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People Should Follow Guidelines to Prevent the Spread of COVID-19 and Influenza While Seeking Care

PHOENIX — Arizonans have dramatically reduced the spread of COVID-19 by wearing masks, distancing, washing hands thoroughly, and taking other steps to protect themselves and the community. But it’s also important to continue seeking routine medical care such as wellness visits to primary healthcare providers, cancer screenings, managing chronic health conditions, and keeping children up to date on routine vaccinations. 

The Arizona Department of Health Services (ADHS) has launched a public awareness campaign reminding Arizonans to look after their overall health, and also to call 911 and seek care during medical emergencies. 

“People who experience a medical emergency such as a suspected heart attack or stroke should not avoid calling 911 because of concerns of COVID-19 in hospitals,” said Governor Doug Ducey. “Our hospitals statewide have done a tremendous job in developing and implementing protocols to minimize the risk of COVID-19 spread in their facilities.”

Seeking care in the event of an emergency is critical because rapid treatment for certain conditions can dramatically improve a person’s chance of survival. Through July 2020, nearly 1,800 more Arizonans suffered a cardiac arrest compared to 2018, with 10% fewer people transported to the hospital and 10% more people dying from heart attacks. Arizonans should seek emergency care if they are suffering symptoms of a heart attack or stroke. 

Taking action at the first sign of these symptoms can dramatically improve the chances of recovery and could mean the difference between life and death. If anyone is experiencing life-threatening symptoms of a stroke, such as sudden weakness, numbness, or confusion, or symptoms of a heart attack, such as chest pain, shortness of breath, or nausea, call 911. In addition, it is not unusual for women to have additional symptoms, such as unexplained tiredness and vomiting.

“Arizonans have done a great job of helping to reduce the spread of COVID-19 by staying home and avoiding large gatherings. While we all must remain vigilant, now is not the time to skip routine medical care,” said Dr. Cara Christ, director of ADHS. “This is especially important for people with chronic health conditions such as diabetes and asthma who are at higher risk for serious complications from COVID-19 and the flu.” 

Arizonans are also encouraged to keep their children’s vaccinations up to date and to get an influenza shot this year. Through July, the number of childhood vaccine doses ordered by healthcare providers participating in the Vaccines for Children program is 21% less than an average year, indicating that many Arizona children may not be up to date on their childhood immunizations.  

“Immunizations are the most effective tool that we have to keep our children safe from diseases such as measles, pertussis, and dozens of other diseases that can cause serious illness, so parents need to ensure their children’s immunizations are current,” Dr. Christ said. “Everyone should also be vaccinated against influenza as soon as possible. We are entering influenza season in Arizona, and we still have community spread of COVID-19. The influenza vaccine is the most effective prevention tool we have against the virus and can lessen the severity if you do get influenza.”   

Arizonans should take the following precautions to mitigate the spread of COVID-19 and influenza: 

• Stay home when you are sick.
• Wear a mask every time you are in public, even if you do not feel sick.  
• Physically distance by staying at least 6 feet away from others who are not in your household when you are in public. 
• Avoid gatherings of more than 10 people. 
• Arizonans at higher risk for severe illness should continue to stay at home and avoid crowded public spaces. People at higher risk for severe illness include adults 65 or older and people of any age who have serious underlying medical conditions. 
• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Cover your cough or sneeze with a tissue or your sleeve (not your hands) and immediately throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces.

To find a flu vaccination clinic near you, please visit azhealth.gov/RollUpYourSleeve.    

As the largest and most diverse generation alive right now, young people have a chance to make a real impact in our country if every eligible voter participates in elections. In order to make sure that you can raise your voice and cast your vote in the upcoming local, state, and federal elections, you need to be registered to vote. 

If you need to register for the first time, or you moved since you last registered, you can now update your registration online right here! 

How to register:

1.    Visit ArizonaStudentVote.org,  fill out your contact information, and follow the steps provided. 

2.    If you have a AZ State-issued ID or Driver’s License: you are eligible to register completely online. Once you follow the online steps throughArizonaStudentVote.org, you will be registered to vote! 

3.    If you do NOT have a state-issued ID or license: complete the online form, then follow the steps to print out the registration and mail it to your local or state board of elections office with necessary additional identification listed on Arizona.Vote website,  

4.    Once registered, or re-registered, you'll receive a ‘proof of registration’ from the county in which you are registered. 

5.    Have more questions? Contact svonck@arizonapirgstudents.org

Already registered but want to stay up to date on the latest election information? Sign a pledge to vote this fall

THE RURAL MONITOR | by Allee Mead | September 9, 2020

The Whiteriver Indian Hospital in eastern Arizona saw its first COVID-19 case on April 1. Physician epidemiologist Ryan Close, MD, MPH, said that the hospital’s service area, about 18,000 American Indian people on the Fort Apache Indian Reservation, “had some of the highest case counts per day as anywhere seen in the country.” Contact tracing was an important step to help bring these numbers down.

