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Is Arizona Stuck on Stupid Or Is It a Conspiracy of Cowards?
Consider the words of Arizona’s doctor, Dr. Cara Christ, director of the Arizona Department of Health Services, and the words and demeanor of Arizona Governor Ducey. Then consider the cowering state legislature. Is Arizona stuck on stupid, or governed by a conspiracy of cowards?
See if this makes sense to you, if it inspires you to bow down and accept a governor’s claim of continuing necessity based in the best science [emphasis added]:
Arizona Specific COVID-19 Models and Projections
Since December 2019, when we first heard about cases of a novel coronavirus in Wuhan, China, the Arizona public health system has been closely monitoring COVID-19 on an international, national, and local level. Mitigating the spread of COVID-19, as well as responding to the impacts of the virus, remains our highest priority. Since our first case was reported in Arizona back in January, we have been working to protect our populations that are most severely impacted by the disease and preparing our healthcare system for a surge in cases. While many of the current models show that Arizona’s capacity is sufficient to meet the projected need for hospital beds and ventilators, in order to protect Arizonans, we have been preparing for a worst-case scenario while working to facilitate much better outcomes.
Back in February and March, when we didn’t know as much about COVID-19 as we know now, predictive models were based on the very limited experience and data from our Chinese counterparts in Wuhan and Guangzhou, China. Using Arizona-specific population data and modeling formulas from Harvard, the team at the Arizona Department of Health Services (ADHS), developed our initial Arizona projection looking at the anticipated need for inpatient and intensive care unit (ICU) beds required to treat COVID-19 patients. Based on that initial modeling, an estimated 13,000 additional inpatient beds and an additional 1500 ICU beds would be needed to care for Arizonans with COVID-19. When we calculated the potential spread, we estimated our peak resource needs would fall between the middle to end of April. Using those numbers, ADHS started to develop plans and work with healthcare partners to ensure we would have enough access to care to meet the demand.
As more information about the virus started coming out, additional models became available online. It’s important to note: these models all vary dramatically and are updated as new data is available. The two most prominent are found at healthdata.org and COVIDActNow.org. The models at healthdata.org are developed by the Institute for Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington. Early in the response, these models were predicting peak resource use around April 20, with 5,342 inpatient beds, 787 ICU beds, and 436 ventilators needed. The IHMEmodels have always been more optimistic than the original ADHS projections, and are updated every couple of days based on the data and mitigation strategies put into place. As of today, April 22, this model forecasts that Arizona has already passed our peak of resource utilization and only requires 424 inpatient beds, 103 ICU beds, and 92 ventilators*. This is well under our available resources and current hospital capacity.
The COVIDActNow.org model, otherwise known as the U.S. Interventions Model, is a data platform that projects COVID infections, hospitalizations, and deaths across the United States. It was built with input from experts at Google, Stanford University, Georgetown University, and other public health and analytic experts. In its early stages, this model was less optimistic than our initial Arizona projection, predicting tens of thousands of hospitalizations and deaths with our healthcare system becoming overloaded at the end of May. The COVIDActNow model is updated on a regular basis and incorporates current data and the state’s mitigation strategies to come up with newer predictions. Currently, it is showing that Arizona is predicted to be able to meet any COVID-19 healthcare requirements with our current available capacity and our current mitigation strategies in place*.
Over the past several weeks, ADHS has partnered with experts from Arizona State University and the University of Arizona to develop a more targeted, Arizona-specific model, with the most recent update received on Tuesday, April 21. This group of experts has worked on the COVID-19 response with the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). This model was extensive, taking into account our current data, mitigation strategies, and potential summer effects on viral transmission. It produced various scenarios that gave us a baseline estimate, with high and low ranges of potential hospitalization and ICU needs of Arizonans. The initial data we received 2 weeks ago from our Arizona team showed an estimated need for hospitalization of 15,000 individuals and 7,000 ICU beds needed. The recently updated version included newer data, and the model shifted. The most recent baseline estimates a peak need for 600 hospital beds and 300 ICU beds around May 22.
