an 11% reduction in all-cause mortality while only experiencing 25 Covid deaths. This should begin to debunk the false narrative about our response being worse than the virus itself. New Zealand’s economic performance also belies the false narrative surrounding the choice between saving ourselves and saving our economy.

With >10,000 Covid-19 deaths reported to date, Covid-19 will almost certainly be recognized as Arizona’s third leading cause of death in 2020. This will be 10 times the number of influenza and pneumonia deaths typically reported. If Covid-19’s true toll was accurately captured, it would likely rank as Arizona’s leading cause of death. Given the outbreak’s current severity, these numbers could be repeated in 2021.

Hospital Covid-19 occupancy continues to increase with each week setting new records for ward and ICU occupancy. If viral transmission continues to increase, hospitals’ coping mechanisms could be exhausted before the end of January. Because many of these coping mechanisms are hidden from view, it is likely that hospitals will appear to fail abruptly and with little “seeming” warning.

Hospitals continue to postpone scheduled procedures to create additional capacity for Covid-19 patients at the expense of others with serious medical conditions. However, patients who would have been previously hospitalized are undoubtedly being treated in an outpatient setting.

Health professionals are being asked to work additional hours and assume duties outside their traditional scope of practice. Shortages and burn-out will degrade our capacity to provide critical care services over the coming weeks.

The test positivity rate for traditional nasopharyngeal PCR testing set another record this week at 35% positivity. This indicates a substantial mismatch between testing capacity and demand and supports the notion that viral transmission is growing faster than case counts alone would suggest, that our viral control measures are wholly inadequate, and our testing capacity compared to other regions is poor.

Webinar: Arizona Corporation Commission Energy Rules

Jan 13, 2021 06:00 PM AZ Time

Register Here

A couple of months ago the Arizona Corporation Commission passed new regulations that will require state-regulated utilities to get 100% of their power from carbon-free sources by 2050. The regulation doesn’t have a specific mandate that the energy be from a renewable source like solar and wind (the regulation counts power from APS’s Palo Verde nuclear plant as a carbon-free “clean energy” source).

The regulation passed by the Commission still requires a formal Rulemaking to flesh out and finalize the requirements. That final Rulemaking will formally set the new requirements for energy storage and energy efficiency gains for power-generating utilities.

Our hope is that the final Rules will bring Arizona more in line with other states that have significantly beefed up their clean-energy mandate.

Oral public comment sessions are being held on January 19th & 20th and written comments are due on January 22nd AzPHA will be submitting comments on the final Rule before the deadline.

Interested in learning more?  A group called Solar United Neighbors is putting on a free webinar that will help you understand the new 100% carbon-free energy rules and how to make a comment with the Arizona Corporation Commission (ACC) during the public comment period.

Webinar: Arizona Corporation Commission Energy Rules
Jan 13, 2021 06:00 PM AZ Time

Register Here

UK Temporarily Authorizes Use of the Oxford/AstraZeneca Vaccine

Last Wednesday the UK’s Department of Health & Social Care and their Medicines and Healthcare Products Regulatory Agency temporarily authorized the AstraZeneca/Oxford vaccine. Here is their clinician information packet with some of the particulars

Here’s the short summary of the safety profile:

“The most frequently reported adverse reactions were injection site tenderness (>60%); injection site pain, headache, fatigue (>50%); myalgia, malaise (>40%); pyrexia, chills (>30%); and arthralgia, nausea (>20%). The majority of adverse reactions were mild to moderate in severity and usually resolved within a few days of vaccination. By day 7 the incidence of subjects with at least one local or systemic reaction was 4% and 13% respectively. When compared with the first dose, adverse reactions reported after the second dose were milder and reported less frequently.  Adverse reactions were generally milder and reported less frequently in older adults (≥65 years old).”

Here’s the short summary of the efficacy profile:

“In this population, vaccine efficacy from 22 days post dose 1 was 73.00% (95% CI: 48.79; 85.76 [COVID-19 Vaccine AstraZeneca 12/7,998 vs control 44/7,982]).  Following vaccination with COVID-19 Vaccine AstraZeneca, in participants who were seronegative at baseline, seroconversion (as measured by a ≥4 fold increase from baseline in S binding antibodies) was demonstrated in ≥98% of participants at 28 days after the first dose and >99% at 28 days after the second.” 

