Sobering Epidemiology & Hospital Capacity Update from Dr. Gerald

VIEW THIS WEEK’S FULL REPORT

Summary from Dr. Gerald’s Report: This past week saw another marked increase in viral transmission. Arizona is now experiencing high levels of transmission that will be sustained for weeks to come. This outbreak will almost certainly be as big as the one experienced in summer of 2020. While I am optimistic it will not reach the levels seen in the winter of 2021, the experience of other similar states (e.g., Louisiana, Florida, and Texas) suggests this could be wishful thinking.

As of August 1st, new cases were being diagnosed at a rate of 195 cases per 100,000 residents per week. The rate is increasing at 51 cases per 100,000 residents per week. Another wave of cases and hospitalizations, caused by the increasing prevalence of the Delta variant is now certain. The Delta variant now accounts for >75% of all cases.

Resumption of in-person instruction in K – 12 schools and universities in August will lead to frequent school-associated outbreaks and will undoubtedly increase community transmission without vaccine or mask mandates, weekly surveillance testing, and adequate ventilation. The transmissibility of the Delta variant combined with high levels of transmission among adults will essentially force transmission among children.

Hospital COVID-19 occupancy is increasing and is likely to exceed 15% of all beds in the general ward and 20% of beds in the ICU for many weeks. Access to care remains somewhat restricted as occupancy remains unseasonably high. Once again, elective procedures are likely to be postponed. Hospitals should (and likely are) preparing for another meaningful surge that will strain staffing in critical care areas.

Current levels of hospital and ICU occupancy are similar to or slightly ahead of those of the winter 2021 outbreak. Current community transmission is impacting hospitals similarly to how it did this past winter despite a high degree of vaccine update among those >65 years. We should not hold a false sense of security that this outbreak will necessarily have less impact on our already overburdened hospital system.

Arizona is now experiencing 50 deaths per week. This amount will increase in the coming weeks and will almost certainly exceed 100 per week by the end of August.

VIEW THIS WEEK’S FULL REPORT

When All Is Said & Done, Mix & Match Vaccines May Provide the Best Protection

NATURE: IMMUNOGENICITY AND REACTOGENICITY OF HETEROLOGOUS CHADOX1 NCOV-19/MRNA VACCINATION

Abstract: In this observational study we show that, in healthy adult individuals, the heterologous vaccine regimen induced spike-specific IgG, neutralizing antibodies and spike-specific CD4 T cells, the levels of which which were significantly higher than after homologous vector vaccine boost and higher or comparable in magnitude to homologous mRNA vaccine regimens.

Moreover, spike-specific CD8 T cell levels after heterologous vaccination were significantly higher than after both homologous regimens. Spike-specific T cells were predominantly polyfunctional with largely overlapping cytokine-producing phenotypes in all three regimens.

Translation: This journal article has super-interesting results, suggesting that combining a regimen of mRNA and non-mRNA vaccines may induce the best and longest-lasting protection against COVID-19. They found that “mix and match” vaccination with AstraZeneca and mRNA vaccines induces terrific immunity- both in antibody titer and T Cells.

That mix and match produced basically the same antibody response as 2 mRNA vaccines, and better than 2 AstraZeneca shots. Interestingly, T-cell immunity was significantly higher among mix and match participants- higher than in the group that got 2 mRNA vaccines.

Note: This is a small sample size and should not be used to make policy decisions, but it does provide interesting results!

Pima County Health Department Issues Standing Order for COVID Cases in Schools

DIRECTIVE DEFIES MS. HARRIER’S SILLY LETTER ‘PROHIBITING’ QUARANTINE

The Pima County Health Department issued a standing order last week specifying the requirements that schools and students must must follow when there are COVID-19 cases in schools.

The order also outlines the necessary isolation timelines for vaccinated and unvaccinated students and aims aims to eliminate confusion among schools in Pima County’s jurisdiction and to slow the spread of COVID-19.

NEW MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH EDUCATION CAMPAIGN

Maricopa County recently launched a COVID-19 Vaccine Campaign Campaign. The campaign (supported through federal funds) includes television and radio ads, billboards, and social media promotions in English and Spanish.

