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

Unvaccinated Adults Packing AZ Hospital ICU’s – COVID-19 Patients Now Occupy 30% of All ICU Beds

Takeaways:
  • Slow Decline in New Cases Continue
  • Hospital Influx Moderating but Rural Hospitals Unable to Transfer Patients as ADHS is Unwilling to Open Surge Line
  • Mid September Deaths Now Exceed 300/Week
View the Full Report
Weekly Report Introduction by Dr. Gerald:
Case counts continue to trend down slowly in most places with Yuma being the first county to fall below the threshold marking high transmission, <100 cases per 100K residents per week. Although still absurdly high, test positivity is receding following the Labor Day disruption in testing patterns.
Hospital occupancy has finally begun to drop off its plateau but available occupancy (excess capacity) remains on a razor thin margin. Rural hospitals are complaining about not being able to transfer their patients to urban centers. There’s just not much slack in the system and our ability to respond to any new threat is compromised. Let’s just hope we don’t find out the hard way.
Arizona’s judiciary is poised to rule on the governors’ and legislature’s attempts to prevent schools from requiring masking.  New data was released in the MMWR this week, some from ASU/MCDPH/PCHD confirms what we already suspected/knew – fewer outbreaks occur in schools requiring masks compared to those that do not.  Good data from local and national sources bear this out.
In an important reversal of my prior communication, it looks like COVID-19 deaths will almost certainly reach 300 deaths per week the week ending September 5th (already at 280) and/or September 12th (already at 218).  I just wasn’t patient enough to allow death notifications to make their way through the system.
The big news this week is that the FDA advisory panel on vaccines recommended Pfizer third dose boosters for those 65+ or at high risk but the CDC director over-ruled her advisory panel and recommended occupation as reason among those younger than 65.
Everyone is weighing in on this so I might as well. I support the FDA and CDC advisory committees’ original recommendations and think the CDC Director erred in over-ruling them. Use of executive privilege in these situations is becoming all too common and panders to the extremes no matter which party’s appointee does it. One of the potential benefits of advisory committee decisions is that they are at least somewhat insulated from political considerations, not that they always get it right.
Will Humble Disease Control, Early Childhood, Public Health Law, Wills Blog

New CDC MMWR Shows that Governor Ducey’s Hostility Toward Universal Classroom Masking is Causing Kids to Get Sick & Miss School

CDC MMWR: Association Between K-12 School Mask Policies and School-Associated COVID-19 Outbreaks in Maricopa and Pima Counties, July – August 2021

More evidence was published today in a new CDC MMWR showing that Governor Ducey’s hostility toward universal classroom masking is causing kids to get sick and miss out on in-person learning. Researchers from ASU, CDC and the Maricopa and Pima County health departments found that schools without a mask requirement were 350% more likely to have a COVID-19 outbreak than schools with a mask requirement in place at the start of school year.  

The team examined COVID-19 outbreak data among 999 K-12 public, non-charter schools in Maricopa and Pima Counties during the first six-weeks of the school year from July 15 to August 31, 2021.  After controlling for grade levels, enrollment size, Title 1 status, county school location & COVID-19 community case rates, schools without a mask requirement were 350% more likely to have an outbreak than schools that had a mask requirement in place at the start of the school year.

Among the 999 schools, 21% had a mask requirement when school started, 31% implemented a mask requirement a median of 15 days after school started and 48% had no mask requirement during the entire time period.  

Of the 191 school-associated outbreaks in July and August, almost 60% occurred in schools without a mask requirement. Only 8% occurred in schools with a mask requirement in place at the start of the school year. About 1/3 of outbreaks occurred in schools with mask requirements implemented later in the year.

From the Report:

“In the crude analysis, the odds of a school-associated COVID-19 outbreak in schools with no mask requirement were 3.7 times higher than those in schools with an early mask requirement (odds ratio [OR] = 3.7; 95% CI = 2.2–6.5). After adjusting for potential described confounders, the odds of a school-associated COVID-19 outbreak in schools without a mask requirement were 3.5 times higher than those in schools with an early mask requirement (OR = 3.5; 95% CI = 1.8–6.9).”

