Will Humble Marijuana, Medical Marijuana, Social Determinants, Wills Blog

State Health Department Releases a List of Zip Codes That Have Been “Disproportionately Affected by the Enforcement of Arizona Marijuana Laws”

Agency Fails to Release their Methodology (at Least So Far)

When voters approved the new Adult Use Marijuana law last November they required the ADHS to establish a social equity program that would provide an opportunity for people that live in areas that have been “disproportionately affected by the enforcement of Arizona Marijuana Laws” an opportunity to qualify for a license to run a marijuana store (all the other stores are converted medical marijuana dispensaries).

In total, the ADHS will be issuing a couple of dozen additional marijuana licenses to persons who qualify under the social equity program.

The language that the voters approved told the agency to give preference to person that live in areas that have long suffered from over-policing and over-prosecuting for possessing small amounts of marijuana.

Last Friday, ADHS released the set of Zip Codes that they believe qualify as having been over policed and over prosecuted. Interestingly, they didn’t provide a map or disclose the criteria that they used to make the decision. Puzzling why they would release the list with no description of the methodology or data sets that they used.

For me, this is an important development, because it’s the first time that I’m aware of that the State of Arizona has officially conceded that certain parts of the state have been disproportionately suffering from over-policing and over-prosecuting, with important social justice consequences.

Will Humble Disease Control, Public Health, Vaccination, Wills Blog

Dr. Gerald’s Weekly Epi & Hospital Occupancy Report: Transmission Remains High; Access to Care in AZ Hospitals Remains Restricted

View the Full Report

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.

Will Humble Disease Control, Early Childhood, Public Health Law, Wills Blog

U.S. Treasury Department Scolds Doug Ducey for Using Federal Relief Funds to Discourage Schools from Requiring Masks

 Treasury Department Demanding Answers
Read the Letter from the Treasury Department to Ducey

Just when you thought you’d seen the limits of the governor’s poor decision-making, he goes a step further. Back in August, he went so far as to misuse federal funds to provide financial incentives for K-12 schools to ignore CDC COVID mitigation recommendations. In a second Executive Order, he offered $7K per pupil in federal money to families that live in districts following CDC mitigation measures.

Let’s start with the school bribery scheme.

In that E.O. the governor offers to increase per pupil funding by $1,800 per year for schools that ignore CDC mitigation measures (universal masking).

Now on to the scheme where parents get $7,000 ‘cash on the barrelhead’ if they live in a district that is following CDC mitigation measures and they don’t want to send their kid there because of that.

Fortunately, the U.S Department of Treasury has been keeping a close eye on Governors that are misusing federal funds, including Governor Ducey. Today, the Treasury Department sent Doug Ducey a letter telling him that spending federal COVID relief funds for things that discourage compliance with evidence-based solutions for stopping the spread of COVID-19 is not permissible. The letter closes by demanding that the Governor “… describe how the State will “remediate the issues identified with the two programs”.

Here is an excerpt from the sternly worded admonishment letter:

We are concerned that two recently created Arizona grant programs undermine evidence-based efforts to stop the spread of COVID-19. We understand that the State of Arizona has established a grant program for school districts with SLFRF funds that is conditioned on, among other things, the recipient school districts not requiring the use of face coverings during instructional hours and on school property.” In addition, we understand that the State of Arizona has established a school voucher program with SLFRF funds to provide up to $7,000 per student to families fortition or other educational costs at a new school that does not require face coverings if the students current school is requiring the use of face coverings during instructional hours and on school property.

The purpose of the SLFRF funds is to mitigate the fiscal effects stemming from the COVID-19 ‘public health emergency, including by supporting efforts to stop the spread of the virus.5 A program or service that imposes conditions on participation or acceptance of the service that would undermine efforts to stop the spreadofCOVID-19 or discourage compliance with evidence-based solutions for stopping the spread ofCOVID-19 is not a permissible use of SLERF funds.

Accordingly, Treasury requests that the State of Arizona provide a response describing how the State will remediate the issues identified with the two programs described above. Please submit your response to Jacob Leibenluft, Chief Recovery Officer at the Treasury Department, within 30 business days of receipt of this letter.

Failure to respond or remediate may result in administrative or other action, including as provided under Treasury’s Interim Final Rule.”

