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The Washington PostDemocracy Dies in Darkness

How Arizona ‘lost control of the epidemic’

People line up Saturday in Phoenix to get tested for the coronavirus at a site hosted by the Puente Movement migrant justice organization. (Matt York/AP)
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PHOENIX — A drive-up testing site equipped for several hundred people in West Phoenix was swarmed on Saturday by about 1,000 people, leaving some baking in their cars for hours.

A nearby testing station has already reached capacity for this weekend, appointments vanishing within minutes. Hospitals are filling up. Restaurants are again shutting down, more than a month after Arizona reopened its economy under the mantra “Return Stronger.”

Arizona has emerged as an epicenter of the early summer coronavirus crisis as the outbreak has expanded, flaring across new parts of the country and, notably, infecting more young people.

Maricopa County, which includes Phoenix, is recording as many as 2,000 cases a day, “eclipsing the New York City boroughs even on their worst days,” warned a Wednesday brief by disease trackers at Children’s Hospital of Philadelphia, which observed, “Arizona has lost control of the epidemic.”

But physicians, public health experts, advocates and local officials say the crisis was predictable in Arizona, where local ordinances requiring masks were forbidden until Gov. Doug Ducey (R) reversed course last week. State leaders did not take the necessary precautions or model safe behavior, these observers maintain, even in the face of compelling evidence and repeated pleas from authoritative voices.

“We have failed on so many levels,” said Dana Marie Kennedy, the Arizona director of AARP, who said her organization has yet to receive a response to four letters outlining concerns to the governor. She is working on a fifth.

Neither the governor’s office nor the state health department responded to requests for comment.

At critical junctures, blunders by top officials undermined faith in the data purportedly driving decision-making, according to experts monitoring Arizona’s response. And when forbearance was most required, as the state began to reopen despite continued community transmission, an abrupt and uniform approach — without transparent benchmarks or latitude for stricken areas to hold back — led large parts of the public to believe the pandemic was over.

And now, Arizona is facing more per capita cases than recorded by any country in Europe or even more than the confirmed number of cases in hard-hit Brazil. Among states with at least 20 people hospitalized for covid-19, the disease caused by the coronavirus, no state has seen its rate of hospitalizations increase more rapidly since Memorial Day.

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This week, Arizona reported not just a record single-day increase in new cases — with Tuesday’s tally reaching 3,591 — but also record use of inpatient beds and ventilators for suspected and confirmed cases. Public health experts warn that hospitals could be stretched so thin they may have to begin triaging patients by mid-July.

Soon, the only option might be “crisis standards of care,” said Will Humble, a former director of the Arizona Department of Health Services. “If you’re in a bed, normally they’ll keep you for a few days, but they’re going to send you home with oxygen.”

Ducey, speaking to reporters Thursday, said hospitals are “likely to hit surge capacity very soon.”

“This virus is everywhere,” the governor said.

The situation in Arizona — as President Trump this week paid his second visit in as many months to the state, which could be a battleground in November — has exemplified the march of the virus across the Sun Belt, where it has also thrashed Florida and Texas, creating conditions as dire as at any point during the pandemic. Texas Gov. Greg Abbott (R) on Thursday paused his state’s reopening and ordered hospitals in four counties to postpone elective surgeries.

Florida has become a coronavirus hot spot. Covid-19 cases have been on the rise since the state reopened in early May, surpassing 100,000 on June 22. (Video: Robert Ray/The Washington Post)

Coronavirus deaths lag behind surging infections but may catch up soon

Physicians fear there is now less buy-in from a public weary of restrictions and polarized by a highly partisan response to the health crisis. In Southern states, some epidemiologists also are cautioning about what they are calling a “reverse summer effect,” with warm weather — once thought to interrupt the spread of the virus — driving residents into indoor spaces with recycled air.

“My level of frustration is high,” Kennedy of AARP said. “We could have stopped this.”

The last time she met with Ducey was March 11, Kennedy said, when she stood by his side as he declared a health emergency and promised to safeguard nursing homes and assisted-living facilities. He has failed to follow through on those efforts, she argued, saying testing of facility staffers has remained inadequate and equipment needs have gone unmet. Cara Christ, Ducey’s health director, has been absent as well, Kennedy said, pulling out of plans for a virtual town hall meeting with AARP members in April.

Now, a crisis that crashed down first on the state’s elderly population is increasingly taking hold among younger people.

The mean age of Arizonans killed by covid-19 fell from 78 on April 27 to 69 on June 14, according to data processed by a modeling team made up of experts at Arizona State University and the University of Arizona. The average age of patients testing positive for the virus dropped from 51 on April 5 to 39 by mid-June. While older individuals are known to be at greater risk from the virus, Arizona has three times as many positive tests among people age 20 to 44 as it does in any other age bracket, according to state data.

The state’s cases began rising dramatically about May 25, 10 days after Ducey allowed the state’s stay-at-home order to expire, said Joe K. Gerald, an associate professor and public health researcher at the University of Arizona who is part of the academic team providing models to the state health department.

Ross F. Goldberg, president of the Arizona Medical Association, said that “people thought it was back to normal times.”

That mistaken view has persisted, even as new cases mount.

“I have to see somebody sick, directly related to me or close to me, in order for it to become like reality,” said Joshua Kwiatkowski, strolling this week at an open-air shopping center in Tempe, Ariz. “So it hasn’t really, I guess, sank in.”

