More local kids getting COVID, Pima County needs more people vaccinated, chief medical officer says

More kids too young to be vaccinated have been reported to have COVID-19 over the past week, but hospitalizations for the virus in Pima County have “plateaued” and the number of pediatric cases is still "relatively modest," Pima County Health Department officials said Tuesday.

Despite the optimistic note, the overall numbers of new infections and deaths in Arizona remain well above the figures for July.

Over the weekend, the number of reported COVID cases in Arizona fell below 1,000 for the first time since mid-July with 218, 87 and 52 cases reported statewide on Saturday, Sunday and Monday. Pima County reported 12, 10 and 5 cases each of those days. But on Tuesday, there were 822 reported cases statewide, with 49 in cases in the county and one death here.

The Centers for Disease Control still has Pima labeled as an area of "high" COVID transmission — like the most of the country and all counties in the state. Pima County has held that designation most of August as its rate of transmission rate has been above 100 cases per 1,000 residents since early in the month. For last week, that rate was about 196 cases per 1,000 people.

Many of the new reported infections are among children, including those too young to get their COVID shots. And the number of open hospital beds in Pima County is still limited, especially intensive care beds. The level of new cases remains high enough, and the percentage of people fully vaccinated is still so low, that Dr. Francisco Garcia, the county’s chief medical officer, advised that people should consider not traveling over the coming Labor Day weekend.

Last week, Garcia said the county was nearing a peak and then decline in the number of COVID cases. Arizona and Pima County’s day-by-day numbers reflected his forecast over the several days, but he told reporters Tuesday that the county is seeing the number of cases increase in a few age groups, mostly in kids younger than 12, who are ineligible for a vaccine.

'Very worried' about school outbreaks

The county saw 340 more cases of kids aged 0-11 infected with COVID over seven days. He said the county’s total number of COVID cases since last week is 2,065 cases higher. The 0-11 age group made up 16.5 percent of those new cases, which brings the total for the age group up to 890 as there were 550 cases in this age group last week, Garcia said.

For the rest of the pediatric age group, ages 12-19, there was an increase by 242 cases, Garcia said, which makes up about 12 percent of the total new cases.

Among hospitals in Pima County, there were 6 pediatric patients hospitalized related to COVID as of Tuesday morning, which Garcia called “relatively modest” when compared to cases in other Arizona counties, but he said that he and the county “continue to be very worried and very concerned about pediatric cases.”

Since some schools began classes in July, there have been 1,235 COVID cases reported by schools, Garcia said. This includes adults at schools but is mostly made up of kids younger than 12.

“This most vulnerable age group is the age group that we see being impacted,” he said. “We see that this phenomenon is playing out across all our different school districts and all our different schools.”

As of last week, there were 50 confirmed outbreaks in schools, Garcia said.

He also said larger schools will likely have more cases.

“The higher the number of students in a school, the more likely you’ll be to see more school-related cases,’ he said.

Having a plan to protect Pima County kids in school from the virus is complicated, he said, because of differing school sizes and their various densities per classrom, but he said it helps that the Pima County Health Department can issue legally binding orders that allow schools to implement mask mandates as mitigation strategies.

Right now, five school districts in the county have implemented masking: the Amphitheater, Catalina Foothills, Marana, Sunnyside and Tucson Unified school districts. They started requiring masks at different times, but Garcia said that all of them have been reporting a smaller number of cases relative to their sizes, though a few of those districts are reporting a higher total number of cases compared to the other districts.

“Mask mandates in schools actually have an impact,” he said. “It’s a really important and critical tool that our school districts and our schools have to be able to keep children and families safe.”

Garcia said that contact tracing for school-related cases has been challenging and that schools have been critical partners in making sure parents respond to contact tracing outreach.

He said that when the county Health Department tries to reach parents by phone, they’re able to make contact with them about 50 percent of the time, but it helps when the schools work with them to reach parents.

“Part of the reason schools and school districts are such critical partners is because they’re really trusted by families,” he said “When schools and school districts foam the runway by sending out letters to impacted children (saying we’re going to call), we believe there’s a higher likelihood we will get participation.”

But he said that contact tracing is a challenging “boots on the ground” effort that requires that parents pick up the phone for it to work.

“There’s no shortcut to that,” he said.

