AZ may permanently pay parent caregivers. Public comment ends Monday (azcentral.com)
Maricopa County heat-associated deaths jump to 89 so far in 2023 (azcentral.com)
Summer COVID-19 surge, measles emerging in more adults – Arizona PBS (azpbs.org)
Gov. Katie Hobbs names new slate for Arizona-Mexico Commission (azcentral.com)
Here’s how Phoenix-area schools are handling COVID-19 this year (azcentral.com)
Comments Due by 5pm Monday
In the early stages of the COVID-19 pandemic AHCCCS launched an initiative allowing AZ parents who are caregivers for children (minors) with disabilities (and enrolled in the long-term care system called ALTCS) to get paid for their caregiving.
The move was absolutely necessary at the time because so many caregivers were unable to work either because of risk factors or because they were in isolation or quarantine for long periods. Many caregivers dropped out of the workforce altogether or perished during the pandemic.
The initiative has been popular among parents who, for years, have struggled to find caregivers for their children. AHCCCS also saw benefits as the care network expanded greatly (one of their charges from their parent organization – the Centers for Medicare and Medicaid Services or CMS).
AHCCCS has been exploring whether to make the program permanent, allowing parents who qualify to get reimbursed for “attendant” care (bathing, eating, grooming, and using the bathroom etc.) indefinitely. Note: The proposal doesn’t include reimbursement for “habilitation” care, which is more structured and goal oriented.
Right now, about 20% of the 17,000 kids enrolled in AHCCCS and living at home & receiving home and community-based services are getting their services from parents as the paid caregiver. The remaining 13,500 are being served by caregivers who are not their parents.
AHCCCS has been accepting comments on the proposal for some time now – but the final deadline to comment ends at 5pm Monday.
Arizona lost a long-time public health professional on July 18th when Phyllis Primas passed away.
In addition to groundbreaking academic and public health work at ASU, Phyllis worked at ADHS for several years in maternal & child health and later in nursing at Maricopa County Public Health.
Phyllis was a long-time member of AzPHA, joining in October 1976, shortly after arriving in Arizona for a teaching post at ASU.
She wasn’t just an AZPHA member… she was a long-time sustaining member at the ‘Patron’ level (a $500/year support level). Phyllis also served in several leadership positions on AzPHA Board of Directors, including a term as President.
Phyllis Primas, BSN, MPH, PhD. was born in Allentown, PA. She received her doctorate in higher education administration from the University of Pittsburgh. After graduation, she was Associate Director of a public health demonstration project in West Africa through the University of Pittsburgh.
She moved to Arizona in 1975 and accepted a position at the Arizona State University College of Nursing, teaching community health courses in the graduate program.
She also chaired thesis programs and was awarded a federal grant to develop and maintain a community health clinic for the homeless, Breaking the Cycle.
Phyllis left ASU in 1981 for a position at the Arizona Department of Health Services as Manager of Community Maternal and Child Health. In 1985, she was hired as the Director of Nursing at the Maricopa County Health Department and later returned to ASU.
She had a robust research and program planning profile, authoring many reports which you can see on this ASU Research Profile. She retired from ASU in 2002 as a Professor Emerita.
Other community involvements included as Associate Dean for the original UA College of Public Health. She was a founding member of AzPHA’s active retiree group that Barbara Burkholder hosts.
Phyllis Primus: A Live Well Lived
Although measles was declared eliminated in the United States in 2000, almost 1,300 cases of measles were reported in 31 states in the U.S. in 2019— the greatest number since 1992. The 2019 U.S. measles outbreaks were all linked to travel-related cases that reached at-risk populations (un or under vaccinated against measles) in the United States.
Increase in Measles Cases — United States, January 1–April 26, 2019, | MMWR
Outbreaks can happen in areas where people may be unvaccinated or under-vaccinated, including the United States. Right now, measles outbreaks are occurring in every region of the world. Measles can enter the United States through infected travelers entering or travelling through to the U.S. as well as through infected U.S. travelers returning from other countries.
Top 10 Countries with Global Measles Outbreaks
Rank Country Number of Cases
1 India 67,592
2 Yemen 23,680
3 Pakistan 5,853
4 Cameroon 4,926
5 Nigeria 4,389
Over 61 million doses of measles-containing vaccine were postponed or missed due to COVID-19 related delays in supplementary immunization activities. This increases the risk of bigger outbreaks around the world, including the United States.
As the years have gone by, more and more people are becoming susceptible to measles. Pretty much everyone over 63 had measles as a kid and those that recovered have lifetime immunity. Cases of measles plummeted in the US after mass vaccination campaigns in the early 1960s. The US (and Arizona) enjoyed very high vaccination rates in the next 4 or 5 decades… but after that vaccination levels started declining coinciding with the ‘anti-vax’ movement.
