Monday, July 6, 2020

The Covid Thing

The last time I wrote about Mr Corona was in April.  Today let's talk about the situation here at THC Central. 

Until Memorial Day, Arizona, and particularly Maricopa County (Phoenix metro), where THC HQ is located, had been managing Covid.  Case loads stayed relatively low in the county as had the death toll, which had hit those in Long Term Care (LTC) the hardest, with 71% of all fatalities in that category.

In early May the state began easing restrictions on top of rapidly expanding testing beginning in the latter part of April.  While cases went up somewhat during May, it seemed primarily an artifact of the increased testing as the positive rate declined from 9% in mid-April to 5% in mid-May.  At the end of Memorial Day weekend Maricopa had 8,340 cases.  As of today's report, the county has 64,686 cases though the amount of testing has only doubled during that period.  Moreover, positive test rates are exceeding 20%.

During the first 70 days of the pandemic, Maricopa had 368 deaths, 71% of which were LTC.  In the 40 days since we've had 475 deaths of which 44% were LTC.  Likewise, we had 1,092 covid-related hospitalizations in those 70 days, compared to 1,729 in the 40 days since May 25.  And the figures for the most recent 40 days are an undercount as Maricopa only reports cases confirmed by positive tests and there is a 7-10 day lag period in that reporting.

While the Maricopa case count has gone up 8x, the entire state has seen a 6x rise during this period.

What happened?

I believe a number of factors are in play.  For the state as a whole the disproportionate impact on our Indian communities has continued.  They amount to 4% of our population but 15-18% of cases and fatalities.  More recently, the main border towns, Yuma and Nogales, have seen an explosion in cases as American nationals and dual citizens flee the deteriorating covid situation in Mexico (and Mexico is concerned about covid infected Americans coming into that country).  Some of the impact from this is probably also having an effect in the Phoenix area.

In Maricopa during Memorial Day weekend and for the next couple of weekends we saw bars and restaurants jammed with young people and according to contact tracing by the county health department this was a major source of new cases.  The marches and demonstrations related to George Floyd's death may also have played a factor.

I think weather and air conditioning also probably played a significant role.  In Phoenix our outdoor time of the year is from October into mid-May, after which the heat forces us indoors, whether in bars, other public venues, or our homes.  We know that covid is more transmissible in crowded indoor conditions and air conditioning can move the virus around.

The post-Memorial Day surge has been accompanied by a change in demographics.  Through that weekend 47% of Maricopa cases were below the age of 45.  Since then 67% of cases have been in the 0-44 age bracket.  Those 65+ constituted 22% of cases as of May 25, but only 8% of those reported since.

The other significant demographic change has been in the Hispanic population which is 31% of Maricopa County.  On May 25, Hispanics accounted for 38% of cases and 32% of hospitalization, but since then 52% new cases and 43% of those hospitalized.

The result has been, at first glance, paradoxical.  Because the new cases have shifted to a younger and healthier demographic the hospitalization rate which stood at 13.1% on May 25, has been only 3.2% over the past 40 days, while the fatality rate dropped from 4.4% to 0.9%.  In that respect, while the case numbers are bad, hospitalizations and deaths significantly lag that rate of increase so Arizona does not look like New York in March and April (and if back then New York City had available the amount of tests we have today, it would have resulted in at least the same number of daily new cases as we are seeing for the nation as a whole right now).

Yet average daily hospitalizations and deaths have increased because the absolute number of cases has risen so dramatically and that increase has placed increasing stress on Maricopa hospitals and healthcare providers who are beginning to run short of beds, equipment and PPE.  I expect deaths to increase this week.

If the situation does not begin to turn around in the next 7-10 days we will hit a breaking point and may see deaths escalate further as less individual attention can be given to each patient and then the situation could become closer to New York.  I hope that with the institution of mask ordinances two weeks ago and the closing of bars we will see an improvement.  We need it.

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