The Washington PostDemocracy Dies in Darkness

Arizona’s pandemic outlook worries experts as mask and vaccine mandate battles rage

A nurse checks the vitals of a Navajo Indian woman at a coronavirus testing center at the Navajo Nation town of Monument Valley in Arizona on May 21. (Mark Ralston/AFP/Getty Images)

Arizona has caught up to New York when it comes to reported deaths per capita — even though the latter was ravaged by the coronavirus early in the pandemic before treatments or vaccines were developed.

Some health experts worry Arizona could be headed for a deepening crisis as winter approaches. Although average daily deaths from covid-19 remain much lower than during the state’s second wave in January, Arizona experienced a 138 percent increase in the seven-day rolling average of daily new deaths per 100,000 people last week, according to data collected by The Washington Post.

“It’s bad,” Will Humble, executive director of Arizona’s Public Health Association, told The Post.

Some public health experts say Arizona Gov. Doug Ducey (R) lifted pandemic-related restrictions in March without putting in place measures to mitigate the risks of reopening, causing cases to rise again in July just as the more contagious delta variant was becoming the most common coronavirus variant in the United States.

Now, Ducey — who is vaccinated and has urged others to get vaccinated but argues it should be a personal choice — is engaged in a battle against the federal government on several fronts in an effort to prevent mask mandates in schools and vaccine mandates in workplaces in his state.

Last week, the U.S. Labor Department warned Arizona (and two other states) about its “continued failure to adopt” a Biden administration emergency public health directive requiring, among other measures, that health-care workers receive paid time off to get vaccinated and to recover from potential side effects. Ducey called the reprimand, which could result in the federal government stripping the state of its ability to enforce its own workplace safety standards, “nothing short of a political stunt and desperate power grab.”

Arizona on Saturday reported 3,145 cases of the coronavirus and 30 deaths from covid-19 — twice as many daily cases as the state was reporting three months ago. The governor’s office did not immediately respond to an emailed request for comment.

Humble attributes this increase to the delta variant, a lack of public health restrictions and pockets of vaccine resistance among the elderly, a more vulnerable population.

More than 52 percent of Arizona’s population is fully vaccinated, according to Post data, but “we’ve hit a brick wall when it comes to vaccinating vaccine-resistant seniors,” explains Humble, “so that’s what’s causing the continued influx into the hospital system.” He says that won’t change; “they’re just going to end up getting infected,” he predicts.

During the summer of 2020, Arizona’s health authorities activated crisis standards of care, and hospitals began rationing medical supplies. The situation has improved, but the persistently high levels of cases and deaths following a long period of low community transmission are concerning, according to a recent report written by Joe K. Gerald, associate professor at the University of Arizona’s Zuckerman College of Public Health, and Patrick Wightman, a researcher at the school’s Center for Population Science and Discovery.

“Despite the knowledge and ability to do better, absolute rates of community transmission remain higher this year than last among all age groups but particularly among children,” the report published last week states, with the caveat that “improvements [are] being observed this year while rates were worsening this time last year.”

How Arizona 'lost control of the epidemic'

Humble also says it’s not clear how successful a campaign to roll out pediatric coronavirus vaccines among 5-to-11-year-olds will be if it receives Centers for Disease Control and Prevention approval to kick off next month. He estimates that only a portion of parents in Arizona “are enthusiastic” about getting their child vaccinated — a step he and other experts say is crucial to reducing community transmission at a time when children between 5 and 11 have a higher per capita weekly incidence of the coronavirus than 65-to-74-year-olds nationwide.

Only 21 percent of Arizonans under the age of 20 are vaccinated, according to state data, compared to 93 percent of people ages 65 and up. “It’s not like the kids are ending up in the hospitals, but they are starting chains of transmission [to] vaccine-resistant adults and seniors who do end up in the hospitals,” Humble says.

Arizona is not the only state with a concerning public health outlook: According to Post analysis, daily deaths have increased by 267 percent over the past seven days in Alaska, by 143 percent in Montana and by 100 percent in Rhode Island.

Still, it’s a particularly sensitive time for public health as winter approaches, bringing with it a potential “twindemic” of influenza and rising covid-19 infections, and as evidence begins to suggest that the protection from infection conferred by the coronavirus vaccines can start to wane after a few months.

Flu practically vanished last year. Now doctors are bracing for potential ‘twindemic’ of flu and covid-19 spikes.

Arizona ranks 38th in the nation in terms of share of people ages 65 and over who have received a booster dose, Gerald and Wightman note in their report.

“With waning vaccine efficacy and a potentially short duration of acquired immunity, herd immunity is not achievable,” they say. “As winter approaches, more previously vaccinated and previously infected individuals will become susceptible.”