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Pima, Az health officials warn of COVID spreading during Thanksgiving

Bisbee hospital shuts operating room to deal with COVID patients, while Az docs & nurses suffer 'combat exhaustion'

Arizonans should keep their guard up against COVID-19 during the holidays, health officials said on Tuesday, warning that Thanksgiving and other gatherings could exacerbate a surge driven by the winter weather and the waning effectiveness of the initial vaccine doses.

Taking the same precautions that health officials have been preaching throughout the pandemic is enough to stay safe and protect the community in the coming weeks, said Dr. Theresa Cullen, director of the Pima County Health Department.

Cullen advised vaccines, boosters and masks for everyone, while state health officials are warning of doctors and nurses suffering "combat exhaustion." Bisbee's hospital moved to "crisis standards" of care, shutting down its operating room Monday night to deal with a crush of COVID patients.

“Get vaccinated if you’re not — remember: COVID is still primarily the disease of the unvaccinated — (and) get boosted,” Cullen said Tuesday. “We are strongly, strongly recommending that people wear a mask in any public indoor space.”

Pima County reported 19 additional COVID deaths and 515 new cases Tuesday, while Arizona reported 120 deaths and 3,057 new cases statewide — with Arizona Department of Health Services officials indicating that a reporting problem meant that a large number of new cases were not included in the totals.

During November, Arizona and Pima County have both seen some of the highest daily new case totals since the previous surge started in late July and early August, when K-12 schools resumed, despite predictions by the county that caseloads would drop in September.

Statewide, Cullen estimated that 97 to 98 percent of people who have died from COVID since June, when people started becoming fully immunized, have been unvaccinated.

The most recent positivity rate for the county, which represents how many COVID tests indicate an infection, is 16 percent. That number has been climbing in recent weeks and was at 14 percent last week

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About 61 percent of the total county population is vaccinated and 71 percent have at least one dose. Almost 100 percent of the over 65 population in the county has at least one dose of the vaccine, but only 71 percent of the over 12 population is fully vaccinated, and 72 percent of the over 18 population is.

Hospitals 'exhausted'

On Tuesday, there were 392 COVID-positive patients in Pima County hospitals. Hospitals here reported just 11 ICU beds were available Tuesday — about 3 percent of intensive care beds — and 29 percent of occupied ICU beds were being used by COVID patients, Cullen said.

The highest rate of ventilator usage since February was recorded this week, Cullen said, with 48 percent of ventilators in use by COVID patients. The county does have backup ventilators but Cullen said getting those them where they're needed will be difficult because hospitals are entering a “crisis situation” as winter approaches.

"Just because we have ventilators available in our warehouse does not mean either that we have a place to send them or we have staff that is trained to support them," she said. "It is important to note that while ventilators are available and there would appear to be capacity...that doesn't mean we couldn't be in a situation where we're in crisis."

Pima County, along with every county in Arizona, is still an area of “high” transmission, according to the Centers for Disease Control. The CDC designation means that the county has more than 100 news cases per 100,000 people over a seven-day period. On Wednesday, that rate was 416 new cases per 100,000 people in Pima County.

The county has been over the 400 marker for three days now, and its infection rate has been climbing since early November. Last week, Cullen said “That moniker of 'high' transmission is not helpful right now. If anything, we’re in ‘high, high’ transmission at the current time, and we don’t have a sense in the current wave where we’re going to stop,” as she announced the county was entering a fifth surge in infections.

Arizona hospitals are 'rubber band' that 'can't be stretched anymore' 

During a press conference in Phoenix, nearly a dozen medical leaders pleaded with the public to get vaccinated and practice COVID-19 mitigation like wearing masks and social distancing as they worried about the state's ability to manage the current "surge" in COVID-19 cases just as winter visitors drive up hospital visits.

Dr. Richard Carmona, former U.S. surgeon general and special pandemic advisor to Gov. Doug Ducey, likened doctors and nurses to being in "combat" against the virus. 

After two years, people are "suffering combat exhaustion," he said.

"Often we don't speak about the mental health issues, but the mental health issues are significant," he said. "People are just tired, they want to go home be with their families. Think about the nurse that's in their ICU for a 12 hour shift in PPE—personal protective gear—but they can't go home and hug their kids until she takes a shower or he takes a shower. Think about the immense mental burden of coming in and knowing you're going to lose patients every day and that ICU just like you're in combat."

