Arizona is on the brink of a humanitarian catastrophe

During a live interview streamed on Facebook, Dr. Anthony Fauci, the top infectious disease expert in the U.S., said Monday that the U.S. is “still knee-deep in the first wave” of the COVID-19 pandemic. As COVID-19 Cases Surge, Fauci Says U.S. Is Still ‘Knee-Deep’ In First Wave.

Fauci’s reference reminded me of Pete Seeger’s classic Waist Deep in the Big Muddy (selected lines):

“We were, knee deep in the Big Muddy,
But the big fool said to push on.”

“We were, waist deep in the Big Muddy
And the big fool said to push on.”

“We were, neck deep in the Big Muddy
And the big fool said to push on.”

“We were lucky to escape from the Big Muddy
When the big fool said to push on.”

Well, I’m not going to point any moral,
I’ll leave that for yourself
Maybe you’re still walking, you’re still talking
You’d like to keep your health.
But every time I read the papers
That old feeling comes on;
We’re, waist deep in the Big Muddy
And the big fool says to push on.

The coronavirus pandemic is surging out of control in the United States because of the “big fool’s” insistence on reopening the economy and returning to normal, pretending that the pandemic has been magically solved and is now behind us.

Nowhere has it had more devastating consequences since the “great reopening” than here in Arizona. We are ground zero for the worst COVID-19 outbreak in the nation (per capita) right now. Arizona has highest percentage of positive COVID-19 tests in the US.:

One in four COVID-19 tests in Arizona is coming back positive, the highest percentage in the country, according to Johns Hopkins University, and an indicator that there isn’t enough testing to keep up with the new coronavirus’ spread in the state.

Arizona’s COVID-19 metrics have been moving in the wrong direction for more than a month.

A high percentage of positive tests means that testing is limited and may only be reaching those who are the most sick, and that the virus is widespread and impacting wide swaths of people. Ideally, people who are asymptomatic and those who have been in contact with known cases should get tested.

A low percentage of positive tests means testing is widespread, hitting those with and without symptoms, or that the virus is losing its spread in a community.

According to the World Health Organization, one sign among many that the epidemic is controlled is that percent positive is less than 5% for at least two weeks, assuming comprehensive testing.

Arizona has the highest percentage among all states of positive tests, according to data from Johns Hopkins, with an average of 25.3% of tests coming back positive as of Tuesday.

Other states seeing surges in case still have lower percent-positive rates. In Florida, the rate is 18.7%, and in Texas, it’s 13.8%, according to Johns Hopkins as of Tuesday.

The nationwide percent of positive tests is 9%, according to the U.S. Centers for Disease Control and Prevention.

And remember, the CDC says COVID-19 cases in U.S. may be 10 times higher than reported: “Our best estimate right now is that for every case that’s reported, there actually are 10 other infections,” Dr. Robert Redfield, director of the CDC, said on a call with reporters Thursday.

Arizona is not “knee deep in the big muddy” of COVID-19, we are “neck deep in the big muddy” of COVID-19 and about to drown. We have a humanitarian catastrophe.

Arizona has more cases, a higher percent of positive cases and more hospitalizations than it did in May. It no longer meets any of the White House criteria for reopening after crisis care standards were activated last week [Arizona did not meet the standards before reopening].

During the past three weeks, cases increased by 169% and tests increased by just 77%, indicating cases are growing far more than what would just be accounted for by increased testing, at the same time as the percentage of all tests that are positive is growing.

“We’re off the charts,” said Will Humble, executive director of the Arizona Public Health Association.

The percent of positive tests needs to be driven way down from where Arizona is at to show that the state has enough testing to meet its needs, Humble said.

“Two things have to happen for it to go down: You need to have more testing in the community, and you need at least a stable community spread happening,” Humble said. “But what we have had is a big increase in community spread over the last six weeks and a modest increase in the number of tests. And what you get is an increasing percent positive.”

Arizona reported 117 deaths from the coronavirus on Tuesday, bringing the total to 1,927. Arizona Coronavirus Death Toll Mounts as Hospitals Near Capacity:

Cases in the state are climbing and, according to the Arizona Department of Health Services, the state recorded 3,653 new cases of COVID-19 on Tuesday, bringing the count to more than 105,090 cases.

Like much of the country, increases in Arizona cases are occurring among younger people. Health officials have suggested that might be a contributing factor to death tolls remaining stable in many places, although they have warned that fatalities are likely to rise as the numbers of infections escalate. That projection appears to be playing out in Arizona.

The Trump administration’s covid-19 response coordinator acknowledged Tuesday that the country was not prepared for the spread of the disease among young Americans — a key factor in recent spikes of infection across several states. Birx says U.S. underestimated community spread of coronavirus, spurred by young people:

[Dr.] Deborah Birx, the physician who oversees the White House pandemic response, said leaders in states that were not hard-hit early on “thought they would be forever spared through this,” and when they reopened their economies, they didn’t expect a surge in cases spurred by a cohort of mostly millennials.

As cases increase, the state is reporting one of its lowest numbers of available intensive care unit hospital beds.

Five percent, or 5,272, COVID-19 patients are hospitalized, and Arizona had 10%, or 167, of its ICU beds available as of Monday. The health department said 1,481 ICU beds in use.

Additionally, the state has about half of its ventilators, life-saving machines used on the most critical patients, available. Fifty-one percent, or 895, were being used as of Monday.

Regina Romero, the mayor of Tucson, told CNN on Tuesday that she is very concerned about the dwindling hospital capacity. Pima County, where Tucson is located, has the second highest number of cases in Arizona, with 10,184, including 311 new cases on Tuesday. The county has reported 302 deaths, including 20 on Tuesday, according to the Arizona Department of Health.