Every person featured is a real Maricopa County resident who got vaccinated against COVID-19. Many of the photos are from actual vaccine events organized by Maricopa County (these are not simply ads featuring a political appointee in a parking lot reading a script).

You can read kore Maricopa.gov/COVID19Vaccine for English and maricopa.gov/vacunacovid19 for Spanish. You can Download shareable campaign assets here.

CDC Recommends Vaccinated People Wear Masks in Public in Areas of High Transmission

IMPLEMENTING COVID-19 PREVENTION STRATEGIES IN THE CONTEXT OF VARYING COMMUNITY TRANSMISSION LEVELS & VACCINATION COVERAGE

Last week CDC changed their guidance for people living in areas of high transmission (like Arizona) urging everyone to wear a mask whether or not they’re vaccinated. There was a lot more to the guidance – but that was the top line change.

I initially had a beef with the CDC on that change because they relied on unpublished data to make the policy change:  “… based on emerging evidence suggests that fully vaccinated persons who do become infected with the Delta variant are at risk for transmitting it to others”  (CDC COVID-19 Response Team, unpublished data).

I have a problem with agencies making policy changes without disclosing the data sources that they’re using. In this case, CDC made a major policy change that impacts the behavior of hundreds of millions of people based on data that was unpublished.

Decision-making like that makes it very difficult for public health people in the field to defend the new policy. The agency is essentially saying ‘trust us, we’re right but we won’t tell you what the data is that drove the decision‘. Furthermore, it impairs adherence to the new policy because it’s not backed up by reviewable data.

Later in the week, CDC finally published the data that they used to develop the policy change earlier in the week.

Some of those data were published Friday in CDC’s Morbidity and Mortality Weekly Report.  It presented data suggesting that Delta infection results in similarly high SARS-CoV-2 viral loads in vaccinated and unvaccinated people… suggesting an increased risk of transmission in vaccinated persons with breakthrough infections (this has not been known to be the case in previous strains).

I’m OK with the guidance now, but I sure wish they had published their sources before making the policy change.

Remember, that the vast majority of persons infected with the virus at any given time are unvaccinated, so I’d still characterize the CDC’s decision to recommend public masking of vaccinated persons something that is being done ‘out of an abundance of caution’.

Expect Legal Action This Week

There’ll no doubt be some legal action this week challenging the laws the governor signed that micromanage COVID mitigation by schools, counties and cities. There are several court challenges that could happen. Here are a few examples:

K-12 Schools

The state legislature prohibited school districts from requiring students to wear masks inside classrooms in the K-12 budget bill. Governor Ducey enthusiastically signed the bill preventing districts from requiring masks (despite CDC guidanceAmerican Academy of Pediatrics recommendations and tons of evidence for this important protective measure).

I expect one or more school districts to file an action in Superior Court challenging the K-12 Budget Reconciliation Bill because it violates the State Constitution’s requirement that all bills have a single subject (see this blog post and this report from the Network for Public Health Law).

Another argument may include the fact that Ducey’s restriction makes it impossible for schools to have fidelity to in loco parentis (“in the place of a parent”) which refers to the legal responsibility of schools to take on some of the functions and responsibilities of a parent on campus.

The Phoenix Union High School District is already ignoring the governor, announcing in their letter to parents entitled: PXU Announces Mask Requirement and the Safe Return to In-Person Learning that they’ll be requiring universal masking of all staff students and visitors regardless of vaccination status.

Expect more districts to defy the directive and require masks in classrooms despite ARS 15-342.05. This will probably trigger an action by A.G. Brnovich and/or Ducey to try to compel the district to stand down, sending the case to Superior Court- but this time with the school district as the defendant rather than the plaintiff.

Note: ARS 15-342.05 doesn’t take effect until September 29 (90 days after the end of the legislative session), however bill included a retroactivity clause back to June 30, 2021. A legal question is whether the restriction on districts takes effect on September 29 or whether it is already in effect because of retroactivity.