Last week, our federal partners from the Centers for Disease Control and Prevention (CDC), the Assistant Secretary for Preparedness and Response (ASPR), and Federal Emergency Management Agency (FEMA) shared the modeling they had built for Arizona based on projection formulas developed by the Johns Hopkins University. This federal model takes into account the current data from the state as well as the mitigation strategies Arizona has put into place. While we are still pending approval from our federal partners to publicly share this data, this model is updated regularly and is the tool the federal government is using when determining resource allocations on a national level. This model predicts our peak resource utilization to occur around June 11, assuming our mitigation strategies are lifted at the end of the current Stay Home, Stay Healthy, Stay Connected order on April 30th. Given that our goal was to reduce transmission of COVID-19, if this model holds true, this later peak would reflect the success of those mitigation strategies. Its projections, even with the mitigation strategies lifted, predict that our current resources, including inpatient beds, ICU beds, and ventilators, will meet a healthcare surge due to COVID-19. This model appears the most realistic and the predictions are reassuring.
As you can see, the model projections vary widely and are highly sensitive to our mitigation strategies. All of our efforts to date have decreased the transmission of COVID-19 in our community and helped our healthcare system increase resource capacity to meet Arizona’s healthcare needs. While most of the models show that we currently have the capacity to meet the healthcare demands for Arizona, it is the responsibility of public health to plan for the worst-case scenario. We want to make sure every Arizonan can access the level of care they need at the time they need it. This is why we are still working on developing plans for alternate care sites, such as the one at St. Luke’s, and facilitating the Arizona Surge Line to help coordinate transfers of patients to prevent surge at any one hospital. As the data evolves, so will our plans. While the models may try to predict what lies ahead, they are simply predictions. Moving forward, the best course of action is to continue using all of our real-time, Arizona specific data to assess the health of our healthcare system and evaluate the trend of our cases to make decisions that are best for Arizona.
* These electronic models may change by day, so the data presented on the website may not match the numbers posted in this blog.
Is that all perfectly clear? Why would you believe any of these models or make the Governor “Dicey” decision to continue strangling small businesses and prolonging lethal side effects of his orders? Cancer, heart disease, stoke, suicide, overdose deaths: all these are on Ducey now. Notice the “public health” expert was completely silent on the side effects she knows to be associated with her prescription for Arizona. This Chamber of Commerce Republican is also destroying the life savings and livelihoods of Arizonans who barely hung on for 45 days, and who now will not have a chance to start clawing their way back out of a mountain of debts until May 16. “Returning Stronger” is a cynical joke, true only for his corporate and government pals, who despise the deplorable way Arizonans voted in 2016.
Here is a snapshot from the ADHS website, showing some of the broad scope of real public heath.
Note the emphasis on preventive care. That has been flushed down the memory hole by the woman most responsible for advocating for this proven life-saving strategy. All such appointments have been cancelled in the name of creating bed capacity for just one disease. Arizona women are now unknowingly suffering from breast cancer, while Arizona men have colon cancer growing beyond safe early treatment. I got word Friday that hospitals will soon report massive surges in deaths at home from people who should have come to the urgent care or ER, but were warned off by this reckless, cowardly governor and the doctor who is supposed to be looking out for all Arizonans.
See Governor Ducey‘s strained, resentful attempts to deflect responsibility for picking and choosing kinds of business he puts his boot on. It is all about science, he keeps saying, pointing to the very woman who published what you read above and who has failed at every turn to warn of the known lethal side effects, even though she is in charge of all of public health for the state of Arizona’s. And it gets worse.
The Maricopa County Treasurer, a small-government conservative Republican, has been raising the alarm for a month that property tax bills were due across the state on May 1. He called on Governor Ducey and the Republican-controlled state legislature to pass emergency relief. They failed to do so, even as Ducey postured against evictions and claimed to be guided only by science.* The legislature could have met to save Arizonans from tax bills they cannot now afford to pay, but that would have made them also own Governor Dicey’s decisions on whose necks he kept the government boot. President Trump plans to visit Arizona in a week, which will drop him in the middle of the mess.