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"If you look at the numbers, OK, every day in our United States in our state, people are still dying," he said. "We're struggling with the capacity. We're having problems with staffing, because even if we can find a bed, there's often not a nurse or a doctor to take care of a patient because there's so many."

"So you've heard the message repeatedly from all of my colleagues—it's not just about you. It's about you helping to protect your family, your community, actually the state the nation, because we are never going to be able to control this until we achieve that herd immunity," he said. 

Keith Frey, the chief physician for CommonSpirit Health, a nonprofit Catholic hospital network based in Colorado, said that hospitals in the state were under strain. 

"We have been very elastic," he said through the pandemic's surges. "We've been able to flex up and flex back, but we're at that point—the law of the rubber band is such that you can stretch rubber band to a certain point and then that you get to a point where that rubber band can't be stretched anymore." 

"We are letting you know we're very close to that point," he said, adding that nurses and doctors are "exhausted. 

"Please help us help you so we can continue to be here for you. That's what we've been called to do," he said 

Dr. Robert Seamon, the chief executive officer for the Copper Queen Community Hospital, based in Bisbee, said that on Monday night, the facility moved to a "crisis standard of care." The hospital, one of just seven based in Cochise County, shut down its operating room because it had to move nurses to deal with COVID-19 patients. This has affected not only a patient with congestive heart failure who needed dialysis and had to wait to be transferred to another hospital, but also two people whose colonoscopies are delayed until May of next year because of the surge in COVID-19 patients. 

Statewide, COVID-19 cases have been ramping up since the beginning of November, and last week, there were on average nearly 3,500 cases of COVID-19 per day, according to data from the Arizona Department of Health Services. 

Dr. Kara Geren, an emergency medicine specialist based in Scottsdale, said that during her shift yesterday, she cared for so many COVID patients that she "lost count." 

"We are very concerned about the volume of very sick people flooding our hospitals," she said. "Arizona hospitals are rapidly running out of capacity," Geren said, adding that during this most recent surge of COVID-19 cases, 94 percent of all inpatient beds and 94 of all intensive care unit beds in Arizona were in use.

"This means that in all of Arizona with a population of 7.2 million people only about 100 ICU beds are left," Geren said. 

"This is visible in every emergency department in Arizona," she said. "Patients are waiting hours upon hours to receive care in the emergency department, and patients admitted to the hospital wait days before moving out of the emergency department. Patients requiring specialty care at a different hospital wait days before they can be transferred and get the care they need." 

"This impacts everyone—if someone needs an ICU bed for a serious trauma, heart attack, stroke or other major major medical problem an ICU beds can be hard to find," she said, adding that patients with COVID-19 account for at least one-third of all hospital beds, a ratio that "pushes hospitals to capacity and beyond." 

"Of those COVID-19 patients in the ICU and sick enough to be hospitalized more than 80 percent of them are unvaccinated people," she said. 

Boosters and vaccines for kids 5-11

Free boosters, vaccines and tests are available in Pima County though Cullen said that people who have the means to buy their own tests should do so so people who need free tests can get them and have them available.

The county is planning to have a static or semi-permanent booster site established by next week, but for now, all three booster brands — Pfizer, Johnson & Johnson and Moderna — are free at county-listed sites that also provide free vaccines

Kids age 5-11 can also get a free vaccine. There are about 88,000 kids that age whom the county wants to vaccinate, Cullen said. The county estimated that they needed to vaccinate about 25,000 5-11-year olds in November, and they’re on track to have that done by Dec. 1, Cullen said. Last week, the county vaccinated 12,000 kids in the newly vaccine-eligible age group, she said.

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Those 5-11 vaccines are available at school-based vaccine clinics, the Abrams Public Health Center and at the county’s three other public health clinics — the Theresa Lee Health Center, the North Clinic and the East Clinic. Most pharmacies and pediatric offices also offer the younger vaccine, she said, making it readily available throughout the county.

“There’s no impediment for children to be able to get their shot other than they need to be accompanied by a guardian,” she said.

Az doctors blame Ducey for COVID resurgence

"I have seen COVID-19 ravage families leaving children without parents and grandparents and putting children in the hospital for months; getting adults and children vaccinated against COVID-19 is our best path out of this pandemic," said Geren. 

