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What the Devil won't tell you

Pima County starting to think about a COVID Plan B; it's probably for the best

A Plan B for coronavirus seems to be lurking in the future and it's time we start giving it serious consideration.

I’m not at all arguing surrender, but at some point in the next six to nine months we are going to (and this is likely global) probably have to more carefully pick our battles.

Pima County health officials seem to be of the same mind, or I'm agreeing with the mindset they are acquiring.

Pima County Health Director Theresa Cullen told a gaggle of reporters Wednesday that the county is, in fact, working on a draft that would let 1 million local residents get back to a kind of normal without hitting federal “all-clear” benchmark of 10 cases per 100,000.

“In the near future we will (not) see a case rate that is at or below 10 per a hundred thousand,” Cullen said, and added a really important warning. “High transmission is 100 cases per 100,000. If anything we are in high, high, high transmission and we don’t have an indication for when it’s going to stop.”

So no, no, no, we don’t get do a victory dance any time soon. Put your mask back on dammit. We are still swimming through a resurgent pandemic in Pima County with 347 cases per 100,000 and just 2 percent availability of intensive care unit beds.

The pandemic is especially gaining strength among kids. Schools in Pima County have experienced 176 outbreaks — 30 in the four days between Nov. 12 and 16. Thousand of kids have been infected. The county has ordered the closure of 106 classrooms since the school year started.

Kids don’t get as sick as adults and there has been only one pediatric death here, but the kids can act as vectors and get those around them sick. 

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So get vaccinated and wear masks. We’re all sick of wearing them. We’re all sick of hearing about them. Still, the case rate is high and the danger is real right now.

Is 50 the new 10?

However, the county is starting to get next to the idea that normalcy may be substantially less COVID free than what the federal government considers victory.

As a society we just have to come to grips with the fact that a certain number of people simply champion the virus in the name of their freedom. It’s not a type of freedom that applies to any other human activity. Government is still free to regulate sex, gender, drinking, smoking, fashion, mumps, measles, rubella, smallpox, polio, voting, immigration, the female reproductive system and foul language, but guns, carbon and coronavirus must proliferate or America is just a whatever whatever security state, blah, blah, blah.

There appears, at this point, to be a sufficient number of hard no's on the vaccine to prevent us from achieving any real herd immunity.

So now what?

Cullen said some inside the health department have mentioned 50 cases per 100,000 as a potential threshold of normalcy. The number 50 is not official, mind you. She did not say it was the working assumption of the proposal her department is kicking around. However, she said it on purpose and clearly wants people to know the thinking inside the Health Department.

It’s not the first time (this week) she’s gotten out in front of the CDC. On Monday, she issued a formal beseeching, I guess one would call it, that everyone vaccinated and older than 18 get a booster shot, pronto. CDC guidelines are far less sweeping. People who are under 65 and basically healthy, and not working in jobs where they're exposed, are not yet advised by the feds to get one.

Cullen hasn't exactly broken with the guidance really because it does recommend individuals in high-risk areas get boosters. 

“We have been 100 percent aligned with the CDC,” Cullen said. “There was a caveat for those who live and work in high-risk areas. I made the determination that we were a high-risk area.”

The CDC's guidance isn't clear that it meant for public health officials to make that call for entire counties or states.

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Word is filtering out of Washington that the CDC may soon change its directives to be more in line with what Cullen and other state health officials are now recommending with boosters.

About a quarter of the new cases are “breakthrough cases” and a significant number of those few vaccinated coronavirus patients hospitalized received the vaccine about six months ago.

Given where the capacity problems at hospitals within Pima County, Cullen’s recommendation makes sense as the calendar turns toward winter and the holidays when families will gather in close quarters.

It is probably smart policy for Cullen to back off from the federal government’s stated goal, but more for policy reasons than biomedical ones.

How to disappear completely

See, the fear that I have, and that Cullen told me she shares, is the mysterious concept of public fatigue with coronavirus. At what point, does society feel like it’s been dealing with things like “mitigation” for too long and just starts to ignore health officials completely.

I worry we may have over-reacted early with lockdowns that turned a distance race into a sprint. It sapped our collective strength for what would be a long slog forward. Those early mitigation efforts have left us weary of the road ahead that leads to herd immunity.

Will COVID fatigue keep the vaccinated from getting boosters? If so, what the heck happens if the virus spikes again this time next year but we’ve decided we’ve had enough.

I don’t know and what’s alarming is that when I asked Cullen to speak to societal fatigue she said she didn’t know either. Her best advice was get the vaccine and wear a mask.

But I think she does know, actually. Why else would we be looking to live with a new normal that is less normal than the CDC’s version of normal? I don’t know what it looks like and I don’t want to speculate because I am dangerously unfit to make medical recommendations.

I do have some understanding about how human beings react to policy and there is tremendous value in taking a fresh look at how much we can do to live our lives again, rather than look at what we have to do to crush the virus.

I’m not suggesting surrender here, and now is not the time to start even talking about backing off virus control duty. However, as more people get vaccinated and as more people get sick, the universe of uninfected and unvaccinated will shrink.

The country and county may be more likely to get the vaccine if the numbers drop down to 50 cases per 100,000, and we are able find more normalcy.

Sometimes we treat rules as if whatever is not expressly prohibited is OK. With coronavirus I can see how people feel like they can only do what is prescribed.

We have been living in a world where the leaders have been thinking in terms of prescriptive restrictions. Less important has been “what can we tell the people they can do? How much of their life can they have back?”

The truth, of course, is that we’re really not that bad off right now. People are going to bars, restaurants and movies but they still live under a barrage of news about can’ts, shouldn’ts and don’ts. Included in this incoming is the recommendation to avoid bars, restaurants and movies.

But CDC’s guidance still says:

If you are fully vaccinated, to maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission.

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Click on the area of the fed's map showing areas of high or substantial transmissions and it’s pretty much everywhere.

The advice is so vague it's hard to follow, without erring on the side of extreme caution.

The CDC also tell us to avoid crowds and poorly ventilated areas and continue to social distance. Still no handshakes or hugs? How do we know how well ventilated an area is? We are social creatures and kind of need some human interaction to survive.

How long are we supposed to keep doing this if (if, if, if) we can get the transmission rate down from 300 per 100,000 to 50 per 100,000 because we haven’t hit 10 per 100,000.

Maybe we lift restrictions with the caveat that if the numbers go back up, the restrictions will return. The opposite can be true: If we reach X level, Y can happen.

If X, then Y; such that Plan B

One hope is that when we stop talking about the unvaccinated, they wonder why they are getting less attention and just go get the shot. It’s kind of like how you approach a total brat of a kid.

I’m also open to the idea of importing 10 vaccinated migrants from decidedly un-Scandanavian countries for every unvaccinated American. The new arrivals can live in those big empty rectangular states. That will get us to herd immunity and get their attention. It would be fun watching Tucker Carlson grapple with a myocardial infarction right there on national TV.

I would love to have vaccine mandates all across the country and vaccine passports. We just have a federalist system of government that devolves power to totally reprehensible governors who think the road to the White House is paved with headstones.

I’m assuming immigrant-as-numerator proposal isn’t going to fly. I don’t trust the states or the courts to allow us to move forward with the strength or power required.

We may have to start thinking about Plan B.

I’m glad Pima County leaders are starting to sketch it out.

Blake Morlock is an award-winning columnist who worked in daily journalism for nearly 20 years, and as a communications director for the Pima County Democratic Party. Now he’s telling you things that the Devil won’t.

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Coronavirus requires the public's immediate attention (and vaccination) but at some point, we are going to have to figure out how and when to land this thing.


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