PRESCOTT, Ariz. — State officials here bracing for the impact of the coronavirus pandemic have had weeks to plan for a potential surge in cases, unlike many other U.S. and international hot spots.
Now, with the state's peak period of hospitalizations expected to hit next month, officials say they hope that extra time was enough to adequately prepare a hospital system that presently faces a shortage of up to 13,000 beds in a worst-case scenario.
"Arizona has benefited from the lessons out of Washington and New York in terms of what patient surge looks like when you don't build out capacity like Arizona has done," said Ann-Marie Alameddin, the president of the Arizona Hospital and Healthcare Association.
Arizona reported its first death from the disease on March 20 — the day New York City registered its 112 death and Washington state, where the outbreak started in the U.S., its 83 death.
With the extra time to prepare, the state has, thus far, staved off an inundation of hospitalizations. Gov. Doug Ducey issued a stay-at-home order last week that drew criticism from some of the state's mayors for exempting certain businesses.
So far in Maricopa County, which encompasses Phoenix, the country's fifth-largest city, the death toll stands at 37 and the number of positive tests has only incrementally grown to 1,559, in a population of more than 4 million.
"We are not currently experiencing capacity issues at our Arizona facilities," said Becky Armendariz, spokesman for Banner Health, the state's largest health care provider.
As part of the state's effort to clear bed space for a potential surge, Ducey issued an executive order in mid-March that halted elective surgeries in the state. Alameddin, the head of the hospital association, credits that order for reducing the use of hospital beds across the state by 30 to 40 percent.
"There is plenty of capacity right now because elective procedures have been canceled," Alameddin said. "There's definitely capacity in the system," she said, adding that the state was "doing what needs to be done to build out for a surge."
While state officials say they are still looking to add bed capacity, Arizona has yet to begin construction to build out additional hospital sites for its own worst-case scenario expectations.
"April is going to be a difficult month," Ducey said Tuesday at a briefing in Phoenix, adding that the state expects to hit its high point in hospitalizations in May.
At a briefing on March 25 alongside Ducey, Dr. Cara Christ, the director of the Arizona Department of Health Services, asserted that the number of hospital beds in the state is only half of what it would require in an extreme surge in hospitalizations.
"When we look at the modeling based on the number of cases and the trajectory, we anticipate that we could need an additional 13,000 hospital beds and an additional 1,500 ICU beds," Christ said.
Over the weekend, the U.S. Army Corps of Engineers — invited by the state to assist in the process —completed assessments of 10 potential field hospital sites in Phoenix, Tucson and Flagstaff. Bob Klein, a liaison officer for the Army Corps National Guard, said the state health department is now in possession of those assessments and has the authority to move forward with construction.
On Tuesday at the governor's briefing, Christ said her department would sign a lease by Wednesday on one of those locations — the shuttered St. Luke's Hospital in Phoenix — which would activate an additional 340 ICU beds. Federal and state officials say the construction process will take about three weeks.
Christ said the state is now beginning its scope of work requests for potentially four other larger venues, though it would still leave Arizona short of more than 8,000 beds in a worst-case scenario by the state's own modeling.
The Phoenix City Council on Monday night began discussing the prospect of taking its own measures to increase bed capacity. City officials are presently evaluating what it would take to outfit the south end of the Phoenix Convention Center in downtown Phoenix into a medical-grade facility.
"We've been sounding the alarm for awhile," said Annie DeGraw, spokeswoman for Phoenix Mayor Kate Gallego. "Phoenix has an even greater bed shortage,"she said. "It really put us in a scenario where we needed to start revving the engine earlier."
DeGraw added: "We've consistently seen cities and states that have put in the resources and the planning — thoughtful planning, earlier — have had better outcomes."
Local officials across the state also remain frustrated with the lack of access to adequate COVID-19 testing kits. "Testing is incredibly important so that we are not flying blind to what is happening in our communities," said Tucson Mayor Regina Romero.
Beyond the state's urban cores, the Army Corps of Engineers is also now making assessments on the Navajo Nation to potentially construct seven additional medical facilities on the reservation.
The nation's largest tribe, with territory spanning more than 27,000 square miles through Arizona, Utah and New Mexico, is facing the highest rate of COVID-19 spread in the region. Navajos living on the reservation in Arizona have tested positive for COVID-19 by a rate seven times higher than that of the rest of the state's population.
"We have high rates of diabetes, high rates of cardiovascular disease — there's a high vulnerable population here on the Navajo Nation," said Navajo Nation President Jonathan Nez. "This is serious. This is a serious public health emergency on the Navajo Nation."
The disparate health care resources led the Arizona National Guard to activate four missions to the Navajo Nation in the last week to deliver sets of PPE for front-line medical workers, provide the services of several medical professionals and assist FEMA in the construction of a federal medical station in Chinle.
Another distinctly vulnerable population, the state's elderly population, is bracing for its own outbreak.
"This is serious. I think they're scared. They're susceptible," said Steve Hess, 78, a resident of Sun City West. "I'm just real hesitant to even go into a grocery store. I have an immune system that is depressed. I have diabetes. I'm older. I have all the things you have to watch for."
Hess is living at a hotel and separated from his wife, Billie Hess, who tested positive for COVID-19 more than one week ago.
The Sun City retirement housing developments in Arizona are home to roughly 80,000 residents, most older than 65.