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Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.

The Rapid Rise of Arizona to COVID-19 Hotspot

JUN 25, 2020 | SASKIA V. POPESCU
For several weeks, Arizona seemed like it might miss its coronavirus 2019 (COVID-19) peak or at least avoid staggering cases like those of New York and California.

Things started to change a couple of weeks after the stay-at-home orders expired and the state rapidly reopened. Arizona is now having a meteoric rise in COVID-19 cases, recently surpassing 52,000 and setting daily records for hospitalizations and bed capacity.
 
On Friday, June 20, the state reported 3246 cases, a new daily record. The state’s positivity rate has hovered between 8-12% in recent days and a rate of 18.63 for fatalities per 100,000. While some have maintained this is a product of more testing availabilities, the truth is that as such growing numbers rather than stagnant or declining suggest otherwise. The COVID Tracking Project reported that since Sunday, June 14, 20% of the reported tests in Arizona have come back positive. Across the board, all metrics are on a rapid ascension.


 
Many might wonder what happened—how and why did things go so bad so fast? The first piece is that Arizona never met White House gating criteria for safely reopening (e.g. relaxing restrictions). At the time orders expired on May 15 and Governor Ducey allowed the reopening of restaurants and other businesses, Arizona’s COVID-19 cases were pretty stagnant around 500-plus, meaning that there was no continued downwards trajectory for 14 days. Hospitals also reveal this in bed capacity—holding at 6-70% in use and no consistent downwards trend. 
 
Like clockwork, cases began to quickly rise roughly 2 weeks after Arizona reopened. May 26 saw 808 cases, and then an increasing growth to the new daily high of more than 3200. Intensive care unit capacity is taking a hit too, as 85% of beds in the state are occupied. Another 83% of inpatient, non-ICU, beds are currently in use. Images of packed bars and restaurants without masks occupants were seen across the nation as Arizonans celebrated Memorial Day in a reopened state.

Unfortunately, we are now paying the price for that. 
 
The issue isn’t just reopening and relaxing restrictions too early though. That’s one piece, but a second component to this situation is also the speed at which those restrictions are relaxed. This is meant to be an incremental process to allow time for identification of spikes and rapid response if they do occur.

Phases with weeks in between to allow for public health and healthcare response without becoming inundated, is critical. None of this happened in Arizona. Elective surgeries were allowed to begin on May 1, meaning that by the time restrictions were relaxed, hospitals were ramping up and filling beds, creating the perfect situation for a stressed healthcare and public health system in the face of rapidly rising COVID-19 numbers. 
 
A couple of other things are likely to amplify this current hotspot. First, President Trump held a rally on Tuesday, June 23. Rallies are prime environments for SARS-CoV-2 transmission: enclosed spaces, large volumes of people tightly packed together for hours, often shouting and yelling. Images from the Tulsa, OK, rally provide little confidence that masks will be worn, even when distributed.

A second piece to this worry is that as Arizona temperatures soar, so does the push for residents staying indoors. Gone are the days of outdoor exercise or activities to allow for social distancing and natural ventilation. With temperatures easily soaring above 110 F, people will be pushed indoors—and not just in their own homes, but also restaurants and businesses. 
 
Arizona’s COVID-19 situation is a prime example of why reopening efforts must be slow and steady as to avoid overtaxing the healthcare and public health system. Public health interventions need time to work and time to be properly scaled down. Hospitals are stressed and even with community mask requirements now in effect, the impact of those will likely take weeks.

Now is not the time for impatience, but rather vigilant community support and encouragement of public health. 
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