While we understand parents may have questions about the COVID-19 vaccine, the fact is that all the evidence indicates they are safe and effective, and more than 2.6 million U.S. kids between ages 5-11 have now been vaccinated safely," she said. "As physicians, we strongly encourage anyone with questions about the COVID-19 vaccines to please get information from their doctor, and not from social media or anti-vaccine politicians." 

"While some state leaders have spread fear about vaccines and tried to divide us about COVID-19 protections generally, it’s not too late to get the facts and make the safe choice that will allow us to celebrate the holidays and start the new year with good health," she said. 

Dr. Cadey Harrel, a family physician in Tucson and head of the Arizona chapter of the Committee to Protect Health Care, blamed state leaders for the rise in infections, and pleaded with people to get vaccinated. 

"When more people are vaccinated, the virus that causes COVID-19 has fewer hosts left to infect and multiply in, drastically reducing community transmission, but Arizona still has a long way to go to achieve this effect and stop the virus in its tracks," she said. 

However, Gov. Ducey and the state Legislature have encouraged the most recent surge, Harrel argued.

"This was avoidable but our Governor and legislature are encouraging this to happen and to continue to happen," she said. "Under the failed leadership of Gov. Ducey and our Arizona State Legislature, Arizona sadly has become the only state in which COVID-19 is the leading cause of death," she said. 

During the summer, the state Legislature packed the state's must-pass budget bill with a series of laws intended to block mask and vaccine mandates. However, those bills faced an immediate challenge in court, and in Sept., a Maricopa Superior Court Judge found that state legislators violated Arizona's constitution. The governor's office sought to appeal, but were rebuffed by a unanimous decision from the state's Supreme Court. 

Meanwhile, state Attorney General Mark Brnovich continues to pursue legal action against the Biden administration over the federal vaccine mandate, which will require federal workers and contractors to get employees vaccinated, or allow for accommodations for religious exemptions. 

"Currently, the state has also fought both mask and vaccine mandates even using our taxpayer dollars and resources in court defending an unconstitutional law that prohibits mass mandates in our public schools," Harrel said. "All of this was actually before most children were even eligible to be vaccinated—it's clear that Gov. Ducey and Republicans in our Legislature are doing all of the wrong things to keep Arizona family safer, and in fact, are willfully putting people's lives in danger with their hostility towards proven public health policies which can get more people vaccinated and help to protect our communities." 

"Vaccinating as many kids and adults now is how we can keep our schools open so children can learn in-person safely, without sudden closings that affect all families and disproportionately impact low-income, underserved families." 

"Widespread vaccinations now can help make the holiday season a little safer and merrier for all Arizona families. The best gift we can give to our families is a holiday season they can enjoy without worrying whether they’ll get infected with a virus that has sickened 1.2 million Arizonans and is now the leading killer in our state," she said. 

Schools

As of Tuesday morning, the county reported that, since the school year began, there have been 189 outbreaks of the virus in Pima County schools using the CDC definition of an outbreak — multiple cases in schools between two students who aren’t in regular contact outside of school. There have also been 112 classroom closures as a result.

Over 6,000 people have been identified by the county as either a school-related COVID case or a contact, someone who's been exposed to the virus, since the start of the school year, Cullen said. Despite the numbers, Cullen said schools have still done a “marvelous job” of layered mitigation, a strategy to reduce infection with multiple measures in different areas of the school.

Cullen told Tucson Mayor Regina Romero on Tuesday during an update to the Tucson City Council, that "it's safe to be in school."

"Obviously we're encouraging districts to adopt a mask mandate, if they can, or to ensure that people are masked," she said. "But the reason why I think it's safe is we have a very good, robust system in place that allows us to early identify case."

Kids and schools have been very forthcoming about the information they need to contact trace, Cullen said, and the county has been able to work well with schools.

County health officials are struggling to predict what the impact of coming vacations like Thanksgiving and winter break will be on the schools and whether it will reduce or worsen their caseload, Cullen said.

“We can look at the schools and vacation in two ways,” she said. “Kids will no longer be in the classroom, so there’s not a gathering of individuals close together...however, now they’re going home, and they may be interacting with people they may not have interacted with for the past few months because families are coming in.”

Fewer tests will be coming back positive from schools, Cullen said, but because schools will be performing fewer tests, which will lower the school positivity rate. The real concern, she said, is what will happen in early January, when winter and autumn vacations are over.

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 (pictured in this May 2020 file photo) talked to reporters on Tuesday about the importance of staying safe against COVID during the holidays.

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