The Arizona Department of Health Services is releasing new data, including ZIP codes and the race and ethnicity of cases, regularly on its COVID-19 website.
While the new data brings Arizona more in line with what other states have publicly released, it also raises new questions about what the public can glean from it and how complete a picture it provides.
In an interview with The Arizona Republic Wednesday, the department’s assistant director, Jessica Rigler, answered questions about this new data, what other data could be released in the future, and how the state’s response to the disease is going. It has been edited lightly for clarity.
Why release this new data on Easter Sunday?
So we have a schedule for our dashboard enhancements that go live on Sundays. And so we had a prior enhancement that went live the Sunday previous as well. Any new enhancements for this week will also come live on Sundays. It wasn’t specific to Easter, just the enhancement schedule.
Why is a large chunk of the data on race and ethnicity unknown for the cases and the deaths? And then when could that data be whole?
That’s a great question that we’ve been fielding a lot. So the way that these cases get reported to us are through laboratory reports, and when the department receives laboratory reports, they come in to us electronically and they typically only contain a patient’s name, date of birth, sometimes gender and then the ordering physician for the lab, as well as the results. Then what happens with those is they get loaded into our surveillance system and sent back out to the local health departments for investigation. Local health departments will either do medical record review or do case interviews depending on the disease. Same with COVID, they might do either one or the other and try and extrapolate as much information as they can.
Usually when we’re reporting data, we’re not doing it on a daily basis, and so we get cleaner data by the time we report it. But because we’re doing this on a daily basis, it takes a while for that information to backfill, if it’s even collected at all. We’re working on additional processes, though, to try and match up the data so that we could have more completeness in this field moving forward.
What are some of the key takeaways that the department has seen from this new data and how will it inform the state’s response?
I think one of the big things that it does is underscore that there is COVID throughout our state. You know, with that ZIP code map, you can really see that many of the ZIP codes that actually have population living in them have cases of COVID, which helps to reinforce our message that we really do want people to continue to stay home, unless they need to conduct essential business. And wash their hands. Especially stay home if they’re sick. This disease is still circulating in our communities.
Does the department know why, or is there any investigation being done about why Native Americans are disproportionately dying from COVID-19 here?
We know that we have a significant outbreak up on the Navajo Nation. And so that’s one reason that you’ll see differences in our case numbers, especially in relation to the percent of the population that Native Americans make up. Also with other disease situations, we have seen Native Americans disproportionately affected. So back during H1N1, that was another situation that really did hit the Native American community hard. And so it gives us the opportunity when we look at this data to think through how we might be able to better support our tribal residents in providing resources or additional interventions or prevention measures.
Do you think it at all relates to underlying conditions or the lack of access to care?
It certainly can. It really depends on the population. For instance, it’s been brought up related to Navajo Nation, that there are in some areas a lack of access to running water, which can certainly impact the ability for more frequent hand hygiene as well as disinfection and sanitization, which are key steps to preventing disease spread.
It also looks like men are disproportionately dying. Is there any understanding of why that may be?
We’re still looking into that. This is similar to what we’ve seen internationally as well as nationally, where men have a higher proportion of deaths than women do.
So far there’s been no released information on recoveries. Why is that? And then does the state plan to begin reporting that specifically any time soon?
We’re hoping to get that “recovered” data up through our next enhancement, if possible. And so our goal is to try and get it up by this weekend. But we’ll see, depending on how that process goes, if that’ll have to get delayed by a week or not. But it is data that we plan to report out. The “recovered” definition, though, is tricky. So there’s no standard definition for what counts as recovered. You know, early on, before this was widespread, we were doing serial testing of cases so that you could tell the second they turned negative, which is a pure way to define recovered.
But given how widespread of a disease this is, and the lack of testing supplies, that’s really not the best way to do this moving forward. And so what we’ve seen a lot of states doing, and something that we’re looking at, too, is coming up with a different algorithm to identify people who have recovered, which is basically looking back, since identification of illness, back 30 days or whatever, to match with death certificates. So … basically tracking known cases against people who have died within the last month or something, and then using that as a framework for estimating recovered.
There’s also not any information up yet about underlying conditions. Is that something the state will begin reporting at any time?
That’s another enhancement that we’re working on right now. Underlying conditions fall in that similar bucket to race and ethnicity, where we’ve got a higher percentage of unknowns in that data for the same reasons that we do in race/ethnicity. We’ve got some additional matching procedures going on through electronic medical records processes to try and get that data a little bit cleaner, so it’s more meaningful when we release that as well. But we’re hoping to get that up soon also.
DHS Director Dr. Cara Christ had mentioned that the department is working with universities to come up with modeling or projections. Is that something that will be ready soon?
As soon as we’ve got that cleared and ready, we’ll be putting that information out as well. We rely on a whole variety of models; that university work that’s going on is one. But there’s publicly available models on a national scale also that you can drill down to Arizona, and we take a look at those also.
Has anything changed with regard to testing guidance? Will there be testing more broadly available anytime soon?
