Growing Impatience And Repealed COVID Mandates: Where Do We Go From Here?


With 2020 in hindsight, governments are loosening regulations and distributing vaccines as COVID cases continue their decline. In the week of March 1 alone, the states of Texas and Mississippi ended their mask mandates, a new vaccine from Johnson & Johnson began its rollout, and here in Arizona, Governor Doug Ducey ordered schools to offer in-person teaching by March 15 and lifted occupancy limits for restaurants, gyms and bars. But public health officials still stress caution, both because of continued cases, and the difficulty inherent to predicting the pandemic.

“We want to continue cautiously moving forward,” said Pima County Health Department Director Dr. Theresa Cullen. “There are encouraging signs across the board as far as cases, hospitalizations, and vaccine distribution but, we cannot let our guard down.”

For Joe Gerald, PhD, director of the University of Arizona’s Public Health Policy & Management program, every COVID death that happens now is a “double tragedy,” because it happens in a setting in which “we knew better” and the vaccines are so close to being administered to all who want it.

Gerald has spent years researching respiratory-related illnesses and interventions for them, including tuberculosis and asthma. Since the pandemic began, Gerald has managed a weekly report modeling COVID cases within the state. But even with his experience, he admits it’s not possible to make an accurate forecast for this upcoming summer or beyond. In fact, COVID modeling groups are hesitant to go more than four to six weeks in the future because the pandemic includes so many unknowns.

Gerald says three main questions remain for the future: how much vaccine hesitancy is there truly going to be once everyone is able to receive a dose; will a variant emerge that can evade vaccine or natural immunity; and finally, how long will our vaccines and natural immunity last?

“If we do a good job vaccinating, and we have the vaccine available, we’ll be done by May,” Gerald said. “If Biden’s plan comes true and people accept the vaccine, this summer is going to look really good. But we’re going to have to follow the emerging research that is tracking these variants… If we get our vaccine acceptance rate to 70%, 80% or higher, then we’re good, we shouldn’t see a resurgence. That’s the best-case scenario.”

Because of a gradually inoculated population and greater access to vaccines, Gerald does not anticipate the state to experience another wave as we did in early summer and late fall 2020. But even if we do, our hospitals and mortuaries shouldn’t face the same pressures they previously experienced.

“I don’t think we’re going to see another wave. If we do, it’s going to be smaller and it’s going to have the added benefits of fewer hospitalizations and deaths,” Gerald said. “Given what we understand about the current virus and variants that are present in Arizona, I’m pretty optimistic about what’s going to happen moving forward.”

But there’s another major question: How low can we keep the community transmission rates between now and when we can get a vaccine to every person who wants one?

Arizona’s transmission rate is currently around two times as high as the dip between 2020’s summer and fall outbreaks. This equates to 50 to 100 cases per 100,000 residents per week depending on the county, which translates to roughly 8,000 new cases a week statewide.

“That doesn’t seem like a lot, but I think that’s mainly because we’ve already experienced such dire circumstances that it looks great compared to that. While in the moment it’s not going to add up to as many deaths, if we allow that to continue for a prolonged period, it still adds up,” Gerald said. “That’s why I think many public health officials are really frustrated with the pace at which our political leaders want to go in withdrawing business restrictions and mask mandates, because we recognize it’s not over and we still have another two-to-three months of hard work in front of us.”

Gerald admits there are problems with Arizona’s and other states’ vaccine distributions, namely racial and economic disparities. A March 5 article in the New York Times reported that communities of color have received fewer vaccines. However, a survey from the Associated Press’s National Opinion Research Center also found vaccine hesitancy to simply be higher among black and hispanic communities.

“We’re leaving out many Arizonans whose present health status, occupation, language, culture or whatever else, doesn’t allow the same access to the vaccines because the registration is difficult or confusing. This is a feature of how we structured our system. It doesn’t have to be this way,” Gerald said. “Right now our strategy is ‘the supply is limited, so let’s make those who can come to the vaccine, come to the vaccine.’ But we need to do more to get the vaccine to those who are vulnerable.”

Gerald argues authorities have distributed too many of our state’s allotted vaccines to largescale vaccination Points of Distribution, and have hindered federally qualified health centers who are best positioned to reach vulnerable sectors of the community. However, he believes the upcoming Johnson & Johnson vaccine—which only requires one dose and has more flexible storage requirements—can fill in some gaps.

“It’s probably not going to happen at the state level. There’s too much riding on the Governor’s own political fortunes to show success through the state’s PODs,” Gerald said. “What we really need to see happen is the federal government allocate more to these alternative pathways directly to federally qualified health centers, directly to the retail pharmacy chains.”

However, he does say Ducey’s recent executive order requiring schools to offer in-person learning by March 15 is reasonable. This is because the Governor’s requirements align with the CDC’s requirements, so long as things continue to improve as they are. Most Arizona counties are in “substantial” spread, but are trending toward moderate.

“As long as conditions continue as they are now, or continue to get better, I think the Governor’s plan is entirely reasonable,” Gerald said. “There is a little bit of risk if we get worse and experience a third wave. What the Governor calls for is if you open your high school—which you basically have to do now—and things get worse and go back to the ‘high’ transmission level, then you have to stay open; you can’t go backwards.”

On March 5, the Pima County Health Department also announced their own reduced mandates, increasing the size of permissible gatherings from 10 or fewer to 25 or fewer. However, they stressed we are still far from the pandemic being over.

“We’re seeing this growing impatience with recommendations from public health officials, as if we want to keep the communities on lockdown and businesses closed. But I think public health officials and healthcare workers who’ve been on the frontlines, we’re coming from a much different perspective than the general community and political leaders,” Gerald said. “I think public health officials are being appropriately cautious, and there are some growing disagreements with political leaders, particularly with the mask mandates. What we’ve learned is they should be ‘first-on, last-off.’ They’re simple, inexpensive, and reasonably effective when there’s a high degree of adherence. And by keeping masks on, it actually allows us to open things sooner.”

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