Cities & Counties

In light of the new guidance from the CDC regarding mask wearing in areas of high transmission (see next piece) we could see cities and/or counties to require visitors to city and county buildings to wear masks regardless of their vaccination status. Such a policy would be in violation of SB 1819 which prohibits:

“… a county, city or town from making or issuing any order, rule, ordinance or regulation… including an order, rule, ordinance or regulation that mandates the use of face coverings…”.

For example, cities could require city library visitors to wear masks regardless of vaccination status. Such a policy would likely trigger an action by Brnovich or Ducey to try to compel the city to comply with the new law- sending the case to court. Cities/counties could then make an argument that SB 1819 also violates the single subject requirement in the state constitution.

Herd Immunity: Where is the Threshold in Arizona?

Israel’s experience provides some clues

As we get closer to achieving herd immunity in Arizona (see last week’s post) we will hopefully (at some point) begin to see cases decrease even in the absence of required or voluntary mitigation. We’re  clearly not there yet as evidenced by our steadily increasing cases and an R0 of about 1.2 (AZ had more than 1,000 cases Saturday).

Up until now, we had to guess what the vaccination threshold is in order to achieve herd immunity. No longer. We now have one country that has achieved herd immunity mostly via vaccination: Israel. As the first country to achieve this via vaccination, their experience can shed light on what Arizona needs to do in order to get to herd immunity.

Note: The West Bank and the Gaza Strip are nowhere near herd immunity. As of last week, they had received only 37K doses of Pfizer and 24K doses of AstraZeneca from COVAX and 100,000 doses of the Sinovac from China for distribution to their more than 5 million people- enough vaccine for 1.5% of their population). Pfizer vaccine is being offered to Palestinians living in East Jerusalem.

The dominant strain of the SARS CoV2 virus in recent weeks in Israel has been the B.1.1.7 strain which is 45% more transmissible than the wild-type strain. In that way Israel and Arizona are similar (B.1.1.1.7 is rapidly becoming dominant in Arizona- see TGEN’s variant tracker). Israel and AZ are similar on other ways as well.

Both AZ and Israel prioritized seniors for vaccine and both are mostly using mRNA vaccines (Israel is exclusively using Pfizer). Both had large surges of infections over the last year, although Arizona performed much more poorly because of the policy decisions made by our governor and health director.

What can we learn from Israel’s experience that might predict Arizona’s future?

A recently published study entitled BNT162b2 Vaccination Effectively Prevents the Rapid Rise of SARS-CoV-2 Variant B.1.1.7 in high risk populations in Israel found a sharp decline in cases among seniors in Israel when ~50% of seniors were 2-weeks post their 1st vaccination dose. As they passed through the 50% vaccination threshold in other demographic groups, they began to see a substantial decline in transmission among that cohort, finally achieving population herd immunity.

How is Arizona comparing – and how close are we to achieving 50% coverage? Here’s the percentage of Arizonans that have been vaccinated in Arizona by age group:

Age     % Vaccinated

15-24…..  21%

25-34…..  29%

35-44…..  36%

45-54…..  42%

55-64…..  57%

65-74…..  77%

75+…….   80%

Overall, about 41% of all adult Arizonans have been vaccinated with at least one dose (about 3 million have received at least one dose- with about 2.3 million fully vaccinated). Here’s the case breakdown by age group:

Age     % of Total Cases

20-44……… 59%

45-54……… 24%

55-64………   9%

65+………..   4%

A back of the envelope calculation tells us that if we can get an additional 1.4 million Arizonans fully vaccinated in the coming weeks we’ll be able to hit the 50%+ mark (out of our total population of 7.2M).

But… nearly 1/2 of those 1.4M persons have received one dose of the vaccine. If we can complete the vaccination schedule for the 700,000 that have received one dose and get an additional 700,000 persons fully vaccinated, we could probably get to the herd immunity threshold.

What do we need to do to get there?

There are basically 4 groups that have yet to be vaccinated in AZ. Each require a unique strategy to achieve success.

