With later COVID-19 peak predicted, re-opening AZ may be weeks off still

By: - April 27, 2020 3:21 pm
COVID-19 protest capitol

Some protesters calling on Gov. Doug Ducey to lift restrictions on business operations and public gatherings also drove around the Capitol, honked and yelled to voice their opinion on April 20, 2020. Photo by Laura Gómez | Arizona Mirror

Lifting the restrictions implemented to curb the spread of COVID-19 that have shut down large portions of Arizona’s economy might be several weeks further away than initially thought, as new predictive models suggest the peak of cases won’t happen for at least a month.

Dr. Cara Christ, the director of the Arizona Department of Health Services, said the agency is looking at two models – one that shows COVID-19 cases peaking around May 22 and the other showing the peak around June 11. 

The first model, developed to be more Arizona-specific, predicts the state will need 600 hospital beds and 300 ICU beds on May 22. 

Initially, estimates showed that the peak need of hospital resources would come in late April. 

“Back in February and March, when we didn’t know as much about COVID-19 as we know now, predictive models were based on the very limited experience and data from our Chinese counterparts in Wuhan and Guangzhou, China,” Christ wrote on the agency’s website, adding that estimates have changed as public health officials learn more about COVID-19. 

The other model Christ said the agency is looking at is a federal model set up by the U.S. Centers for Disease Control and Prevention, the Assistant Secretary for Preparedness and Response and the Federal Emergency Management Agency. 

It predicts that the peak of COVID-19 cases in Arizona will be on June 11, if Gov. Doug Ducey lifts the stay-at-home order on April 30. 

“Given that our goal was to reduce transmission of COVID-19, if this model holds true, this later peak would reflect the success of those mitigation strategies,” Christ wrote. 

Despite the differences of when the peak number of COVID-19 cases is expected, both models predict that Arizona’s health care system has enough hospital beds, ICU pace and ventilators to deal with the expected surge in cases. 

One of the most widely used predictive models, led by the Institute for Health Metrics and Evaluation of by the University of Washington, recommends that Arizona should not start relaxing social distancing measures until after June 26, and then only with containment strategies that include testing, contact tracing, isolation and limiting gathering size

IHME’s model predicts 583 COVID-19 related deaths by Aug. 4, but the model has yet to take into account deaths reported after April 21. Since then, state health officials have reported 62 deaths. 

Deaths are the most important data point for any predictive model, as they are the most reliable figure for epidemiologists and researchers. As the death toll increases, the forecast for peak need of hospital resources shifts.

In all, Arizona has reported 6,716 cases of COVID-19 and 275 deaths have been attributed to the illness. Nationwide, there have been almost 984,000 coronavirus cases resulting in nearly 56,000 deaths, according to Johns Hopkins University. 

Re-opening Arizona

While Ducey is still considering whether to lift the stay-at-home order after April 30, he did has announced that elective surgeries will resume May 1.

Ducey said that Arizona will adopt President Donald Trump’s plan to reopen the economy in three phases and only after the state’s number of cases decline for 14 days. 

Ducey COVID-19 response April 22
Gov. Doug Ducey gives an update on the COVID-19 pandemic response during an April 22, 2020, press conference. Photo by Rob Schumacher/Arizona Republic & USA Today Network | Pool photo

Phase One would include the reopening of some businesses, such as gyms and movie theaters that would be able to implement social distancing measures, but would keep schools and bars closed and would continue to prohibit visits to senior living facilities. It would also require people to continue to avoid gatherings of more than 10 people and would ask vulnerable individuals to stay home. 

Arizona hit a peak of 310 confirmed cases on April 23, and has seen fewer cases reported in each of the four days since. 

But frustration is growing as unemployment soars, small businesses shut down and people struggle to pay their mortgage, rent and other necessities. 

Since mid-March, nearly 420,000 Arizonans have filed for unemployment benefits, with the Employers Council in Arizona predicting that the state is heading toward a 10% unemployment rate. 

Demonstrators protested earlier this month in front of the Capitol in opposition to Ducey’s stay-at-home restrictions and demanded an immediate reopening of the economy. 

But despite pressure from protesters, health experts believe Arizona will not be ready to lift COVID-19 restrictions until the state ramps up its testing and businesses adopt mitigation measures.

Private and public labs nationwide have said they are still struggling to increase testing because of a lack of supplies such as swabs and a shortage of key chemicals. 

Will Humble, the executive director of the Arizona Public Health Association and a former ADHS director, said the key to starting Phase One of reopening is to be able to provide a test to any person who is experiencing symptoms – something ADHS did on April 23.

“It’s not about the number of tests that we have, it’s making sure we have the ability for people that need the test to get a test,” Humble said. “If you have any type of symptoms at all, you need to get tests quickly and without hesitation and with a good turnaround time.”

Arizona has conducted 66,543 tests so far. Measured in tests per million residents, the state is in the bottom 10 states nationwide. 

Humble said Arizona also needs to work closely with businesses to ensure their employees and customers are protected. 

“If you’re a restaurant, you need to have a kind of mitigation set in place, such as separating the tables, making sure the host and the food servers are wearing masks, making sure there are enough gloves for the food workers in the back and limiting the number of total capacity,” Humble said. 

“Every business now has an opportunity to think through these mitigations measures, and that’s what the social distancing and the stay-at-home order has helped,” he said. 

Mara Aspinall, a professor of practice at Arizona State University’s College of Health Solutions and managing director of BlueStone Venture Partners, said that people will remain afraid to rejoin society until the state provides testing on a large scale. 

Aspinall said that as long as people feel unsafe leaving their homes for fear of contracting the virus, the economy will not be able to quickly reopen. 

“I believe we have to reopen society first so people can feel comfortable just venturing out to do anything, and very soon after that, they will feel comfortable going to work, spending money or otherwise, Aspinall said. “Fear prevents any confidence in the restoration of our society.”

She also said that there needs to be antibody testing done, as well, to understand how deadly the virus really is and if enough of the population has become immune for social distancing measures to be eased. The University of Arizona is producing 250,000 COVID-19 antibody tests, though the World Health Organization has said there is no proof yet that people who have developed antibodies are immune.

Aspinall said the state also needs to develop a system of contact tracing, which means identifying people who may have come into contact with an infected person and collecting further information about them. 

Contact tracing is being used successfully in Singapore and South Korea and is being tested in some provinces in Canada. 

Until those measures are put in place, health experts believe the state will not be ready to reopen, as a key to preventing a second wave of COVD-19 cases is the ability to mitigate outbreaks as they occur and keep them from becoming widespread. Were that to happen, reinstating economic restrictions could prove even more damaging.

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