He said schools are emailing notices to parents whose kids may have been exposed to the virus, and the health department will call them. Those letters are going out very quickly after learning about individual COVID cases in schools, he said.

Hospitals and ICU beds

The age group that made up the biggest share of new cases over the past week was the 20-44-year-old age group. The group had 858 additional cases, representing 41 percent of the total new cases reported over the past week.

The number of COVID-related hospitalizations of Pima County residents has been “relatively modest” as with pediatric admissions, Garcia said, but he said there has been an additional 114 county residents, including children, admitted to hospitals in the past week.

Garcia said that 20 percent of the ICU beds in the county are being used by individuals with COVID. He said that number can be considered either high or low because other Arizona counties are experiencing much higher ICU bed usage by COVID patients. He said that either way it’s “certainly a very significant number.”

On Friday, Pima County reported 346 of their 357 ICU beds were in use, meaning only 11 beds, or 3 percent, were available. Last Thursday, Garcia said that the percentage of ICU beds available had been around 4 to 5 percent.

“I’m not concerned about ICU bed capacity at this time,” Garcia said Tuesday. The morning's numbers lead him to believe the county has “sufficient capacity right now overall,” and not just for COVID patients.

“Overall, in the system, our hospitals are doing well,” he said. “They’re a little bit strained in terms of staff, but they’re otherwise doing well.”

The overall trend for the number of COVID-related ICU bed usage, Garcia said, is that it's “starting to plateau at the very least,” but, even though those figures might be level off, he said that “it’s too early to claim victory, and I’m certainly not doing that.”

'Pretty darn good' vaccination rates

The county’s vaccination effort continues to go well in general, Garcia said.

“I believe we continue to be in good shape with regards to that,” he said.

Reporting numbers updated on Monday, Garcia said that the number of Pima County residents who have received at least one dose is 662,945 and 574,681 are fully vaccinated.

That means 63 percent of Pima County residents, including children still ineligible for COVID vaccination, have had at least one shot, and that 55 percent are fully vaccinated.

“That’s pretty darn good,” Garcia said about those vaccination rates.

Looking at the vaccine-eligible population, which is everyone 12 and older, 73 percent have had one vaccine shot and 63 percent are fully vaccinated.

“I believe that is part of the reason why we are not seeing the greater impact in terms of our hospitalization numbers,” Garcia said. “I think that that continues to be a really important and really good story to tell.”

Garcia said that the parts of the county that have the lowest vaccination rates tend to be in rural and less-populated areas.

He specifically mentioned rural northeastern Pima County as an area that he and the county “continue to need to work on” in terms of getting people vaccinated, and the Three Points area near the junction of SR 86 and 286 as one that “continues to be an area that we worry a lot about.”

He said that there are “really low” vaccination rates reported for the Davis-Monthan Air Force Base and for the federal and state prison facilities in the county, but this has to do with “limited visibility” — a lack of data released from those areas.

Nonetheless, Garcia said that the county has been able to reach a “small but significant proportion” of the population on the Air Force base.

Garcia said the county doesn’t have a way of tracking vaccine hesitancy and has been relying on national numbers, including polls by the CDC, to get a sense why individuals are hesitant to get their shots.

As employers in the county are contemplating vaccine mandates, the county is still seeing a “significant number” of individuals who are hesitant about getting vaccinated, but the number of excuses “has gone down exponentially” because of the FDA's approval of the Pfizer vaccine, he said.

“I do believe that attitudes are changing,” he said. “Attitudes and preferences continue to be something that is complicated, and I’m not sure how much people are going to change their minds.”

He said that he doesn’t think vaccine hesitancy has much to do with some people’s unfounded belief it won't protect against the Delta variant, but that most people understand just how dangerous the variant is.

But he also said, “the bottom line is we don’t need every single person to get vaccinated.”

He said the county needs to get to “critical thresholds,” which he said would mean getting at least 75-80 percent of all the county’s residents vaccinated. At this point, 63 percent of all Pima County residents are vaccinated.

“I will take anyone who wants to get vaccinated, and we will get them vaccinated,” he said.

'Robust demand' for COVID tests

Demand for continued testing for the coronavirus is still high statewide, and the county offering free testing to meet that need, Garcia said.