  1. Persons that still lack access to vaccine because of their circumstances. This category includes folks that are juggling multiple jobs, lack reliable transportation, face language and other communication barriers.

  2. Persons with busy lives that want to get vaccinated (and face no economic or language barriers) but that won’t get vaccinated unless it is made very easy. This group also includes men that are willing to get vaccinated but aren’t motivated to make an appointment (men are vaccinated at far lower rates than women in Arizona).

  3. Persons that still have questions before they’re willing to get vaccinated. You can call these folks vaccine hesitant. They mostly want to have a conversation with someone they trust before deciding to get vaccinated.

  4. People that are unwilling to get vaccinated and are set in their position.

To get to herd immunity we need to adjust our vaccine strategy away from the mass-vaccination sites that require an appointment toward community-based locations. Here are some ideas for each category of yet to be vaccinated people:

For people in Category 1 we need higher touch community-based solutions. Mobile clinics in partnership with trusted organizations like churches, community centers, local nonprofits and the like. Flexibility is the name of the game here. It’s not rocket science, but it is more labor intensive.

Our county health departments are working hard via mobile and community based clinics to make inroads for this population. Continued creative engagement will continue to make progress here. More vaccine and resources still need to be moved away from the vacant state-financed and university-run sites toward counties.

For people in Category 2, we need to get rid of the appointment systems. This group wants spontaneous convenience. Hopefully, pharmacies and other locations will begin offering COVID vaccines without appointments.

Our county health departments and even the state-financed and university run mass vaccination sites have now largely gone to a no-appointment system- which will help a lot with Category 2 people.

Category 3 people are most likely to get vaccinated at their doctor’s office or clinic after a conversation with their nurse, nurse practitioner or doctor. Starting next week doctors that have already been on-boarded by the ADHS as a COVID vaccine provider can FINALLY order up to 200 doses of Moderna vaccine for their patients.

Governor Ducey & Director Christ’s Executive Order 2020-62 creates a regulatory barrier for doctor’s offices to get vaccine. That EO needs to be repealed and the ADHS needs a full-on effort to make it much easier for doctors and clinics to order vaccine in order to make progress with this population.

Category 4 people are a problem. Putting effort into this cohort is a bad return on investment at this point. Better to focus our resources on Category 1, 2, and 3 people.

As long as we implement the recommendations above, there’s a good chance we can achieve vaccination rates sufficient to greatly suppress transmission in all age groups and achieve herd immunity like Israel did. There will be plenty of vaccine… the question is whether the state’s strategy and execution will be effective enough.

Forecasting Exercise: To get to herd immunity (using Israel’s experience as the model) we’d need to finish vaccinating the 700,000 persons that still need their booster shot and then fully vaccinate an additional 700,000 persons. Put together, that’s an additional 2.1M vaccines to administer.

Last week about 250,000 vaccines were administered statewide. If we assume a steady pace at that rate (which is optimistic because we have seen a drop off in vaccines administered in the last few weeks), we could administer 2.1M doses in 8 weeks (and herd immunity) by the 4th of July.

However, if we assume that the persons that have received 1 dose are protected enough not to spread the virus, and that the new 700,000 new persons that need to be vaccinated once are vaccinated at a rate of about 125,000 per week (1/2 of the current weekly doses administered), we could achieve a goal of getting at least 50% of the adult population vaccinated with at least one dose (and herd immunity) by June 15.

Legislative Session Musings

It’s been a bit since I did an update on the legislative session- in part because I’ve been so consumed with the administrative advocacy regarding the pandemic.

Luckily for us, Tara Plese, Member and Chief External Affairs Officer for the  from the Arizona Alliance for Community Health Centers (and AzPHA member) just sent out a good legislative session summary to their members and she have me permission to plagiarize large portions of her work. Here goes:

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On Tuesday, the legislative session officially hit the 100-day mark. Technically, that should signal that the end is near, as House and Senate rules say the Legislature must finish its work by the Saturday following the 100th day of the session. But the Arizona Legislature can extend the deadline. Rules also allow the Senate President and Speaker of the House to extend the session for an additional seven days (which they did on Tuesday).

