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Arizona continues to experience high levels of community transmission with case rates now plateaued instead of consistently improving. Test positivity remains stubbornly high reminding us that test capacity, accessibility, and/or uptake is inadequate to meet public health needs. 

With waning vaccine efficacy and a potentially short duration of acquired immunity, the unvaccinated cannot “free ride” on high levels of community immunity. Instead, they will almost certainly become infected. This means that persistently high levels of transmission, and more importantly hospitalizations, are possible for an extended time until the supply of unvaccinated, previously uninfected adults is exhausted.

Vaccination remains the most important public health priority to reduce transmission and severe illness; however, mask mandates, restrictions on indoor gatherings, and targeted business mitigations are still needed to reduce/control transmission in the short-run with the primary goal being to prevent overwhelming our critical care facilities and reducing pressure for vaccine-escape variants.

Recent reports indicate that vaccine immunity to infection falls against the Delta variant by 6 months. Accordingly, it is becoming more likely that the Delta variant could sustain forward transmission even in a highly vaccinated community without additional boosters or other non-pharmacologic interventions.

Because immunity against severe illness is much longer lasting, infections among the vaccinated will have less impact on individuals and communities. This provides hope of an end-game where we can (mostly) live with SARS-CoV-2.

COVID-19 hospital occupancy is slowly improving. Nevertheless, occupancy is likely to exceed 20% of all beds in the general ward and 25% of beds in the ICU for another week or so. Access to care will remain restricted; therefore, delays in elective (non emergency) procedures will persist in the face of staff shortages in inpatient and outpatient settings.

Weekly COVID-19 deaths now exceed 200 per week and will almost certainly reach 300 for the week ending September 5th and perhaps September 12th too before receding.