Record high 1,654 new cases reported on Friday as state reassures public about hospital capacity

The day after Gov. Doug Ducey downplayed Arizona's recent spikes in daily COVID-19 cases and ongoing increases in hospitalizations and deaths, the state's numbers continued to climb on Friday, with a record high for new cases reported and a record high for inpatient hospitalizations.

Friday saw 1,654 new cases, the most new cases reported in one day. 

Inpatient hospitalizations for patients with suspected or confirmed COVID-19 hit its highest number on Thursday, with 1,336 hospitalizations, up from the previous high of 1,291 hospitalizations on Wednesday. Emergency department visits for patients with suspected or confirmed positive COVID-19 also reached its highest level on Thursday with 915 patients, far surpassing the next highest of 848 patients on both Monday and Wednesday. 

Ducey focused his news briefing on Thursday on hospital capacity — saying that although positive COVID-19 cases have been increasing, Arizona's hospitals are fully prepared to handle more patients.

Arizona's sharp increases over the past two weeks, particularly the spikes in positive cases, have raised questions and alarm locally and nationally about whether the state has done enough to slow the spread and what other precautions may be necessary. 

During the past two weeks, the state has reported higher daily increases in cases, deaths and hospitalization rates than any time previously. Ducey's stay-at-home order expired nearly a month ago. 

Some experts warn that Arizona is experiencing a spike in community spread, pointing to increases in the number of positive cases, the percent of positive tests out of total tests, and hospitalizations. But Ducey said concerns about hospitals was "misinformation" and that Arizona hospitals are doing fine. 

The health department’s data page had technical difficulties and did not load for most of Friday.

Here's what you need to know about Friday's new numbers.

Reported cases: 32,918 known cases

• Cases increased by 1,654, or 5.3%, from Thursday's 31,264 identified cases. This is a record high for daily reported cases.
• 17,010 in Maricopa, 3,628 in Pima, 2,841 in Yuma, 2,512 in Navajo, 1,927 in Apache, 1,363 in Pinal, 1,345 in Coconino, 833 in Santa Cruz, 584 in Mohave, 367 in Yavapai, 217 in La Paz, 178 in Cochise, 54 in Gila, 48 in Graham and 11 in Greenlee, according to state numbers.
• The Navajo Nation reported 6,378 cases and 298 confirmed deaths as of Thursday. The Navajo Nation includes parts of Arizona, New Mexico and Utah.
• The Arizona Department of Corrections said 249 inmates had tested positive for COVID-19. 2,042 inmates have been tested out of a population of 40,689.
• Laboratories have completed a total of 320,816 diagnostic tests for COVID-19, 8.1% of which have come back positive.

Reported deaths: 1,144 known deaths 

• Deaths increased by 17 from Thursday's 1,127 known deaths.
• 536 in Maricopa, 222 in Pima, 86 in Coconino, 79 in Navajo, 64 in Mohave, 53 in Apache, 43 in Pinal, 33 in Yuma, nine in Santa Cruz, seven in Yavapai, four in Cochise, three in Gila and fewer than three in La Paz, Graham and Greenlee.
• People aged 65 and older made up 872 of the 1,144 deaths, or 76%. 
• While race/ethnicity is unknown for 12% of deaths, 46% of deaths were white, 18% were Native American, 18% were Hispanic or Latino and 3% were Black.