Ducey’s Childlike Response: Take Me to Court

In characteristic fashion, Governor Ducey dismissed the US Treasury Department’s demand that he remediate his harmful practice of bribing schools not to require universal classroom masking. His short statement back to Treasury was that he will not be responding to the letter, telling Treasury to take him to “court”.

That sounds silly, considering that all federal grants come with certain conditions, conditions that Governor Ducey has broken. Remedies for failure to comply with the terms and conditions of grants are usually administrative sanctions rather than legal ones.

In other words, since the federal government is a large distributor of funding to Arizona, a usual administrative remedy would be for the federal government to withhold additional federal funding until the state demonstrates that it will stay in compliance with future terms and conditions by remediating his past non-compliance.

School Bribary Funds Disclosed

On Friday, Yana Kunichoff from the Arizona Republic disclosed which Arizona schools received funds under the governor’s program that is now under federal scrutiny. More than $109 million in federal COVID-19 relief funds has been allocated to 98 school districts and charter schools under that program, which was only available to districts without mask mandates.

You can search for which charter school chains and school districts received the cash in Yana’s article: School funding: Which schools got money from Ducey’s COVID-19 program? One thing that you’ll notice right away is the enormous amount of money that went to charter schools, especially the BASIS Charter Schools and others like it.

Will Humble Wills Blog

Save the Date: Annual AzPHA Public Health Award Celebration: November 9, 2021

Accepting Nominations Now!

Each year the Arizona Public Health Association has a special awards event in which we recognize public health professionals and health care workers across Arizona who are performing extraordinary services to our community.

Please take a few minutes to share those stories and others so that we may recognize them at our 2021 Arizona Public Health Awards to be held Tuesday, November 9th from 5;30 – 8:30 pm at the University Club (39 E. Monte Vista Road) in Phoenix.

It will be an outdoor, happy hour event. Tickets will be $40 per person. Registration begins later this week!

Please take a moment to view our award  categories and submit your entries by October 15, 2021

Nominate Here!

Past AzPHA Awardees By Category

AzPHA Scholarship Award

Cele Cohen Nursing Award

Elsie Eyer Commitment to Underserved People (CUP) Award

Harold B. Woodward Award

HEMMY Award

Senator Andy Nichols Honor Award

Will Humble Disease Control, Prevention, Public Health, Wills Blog

Governor Ducey’s Decisions Increased COVID Death Toll

AzPHA Executive Director Editorial in the Arizona Daily Star

By Will Humble

610 days after the state’s first COVID-19 death, Arizona is tragically, incomprehensibly, and preventably approaching its 20,000th life lost due to COVID-19. 

The most devastating part of this horrible pandemic milestone: Many of these deaths, and the countless additional lives impacted by each of their tragic passings, could have been avoided had it not been for poor, misguided, and overly-politicized decisions by Governor Ducey and former Arizona Department of Health Services Director Cara Christ.

Their willingness to play political hardball with a deadly pandemic is nothing new, but it wasn’t always that way. For the first couple of months of the pandemic, their response was somewhat thoughtful and nowhere near the level of political gamesmanship that we’ve suffered since. 

The memory of Ducey’s initial mitigation measures — a successful stay-at-home order in March of 2020 and a later “pause” of business operations in June of 2020 as a summer surge brewed — feels like a fever dream. His willing collaboration with officials regardless of political party is now a distant memory as his lethal politicization of the public health crisis continues to cost Arizonans their lives.

As a public health practitioner with over thirty years of experience, I can’t underestimate the dangerous impact that the governor’s knee jerk decisions — most of which run counter to any scientific evidence — have had in our state. 

Instead of eyeing his next primary election and catering to anti-science politicos, we’re asking the governor to please step up, drop the partisan posturing, abandon his pre-existing unwillingness to use mitigation measures, and get to work to end the pandemic in Arizona once and for all.

Here’s the bottom line: we want Doug Ducey and his team to begin doing what President Biden has done from the beginning — guiding us out of the pandemic. What’s more: we’re willing to help. We’re facing complex problems that threaten not only the lives of Arizonans, but the stability of our economy and the safety of our schools.

Here we are, 610 days into the COVID-19 pandemic in Arizona, about to surpass 20,000 deaths, and our governor is more interested in posing in front of border fences and criticizing President Biden’s efforts to proactively address the pandemic than applying evidence-based mitigation measures that we know work.

Thankfully, we now know how to get out of the pandemic. Give cities and counties back their ability to implement masking and other mitigation measures.

