COVID cases continue to grow, leading health experts to worry about third wave in AZ

COVID-19 cases and hospitalizations in Arizona continue to rise while new state laws are preventing local governments and schools from implementing mitigation strategies to combat the increased spread.

Arizona reached a high rate of transmission of 108 COVID-19 cases per 100,000 individuals per week, according to the July 23 COVID-19 report from Dr. Joe Gerald, an epidemiologist at the UA Zuckerman School of Public Health who has been tracking the disease for more than a year.

Gerald reported a 35% increase in COVID-19 cases of Arizonans for the week ending July 18 as well as a 26% increase in the occupancy of general ward beds by COVID-19 patients and an 18% increase in ICU beds occupied with COVID-19 patients as of July 21. He notes this level of hospital occupancy for COVID-19 patients of general ward and ICU beds are similar to numbers seen in March.

In his report, Gerald said the rise in cases “seems almost certain” to most likely be caused by the increased prevalence of the Delta variant, accounting for about 75% of all cases.

The Delta variant, first identified in India, has increased transmissibility, meaning the variant is more infectious, according to the Centers for Disease Control and Prevention (CDC).

With an exponential rise in cases and more cases of the Delta variant, Gerald and other health officials stressed the importance of vaccinating the unvaccinated population, as they account for the majority of positive cases of COVID-19, along with the majority of hospitalizations and deaths.

At a July 23 press conference, Arizona Department of Health Services Director Dr. Cara Christ, reported that 90% of cases in July have been in individuals not fully vaccinated. Since March, 94% of individuals hospitalized for COVID-19 were not fully vaccinated and 98% of deaths were also of individuals not fully vaccinated.

Gerald noted that not fully vaccinated individuals have less protection against the Delta variant than fully vaccinated individuals, meaning they have received two doses of Pfizer or Moderna or one dose of the Johnson & Johnson vaccine.

“It’s definitely possible that the current vaccine could at some point in the future become obsolete. We’re not there yet,” said Gerald. “The Delta variant does not threaten our current vaccination effort. For individuals who are fully vaccinated particularly with Moderna or Pfizer, you’ve had your two doses, you’re two weeks passed that, they provide 90% protection against infection and development of severe disease.”

While he said at some point Arizona may have to consider boosters, the priority should remain vaccinating people who haven’t yet been vaccinated.

In a statement released Friday, Gov. Doug Ducey urged Arizonans to get vaccinated, while continuing to assert the state would not mandate or enforce key mitigation strategies.

“We will not be listening to the lockdown lobby. Businesses will stay open. Students will be able to attend school. There will be no mask mandates,” said Ducey. “We have a proven solution with the vaccine. I strongly encourage every Arizonan who is eligible for the vaccine to get it so they can protect themselves and our whole state.”

At the end of the legislative session, Ducey signed into the law several statutes limiting the ability of the local jurisdictions and schools to combat COVID-19. Senate bill 1819 prohibits a county, city or town from issuing any order “related to mitigating the COVID-19 pandemic that impacts private businesses, schools, churches or other private entities, including an order, rule, ordinance or regulation that mandates the use of face coverings, requires closing a business or imposes a curfew,” while the K-12 budget bill made it illegal for schools to require face coverings.

Arizona Public Health Association Executive Director Will Humble noted on his blog that Ducey, Christ and Republican lawmakers “have tied the hands of virtually the entire state to the point where nobody is allowed to do virtually anything to slow the spread of COVID-19. … It’s like they have us in reverse lockdown.”

Two weeks ago, two Arizona schools received a letter from Ducey’s office requesting a change in their isolation and quarantine policy as it stated fully vaccinated individuals would not have to quarantine, following ADHS guidelines.

Despite the actions by state officials, Christ said ADHS “public health guidance and recommendations have not changed” and continues to recommend unvaccinated individuals wear masks and get vaccinated.

However, since the peak in April, vaccination delivery has stalled. As of Monday, July 26, 46% of Arizonans have been fully vaccinated. Among the almost 4 million Arizonans who have yet to be fully vaccinated, are children younger than 12 who are not eligible for a vaccine.

As students head back to school next month to full in-person learning and schools and local jurisdictions limited in their COVID-19 response, Gerald believes the new school year has the potential to accelerate transmission.

“It has the potential to throw fuel onto a fire that’s already started,” said Gerald. “When we think back to the summer of 2020 and school reopening we were actually coming off the peak rates in early July, and things were generally improving. Whereas, this time around it’s the exact opposite. We are headed up at the same time that we’re trying to restart schools and so there’s already a brewing outbreak ongoing.”

He noted that while children historically have not been “great incubators and accelerators of transmission” the Delta variant could possibly override this and make children more effective in transmitting the virus.

As a parent of three kids, with two not yet eligible for the COVID-19 vaccine, Christ said she is making her two unvaccinated children wear masks and urges parents to do the same. They also recommend parents keep their children home if they have any symptoms.

“Not only are we seeing COVID in the community, we’re starting to see increased other respiratory viruses,” Christ said. “So we just want to make sure we’re not spreading anything at school. So make sure that you keep your kids home when they’re sick.”

Nearly 32% of 12 to 17 year olds have been vaccinated with at least one dose of vaccine, said Christ on Friday. Gerald reported that children 15 to 19 years of age have case rates similar to those of adults, but cases are rising among all age groups.

“With inadequate vaccination uptake, eliminating COVID-19 is no longer a plausible public health policy goal,” said Gerald in his latest report. “COVID-19 is almost certain to become an endemic disease with varying temporal and geographic implications. Fortunately, vaccination will remain a viable disease control strategy offering a high degree of protection to those willing to accept them.”

Gerald said we would continue to see a rise in cases into October, but would likely not increase to previously seen outbreaks of COVID-19.

“I think it is very unlikely that it’s going to be as big as what we experienced this past winter, I don’t think it would be as big as possible for it to be as big as what we experienced even last summer. So it’s somewhere between where we are right now, and where we were in the summer of 2020,” said Gerald.

He noted that Pima County, which has been quicker at implementing mask mandates and other mitigation strategies, has a lower rate of transmission than Maricopa County or the state, with about half their rate of transmission.

“The Governor’s office and the legislature are really standing in the way of public health progress. They’re tying our hands in making it much more difficult to achieve our public health goals,” said Gerald. “It’s hard to see how that’s going to work out well for us....so instead of hampering our efforts to get people vaccinated the state should and could be doing more to help us achieve our goals and right now they’re kind of standing in our way.”

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