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Epidemiology and Public Health Response

Initial exposures and spread

The first confirmed case of COVID-19 in Arizona was reported on January 26, 2020 in Tempe. The patient, a 20-year-old male Arizona State University (ASU) student, had returned from Wuhan, China. The second confirmed case was reported on March 3, 2020 in Maricopa County in a 20-year-old male who had traveled outside the state. On March 6, ADHS reported the third case, a woman in her 40s, who represented the first identified case likely caused by community spread. Community spread is thought to have begun around early March with a doubling time of cases between March 17-24 of 1.7 days. On March 26, ADHS updated the community transmission level of COVID-19 to widespread.

Clusters of cases have been linked to assisted living and long-term care facilities as well as other congregate settings. The first cases linked to such settings were reported the week of March 22, 2020.

Hospitalization and Hospital capacity

According to ADHS, 5% of COVID-19 case have been hospitalized. Of these, Native Americans and African Americans have been disproportionately represented in Maricopa County.

To increase hospital capacity and handle a potential surge in COVID-19 patients, on March 30, ADHS announced that St. Luke's Medical Center which closed in November, 2019 would be reopened with the help of the US Army Corps of Engineers and the Arizona National Guard. The initial plan included over 330 ICU beds with a reopening date in late April; however, though ready, St. Luke's has not been reopened, and ADHS's current plan is to use it for a lower level of care if needed. On April 21, 2020, the ADHS established the Arizona Surge Line, a centralized statewide system for hospitals and medical providers, which enables coordination when COVID-19 case levels become overwhelming. The system aims to facilitate patient transfer from one level of care to another, coordinate transfer of patients to balance patient numbers across hospitals when resources are scarce, and support clinicians who are treating cases. In Tucson, patients have been transferred to Phoenix and out of state when capacity was reached in early July. Beginning June 27, 2020, hospitals in Arizona requested implementation of 'crisis standards of care' to aid in decision making when and if resources are limited. As of July 2, 2020, however, no hospitals were having to triage patients under this plan. Also on July 2, 2020, adult intensive care bed use first reached a high of 91%. Hospital bed status is self reported daily to ADHS as per executive order 2020-37.

Deaths

The first confirmed death in Arizona from COVID-19 was announced on March 20, 2020. While the largest percentage of cases has been in younger age groups, the highest percentage of deaths has occurred among those over age 65.

Testing

PCR Testing for COVID-19 by the Arizona Department of Health Services began on March 2. Additional testing in Arizona has been implemented by Sonora Quest Laboratories, the Mayo Clinic in Arizona, ASU BioDesign Institute and the Translational Genomics Research Institute's division in Flagstaff. On Saturday, May 2, a testing blitz began with the goal of testing 10,000-20,000 people each Saturday for three weeks and two additional weeks were added. As COVID-19 cases continued to rise in June, testing capacity has struggled to meet demand.

Contact Tracing

Local health departments are working to increase staffing for contact tracing of COVID-19 positive cases. According to Dr. Cara Christ, the director of the Arizona Department of Health Services, ADHS has developed a system for contacts to monitor and report symptoms over a 14-day period via phone, text or online. On June 17, 2020, Ducey announced that the Arizona National Guard would assist with contact tracing with 300 guard members requested. Maricopa County Department of Public Health has been criticized for not following CDC recommendations for contact tracing, for only having the capacity to contact trace approximately 500 cases per day, and for only calling high-risk and older patients who test positive.

Modeling and Projections

Models that project the trajectory of the COVID-19 pandemic in Arizona are used by the ADHS to forecast resource needs. Initial models suggested that Arizona would reach its peak in COVID-19 cases in mid-April to late May. In April, ADHS began working with a team of researchers at Arizona State University and University of Arizona to develop state specific models and projections. However, the modeling team was instructed to halt their work on May 4, 2020 and notified that they would no longer be allowed access to special data sets used for this work.. The modeling team had recommended against reopening before the end of May, and the ADHS notification coincided with the governor's decision to begin reopening. The state also announced that it would be using FEMA's model for COVID-19 predictions, although the department also declined to reveal the results of the model. After criticism of their decision to stop working with the ASU/UA modeling team, ADHS announced on May 7, 2020 that it would continue the partnership. On May 26, ADHS reported that they had been given permission to share the results of FEMA's model; however, on June 5, it was announced that this model may not be available to the state going forward.

