Will Humble Uncategorized, Wills Blog

National Public Health Week Message from AzPHA Board President Pele Peacock Fischer

This week marks the 25th annual celebration of National Public Health Week, a celebration that usually passes without much notice.

This year is starkly different. The COVID19 pandemic has put public health in the national spotlight, with many Americans suddenly attuned to the importance of public health in our communities.

Many Arizonans have come to recognize just how essential our public health efforts and public health workers truly are. To quote the White House proclamation:

“Whether it is the scientists and researchers who developed life-saving vaccines in record time; or local leaders who have taken evidence-based action to keep their communities safe; or the staff and volunteers who have worked to slow the spread of the virus through testing, case investigation, and contact tracing; or the doctors, nurses, and clinicians who continue to provide around-the-clock care to those who have fallen ill, dedicated public health professionals on the front lines of our response to COVID-19 deserve our gratitude.”

In Arizona, our county and state health departments worked tirelessly and made many sacrifices to protect our communities, despite years of budget cuts and neglect. There are many unsung heroes toiling away in county buildings in fields like epidemiology and health statistics that until this year were vastly misunderstood and undervalued.

This is an unprecedented time of change, and also an opportunity to finally recognize the importance of a maintaining a robust public health system.

So this year, to mark National Public Health Week, please join us in thanking those public health professionals who work every day – and sometimes put their lives on the line — to ensure our health and safety.

– Pele Peacock Fischer, JD

  Board President,

  Arizona Public Health Association 

Will Humble Disease Control, Wills Blog

AZ Attorney General Opinion Temporarily Unravels the Governor’s Prohibition of County Mask Mandates

Ducey Promptly Follows Up by Signing HB2770 Which Says that Businesses Can Ignore Mask Requirements and Regulations – Even in Hospitals or Factories

 The Arizona Attorney General issued an opinion last week saying that Governor Ducey can’t use his emergency authority (under the declared public health emergency) to stop counties from enacting their own mask mandates. As you recall, a couple of weeks ago he issued an edict that counties and cities can’t have and enforce mask mandates.

The legal opinion rests on the fact that the governor used executive authority derived from the public health emergency declaration in the emergency management statutes (ARS 26-307) to prevent counties from having and enforcing mask mandates.

The problem for him is that Pima County (and the other counties with mask mandates) used separate authority in their normal public health statutes (36-183.02 – Sanitary regulations) to require masks in public.

“Each county shall investigate all nuisances, sources of filth and causes of sickness and make regulations necessary for the public health and safety of the inhabitants.” 

Interestingly, the A.G. opinion says that Director Christ can overturn county mask mandates if she so desires. Because of the public health emergency, she has broad authority under 36-787 – Public health authority during state of emergency or state of war emergency) to set statewide policy through rules or regulations regarding face coverings according to the A.G. opinion.

So basically, she needs to decide if it’s important enough to her that counties don’t have mask mandates that she’ll impose a statewide prohibition on mask mandates. I’d say the odds are about 60-40 that she does.

Governor Signs HB2770 Which States that Businesses Aren’t Required to Enforce Mask Mandates – Even in Hospitals and Factories

The Governor signed HB2770 Friday which will completely eliminate any enforcement of mask mandates that are imposed by the state, counties or cities. Once the bill takes effect 90 days after the end of this legislative session, businesses (including medical and manufacturing facilities) can ignore any mask mandates that are in place- regardless of what regulation currently requires them.

Had this bill been in place before the pandemic, there never could have been a business based mask mandate by any jurisdiction. It even negates the regulations that ADHS has that require infection control masks in medical facilities like hospitals. Additionally, it negates any protective equipment mask requirements that the Industrial Commission has for chemical or infection control purposes.

Astonishingly irresponsible to sign a bill that completely gets rid of this non-pharmaceutical intervention during an emergency and also stripping all regulations from the Administrative Code that require infection control or environmental exposure masks.

Of course, the ADHS under the leadership of Director Christ offered no statement or testimony in committee expressing any concern whatsoever about the bill.

Such is the state of the public health leadership in this state.

Will Humble Maternal Health, Prevention, Wills Blog

Leveraging Doulas to Improve Birth Outcomes

Doulas are professionals who provides physical, emotional, and informational support to a woman throughout pregnancy, childbirth, and postpartum. Doula’s act as a facilitator between the laboring women and her physician by ensuring that mom and dad get the information they need in a way that they understand so they can make informed decisions.

A growing body of evidence suggests that continuous support from doulas or other non-clinical labor support can improve birth outcomes for both mothers and infants, fewer preterm and low-birth weight infants, and reductions in cesarean sections. In fact, when doula services are included throughout the pregnancy and birth process, births cost less. A recent study found that when a doula is included in the process births cost an average of $986 less – including the doula service fee.

SB 1181 would go a long way toward building doula’s into the public health and healthcare workforce by providing a way for doula’s to get a ‘certificate to practice’ from the ADHS as a state-certified doula. A person providing doula services wouldn’t be required to get a certificate in order to practice. However it would provide baseline professional standards and ultimately provide a pathway for reimbursing doula’s for their services – which would build the doula workforce.

