PLEASE NOTE UPDATES ON 6/8/20 AT THE END OF THIS ARTICLE
Ongoing analysis of Governor Ducey’s COVID-19 pressers:
June 4th:Governor Doug Ducey and AZ DHS Director Dr. Cara Christ gave the press another update on the COVID-19 epidemic and the protests of police violence in response to the brutal on-camera murder of George Floyd. I will post at a later time about Ducey’s response to the protests and murder of George Floyd. I will also follow up with Dr. Cara Christ’s update on Arizona’s testing program in a later post, too. In this post, I will focus only on the status of Arizona’s epidemic.
Ducey continues to elide and avoid the central issues of the COVID-19 epidemic in Arizona: the number of diagnosed cases, positive testing percentages, and COVID-19 hospitalizations are all obviously headed upwards.
Despite the clear evidence of these facts, Ducey and Christ will only say that they will continue to “monitor the situation” but would not commit to any policy responses to the trends.
Ducey’s premature re-opening of businesses and lessening social distancing is clearly causing a new surge of infections, and all Ducey will say is that “we expected this.” If he expected a surge in cases and deaths as a result of his policy, why did he pursue it?
The whole purpose of the White House’s plan was supposed to be to re-open the economy SAFELY, wasn’t it?
The plan states:
“President Trump has unveiled Guidelines for Opening Up America Again, a three-phased approach based on the advice of public health experts. These steps will help state and local officials when reopening their economies, getting people back to work, and continuing to protect American lives.”
Is the plan failing to protect Arizonans’ lives because Ducey failed to actually follow the recommendations of the CDC and the White House, (B4AZ exclusive content) and continued to re-open despite evidence that the epidemic was not slowing (B4AZ exclusive content)? Or because the plan was never intended to do anything but give Governors political cover to re-open as soon as possible, despite the anticipated consequences to public health?
A Downward Trajectory (OF WHAT?):
Starting at 16:37 in video.
Ducey hinges much of his case that Arizona’s epidemic is headed the right direction on the clearly downward trajectory of the following graph:
But what does this graph ACTUALLY show? “CLI Average visits” says the caption. The numbers are percentages. Percentages of what? Visits to where? And by who? This graph contains insufficient data to interpret it; it could really tell any story Ducey wants.
Nobody seems to question just what this graph is based on, and are assuming that Ducey is being honest about what it actually shows. I think Ducey has lost the right to any presumption of candor.
Somebody needs to track down the actual data these percentages are based on. Ducey is claiming that this graph means COVID symptoms presenting in Arizona are declining but without any real evidence of that fact.
One might think that Ducey’s graph would be based on data from his own DHS. Indeed, the DHS COVID dashboard has a graph presenting “Hospital COVID-like & Influenza-like illness Surveillance“. Bingo! That must be what Ducey is basing this graph on, right?
There does appear to be some rough correlation between the slopes of the lines in both graphs. And both graphs end on 5/24/20 (despite the last date being 5/31 on the bottom axis, using the actual graph indicates the end-point value is actually data for 5/24/20). So there is clearly some relation between the two graphs.
If you compare the percentages from 5/24 on the Governor’s graph of COVID symptoms (3.7%) to the above graph (3.0% for Emergency Department visits, and 4.4% for Inpatient visits), it suggests a possible connection. The average of 3.0% and 4.4% would be naively calculated at about 3.7%. Is that what Ducey’s data wonk has done to create the Governor’s graph?
If so, that’s mathematical malpractice. One would have to assume that the total number of visits to the Emergency Department and inpatient admissions are roughly equal to meaningfully average those percentages. That’s highly unlikely according to a hospitalist I spoke with, and we don’t have the underlying data to indicate that’s the case, nor does DHS offer it up on its’ website. What is really needed is the raw numbers of admissions, as well as the percentage presenting with symptoms of COVID.
These graphs, without their supporting data, are nearly useless at actually surveilling COVID symptoms.
Worse, I suspect they are both actively misleading.
Data taken only at hospitals will completely miss symptoms that present only to family or non-hospitalist physicians in person or by tele-medicine, which is how most COVID symptomology is presented to most doctors at this time. Only those who show up to the hospital or ED and are subsequently admitted are going to be counted by this data. That could be wildly misleading as to the actual rates of symptom presentation in the population. We just don’t know.
But that is just tip of a misinformation ice-berg.
Diagnosed Cases Are Rising:
Starting at 17:08 in video.
Anyone can clearly see below that the number of diagnosed cases in Arizona is on the rise.
Ducey is being obtuse and disingenuous when he claims “…What you see here is a lot of data and information [“which I hope you’ll ignore, because I will.” -MB]. We don’t have a trend established at this time. [“Except the obvious one I won’t admit.” -MB] Uh, we’ve seen some growth in cases as of late, and [“instead,” he means… -MB] we’ll look where we’re at in terms of percentage positive.”
Essentially, Ducey denies what anyone can clearly see for themselves: cases are rising.
The trend is even more clear when you look at the data as presented on the AZ DHS dashboard:
Given the timing of roughly two weeks since Ducey announced the grand “re-opening”, the rise is clearly the result of Ducey’s lessening of social distancing and service closures.
Positive Test Percentages Are Rising:
Starting at 17:45 in video
Ducey quickly moves on to the percentage of positive PCR tests that he relied on two weeks ago to falsely justify Arizona having met the White House plan’s gating criterion (BfAZ exclusive content). It has become even more clear that even this misleading data set does not support his favored conclusion that Arizona was or is ready for the White House’s Phase One.
This graph clearly shows a steady rise in the percentage of positive tests over the past three weeks.
