We’re Arizona Republic reporters covering COVID-19 in Arizona, which had the highest rate of new cases in the U.S. for most of January. We found 7 contributing reasons why Arizona is one of the worst states in the nation for COVID-19. Ask us anyth...

Why aren't younger arizona citizens who are immunocomprised moved up in the vaccination schedule?

From Stephanie: This is a great question and one that we are writing about today. The story should post either tonight or tomorrow. The state JUST on Monday announced it's going to an age-based approach, so moving into the 55 and older group now, then 45 and older and so on.

This approach statistically captures more people with high risk underlying conditions, the state says. But it does not acknowledge younger, immunocompromised people, like the 20-year-old with Down Syndrome, the 28-year-old with heart problems or the 19-year-old with leukemia.

Some of these groups are appealing to the state to be included earlier, so we'll see what happens with that. Just this morning state health director Dr. Cara Christ said she thinks the age-based approach will allow the state to get through the vaccination process faster, and that all age groups likely will have received at least one dose by summer. She expects to get to the 45+ group by early April.

From Alison: A bit more to add --

Initially, adults of all ages with high-risk health conditions were set to get the vaccine in phase 1c, the next big phase. In the new plan, younger Arizonans will get the vaccine later in the rollout based on their age, regardless of their medical conditions, unless they qualify as a frontline essential worker. The health director laid out this general timeline this morning:

“We’ve got a tentative estimation for at the beginning of March we moved into age 55 and above. At the beginning of April we believe we’ll be in 45 and above. At the end of April, beginning of May, 35 and above, and then we’ll open it up to everybody four to five weeks after that. So we anticipate being through all the ages that are eligible for vaccine by the start of summer.”

Here’s an article from Monday with more info about the state’s new rollout scheme: https://www.azcentral.com/story/news/local/arizona-health/2021/03/01/az-going-age-based-vaccine-rollout-begins-those-55-and-older/6877115002/.

Initially, adults of all ages with high-risk health conditions were set to get the vaccine in phase 1c, the next big phase. In the new plan, younger Arizonans will get the vaccine later in the rollout based on their age, regardless of their medical conditions, unless they qualify as a frontline essential worker.

So the snowbirds are gonna get it now when its cool, then leave, while us younger Arizonans with medical conditions suffer. Fantastic. I thought I couldn't hate Ducey more than I already do.

This is from Stephanie. Yes, you are right that snowbirds got the vaccine and some of them will go home and that the age-based approach does not appear to be ideal for younger people with high-risk conditions.

Dr. Cara Christ had a response to this specific issue this morning, and Alison has that information! She's writing you an answer now.

Okay this is Stephanie again. Sorry I guess Dr. Christ did not directly address that this morning.

This is what she said, but it does not directly address the people who are in their late teens and 20s with underlying conditions.

"This likely will move through the age categories much quicker, and so we will be able to get them. We anticipate being through the age categories by summer.”

From my perspective it appears that you are right, they are getting bumped.

Trying to find out more because I know disability rights advocates have very big concerns about this issue.

How does the state treat obesity and smoking in regard to high-risk conditions? I ask because my state (IL) classifies both of these as high risk and thus make a person eligible for the vaccine. I somewhat understand obesity (although it is 40% of the US population), but what about smoking?

From Alison:

Hi- that's a great question. Arizona actually changed its vaccine rollout plan this week and high-risk conditions are no longer a category. So instead, people will get vaccinated by age group or by essential workers. So if you're a smoker or obese or have a high-risk condition like heart disease, for example, you'll get vaccinated in your age group and not in a special priority group. The CDC says people who smoke or smoked are some of a number of groups that are at increased risk of severe illness from the virus, so that's why they are prioritized in some states. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#smoking

So what were the 7 contributing reasons?