“In the two largest Arizona counties, with variable K–12 school masking policies at the onset of the 2021–22 academic year, the odds of a school-associated COVID-19 outbreak were 3.5 times higher in schools with no mask requirement than in those with a mask requirement implemented at the time school started. Lapses in universal masking contribute to COVID-19 outbreaks in school settings; CDC K–12 school guidance recommends multiple prevention strategies. Given the high transmissibility of the SARS-CoV-2 B.1.617.2 (Delta) variant, universal masking, in addition to vaccination of all eligible students, staff members, and faculty and implementation of other prevention measures, remains essential to COVID-19 prevention in K–12 settings.”

Fortunately, courageous school districts have challenged the constitutionality of Governor Ducey’s prohibition of universal masking requirements in public schools, scheduled to kick in next Wednesday. Judge Katherine Cooper from the Maricopa County Superior Court heard the lawsuit filed by a coalition of organizations including the Arizona School Boards Association, the Children’s Action Alliance, the Arizona Education Association, and the Arizona Advocacy Network See the Complaint.

The suit asks the court for Injunctive Relief on the portions of the health and K-12 budget bills that prohibit school districts from implementing universal masking policies. The action rightly points out that the legislature passed, and the governor signed three budget bills (HB 2898, SB 1824, and SB 1825) that “… include substantive policy provisions that have nothing to do with the budget” in direct violation of the state constitution.

Regardless of how Cooper rules in the coming days, the case will be quickly appealed to the Arizona Supreme Court. I expect a Preliminary Injunction stopping the implementation of Ducey’s harmful policy will be issued pending a final ruling on the merits of the case.

The case has far-reaching implications. If the court holds that the Budget Bills were unconstitutional because they violate the single subject requirement, then those aspects of the BRB that pertain to the case will need to be excised.

The court could even rule that the budget reconciliation bills (BRBs) are unconstitutional in their entirety, which would result in a special legislative session to draw up a new state budget for 2022.

It’s too bad that we’re stuck with a Governor that is so hostile to science and who cares so little about whether kids are safe and have a chance at in-person learning.

Will Humble Disease Control, Wills Blog

Rural Hospitals Ask Arizona Department of Health Services for Help with Patient Transfers

Interim Director Don Herrington Tells Them to Pound Sand

Representatives of rural county hospitals in Cochise, Santa Cruz, Pima and Yuma Counties sent ADHS Interim Director Don Herrington a letter this week urging him to help them by facilitating patient transfers from saturated rural hospitals to urban facilities. Rural hospitals are very different from large urban hospital systems in that don’t have sister hospitals to smooth out care to meet patient needs.

One of the few successful initiatives that former Director Christ implemented was the Surge Line, which helped rural hospitals’ ability to transfer patients to other facilities. The Surge Line was critically important during the July and December – February hospital crises’ (precipitated by Governor Ducey and former Director Christ’s poor decision-making and operational failures).

Yesterday, Don sent this letter to those rural hospital representatives telling them to ‘Pound Sand’:

“The capacity challenges facing hospitals in the Southern region are similar across all regions of the state. Due to the healthcare staffing shortages across the entire state limiting available beds across the healthcare system, expansion of the Arizona Surge Line to all patient transfers is not currently a viable option to improve patient transfers. As you’ve stated, the most immediate way to bolster capacity and improve patient outcomes in Arizona is to enhance staffing in hospitals across the state. This initiative is currently underway with over 70 nurses contracted through the Surge Staffing Initiative expected to start in Arizona this week and nearly 200 expected to start by the end of September. Contracting for additional nurses is ongoing.”

Astonishingly, Interim Director Herrington said “no” we will not help you with patient transfers. Furthermore, he suggested that the solution will come when “…70 nurses contracted through the Surge Staffing Initiative” arrive in the state.

Are you kidding me? 70 nurses over 3 shifts can cover like 70 ICU patients. He really thinks that bringing in 70 nurses is going to solve the problems of a saturated rural hospital system?

Furthermore, the letter throws another shiny mirror into the corner of the room by again promoting Regeneron (a monoclonal antibody treatment that is marginally effective in some people with high-risk conditions very early in their infection). The Regeneron reference is clearly included in the letter to throw a bone to the governor. Many right-wing governors hostile to vaccine requirements and masking are touting Regeneron as a solution to saturated hospitals.

Governor Ducey has hopped on that hay-ride big time, and now it appears that Interim Director Herrington has too.

Those of us that were hoping that the leadership change at ADHS was going to make a difference are losing faith fast. I’ve lost it.

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