Pima County urges booster shots for all 'as soon as possible' as COVID-19 cases spike again

Everyone 18 years and older should get a COVID-19 booster "as soon as possible" as the rate of COVID-19 cases continues to increase, the Pima County Health Department said Monday.

Vaccination sites run by the county are making booster vaccinations available to everyone over 18, so long as it has been six months since their second dose of either the Pfizer or Moderna vaccines, officials said. Those who received a single shot of the vaccine manufactured by Johnson and Johnson can receive a booster if it's been over two months since their shot.

For booster shots at pharmacies or other medical providers, people will need to have an underlying medical condition, or work or live in a high-risk setting, the county said. People seeking a booster will not have to provide documentation in most situations, the county said.

"We are seeing some of the highest COVID-19 infection rates and hospitalizations since the surge last winter," said Dr. Theresa Cullen, director of the Pima County Health Department. "It is likely that all residents in Pima County can be exposed to COVID-19 where they live or work, and that is why we urge 18 years and older to get their booster."

New reported cases of coronavirus here have increased by a third over the past month, officials said.

Boosters have already been available for adults 65 and older, or for those who have an underlying medical condition, or who live and work in high-risk settings, after the Centers for Disease Control cleared their way in late October. People can receive either the same vaccine that they received earlier, or they can shift to another vaccination in what some public health officials have called a "mix and match strategy."

As the CDC noted on Oct. 21, "There are now booster recommendations for all three available COVID-19 vaccines in the United States."

"Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots," the CDC said.

"These recommendations are another example of our fundamental commitment to protect as many people as possible from COVID-19," said Rochelle P. Walensky, director of the CDC. "The evidence shows that all three COVID-19 vaccines authorized in the United States are safe – as demonstrated by the over 400 million vaccine doses already given. And, they are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant."

A list of vaccine sites in Pima County is available at pima.gov/covid19vaccine, and the county asked for people to bring their vaccine cards when they get their booster.

County facing 'significant increase' in COVID-19 cases

Pima County is experiencing "a significant increase" and cases have spiked 30 percent over the last 30 days, health officials said. While Pima County has been in a state of high transmission since August, the county is now "experiencing additional acceleration of cases," with 305 cases per 100,000 residents by Thursday, Nov. 11. This puts Arizona among the top 10 states with COVID-19 infections.

Since July 1, the county has had 34,000 new cases of COVID-19, and there are fewer hospital beds available as COVID-19 patients swamp emergency rooms and hospitals. As of Nov. 12, there were 292 people hospitalized with COVID-19, and 95 percent of hospital beds in the county were filled.

At the same time, there are more new cases in K-12 schools, the county said. Schools here have reported over 4,600 cases since July 20, including 140 separate outbreaks.

This has required the closure of 90 classrooms, and in the largest event, the closure of an entire school.

Two weeks ago, the Tanque Verde School District shuttered Agua Caliente Elementary School after it was hit hard an outbreak, affecting at least 40 children. The school was slated to reopen on Monday, but will do so under a new mask mandate implemented by the district's governing board during a contentious 3-2 vote on Nov. 9.

Over the last two weeks, schools in Pima County reported 1,352 COVID-19 cases averaging about 108 new cases per day. And, cases increased nearly 20 percent one week to the next, indicating significant week to week shift.

The county said that last year, school cases were just 4 percent of the overall case-load, a figure tamped down by the large number of remote learning at schools across the county, but now that county schools are largely back to in-person classes, cases in schools account for about 15 percent of cases, the county said.

Since the pandemic began, there have been 150,056 cases of COVID-19 in Pima County, and 2,792 residents here have died.

COVID-19 cases in Arizona show signs of "exponential" growth, according to a new report published by the Arizona Public Health Association, based on analysis by Dr. Joe Gerald, with the University of Arizona's Zuckerman College of Public Health who noted an "abrupt increase in transmission levels among all age groups starting in early October."