Stop micromanaging the universities and community colleges and let them incentivize vaccination and have a reasonable student code of conduct that requires unvaccinated students to get tested weekly.

Take his boot off the throats of local school boards and allow them to use evidence-based practices like universal masking to keep students healthy and in the classroom this fall. Begin using evidence-based, targeted messaging to persuade Arizonans to get vaccinated.

We just need Ducey to find the courage and political will to get the job done.

Governor, respectfully, it’s time to start doing your current job instead of positioning yourself for whatever you see as your next posting. 

Nearly 20,000 Arizonans have died, and more will continue to suffer if you don’t put your partisanship aside. Your aspirations beyond the governorship can wait — the health and wellbeing of our state can’t.

Will Humble Disease Control, Wills Blog

New Cases Per Week Stop their Former Decline; AZ Crosses the 20,000 Deaths Threshold; Unvaccinated COVID Patients Continue to Pack Hospitals, Impacting Non-Covid Care

View This Week’s Epidemiology & Hospital Utilization Report from Dr. Gerald

This week Arizona crossed over the 20,000 COVID-19 deaths mark. This pandemic would always have taken many lives no matter what kinds of interventions that Governor Ducey and former Director Christ implemented. The fact that they were hostile to masking requirements (even preventing cities and counties, schools and universities from requiring masks) and were unwilling to do any mitigation in bars, restaurants and nightclubs led to Arizona’s lethal outcome.

Arizona is 6th in the nation in COVID19 mortality because of Governor Ducey and former Director Christ’s decisions. For example, Colorado and Washington State have similar populations to Arizona yet have only had about 7,500 COVID-19 deaths. The difference? They have thoughtful governors and health directors.

Some have suggested that Arizona has had such a lethal pandemic because we have a disproportionately high number of older persons per capita. This is FALSE.  After adjusting for age, Arizona has the 3rd highest per-capita death rate from COVID19, just under New Jersey (which experienced the first wave at a very bad time) and Texas, which, like Arizona, has a governor and health director that are hostile to all public health interventions.

Current Situation Report from Dr. Gerald:

Arizona continues to experience high levels of community transmission with case rates plateauing. The decline in cases per week over the last 2 weeks has stopped and we are now no longer decreasing. 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, there’s little reason to believe the unvaccinated can evade infection with the considerably higher risk of severe outcome it entails. See this article from The Lancet for details. This trifecta means that persistently high levels of transmission, and more importantly hospitalizations, are possible for an extended time-period until we’ve exhausted our supply of unvaccinated, previously uninfected adults.

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. Access to care will remain restricted even on the backside of waning COVID-19 case rates. Expect delays in elective procedures to persist especially given worsening staff shortages in inpatient and outpatient settings.

View The Full Report
Will Humble Disease Control, Prevention, Wills Blog

New At-Home Antiviral Pill May Be an Effective Treatment for COVID19

Please Don’t Call It a Game Changer, It Isn’t. The Vaccines Are!

Merck said in a press release today that an antiviral drug that they’ve been investigating “… significantly reduced the risk of hospitalization or death at a planned interim analysis of the Phase 3 among non-hospitalized adult patients with mild-to-moderate COVID-19.”  They say that the investigational antiviral drug, called molnupiravir, cuts hospitalization or death by approximately 50%. The press release said that 7.3% of the 775 patients who received molnupiravir were either hospitalized or died (28/385) compared with 14.1% of placebo-treated patients (53/377); [p=0.0012]. No deaths were reported in patients who received the drug compared to 8 deaths in patients who received placebo.

The Phase 3 clinical trial was stopped early because the trial was approaching full recruitment of the Phase 3 sample size (1,550 patients) with more than 90% of the intended sample size already enrolled.

HHS has already contracted for 1.7 million courses of molnupiravir subject to the FDA giving emergency use authorization.

Here’s an article from Nature Structural & Molecular Biology that describes how the medicine inhibits viral replication preventing viral reproduction by causing lots of base pair mistakes which is called ‘error catastrophe’.

Editorial Note: While the results presented by Merck in their press release are impressive, these results don’t even come close to the protective effect that vaccines provide. Plus, vaccines prevent infection and transmission of the virus, while this drug only provides a treatment.

From a public health perspective, the vaccines are FAR superior. Additionally, over-promoting this drug (if it is given emergency use authorization) will give one more excuse to people that have been thus far unwilling to get vaccinated to skip the vaccine… as they’ll feel like this drug will provide a safety net under them if they get infected. In the mean-time, they’ll spread the illness to others.

