As the state of Arizona ends the Covid-19 shutdown with openings of everything from public pools to bars, the Yavapai County Community Health Services department remains ready for whatever happens, says Leslie Horton, director of Public Health.
For now, the department is busiest answering questions from business owners about the proper way to operate, with calls flooding in all day for the weeks.
“Restaurants opened with limited capacity on the eleventh, and retail opened on the fourth with limited capacity,” Horton said. “On the eighth they were allowed to go back to normal with guidance for social distancing and proper hygiene (hand washing) to protect the most vulnerable. Each of these establishments, when they open, has to follow certain protocols.”
The county health department has guidelines listed on its website that are derived from recommendations by both the Centers for Disease Control and Prevention and the state, she said.
Decisions on reopening were made by Governor Doug Ducey, with no sign-off from health researchers or officials, an act that many see as a political choice to restart the economy. Arizona and its cities, like those in most Republican-run states, depend heavily on sales taxes for their revenues, so with shopping and dining out shut down, our tax revenues have plummeted.
Ducey announced the opening of gyms and pools on the 13th, a decision that no one expected and which was made at the last minute, instead of as part of the rollout that had already been announced. “The reopening has definitely increased our workload,” Horton said.
Horton said the testing blitz confirmed what the department expected: that the level of positive cases is low in Yavapai County, at 1-2% positive for the general population. Those who have symptoms or have had known exposure and are being tested at hospitals have a 3-4% positive rate. Community spread has been minimal, with the exception of Mingus Mountain Academy, where the virus infected 84 girls living onsite and 20 staff.
“We hadn't seen a surge until Mingus Mountain Academy,” Horton said. “In a setting like that, a virus can spread very quickly, whereas in our general community, we’re seeing maybe one or two cases a day. Hygiene practices, physical distancing and wearing a mask are recommended if you can’t physically distance.”
While the stay-at-home order is lifted for nonessential workers, Horton said the department still advises people over 65 or who have underlying health conditions that put them in the high-risk category to “stay at home more often and be extra careful.”
While Yavapai Regional Medical Center hospitals are open for elective surgeries again, they have strict guidelines for testing patients before proceeding, including testing them for Covid-19 just prior to surgery. Even though hospitals are going forward with those surgeries, Horton said that medical personal protective equipment like masks are still not easy to get and are being delivered randomly. “Most are on backorder.”
Public Affairs Officer Mary Dillinger of the Northern Arizona Veterans Administration Healthcare System said the hospital is following CDC guidelines for healthcare facilities and its PPE practices have limited infection rates to 0.24% of the workforce.
“We are currently adhering to social-distancing guidelines and have implemented a universal masking policy,” Dillinger said. “To reduce Covid-19 exposure, we are screening everyone who enters the facility. We have also substantially increased telehealth appointments, and used telephone appointments where appropriate.”
In adapting its facilities, the Northern Arizona VA converted one ward to specialize in Covid-19, and another into a potential rehabilitation ward post-Covid-19 veterans to care for their rehabilitation and convalescent needs. It also curtailed nonessential specialty procedures and radiology procedures while continuing emergency care. As part of the VA’s Fourth Mission, its staff mobilized to assist the Navajo Nation with patient care, food and water needs, and other support.
“We've limited out-of-state Domiciliary and Community Living Center (CLC) admissions, examined local admissions using strict screening and testing, and stopped staff assigned to the CLC from working in other areas in order to protect this vulnerable population,” Dillinger said.
Horton said she’d heard of only two medical personnel in the area who tested positive for the virus. One was a doctor in the Quad Cities, the other in the Verde Valley, and both have recovered.
One of the unexpected side effects of the shutdown was an increase in suicides from fear and stress related to job loss, economic insecurity and fear. “These are people who don’t have Covid, but (have) economic and mental impacts, job loss, and other stressors — and we’ve seen an increase in domestic violence,” Horton said. “We’re seeing fewer surgeries that are considered elective but are necessary, people putting off medical treatment and other side effects we couldn’t have predicted before.”
Dillinger said the VA is ready for whatever happens with the reopening of the state, but has opted to delay resuming non-urgent elective procedures while developing a “phased recovery plan,” keeping patient and staff safety as top priorities.
“We plan to continue to use telehealth, video and phone visits for behavioral health, primary care and pharmacy, as needed,” Dillinger said. Specialty providers are treating patients when necessary, and the hospital is using its Rehabilitation Ward to quarantine new CLC residents.
Now that Yavapai County is open for business, Horton said she expects a continued “slow trickle” of virus cases if all goes well.
“The best-case scenario is people keep their good habits we’ve been cultivating with hygiene and social distancing, and the economy continues moving forward, Horton said. “We’re making sure we’re doing our best to protect those who need our protection.”
The worst-case scenario?
“We see some sort of outbreak and increase of cases,” Horton said. “I’m not sure we’d go back to closure, but we would need to be highly protective of those who are vulnerable. If those infected are young and healthy, like at Mingus, we expect they will recover.”
Toni Denis is a frequent contributor to 5enses.