In addition to treating COVID-19 patients, Close said that the hospital’s role was to make sure residents could access testing and to proactively test those in close contact with individuals with COVID-19. The hospital’s contact tracing initiative starts with a phone call, in which the contact tracer explains that the person receiving the call has tested positive for COVID-19 and asks to meet in person to discuss contact history.

Every day, a team of contact tracers wearing personal protective equipment visits high-risk individuals and assesses their symptoms. “High-risk” outreach is focused on those who have tested positive for COVID-19 and are at particular risk for poor outcomes and deterioration. This daily effort requires its own team of about four to six people, who meet with the larger contact tracing team twice a day.

Besides checking symptoms, Whiteriver Indian Hospital conducts in-person contact tracing because its service area has poor cell phone reception and not everyone has landlines. This was not news to the hospital’s public health nurses, who were already conducting in-person contact tracing for other communicable diseases. Their expertise led to the hospital’s COVID-19 contact tracing strategy. Close added that the hospital had to “quickly double and triple [its] contact tracing capacity to be able to send people into the field.”

Across the country, contact tracing continues to be an important step in combatting the coronavirus pandemic, especially as schools and businesses open up and as community members become more active outside the home.

In addition, ethnic minority populations have been disproportionately affectedby the pandemic. For example, 1.3% of COVID-19 cases (in which race and ethnicity were known) reported to the Centers for Disease Control and Prevention (CDC) were among American Indian and Alaska Native (AI/AN) people, even though they make up 0.7% of the United States population. The cumulative incidence (or cumulative cases of COVID-19 per 100,000 population) among AI/AN people was 3.5 times the incidence among white people.

In-Person Contact Tracing

Whiteriver Indian Hospital’s contact tracing teams travel with pulse oximeters to test all household members’ oxygen saturation, regardless of whether a person feels sick. Close has reported cases in which people have not felt sick but had low oxygen levels: “At the peak of the epidemic for us, in one in five households that we would trace, we would find someone who unexpectedly had low oxygen and had to be hospitalized.” Now, he said, that happens one in 20 households.

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KAISER HEALTH NEWS | By Markian Hawryluk | AUGUST 28, 2020

In the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.

Six years later, those senators are up for reelection. Not only is the law still around, but it’s gaining in popularity. What was once a winning strategy has become a political liability.

Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the COVID-19 pandemic and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election.

With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic challengers promising to protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim three-vote majority in the Senate but are defending 23 seats in the Nov. 3 election. Only one Democratic Senate seat — in Alabama, where incumbent Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for Republicans.

“The fall election will significantly revolve around people’s belief about what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.

The Affordable Care Act has been a wedge issue since it was signed into law in 2010. Because it then took four years to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for the Colorado Health Institute, a nonpartisan nonprofit focused on health policy analysis. And they continued to attack the law as it took full effect in 2014.

Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President Barack Obama’s assertion that “if you like your health care plan, you’ll be able to keep your health care plan.”

But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped. Thus, political messaging has changed, too.

“This time it’s the opposite,” Hanel said. “The people bringing up the Affordable Care Act are the Democrats.”

Despite Gardner’s multiple votes to repeal the ACA, he has largely avoided talking about the measure during the 2020 campaign. He even removed his pro-repeal position from his campaign website.

Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.

His opponent, Democrat John Hickenlooper, fully embraced the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s campaigning on that record, with promises to expand health care access even further.

Polling Data

Polling conducted by KFF for the past 10 years shows a shift in public opinion has occurred nationwide. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)

“Since Trump won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation. “This really solidified in 2017 after the failed repeal in the Senate.”

The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had flipped, with 51% favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.

Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — have proved even more popular than the law as a whole. And the provision that consistently polled unfavorably — the mandate that those without insurance must pay a fine — was eliminated in 2017.

“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.

Political Messaging

Following the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.

“They ran on any other issue they could find,” Fowler said.

Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.

Then, in the 2018 election, Democrats seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.

“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.

As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support for the lawsuit challenging preexisting condition protections or specific provisions of the ACA that their votes would have overturned. Republicans say they, too, will protect people with preexisting conditions but otherwise have largely avoided talking about the ACA.

“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said. “It’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado than it is to talk about health care.”

Similar dynamics are playing out in other key Senate races. In Arizona, Republican Sen. Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives. She publicly acknowledged those votes may have hurt her 2018 Senate bid.