Will Humble Disease Control, Early Childhood, Wills Blog

Judge Cooper Rules that Ducey’s Harmful School Mask Requirement Ban is Unconstitutional

Read the Ruling: Superior Court Ruling Overturning Ducey’s Harmful Anti School Mask Law

Judge Katherine Cooper just ruled that Ducey’s ban on school mask requirements violates Arizona’s constitution because the Budget Reconciliation Bill (HB2898) that contained the harmful ban  violates the Title Requirement of the Constitution- which says that the title of the Bill needs to reflect the contents therein.

Here are direct excerpts from the Ruling:

CONCLUSION
In Bennett, the Arizona Supreme Court apprised the Legislature that the single subject
and title requirements apply to budget-related bills. And, in Hoffman, the Court specifically
stated the single subject rule applies to every act considered by the Legislature. Despite these
warnings, the Legislature passed four budget reconciliation bills that fail to meet the
constitutional requirements of Section 13. For the reasons stated, the Court finds that the BRBs
violate the title requirement and SB1819 also violates the single subject rule.

IT IS ORDERED finding in favor of Plaintiffs on Counts I and III (declaratory
judgment) of the Complaint; and declaring SB1819; Sections 12, 21, and 50 of HB2898;
Sections 12 and 13 of SB1824; and Section 2 of SB1825 are unconstitutional and, therefore,
void.

Cooper also voided the Budget Reconciliation Bill that covered the community colleges & universities- voiding the harmful micromanagement of higher education when it comes to a student code of conduct relating to COVID  mitigation.

Governor Ducey and Attorney General Brnovich will undoubtedly appeal this ruling to the Arizona Supreme Court. Stay tuned for that action, but for now, schools will continue to be able to require universal classroom masking and community colleges and universities can ignore the harmful micromanagement contained in SB1825.

Western Region Memo – Cooper Decision
Will Humble Vaccination, Wills Blog

Pfizer Vaccine May Be Available for Kids 5-11 by Halloween

Pfizer Announces Positive Topline Results of COVID-19 Vaccine in Children 5 to 11

Pfizer and BioNTech issued a press release suggesting that their Phase 2/3 trial in kids 5 to 11 years old showed a “favorable safety profile and robust neutralizing antibody response” in children 5 to 11 years of age. Their trial used a two-dose regimen of 10 µg administered 21 days apart (1/3 of the dose that’s in the adult vaccine).

Because their vaccine already demonstrated clinical effectiveness in the first trial, they did the study a little differently- focusing on the antibody titer that the vaccine stimulated (rather than comparing the number of persons that contracted COVID-19 in the vaccine and placebo groups).

They say that the antibody responses in the participants given 10 µg doses were comparable to those recorded in a previous Pfizer-BioNTech study in people 16 to 25 years of age that got the 30 µg doses.

There were 2,268 participants in the trial. The SARS-CoV-2–neutralizing antibody geometric mean titer (GMT) was 1,197.6 (95% confidence interval [CI, 1106.1, 1296.6]), demonstrating strong immune response in this cohort of children one month after the second dose.

“This compares well (was non-inferior) to the GMT of 1146.5 (95% CI: 1045.5, 1257.2) from participants ages 16 to 25 years old, used as the control group for this analysis and who were administered a two-dose regimen of 30 µg. Further, the COVID-19 vaccine was well tolerated, with side effects generally comparable to those observed in participants 16 to 25 years of age.”

The company has submitted the data for peer review and will be asking FDA for EUA shortly. If they do submit the data quickly as promised, the FDA could make that EUA by mid-October, giving parents of elementary school kids an opportunity to vaccinate their progeny before Halloween.

Will Humble Wills Blog

Annual AzPHA Public Health Awards: Accepting Nominations Now!

Public health professionals and health care workers across Arizona are performing extraordinary services to our community in the midst of the coronavirus.

Please take a few minutes to share those stories and others so that we may recognize them appropriately at our 2021 Arizona Public Health Awards to be held November 9th from 5 – 8:30 pm at the University Club (39 E. Monte Vista Road) in Phoenix.

It will be an outdoor, happy hour event. Tickets will be $40 per person. We expect to begin registration in October.

Please take a moment to view our award  categories and submit your entries by October 15, 2021

Nominate Here!

View Our Past Award Winners
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