This is a more traditional vaccine when compared to the Pfizer and Moderna vaccines. This one uses an adenovirus vector to develop the immune response, while Pfizer and Moderna use a new mRNA technology.

Importantly, this vaccine is supposed to be stored at regular refrigerator temperatures, has a 6-month shelf-life, and can be stored between 2°C and 25°C during the in-use period. These characteristics make the vaccine far more flexible and easier to use in a much wider range of settings.  It will be particularly valuable for developing nations with limited infrastructure.

Back in May,  HHS announced that they had contracted with AstraZeneca providing $1.2B to support the development of their candidate vaccine (which has been developed in conjunction with the University of Oxford). The agreement is to make available at least 300 million doses of the vaccine for the United States. 

I couldn’t find info on how many doses have already been manufactured that may be available in the U.S. when the vaccine is ultimately given Emergency Use Authorization (most likely in January).

ADHS Director Scraps COVID-19 Spread Metrics for Business Operations

Substantial Spread Effectively No Longer Exists as a Category for Informing Interventions

Over the summer a host of stakeholders including the business community developed COVID-19 metrics to inform policy decisions like when it’s time to impose additional operational restrictions on bars and restaurants. Shortly after the ideas were presented to the Governor’s Office, the ADHS adopted the metrics and highlighted them as a key tool for driving future intervention decisions.

The metrics were then used when the state decided to lift the limitations put on bars, restaurants and gyms during the summer “pause”.

The protocol was scrapped in mid-December to ensure that the state metrics never suggest additional operational restrictions are needed at bars and restaurants no matter how bad community spread gets.

Here’s a story from the Health Arizona Daily Star that describes the decision by Dr. Christ to scrap the business metrics and her rationale for doing so.

Under the former criteria, bars and in-person dining are not allowed to operate when a county is in the ‘Substantial’ category.

As community spread began to increase in late October and into November & December, county after county moved into the Substantial spread category. When asked why the ADHS was not advocating for enhanced interventions because of the substantial spread, Dr. Christ (the agency director) said that while the metrics and protocol were valuable for deciding when to open businesses, they weren’t useful for deciding when to close them or to impose additional operational restrictions.

As that argument became increasingly untenable, the agency changed the standards governing business operations such that it’s impossible to reach a threshold in which community spread is high enough to warrant enhanced interventions on bars and restaurants no matter how serious the infection rate gets. Basically, Substantial Spread has been eliminated as a category.

Initial Vaccination Efforts Complicated by Glitchy ADHS Computer System

Less than 18% of the COVID19 vaccines that have been delivered in Arizona had been used as of 12/31. Clearly something is amiss, but what?

It turns out that one of the core reasons for the slow use of vaccines had to do with an ADHS computer software system. It was supposed to efficiently make vaccination appointments and provide billing information among other things. It’s built into the ADHS’ Vaccine Management System (VMS).

It’s a long story, but glitches in the ADHS’ VMS scheduling software failed to make appointments for thousands of healthcare workers that had pre-registered for vaccination. Many received no information at all back from the ADHS system. Others were instructed to go to Show Low, Globe or Snowflake for their vaccine even though they live in Maricopa County.

As a result, two of the five mass vaccination sites in Maricopa County were largely empty for many days in December. The glitches have apparently been corrected as of this weekend.

It’s a long story, but if you want to read more, check out this story by Ray Stern in the Phoenix New Times:  Arizona Vaccine Rollout Delayed by Computer Glitches, County Says.

New COVID Vaccine Executive Order Issued

Last week the Governor issued an Executive Order that he said is designed to make vaccination efforts more streamlined. The Executive Order says that the ADHS is supposed to use a statewide “vaccine allocation model”, can reallocate vaccine, and must approve all private vaccination sites. It also requires counties to post their vaccination progress and vaccination sites on their websites.

The Order doesn’t give the ADHS any authority that it doesn’t already have, but it does provide some direction and expectations to the Department.

Here’s where you can look it over. Honestly, it doesn’t look substantive to me.