Abstract
There had been three Arizona COVID-19 Reopening Phases. On March 5, 2021, Arizona’s Reopening Phase 3 began. The state is the sixth largest in size of the United States 50 states and about the same size as Italy. There were four case surges — in the summer and fall 2021 with Delta variant, and the winter 2021-22 and summer 2022 with Omicron variants. This 18 months longitudinal study examined changes in the number of new COVID-19 cases, hospitalized cases, deaths, and vaccinations. There was an increase of more than 1.4 million cases during the study period. The data source used was from the Arizona Department of Health Services COVID-19 dashboard database. Even with the case surges, the new normal was low number of severe cases, manageable hospitalization numbers, and low number of deaths.
Keywords
COVID-19, Arizona returning to normal, Longitudinal study, Arizona and COVID-19
Introduction
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is also known as COVID-19 (coronavirus). It is a respiratory disease (attacks primarily the lungs) that spreads by person to person through respiratory droplets (coughs, sneezes, and talks) and contaminated surfaces or objects. Since the virus first appears in Wuhan, China in December 2019, there has been more than 600 million cases in the world. On September 7, 2022, Johns Hopkins University [1] reports that there are 606,889,445 total COVID-19 cases and 6,507,958 deaths associated with the virus in the world. The United States has the highest total cases (95,020,855) and deaths (1,048,989) in the world [1].
A three prolong attack is used against the virus by encouraging the public to practice preventive health behaviors that reduces the risks of getting respiratory infections (e.g., coronavirus, flu, and cold), and using vaccines and therapeutics. The preventive health behaviors include, but not limited to, practicing physical and social distancing, washing hands frequently and thoroughly, and wearing face masks. Johns Hopkins reports that more than 12.18 billion vaccine doses have been administered in the world and the U.S. has administered more than 605 million vaccine doses (September 7, 2022) [1].
There has been three Arizona Reopening Phases. During Arizona’s Reopening Phase 2 winter surge in 2020, ABC and NBC News report that the state has the highest new cases per capital in the world [2,3]. On September 7, Arizona is ranked 12th in total COVID-19 cases (2,258,040) and 11th in total deaths (31,162) of the 50 U.S. states [1]. Arizona is the sixth largest in size (113,990 square miles / 295,233 square kilometers) of the U.S. 50 states and is about the same size as Italy (301,340 square kilometer) [4,5]. The state population estimate is 7,276,316 on July 1, 2021 [6].
A partnership between the U.S. federal government and each of the 50 states is required to address the COVID-19 pandemic [7,8]. The federal government provides the national guidance primarily through the Centers for Disease Control and Prevention (CDC) and needed logistical support (e.g., provide federal supplemental funding, needed medical personnel and resources, and other needed assistance). The states decide on what actions to take and when to carry out those actions; the state COVID-19 restrictions; when to carry out each reopening phase; and the state vaccination plan.
On March 5, 2021, Arizona Governor Douglas Ducey begin Reopening Phase 3 (final reopening phase) after the state had administered more than two million vaccine doses and several weeks of declining cases [9,10]. This eases more of the COVID-19 restrictions. As more people become vaccinated and those infected recovered and have immunity against the virus; the numbers of cases, hospitalizations, and deaths will be low; COVID-19 will be manageable; and the state returns to normal.
The remainder of the paper examines Arizona Reopening Phase 3 (March 5, 2021 to September 7, 2022) looking at changes in the number of new COVID-19 cases, hospitalizations, and deaths.
Methods
This was an 18-months longitudinal study. The Arizona Department of Health Services (the state health department) COVID-19 dashboard database was the data source used. The study examined the changes in the numbers of new COVID-19 cases, hospitalized cases, deaths, and vaccines administered.
There were several data limitations. The COVID-19 case numbers represented the numbers of positive tests reported. When more than one test given to the same person (e.g., during hospitalization, at work, and mandatory testing), there were individual case duplications. Aggressive testing resulted in increases in false positive and false negative testing results. The case numbers did not include positive home testing results.
Delays in the data submitted to the state health department affected the timeliness of data reported and caused fluctuations in the number of cases, hospitalizations, deaths, and vaccinations. The state health department continued to adjust the reported numbers that may take more than a month to correct the numbers. The deaths associated with the coronavirus may cause by more than one serious underlying medical conditions, and the virus may not be the primary cause of death.
Results
A case could be mild (no symptoms), moderate (sick, but can recover at home), and severe (require hospitalization and/or result in death). There were four case surges during the Reopening Phase 3: 2 summers, 1 fall, and 1 winter. The 2022 cases (882,671) had already exceeded the 2021 total case numbers (838,836). Figure 1 shows the Arizona weekly COVID-19 cases during January 1, 2020 to September 10, 2022.
Figure 1: Arizona Weekly COVID-19 Cases: January 1, 2020 to September 10, 2022.