From here on, the session can only be extended by a majority vote of both chambers, but there is no limit on the number of extensions the body can approve. After the 120th day, legislative per diem gets cut in half, although the decrease in pay has never been a motivation for members to work more quickly.

So, what is is holding up the process? Money, of course. Lawmakers will not adjourn until they have reached consensus on a budget. Those negotiations are still ongoing behind closed doors, as leadership in both chambers attempt to craft a deal that will get 31 votes in the House, 16 in the Senate and a signature from the Governor. At this point, it’s anyone’s guess as to how long that might take.

Budget and Tax Cut Negotiations

At the height of the pandemic, no one could have predicted that Arizona would be flush with cash when it came time to finalize the budget for the next fiscal year. Between the $16 billion from the latest federal relief package ($12.2 billion of which is allocated to the state government), the $38 billion from previous federal relief payouts from the CARES Act, and an increase in tax revenue during the pandemic from “Wayfair” (legislation enacted in 2019 requiring online sellers and marketplace facilitators to file and pay transaction privilege tax), Arizona is looking at a $1 billion surplus- in addition to the $1 billion that’s already in the state’s “rainy day” fund. With all those dollars at play, budget negotiations are more complex than years past.

While Republicans have agreed that a major tax cut is a top priority, they have yet to agree on specifics. Based on what has been publicly shared, preliminary proposals could result anywhere from $450 million to more than $1 billion in tax cuts when fully implemented.

Leadership in the House is pushing for a flat income tax of 2.5% over the next three years while Sen. J.D. Mesnard is lobbying for an alternate income tax intended to lessen the potential impact of recently passed Prop. 208 (education funding) on businesses that file taxes under the individual tax code. A third proposal under consideration is a reduction to commercial property tax.

Senate Republicans met to discuss the budget in a closed caucus yesterday, but leadership didn’t allow senators to take budget documents out of the room. ting told our reporter they didn’t get much out of it and predicted the Legislature will be here for another month.

The main difference between the two chambers is that the House is much further along on a tax plan. The Senate budget has remained, relatively, unchanged. The Senate appears to be more fixated on their election audit.

The House voted unanimously to rush a bill conforming Arizona’s tax code to changes made at the IRS under the Covid-19 relief bills passed last year and in March. After languishing in the House for more than a month, S1752 (conformity; internal revenue code) passed the House Appropriations Committee unanimously in the morning, and quickly moved through rules and COW before finally getting 60 votes on the House floor.

The generally routine step of aligning the state and federal income tax codes was more complicated and significant this year due to the need to conform to three federal Covid-19 relief measures. Conformity means Arizonans will not owe state taxes on their federal Covid-19 stimulus checks or on federally tax-exempt unemployment payments.

High profile bills

Most of the remaining bills before the Legislature are ones that have been the subject of extremely heated debates throughout the session. Tensions have heightened over the past several weeks, and the open display of raw tensions during floor debates has been remarkable—even by the standards of a state Legislature.

However, the Legislature passed a proposal to impose a new restriction on a woman’s right to terminate a pregnancy by making it a crime to abort a child because of a fetal genetic defect. Strongly opposed by Democrats in both chambers, SB1457 (abortion; unborn child; genetic abnormality), which now goes to Gov. Doug Ducey, says any medical professional who performs or aids an abortion in those cases can be sentenced to up to a year in state prison. Ducey has not said whether he will sign or veto the measure sponsored by Republican Sen. Nancy Barto.

Also the subject of intense debate this week was SB1485 (early voting list; eligibility), sponsored by Republican Sen. Michelle Ugenti-Rita, which would purge infrequent voters from Arizona’s early voting list. The measure unexpectedly failed when GOP Sen. Kelly Townsend flipped to a “no” vote, vowing to vote against all election bills until the audit of 2020 election results is complete. It remains unclear what that could mean for a handful of other partisan election bills, as Republicans hold a razor-thin margin in both chambers.

