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How Arizona Can Start Again On Its COVID-19 Prevention Message

STEVE GOLDSTEIN: The state Department of Health Services is reporting 4,928 new cases of COVID-19 today and 73 additional deaths. Arizona's health care providers are already struggling to keep up with the surge in COVID-19 cases and corresponding demand for care. Hospital capacity is rapidly depleting and critical doctors and nurses are being stretched thin. Earlier this year, Arizona was able to recruit help from other states. But with cases spiking across the country, outside help is getting harder to come by. Dr. Michael White is the chief clinical officer for Valleywise Health. During a press conference (Wednesday), he spoke plainly about the current situation, even before we see the effects of Thanksgiving travel.

MICHAEL WHITE: For ICU this morning, I have one available ICU bed, which means I'm at 98% capacity this morning. So that's where we're sitting today.

MARK BRODIE: White also said he has 10 ICU beds he cannot staff because of the rising demand on hospital resources. And he warned the situation will soon get worse. White anticipates the state will reach another peak in new cases before Christmas, and his prediction is rooted in past data. Dr. Marjorie Bessel is the chief clinical officer for Banner Health. In a separate press conference (Wednesday), she explained the state's rising positivity rate is evidence of more stress on hospitals to come.

MARJORIE BESSEL: We look at percent positivity of tests as an early indicator of what's coming for us for hospitalizations. In the state of Arizona, last week we were at 18%. The peak in our summer surge was 21%, and that occurred in the month of June.

GOLDSTEIN: This spike mirrors that first surge in the summer, but the state is taking fewer precautions to stop the spread. New cases drop dramatically when the governor issued a statewide stay-at-home order and shuttered many non-essential businesses. The governor has indicated he is not willing to implement such an order again. He has also resisted calls for a statewide mask mandate or curfew. In southern Arizona, both the Pima County Board of Supervisors and the Tucson City Council have implemented curfews as the spike dramatically affects health-related operations there. I spoke with Pima County Health Director Theresa Cullen to find out what options she and her colleagues actually have left.

THERESA CULLEN: You know, it's such a really critical question, right? Because we talk about a toolbox or a tool bag, and I say it's pretty limited. And so what we've done is pull out every tool we can from there. Many people will be familiar with the three Ws: Wear — wear a mask; wash your hands; and wait. And the wait is really talking about the physical distancing. Actually, I had a veteran the other day tell me that third W should mean wingspan, which is make sure that your wings — your arms — are out and nobody's within that space. However, once we get beyond that, what options do we have available, especially at a county level where people are looking to us for guidance? Pima County last Friday issued a public health advisory that was really an attempt for us to say, "Hey, you guys, we're in a critical situation in this county. We all need to follow this concept of layered mitigation, which is to do the three Ws. At the same time, make sure you isolate or you're quarantined if you're sick, you avoid nonessential travel, you make sure that we work together to protect our critical and essential workers." Obviously, we want to protect the sick in the vulnerable at the same time. A lot of this is related to the messaging, and what can we do to ensure that people understand the severity of what we are seeing at the current time?

GOLDSTEIN: Frankly, it's a waste of your time to be frustrated. But considering all the messages that were going out before Thanksgiving, asking people to still practice all of these things and obviously many millions of people didn't do it. How hard is it to then express that message again, hoping that more people will think about it this time?

CULLEN: It's a really important philosophical and reflective question that I asked myself, and we ask our staff at the health department. You know, I remind people that the parts of us that are human are the parts that use our senses, right? They're the parts that want to engage with others. They want to be close to others. They want to hear what people are saying. They want to be able to touch them. And, you know, think about Thanksgiving. They want to be able to share. They want to give thanks for what they have in their lives. So despite the fact that many people elected to not embrace our recommendations, I think what that means right now is we re-level set, we start again. You know, COVID has been compared to Sisyphus. You roll up the hill, you get up a little higher, you're doing better. And man, slams you right back to the bottom. That is exactly what we have in our county right now. The problem is that the bottom has cratered. We are at a lower place, meaning we have more cases and more transmission than we have ever had in the past. And because of that, the responsibility is on all of us. But, but I also want to remind people that while there's a huge individual responsibility, there's a collective responsibility. We know that there are people that worked on Thanksgiving, right? Our essential workers, they worked on Thanksgiving, so they weren't home with their families. So while we encourage people to stay home, they don't have the option to do that. And so I think as a public health department in the community where I am, which is Pima County, we are trying to ensure that we deliver a collective measure. That as a community we need to come together. And there's multiple ways we do that. Some of it is trying to remind people that it could be your grandma, it could be your sister, could be your brother that's in the hospital. It could be someone who doesn't have COVID but is waiting nine hours in the emergency room to get seen. And because of that, there may be adverse consequences because of some delays. So we need to come together. And I think the other thing to remind people, Steve, is there is no one magic bullet here. This is layered mitigation. We have hope because we do anticipate we will have vaccinations available starting hopefully sometime next week for a limited number of people. But even in those early phases of the vaccine immunization process, we are all still going to have to remember that we have to protect each other.

GOLDSTEIN: How much will vaccinations help when it comes to frontline workers to relieve some sort of mental burden at least?

CULLEN: I'm glad you pointed that out. There's clearly this post-trauma that's going on for frontline workers, this concern that I've had ever since this happened about post-traumatic stress disorder occurring in our frontline workers. One way we know we can alleviate and in some cases avoid that is by making people understand that there's a light at the end of the tunnel, that there is hope. I want to clarify — I don't believe that we will see a tremendous impact initially from the early vaccines because the numbers will be quite limited. But as we go into the months forward, we will see that impact. We also don't know what we call the immunogenicity of the vaccine. Do you need your second shot before you get to the 95% effectiveness that we've been hearing? If you do, then you're three to four weeks after your first shot. So with that, we're definitely into the end of January at the earliest. But I think that some of it is about just knowing about the community, understanding that there is another fairly major tool going into that toolbox that hasn't been there. And we're going to be able to pull it out and make sure it's available.

GOLDSTEIN: Dr. Cullen, finally, as we mentioned, we've seen the numbers generally spike. We've seen the number of deaths from COVID increase and we're seeing hospitals pushed to their capacity when it comes to ICU, when it comes to health care professionals. What are you most concerned about right now when we talk about those figures?

CULLEN: You know I'm a physician, so I'm going to default to the health care system. I think what concerns me the most right now is what we're seeing happening in the health care system. Our health care system has reached capacity. The reason why I say the health care capacity is, I try to think about, Steve, what is it that motivates behavior? And what I hope is that if people realize the limitations on health care capacity, they don't even need to think of it in terms of COVID — they need to think about it, "What if I get sick? What if there is an accident? What if my father has a heart attack? Will they be able to get the care they need?" If the health care system is overwhelmed with COVID, there is the potential for delays in what we know are needed to ensure appropriate health care. The impact in terms of morbidity and mortality, I think is best exemplified by what we're seeing in the health care system.

GOLDSTEIN: That is Dr. Theresa Cullen. She is Pima County's health director. Thanks so much for your work and take care.

CULLEN: Thank you very much.

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Steve Goldstein was a host at KJZZ from 1997 to 2022.