Currently, Minnesota and Oregon take advantage of the fact that doulas can reduce healthcare costs while improving outcomes in their state Medicaid programs. Oregon Medicaid program provides direct payments to doulas through their contracted managed care organizations as does Minnesota. Last year, Minnesota increased the reimbursement rates for doulas after recognizing the role they play in improving outcomes and reducing overall costs. 

Several organizations, such as DONA International, provide doula training and certification. Women can also choose to become certified as community-based doulas through HealthConnect One. This community-based doula program model, which has been replicated nationwide to serve unique populations, trains doulas to provide culturally sensitive pregnancy and childbirth education to underserved women in their own community.

While all doula services can be beneficial, creating a standard for the training and certification of doulas may improve understanding and acceptance of doula care.

Fortunately, SB 1181 is receiving bipartisan support this year and it looks like it may be going to a final floor vote in the House this week. We certainly hope so!

Looking for more info? Access this UA Issue Brief on Doula Coverage to Help Minimize Arizona’s Birth Woes.

Will Humble Vaccination, Wills Blog

Special Vaccination Event Set for Persons with Developmental & Intellectual Disabilities 

We’ve been helping a host of partners over the last few months to get the ADHS to prioritize persons with developmental and intellectual disabilities for vaccination. Our original goal (going back to December) was to get the ADHS to put folks with disabilities into Category 1b like many other states had done. While those living in group homes were prioritized, all others were not, despite the compelling evidence that many of them are at high risk for a bad outcome. We were unsuccessful at convincing Director Christ to take this important action but we didn’t give up.

When the ADHS went to the strictly age-based system, we pointed out that persons with disabilities under the age of 55 (who had been waiting patiently in line in Category 1c) now had to wait even longer- until their age was called. It didn’t work, but we didn’t give up.

Fortunately, continued advocacy by the ARC of Arizona, Special Olympics, the DDPC, the ACDL, and Ability 360 was successful in scoring a special-needs vaccination event next weekend at the Disability Empowerment Center in Phoenix.

The event will be on Saturday, April 10 from 2:30pm to 9:00pm and on Sunday, April 11 from 8am to 6pm. Appointments are required and can be scheduled with Passport Health at Clinic Sign Up Information (passporthealthglobal.com).

Spread the word!

Will Humble Disease Control, Vaccination, Wills Blog

If You’ve Recovered from COVID-19 Should You Still Get Vaccinated?

The short answer is YES…  but emerging research shows that (among people that have been infected and recovered) the the first dose gets you to a very high level of protection but that the booster shot is unlikely to provide you with any extra benefit – at least in the short-run.

Here’s the story:

Dr. Joe Gerald’s best estimate is that close to 35% of Arizonans have been infected with and recovered from the SARS CoV2 virus that causes COVID-19. Now that all adults qualify to try to get a vaccine, more people are wondering if they need to or should get a vaccine even though they had COVID-19 and recovered?

The short answer is yes. After looking at the current evidence it looks like people that have been infected and recovered benefit from higher immunity if they get a vaccine. But, research that came out today suggests that the booster shot is unlikely to provide any additional benefit (again this is just among people that have been infected and recovered).

Infection with the virus provides good immunity for most folks. Research shows that antibody and T-cell responses post infection provide good protection against reinfection. Research also shows that 91% of people who recover are unlikely to be infected again for six months (even if they just had a mild infection or even no symptoms).  But…  infected but asymptomatic people make fewer antibodies than people that had symptoms.

Before actual data existed, I had expected that those with a natural infection would have better protection than people who had been vaccinated but never caught COVID-19. I was wrong about that.

A Research Letter in The New England Journal of Medicine found that antibody levels are higher in fully vaccinated people (Moderna or Pfizer) than in those who had recovered from infection. That was surprising to me.

It’s clear that people that have been infected but recovered should get vaccinated. But do they need the follow up booster? Data published today in the journal Nature suggest that while the first dose of Pfizer or Moderna provides a clear benefit for previously infected folks the booster shot is unlikely to provide extra benefit – at least in the short-run.

The article in Nature is called Antibody responses to the BNT162b2 mRNA vaccine in individuals previously infected with SARS-CoV-2 found that:

“…  individuals previously infected with SARS-CoV-2 developed vaccine-induced antibody responses after a single dose of the Pfizer–BioNTech mRNA vaccine were similar to antibody responses seen after a two-dose vaccination course administered to infection-naive individuals.”

“… a second vaccine dose did not offer previously infected individuals a substantially greater benefit over a single dose in antibody neutralizing potential. Thus, our data suggest that a single dose of the Pfizer–BioNTech vaccine is sufficient for individuals with prior SARS-CoV-2 infection…”.

Bottom line: folks that have been previously diagnosed with COVID-19 should get vaccinated, but the research published today suggests that booster shot is unlikely to provide additional benefit.

Editorial Note: Future research might show that there is a benefit to people that had previously been infected – especially over the long run. Also, at some point those vaccination cards might be used for travel and other privileges so there may be an administrative benefit for getting the Moderna or Pfizer booster if you’ve previously been infected with SARS CoV2.

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