COVID surge in cases, hospitals expected to continue for weeks, Pima officials say

High numbers of new COVID-19 cases and hospitalized patients have Pima County health officials sounding a pessimistic note this week, despite the continued push to vaccinate more residents.

Arizona reported 2,222 new cases on Wednesday and 26 deaths. Pima County reported 151 new coronavirus infections for the day and one new death.

Dr. Theresa Cullen, the county health director, said that despite a downward trend in the number of daily cases statewide since late August, she and other county officials “remain concerned about what we’re seeing” as the wave of the Delta variant of COVID has continued across the state.

Hospitals are full, Cullen said, with just 11 intensive care beds available in all Pima County hospitals last Thursday. In the last two days, about twice as many ICU beds in the county have been filled with COVID patients compared to previous weeks.

Rural medical facilities in Southern Arizona, Cullen said, are having an especially difficult time finding space for both COVID and non-COVID patients.

The county has also been seeing an increase in children being admitted to hospitals, she said, and that’s been coupled with an increase in respiratory diseases that are being found in 1- to 4-year-olds.

Pediatric healthcare providers say they’re seeing respiratory diseases that are usually seen in the winter, Cullen said, and this has given the county cause to start considering new preparations.

The county is still trying to provide better access to testing and get more of the county population vaccinated, she said.

While last week the county's chief medical officer, Dr. Francisco Garcia, sounded a cautiously upbeat note about the number of new cases and slightly lower number of hospital beds in use, Cullen told reporters Wednesday that she’s not optimistic that the county will see an end to the current surge by the end of September.

Every county in Arizona is still considered an area with “high” community transmission of the virus by the Centers for Disease Control — as are nearly most counties across the United States. Counties with more than 100 cases per 1,000 people over seven days are determined to have high transmission, the CDC's most severe rating, and the current rate in Pima County is 194 new infections per 100,000. The rate at which people test positive for the virus is also a determining factor, with anything above 10 percent of tests showing new infections rated as "high" risk. Pima County's positive testing rate has been fluctuating between 8 and 11 percent in recent weeks, with last week's results at 8.2 percent according to the CDC.

Hospitalization

The county “has not seen any drop-off in hospitalizations,” Cullen said, despite a statewide downward trend in new cases. The trend in recent weeks, she said, is that hospitals have been more overwhelmed because of their intake of COVID patients, especially in rural Southern Arizona.

In Pima County, the number of new hospital admissions increased last week by 29 percent, according to CDC data.

Cullen reported that the number of ICU beds being filled by COVID-positive patients in the last two days is about twice as high as was reported in recent weeks.
Last Friday, Dr. Francisco Garcia, the county’s chief medical officer, reported that 20 percent of ICU beds were being used by COVID patients. Cullen said that in the last two days, that portion increased to 40 percent of ICU beds.

The number of ICU beds available can be modified in a moment’s notice based on staffing at a hospital, she said, but the other critical problem is that staffing at hospitals, especially those rural hospitals, remains in “a precarious situation.”

Hospitals have not had nurses available to help either COVID or non-COVID patients. Because of this, Cullen said that she expects hospitals to continue to be overwhelmed by the virus.

“Right now, I would not predict that we will see a drop-off in hospitalizations in the next few days or in the next week,” she said. “It’s not what our actual numbers have shown in the last seven days.”

Rural hospitals in Southern Arizona have had to transfer patients to a higher level of care — mostly to hospitals with any of the limited number of open ICU beds — because of their COVID admissions, Cullen said.

“They may not need to be intubated at that time of transfer, but they need to have the ability to have more acute care,” she said. “That’s where there’s been significant hours of transfer noted.”

Cullen, who used to work as a rural doctor, said that having to wait for transfer is “not only a frustrating experience, it’s a frightening experience for everybody that’s involved.”

For the healthcare provider, she said, it can be difficult to tell a patient “‘I need you to go somewhere else, and I’m going to find a bed for you’ then hours later, I’m still searching.”

Last week, Garcia also indicated that he was optimistic that if the numbers for September continued to trend downwards and the effect of virus transmission on campuses passes, he’ll feel confident saying the current surge is complete.

Cullen said she has a different opinion, saying that even though the county appeared to be plateauing in its epi-curve, there’s still some doubt because the effect of K-12 and college campuses remain of concern, the Mu variant is of interest and the slow vaccination rate still leaves the county vulnerable.

“I’m not as reassured as Dr. Garcia,” she said. “I think we need seven, 12, 10 days for us to get a better sense of where we are.”

Vaccinations

About 56 percent of the local population is fully vaccinated, Cullen said. According to Pima County data, 546,566 residents are fully vaccinated, and 606,892 have one dose.

“We continue to do well under some evaluations,” she said. “But I’m still concerned.”

People in younger age groups are less likely to have gotten their COVID shots than those who are older. The 12 and older age group and those 18 and older are 65 percent vaccinated, which she said is “really good news,” but she compared those numbers with the 65 and older population, — which have 85 percent of people vaccinated.

Cullen said she’s also concerned about how slow those numbers are increasing on a daily basis. Despite the county being able to vaccinate more people, Cullen said she sees that the unvaccinated population is only taking small steps.

“We do see people consistently getting immunized at a much lower rate than we would like to see,” she said.

The way out of the pandemic, she said, is for people to seek vaccinations at a rate where the county starts seeing larger jumps in the vaccination rates like going from 60 percent to 75 percent.

Right now, the county is seeing a .1 to .2 percent increase on average when the vaccination rates increase. At that rate, the county will see a percentage point increase every 10 days, and to jump five percentage points would take 50 days.

“Ideally, what we’d like to see is that those numbers go up within 10 to 15 days,” she said.

This is especially important because sequencing shows that the vast majority of cases the county is seeing are the Delta variant, she said, and the county has reported two cases of the Mu variant. Variants that can be more serious can develop more easily when not enough people have gotten their shots, she said.

“As we see changes in the virus itself, what we know is the best way to mitigate against those viral changes and viral mutations is to get more people vaccinated,” she said.

Cullen also said that the county has seen 150 cases of influenza so far — though she said there are more undetected in the community — and with flu season approaching, she encouraged people to start getting their flu shots soon.

She said the county is expecting to see an acceleration of flu cases compared to last year, and their plan heading into flu season is to make sure they can offer the flu shots alongside the COVID vaccine, and at county sites for those who've already gotten their coronavirus shots.

Testing

With the county’s recent rollout of testing sites, it has switched from PCR testing to the more rapid antigen testing, and the County Health Department is doing between 300-500 of those tests a day, Cullen said.

Paradigm Labs, a partner with the county in testing, also reports doing about 500 tests a day, she said. The total 800-1,000 tests a day that the county can account for does not include people who are tested through ASU or at Tucson International Airport, or at pharmacies or doctor's offices. About 100-150 people are being tested at the airport daily.

Cullen said the county has not seen a drop-off in testing. Part of this has to do with contact tracing by the county, she said, and the county urging testing for anyone who has been in contact with a COVID-positive case.

“The good news is people are still seeking testing,” she said.

Despite Cullen's assessment of county-run testing, the CDC tallied about 19,600 tests performed last week in the county, indicating that number was about 20 percent less than the preceding week.

The county is still using PCR-based testing for viral sequencing to detect strains of COVID like the Delta variant and the more recently arisen Mu variant.

Because of the switch to antigen-based testing, she said, the county will have the funding to continue offering testing for a while.