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COVID booster shots, protecting kids concern Pima officials as Delta scourges

800 school-related cases reported; 11 ICU beds open in Pima County hospitals

Pima County is preparing for a rollout of third doses of the COVID-19 vaccine and doing everything it can to keep kids in classes, Health Department officials said Thursday, as a third wave continues to spread the deadly Delta variant.

More than 800 school-related coronavirus cases, mostly in children, have been reported here, and the county has fewer than a dozen available intensive-care beds as COVID and other patients have pressured area hospitals.

Arizona has seen close to 2,000 new cases each day since the end of July in a new wave of COVID cases characterized by the Delta variant attacking the unvaccinated and casting a heavy toll on people under 65.

On Thursday, Arizona reported 3,546 new cases across the state and Pima County reported 401 new cases, a number that’s “very high,” County Health Director Dr. Theresa Cullen told reporters.

The rate of infection for Pima County is 168 cases for every 100,000 people, a “significant increase” from where the county was about a month ago, Cullen said. Anything above 100 cases per 100,000 people puts a county in a red zone marking high transmission rates for data tracked by the Centers for Disease Control.

Cullen said that the county’s positivity — the number of people who test positive for the virus — is somewhere between 7.9 and 11 percent, though she said the data is showing rapid daily fluctuations.

However, the number of people getting tested has significantly increased, Cullen said during a virtual press conference. The county has recorded that between 1,500 to 3,000 people per day are getting tested, which includes tests done by the state, individual hospitals and private testing sites like those at Walgreens.

11 open Pima County ICU beds; 800 school cases

As of Wednesday, just 11 ICU beds were available in the county, which is an increase from the 5 or 6 beds that were available earlier in the week, Cullen said. This is better than during the winter, she said, when no beds were available at times. Meanwhile, other states like Alabama are seeing counties without ICU bed availability, she said.

Out of that ICU population in Pima County, 15 percent of them are COVID patients, which is the highest that figure has been since March 2, Cullen said.

The county also had almost 200 COVID-positive inpatients, or visitors who are hospitalized overnight, as of Thursday, but Cullen said that number could be higher because some inpatients were awaiting the results of COVID tests when those numbers were reported.

The county is also seeing an increasing number of cases related to schools. As of early Thursday morning, Cullen said the county reported upwards of 800 school-related cases. A little over 100 were school staff or faculty, and the rest were students, she said. The county has also declared 30 outbreaks at schools so far.

Keeping kids in their classrooms is a priority for the county, Cullen said.

“We are doing everything we can to keep schools open,” she said. “We believe students need to be in school.”

Cullen said that they have shut down classrooms where there are outbreaks. The county doesn’t make the decision lightly though, she said. The county first “aggressively evaluates” what happens in a classroom after an outbreak, and avoids shutting down classrooms if they see that cases are from one part of the classroom like a shared table or if there’s another way to change the classroom to keep it safe, for example by separating students more.

“If we can keep a classroom open, we do,” she said.

Over the past few days, the county has also recorded “high single-digit” numbers for pediatric admissions in their hospital, Cullen said, and county hospitals have seen severe cases, including some children ending up in the ICU. However, she said they have not seen any deaths among recent pediatric ICU cases.

Pediatricians are also reporting more COVID cases, she said, but those cases are not ending up in the hospital or ICU or requiring more acute care.

Cullen also talked about why there’s a significant number of breakthrough cases or COVID cases involving people who have been fully vaccinated, which she said has to do with what appears to be the vaccine’s decreasing immunogenicity — its ability to provoke a response to the virus in the body.

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“From a clinical perspective, we remain concerned that we are seeing decreasing immunogenicity with the vaccine the further out we get from the last dose,” Cullen said.

'Breakthrough' cases as vaccine effectiveness wears off

With every vaccine, there is variation in how well it works and a percentage of people who don’t respond to a vaccine the way they’re supposed to, Cullen said, and this is reflected in the “significant” number of breakthrough cases.