Researchers at both the University of Arizona and Arizona State University are providing regular updates about Arizona COVID-19 trends and projections. These can be compared with state-level models and projections by organizations outside the state including the Institute for Health Metrics and Evaluation at the University of Washington (the IHME model), and the Covid ActNow projections. Additional forecasts of total deaths and total hospitalizations are received and compiled by the Centers for Disease Control.

Impact

Schools

Following the outbreak of COVID-19 in the United States, academic institutions across Arizona moved to distance learning. On March 30, Governor Ducey declared a statewide closure for all schools and mandated the option for students to complete coursework in an alternate method.

Following the lifting of the Arizona's lockdown order, Gov. Ducey announced that schools would be reopening for face-to-face instruction in the fall. The director of Arizona Department of Health services, Dr. Cara Christ, described the intent to "reduce class sizes, create disinfectant protocols and be flexible with parents and employees who have health problems that put them at higher risk for severe complications from COVID-19."

On 1 June 2020, the Arizona Department of Education release guidelines for the reopening of public schools. Measures included masks for staff and older students, staying home in the event of COVID-19 symptoms or diagnosis, provisions for frequent disinfection of surfaces, and socially distanced seating. Ducey announced on June 29, 2020 that in-person school would be delayed until August 17.

Higher education

A door on the ASU Tempe campus with a sticker about the requirement to wear masks.

By March 12, several universities (including all three state universities and some community colleges) announced that courses would be moved to an online format for at least two weeks following spring break. By March 16, all three state universities (University of Arizona, Arizona State University, and Northern Arizona University) announced that they would continue online courses through the end of spring semester. By late April, all three state universities publicly announced the intention to resume in-person classes in the fall semester. All universities described plans for measure to ensure public safety, including diagnostic testing for students/faculty/staff and modifications to classroom formats. In June, all three state universities announced that all students, faculty, staff and visitors are required to wear masks on campus inside buildings and outside where maintaining social distancing of six feet is difficult.

Multiple universities also announced budget cuts to staff and faculty salaries due to financial hardship from the COVID-19 pandemic. In mid April, the University of Arizona released a furlough and paycut plan from June 2020 to June 2021. Similarly, NAU announced payouts and reduced contracts due to an anticipated decrease in enrollment.

Sports

Major League Baseball (MLB) cancelled the remainder of spring training on March 12, affecting ten separate Cactus League venues in the Phoenix area (and over 66,000 seasonal and 2,000 volunteer jobs), and on March 16, MLB announced that the regular season would be postponed indefinitely, after the recommendations from the Centers for Disease Control and Prevention (CDC) to restrict events of more than 50 people for the next eight weeks, affecting every team that trains in Arizona: the Arizona Diamondbacks, Cleveland Indians, Cincinnati Reds, Chicago Cubs, Chicago White Sox, Colorado Rockies, Kansas City Royals, Los Angeles Dodgers, Los Angeles Angels, Milwaukee Brewers, Oakland Athletics, San Diego Padres, San Francisco Giants, Seattle Mariners, and the Texas Rangers. The Cactus League attracts over 1 million visitors to the state and generates more than $600 million a year in economic impact to the greater Phoenix metropolitan economy. In early April, MLB began discussing plans to conduct its 2020 season entirely in the Phoenix area, with teams playing at Chase Field and spring training complexes to empty crowds.

In the National Basketball Association, the season was suspended for 30 days starting on March 12, affecting the Phoenix Suns. On March 19, Suns guard Devin Booker announced a pledge of $100,000 to launch a donation campaign on video streaming platform Twitch, which would be matched by Phoenix Suns Charities. The funds would benefit local Phoenix area charities assisting seniors, families and children, and help with local healthcare initiatives during the COVID-19 crisis including drive-through clinics.

Also on March 12, the National Hockey League suspended the season indefinitely, affecting the Arizona Coyotes.