“We are continuing to improve our testing capacity. Testing demand continues to be pretty robust across the state, and it continues to be something that we work on,” Garcia said.

On Saturday, the county started offering free testing at the Abrams Public Health Center, 3950 S. Country Club Rd., with tests available from 1-8 p.m. on Tuesdays through Saturdays.

Garcia said that the county is seeing a steady number of visitors coming to their testing sites at the Tucson International Airport and the Ellie Towne Flowing Wells Community Center, which have different hours and testing methods.

He said that last week there were 1,245 positive tests out of 15,000 total tests performed in Pima County. This is about an 8 percent positivity rate — a level considered "high" by the CDC.

“It looks like the demand may be going down a little bit,” he said. “But given that positivity rate, we think it’s still really essential to make sure there are no barriers for folks who want to get tested.”

He also encouraged anyone who can afford to get tested through their doctors or at a CVS or Walgreens to do so.

“But we don’t want costs, we don’t want insurance issues, we don’t want anything to stand in the way (of getting tested),” he said. “We believe that people in Pima County need to be able to access those services.”

Pima County is funding the free tests at Abrams, and Garcia said the county is working with its testing partner, Paradigm Labs, to stand up or fund more free testing though the details for that plan are still developing, he said.

Boosters

Garcia said that Pima County has been “elaborating a plan” since the White House announced their plan in mid-August to deliver COVID booster shots to individuals with weak immune systems or who were fully vaccinated eight or more months ago.

However, he said that he’s not prepared to give a sense of what that rollout looks like yet.

“We have as a priority a need to make sure that the most vulnerable folk in the community get vaccinated and that will apply to boosters too,” he said. “But stay tuned.”

The CDC’s guidance for counties is to deliver boosters to people who were vaccinated eight or more months ago — and to the immunocompromised — because the concern is that in eight months immune systems will lose a degree of strength to combat COVID.

However, Garcia said that the county has not seen an increased number of breakthrough cases, or COVID cases in the fully vaccinated, over time or any other evidence in the county or from elsewhere in the nation of waning immunities.

“We’ve been tracking the breakthrough issue very, very closely,” he said.

He said that the county started vaccinating in earnest in late January and early February, and the number of individuals hospitalized with breakthrough cases is less than 2 percent since that time — or 35 out of 3,073 COVID-related hospitalizations with 4 of the 809 COVID-related deaths being people with breakthrough cases.

With this, Garcia said that he has not yet seen evidence of waning effectiveness of the vaccines. It could be the case that it’s still too early to start seeing any real difference, he said.

There are still two reasons to consider getting a booster shot, he said, which is to protect yourself against the stronger Delta variant and to protect yourself if you’re immunocompromised.

“There are folks for whom we fully expect their immune system to not be as robust,” he said. “Have we seen evidence of waning immunity? By and large, on a population level, not yet. I do expect to see some (waning immunity) in those most vulnerable groups because that is how your immune system works.”

Getting more people fully vaccinated is the priority for the county, Garcia said.

“That’s our best protection,” he said. “The reason you don’t see hospitalizations and ICU usage as high as it is in other counties and other states is because we’ve been aggressive (at getting people vaccinated).”

He said Pima County has been performing better in terms of the percentage of its population that is fully vaccinated compared to other counties in the state, as well as the national level.

Getting more people their shots "continues to be our main focus,” he said. “Because we believe that is how you defeat this in the long run.”

Labor Day travel

Garcia said it’s always difficult to judge what’s going to happen on Labor Day in terms of whether people travel or stay home for the three-day weekend, but he said he advised people to stay home, especially if not full vaccinated, and to where a mask in public spaces. 

"Avoid travel. I would tell you to avoid public spaces and public transportation," he said, sharing advice. He also said “I think you should be wearing a mask anytime that you are indoors in a public space.”

He said anyone taking a bus, plane or any other shared mode of transportation needs to wear a mask and that this applies if taking a Lyft or Uber, too.

Only the fully vaccinated should be traveling if at all, he said. “You really should reconsider traveling if you’re not vaccinated. If you're fully vaccinated, it's one thing, but if you’re not fully vaccinated... some people have to travel out of necessity, and if that happens to be you, please do protect yourself with a mask. Otherwise, I would tell you to avoid traveling.”