Hi, Alison here. The reasons we found (in no particular order) are: bars/restaurants stayed open and AZ does not have statewide mask mandate; haphazard enforcement of mitigation measures; elected officials who downplay the virus; individual behavior; winter travel destination; timing of the state's second surge; geography. Link to the story is here: https://www.azcentral.com/story/news/local/arizona-health/2021/02/01/why-arizona-is-worst-nationwide-us-rate-new-coronavirus-cases/4281247001/

How do you reconcile your thesis with the lack of correlation between stricter lockdown measures and covid success?

https://www.statista.com/statistics/1109011/coronavirus-covid19-death-rates-us-by-state/

Despite having polar opposite approaches, California and Florida are neck and neck in terms of deaths per 100k population. Both sit about middle-of-the-pack among the states. And Florida has a much older population.

Many heavy-lockdown states have experienced some of the worst deaths per capita, while many states which did not lock down as hard or have as much compliance and enforcement did better than the median. The reverse is also true, so there seems to be no correlation at all between lockdowns and covid success.

EDIT: Despite signing off earlier without responding, the OP has returned and replied. OP points to NZ as an example of lockdown success, which of course is an example where there were totalitarian lockdowns worse than anywhere in the US. In fact every few months during this pandemic Reddit rejoiced “NZ beats covid again” only for NZ to lock down their country over and over when one case here and there pop up. NZ also has a culturally homogeneous population, little skepticism of government, willingness to comply, and is a small isolated island nation (the perfect conditions for isolating).

But again, I asked about correlation. For every place that had lockdowns and had success, you can find a place that had lockdowns and didn’t have success. Naming NZ does not establish a correlation, which you need to see in order to decide lockdowns have any efficacy whatsoever.

I encourage people to read up on what the entire body of infectious disease knowledge said about lockdowns before covid came along. Hint, none of these big governing bodies or public health institutions recommended this type of response for respiratory pandemics. Everything you can find from pre-covid says lockdowns were not advisable, were unsupported by evidence, and caused massive collateral damage.

Not until China did it, and then one hack in the UK published massively inflated death projections from a useless, inaccurate computer model did this happen. Had they told us up front “one year” instead of “two weeks” nobody would have agreed to it. The contentious state of American politics is the only reason so many people ended up supporting lockdowns. I beg you to be willing to question the proclamations of the political group you associate with, and accept that people who are mostly right can easily be wrong on individual issues.

Hi, this is from Stephanie: One need look no further than country-by-country comparisons to see that strict measures have an effect on both case and death rates. New Zealand has a population similar in size to Arizona. Arizona has had more than 16,000 deaths from COVID-19. New Zealand has had 26.

An argument that Florida's death rate of 144 deaths per 100k people is "neck-in-neck" with the California rate of 132 deaths per 100k people does not take into account the recent spike in cases in Florida. Deaths are a lagging indicator and typically happen two to four weeks after a surge in cases. Over the last 7 days, Florida was 9th in the country for its rate of new cases; California was 48th.

Our "seven reasons" story was about contributing factors. No one factor seemed to drive Arizona's cases up, but rather, a combination of factors.

There are numerous evidence-based studies and research articles that show targeted mitigation strategies like bans on indoor dining work in slowing the spread of COVID-19.

This study from the CDC showed that adults with COVID-19 were twice as likely to have eaten inside a restaurant within two weeks of becoming infected: https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a5.htm?s_cid=mm6936a5_x

This study from South Korea found that transmission within less than five minutes was possible in an indoor setting with direct air flow from more than 6 feet away: https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e415

One that was used here in Arizona to bolster the argument from medical leaders to put stricter measures in place was a Nov. 16 research article in the scientific journal Nature Human Behavior that found the most effective nonpharmaceutical interventions are curfews, lockdowns, and closing and restricting places where people gather in smaller or large numbers for an extended period of time.

"This includes small gathering cancellations (closures of shops, restaurants, gatherings of 50 persons or fewer, mandatory home working and so on) and closure of educational institutions," the international team of researchers wrote.

