COVID-19 appears to be on the rise since stay-at-home order expired

The number of new COVID-19 cases is on the rise, other key indicators are also moving in the wrong direction, and the trends appear to coincide with the expiration of Gov. Doug Ducey's stay-at-home order.

Ducey allowed his stay-at-home order to expire on May 15, citing consistent decreases in reports of COVID- and influenza-like symptoms, a falling percentage of Arizonans testing positive for the coronavirus and sufficient hospital capacity. While some businesses, such as bars, are still closed, and large gatherings such as sporting events are still forbidden, restaurants, nightclubs, salons, gyms and other places that had been closed since mid-March are now back open.

But in the two and a half weeks since the order expired, COVID cases have steadily increased in almost every county in the state. New hospitalizations have remained high. And total hospitalizations have hit record levels several days in a row as new patients check in faster than older COVID patients check out.

Will Humble, the executive director of the Arizona Public Health Association and the former director of the Arizona Department of Health Services, said new cases started rising around May 26-27, a little more than 10 days after Ducey's executive order expired.

Arizona State University's Biodesign Institute has been tracking various COVID-related data, including the number of new cases versus the number of total cases statewide, as well in each county, which shows the rate at which new cases are appearing. With the exception of Yavapai County, every county, as well as the state as a whole, shows a checkmark-shaped pattern indicating a drop in cases, followed by a rise around May 26.

"This is where you get to observe what happened as a result of ending the stay-at-home order," Humble said.

The five highest daily totals of new COVID-19 cases since the outbreak began have been in the past week. The previous high was 563 new reported cases, set on May 15, according to data from the Arizona Department of Health Services. In the past week, Arizona has notched totals of 770, 763 and 736, the agency reported. Initial daily counts this week have exceeded 1,000 for the first time since the outbreak began.

Due to lags in reporting and other quirks in the system, the number of new cases reported each day may include cases from prior days, and therefore isn't always an accurate way to measure the state of the pandemic in Arizona. And the Ducey administration has attributed increased reports of new cases to increases in testing, including from an ongoing "testing blitz."

Humble said a more important metric is the number of new hospitalizations per day. Not counting numbers from the past week, which Humble said are always unreliable because they're incomplete, daily new hospitalizations have held fairly steady.

"Really, big picture-wise, if you look at the number of new hospitalizations per day, it's not getting better, it's not getting worse," Humble said.

According to ADHS figures, the number of total hospitalizations has consistently risen each day since May 25. Humble said coronavirus patients have been checking into hospitals faster than they've been recovering and checking out. According to a report by the news outlet Axios, the share of total hospital beds occupied by COVID-19 patients has increased by 7.8% in recent weeks, the largest jump of any state in the U.S.

And the state may still see additional spikes from Memorial Day revelry, Humble said, noting that it takes at least 10 days to see COVID-19 manifest itself due to the lag time between when a person gets infected and when they start showing symptoms.

Dr. Bob England, who recently served as Pima County's health director, agreed that the number of people hospitalized with COVID-19 is a better indicator than the number of new cases. He said the increased testing, though it led to many low-risk individuals being screened for the virus, has likely resulted in higher numbers of new cases.

He called the increasing number of total hospitalizations "concerning."

"I think there's a real increase. It's not nearly as clear how much or how fast," England said.

But England said it's probably too early to tell whether the increase is directly related to Ducey's loosening of restrictions. The lag-time Arizona should be looking at is more like two to three weeks, because there's a two-week incubation period for the disease, and once people start showing symptoms, some wait a few days before actually bothering to get tested or go to the hospital.

In addition, there may be spikes from Memorial Day and the ongoing protests over a Minneapolis police officer's killing of an unarmed black man last week.

"I don't want to exaggerate this. We haven't seen something I'd call a big surge yet. But we're only just beginning to see the impact of two-and-a-half, three weeks ago. So, we have to just keep watching," England said.

Another figure that Humble warned may not be the most accurate measure of the severity of the COVID-19 outbreak is the percentage of positive diagnostic tests for the virus.

While ADHS reports a total of 6.9% of Arizonans have tested positive in total, that's a cumulative number since the outbreak began and doesn't measure day-to-day figures, which the agency doesn't make public. Because the numbers are cumulative, Humble said the total percentage of positive tests will rarely deviate from around 6.8%.

"These are cooked," Humble said of ADHS's positive testing figures.

ASU's Biodesign Institute tracks the percentage of positive tests on a daily basis going back two weeks. According to those data, the number of positive tests has fluctuated over the last 14 days, ranging from 5.4% on May 25 to 11.5% on Wednesday and 14.7% on Thursday.

Humble said the ideal number would be 3-4% per day, which he said would indicate that Arizona's testing system is sufficiently robust. While the availability of tests has increased since the early days of the outbreak, when diagnostic tests were relatively scarce, he said testing isn't yet where it should be, especially in places like long-term care and assisted living facilities. England said those facilities account for about 60% of the state's coronavirus cases.

Not all the news is negative, however. Humble said Arizona's hospital capacity – the percentage of hospital beds that are still available – is still hovering around 20%, which he said is a healthy number.

"The good news is there's some padding in the hospital system," Humble said.

Spokespeople for the Ducey administration and ADHS did not return messages from the Arizona Mirror.

As of Thursday morning, ADHS reported that Arizona had seen a total of 22,753 COVID cases and 996 deaths.