At this point in the presser (18:23 in video), Ducey admits that he has fully expected all along that cases would increase upon re-opening. He also claims he has consistently communicated that fact.
“As you see an increase in testing, we’ve been consistent in saying you will see an increase in cases.”
That’s a lie. That was never his claim. He claimed that he would move forward safely and incrementally, responding to the latest data. He claimed that any increases in cases we were seeing were merely an artifact of increased testing, not a new outbreak starting. Now he is claiming that he has always said we should expect a rise in cases as a result of re-opening. That’s not true, which is probably why he claims it so emphatically.
It is jumping ahead considerably, but I was gratified to see that an intrepid and informed reporter actually took Ducey and Christ to task on the positive testing percentage and other data. Howie (Fischer, of Capitol Media, I presume) goes directly at Ducey’s whole misleading presentation at 30:30 in the video. It is truly is a joy to watch. Howie points out the graph data ends on May 31st, “which is convenient since on June 1st the positive tests went to 6.5, June 2nd – 11.5%, June 3rd – 14.7%, and we’re really at 1000 deaths,” says Howie. Howie goes on to point out that hospitalizations are up and our cases per 100K of population are now higher than California’s.
“Did you screw up?” cracked Howie. Howie totally nailed it. He should have dropped the mic on the floor and walked out of the room.
Positive tests percentages are rising slightly in Ducey’s own graph, which itself would place us outside the White House’s gating criterion for Phase One, but the latest data cited by Howie is becoming even more alarming. All Ducey can say in response to Howie’s sharp questions is a lame rejoinder that more tests inevitably means more cases. That is exactly the argument that Donald Trump makes for not wanting to do testing in the first place: because if you don’t test, there’s no case, right?
“We anticipated that [rise in cases]” claims Ducey.
If Ducey anticipated all along that re-opening would cause a new outbreak, why did he do it? He admits with this statement that he knew it wasn’t safe to re-open, and he did it anyway.
COVID-19 Hospitalizations Are Rising:
at 18:25 in video
UPDATE 6/8/20: It seems that AZDCS had a data reporting issue that resulted in the reporting of an extra 650 filled ICU beds and ~2200 filled regular Inpatient beds. This error by AZDHS changes slightly the past and current utilization rate calculation. The error has been retroactively amended on the DHS COVID-19 dashboard, on which I had relied, and it now seems that Arizona’s utilization rate has been slightly under 80% and briefly over 80% over the past weeks. This section’s discussion was therefore based on incorrect data provided by AZDHS. The underlying concern about hospital capacity remains valid, it is just slightly less dire than the data at the time indicated. MB
Now that Ducey has pivoted from his prior assertions that reopening is safe because the peak had passed and we were on the way to a reduction of infections, to asserting that he has always said, and always known, that opening would produce a new outbreak, Ducey plants a whole new goalpost, “[w]hat we wanted to do is be prepared for the increase in cases, so we’d have the capacity inside our hospital system.”
OK. But that’s also not the argument he’s made in the past. He argued the IF there was to be any resurgence in infections, we’d be sure to have the capacity to handle it, not that he was ensuring our hospitals were prepared for WHEN the surge inevitably came.
Instead of focusing on the epidemiological data that clearly indicates we are seeing the beginning of a new outbreak, Ducey now wants to focus on having sufficient capacity to care for those who will inevitably sicken. He ignores the inconvenient fact that a percentage of those who sicken will inevitably die.
Ducey is shifting his rationale for moving forward on the basis of public health data and containing the infection, to moving forward so long as our capacity to manage the inevitable casualties of his policy doesn’t exceed our capacity. That’s nowhere near where he started two weeks ago.
But one movement of the goalposts is not enough for Ducey.
“The measure here is that we can treat all patients without crisis care,” Ducey asserts.
But that is not the gating criterion for sufficient hospital capacity given in the CDC’s detailed guidance on the White House plan [at page 32].
- “Transition into Phase One: Inpatient and ICU beds <80% full for 7 consecutive days AND no staff shortages for 7 consecutive days AND PPE supplies adequate and available for >4 days”
Ducey knows that Arizona’s hospital system does not meet the gating criterion for Phase One as defined by the CDC. We’ve been above 80% the entire time he’s been trying to re-open Arizona. We’ve been above the 80% utilization cut-off continuously since 5/13/20.
Instead of meeting the gating criterion per the CDC’s guidance, Ducey simply uses the language of the summary of the criteria [at page 24]:
- “Indicators for hospital readiness:
- Capacity to treat all patients without utilization of crisis care standards”
What the CDC’s summary language actually means is defined by their detailed metrics: “ICU beds <80% full for 7 consecutive days.” What Ducey decides it will mean to him is: “do whatever you want.”
Ducey is asking Arizonans to accept a manageable level of casualties in exchange for lessening public health restrictions. That was not the deal he sold everyone on.
He claimed that he would re-open, see what happens, and adjust based on public health outcomes. Well, we’ve seen the outcome: a resurgence of the epidemic.
But now, Ducey says the NEW deal is that we’ll stay open as long as our hospitals can handle the fallout. Well, according to the CDC, we are already in such dangerous territory we shouldn’t even have moved into Phase One. But now Ducey says, since we don’t have people dying in tents yet, we’re cool.
Do you really want to get to that point? Do we have to actually HAVE a capacity crisis in our hospital system before Ducey will admit his experiment has failed? How many more must die before Ducey will do what he promised and adjust his policy to fit the data and not the other way around?
UPDATE 6/8/20: It now appears that Ducey’s “without crisis care standards” criteria may be implicated by a shortage of ECMO machines for the very sickest COVID-19 patients whose lungs have shut down entirely, and would otherwise die if an ECMO were not available. MB