Additional background information on why the above requested actions are so urgently needed:
Arizona’s current healthcare crisis:
The impact of COVID-19 on our state has been immense. As of December 18th, Arizona has the 4th highest COVID-19 death rate in the United States (323/100,000) and, tragically, is on course to join the top three. From December 2020 – December 2021, COVID-19 was the leading cause of death in our state, ahead of cancer and heart disease. Within this last week, our state has had the fewest number of available hospital beds since the start of the pandemic, with less than 450 inpatient beds and less than 75 ICU beds statewide. This month it was announced that ECMO is not available for patients in need – we are currently in crisis standards of care for the most critically ill patients with respiratory failure. In addition to non-COVID health related emergencies, the highly contagious and deadly Delta variant has played a critical role in increasing the number of inpatient admissions. Now, the even more contagious Omicron variant is further accelerating the spread of COVID. The largest hospital system in Arizona, Banner Health, had the foresight earlier this month to appeal directly to the community at large with a public statement announcing that more than half of their 18 hospitals in the state were operating over 100% capacity, with the whole health system operating around 97%. Recent reports indicate that 32% of inpatient beds and 41% of ICU beds are in use by COVID-19 patients, which is the highest since early February 2021. These numbers are not static, but have been deteriorating due to transmission, and will likely deteriorate even more rapidly as Omicron becomes dominant.
Notably, most hospitalized patients with COVID are unvaccinated:
- Northwest Medical Center reported that approximately 85% of their COVID hospitalized patients are unvaccinated,
- Banner Health reported that this number was closer to 88% for those in the Intensive Care Units,
- ValleyWise reported more than 95% of hospitalized patients were unvaccinated.
Numerous health systems, such as Mayo Clinic, ValleyWise and Dignity Health, are postponing non-emergent surgeries and procedures. Patients who need a hospital bed for non-COVID related health problems are waiting days for one or being transported out of state to receive care. Furthermore, last week the Arizona Department of Health Services called upon FEMA on behalf of multiple Arizona hospitals with a request to send aid, both monetary and in the form of healthcare workers, to meet the ever increasing demands on our healthcare system due to low state COVID-19 vaccination rates, difficulty accessing vaccines and testing in a timely fashion, and inconsistent use of other proven preventative public health measures by the general public. Public health measures are essential to prevent continued increase of caseloads by achieving an R less than 1 despite high transmissibility of Omicron in both vaccinated and unvaccinated populations.
The effect of Omicron on Arizona’s healthcare system:
With the Omicron variant circulating in our communities, we anticipate that case rates will continue to climb at a pace we have not yet encountered in previous COVID surges. Harvard University experts agree that combined Delta and Omicron surges are imminent and pose additional threat to an already overtaxed Arizona healthcare system. Based on early epidemiologic data in other countries where it is now widespread, Omicron appears to be at least twice as infectious as the Delta variant, and it poses a much greater risk of COVID reinfection and infection of vaccinated individuals. Public health experts with the World Health Organization have stated that Omicron is spreading faster than any variant to date and that vaccines alone will not protect our communities. They clearly state that additional prevention measures such as masking, physical distancing, robust ventilation, and hand hygiene need to be implemented and maintained to control transmission. They stressed that while no single measure is enough to stop the spread of Omicron, together they are enough to reduce pressure on healthcare systems around the world, especially those on the brink of collapse.
Without immediate action and intervention, the impending Omicron surge will cause many preventable deaths, for both patients infected with COVID-19 and those seeking care for non-COVID life-threatening illnesses. Arizona is designated as a state with a “very high” vulnerability level by Covid ActNow, with 48% of the population living in a high vulnerability area. States with this designation have pre-existing economic, social, and physical conditions that make it more difficult to respond to and recover from a COVID surge. As such, Arizonans will be disproportionately impacted with higher morbidity and mortality than residents of other states by the approaching Omicron surge. It is imperative that Arizona not solely rely on calls for individual responsibility; hospital leaders and lawmakers must implement robust mitigation measures across the state for proactive community-wide protection.
Continued threats to Arizona’s healthcare staffing:
Arizona’s current and future healthcare staffing is threatened by the continued failure of our state to universally adopt preventative public health measures, the reluctance to take action to alleviate the burden on our healthcare system, and the lack of pay equity for those working on the frontlines. Without robust community mitigation efforts, we anticipate a large percentage of current healthcare workers will fall ill with the Omicron variant despite their vaccinated status, putting additional strain on staffed hospital bed capacity and contributing to further spread of the virus. Furthermore, since the start of this pandemic the healthcare field has witnessed a tragic loss of healthcare workers from COVID-related illness and death, and with many others leaving their chosen professions due to the trauma and moral injury resulting from the massive number of witnessed (preventable) deaths. According to a recent report from the American Medical Association (AMA), one in five physicians and two in five nurses intend to leave practice in the next two years. A poll conducted earlier this year reported that an estimated 18% of healthcare workers have quit their jobs, 31% have considered leaving, and over 75% citing continued supply and staff shortages negatively affecting them and their workplace.
Not only are healthcare workers suffering from the mental health toll of this pandemic, but they are being asked to work additional shifts, cross-cover different departments that are not within their area of expertise, and are being paid inconsistently across hospital systems for their work. Many nurses are leaving to become travel nurses after learning the (more substantial) pay provided by Arizona hospitals to “travelers” for the same level of work as their employed position. We need our hospitals to value healthcare workers currently employed, and to pay them equitably for their additional labor and the taxing working conditions they are encountering. These highly skilled individuals cannot be replaced easily; it takes time and substantial cost to replace healthcare workers. The authors of the AMA study cite prior research showing that “replacing a nurse may cost up to 1.2 to 1.3 times their annual salary. Replacing physicians may cost $250,000 to more than $1 million per physician.” Arizona will continue to face serious healthcare access issues for years to come as a result of pandemic-related attrition with high replacement cost, coupled with a pre-existing healthcare worker shortage, particularly in primary care. This healthcare worker shortage, along with a high percentage of the aging population in our state, weighs heavily on our healthcare system and ensures increased demands are imminent. These demands, without proactive action today, are detrimental to the future health and wellness of our families and communities while exacerbating existing health inequities.
Inconsistent visitor policies implemented among Arizona hospitals further perpetuates the spread of this dangerous disease in our communities. The highly infectious Omicron variant circulating in our community makes this particularly worrisome. Some hospitals allow for family members to visit patients who are ill with COVID with variable PPE compliance. As healthcare workers, we understand the need for families to feel supported and to have closure when a loved one is dying. However, vaccination/booster status and PPE compliance policies should be implemented to not only help reduce the spread, but to prevent continued moral injury to healthcare workers who are watching these visitors leave the ICU to inevitably infect someone else.
https://www.nytimes.com/interactive/2021/us/covid-cases.html, December 18, 2021
Devoid, A. COVID-19 becomes Arizona’s leading cause of death. Tucson.com. December 19, 2021. https://tucson.com/news/local/covid-19-becomes-arizonas-leading-cause-of-death/article_01c6eaa6-5c61-11ec-9929-47566ac81cb0.html
Arizona Department of Health Services COVID-19 Dashboard. https://www.azdhs.gov/covid19/data/index.php#hospital-bed-usage
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