How Policy Decisions Shaped 6 Months Of COVID-19 Spread In Arizona

By Katherine Davis-Young
Published: Monday, September 21, 2020 - 5:52am
Updated: Monday, September 21, 2020 - 8:08am

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SPECIAL SERIES: COVID-19 In Arizona: 6 Months In
billboard in north Phoenix for the Mask Up Arizona campaign
Sky Schaudt/KJZZ
A billboard in north Phoenix for the Mask Up Arizona campaign in July 2020.

It's been nearly six months since Gov. Doug Ducey required all but essential businesses in Arizona to close to slow the spread of COVID-19. The stay-at-home order would last six weeks, then Ducey told Arizonans it was safe to reopen.

“We are clearly on the other side of this pandemic," Ducey said at a May 12 press conference

In the weeks that followed, the state would see a dramatic rise in infections and deaths. But why was the surge in Arizona so much worse than in other states that lifted stay-at-home restrictions? Experts say policy decisions shaped the way the virus spread through the state. 

“A lot of messaging coming out from state and national leadership was just like ‘OK, well we’re past the worst of this, Arizona’s just not going to get hit that hard.’ And unfortunately, we know that that was just not the case,” said Saskia Popescu, an Arizona-based epidemiologist and a member of the Federation of American Scientists COVID-19 Task Force. 

Arizona Gov. Doug Ducey
Howard Fischer/Capitol Media Services
Arizona Gov. Doug Ducey answers questions about COVID-19 on Aug. 20, 2020.

Arizona was averaging about 350 new cases per day when the state began reopening. By early July, the average was about 3,500 — a tenfold increase in under two months. Arizona hospitals neared capacity. The state even activated crisis standards of care, meaning doctors could prioritize which patients to treat based on likelihood of survival.

“It really stretched us from a health care delivery perspective," said Dr. Marjorie Bessel is chief clinical officer of Banner Health, the state's largest hospital system. “Unfortunately for Arizona, we were the hottest hotspot of COVID during that time in the world."

The state's stay-at-home order had slowed the spread of the virus, but the state's reopening had reversed the trend. 

“By and large, [Arizona's] stay-at-home order was crafted in a smart way and I think it actually went far enough to do what it needed to do,” said Will Humble, the former director of Arizona’s Department of Health Services.

Humble sees problems not with when Arizona reopened, but how — with guidance rather than strict requirements on social distancing for businesses and with few enforcement measures to limit crowds where the virus would spread easily.

“When we saw the behavior at the bars and the nightclubs and everywhere really in Arizona on Memorial Day, nothing changed," Humble said. 

More than six weeks passed between when the governor lifted the stay-at-home order and when he told bars, gyms, movie theaters and water parks to close for the second time. In that period, Arizona's total positive cases increased 600% and the state reported more than 1,000 COVID-19 deaths. Humble said that was valuable time.

“These policy decisions had direct consequences and those consequences are excess mortality,” Humble said. 

As cases soared and the governor's office held off on major policy actions, mayors had few options to implement local-level changes. Early on in the pandemic, Ducey had banned cities or counties from putting in place any health measures that went further than rules set by his office. 

Popescu said the conflict became apparent around the issue of face masks.

“It’s a frustrating example of a very fractured public health response," Popescu said. 

Doug Ducey
Howard Fischer/Capitol Media Services
Gov. Doug Ducey arrives at press conference June 17, 2020, wearing a mask, the first time he has done that since declaring a state of emergency over COVID-19 since March.

Public health experts had recommended face coverings for months, then on June 11, a National Academy of Sciences study confirmed mask use could reduce infections. Other states took action, but mask ordinances were still banned in Arizona.

“To issue statewide mandates like New Mexico did would have been really helpful and I think would have driven the message home that this is a serious issue," Popescu said. 

Members of Arizona’s medical community, and many mayors urged Ducey to reverse the ban. On June 17, wearing a mask for the first time at a press conference, he did.

The governor's office and Arizona's Department of Health Services have heavily promoted mask wearing, but the governor's own inconsistent mask use and participation in events where health measures are not enforced have sparked criticism. For example, days after Phoenix's mask ordinance took effect, Ducey attended a crowded indoor campaign event for President Trump in the city where most attendees did not wear masks.

Most other states now have statewide mask orders, Arizona still only has local mandates. Even so, Bessel said masks have had a noticeable impact.

“I know that there are just so many different perspectives on masking, but the science tells us that it works," Bessel said. 

Just over two weeks — or one full incubation period — after many Arizona cities began requiring masks, the state’s case numbers began to decline.

The spread slowed so much that by late August, many Arizona bars, gyms and other businesses were allowed to begin reopening again.

Department of Health Services director Dr. Cara Christ told KJZZ's The Show, this reopening would be based on stricter benchmarks and would require more caution from businesses. The state even launched a hotline to take reports of businesses not complying with indoor occupancy limitations or other health precautions. 

“[Arizona businesses] know what happened back in June and they’re trying to prevent that from happening again and resulting in another shutdown," Christ said. 

Bessel said as Arizona’s outbreak slows, health care workers are able to catch their breath. But she said the pandemic is far from over.

Dr. Marjorie Bessel
Howard Fischer/Capitol Media Services
Marjorie Bessel

“The combination of another wave or spike of COVID on top of influenza and other respiratory illness in the fall and winter months is certainly something that could stretch us," Bessel said. 

For now, questions remain surrounding continuing enforcement of health measures at businesses, school districts returning to the classroom, distribution of a potential vaccine, and the many other policy decisions that will shape the way the virus progresses in Arizona for the next six months.

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