Source: Arizona Department of Health Services Arizona COVID-19 weekly Cases Graph*2022 cases as of September 14.
At the end of the 18 months of Arizona Reopening Phase (began March, 5, 2021), there were 1,432,921 COVID-19 cases, 59,091 case hospitalizations, and 14,839 deaths associated with the virus in Arizona (Table 1). There were higher percentages of hospitalizations, and deaths in the first 6 months of the first year than the following two 6-month periods.
Table 1: Arizona Reopening Phase 3 Total Numbers of COVID-19 Cases, Hospitalizations, and Deaths: March 7, 2021 to September 7, 2022
Source: Arizona Department of Health Services COVID-19 Dashboard.
Arizona 2021 population estimate is 7,276,316, July 1, 2021 – U.S. Census.
Table 2 tracks the weekly total and weekly numbers of COVID-19 cases, hospitalized cases, and deaths during the past 6 months (March 9 through September 7, 2022). The largest weekly numbers of cases (20,198) occurred on July 6, while hospitalizations (1,955) occurred on March 9. The largest weekly number of deaths was on March 16 (457).
Table 2: Arizona Total and Weekly Numbers of COVID-19 Cases, Hospitalizations, and Deaths
Source: Arizona Department of Health Services COVID-19 Dashboard.
Arizona 2021 population estimate is 7,285,370, July 1, 2021 – Arizona OEO.
Figures 2-4 compare the numbers of COVID-19 cases, hospitalized cases, and deaths by age groups for the three 6-month periods. A case could be mild, moderate, and severe. Most people recovered and did not require hospitalization. There was an increase of 1,432,921 cases during the 18 months. The 20-44 years age group had the largest number of cases (Figure 2). There were more females (52.8%) than males (47.2%) who got the virus on September 7, 2022.
Figure 2: Arizona Reopening Phase 3 COVID-19 Cases by Age Groups for Three 6-Month Periods.
Source: Arizona Department of Health Services COVID-19 Cases by Age Groups Statistics.
The percentages of total hospitalized cases (severe cases) decreased from 7 percent on March 6, 2021 to 5 percent on September 7, 2022. The case hospitalizations had increased by 59,091 during the study period. Seniors had the highest percent of the total hospitalizations (43.7% on September 7) and those under 20 years of age had the lowest percent (4.5%). Eighteen percent (18.1%) of seniors diagnosed with COVID-19 hospitalized, while 1.1 percent of those under 20 years of age hospitalized. There were more males (52.2%) than females (47.8%) hospitalized. Figure 3 shows the hospitalization numbers for each age group with the virus for the three 6-month periods.
The numbers of deaths had increased by 14,839 during the 18 months. The rates of fatalities per 100,000 population increased 227.05 to 433.50. As expected, seniors had the highest percent of total deaths (71.3% on September 7) and those under 20 years of age had the lowest percent (0.2) Eight percent (7.9%) of the seniors diagnosed with COVID-19 died, while 0.01 percent of those under 20 years of age died. There were more males (59%) than females (41%) who died. Figure 4 shows the numbers of deaths for each age group with the virus for the three 6-month periods.
The first U.S. COVID-19 vaccine, Pfizer/BioNTech Comirnaty, approved for emergency use authorization on December 11, 2020. In late December, Arizona began to administer vaccines. During Reopening Phase 3 (March 5, 2021 to September 7, 2022), there were 10,451,502 vaccine doses administered, and 3,813,974 fully vaccinated against the virus. Figure 5 shows the numbers of COVID-19 vaccines that were given in Arizona (persons fully vaccinated, persons receiving at least one dose, and total doses given) during the 18 months.
Initially, there were three vaccines available (Pfizer/BioNTech Comirnaty, Moderna Spikevax, and Johnson&Johnson Jcovden). Novavax Nuvaxivud became the fourth vaccine available in July 2022. The vaccines provided different levels of protection against COVID-19 and its variants. Those 65 years and older had the highest vaccination percentage, while those under 20 years of age had the lowest (Figure 6). It was expected the vaccination rates for this age group will increase with the approval of younger children vaccines use.
Figure 3: Arizona Reopening Phase 3 Hospitalized COVID-19 Cases by Age Groups for Three 6-Month Periods.
Source: Arizona Department of Health Services Hospitalized COVID-19 Cases by Age Groups Statistics.
Figure 4: Arizona Reopening Phase 3 COVID-19 Deaths by Age Groups for Three 6-Month Periods.
Source: Arizona Department of Health Services COVID-19 Deaths by Age Groups Statistics.
Figure 5: Arizona Reopening Phase 3 COVID-19 Vaccination Numbers: March 5, 2021 to September 7, 2022.
Source: Arizona Department of Health Services COVID-19 Vaccination Statistics.
Figure 6: Arizona COVID-19 Vaccination Percentages (at least one dose) by Age Groups on September 7, 2022.