The Paycheck Protection Program, celebrated by President Trump, is a marvel of government efficiency, and only a bucket of water thrown on a house fire. The sheer scale of small business, repeatedly invoked by President Trump, makes any government bailout only a garden hose to the water main needed to meet all the entrepreneurs’ bills. In this situation, with the obvious junk science and patent medicine being peddled by Arizona’s doctor, Governor Ducey is busy kicking the rungs out of the ladder between his Chamber of Commerce pals and the men and women who are the true heart of Arizona’s economy. He has even refused to use the state rainy day fund to help small businesses, to give even a bit of help to those whose lives he is destroying. Once again, the Republicans who control the legislature are MIA, cowering in the hope that blame will not attach to them.
This will not end well for President Trump, Republicans, or Arizonans unless something changes very soon.
Published in General* Press Release
Tax Deadline UpdateI’m extremely disappointed to report despite all our efforts to request to extend the delinquency date to pay 2019 property taxes, no action has taken place. Senate President Karen Fann expressed support at first, and although many legislators have enthusiastically voiced their support, there doesn’t appear to be any progress. There has been no response from House Speaker Rusty Bowers or from Governor Doug Ducey.
I will continue to fight to get relief for homeowners including an extension and/or waiver. However, if the Legislature and the Governor do not extend the deadline and if you are unable to pay the balance of 2019 property taxes by May 1st at 5:00pm, here is a suggestion for you to make your own one-month extension: If you pay late, you will incur an interest penalty. We suggest you pay on the last business day of the month, because whether you pay May 2nd or May 29th, the interest amount is the same.
Regrettably, there is no other relief County Treasurers can provide for homeowners; I am restricted by law. Only the Legislature can change the law and that seems unlikely.
Additionally, after consultation with the County Attorney’s Office, I have determined there is a legal way to provide some relief to some taxpayers. ARS 42-18056 G gives County Treasurers the authority to “enter into a payment plan agreement” with business personal property taxpayers who become delinquent on their taxes of more than $1000. Those qualifying businesses will receive a letter explaining what action to take.
I wish you all well and please stay safe.
With great respect,
Royce T. Flora
Maricopa County TreasurerSenate President Karen Fann 602-926-5874
Speaker of the House Rusty Bowers 602-926-3128
Governor Doug Ducey 602-542-4331
Maricopa County Treasurer’s Office 602-506-8511
Did Gilead aid the hit job against HCQ?
https://defyccc.com/gilead-remdesivir-hcq/
Gilead has an interesting list of investors. Lots of big money and institutional money. This is no mom and pop outfit.
https://stockzoa.com/ticker/gild/
it gets better
https://defyccc.com/covid-19-panel-gilead-ties/
at least 7 members of covid-19 panel ‘forgot’ to disclose their ties to Gilead
https://archive.is/72wm4
100 deaths per million is a ‘typical’ flu season
the 2018 flu epidemic was around 200 deaths per million
Does the governor of AZ not realize how many Cold Stone franchises are losing income, racking up debt and possibly teetering on bankruptcy?
At this point we have enough data not to rely on models/projections/guesses.
No one wants to look at the data because it’s not ‘sophisticated’.
WAG
snafu
fubar
What would the intervention be? Another lockdown?
I don’t want to be difficult just for the sake of being difficult. To implement something like what you seem to propose, there would have to be a threshold level of — what, exactly? New cases? Hospital admissions? It would have to be something, which would be the “tripwire” you propose. And then what? “Intervene,” you say, but how?
This is a very challenging situation. I am concerned that proposals like this will put us in yo-yo lockdown mode, and to what end? Who’s going to run out and re-open their business, knowing that if there’s some arbitrary uptick in the number of cases, they’ll just be shut down again?
I am concerned about something else. When I start posting and commenting on these issues, I get annoyed and frustrated. I worry, a bit, that this causes me to be unable to think clearly. I don’t think that this has happened, but I have to admit that it is a possibility.
Like when most people “predict” the outcomes of elections, or the stock market…
The lefties should be required to stay in PRC (People’s Republic of California) and not allowed to escape the disaster they have created, which they will then create again wherever they flee to.
You may be concerned, but this is exactly Oregon’s reopening plan.
Good catch. As with other agencies, they would be hearing the Chinese Communist filtered reports. At the same time, Arizona has a lot of international students in the heart of our largest population center, including a very large Chinese student population. We reported the 5th case in the nation in late January. That would have been after students were already back from the winter break, so was likely a man involved in the technology sector.
