As coronavirus cases in the state continue to spread at the fastest rate since June, public health professionals and hospital staff are already preparing for another COVID-19 surge in Arizona.
Although metrics tracking the spread of the virus waned after summer, recent state and county-wide data are showing increased positive cases, hospitalizations and deaths from the virus.
On Tuesday, Nov. 10, Arizona reported 3,434 new cases, the highest single-day jump since July 25. Within the first nine days of November, the state is averaging 1,528 new cases a day.
As of Tuesday, Nov. 10, Pima County had reported 31,013 COVID-19 cases of the 259,699 cases statewide. A total of 661 people had died after contracting the virus in Pima County.
The county has a coronavirus positivity rating of 7.4%—a rate of 5% is a good indicator the spread of the virus is under control.
"I think people thought there was light at the end of the tunnel and now this is happening again," said Pima County Public Health Director Theresa Cullen. "We had that horrible time in the middle of the summer then we came back down. At our lowest, we were down to 400 [cases a week], but now we're going back up. I'm hoping we are not going to go back as high as we were in the summer, but I don't know what's going to happen."
Statewide hospitalizations for COVID-19 cases have increased in recent weeks and reached 1,232 hospitalizations on Nov. 8, the highest reported total since Aug. 14, according to data from the Arizona Department of Health Services (ADHS).
Gordon Carr, the chief medical officer for clinical outcomes at Banner University Medical Center Tucson and South, says the hospitals he works at are receiving more COVID-19 patients, and medical staff is preparing.
"We are starting to see an uptrend in patients requiring hospitalizations for COVID-19. I think it's important that all of us are prepared for things to get worse before they get better," Carr said. "If we look at current trends in terms of new cases, and if we look at the increasing reproductive rate of COVID-19 in our state and in our county right now, we are expecting to see more hospitalizations."
Dr. Clifford Martin, an infectious disease specialist at the Tucson Medical Center (TMC), said at a press conference Thursday that a month ago, the hospital had one to two COVID-19 patients, and as of last week, they have 50.
"What I think has happened is that, as happens in any long term effort, people started letting their guards down. We all are feeling fatigued, and as a result, we're seeing the predictable increase again," Martin said.
COVID-19 cases coming from schools, institutions and the community
One of Cullen's main concerns is the danger of transmission in large gatherings amid holidays like Halloween. The University of Arizona's percent positivity rate for COVID-19 was 1.1% from Oct. 23 through Nov. 1, an increase from the 0.6% rate the university reported the previous 10-day period.
Cullen says although "we have not seen the impact yet" from Halloween parties that occurred over the holiday weekend, the hundreds.
A coronavirus case spike hit the University of Arizona in mid-September causing a voluntary 14-day self-quarantine, and cases relatively declined after. Now that COVID-19 cases are surging again, Cullen doesn't believe university students are solely to blame.
Many schools have reopened for hybrid learning and are reporting positive student COVID-19 cases. Furthermore, Cullen said there's also "an institution that's having an outbreak, and that's contributing over 100 to 150 cases in the last week."
"I think the university is contributing, but I think it's the general community that is contributing more," she said. "We have K-12 schools that are contributing, we have the institution that's contributing. The university is contributing, but the numbers at the university overall are not that high."
Hospitals gear up for a surge
Although case counts are increasing statewide, Ducey doesn't plan on imposing new safety restrictions to prevent further spread of COVID-19, and said at an Oct. 29 press conference, "the mitigation that we've put out, the plan we put into effect, remains in effect."
Regardless of the governor's mitigation plans, hospitals across Tucson are gearing up for a COVID-19 surge they say they're already seeing.
According to Carr, both of the Banner University Medical Centers in Tucson say they are adequately staffed, have enough ventilators to meet the current demand and aren't currently concerned about their ICU bed capacity, although they are meticulously monitoring these conditions.
Banner receives many patients from the "Arizona Surge Line," a system established by ADHS in April that all Arizona hospitals participate in. The centralized system prevents one hospital from becoming overwhelmed by facilitating COVID-19 patient admission and transfer. Hospitals can call the surge line to transfer a patient to a different facility that may provide a more appropriate level of care.
"Surge capacity is the ability to take care of a significant, sudden influx of patients, and it really boils down to three key elements: staff, structure and stuff," Carr said. "So at Banner Health, just like at large health systems across the country, we have teams working across our system on a daily basis to ensure that we're doing everything we can to have the staff, the physical capacity and the equipment we needed to serve our communities."
TMC also receives many patients from the surge line, and although they feel prepared right now, the upcoming influx of cases is of constant concern to hospital staff—especially with the chaos of the summer surge fresh on their minds.
Martin says TMC has more capacity to administer COVID-19 tests and said, "we're not in the absolute dire shortage of personal protective equipment that we were back at the beginning of the year."
"We definitely have much more capacity from an operational standpoint to deal with those issues. It is true, however, that within the last week, we're starting to test that capacity a little bit," Martin said. "This week, with the increases in cases that we're seeing in the community, and the increase in cases that we're seeing in the hospital, we're preemptively starting to have discussions about how we might use that differently if we continue to see this uptick."
Both TMC and Tucson's Banner hospitals are planning for a surge, and after the influx of cases that ensued in the summer, they feel more prepared this time around.
"I do think that we have learned a lot in the hospital about how to care for the patients, how to intervene earlier, and so our length of stay is lower, our ability to manage these patients has been fine-tuned. We're still having people die from this disease, but not the way we did," said Judy Rich, TMC's president and chief executive officer. "A lot of learning over these last several months and a lot of respect for the disease and how easily it's transmitted, but we're not really predicting that we're going to get into the kinds of severe, sudden impact we saw in July."
Carr agrees hospitals will be more prepared this time around, but he stresses this is not a reason to become complacent.
"We all learned a lot from the summer surge. Our doctors, nurses and other clinical professionals learned a lot in terms of how to care for these patients...All of those lessons will serve us very well in the next surge," Carr said. "But it's really critical to understand that no matter how well prepared we are, a key element in getting through the next wave is going to be for our community to maintain a very high level of non-pharmacologic interventions that we've been talking about."
As an insider to the painful reality of COVID-19 within the hospital walls, Martin believes the general public may not understand the dire consequences the pandemic has caused.
"There's a tendency, if you are not in the hospital, to look around and wonder what the big deal is because you don't see the impact of the disease on the streets other than businesses being affected and people staying home. Then you come into the hospital and you see what it's like in a month to go from an ICU that had no COVID patients to 50. And you recognize that if we don't make a change today, and that exponential curve increases...we are going to be in a crisis."
Cullen expects the surge in cases to continue given the upcoming holiday season and the likelihood of travel and large gatherings. She said while the health department recommends people stay home and avoid large gatherings, Cullen realizes many won't abide by those guidelines.
"I think we have to, as the health department, be creative and recognize that it's one thing to say you should all stay home and not have family gatherings and there's another recognition that isn't very realistic," Cullen said. "So we need to figure out how we can keep people safe in an unsafe environment."
Those on the frontline of the battle against COVID-19 implore the public to continue following safety measures like mask-wearing, social distancing and frequent hand washing and sanitization.
"Exponentially, there's a portion of patients that are going to die from this and other phenomena as well, so we're continuing to push the message that, despite what you see around you, everyone is at risk," Martin said. "Even if you're not at risk of getting it yourself, you have a responsibility as a community member and a citizen to not spread it further, because eventually, someone you love will get it and be adversely impacted."