Gov. Doug Ducey signed an Executive Order on Thursday limiting indoor dining to less than 50 percent occupancy as Arizona continues to grapple with coronavirus.
The move follows a June 29 order closing bars, gyms, water parks and movie theaters.
Ducey called June a "brutal" month for Arizona; and there has been a 50 percent increase in cases since June 21.
"Our COVID-like illness continues to increase inside emergency rooms," he said at a press conference. "COVID patient use is up, and so is the percentage of positive tests. So we see increases across the board."
On Saturday, the Arizona Department of Health Services reported a 14.1 percent PCR positivity rate for all tests done in the state. PCR tests determine current COVID-19 infection as opposed to serology tests, which look for past infections.
ADHS also reported 1,556 adult ICU beds, or 90 percent of the total ICU beds in the state, were in use on Friday. That left 174 open ICU beds. But not all ICU beds are counted in the census.
ICU bed capacity
Kelly Adams, the CEO of Santa Cruz Valley Regional Hospital in Green Valley, said they had all six of their ICU beds available Friday morning.
However, the hospital doesn't have a pulmonologist, so they don’t keep patients requiring higher-level care such as ventilators longer than 24 hours.
Adams said COVID-19 patients who don't require ventilators remain at the hospital as long as needed. On Friday, there were four people in the hospital for COVID-19, he said.
Pima County Health Department Director Dr. Theresa Cullen said SCVRH’s six ICU beds are not included in the county’s count because it can't take care of patients needing higher-level care.
“They can stabilize patients, but they have to (transport) if they are going to be a long-time ventilator patient," she said. "And the vast majority of ICU patients end up in the ICU because they need ventilators."
She said the Veterans Affairs hospital's 14 ICU beds in Tucson were also excluded from the county's overall capacity. However, the VA agreed last week to allow five ICU beds for non-veteran use.
Cullen said there were 17 ICU beds available in the county Friday morning. The county reported 357 ICU beds in the county's capacity July 2.
"Seventeen is much better than it's been in the past," she said. "The vast majority of hospitals this morning are reporting at least one ICU bed, which is really good," she said Friday. "We've had reports to us that there's been hours when there's been no ICU beds in Tucson. We haven't seen that ever on the numbers, but we get reports from the hospitals."
The county runs a report from a software program called EMResource, Emergency Management Resource, every morning. Hospitals report adult ICU beds, emergency department beds and ventilator usage each night around midnight.
Cullen said the Emergency Department bed and ventilator reports are not as useful as ICU numbers.
She said the ED bed number can change dramatically throughout the day, and ventilator usage also includes those in operating rooms.
The EMResource report also pulls information on COVID-19 positive admissions and discharges.
"There are other fields, but these are the ones we primarily pay attention to every day," Cullen said. "And when you look at what the governor presented – when he presents ICU beds, general medical beds, ventilators – he's pulling his data from this EMResource."
Lag times in reporting
There are lag times in some COVID-19 numbers reported but when it comes to the capacity numbers, the lag isn't significant.
With the numbers submitted around midnight by hospitals and then pulled around 8 a.m. by health agencies, the EMResource data is theoretically about eight hours old when accessed. However, it doesn't take into account changes throughout the day.
"It depends on that moment in time," Cullen said. "I'm looking at the numbers for July 10, today, in Pima County, there were 57 positive COVID admissions. But in the last five hours, there could have been another 10."
She said it's a useful resource for looking at trends and it's trend data that is a source of worry.
Other numbers come with more lag time, such as death data. Determining whether COVID-19 deaths are on the rise or decline is harder to determine, she said.
"I can't say because death data lags four to six weeks, sometimes eight weeks. It's based on death certificate data, and that goes to the medical examiner. There are days we don't have any deaths,and there are days we have 20 deaths. Those 20 deaths weren't from yesterday."
What metrics matter
It can be hard sifting through all the available data and figuring out which is a legitimate concern.
Cullen said she finds the public's best resource is the COVID-19 progress report chart on Pima County's Back to Business website.
"What it looks at are disease data, health care system data and public health tracking and prevention data," she said. "That's what people should pay attention to, and the reason why is it's aggregate data. So, we take data from different sources and we put it together. But it also reflects these different parts of our strategy, and all of those parts are important."
The progress report compiles data into three sections with three categories each. The county then determines if the criteria in each category is met, in progress or not met. None of the subsections in the three categories qualified as “criteria met” as of Saturday.
U.S. Reps. Paul Gosar and Andy Biggs, Republicans from Arizona, made waves by claiming the media are overblowing the pandemic's severity and that medical experts, such as Drs. Anthony Fauci and Deborah Birx, should not be relied on for information.
Cullen said medical experts decided which metrics matter most, and those numbers are as accurate as can be.
"Sometimes those numbers come in late and we have to modify them, but the numbers speak for themselves, is what I would say," Cullen said. "There's no manipulation of the numbers. We're not picking metrics to say something's good or something's bad. We're picking quality metrics that have been used by other jurisdictions that reflect the impact of the virus."
Santa Cruz Valley Regional Hospital
Adams said the four COVID-19 positive patients at SCVRH are in regular beds and isolated. On Friday, they had eight in-patients without COVID-19.
The lack of a pulmonologist has meant SCVRH sends its COVID-19 patients needing ventilators to other hospitals through the state's surge line, he said.
"Without a full-time pulmonologist, we can keep them and manage them most appropriately up to 24 hours," Adams said. "We have not seen any ventilator patients here for some time. That's kind of the latest thing. We're certainly seeing more COVID cases, but we're not seeing the intensity of the illness."
Adams said he doesn't know why the intensity of the cases has diminished, but Cullen pointed to medical treatment of COVID-19 improving as time progresses.
"We have figured out different ways to give people oxygen," Cullen said. "We've figured out ways to keep people off ventilators who need high-flow oxygen. We have remdesivir available. We have dexamethasone, that other medication. I just think we're learning. There's more science to what we're doing, and that's probably contributing to it."
Remdesivir is an experimental medicine for treating conditions caused by coronavirus that has shown promise recently.
At SCVRH, Adams said the challenge of finding a pulmonologist isn't a problem specific to Green Valley.
"There are just not enough pulmonology physicians to go around," he said.
SCVRH is also steady with elective surgeries but hasn’t recovered to pre-COVID-19 numbers. Adams said SCVRH is currently at about 35 percent of normal, and the decline isn't a matter of hospital resources but patient reluctance.
"We've had several patients that are ready for surgery and told the surgeon, 'No, I'm not going to the hospital. I don't want to be exposed to COVID,'" he said. "Well, our response is that the hospital is the safest place to be."
With COVID-19 patients in isolation, restrictions on outside visitors, sterilization procedures and PPE usage, Adams sees the hospital as better than other places people frequent.
"You're more than likely to catch COVID at the grocery store or the big box store as opposed to the hospital," he said. "It's a very safe environment for elective procedures."