"Arizona continues to experience high levels of community transmission with case rates unexpectedly climbing 62 percent in the past 3 weeks," the group wrote. "Test positivity remains high, reminding us that test capacity, accessibility, and/or uptake is inadequate."

AZPHA said that increasing case rates among older, highly-vaccinated groups serves as a "warning" that major shifts in behavior, as well as waning immunity could result more cases and likely more hospitalizations. "As of Nov. 7, new cases were being diagnosed at a rate of 328 cases per 100K residents per week," the group said. "For most counties, current rates exceed those observed at the height of the summer 2020 wave."

"Unvaccinated Arizonans will not be able to avoid infection by 'free riding' on high levels of community immunity," said Gerald. "The decision to remain unvaccinated carries a much greater risk than getting vaccinated does."

"Arizona continues to experience a persistently high number of cases, hospitalizations, and deaths," he added. "With waning vaccine efficacy and a potentially short duration of acquired immunity, herd immunity is not achievable."

"At this time vaccine mandates for adults are warranted for their protection as well as the community’s," wrote the Arizona Public Health Association.

'Pandemic isn't done with us'

In Arizona, only around 64 percent of those eligible have been fully vaccinated, covering about 3.8 million people. Another half-a-million have received at least one dose of the vaccine, according to figures from the Arizona Department of Health Services. 

This puts Arizona far behind Connecticut, where 82 percent of the population is fully vaccinated. Among western states, Arizona is behind California, New Mexico, and Colorado, but is running just slightly ahead of Nevada. And, West Virginia has the worst vaccination rate in the nation, with just 41.2 percent of the total population vaccinated. By shear numbers, California leads the nation, having vaccinated 24 million people, followed by Texas which has vaccinated 15.6 million people.

"After nearly two years, I don’t blame anyone for feeling done with the COVID-19 pandemic. The unfortunate truth, however, is the pandemic isn’t done with us," wrote Don Herrington, the interim director of ADHS in a recent blog post.

"Recent case numbers bear this out," he wrote, adding that after coming down steadily after a peak in mid-August, cases statewide increased throughout October. "That isn’t the case in every county, but it is in Maricopa and Pima counties, the state’s largest, along with several rural counties."

It isn’t clear why this is happening, though the timing coincides with the start of cooler temperatures, fall break for schools, and the continued dominance of the highly contagious Delta variant," he said. "What is clear is the things everyone can do about it," Herrington wrote, adding that people should continue wearing masks indoors and follow other mitigation efforts.

In a public health advisory published Monday, the Pima County Health Department made similar recommendations, including urging parents to vaccinate children 5 years or older with the Pfizer-BioNTech vaccine. The Health Department also "strongly recommends" that all teachers, staff, students and visitors to K-12 schools "always" wear masks indoors during school "regardless of vaccination status."

The order also expands to anyone in a congregate living situation, and covers both vaccinated and unvaccinated residents. The county also pushed for masks inside correctional facilities and homeless shelters, and said that people traveling on planes, buses, trains, and other forms of public transportation should wear masks. This includes people traveling into or out of the U.S., and the county asked for people to wear masks in airports, bus and train stations.

Both Herrington and Cullen noted the chance of "breakthrough" cases, or cases in which people get sick even after they are fully vaccinated.

The county has seen about 7,600 COVID-19 breakthrough cases from February to October, and the total breakthrough case rate is about 1.2 percent. As Herrington wrote breakthrough COVID-19 cases "are rare among those who are fully vaccinated."

Moreover, such cases are "normally much milder, and vaccinated individuals are far less likely to be hospitalized or die from COVID-19," he wrote. "But your goal should be avoiding any potential breakthrough case – and the potential that you will spread COVID-19 – by following mitigation strategies like masking up and maintaining physical distance."

"The boosters will keep your immunity up, which, in turn, offers great protection against hospitalization and cuts down on the transmissiblity of the disease," Cullen said.