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Here is Dr. Gerald’s Weekly Report. At least things aren’t continuing to get worse. Below is his narrative intro:

In a bit of an unexpected change, conditions markedly improved this past week. Cases as well as hospital and ICU occupancy were lower. Like everyone else, I am looking for a glimmer of hope but don’t want to get my (or your) hopes up as I don’t really understand why things are better. I worry there is the real possibility that this improvement could be short-lived.

It is tempting to speculate what might be occurring. Importantly, improvements appear to be country-wide (see Rt.live). This suggests a common thread independent of geography, climate, or local policy. This thread is likely to be a behavior that is structurally and/or culturally imposed. So, here is me crawling out on a limb…I’m going to put my money on university and K-12 closures over the holiday period (see Haug 2020 Ranking the Effectiveness of worldwide COVID-19 Government Interventions which identifies educational closures are the second most effective mitigation policy).

Arizona basically exited the exponential curve the first week of December following university closures. We saw an actual decline in cases beginning the first week of January following closures of K – 12 for Christmas. Yes, I know actual school activities varied widely across school systems but still. Agree or disagree, I am happy to hear your thoughts. If my hypothesis is true, cases could increase in the coming weeks as schools resume their pre-holiday level of activities.

Evidence Review Reinforces Evidence that Face Masks Work

For many months now, there has been clear evidence that proper mask wearing while in public spaces is a very effective way of slowing the spread of COVID-19. A new study of studies out this week reinforces that evidence. It also establishes that good adherence to mask wearing improves economic activity (GDP). Below is an excerpt from the study.

The available evidence suggests that near-universal adoption of nonmedical masks when out in public, in combination with complementary public health measures, could successfully reduce Rt to below 1, thereby reducing community spread if such measures are sustained. Economic analysis suggests that mask wearing mandates could add 1 trillion dollars to the US GDP.

Models suggest that public mask wearing is most effective at reducing spread of the virus when compliance is high. We recommend that mask use requirements are implemented by governments.

Such mandates must be accompanied by measures to ensure access to masks, possibly including distribution and rationing mechanisms so that they do not become discriminatory. Given the value of the source control principle, especially for pre-symptomatic people, it is not sufficient for only employees to wear masks; customers must wear masks as well.

Editorial Note: Despite the clear evidence that face coverings are very effective Arizona still does not have a statewide mask mandate. A meaningful mandate that focuses on business compliance would have clearly not only slowed the spread of COVID-19 in Arizona but also would have improved economic activity.

Nevertheless, Governor Ducey and Director Christ are not interested in such an intervention. Since they are the persons vested with the authority in ARS 36-787 – Public health authority during state of emergency or state of war emergency it is clear this high return on investment evidence-based intervention will not be used in Arizona.

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.”

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.

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.