Cullen said this is also why there are recommendations for a third dose from the CDC and Food and Drug Administration for people who are have weakened immune systems.

She said evidence of decreasing immune responses is also behind recommendations that everyone who’s fully vaccinated should get a third dose starting September. 20.

Despite the vaccine's apparent weakening over time, Cullen said that it’s important to note that with breakthrough cases, there is a significant decrease in deaths among people who have gotten their shots, compared to COVID cases among unvaccinated people.

“People that are considered a breakthrough case are not hospitalized at anywhere near the rate of people that have been fully immunized,” she said.

Also important to realize, Cullen said, is that the number of breakthrough cases has gone up in recent weeks and will continue to rise because the number of people getting fully vaccinated is also going up. The number of breakthrough cases does, however, still reflect the decreasing effectiveness of the vaccine over time, she said.

The number of breakthrough cases is also underreported, she said, as many people who get sick from the virus choose not to test.

The county and all other vaccine providers are already offering third doses at their vaccine sites for people who are immunocompromised, but Cullen acknowledged that the county has no system in place to verify whether someone qualifies.

“We are not requiring a prescription or any proof that you are immunocompromised,” she said. “This is an honest relationship between us and the person coming in saying that they meet the criteria.”

Cullen said that there will be a point when the county will have to deliver third doses at a larger scale, saying the county expects to have to give 20,000 third doses per week for a multiple-month period.

“Our goal is to ensure that we have enough ability, enough assurance that we can give that number of shots starting September 20,” she said.

The understanding people should have is that their vaccinations will start becoming “latent,” or significantly decreased in immunogenicity, eight months after they were fully vaccinated, Cullen said, though she added that understanding is only a “suspicion” right now.

The rollout for delivering that third dose on a large scale will look like the initial rollout of the vaccine. The priority will be on first vaccinating the 1A group - including healthcare workers, assisted living workers, long-term care providers and those who administer death or work around the dying.

The county is also looking at the need for pop-up and mobile clinics and will likely place them in the same place where the vaccines have previously been provided including four mobile pods in Tucson, Cullen said.

UA will have largest-ever freshman class

The county is also preparing for the large number of incoming first-year students at the University of Arizona. The UA reported on Thursday that they’re expecting more than 8,700 incoming first-year students, their largest first-year class in their history, to start in-person classes on Monday.

Cullen said she’s hopeful most of those students are fully vaccinated but she knows that many aren’t.

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“Obviously, we’re concerned,” she said. “We’re going to have a huge influx of students coming in in a very rapid time in a way that they were not here last semester.”

Cullen said she and the county are working closely with the UA to take precautions including requiring adequate testing on campus and in congregate living facilities like dorms. The county Health Department will also recommend to the UA that they test everyone in congregate living facilities where there are a certain number of COVID cases, she said.

Cullen is also on the UA’s public health advisory group, which is responsible for guiding their decisions for protecting public health on campus.

The current R-0  ("R-naught") for the Delta variant, which measures how many people an individual can spread a virus to, is at 6 people, meaning one person is expected to spread the virus to 6 other people, Cullen said.

That R-0 number is high, she said, and raises concerns about how quickly the student population can spread the virus, especially among those who aren’t fully vaccinated yet.

“You could see how we could have a rampant, rapid spread comparable to what we had last year in September,” she said. “Our hope is that people will mask, people will be vaccinated, if they’re not vaccinated, they will test on a regular basis.”

Cullen said the county is also worried about the snowbird population but doesn’t expect them to start arriving for another four to eight weeks.

Bennito L. Kelty is TucsonSentinel.com’s IDEA reporter, focusing on Inclusion, Diversity, Equity and Access stories, and a Report for America corps member.

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Dr. Theresa Cullen talked to reporters Thursday about what the Pima County Health Department is doing in the midst of a new wave of COVID cases that has been threatening to hamper a return to in-person classes and burdening area hospitals. (December 2020 file photo)

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