Vaccination rates continued to slide over the last 10 years, and the statewide immunization rate for Kindergarteners now at 91%, well below the community immunity threshold for measles of 95%. Kids that don’t get caught up (or get vaccinated once they turn 18 because their parents had not vaccinated them as kids) will remain susceptible to infections as an adult. Cases of measles tend to be worse among kids under 5 and adults over 20. Measles Clinical Information
Right now, most susceptible people in the US are under 25 years old, as childhood measles vaccination rates were very high between 1963 and 2000. Most outbreaks of measles in the US these days are a result of a susceptible young adult (unvaccinated) travels abroad to a country with lots of measles and return to communities with low vaccination rates.
Vaccination rates aren’t uniform across the state. Yuma and Santa Cruz counties continue to enjoy the highest vaccination rates (above 95% for MMR among Kindergarteners). Yavapai consistently has the lowest vaccination rates with MMR coverage at only 74% and nearly 10% of students totally unvaccinated among Kindergarteners.
Another continuing trend… students enrolled in charter schools have vaccination rates much lower than students in district public schools. Also, higher income districts tend to have lower vaccination rates.
There are evidence-based strategies that can be implemented at a statewide level, but such initiatives require leadership by a state health department.
Interventions to increase pediatric vaccine uptake: An overview of recent findings
For information on school immunization requirements, review the Guides to Arizona Immunization Requirements for Child Care/Preschool and Grades K-12.
Gov. Hobbs declares heat emergency in 3 Arizona counties
Hobbs declares heat state of emergency Gov. Katie Hobbs’ health director was sabotaged. So was Arizona EG.5 strain of COVID-19 has been increasing in Arizona
Americans suffer when health insurers place profits over people Initiative campaign launches in Arizona to expand abortion rights Campaign launches to give Arizonans a constitutional right to abortion access |
Even though the state and federal public health emergencies are over it doesn’t mean COVID is over or that we’re not getting reports of illness. Labs and clinicians that find a case of COVID are still supposed to report that data to the state and county health departments. The state and county also still get some COVID hospitalization data. So, what are they finding this Summer?
EG.5 strain of COVID-19 has been increasing in Arizona
Not much really. Throughout the course of the pandemic, we’ve seen pretty consistent surges of infection every six months… consistent with community neutralizing antibody titers (which wane after 6 months). T-cell immunity lasts a lot longer and protects well against severe disease. Nationwide, COVID hospitalizations have been up slightly in the last couple weeks (12%) but in Arizona it’s down about 25%.
The burden in hospital emergency departments these days is due to dehydration and heat-related illnesses.
Gov. Hobbs declares heat emergency in 3 Arizona counties
It’s still possible we will observe an upswing in infections in the next month or two… or it could be that the pattern has changed and will change to a pattern more like cold viruses and influenza.
Nationally, the Omicron strain called XBB.1.9.2 has taken the top spot in the US, accounting for about 17% of new COVID-19 cases. In the UK, EG.5.1, nicknamed “Eris,” accounts for about 15% of COVID-19 cases, making it the second most prevalent variant there. The rise of EG.5.1 is also notable in Asia, where it was originally detected.
Symptoms of EG.5.1 are similar to the common cold or allergies, with sore throat, runny nose, clogged nose, sneezing, dry cough, and headache as the leading symptoms. Shortness of breath, loss of smell, and fever are not on the list.
Meanwhile, the FDA’s expert advisory committee (VRBPAC) is recommending that the US shift to a monovalent booster shot this fall. That monovalent shot would drop the old ancestral strain antigen and strictly focus on the XBB-lineage of the Omicron variant with a preference for XBB.1.5.
See: Updated COVID-19 Vaccines for Use in the United States Beginning in Fall 2023 | FDA
Here’s the FDA’s one page summary of why they think the fall booster should focus on XBB.1.5: Recommendation for the 2023-2024 Formula of COVID-19 vaccines in the U.S.. The CDC’s advisory committee – the Advisory Committee on Immunization Practices (ACIP) hasn’t yet made a recommendation about the makeup of the fall COVID vaccine – but it’s a safe assumption they’ll be in line with VRBPAC.
Governor Hobbs declared a heat emergency releasing some money (about $200K) to reimburse counties for their heat release work this summer. The declaration
While the media coverage has mostly focused on the emergency declaration… Hobbs also signed an executive order that’s of potentially more public health consequence than the emergency declaration.
That Executive Order (not the emergency declaration) requires ADHS, ADOA, ADEM and the Governor’s Office of Resiliency to develop a written report with recommendations to improve the heat relief system in future summers. The reports are due on March 1, 2024.
ADHS’ tasks are supposed to describe where the heat relief stations should be and look at resource allocation changes needed in emergency departments, heat related workplace incidents, and morgue capacity. The report is also supposed to come up with a plan for more formalized & centralized statewide cooling centers. The report is supposed to include recommended statutory changes.
