Remembering Pete Wertheim

Arizona, AzPHA, and so many of us lost a good friend and mentor this week. Pete Wertheim passed away yesterday after courageously facing brain cancer. We will all miss Pete, his smile, sense of humor, his easy way, and his dedication to good solid public policy.

Pete was a long-time sustaining member of AzPHA, served on the Board of Directors and as Board President in 2011. Pete worked really hard to improve AzPHA’s business and other processes – working closely with AzPHA Executive Director Jennifer Bonnet to build us into the organization that we are today. Here’s what Jennifer shared about Pete…

“I remember Pete for “how” he accomplished rather than “what.” He worked with such warmth and humor that everyone felt welcome and engaged around him. We worked together on many tough legislative issues, yet,  I am recalling our more casual exchanges at a pub with colleagues after a long day at work.”

Many of you worked with Pete professionally and personally…  and you know that Pete was just so authentic and just such an all around good guy. He was committed to good public policy and transparency and was always on the lookout to set policy that would work effectively in the long run. He called things out when he saw things that were sneaky, inefficient, or just plain wacky. He knew and taught us that the devil was in the details.

I got to know Pete really well when he was the Chief Legislative Liaison for the ADHS during the time when Susan Gerard was the Director. Pete was just so good at tracking all the bills and always keeping us informed. He taught us to dive into the details of bills to figure out what effect they might have on the people.

Pete and Susan worked hard to get the financing needed to build a new Forensic Unit at the Arizona State Hospital.  His work paid off in 2008 when the agency was able to get funding for the new facility just before the recession. The former ASH Wick Units were many decades old (built in the early 60s) and were just inconsistent with providing a safe and therapeutic environment.

It was challenging getting 10’s of millions of dollars from the legislature for a new forensic unit, but Pete didn’t give up- he just worked so hard to get that important facility funded. What did it was the way he could connect with legislators that made it happen.

Barb Fanning, a good friend of Pete and co-worker during his time at the ADHS put it this way… 

Pete was one of the most genuine people I have ever known. He loved his work and had an unrivaled work ethic. He also brought a refreshing sincerity to all of his relationships, both personal and professional – everyone who knew Pete adored him. The healthcare industry in Arizona is better because of him, but the people who work in it are missing a great advocate and a dear friend.”

Most recently Pete served for several years as the Executive Director for the Arizona Osteopathic Medical Association. Before that, he worked for a year as the Communication and Public Affairs chief for the City of Prescott. He started that job practically the same week as the devastating Yarnell fire.

His career also included working as the VP for Communications and the Arizona Hospital and Healthcare Association. His early career was as a Legislative Research Analyst and Policy Advisor for the Arizona House of Representatives. That’s where he really refined his policy chops.

But most of all…  Pete was just a really good person. Always there with an easy smile and an interesting story.  A good friend.  We’ll all miss him.

Lawsuit Urges ADHS to Release Care Home COVID Case Numbers & PPE Availability 

Perhaps you’ve heard about the lawsuit brought by several media outlets urging the court to force the ADHS to release data that they are receiving under the enhanced surveillance advisory for nursing homes and assisted living centers.

Here’s a link to the Agency’s response to court telling them that they should’t have to disclosure of the number of cases of COVID in the facility or even information about the quantity of PPE available and used by the facilities.

The primary arguments used by the agency include that disclosing PPE availability and use and facility specific case data would

“… be financially detrimental to the facility”; and “… have deleterious effects in the community’s trust that the Department can prevent infectious disease”.

You can read their full argument here

It’s easy to see why organizations like AARP Arizona and many Arizonans are interested in being able to see that information. After all, the majority of deaths that have occurred have been in assisted living and skilled nursing facilities.

In addition, Arizona remains dead last in testing and has been prioritizing drive through Saturday testing events over more refined and targeted testing among residents and staff in congregate settings where the majority of deaths have been occurring.

Hopefully we’ll soon see what Arizona law really says about disclosing information about PPE and case counts in these settings and how much discretion the ADHS Director really has in making that decision.

Note: HHS is distributing $4.9 billion in relief funds to skilled nursing facilities to help them combat the effects of the COVID-19 pandemic. The funding will be used to support nursing homes suffering from significant expenses or lost revenue attributable to COVID-19.

ASU Biodesign Institute Posts Useful COVID Trends Website

You’ll want to bookmark it

The ASU Biodesign Institute team has developed and posted a nifty Critical COVID-19 Trends website. You should bookmark it.

There are so many interesting data trends on the site including: 1) case trends by county; 2) daily positive test trends; 2) the percent of PCR test that are positive by day; 3) the new vs. total cases by county; and 4) the total deaths vs. total cases by county. Most of the data on this ASU site is info that you won’t be able to find on the ADHS Data Dashboard.

The total deaths vs. total cases graph shows you which counties are suffering with more severe outcomes. The percent positive of PCR tests by day shows you the daily trend in percent positives- which is really important because a determining point for moving to the next Phase of opening is the 14-day trend in the number of positive PCR tests divided by the total number of PCR tests done.

For example, the ADHS data dashboard shows the percent positive of the laboratory test results by the week….  but the ASU has them by the day. With all the data lumped into a whole week it’s hard to get a sense of a trend. It’s a lot easier to see whether there is a trend or not with daily data. Accountability and transparency.