The corporation to which he and his business partner sold Cold Stone will do just fine, going though bankruptcy at worst, while the undergrowth of hungry young competitors on the rise will be almost entirely burned away. His policy consistently favors big business and deep pockets over real entrepreneurs.
Pretty much. With stock markets you can have a persistent trend for a while, but if you are a trend follower you are guaranteed to miss the next turn. And trying to predict the next turn is even crazier.
People who predict elections do it on the basis of polling. It is virtually impossible to define or obtain a representative sample for an election poll, so the sample distribution or odds are just about meaningless. Between the time when landlines became almost universal and the time when cell phones displaced significant numbers of landlines, you might have had a shot. Now, no chance. Pollsters for the Democrat party or media try to obtain polls that pump up the Democrat party. Pollsters for Fox News (at least the older form of Fox News) or the Republican party try to pump up the Republicans. Neither try to accurately predict the outcome.
And then there is gaming the system: if I ever agreed to do a political poll, I would lie about everything, to drive down the accuracy of the poll. I happen to think that political polls are toxic to elections, and my only objective in participating would be to help them die out. As far as I’m concerned the value of the political polling segment of the economy is about equal to boiler shops selling time-share condos, and other shady operations. Their loss would be an “addition by subtraction” to our lives.
For the record (as if anyone cared) I favor careful monitoring but I do not favor a tripwire. Too many unknown unknowns are lurking.
Doug Ducey is no Noem.
That’s certainly a possibility, but I also think we need to start looking at intermediate options. For example, banning groups over certain sizes and closing specific types of businesses (bars, cinemas, bowling alleys, etc.). Or mandatory masks.
Given the experience in Sweden and elsewhere that infection can be “managed” somewhere between zero transmission and explosive transmission, we should be actively investigating more targeted (albeit often still uncomfortable) steps.
The notion of using metrics to determine the Covid response is already quite well established. For example, about a month ago Scott Gottlieb put out a framework together with the Johns Hopkins epidemiologists describing a road map to re-opening. It’s based on meeting certain gates for metrics like current caseload, trend, hospital capacity, testing capacity, and tracing capacity in each state/jurisdiction.
We’re never going to have the level of fine-tuning that Gottlieb and colleagues envision, and most states also won’t reach their demands for testing and tracing capacity before their citizens start clamoring for freedom. Nonetheless, I think the general concept is spot-on. Gov. Abbott seems to have adopted key features of this approach in his plan to re-open Texas.
What’s really necessary in my opinion are schemes to perform “background surveillance” of the population. In other words, PCR testing of random samples of the population to monitor for unnoticed transmission of the virus. This is actually quite feasible even with “inadequate” testing capacity, because the PCR assay is sensitive enough that individual samples can be pooled into one test. That allows up to 8x as many people to be screened and provides enough accuracy to detect a spike in cases. That information could be combined with the partial steps I listed in my last comment to represent a “tripwire” and “interventions” that might plausibly keep the virus from exploding without resorting to more drastic lockdowns.
I agree that a yo-yo situation might be very harmful. In fact, it’s one of the arguments used by proponents of extending the current lockdowns: continuous cycles of re-opening and re-closing (and the uncertainty that brings with it) would be so damaging that it’s better to simply keep the current lockdowns in place until we have the situation under such good control that we can go the South Korea route and re-start nearly the entire economy at once without fear of a major viral rebound.
That’s a tempting argument. I disagree with it because I don’t see the US as a nation establishing a reliable South Korea-like system soon enough.
Thus, I think the best approach is to re-open incrementally yet ambitiously, but with a plan. And that plan should include surveillance tripwires and intermediate measures, and should explicitly state that lockdowns are still an option (albeit last-ditch) should the other measures fail.
My suspicion is that upon reopening, we will discover that viral transmission is highly dependent on factors like climate, population density, and lifestyle (i.e. residential structure, transportation habits, etc), and that many US states won’t see a major uptick during the summer but rather just a slow burn. However, a few states might indeed have to partially re-close. I think that outcome would be far superior to either a) throwing caution to the wind by rapid reopening without a solid plan and risking panic if another NYC-size death wave occurs, or b) waiting until the requirements proposed in the Gottlieb plan are met.