The county has an overall positivity rate of 9.1% and 746 people are hospitalized.

Romero told CNN that ICU beds in the county are at their limit and only five to 10 of them are available on some days, which may force the county to send patients to other states for care. She added that test results are taking too long and contact tracing is a disjointed process.

“What’s happening in Arizona is a microcosm of … the direction that President Trump has led us in,” Romero told CNN’s Kate Bolduan. “There is no coordinated effort for testing in this country, much less here in Arizona. We need help. We’re in crisis.”

“We need the governor and the federal government to come and help organize our efforts so that we can take this under control,” Romero added.

The Daily Beast reports, Arizona Is Awash in COVID-19 and Testing Is a ‘Shitshow’:

Two weeks ago, Brett Barry walked into a CVS near his home in Phoenix to get a coronavirus test … It took three days just to schedule a testing appointment, and the pharmacy said it could be up to a week before his results came back … As of yesterday, 14 days after Barry was tested for the coronavirus, he still had not received his results.

In Arizona—which began reopening in early May, only to lock down again after being hit with a tidal wave of cases—the testing infrastructure is underwater. Residents like Barry are waiting up to two weeks for results, while others are waiting up to 13 hours just to get tested. The top testing lab in the state said it is receiving double the amount of orders it can handle. And a crucial testing instrument isn’t arriving until August.

“What really pisses me off is I sheltered [in place] for three months,” Barry said, adding that he has diligently been wearing a mask in public since April. “And now it looks like we’re going to have to start over again.”

In recent weeks, Arizona has climbed to No. 8 on the list of states with the most confirmed coronavirus cases, passing 100,000 on Monday. On Tuesday, the state hit a record high number of deaths in a single day. Ninety percent of ICU beds are full, and some hospitals are reportedly shipping patients out of state.

Kate Gallego, the mayor of Phoenix, has even called on the Federal Emergency Management Agency (FEMA) to step in, saying her city is in a “crisis related to testing.” Phoenix Mayor Kate Gallego says federal government denied requests for COVID-19 testing help.

“I’ve been spending time begging everyone from Walgreens to open up testing, out-of-state testing companies to come in, because it’s awful to see people waiting in a car while you’re feeling sick,” she told ABC’s Martha Raddatz this weekend. “And this is as many months in.”

Arizona Chief Operating Officer Daniel Ruiz told The Daily Beast that test results could take anywhere from one or two days to a high of five or seven, calling the upper end of the spectrum “really frustrating, from a public health standpoint.” But the website for Sonora Quest Laboratories, which handles 80 percent of testing in the state, says most patients should expect to wait at least six or seven days for results. A voice message for the follow-up line at CVS Minute Clinics, where Barry was tested, gives a similar wait time.

* * *

The testing delay also poses broader public health problems. According to Jeffrey Klausner, a professor of epidemiology at the UCLA Fielding School of Public Health, positive test results are the easiest way to convince someone to self-isolate and stop the spread of the virus. And the sooner an infected patient receives those results, he said, the sooner they will take preventative measures.

“People who don’t know their infection status could go out and continue to spread, particularly to older people,” he told The Daily Beast. “They may not access medical care as early, because people may not be as aware or concerned that they actually have a true infection.”

Arizona didn’t always have such a severe backlog. In May, the governor’s office and state health department had to extend a three-weekend “testing blitz” for two more weekends after they failed to attract even 10,000 people for testing every Saturday. And Ducey said as recently as June 11 that the state was in good enough shape to continue reopening.

In recent weeks, as the number of cases in the state skyrocketed, so did the demand for tests. More than 900 people showed up to a single testing event on June 18, according to local news reports, leaving residents waiting up to 13 hours in 100-degree heat. Seven hours after the event was scheduled to end, organizers started turning people away—some of whom had lined up before the event started.

“At some point, we had to cut it off because we didn’t have enough tests, and our staff and volunteers were being pushed to the limit because of the heat,” Tomás León, the senior vice president of marketing and Strategy at Equality Health, told The Arizona Republic.

The day before, Sonora Quest had received 12,000 test orders—a record number for the laboratory, and double its capacity, according to Reuters. Two weeks later, the testing backlog caused the lab to miss a deadline to report new coronavirus cases to the Arizona Department of Health Services. Sonya Engle, the lab’s chief operating officer, told a local radio station that Sonora Quest was looking to add a third testing platform that would enable it to process 40,000 coronavirus tests per day—but according to Reuters, the platform isn’t slated to arrive until August.

Cara Christ, the director of the Arizona Department of Health Services, admitted that the number of testing requests that weekend had taken the agency by surprise. When they reached out to the laboratories to provide support, she said, they learned that the labs were running low on reagents and other materials necessary to run the tests.

“I think that even Sonora Quest was surprised by the recent demand in testing,” Christ said, adding that the department had been “working with our federal partners to address each of those issues of the past couple of weeks.” (Sonora Quest did not respond to several emails seeking comment.)

Asked why the governor’s office did not anticipate a surge in demand, based on the catastrophic outbreaks in states like New York, Ruiz said these surges were “dynamic” and that strategies would “vary based on the state and what they’re seeing in terms of their case increases.” He added that the governor’s office planned to announce a project with a private lab this week that would “exponentially increase” the state’s testing capacity.

Meanwhile, Barry is still checking his CVS account daily, waiting for his test results.

There is no leadership from the White House or the governor’s office. Their failures have created a humanitarian catastrophe in Arizona.

Stay at home. Wear a mask. Wash your hands frequently. Don’t touch your face. Stay at least six feet apart from others if you must go out in public. Do your part. The life you save may well be your own.

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