Federal vaccine mandates have fueled fresh debate about how to contain a stubborn pandemic, even as the rush of new cases begins to ebb in Navajo and Apache counties.
Schools remain at the center of the debate, with the delta variant fueling unprecedented clusters of cases on school campuses — and a five-fold increase in the hospitalization of children infected with the virus.
Arizona’s recent flood of new cases has slowed, with an 11% decline as a daily average over the past two weeks. Arizona is averaging about 2,800 new cases per day — which is actually an 11% decline compared to two weeks ago. The state has about 38 new cases per 100,000 compared to a national average of 45 per 100,000. Tennessee has the highest rate of infection current at 103 per 100,000.
Navajo County has an infection rate of 34 per 100,000 and Apache County a rate of 47 per 100,000.
Some 58% of Navajo County residents and 69% of Apache County residents are fully vaccinated — but that mostly reflects very high vaccination rates on the Navajo and Apache reservations. In the White Mountains, only about a third of the population’s vaccinated.
Meanwhile, President Joe Biden announced federal vaccine mandates that will cover about two-thirds of the US workforce, including most teachers. He also urged schools to require vaccinations for students older than 16.
Nine states have already mandated vaccines in schools and for school staff — some for those over 12, some for those over 16. That includes the Los Angeles School District, one of the largest in the nation.
However, the Arizona legislature this year barred either mask mandates or vaccine mandates in schools.
Numerous studies have shown that middle schools and high schools produce far more clusters than elementary schools, mainly because students rotate through six classes per day — creating the potential for 180 close contacts daily for each student. By contrast, elementary school students remain in a single class with 20 or 30 students and schools can easily manage the number of close contacts by controlling the way different classes mix at lunch and recess.
Schools in the White Mountains have resumed in-person classes, mostly without mask mandates for students or staff and without vaccine mandates for teachers.
Navajo County so far has reported 19,000 cases in a population of 110,000. The county continues to report about 24 new cases per day — and administers about 100 new vaccines daily. Off the reservation, only 39% of the population is vaccinated. Since the start of the pandemic, the county has suffered 514 deaths per 100,000 population and 16,773 cases per 100,000. About 11% of the 500 tests administered per day are coming back positive.
Apache County has reported 12,743 cases in a population of about 70,000. The county’s reporting about 23 new cases per day and administering about 82 doses of the vaccine. The county has suffered a death rate of 635 per 100,000 and has just 27% of the off-reservation population vaccinated. About 10% of the 278 new tests per day are coming back positive.
In Navajo County, 19% of those under 18 have gotten at least one shot — compared to 69% of those over 65. In Apache County, 25% of those under 18 have gotten the shot — compared to just 36% of those older than 65. That’s a sharp departure from most areas, where vaccination rates are far higher among the elderly — who remain at much higher risk of death and serious illness.
The Biden Administration’s embrace of vaccine mandates for federal workers, healthcare facilities receiving money from Medicare and Medicaid and companies with more than 100 employees puts the state into direct conflict with federal rules and regulations. If people don’t want to get vaccinated at large businesses, they could instead get a test each week to show they’re not infected. It’s unclear who would pay for this test — health plans, employers or employees. Many health plans don’t charge a co-pay for the test. Often, the test costs $100 — or comes for free at federally-subsidized public health clinics. However, people have also suffered medical sticker shock with surprised bills of $1,500 for a test. Federal workers would have 75 days to get vaccinated or face unspecified consequences.
The federal government is now urging schools to require students older than 16 to get vaccinated, now that the vaccines have full, non-emergency approval from the federal Food and Drug Administration. The FDA is expected to issue full approval for use of the vaccine in ages 12 to 16 in the coming weeks and for children younger than 12 before the end of the year.
Arizona Gov. Doug Ducey has said the state will “pushback” against the new federal vaccine requirements. Arizona Attorney General Mark Brnovich — who is running for governor — has suggested the state will file a lawsuit to block the federal vaccine mandates. Both have harshly criticized the new policies as federal overreach and an infringement of individual rights.
Rep. Paul Gosar also blasted vaccine mandates. “There is no law authorized by Congress and no Constitutional provision that conveys the power to the presidency to force any citizen to undergo a medical procedure against their will. Mr. Biden’s decision mandating that Americans take a COVID-19 vaccine is illegal, unconstitutional and a deprivation of individual liberty. This is radial government overreach.”
