Receding Wave: After Two Years and More Than 27K Deaths in Arizona, COVID is in Retreat Again—For Now

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As Pima County reaches the second anniversary of its first official COVID-19 case, the Omicron wave has mostly receded, hospitals are seeing relief from high caseloads, fewer people are wearing masks and many businesses have adjusted to a new normal.

COVID fatigue is undoubtedly setting in even among those who have been following strict precautions. Last month, the Pima County Board of Supervisors declined to extend into March a mask mandate requiring people to mask up in indoor spaces when they could not be physically distant. (Even when supervisors voted to enact the mask mandate in December, Pima County Acting Administrator Jan Lesher conceded that it was impractical to enforce the mandate, although she said it would be “a call to arms for everyone in the county to step up and do their part to help prevent the spread of a deadly virus, especially during the holidays.”)

This week, the county took another step. Lesher announced that masks would be recommended rather than required in county buildings as of March 12.

In addition, the Pima County Board of Supervisors will resume in-person meetings starting on March 15. While the public will not be required to wear masks to attend meetings, county officials say they will reduce the number of people allowed in to the 280-person capacity hearing room by two-thirds to allow for physical distancing.

“We’ve been down this road before with COVID, where the disease seems to be receding and then it comes roaring back worse than before, so I’m relaxing these mitigation rules with cautious optimism,” Lesher said in a county press release. “The County, like everyone else, needs to be vigilant about COVID and not consider the pandemic over. We may need to tighten the mitigation strategies again if there is another major spike.”

Healthcare experts say case numbers are trending downward, although some caution that a future variant or fading immunity could bring a new wave.

“All in all, nothing but good news on the short-term horizon,” said Dr. Joe Gerald, an epidemiologist with the UA Zuckerman School of Public Health who has been tracking the pandemic’s spread in Arizona for the last two years.

But he cautioned that COVID could make a resurgence when school starts again in the fall.

Gerald started his work shortly after the first Pima County patient tested positive on March 9, 2020. Since then, Pima County had seen just more than a quarter-million confirmed cases of COVID as of March 2, according to the Arizona Department of Health Services.

Those same ADHS stats show a total of 3,623 people had died after contracting COVID in Pima County. Across the state, that grim tally had reached 27,708, although it certainly undercounts the actual number, as the official death toll lags for weeks as death certificates are processed by state officials.

In addition, a December 2021 study by the Arizona Public Health Association showed that Arizona’s “excess death” numbers—the number of deaths above the average in the years 2017-2019—jumped by 29% in 2020 (the second highest in the nation, behind New York’s jump of 50%) and by 24% in 2021, which was the highest increase among U.S. states. In total, APHA Executive Director Will Humble noted that “an estimated 36,000 excess deaths have occurred in Arizona due directly or indirectly to the COVID pandemic.”

In a November 2021 report, APHA determined that Arizona was the only state where COVID-19 was the leading cause of death during the pandemic.

“COVID-19 is a distant third (well behind heart disease and cancer) in states that had governors and health directors who made evidence-based intervention decisions and who properly executed key operational priorities,” noted Humble, who headed up the Arizona Department of Health Services during the Brewer administration.

While accurate numbers are not available for recent weeks because of reporting lags, more than 10,000 of Arizona’s COVID deaths have come since mid-July 19 of last year, according to data gathered by Gerald. Arizona has been experiencing more than 400 deaths a week between late November and the end of January, mostly among unvaccinated individuals, as the Omicron variant overtook the Delta variant.

Arizona's Omicron wave started rising during the holiday season. Omicron, a more transmissible variant, resulted in record-breaking numbers of daily new cases during the holiday season, peaking with 17,907 new confirmed cases in Pima County in the week ending Jan. 9. That number had dipped to 2,225 confirmed cases in the week ending Feb. 20, according to a Feb. 28 memo by Lesher to the Pima County Board of Supervisors. (By comparison, Pima County’s low point during the pandemic came in the first week of June 2021, with just 243 cases.)

Omicron’s high death toll came despite the widespread availability of vaccines. A year ago, there was huge demand for the COVID vaccines, with drive-thru distribution points popping up at Phoenix-area stadiums, the county’s Kino Sports Complex and on the UA mall.

A year later, 74% of the statewide population had received at least one shot of the COVID vaccine as of March 2, according to ADHS.

As of last week, roughly 75% of Pima County had received at least one shot of the vaccine. If you take away children under the age of 5, who are not eligible for vaccination, that percentage rises to 79.2%, according to ADHS.

But according to the Centers for Disease Control, only 71.5% of the Pima County population aged 5 and older were fully vaccinated with two doses and only 43% of the population had received a booster dose as of last week. Seniors outpace other age groups, with nearly 63% of those 65 and older having gotten booster shots.

Boosters are recommended for anyone 12 and older, five months after an initial series of Pfizer or Modena vaccines and two months after a Johnson & Johnson (aka Janssen) shot.

The low percentage of people who have received boosters has healthcare experts concerned.

“Low booster rates, low prior infection rates and waning immunity among the elderly poses a risk of continued hospitalizations and deaths despite improving overall conditions,” wrote Gerald.

Don Herrington, the interim director of the Arizona Department of Health Services, noted last week that booster doses “dramatically increase protection against COVID-19, including the Omicron variant.”

Herrington pointed to data that showed that compared to people who were vaccinated and had a booster, unvaccinated people were 11 times more likely to test positive for COVID, 67 times more likely to be hospitalized for COVID and 180 times more likely to die after contracting COVID. Meanwhile, compared to people who had been vaccinated but hadn’t received a booster, unvaccinated people 1.3 times more likely to test positive for COVID, 4.1 times more likely to be hospitalized for COVID and 7.2 times more likely to die after contracting COVID.

Pima County had seen 50,963 breakthrough infections among people who had been vaccinated, according to Lesher, or 7.6% of the fully vaccinated population. But only 962 of those cases (or .14%), required hospitalization and only 220 (.03%) died.

Fortunately, the number of hospitalized COVID patients continues to decline across the state. Arizona’s doctors, nurses and other healthcare workers have faced huge strains through the pandemic. Gerald noted last month that hospitals were just emerging from 191 days of having more than 2,000 patients in hospitals statewide. (By point of comparison, during the winter 2021 surge, hospitals only broke the 2,000-patient barrier for 98 consecutive days.)

During that Delta-Omicron stretch, hospitals faced 75 days of caring for more than 3,000 patients.

As a result, many healthcare workers are exhausted by the jobs and burned out. To add insult to injury, they often find themselves the target of conservative politicians who accuse them of overblowing the dangers of the pandemic.

Here in Pima County, the number of hospitalized COVID patients hit a high less than two months ago, in the third week of January, at 307, according to Lesher’s memo to the Pima County Board of Supervisors. By the second week of February, it had dropped to 117—which, as Lesher notes, is still much higher than the low point of 15 in May 2021.

While COVID is still circulating in the community and health officials still urge caution, Gerald predicts more restrictions will be lifted, especially after the CDC issued new guidelines last month that have moved all of Arizona’s counties except Yuma and La Paz counties into a medium-risk category.

“During March more institutions and individuals will be drawing down their COVID-19 mitigations,” Gerald recently noted in an email. “For those who are healthy, vaccinated or recovered, normalization will pose little risk. Those who have personal health conditions, family members with personal health conditions, or workers who interact with those who are vulnerable should continue to mitigate until transmission levels fall further. We are going to continue an awkward condition, where motivating the healthy to maintain their precautions to protect the vulnerable will become even more difficult.”

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