As nearly all epidemiologic measures are suggesting, Covid-19 remains a challenge for Arizona and more important, there is no easy or quick fix.
Fortunately, since the governor’s executive order on June 29, which paused the operation of high-risk transmission sites such as bars, gyms, movie theaters, and water parks, the increasing trend of the number of new daily cases has gradually begun to slow, but we must remain steadfast. Community transmission is still widespread, deaths are increasing (over 1,000 deaths this month alone, which is what we would expect — deaths lagging in time behind new cases) and there is growing evidence of troubling socioeconomic, racial, and ethnic disparities.
However, there are solutions as we face the challenge of “how do we open and stay open.”
Building on the well-known importance of personal actions (staying home when ill, wearing a face mask in public and physically distancing), widespread and consistent viral testing is a pillar of the public health response of slowing the spread of SARS-CoV-2, particularly during the upswing of an outbreak wave. Arizona’s overall testing capacity has greatly improved since the beginning of the pandemic, but cracks in the system are likely weakening our ability to promptly isolate positive cases. Prolonged wait times for test results and inadequate contact tracing efforts compound over time and directly contribute to exponential spread of the virus.
To meet the challenge, we need a strong, public-private-partnered response supported by decisive, coordinated, governmental action.
First, testing needs to be made more widely available for both symptomatic and asymptomatic individuals, especially in communities where we are observing social, racial, ethnic, and economic disparities in infection incidence and severe disease. Non-Hispanic whites account for only 16% of confirmed cases and less than 40% of deaths with known race/ethnicity data despite accounting for over half of the Arizona population, according to the Arizona Department of Health Services. In Maricopa County, nearly 75% of all confirmed cases are in ZIP codes with household incomes below the countywide median. Gaining a better understanding of the true burden of infection within traditionally underserved communities will help public health officials allocate resources, perform additional targeted testing campaigns, and provide epidemiologists with more precise metrics on which to base our models and recommendations.
Second, testing turnaround times must be shortened. As reported July 23 in Gov. Doug Ducey’s press conference, the average wait time for test results is 5.2 days. For a timely public health response, this should be halved, at least. Aggressive action must focus on increasing laboratory capacity and harnessing creative sample processing strategies (e.g. pool testing).
Third, there should be federal support for more research to developing rapid diagnostic and point-of-care tests, in addition to validating the dozens of Covid-19 tests that have been granted emergency-use authorizations (EUAs) from the FDA. We must also advocate for innovative technologies, such as cheap, daily, at-home testing options to quickly identify infectious individuals so our public health response is timely and effective.
Fourth, public health needs additional resources so their response is timely and thorough, both in terms of identifying hot spots of infection and performing contact tracing.
Finally, elected officials must advocate for sustainable legislation that provides financial support for individuals and employers to reduce barriers for testing and time away from work. These are short-term investments that must be made for a successful recovery.
Kyle Freese, Ph.D., is an epidemiologist at Phoenix-based STChealth.