Adding an interesting layer to all of this is the court ruling issued this afternoon ordering the Senate and its audit team to comply with all laws governing the right to a secret ballot and the confidentiality of voter registration data, and to provide copies of all relevant policies and procedures to the court (the audit team has not yet made those documents public).

You may have heard about a number of controversial bills and actions on the floor in both the House and Senate. To say it has been a difficult week is a bit of an understatement.

Movement on bills and action “on the floor” has slowed as the work on the budget continues. Any bills will money on them are stalled until the work on the budget is nearing completion. We may not see the bill itself pass but may see the funding in the budget.

Bill Update

Our Public Health policy Committee and team of interns have been tracking over 100 bills this session- and we’ve signed up in support or against many of them. Here’s the spreadsheet with the tracking status of each. It also includes a hot link for you to click on which will take you to the actual bill.

A few bills of public health interest have passed and been signed by the Governor including:

SB 1181 Doula Certification. Good bill that charges ADHS with developing rules for the voluntary certification of Doula’s. This will help build the workforce and potentially build a path for reimbursement. Doulas have been shown to improve birth outcomes and reduce costs in Medicaid programs.

SB 1011 Maternal Mental Health Advisory Committee. Good bill which will require a state panel to examine post partum mental health and make policy recommendations.

SB 1016 Naturopath Scope of Practice. This bill expands the scope of practice for Naturopaths in various ways including the ability to sign epi pen standing orders.

SB 1094 AHCCCS Substance Abuse. This bill officially moves the FIRST Grant from ADHS to AHCCCS.

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Bills that are waiting for final approval that we’re supporting include:

SB 1250 Overdose Prevention. We’ve been helping to get this bill over the line for several years. It will (if it passes and is signed) improve substance abuse treatment, improve prevention for bloodborne pathogens. Among other things it will decriminalize syringe service programs.

SB 1486 Drug Paraphernalia. This good bill would decriminalize the possession of fentanyl test strips. Fentanyl is the dominant cause of opioid deaths now and this bill would help people to detect it.

SB 1680 Newborn Screening Testing. This good bill would require the state lab to add all tests recommended to their newborn testing screening testing panel.

Convenience is the Name of the Game

Getting to Herd Immunity Is Going to Require More Innovative & Spontaneous Ways to Get Vaccinated

Each week the federal government updates their 3-week vaccine allocation forecast and informs state health departments how many doses of the various vaccines are available for the following week. State health departments then make decisions about how to allocate the vaccines among the county health departments, clinics, health centers, and in some states like ours, large university-run mass vaccination sites.

From the beginning, Director Christ has been reserving the lion’s share of the Pfizer vaccine for their showcase state-sponsored &  university run mega-sites like the former State Farm stadium site. Moderna has been largely going to county health departments for community-based vaccine efforts (see breakdown).

The large stadium type sites were efficient (at least for wealthier demographics) back when the demand for vaccine was huge and people were willing to tolerate the state’s computer site and fight their way to the large vaccination site which was likely far from their home. It worked, because people were willing to put the level of effort it took to get vaccinated at a mega-site.

Fortunately, county health departments have been wise enough to prioritize more community-based sites, mobile sites, special events and other locations that are much better at getting vaccine to more difficult to reach populations.

Meanwhile, the federal government has recognized that many state health departments (like ours) weren’t being very effective at vaccine into hard to reach communities, and they began to ship vaccine directly to pharmacies and community health centers, which helped a lot.

As supplies increased along with manufacturing capacity (and as the more motivated persons have become vaccinated) we now find ourselves in a different world.

The new name of the game for reaching folks that have yet to be vaccinated (younger persons and those left behind in lower income areas) is convenience. If we’re going to get closer to herd immunity we’re going to have to change how vaccine is prioritized by the ADHS and move allocations away from the inconvenient mega-sites that are far away from people’s homes toward local sites and places that don’t require an appointment.

Indeed, last week the 7 state-financed PODs only administered an average total of  14,900 vaccines per day (104,500 for the week). That’s an average of less than 2,000 shots per large site per day.