Source: Arizona Department of Health Services COVID-19 Vaccinations by Age Group Statistics.
Discussion
The Arizona Governor began Reopening Phase 3 (final phase of reopening) after the state had administered more than two million vaccine doses and several weeks of declining cases on March 5, 2021 [9,10]. The state continued its efforts to vaccinate its population. The number of vaccine dosages administered had increase from 2,016,512 on March 5, 2021 to 12,468,014 on September 7, 2022. Sixty-two percent (4,525,048) of the state population were fully vaccinated. The largest numbers of fully vaccinated persons occurred in the week of April 17 to 23, 2021 (249,755) [9,10]. The pace of vaccination began to slow down in June.
Arizona case numbers had decreased in the spring and early summer 2021. At the end of June, the Arizona State Legislature and Governor had rescinded many of the state COVID-19 restrictions. The state used a three-pronged attack against the virus: (1) encourage preventive health behaviors, (2) increase vaccination numbers, and (3) use therapeutics. During the month of July, the highly contagious Delta variant appeared in the state and began the summer surge. Even with the increase vaccination efforts and other actions, they were not enough to stop the Delta variant. This resulted in the fall surge.
In December, the more contagious Omicron variant appeared in the state and began to surge. The Omicron variant surge in January 2022, and the cases remained high into early March. For more than two months in the spring, the cases were low. The state cases rose at the end May as the Omicron variants moved westward in the U.S. and began the summer surge. By late August, the cases declined.
It has been more than 32 months since the first COVID-19 cases appeared in Arizona on January 22, 2020; the state has not returned to pre-pandemic normal of zero cases and no face mask wearing. Most health facilities require both medical staff and patients wear masks. Many businesses require their staff wear masks and masking wearing is optional for customers, and they still have their virus protective glass/plastic barriers. There are signs of the public experiencing COVID fatigue (e.g., significant numbers did not wear masks during summer 2022 case surge and did not pay attention to the daily/weekly number of case increases).
Many still have anxiety/depression/stress associated with the virus. The causes for the mental anguish are the uncertainty of the virus, constant emergent of new variants, vaccine limitations, the lack control of the situation, and no end to the virus. There are persons who have not adapt to the new normal and have limited their interactions with people.
Overtime, the vaccines are not as effective against the later variants (Delta and Omicron) and Omicron subvariants as the original Alpha – breakthrough infections and wane over time. Even though the vaccines and their boosters reduce the risks in getting a severe case, one can still can get the virus. There has been very little increase in the vaccination rate in the last six months — the number of fully vaccinated percent increased only by 2.9 percent.
The Food and Drug Administration has approved both Pfizer and Moderna new bivalent COVID-19 vaccines that are effective against both the original virus and Omicron BA.4 and BA.5 variants on August 31, 2022. With the new vaccines, it is expected the vaccination rates will rise; the population immunity level will be high enough to keep the winter case surge lower than last year; and the state will move the closer to returning back pre-pandemic normal.
Conclusion
The vaccines, most of the Omicron variant cases are mild or moderate, and therapeutics have kept the number of hospitalizations and deaths low. Even with the occasion case surges, the state new normal are low number of severe cases, manageable hospitalization numbers, and low number of deaths.
References
- Johns Hopkins University Coronavirus Resource Center, https://coronavirus.jhu.edu/.
- Deliso, Meredith. “Arizona ‘hottest hot spot’ for COVID-19 as health officials warn of hospital strain: The state has the highest infections per capita globally, based on JHU data, ABC News, January 7, 2021, https://abcnews.go.com/US/arizona-hottest-hot-spot-covid-19-health-officials/story?id=75062175.
- Chow, Denise and Joe Murphy. These three states have the worst Covid infection rates of anywhere in the world: Arizona currently has the highest per capita rate of new Covid-19 infections, with 785 cases per 100,000 people over the past seven days, followed closely by California and Rhode Island, NBC News, January 5, 2021 and updated on January 7, 2021, https://www.nbcnews.com/science/science-news/these-three-states-have-worst-covid-infection-rates-anywhere-world-n1252861.
- Britannica, Arizona state, United States, https://www.britannica.com/place/Arizona-state.
- My Life Elsewhere, Arizona is around the same size as Italy, https://www.mylifeelsewhere.com/country-size-comparison/arizona-usa/italy.
- United States Census Bureau, Quick Facts, https://www.census.gov/quickfacts/AZ.
- Eng H (2020) Arizona and COVID-19. Medical and Clinical Research 5: 175-178.
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- Eng H (2021) Arizona Reopening Phase 3 and COVID-19: Returning to Normal. Medical and Clinical Research 6: 687-669.
- Eng H (2022) Arizona Reopening Phase 3 and COVID-19: One Year Later. Journal of Clinical Research and Medicine 5: 1-7.