The researchers found that no nonpharmaceutical intervention acts "as a silver bullet on the spread of COVID-19," but that small gathering cancellations are more effective than environmental measures to disinfect and clean surfaces and objects in public and semipublic places; land and border health checks; and measures to enhance testing capacity or improve case detection strategy.

Here is a link to the article about those Arizona health leaders: https://www.azcentral.com/story/news/local/arizona-health/2020/12/02/az-health-system-leaders-want-state-action-covid-19-within-72-hours/3792563001/

Are hearing anything to believe that Arizona will soon follow Texas' lead in allowing businesses open at 100 percent capacity?

Hi Elinor, this is Alison. That's a good question. I wish I knew more, but I don't know much on that now. I know our politics and business reporters are keeping a close watch. Dr. Christ was asked about this at a media event this morning, and here's what she said:

“We are constantly reviewing the data. Our data is heading in the right direction and we are starting to look at if we were to lift mitigation strategies, what would that look like. I don’t have a great answer for you today, but it is something that we’re currently reviewing … We’re still operating some of the mitigation strategies in place – the physical distancing, the disinfecting, the mask use when you’re out and about and around people that you don’t live with - is one of the ways that we have discussed potentially lifting those mitigation strategies.”

Why isn't the state offering vaccines to age 55+ in Tucson like it is at its Phoenix sites? When is it expected to change? When will the Johnson & Johnson vaccine be available in Tucson?

I know for us in Flagstaff we just had to wait for county health to finish a review of what made the most sense up here, and they recently changed it to match that standard I think just yesterday. Ask county health?

Hey, this is Alison. Yes! It's up to counties when they move to the next age group and how they go through the phases. The state recommends that once 55% of the current age group's population has gotten vaccine or officials feel there is no longer demand, they can open up to the next age group. For example, once 55% of the 55-to-64-year-old age group is vaccinated, the next group up will be those who are 45 to 54.

As of Feb. 28, about 48% of those in the 65+ age group had been vaccinated in Pima County; in Coconino County, that was at 71%.

Hi Elinor - this is from Stephanie - and I'll take the first part of your question, which is one I asked the state on Monday. They told me they are "working with" Pima County to get their state pod to open up to people 55 and over. But the threshold is that each jurisdiction must vaccinate at least 55% of the targeted age group before it can move down an age category.

Right now in Pima County (as of Feb. 28), 48% of the over-65 population had received at least one dose of COVID-19 vaccine. So that is still below the 55% threshold. Once they get to 55%, which could be a week or so, I believe they will move to 55 and older. I have reached out to the Pima County Health Department for a more specific answer about that county in general and they have not yet replied. Hoping to find out more today.

Hey Elinor, this is Alison – For your question about the J&J vaccine, state health director Dr. Christ said this morning that vaccine will start arriving early next week and will be sent out to all 15 counties. She said it’ll be up to counties to decide how and where they want to use that vaccine. So the Tucson area will likely have the vaccine next week, but the Pima County health department will decide how it's distributed.

It’s a gamechanger because it’s a one dose rather than two dose vaccine, so it’s faster and simpler to vaccinate people, and it’s still very effective in preventing hospitalizations and deaths from the virus.

Christ said she’s recommending counties use J&J for some frontline essential workers because they tend to be young and healthy and they should be protected as they interact daily with the public.

“One dose would be able to get us there faster with those populations,” she said. “But the counties really are able to develop the strategies for how they’re going to utilize the vaccine in their communities.”

Was the state ever close to opening the extra hospital beds they prepared at St. Joseph's?

From Stephanie: It was St. Luke's where the extra beds are located and it's a good question because the state invested $6.68 million readying the hospital in case those beds were needed.

The state says St. Luke's was only ever to be used for post-acute care because that is what their hospital partners indicated they wanted. The state said they felt that contracting beds in nursing homes, where staff and an infrastructure are already in place, made more sense than using St. Luke's.