There is also a lot of other interesting COVID-related info on the Biodesign home page.

FDA Authorizes First Rapid Antigen Test for SARS CoV2

Last week the FDA issued emergency use authorization for a new type of test that can detect SARS CoV2 called an antigen test. The EUA was issued to Quidel Corporation for its Sofia 2 SARS Antigen FIA. The test is authorized for use in high and moderate complexity laboratories and facilities certified by CLIA.

The test looks for protein fragments associated with the virus. The sample is collected with a nasal swab. It can produce a result in minutes. The antigen test is cheaper and easier but is less reliable than the nasal swab PRC test.

The new antigen test is very specific for the virus but is less sensitive than the molecular PCR tests.  In other words, there are very few false positives but there will be false negatives, meaning that negative results do not rule out infection.

Another Free Contact Tracing Course is Available

Arizona needs a sprawling network of contact tracers to track and halt the spread of covid-19. Some researchers believe that an effective tracking system will require a few hundred contact tracers for a population the size of Arizona. 

Last week I wrote about how the Association of State and Territorial Health Officials had developed a free on-demand training for entry-level COVID-19 contact tracers. The course, called Making Contact: A Training for COVID-19 Contact Tracers supports ongoing public health agency efforts to prepare new contact tracers for their work of helping identify COVID-19 positive cases and those with whom they have been in close contact.

This week the Johns Hopkins Bloomberg School of Public Health unveiled a similar 5 hour online Course that’s designed teach non-public health professionals the fundamentals of contact tracing.

What do Sensitivity and Specificity Mean, Exactly?

When new tests come out, they’re evaluated for how well they work. As tests are evaluated, you’ll often read the words sensitivity, specificy and predictive positive value. Here is a pointer about what those words mean:

Sensitivity refers to the “true positive rate.” It measures how frequently the test is positive when the person being tested actually has the disease. For example, when a test has 80% sensitivity, the test detects 80% of patients with the disease (true positives). However, 20% of patients with the disease are not detected (false negatives) by the test.

Specificity refers to the “true negative rate.” It measures how frequently the test is negative when the person being tested doesn’t have the disease. For example, when a test has 80% specificity, the test correctly reports 80% of patients without the disease as test negative (true negatives). However, 20% of patients without the disease are incorrectly identified as testing positive (false positives) by the test.

Positive Predictive Value is the measure of how likely it is that a positive test is a true positive rather than a false positive. This depends on how many people in the population being tested have had the disease. When there are very few people in the population that have had the disease, then there’s a higher chance that a positive test is a false positive. When there are many people in a population that have had the disease, then there’s a higher chance that a positive test is a true positive.

Antibody Rapid Tests Becoming Less of the Wild-Wild West

The FDA said they’ll be tightening requirements for companies that develop COVID-19 antibody tests to better regulate the frenzy of tests coming to market. The updated policy requires commercial antibody test developers to apply for Emergency Use Authorization (EUA) from the FDA with performance thresholds for specificity and sensitivity.

Previously, manufacturers of the tests could validate their own tests and bring them to market without FDA review. More than 100 antibody tests have entered the market, fueling a congressional investigation into the accuracy of tests.

FDA posted a list of antibody tests removed from the “notification list” of tests offered under the Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency. FDA announced revised guidance recommending that commercial manufacturers of antibody tests submit an Emergency Use Authorization request within 10 business days from the date they notified FDA of their test validation or the date of publication of the revised policy, whichever was later.

Editorial Note: My advice for folks that believe that they may have recovered from a COVID infection and want to find out for sure is to get a blood draw serology test rather than the simple finger stick rapid test. The results are a lot more reliable. That test costs about $100. Turn around time is about 2 days.

How are Antibody Tests Useful for Public Health Purposes?

Antibody tests have several important public health applications. High-quality serologic tests (e.g. the blood draw kind) can be used to estimate the prevalence of past viral infection or estimate the cumulative incidence of infection in a population (progress toward herd immunity).

They can help identify people that can be plasma donors. Plasma from donors with a good IgG titer can provide antibodies for infected persons that helps with their recovery. Antibody status can also help inform persons and employers who is at less risk for infection. 

Last week APHL issued a document outlining potential public health applications for antibody testing.  The statement provides an overview of serologic methods, considerations for selecting assays for seroprevalence surveys and test result interpretation, and outstanding research needs.

University of Arizona’s Antibody Testing Project Underway

The U of A expanded its analysis of blood samples statewide to find out who has antibodies against the SARS CoV2 virus.  The State Legislature appropriated the $3.5M to fund the effort.

Testing sites are opening in all 15 counties tomorrow. Overall, there are 31 antibody testing sites across the state, with additional sites becoming available as needed. The specific testing site for each participant will be selected during the registration process.

Registration for health care workers and 1st responders is now available at covid19antibodytesting.arizona.edu. That site also has the most current information on the antibody testing initiative including qualifications for registering.

Most people who are infected by the virus that causes COVID-19 make antibodies within a few weeks of infection. The presence of COVID-19 antibodies in blood serum means the immune system mounted a response against the virus.