Kwiatkowski said he was not inclined to wear a mask unless required to do so — unless, as he put it, “an Uber driver is feeling some type of way or a store makes you wear it.”

Requirements designed to stanch the spread of the virus have expanded since Ducey changed course last week and allowed local governments to impose stricter rules on masks than the recommendations issued by the state. A petition urging him to mandate face coverings statewide gained signatures from more than 1,000 medical professionals. Ducey also shifted his stance toward businesses, directing them to develop policies in line with guidance from the Centers for Disease Control and Prevention, which had previously only been recommended.

“There will be enforcement, and they will be held accountable,” the governor said.

Numerous cities responded immediately with mask ordinances and emergency proclamations, including Scottsdale, where a tony neighborhood of bars and high-end boutiques had come to epitomize disregard for social distancing guidelines still technically in effect but largely unenforced. Photos and videos of packed businesses accumulated on social media as Ducey and other officials — frequently appearing themselves without masks — insisted most people were behaving responsibly.

The area, known as Old Town Scottsdale and ordinarily packed even on a weekday, fell quiet this week after the wave of new restrictions unleashed by Ducey’s about-face. Most businesses had only a smattering of customers, while some bars and restaurants had already closed their doors for the evening, despite banners hanging from their facades welcoming customers.

Still, resistance to health precautions remains pronounced. At an anti-mask rally Wednesday, a member of the Scottsdale City Council, Republican Guy Phillips, shouted the dying words of George Floyd — “I can’t breathe” — before ripping off his mask, enlisting a rallying cry of the nationwide protests against racial injustice to inveigh against face coverings that reduce airborne transmission of tiny droplets. Hours later, he issued an apology “to anyone who became offended.”

Phillips, who did not respond to an email seeking further comment, runs an air-conditioning business, and, according to his council biography, is a member of the Better Business Bureau, the Arizona Small Business Association and the North Scottsdale Chamber of Commerce, among other business groups.

At virtually every stage of the state’s pandemic response, the interests of business have held sway, said Nathan Laufer, the founder of the Heart and Vascular Center of Arizona, a medical practice with locations in Phoenix and nearby counties, and a former director of the state medical association.

Ducey is a former chief executive of Cold Stone Creamery. The head of the state’s restaurant association, Steve Chucri, is also a Republican supervisor in Maricopa County. He did not respond to requests for comment.

“It’s fine to be pro-business, but you have to be pro-citizen first,” Laufer said. The governor, in belatedly handing local authorities more control, is “playing catch-up,” he added, “but it’s too little, too late.”

Some residents noted that the Republican governor was following his party’s standard-bearer. “Hindsight’s 20/20, but yeah, it was a little late,” said Greg Cahill, loading his car with groceries outside a Costco at Phoenix’s Christown Spectrum mall. “I think he was a little slow. But he’s a conservative man and he wanted to do what Trump said.”

“It’s scary,” the 58-year-old said of the rising cases.

Protests were mounting at the state capitol over Ducey’s stay-at-home order. Lawmakers in his party were pledging to invalidate it. County sheriffs were refusing to enforce it.

And Trump, who was urging governors to jump-start their economies, was coming to Arizona to tour a Honeywell plant and to convene a discussion about issues facing Native Americans.

The day before the president’s visit, Ducey announced plans to accelerate the reopening of his state’s economy, lifting restrictions on salons and barbershops and allowing restaurants to resume dine-in service. A chart displaying the number of new cases, which did not show the 14-day decline recommended by White House guidelines, “really doesn’t tell you much,” Ducey said at his May 4 news conference.

That evening, the state ended its partnership with the university modeling team whose projections plainly showed a rising caseload in Arizona. It was resumed following an outcry.

Two days later, top health officials acknowledged having changed the testing count to include viral tests confirming an infection and serology tests determining the presence of coronavirus antibodies — a move with the potential to artificially lower the positivity rate touted by Ducey at his May 4 briefing.

“This is a good trajectory for Arizona,” he affirmed at the time.

Ducey’s original order reopening the state — and preventing local officials from setting their own rules despite mounting evidence about the benefits of masks and social distancing — was in keeping with a top-down approach to governance that critics say has characterized his tenure. In 2017, he signed a bill approved by the Republican-controlled legislature that allowed any state legislator to direct the Arizona attorney general to investigate a local regulation for a possible violation of state law. Consequences included potentially losing revenue from the state.

“The biggest challenge has been Governor Ducey tying the hands of mayors and county health departments,” said Regina Romero, the Democratic mayor of Tucson, who said she weighed an emergency proclamation mandating masks in mid-March but was advised against it by her city attorney. Her city’s budget is about $566 million, Romero said, more than a fifth of which comes from the state.

“There’s a real threat with money involved,” the mayor said.

Limited resources have also hampered the ability of the hardest-hit counties to conduct thorough contact tracing. Maricopa County shifted in the early weeks of the pandemic to what it called a “mediated” approach in which all sickened people are interviewed but are then made responsible for notifying their own contacts.

A spokesman for the county health department, Ron Coleman, confirmed this week the limited approach is still in use, even as cases soar.

Hugh Lytle, chief executive of Equality Health, said the willingness of people in Phoenix to wait for hours to be tested at the drive-in site organized by his medical group over the weekend has been a wake-up call.

State officials are taking note, he said, of the “overwhelming level of fear and anxiety that’s causing people to say it’s worth sitting in my car for a couple hours.”

Jacqueline Dupree contributed to this report.