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'There's so many people who have lost so much': Arizona's COVID-19 death rate is 2nd-highest in U.S.

On Monday afternoon, Sam Beeson sat in a folding chair outside the Arizona Heritage Center in Tempe. He was waiting for  a memorial for COVID-19 victims to begin. He was there in honor of his wife, Jennifer.

“She was my high school sweetheart,” Beeson said. This month would have marked the couple’s 38th wedding anniversary. 

“I have nothing but good memories,” he said.

Sam’s whole family caught COVID-19 as cases surged in January 2021. Sam works in a hospital, so he had been able to get vaccinated in the first phase of Arizona’s vaccine rollout. For him, the virus was mild. But Jennifer hadn’t been eligible for a vaccine yet. She died soon after contracting the illness, during what would turn out to be one of the deadliest weeks of the pandemic in Arizona.

“We were not able to visit while she was in the hospital until the last day when they told us she was not going to make it, then they did allow me and my son to come in,” Beeson said.

A little over a year later, Sam feels frustrated, wondering if the state could have done more to keep the virus from getting so out of control.

“The whole thing I think could have been done better if we had listened to the scientists, listened to the doctors, and just quit believing in all of the nonsense and conspiracy theories that surround this disease,” he said.

Two years since the start of the pandemic, nearly 28,000 Arizonans have died from COVID-19. That's at least one death for every 263 people in the state. According to the CDC, that’s the second-highest death rate of any state, behind Mississippi. Some say those numbers point to policy failures.

Leaders at the Arizona Department of Health Services say it’s not that simple.

“Tragically, many, many Arizonans have died from COVID-19, but we’re not at a point where we can make comparisons yet,” said Jessica Rigler, assistant director for the division of public health preparedness with the department.

Rigler noted each state is tracking COVID-19 data differently.

“Their timeframes for reviewing deaths may be different, some may be reporting out deaths exclusively based on what’s on the death certificate, while others are using a wider surveillance definition,” Rigler said.

She said it will take more time before we know how Arizona really compares to other states and why some states have seen more death than others.

But it’s not just the death rate that suggests Arizona has been harder hit, according to Will Humble, former director of the state health department and current executive director of the Arizona Public Health Association. A November  report from his association found Arizona is also the only state where COVID-19 became the leading cause of death during the pandemic. Humble and his colleagues  have also reported that Arizona saw the highest increase in overall rates of death for any cause in 2021.

“Those paint a picture of a state that performed quite poorly,” Humble said.

And Humble and others say it's not too soon to begin draw some conclusions about why that may be.

Dr. Joe Gerald, with the Zuckerman College of Public Health at the University of Arizona, said there were social and demographic factors that put Arizona in a more difficult position when the pandemic began. Arizona’s median household income is lower than that of other states, which public health experts say often  correlates with poorer health outcomes. Arizona also has a higher  rate of residents without health insurance than most other states. And Gerald noted Arizona has a high number of people working in frontline professions that would have put them at high risk for exposure to the virus.

“You add all of those things together in a stew, and you find yourself as one of the worst places in the U.S. for COVID burden,” Gerald said.

But Gerald said policy decisions certainly played a role too.

“We’ve essentially let COVID rip,” Gerald said.

Arizona never had a statewide mask mandate, and cases were already spreading out of control by the time Gov. Doug Ducey allowed cities and counties to begin requiring masks in summer 2020. The governor and then health department director, Dr. Cara Christ, had also  scrapped most restrictions for Arizona businesses by the time the state’s second major wave hit that winter.

Humble said those were mistakes that cost lives.

“It wasn’t bad luck,” Humble said. “It was a choice that was made by Gov. Ducey and former director Christ not to do any enforcement of mitigation in those closed, indoor environments that, by then, we knew were the dominant place that this virus amplified.”

Arizona has had a higher than average death rate since early in the pandemic, but the state only rose to the second-highest position in the CDC’s ranking after COVID-19 vaccines became available.

Arizona’s COVID-19 vaccination rate and booster uptake rate are below national averages,  according to the CDC. Humble said evidence overwhelmingly suggests Arizona wouldn’t have lost so many lives in the recent delta and omicron waves of the pandemic if those rates had been higher.

Gov. Ducey has made clear he doesn’t support vaccine requirements for workplaces or schools. But Humble said the governor could have asked restaurants or music venues to require proof of vaccination for entry, as other states have done, to help incentivize vaccinations without requiring them.

“Not only was [Ducey] completely hostile to sticks, he was hostile to carrots,” Humble said.

The governor’s office did not respond to a request for comment for this story.

The omicron surge is now receding. In Arizona and nationwide, restrictions are being lifted as city and state leaders signal they are ready to move on from the pandemic.

But many people, like Sam Beeson, can't move on. These questions about pandemic outcomes are important, he said, because he doesn’t want COVID-19 victims like Jennifer to be forgotten.

“I’m just one guy, there’s so many people who have lost so much,” Beeson said. “I think everyone who died of this disease deserves to be remembered, because they were important to somebody.”

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Katherine Davis-Young is a senior field correspondent reporting on a variety of issues, including public health and climate change.