Similar battles erupted over previous vaccine mandates, including the campaigns that wiped out smallpox and nearly exterminated polio in the US. Smallpox killed 300 million people between 1900 and 1977, when the vaccine eradicated it. Before the development of the first vaccine, smallpox accounted for about 8% of all deaths annually.
Studies have shown that the three approved COVID vaccines are roughly 95% effective against most COVID-19 strains and perhaps 80 to 85% effective against the delta strain. Even when someone suffers a breakthrough infection, those who have been vaccinated are less likely to suffer serious illness or die. It’s unclear from the existing studies whether recovery from an infection without a vaccine offers comparable protection, especially when it comes to the delta variant. Some small-scale studies suggest recovery from infection by a previous strain offers about 34% infection from a new infection by the delta virus — roughly the same level of protection of a single dose of the Pfizer or Moderna vaccines.
Health officials are alarmed at a big increase in cases in schools and hospitalization of children with serious illness due to the spread of the delta variant.
Fortunately, unvaccinated children are still far less likely to get seriously ill compared to unvaccinated adults — even in the face of the much faster spread of the delta variant. However, studies have suggested schools are increasingly the source of clusters of new cases that then spread to unvaccinated adults — both on campus and off.
One study found that unvaccinated and unmasked middle school students have a 40% chance of getting infected at school over time, according to researchers from Georgia Tech and North Carolina State University.
Hospitalization rates among children and teens rose five-fold between late June and mid August as the delta virus pushed aside earlier strains across the country. Hospitalization rates were 10 times higher among unvaccinated children, according to the report from the federal Centers for Disease Control. Some 30,000 children with COVID were hospitalized in August. Despite the big increase, those under 18 with the virus have only a fraction of the hospitalization rate of adults.
States like Arizona with low vaccination rates have seen the biggest increase in new cases and deaths among both children and adults, according to national tracking data.
The delta variant prompted the CDC to change its recommendations for schools, with support for mask mandates indoors when students cannot socially distance. The recommendations was based in part on studies showing that universal masking in schools reduced infection rates by 800%. The combination of masking, natural ventilation of classrooms and fine filters on air conditioning and heating units reduced transmission by 3,000 %. However, the new Arizona law bars school mask mandates.
A new poll last week showed that 59% of Arizona’s likely voters oppose the ban on school mask mandates, while 38% support the ban. The poll included 400 respondents, with a margin of error plus or minus 5%. The Arizona School Boards Association and the Arizona Public Health Association paid for the poll. The ASBA is challenging the state’s mask mandate ban for schools in court. Voters supported vaccine mandates by a smaller margin. The respondents were 42% Republican, 34% Democratic, 8% Independents and 16% undeclared — mirroring the make up of the state’s most likely voters.
Democrats and Republicans divided sharply. Some 92% of Democrats but only 26% of Republicans supported mask mandates in schools. Independents fell somewhere in between, although a majority supported mask mandates.
Some 72% of those surveyed said they have been vaccinated, but that included 52% of Republicans and 93% of Democrats.
“For the Arizona School Boards Association, the heart of the mask issue is local control,” said Ann O’Brien, president of ASBA’s board of directors and a Deer Valley Unified School District governing board member. “We believe that our member districts and their locally elected school board should be able to decide what’s best for their students and staff. In general, voters support masks, but most importantly, they also support allowing our local school districts to have a choice on whether or not they would like to implement a mask mandate.”
The poll showed 62% opposed Gov. Ducey’s plan to use $163 million in federal COVID-19 relief money to reward schools that don’t require masks. The governor had set aside a portion of the federal pandemic relief money intended for schools. The grant program required the state to pass the money along to low-income school districts struggling with the costs of the pandemic and much greater documented learning losses among students. Those low-income districts — including most rural schools including Payson — have already received the maximum allotment through the program. So the money the governor is withholding based on mask mandates can only go to high-income school districts. Payson’s not eligible, noted Gibson.
Some 62% of the voters polled aid they disagree with order that offered money to districts that do not adopt mask mandates.
About 51% also opposed the governor’s order prohibiting local government from requiring proof of vaccination from their employees.
“Vaccines are effective against the Delta variant, but transmission risk remains elevated among unvaccinated persons – particularly in schools,” said Will Humble, head of the Arizona Public Health association. “Once again, the public understands this and a majority think that a private business or local public entity should be able to require proof of vaccination to help stop the spread of COVID-19.”