“I did vote to repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio show during the 2018 campaign. “I’m getting my ass kicked for it right now.”

She indeed lost but was appointed to fill the seat of Sen. Jon Kyl after he resigned at the end of 2018. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.

“Kelly doesn’t have a track record of voting one way or another, but certainly in his campaign this is one of his top speaking points: what he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.

The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North Carolina and Joni Ernst of Iowa. In Maine, GOP Sen. Susan Collins cast a key vote that prevented the repeal of the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.

In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov. Steve Bullock, who used the law to expand the state’s Medicaid enrollment in 2015. At its peak, nearly 1 in 10 Montananswere covered through the expansion.

As more Montanans now face the high cost of paying for health care on their own amid pandemic-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.

“People are losing jobs, and their jobs bring health care with them,” Parker said. “I don’t think it’s a good space for Daines to be right now.”

KOLD NEWS 13 | By Megan McNeil | August 17, 2020 at 5:23 PM MST | 3min:27sec

TUCSON, Ariz. (KOLD News 13) - Dan Derksen, M.D. with the University of Arizona’s Center for Rural Health, said two of the most common factors for COVID-19 impacts, are socio-economic status and living in a rural area, among other risk factors. “COVID-19 has disproportionately affected certain populations,” said Derksen.

Drive times to get care can often be much longer than urban areas and smaller hospitals serve large geographic regions. It’s a problem many in rural areas have faced before the pandemic.  
The Robert Graham Center estimates by 2030, Arizona will need nearly two-thousand more physicians to keep up with demand. Derksen said the Arizona surge line and telehealth have helped ease some of the burden on healthcare systems, but rural areas still face challenges—especially as we enter the fall and winter. 

“We’ve never really emerged from the first wave,” he said. 

Flu and other respiratory illnesses could pile on with COVID-19 infections. 

“(It) could add stress to the systems that are always borderline stretched, especially in these rural areas,” said Derksen. 

Right now, trends are looking more positive, with hospitalizations, daily cases and other daily statistics trending down. Santa Cruz county has almost double the amount of deaths per 100,000 people than Pima County. Federal dollars have helped, sending about $71,000 to 16 rural and critical access hospitals for COVID-19 support, most of those also got another $8,500. Derksen said testing and contact tracing will help these communities continue to see better stats. 

“For these very small communities, it’s very important because we have these people spreading the virus and never having a symptom,” he said. 

According to the Center for Rural Health, about 18 percent of COVID-19 deaths in Arizona have been indigenous people, who make up less than 5 percent of the population.

NBC NEWS | By Kenzi Abou-Sabe, Cynthia McFadden and Didi Martinez | Aug. 3 2020

When the largest Indian reservation in the U.S. was hit by a surge of COVID-19 cases in April and May, it took weeks for federal aid to arrive. By the time it did, Navajo Nation had already begun to flatten its curve, but the virus had exacted a heavy toll. 

“It hit our relatives. It hit people that we knew and love and respected,” area resident Crystal Kee said. “And it has hit us at our core.”

With more deaths per capita than any U.S. state, community members say virtually everyone on the reservation knows someone who has been personally affected by the virus. 

The coronavirus was so devastating on Navajo Nation in part, experts say, because of severely lacking infrastructure on the reservation. An estimated 30 percent of homes don’t have running water, and over half of Navajo communities lack broadband access. Compounding the problem, a lack of healthy food options — there are just 13 grocery stores on land the size of West Virginia — overcrowded housing and high rates of heart disease, diabetes and obesity created a perfect storm for calamity in a pandemic. 

Now, officials and community members want to use some of the $714 million in federal aid they received to prevent a public health crisis of this scale from ever happening again, but two major obstacles stand in their way: onerous regulation that makes construction on tribal land near impossible and a looming deadline that mandates the money be spent by Dec. 30. If the money tribal governments received from the CARES Act isn’t spent by the end of the year, tribes risk having to send it back.

“Don't get me wrong, we are going to get PPEs, but if $714 million is there, we should be able to improve our economy and our communities with that money for the long term,” said Navajo Nation President Jonathan Nez.

Nez wants to spend the money on expanding access to running water and electricity and providing broadband access and more affordable housing on the reservation — in effect addressing the infrastructure gaps that experts said contributed to COVID-19’s deadliness there.

“This money is to combat, yes, the immediate needs of COVID-19, but also for the future. We have no cure. There's no vaccine. So how do we prepare for the future?” Nez said. “If we can get running water to our citizens, it will help push COVID-19 off our nation, and any future virus.”

The stakes are particularly high, experts say, because even though Navajo Nation has had success in containing its COVID-19 outbreak, the states that surround the reservation have experienced surges of coronavirus cases in recent weeks. At one point, Arizona’s infection rate — when adjusted for population size — was the highest in the world.

