Dr. Gerald just published this week’s AZ epidemiology and hospital capacity report, and the results are alarming. Those of you that read this blog seldom see me using that kind of language (at least since June and July) but there’s no other way to say it. This week’s report feels a lot like early June.
We’re now entering exponential growth of cases especially in the 15 to 24 year-old group but also among 25-64 year-olds. As Dr. Gerald says in his report this week:
“We are now entering a crisis, one in which we have little time to walk-back from. While hospitals still have capacity to care for critically ill patients, we are nearing the point at which noticeable shortages of personnel and resources are going to emerge. owing to rapidly increasing case counts and the lag between case identification and hospitalizations. If this “surge” is not quickly addressed, new Covid-19 cases will overwhelm our capacity to provide optimal hospital care within a matter of weeks.”
Community-driven transmission has surpassed the rates we experienced during the second week of June when 13,000 cases were diagnosed. At current transmission levels, Arizona is not far from exceeding the weekly cases we had just before the state authorized using Crisis Standards of Hospital Care in early July.
We’re also are seeing significant viral amplification in rural areas (that generally have no mask mandates in place) with Graham, Gila, Coconino, Yuma, and Navajo counties having higher than average per capita rates.
Hospital admissions and eroding capacity are lagging the case rates just as we saw in June and July. The percentage of ICU beds occupied by patients with Covid-19 has increased from a low of 6.2% on September 13th to 18.4% on November 10th.
The current hospital surge differs from the one in June in that Covid-19 infections have shifted towards younger patients who are less likely to require hospital and ICU care. Also, better infection control practices and staff testing capacity in long-term care settings have led to proportionately fewer cases among the most vulnerable long-term care facility residents (Figure 8 in Dr. Gerald’s report shows the Pima County data).
Those factors, along with improving treatments, more experienced providers, and greater testing accessibility have led to a 23% reduction in hospitalizations and a 45% reduction in ICU cases for the same number of Covid-19 diagnoses (Figure 9). However, when rising community-transmission spills over into long-term care settings, admissions will rise more quickly. Arizona hospitals also have less reserve capacity now than when hospital occupancy was lower this summer.
The return of part-time residents, a backlog of elective procedures, and non-Covid respiratory illnesses also mean that hospitals will reach capacity sooner than they did this summer. If that happens, Arizona can expect less external staffing assistance this time since many other states are experiencing their own hospital capacity crises.
WHAT CAN BE DONE?
Face Coverings
For the last several weeks we’ve been calling for a statewide face covering mandate. Face coverings are increasingly recognized as the highest return on investment intervention to slow the spread of the SARS CoV2 virus (besides vaccines). Evidence from the National Academies of Medicine and Science demonstrated this effectiveness. More compelling results have been shown in a recent Systematic Review of studies in The Lancet. It’s past time for Arizona to implement a sensible statewide face covering mandate similar to the one implemented by Utah’s governor last weekend.
Mitigation Measures in Bars and Restaurants
A recent model reported in Nature, shows that many infections are likely coming from bars and restaurants. Indeed, in Arizona the combination of allowing local jurisdictions to implement face covering ordinances and temporarily closing bars and scaling back restaurant capacity to 50% had a dramatic effect on the spread of the virus.
The best thing we can do as a state right now is to learn from last summer’s lessons and significantly reduce the number of people allowed in bars and restaurants at one time. We know these mitigation strategies work and they are our best option for reducing spread and ensuring that our healthcare system will be able to provide high-level care.
The enhanced mitigation measures will need to be accompanied by better compliance and enforcement than we currently have in place. The governor should consider an executive order to give enhanced enforcement authority to county health departments so they can get bars and restaurants that aren’t following the mitigation measures back into compliance. Counties will also need CARES Act funds to finance the effort.
Personal Responsibility
As we press into the holiday season, the urge to gather socially with friends and family will be tempting, especially given the stress of 2020. However, it’s important that we think through the ramifications of our decisions. Decisions we make through November and December could be with us for months to come and could impact how we visit loved ones in hospitals or long term care facilities, whether our kids can return to school as well as the level of care we receive from our healthcare system.
Failure to act now in proactive ways will likely result in completely closing bars, nightclubs, schools, hospitals and visitations in long-term care facilities in early December when hospital capacity is exceeded and Crisis Standards of Care are again authorized.
