Arizona coronavirus crisis follows deceptive data usage, emphasizes rapid reopening

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Arizona became the epicenter of the coronavirus crisis early in the summer, as the epidemic spread, crossing new areas of the country and, in particular, infecting more young people.

Maricopa County, which includes Phoenix, records up to 2,000 cases a day, “eclipsing New York neighborhoods even in their worst days,” warned a brief on Wednesday from disease trackers at the Children’s Hospital from Philadelphia, who observed, “Arizona has lost control of the epidemic.

But doctors, public health experts, lawyers and local officials say crisis was predictable in Arizona, where local orders requiring masks were banned until Governor Doug Ducey (R) reversed his decision last week. Heads of state did not take the necessary precautions or adopt safe behavior, say the observers, even in the face of convincing evidence and repeated calls from authoritative voices.

“We have failed on many levels,” said Dana Marie Kennedy, director of AARP in Arizona, who said that her organization had not yet received a response to four letters expressing concerns to the governor. She is working on a fifth.

Neither the governor’s office nor the state health department responded to requests for comment.

At critical moments, mistakes by senior officials have undermined confidence in the data supposed to drive decision-making, according to experts monitoring Arizona’s response. And when forbearance was most needed, as the state began to reopen despite continued transmission from the community, a steep and consistent approach – with no transparent benchmarks or latitude to keep disaster areas in check – led to much of the public to believe that the pandemic was over.

And now Arizona faces more cases per capita than any European country or even Brazil, which has been hit hard. Among the states with at least 20 people hospitalized for covid-19, the coronavirus disease, no state has seen its hospitalization rate increase more rapidly since Memorial Day.

This week, Arizona reported not only a record single-day increase in new cases – Tuesday’s number reaching 3,591 – but also record use of hospital beds and ventilators for suspected and confirmed cases. Public health experts warn that hospitals may be so stretched that they may have to start screening patients by mid-July.

Soon, the only option could be “crisis care standards,” said Will Humble, a former director of the Arizona Department of Health Services. “If you’re in a bed, normally they’ll keep you for a few days, but they’ll send you home with oxygen. “

Ducey, speaking to reporters on Thursday, said the hospitals “will likely reach peak capacity very soon.”

“This virus is everywhere,” said the governor.

The situation in Arizona – while President Trump this week made his second visit in as many months to the state, which could be a battlefield in November – illustrated the march of the virus through the Sun Belt, where it also beat Florida and Texas. , creating conditions as dire as any time during the pandemic. Texas Governor Greg Abbott (R) on Thursday suspended the reopening of his state and ordered hospitals in four counties to postpone elective surgery.

Doctors fear that there is now less support from a public weary of restrictions and polarized by a very partisan response to the health crisis. In the southern states, some epidemiologists also warn of what they call an “inverted summer effect,” with hot weather – once thought to stop the spread of the virus – driving residents into indoor spaces with recycled air.

“My level of frustration is high,” said Kennedy of the AARP. “We could have stopped that. “

The last time she met Ducey was March 11, said Kennedy, when she stood by him as he declared a health emergency and promised to protect nursing homes and assisted living facilities . He failed to complete these efforts, she said, saying that tests on facility staff remained insufficient and that equipment needs were not met. Cara Christ, Ducey’s director of health, was also absent, said Kennedy, withdrawing plans for a town hall virtual meeting with AARP members in April.

Now, a crisis that first collapsed on the elderly population of the state is becoming more and more evident among the youngest.

The average age of Arizonans killed by covid-19 dropped from 78 on April 27 to 69 on June 14, according to data processed by a modeling team of experts from Arizona State University and the University from Arizona. The average age of patients who tested positive for the virus increased from 51 years on April 5 to 39 years in mid-June. While the elderly are known to be more exposed to the virus, Arizona has three times more positive tests in people aged 20 to 44 than in any other age group, according to state data.

State cases began to increase dramatically around May 25, 10 days after Ducey authorized the expiration of the home stay order, said Joe K. Gerald, associate professor and health researcher public at the University of Arizona, which is part of the university. team providing models to the state health department.

Ross F. Goldberg, President of the Arizona Medical Association, said that “people thought it was back to normal.”

This misconception has persisted, even as new cases arise.

“I have to see someone sick, directly related to me or close to me, to make it come true,” said Joshua Kwiatkowski, walking this week through an outdoor mall in Tempe, Arizona. Not really, I guess, sunk. ”

Kwiatkowski said he was not inclined to wear a mask unless required to do so – unless, as he says, “an Uber driver feels a certain type of path or a store forces you to wear it “

Requirements to stem the spread of the virus have increased since Ducey changed course last week and has allowed local governments to impose more stringent rules on masks than recommendations issued by the state. A petition urging him to mandate face covers across the state has won the signatures of more than 1,000 health professionals. Ducey has also shifted his focus to companies, directing them toward developing policies that follow guidelines from the Centers for Disease Control and Prevention, which had not previously been recommended.