Cases on Navajo Nation peaked in May, with an average of 104 new cases per day. By July, that number dropped by half to about 48 new cases reported each day. In all, about 9,000 of the roughly 172,000 Navajo members living on and around the reservation have tested positive and more than 450 have died from the virus. 

Local officials say Navajo Nation’s success in flattening the curve has been largely due to three things: widespread adherence to mask-wearing and social distancing, one of the strictest stay-at-home curfews in the country and an aggressive testing regime. 

But even the most stringent measures could prove ineffective amid spiking cases in Navajo Nation’s neighbors: Utah, New Mexico and Arizona. Cross-border travel is frequent, and it’s not uncommon for people to live on the reservation but work in a border town.

“I watch the Arizona predictive models and New Mexico predictive models, including Texas and Colorado, every day, several times a day, because of the big effect it has on us,” said Dr. Loretta Christensen, chief medical officer for the Navajo Nation at the federal government's Indian Health Service.

Of particular concern is the nation’s intensive care capacity. According to Christensen, Navajo Nation health facilities currently have roughly 40 ICU beds. 

During the first surge of cases in April and May, Navajo health centers were able to transfer the most critical patients to ICUs in neighboring cities like Phoenix, Flagstaff and Albuquerque. That ability was critical to their success in managing hospital capacity and caring for patients, Christensen said. Now, as those cities deal with their own surges, that may no longer be an option. 

“I will be totally honest: It will be a huge challenge to manage that volume of patients in our facilities,” Christensen said. “Do I believe our staff can do it? Yes, they've risen way above all levels of performance, and they've been innovative and adaptive and strong.”

Complicating the risk is the fact that thus far, COVID-19 has proven particularly deadly for Native Americans. They have the highest rates of hospitalization from the virus of any racial group in the U.S., according to Centers for Disease Control and Prevention data.

“This isn't a matter of race, but a matter of institutional racism that has made people at higher susceptibility for infectious diseases and kept them at higher susceptibility for many, many years,” said Dr. Laura Hammitt, director of infectious disease programs at the Johns Hopkins Center for American Indian Health at the Bloomberg School of Public Health.

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Trailing Democratic challenger Mark Kelly in one of the country’s most hotly contested Senate races, Arizona Sen. Martha McSally is seeking to tie herself to an issue with across-the-aisle appeal: insurance protections for people with preexisting health conditions.

"Of course I will always protect those with preexisting conditions. Always," the Republican said in a TV ad released June 22.

The ad comes in response to criticisms by Kelly, who has highlighted McSally’s votes to undo the Affordable Care Act. That, he argued, would leave Americans with medical conditions vulnerable to higher-priced insurance.

The Arizona Senate race has attracted national attention and is considered a toss-up, though Kelly is leading in many polls. McSally’s attempt to present herself as a supporter of protecting people with preexisting conditions — a major component of the 2010 health law — is part of a larger pattern in which vulnerableRepublican incumbents stake out positions advocating for this protection while also maintaining the GOP’s strong stance against the ACA.

McSally, who was appointed by the governor to take over John McCain’s Senate seat in 2019, used similar messaging in her failed 2018 bid for the state’s other Senate position. And President Donald Trump echoed the declaration at a June 23 rally in Phoenix, saying McSally — along with the rest of the Republican Party — "will always protect people with preexisting conditions."

With that in mind, we decided to take a closer look. We contacted McSally’s campaign, which cited her support of a different piece of legislation, the Protect Act. But independent experts told us that legislation doesn’t satisfy the standard she sets out.

Past and present

Only one national law makes sure people with preexisting medical conditions don’t face discrimination or higher prices from insurers. It’s the Affordable Care Act.

Both as a member of the House of Representatives and as a senator, McSally has supported efforts to undo the health law — voting in 2015 to repeal it and in 2017 to replace it with the Republican-backed American Health Care Act, which would have permitted insurers to charge higher premiums for people with complicated medical histories.

"Anyone who voted for that bill was voting to take away the ACA’s preexisting condition protections," said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. "Sen. McSally is trying to erase history for electoral purposes."

Especially as COVID-19 cases climb, health care— and, in particular, the ACA — has emerged as a flashpoint in the Arizona election, said Dr. Daniel Derksen, a professor of public health, medicine and nursing at the University of Arizona.

"Martha McSally has in her actions, in her votes, been pretty consistent about cutting back benefits and trying to repeal the ACA without any clear plan in mind that would protect people who gained insurance through the ACA," Derksen added. "Her words on preexisting condition protections don’t align with any votes I’ve seen."