Arizona reopens in phases

ARIZONA — Arizona began the phased reopening of the economy this week, following White House guidelines amidst ongoing debate about the risk involved.

This week the state cleared the reopening of restaurants and most “non-essential” businesses – providing they can adhere to social distancing guidelines. The stay-at-home order was loosened, although people are still urged to avoid non-essential travel. Moreover, people in risk groups like those over 65 and people with diabetes, breathing problems and immune system weakness were urged to stay home.

When people do venture out, the guidelines bar groups of more than 10 and encourage wearing masks in public.

Gov. Doug Ducey chiefly cited continued capacity to handle more cases at hospitals, a decrease in the percentage of positive tests and a rise in the state’s testing capacity.

The state did not meet all of the White House criteria, nor the more restrictive recommendations made by the federal Centers for Disease Control. Despite a big increase in daily testing, the state does not have the capacity to even track down and test the close contacts of those who do test positive. Rather than test close contacts as South Korea and others have done, most counties in Arizona are simply asking people to identify and inform their own close contacts after they test positive.

Gila County has one of the lowest case rates – with 21 cases and two death as of Wednesday. Perhaps because of the low caseload, the county health department has undertaken a more robust contact tracing routine than most. The county offered testing for many close contacts of confirmed cases. Moreover, the MHA Foundation has funded testing for health care workers and paramedics and will shortly open up testing to a much broader audience.

Last week, Gila County had performed 978 swab tests to detect an active infection and 267 antibody tests. On a per-100,000 population basis, so far Gila County has 39.9 cases.

Statewide, 7.5 percent of swab tests have come back positive compared to just 2 percent of tests in Gila County. Meanwhile, statewide 3.2 percent of the antibody tests have come back positive compared to 1.7 percent in Gila County.

So by all of the criteria Gov. Ducey has relied on to move towards reopening, Gila County remains one of the safest corners of the state. Arizona has a relatively low infection rate compared to the national average – but also has one of the lowest test rates.

The national criteria call for a three-phased reopening, with a roughly two-week lag between each phase. In 14 days, someone who got infected at work, a restaurant or a store would have time to incubate, cause symptoms and end up in the official tracking data. So if the opening of restaurants and other businesses this week causes a surge in infections, we won’t see the spike for about two weeks.

Phase one: Started on Thursday

• Vulnerable people remain at home – especially the elderly and those with high-risk conditions. People over 65 account for 80 percent of the deaths in Arizona.

• Social distancing remains in effect in all public areas.

• No gatherings of more than 10 people.

• Avoid essential travel.

• Employers should encourage working at home.

• Schools and group youth activities remain closed.

• No visits to hospitals and nursing homes.

• Bars remain closed except for food service.

• Businesses urged to comply with social distancing requirements, including cleaning, limits on crowds, spacing of customers and other measures

Phase two: Can start in two weeks if cases don’t surge

• High risk people urged to stay home.

• Telework and workplace social distancing encouraged.

• Gatherings of up to 50 people allowed.

• Non-essential travel allowed.

• Schools and daycare centers can reopen.

• Large venues can reopen with moderate physical distancing.

• Bars can reopen.

Phase three: Could start two weeks later — which woud be in mid June — if cases don’t serge.

• High-risk people can go out more, but should practice social distancing.

• Low-risk people should still avoid crowded social environments.

• No restrictions on offices.

• Visits to long-term care facilities and hospitals resume.

• Large venues can operate with limited social distancing.

• Gyms and bars can increase capacity.

So here’s how Arizona stacks up against the White House criteria for a phased reopening.

Criteria: Hospital cases of flu-like illnesses and COVID-like cases decline over a two-week period.

Hospitalization for respiratory diseases like COVID-19 and the flu have clearly declined since peaking at 52 admissions on April 6. The number of daily new admissions dwindled to about 23 on May 3, according to the state tracking system. COVID-19 cases account for about 13 percent of all hospitalizations. The total number of COVID-19 patients in the hospital has actually remained pretty consistent, generally over 700. However, the percentage of ER and inpatient admissions due to COVID-19 and flu-like symptoms has declined from about 7 or 8 percent to 3 or 4 percent since the peak at the end of March. Some of that decline may reflect the end of the flu season, since the statistics included both flu and COVID-19 symptoms.

Criteria: Percentage of positive tests declining in the past two weeks.

Overall, 7.4 percent of the swab tests for an active infection have come back positive. That percentage peaked at 12 percent in March and declined to about 4 percent in May. For most of April, it hovered at around 7 percent. However, that decline’s hard to interpret since the state has only recently loosened up the criteria for who gets tested. Throughout April, the state did about 2,000 tests daily. In May, the number has risen to more like 9,000 daily. In April, mostly only people with active symptoms got tested. In May, anyone with a doctor’s order can get tested. This makes the percentage of positive tests hard to compare from April to May.

Criteria: Rate of increase in new cases declines over a two-week period.

The number of Arizona cases actually continues to rise steadily, but that’s not surprising considering the big increase in testing. The single-day peak of 456 new cases came on May 4 and has declined since. However, results typically straggle in, so the more recent daily toll will likely rise. The overall shape of the curve continues to slope upward.

Criteria: Hospitals have the capacity to handle a fresh surge of cases.

The state’s hospital system has never approached the kind of overload that confronted New York, Italy and Wuhan China. Gov. Ducey ordered the cancellation of all elective surgeries and pressed hospitals to get as many beds ready as possible, when early projections suggested a big shortage of beds and ventilators. Hospitals actually ended up half empty and started laying off workers. The percentage of intensive care beds in use hit a low of 62 percent on April 7 and has remained between 75 and 80 percent since then. The percentage of ventilators in use has remained consistently below one third of those available since the onset of the pandemic. Gov. Ducey recently allowed hospitals to resume elective surgeries.

Peter Aleshire covers county government and other topics for the Independent. He is the former editor of the Payson Roundup. Reach him at paleshire@payson.com

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