The following is the opinion and analysis of the writer:
As America crosses the tragic threshold of 100,000 citizens dead from COVID-19 in less than four months’ time, it is time to accurately assess where the pandemic stands here in Arizona.
Although coronavirus infections are on the decline in many parts of America, infection rates and hospitalizations appear to be on the rise in Arizona. Projections by the University of Washington indicate Arizona will likely have the highest death rate from COVID-19 in the country in a matter of weeks.
The Navajo Nation in the northeast corner of our state has seen the pandemic take hold with the highest per-capita infection rate in the nation. It is so catastrophic that Doctors Without Borders, an organization devoted to providing healthcare support to areas of international conflict experiencing medical crises, was recently dispatched there to help. It is the first time in history that this organization has been deployed anywhere within America’s borders. Our state’s coronavirus testing capacity remains woefully inadequate. Arizona currently ranks 49th in viral diagnostic testing, according to ongoing research from Johns Hopkins University. People remain unclear about where or how they can obtain a test, let alone when a test is needed. Many have abandoned efforts to seek testing after weeks of being given mixed messages about who qualifies for a test. The turnaround time for tests ranges from hours to days to weeks, often providing a result which is irrelevant and unhelpful by the time it has been received.
There is no doubt that the efforts of the Arizona Department of Health Services, the state agency tasked with addressing the outbreak, have failed to contain the coronavirus. The people of Arizona expect, deserve and desperately need far better.
The pandemic will only be contained when at least one of three milestones is successfully realized: an effective vaccine, a proven therapeutic agent, or a robust, comprehensive public health response. We hope to see a vaccine emerge as soon as early next year. A successful pharmaceutical therapy could be developed in the near future. In the meantime, though, our public health officials must mount an effective public health response.
The timing and criteria upon which the decision to reopen our state to more relaxed measures of social distancing is worthy of debate. However, there is no doubt about the basic epidemiologic interventions needed to cause a return to a semblance of normalcy. As with Ebola, cholera and countless other past outbreaks, we must seek out the source and contain it at every turn.
How do we accomplish that? Test, trace and isolate.
While overall testing continues to increase in Arizona, we are currently nowhere near acceptable levels. Private lab companies have failed to provide adequate testing capacity to Arizonans, and universities have not received adequate funding or supplies to expand their substantial programs.
It has been suggested that the supply of tests is currently meeting demand here in our state, but this is simply not the case. As with the successful programs seen in South Korea and elsewhere, people should be able to readily obtain coronavirus testing, regardless of the presence of symptoms, specifically because asymptomatic spread is so prevalent. There is no reason why Arizona couldn’t create a model similar to those countries which have successfully contained the virus through expansive testing programs.
Arizona also lacks a formal plan to develop a system of contact tracing. In this time of record unemployment not seen since the Great Depression, contact tracing could become a viable line of work for many Arizonans. Such a program would easily pay for itself through enhanced economic recovery. Germany has created an effective telephone-based system of contract tracing with roughly 1 tracer per 5,000 people. With a population of now 7.3 million, Arizona would need nearly 1,500 contact tracers to staff a similar effort.
Gov. Doug Ducey and AZDHS should immediately develop a detailed plan to test, trace and isolate. Executing such a plan and committing to full implementation will require bold leadership and a significant investment in the necessary infrastructure of supplies, personnel, technology, methodology and a clear plan of data sharing.
As physicians, we know that it is imperative that our state acts urgently and decisively if we are to save the lives of perhaps thousands of Arizonans who could otherwise die needlessly from this terrible disease. This is a STAT call to action. If we are to find our way out of this pandemic with meaningful reduction of additional human and economic toll, we must get this done.
Dr. Quinn Snyder is an emergency physician and public health advocate practicing in Mesa. This guest opinion was signed by over 100 physicians from across Arizona.
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