ADHS has a testing matrix posted on our website. And that matrix is really meant to guide who gets approved at our state laboratory for testing since we have limited resources here at the state. We just broadened that up over the last couple of days, just slightly, which would allow people who are presenting with a fever or respiratory symptoms, where before you had (to have both) a fever and respiratory symptoms. But I think something to remember is that the other testing labs in the state are not required to follow that specific guidance, and they have broader authority to implement what’s appropriate, given their existing testing supplies and PPE supplies. Still, the testing is only recommended for individuals who have symptoms, though. We would never recommend testing for asymptomatic individuals.
What prompted the release of the ZIP code data?
We have been looking at ways to present additional data out there. We’ve also been looking at what is happening across the country and the way that other states are releasing their data in order to design best practices for Arizona.
As governments consider the possibility of lifting some of these social distancing restrictions, would the data about case locations become more important in avoiding a second surge?
It’s hard to say because we know that people don’t stay just where they live. They might work in a different ZIP code, they might do their shopping in another ZIP code, their child might go to school in a different ZIP code. And so I think that’s just one piece of it. For us, some of the county level data is actually a little bit more instructional that way just because it gives you a better sense of what’s happening in a broader jurisdiction.
As we look ahead to this potential gradual opening of society, is there a team at the health department, or an advisory group, that’s looking at how you would do that safely, like with robust testing or contact tracing, that kind of thing?
There’s some great public health frameworks out there, and we’re meeting internally to discuss what those strategies are as well. We also have routine meetings with all of the directors from the county health departments so that we can discuss what a statewide strategy would look like, since it will need to be intertwined between state and county public health.
Why are the names of assisted-living facilities that have cases not publicly reported?
Our expectation at the department is that the facilities are sharing information with folks that need to know, and so we would expect the facilities are sharing COVID status within their facilities with their staff as well as all of their patients or residents and the families of those individuals. We’ve got some guidance for long-term care facilities on our website right now, and it includes links to patient and staff and family notification letters as a best practice.
The state will partner with UA on antibody tests. Will the results of those be publicly reported at all? Like the aggregate results?
It’s possible. We haven’t gotten that far on the planning process with them to talk about what release of that data might look like. Since it’s being run as a research study, sometimes data is suppressed until publication through journal articles and that kind of thing. But we’ll have to take a look at what that reporting from that study looks like.
From the new data from the hospitals, specifically on capacity and availability of ventilators and things like that, we look pretty prepared. Is that accurate?
Arizona is in a really good spot related to bed and ventilator availability right now, given what we’re currently seeing. Our hospitals have done an excellent job of expanding their capacity per the governor’s executive order, which is creating a lot more bed availability. And then the cancellation of elective surgeries has helped to make sure that the hospitals have beds available in the event of a possible surge of cases here in Arizona. We keep an eye, though, towards worst-case scenario and what happens if you get an incredible surge in cases or what happens, you know, if there’s a flu outbreak or something else at the same time that can also overwhelm the health care system as we look to do additional planning to expand bed capacity in the state.
Is there a sense yet whether the social distancing efforts are working to help bend the curve?
With our data actually being a look backward, it’s hard to say with 100% certainty. However, we are seeing a slowing in the percent increase in cases, and so that is one potential indication that things are working, that they’re going well. But of course, there’s not widespread testing, so it’s a little bit difficult to measure. We also look at our hospital COVID-like illness surveillance, which is a another proxy measure for how much COVID might be out there. And we’re actually seeing the percent of emergency department and visits and inpatient admissions due to people with symptoms of COVID declining over the last couple of weeks, which is another good sign that maybe the measures that have been put in place are starting to work.
Do you think widespread testing will be available at anytime in the near future?
I hope that it is. … We’d like to get to a place where anyone who’s symptomatic who is looking to be tested can be tested. There continues to be movement in that direction. There’s additional testing equipment that’s being approved by the FDA that can be used, and a lot of doctors’ offices and hospitals already have some of that equipment in-house. And I think one of our great learning steps right now is actually the specimen collection materials, so the swabs that are used for nasal swabs, and there’s more work being done at the federal level to validate different kinds of swabs that could be more like Q-tips so we’d have wider availability of swabs. There’s some testing being done to see if saliva might be a good specimen type for specimen collection. So I think as some of that opens up, we’ll have the ability for better widespread testing.
Has there been any improvement in the availability of personal protective equipment at this point?
We’re working on it. The state has purchased several million dollars’ worth of PPE to distribute out through our counties to get to health care and first responders in the state to protect them. But the supply chains are still slow. A lot of the materials are coming from overseas, so it takes a while to get delivered, too. So even when you place an order, it can sometimes take 10 to 15 days before that order is filled. I think we’ll see over time that that supply chain really starts to open up as more domestic manufacturers begin to get their production lines up and going and we have a more steady stream here, but I think it’ll probably be until May before we start to see better availability of PPE.
Reach reporter Rachel Leingang by email at email@example.com or by phone at 602-444-8157, or find her on Twitter and Facebook.
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