Arizona’s ranking in vaccines administered per capita now ranks in the bottom half of states (about 31st). As other states have transitioned to a much more community-based and no-appointment needed sites the ADHS has been doubling-down on the very large mega-sites with high overhead costs (including expensive rent) that have been attracting less and less interest.

This week, ADHS allocated 179,000 doses of Pfizer vaccine to their financed sites despite the fact that last week they only administered a total of 104,000. At that pace, state financed POD freezers will continue to fill up and vaccine will continue to go unused that could have otherwise been used at a county community-based site, in community health centers or in pharmacies.

Note: state financed PODs have only administered 86% of their allocated vaccine vs. counties which have administered 100%.

Let’s hope that the ADHS senior leadership recognizes that the mega-site business model is no longer efficient and that they need to increase allocations to counties, community health centers, pharmacies, clinics and doctors offices.

A shift in the state’s business model for getting vaccine out has been in order for some time now. If they’re going to keep the large state-financed and university-run sites then they need to make them no-appointment needed sites immediately.

It’s Crunch Time for AZ’s Clean Energy Rules

Earlier this week, the Administrative Law Judge presiding over the formal rulemaking for rules issued her recommended opinion and order. If adopted by the Arizona Corporation Commission, the Order would approve Arizona’s landmark Clean Energy Rules which will move our state toward a carbon free electricity generation standard by 2050. The Clean Energy Rules will be on the Agenda of their May 4/5 meeting.

If the Commissioners “substantively” modify the ALJ’s Order at their May 4/5 meeting by amending it, then the Commission would have to do a supplemental rulemaking which would kick the can down the road by several months.

The most likely outcome is that the Commission will vote on an amendment to the proposed rule which will kick off a supplemental rulemaking, further delaying the Rule and making it more likely that the legislature or governor will find a way to scuttle the rule (the governor has made no secret about his hostility to the clean energy rules). 

AzPHA Member Action Item:

Submit written comments supporting the proposed rule

The Corporation Commission will be discussing and considering amendments to the proposed clean energy rules and the  recommended opinion and order at their meeting on May 4/5th. They are accepting comments this week through Thursday, April 29th.  I submitted this letter into the record on behalf of AzPHA. You can use my language or submit your own stuff in support of the proposed rule and opposing additional amendments.

To submit your comments go to azcc.gov, select the tab “Cases and Open Meetings,” and select “Make a Public Comment in a Docket.” This leads to a fillable form that can be submitted electronically. The clean energy rules are under Docket No. RU-00000A-l8-0284.

I did what’s called an “eFile” written comment by selecting the “Cases and Open Meetings,” and selecting “eFile in a Case” and uploading this letter.

Dr. Joe Gerald’s Weekly Epi & Hospital Report Shows Slowly Increasing Cases & Hospitalizations

Arizona Stubbornly Remains in Moderate to Substantial Spread

Arizona case rates remain “stuck” at the threshold differentiating substantial and moderate risk because of the more transmissible variant becoming dominant in AZ (e.g., B.1.1.7) and because of the policy decisions by the governor and ADHS director to eliminate all required mitigation measures and again prohibiting counties from having mask mandates. Last week Covid-19 cases increased 6% from the previous week. The highest rates are among those 15 – 24 years and 25 – 64 years of age, 116 and 81 cases per 100K residents per week, respectively.

Hospitalizations also continue to increase. As of April 22nd, 594 (7%) of Arizona’s 8605 general ward beds were occupied by Covid-19 patients, a 4% increase from the previous week’s 569 occupied beds. COVID ICU bed use is increasing more substantially than general ward beds. Eleven percent (11%) of Arizona’s 1727 ICU beds are occupied with Covid-19 patients, a 21% increase from the prior week’s count of 154 patients

In terms of vaccinations, Arizona continues to rank in the bottom half of states (30th of the 50 states) with 34% of Arizona’s adult population fully vaccinated and another 15% having received one dose (49% with ≥1 dose). Arizona also ranks in the bottom half of states when it comes to vaccinating seniors, with 78% of the ≥65 population having received ≥1 dose.

Here is Dr. Gerald’s full report this week