The Department of Administration (ADOA) is supposed to create a plan to better use state buildings and property for heat relief cooling centers and change personnel rules so that state workers could staff heat relief centers and have the time count toward their job.
The Governor’s Office of Resiliency and the Department of Emergency & Military Affairs are required to coordinate the comprehensive overall plan.
It’ll be interesting to see the quality of the reports that are due March 1, 2024. If the reports are detailed and actionable and IF those recommendations are translated into policy and funded, the plan has a chance to make substantive heat adaptation improvements.
A coalition of abortion care advocates (Planned Parenthood Advocates of Arizona, Healthcare Rising Arizona, the ACLU of Arizona, NARAL Arizona, Affirm Sexual and Reproductive Health and Arizona List) filed a ballot measure with the Secretary of State last week that would expand access to abortion care in the AZ Constitution.
The Arizona Abortion Access Act would permit abortions up to the point of fetal viability (around 24 weeks of pregnancy)… which was the law in Arizona prior to last year (a law signed by former Gov. Ducey last year prohibits abortions after 15 weeks of pregnancy).
AzPHA Special Report: Women’s Reproductive Rights in Arizona 1864-2022
The constitutional amendment (if passed by the voters) would permit abortion care above 24 weeks to protect the life or physical or mental health of the mother. It would also prohibit any law penalizing a person who helps someone get abortion care.
The campaign will need to collect at least valid 383,923 signatures from voters by July 3, 2024, to qualify for the general election ballot. AZPHA member and Affirm CEO Bre Thomas estimates the effort will likely need to raise $0 – $50M.
The measure was carefully crafted to make sure it is of a single subject in compliance with Proposition 129. It also doesn’t raise any fees or taxes – meaning the measure can pass with 50% plus one vote as opposed to 60% as would be required by Proposition 132 if it raised taxes.
Good news. Cooler heads finally prevailed, and the legislature passed a measure last week that will allow Prop 400 on to the ballot in Maricopa County in the fall of 2024. Maricopa County is the only county that needs legislative approval to get their transport tax on to the ballot. It’d kind of a weird story. If you’re interested read this piece: Why Maricopa County’s Prop. 400 transit tax needs OK from Legislature
The measure is a compromise between various factions in the legislature – mainly the Dems and a few of the more centrist Republicans.
The measure will basically ask voters in Maricopa County to continue Proposition 400, a half-cent transportation tax that funds roads and public transportation. (See Senate Bill 1102). The tax funds street and highway projects, along with public transportation.
The money distribution ($24B over 20 years) is as follows: 40.5% allocated to freeways and highways, 37% to public transit and 22.5% to roads and intersections. It includes specific language saying that pot of money can’t be used to build new light rail lines. It also makes sure there won’t be a new light rail station or line around the Capitol.
State law requires all schools to check the vaccination status of their students and ensure they meet statutory requirements for attendance (e.g. are immunized with the required vaccines or has a proper exemption). Schools are also required to submit that data to the ADHS each fall (deadline is November 15). Data submission is required for Child Care/Preschool; Kindergarten; and 6th grade. ADHS is required to publish the data by school. That report comes out each Spring.
ADHS posts some aggregate tables but also a big giant spreadsheet with the vaccination rate by school. A clever parent that knows how to sort in Excel could quickly find the vaccination rate for their kid’s school. Here’s the big file with all the school data. You can look up individual school immunization rates here: ADHS – Arizona Immunization Program – State & National Immunization Coverage Data – Immunization Coverage Data
The statute requiring immunization administration and reporting makes it clear that private schools must comply See: ARS 36-671: “School” means a public, private or parochial school that offers instruction at any level or grade through twelfth grade…”
The cornucopia of new voucher micro-schools popping got me wondering… will the Arizona Department of Education & ADHS be following up to make sure the new unregulated micro schools are actually asking parents for immunization records (or an exemption form) as a condition of attendance this fall? Will they be reporting the results?
Private schools springing up as Arizona’s school voucher program grows
Established private schools have had some years to get up to speed, but the new micro and religious schools popping up overnight (and enjoying little accountability) are brand new.
Inquiring minds want to know what kind of outreach is happening to ensure compliance. Perhaps an Arizona journalist will follow up with Superintendent Horne & ADHS Director Cunico to find out!
ARS 15-871 Definition
ARS 15-872 Proof of Immunization; Noncompliance; Notice to Parents; Civil Immunity
ARS 15-873 Exemptions; Nonattendance During Outbreak
ARS 15-874 Records, Reporting Requirements
ARS 36-671 Definitions
ARS 36-672 Immunizations; department rules
ARS 36-673 Duties of local health departments; immunization; reimbursement; training; informed consent
ARS 36-674 Providing proof of immunization
Arizona Administrative Code Requirements 9-R9-6-700 through 708