Hospitalizations still increasing

• Inpatients with suspected or confirmed COVID-19 hit a record high 1,336 as of Thursday. This was the 11th consecutive day that hospitalizations statewide have eclipsed 1,000, the highest they’ve been since the state began reporting the data on April 8.
• Ventilator use for suspected and confirmed positive COVID-19 patients also hit its highest number on Thursday: 303 patients on ventilators, continuing a trend of high ventilator numbers for the past two and a half weeks — especially high this week. 
• ICU bed use for suspected and confirmed positive COVID-19 patients hit 429 Thursday, tying Wednesday and trailing only Monday's 438. Thursday was the 17th consecutive day that the number has been higher than 370 and the fourth consecutive day it’s passed 400.
• Emergency department visits for patients with suspected or confirmed COVID-19 hit its highest on Thursday with 915 patients, far surpassing the next highest of 848 on Monday and Wednesday. Numbers surpassed 800 on Friday and have been above every day since. Since April 8, emergency department daily visits for COVID-19 were typically in the 400s and 500s.
• Patients with suspected or confirmed positive COVID-19 discharged from hospitals has hovered between around 95 and 130 individuals discharged each day for the past two weeks. The highest day for COVID-19 patient discharge was April 17 with 242 patients discharged.

What's the conversation about these trends? 

The state still isn't talking about possible new mitigation strategies or changes. Instead, Ducey and Dr. Cara Christ, director of the Arizona Department of Health Services, encouraged a redoubling of personal precautions such as physical distancing and mask-wearing when that's not possible. The tone of Thursday's press briefing was defensive, with an emphasis on Arizona being prepared. 

Maricopa County urges people to take more precautions. County public health officials at a Wednesday news briefing urged individuals to wear masks, avoid groups of 10 or more, stay six feet away from others and heed other health precautions to slow the rising spread of COVID-19. The county has seen sharp upticks in case increases over the past two weeks. 

Banner Health, the state's largest hospital system, continues to speak out about rising hospital numbers. Dr. Marjorie Bessel, chief clinical officer for Banner Health, said all nine of its ECMO machines were in use and they could not take more patients for ECMO, which is "not usual" for the hospital system. The state said Monday there was still ECMO capacity in Arizona, with 27 total machines statewide. ECMO is an an external lung machine that's used if a patient's lungs get so damaged that they don't work, even with the assistance of a ventilator.

Bessel said Banner is at 90% of its usual ICU staffed capacity. Banner Health typically has about half of Arizona's suspected and confirmed COVID-19 hospitalized patients. Bessel recommended individuals take action like wearing masks and keeping physical distance so the current trends slow down and hospital systems can keep up. 

One model shifted up its death estimates. A model from the Institute for Health Metrics and Evaluation at the University of Washington has increased its death projections to 4,762 deaths by October 1.

Key figures to watch

The percentage of positive tests is increasing. This is the opposite direction from White House reopening criteria. The percentage of positive tests out of all tests per week increased from 5% a month ago to 6% three weeks ago to 9% two weeks ago, and 12% last week. When the state decided to reopen in mid-May, that number had been trending down, which was good, but it has been increasing ever since. 

Ducey several times said the increase in cases and percent of positive tests correlated with the increase in testing. But over the past two weeks, cases increased by 78% and tests increased by just 53%. 

There is still some hospital capacity. Ducey repeatedly emphasized Thursday the state has enough hospital capacity, pointing to current available space in hospitals as well as additional surge methods and more beds that can be brought online if necessary. One hour before Thursday's news conference, leaders from six major Arizona health systems sent out a letter saying that hospitals in the state have adequate capacity to handle a surge of COVID-19 patients. As of Thursday, 83% of current inpatient beds and 80% of ICU beds were in use for COVID-19 and other patients.

Hospitalization raw numbers continue to worsen. State health department urges hospitals to prepare for crisis situation. As COVID-19 numbers in Arizona climbed last week, the state health director again sent a letter to hospitals urging them to "fully activate" emergency plans. Hospitals are being reminded to prepare for crisis care and to suspend elective surgeries if they are experiencing a shortage of staff or bed capacity. State health officials said the letter that Christ sent Saturday was a reiteration of one they sent out on March 25. Daniel Ruiz, the governor's chief operating officer, said media reports about the letter left the impression that hospitals in Arizona are running out of capacity, which they are not.

Republic Reporter Stephanie Innes contributed to this article.

Reach the reporter at Alison.Steinbach@arizonarepublic.com or at 602-444-4282. Follow her on Twitter @alisteinbach.

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