Figure 2a shows an abrupt increase in transmission among all age groups starting early-mid October, even among those 65+ years who have high levels of vaccination. A similar pattern is evident among school-age children (Figure 2b). Low vaccination uptake, ineffectual or absent mitigation efforts, and waning immunity are ultimately to blame for our circumstances but the cause of this most recent uptick during a relatively stable policy environment is unclear. While a recent cold front dropped average temperatures by 10 -15 degrees beginning October 8^th, the upswing also coincides with fall break for many K -12 schools. Who knows?

The Arizona Supreme Court unanimously ruled that recent legislation banning schools from requiring mask use was unconstitutional. While preventing a ban is better than allowing one, this ruling simply prevents the legislature from making a bad situation worse. Optimal policy would have been to require, not prohibit, face coverings in all K – 12 settings at the beginning of the school year before child vaccine approval was granted.

After 158 days, case rates during the past winter 2020 surge and this current one have intersected (Figure 2c). While this wave never generated a high peak, its base may end up being considerably broader as it could “slow burn” into 2022. If so, its impact will undoubtedly be larger than that of the summer 2020 wave and could approach that of the winter 2021 wave given time. COVID-19 is not done with us yet and may never be!

Test positivity, at 25%, continues to edge up (Figure 3). Testing is inadequate for public health practice and many cases are going undiagnosed. Recent trends are radically different from the resolution of the past 2 waves which saw rapidly declining positivity after the peak. Not sure what explains the difference now or what significance to attach to it other than the obvious fact that transmission remains high on a low testing base.

As of November 3rd, 1828 (21%) of Arizona’s 8778 general ward beds were occupied by COVID-19 patients, a 7% increase from last week’s 1714 occupied beds (Figure 4 and Figure 5 Panel A). Another 679 (8%) beds remained available for use. The number of available ward beds is a bit higher than last week’s 647 beds. Four- hundred fifty-three (453, 26%) of Arizona’s 1778 ICU beds were occupied by COVID-19 patients, a 0% decrease from last week’s 454 occupied beds (Figure 4 and Figure 5 Panel B). An additional 153 (9%) ICU beds remained available for use, similar to last week’s 155 beds.

While peak occupancy with this third wave never reached levels seen in the prior two, the base of the wave has the potential to be broader. For example, the summer 2020 and winter 2021 waves saw 57 and 98 days with combined ward and ICU occupancy >2000 patients, respectively. So far, this current wave has seen 83 days with a combined occupancy >2000 patients with no resolution in sight. Persistently high COVID-19 occupancy will have important implications through our seasonal peak occupancy in February.

Arizona hospital occupancy remains far above seasonal levels. Safety margins, as measured by excess available beds, remain quite low (Figure 6). Hospitals should be prepared for >15% ward occupancy and >20% ICU occupancy for some time to come.

Arizona has been experiencing >200 COVID-19 deaths per week since August 22^nd. The week ending September 5th has now recorded 302 deaths (Figure 7). The weeks ending September 12th and 19^th are close behind with 288 and 298 deaths, respectively. So far, 21348 Arizonans have lost their lives to COVID-19 making it Arizona’s leading cause of death, the only state to achieve such a distinction.

For the week ending October 31st, 2602 Pima County residents were diagnosed with COVID-19 a 6% increase from last week’s tally and 54% increase from two weeks ago (Figure 8).

New cases are being diagnosed at a rate of 249 cases per 100K residents per week and this rate is increasing by 14 cases per 100K residents per week. Trends across the various age groups appear in Figure 9.