“There will be an application and they will be held accountable,” said the governor.

Many cities responded immediately with mask orders and emergency proclamations, including Scottsdale, where a tony district of upscale bars and shops had come to embody contempt for the technically distanced social distancing guidelines still in effect. but largely not applied. Photos and videos of crowded businesses have accumulated on social media as Ducey and other officials – often appearing maskless – insisted that most people behaved in a responsible manner.

The area, known as Old Town Scottsdale and usually crowded even on a weekday, became calm this week after the spate of new restrictions triggered by Ducey’s flip-flop. Most businesses had only a handful of customers, while some bars and restaurants had already closed for the evening, despite banners hanging on their facades to greet customers.

However, resistance to health precautions remains pronounced. At an anti-mask rally on Wednesday, a member of Scottsdale city council, Republican Guy Phillips, shouted the last words of George Floyd – “I can’t breathe” – before taking his mask off, and launched a rallying cry for national events. against racial injustice to combat face covers that reduce airborne transmission of tiny droplets. A few hours later, he apologized “to any offended person.”

Phillips, who has not responded to an email seeking further comments, runs an air conditioning business and, according to his board’s biography, is a member of the Better Business Bureau, the Arizona Small Business Association and the North Scottsdale Chamber of Commerce, among other business groups.

At nearly every stage of the state’s response to the pandemic, corporate interests have prevailed, said Nathan Laufer, founder of the Heart and Vascular Center of Arizona, a medical practice with offices in Phoenix and neighboring counties , and former director of the state medical association.

Ducey is a former CEO of Cold Stone Creamery. The head of the state restaurants association, Steve Chucri, is also a Republican supervisor in Maricopa County. He did not respond to requests for comment.

“It’s good to be pro-business, but first you have to be pro-citizen,” said Laufer. The governor, by belatedly giving more control to local authorities, “is catching up,” he added, “but it is too little, too late.”

Some residents noted that the Republican governor was following his party’s standard bearer. “The 20/20 at Hindsight, but yes, it was a little late,” said Greg Cahill, loading his car with groceries outside a Costco at the Christown Spectrum mall in Phoenix. “I think it was a bit slow. But he’s a conservative man and he wanted to do what Trump said. “

“It’s scary,” said the 58-year-old woman about the increase in cases.

Saskia Popescu, an epidemiologist affiliated with the University of Arizona and George Mason University, said that the seeds of the crisis had been sown in early May.

Protests were mounting in the state capital over the order to stay at Ducey’s house. His party’s lawmakers have pledged to cancel it. County sheriffs refused to apply it.

And Trump, who urged the governors to revive their economy, came to Arizona to visit a Honeywell factory and hold a discussion on the problems faced by Native Americans.

The day before the president’s visit, Ducey announced plans to speed up the reopening of his state’s economy, lift restrictions on salons and hair salons, and allow restaurants to resume food service. A graph showing the number of new cases, which did not show the 14-day decline recommended by White House guidelines, “really doesn’t tell you much,” Ducey said during his press conference at the May 4.

That evening, the state ended its partnership with the university modeling team, whose projections clearly showed an increase in the number of cases in Arizona. It resumed following an outcry.

Two days later, senior health officials admitted that they changed the number of tests to include viral tests confirming infection and serological tests for the presence of anti-coronavirus antibodies – a decision that could artificially reduce the rate of positivity presented by Ducey during his briefing on May 4.

“This is a good path for Arizona,” he said at the time.

Ducey’s initial order to reopen the state – and to prevent local officials from setting their own rules despite mounting evidence of the benefits of masks and social distancing – was consistent with a top-down approach to governance which, according to critics, characterized his mandate. In 2017, he signed a bill approved by the Republican-controlled legislature that authorized any state legislator to order the Arizona Attorney General to investigate local regulations for a possible law violation. the state. Consequences included the potential loss of state revenues.

“The biggest challenge has been for Governor Ducey to tie the hands of mayors and county health officials,” said Regina Romero, Democratic mayor of Tucson, who said that she weighed an emergency proclamation requiring masks to be worn. mid-March, but was discouraged by his city. lawyer. The city’s budget is around $ 566 million, Romero said, more than a fifth of which comes from the state.

“There is a real threat with the money at stake,” said the mayor.

Limited resources have also hampered the ability of the hardest hit counties to conduct a thorough contact tracing. Maricopa County moved in the first weeks of the pandemic to what it called a “mediated” approach in which all sick people are interviewed but then held accountable for notifying their own contacts.

County health department spokesman Ron Coleman confirmed this week that the limited approach is still in use, although cases are skyrocketing.

Hugh Lytle, CEO of Equality Health, said the Phoenix residents’ willingness to wait hours for testing at his medical group’s drive-in site over the weekend was a signal. alarm.

State officials note, he said, “the overwhelming level of fear and anxiety that makes people say it is worth sitting in my car for a few hours.”

Jacqueline Dupree contributed to this report.

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