Here is a link to our explainer story, though it's subscriber-only content: https://www.azcentral.com/story/news/local/arizona-health/2021/01/12/az-spent-6-68-million-getting-st-lukes-ready-covid-19-patients/6585244002/

Have you observed any difference in metrics between Tucson and Phoenix? Anecdotally, I've observed Tucson having much higher compliance in mask wearing than Phoenix, bit I'm not well versed in the metrics to know if it has made a practical difference.

The case rates in both Pima and Maricopa counties are well above the national average, though Pima County's rate is slightly better than that of Maricopa.

The case rate nationally is 8,589 cases per 100k people. In Pima County the rate is 10,524 cases per 100k people and in Maricopa County it's 11,729 cases per 100k. So in this Tucson vs Phoenix competition, Tucson does win, but it's not entirely a win since its case rate is higher than the U.S. average, too.

I travel back and forth between Tucson and Phoenix a lot and compliance with wearing masks really depends on what part of the city one is in, I find. But I do not have any hard data on mask compliance in either city.

Organizations such as the WHO, Avaaz, as well as various governments have repeatedly highlighted the role that disinformation has played in the spread of COVID-19. From what you have seen, how large a role has online disinformation/misinformation played in the spread of COVID-19 in Arizona and what effect do you think online content being spread by antivaxxers will have on undermining public trust in the vaccine roll-out?

Have you reached out to the social media platforms to see why they have largely failed to contain the spread of this type of harmful content?

Our experience so far is that it's not anti-vaxxers who are undermining public trust in the vaccine rollout. The opposition to the vaccine I've heard has more been an issue of people being hesitant about getting a vaccine that's so new, as well as some sub-populations having distrust for the health care system in general, and that's what the polling shows, too.

There are also people who don't believe COVID-19 was a real, or serious pandemic. I am not certain how this population feels about the vaccine. I know I've had readers who believe the vaccine is part of a government conspiracy but I am not sure how prevalent that kind of thinking is in Arizona.

I read your 7 reasons article just posted. Why do you think Ducey has turned everything over to Cara Christ? And hasn’t had a press conference since when...Nov ?

From Stephanie & Alison: So the last time Gov. Ducey had a press conference was Dec. 16. Since that time deaths from COVID-19 in Arizona have doubled from 8,000 to more than 16,000.

We don't know the governor's thinking on this, but Dr. Christ has said she's been handling the briefings about the vaccine because it's more technical in-the-weeds health information.

Ducey has done media interviews but seems to have avoided big public media briefings. Our political reporter Maria Polletta wrote about this on Feb. 12. At that time, his spokesman CJ Karamargin said though Ducey has received criticism for shying away from briefings at various points throughout the pandemic, the Governor’s Office has chosen the best format for each announcement.

“I think Arizonans have access to accurate and unbiased news from numerous media outlets, and we’re working to make sure the governor has the opportunity to speak with as many of them as possible,” Karamargin said. 

“There are multiple ways to get information out from our office, and we’re going to avail ourselves of all of them.”

Here is a link to Maria's story: https://www.azcentral.com/story/news/politics/arizona/2021/02/12/gov-doug-ducey-avoids-public-briefings-covid-19-deaths-surge-arizona/6723580002/

What was the hardest part of writing this article? I feel like I would have a very hard time not feeling angry like the entire time I was examining all the bad decisions made over the past year.

Hi Lindsey, this is Stephanie and Alison. The hardest part about writing the article was twofold:

1. Getting it down to seven reasons.
2. Making sure readers knew that these were contributing factors according to multiple sources, but in some cases, like with elected leaders who questioned the pandemic, they were speculative reasons. So speculative reasons that played a role but were harder to measure the impact of, if that makes sense.

We had a lot of feedback from people who didn't agree with all our reasons, which we of course expected. Some thought our reasons were in a particular order, ranked according to importance, but we did not rank them.