Reported COVID-19 cases in Arizona last week were similar to the previous week's relatively high level, and the percentage of tests returning positive for the virus rose to one in four, according to the state's latest weekly update.
Health officials on Wednesday added 12,987 new COVID-19 cases and 42 new known deaths over the weeklong period ending Nov. 26, slightly below the prior week's addition and well above the case additions from weeks before that. The past two reports have been the highest weekly case reports since early August.
Case counts are still far below last winter, state data shows. Case numbers in recent months likely are not showing the full picture of infections as many more people have used at-home test kits and may not report positive results to their doctors or county health departments.
Some epidemiologists are predicting another wave of infections this fall and winter. Omicron subvariants that are fueling a rising number of COVID-19 cases in Europe and western Asia have been detected in Arizona, setting the stage for another bump in cases here.
Public health officials and medical providers say the best way for Arizonans to avoid serious illness from the emerging strains is to get the updated COVID-19 booster if eligible. The new bivalent booster is updated with protections against subvariants of the omicron variant and it's available to people ages 5 and older.
Six of Arizona's 15 counties were designated as “high” in terms of COVID-19 levels as of Dec. 1, according to guidance from the Centers for Disease Control and Prevention, meaning the CDC recommends people wear face masks indoors in public. "High" counties were Pima, Santa Cruz, Greenlee, Gila, Navajo and Apache. The other nine counties − Maricopa, Pinal, Graham, Cochise, Yuma, La Paz, Yavapai, Coconino and Mohave − were "medium."
The CDC’s “community level” guidance metrics are based on a county’s COVID-19 hospital bed use, COVID-19 hospital admissions and case rates for the virus over the past week.
Reported cases since the pandemic began are at over 2.3 million. Known deaths in Arizona are over 31,700.
Wednesday marked the 40th of the weekly updates to the state's data dashboard, instead of daily updates that Arizonans became accustomed to following for the latest data on infections, illnesses and deaths.
The previous week's update added 13,410 cases and 62 deaths, compared with 10,775 COVID-19 cases and 34 deaths three weeks ago and 7,360 COVID-19 cases and 40 deaths four weeks ago.
This week's update shows the differences between data reported for the week of Nov. 20-26 and Nov. 13-19.
Health officials say weekly updates match how public health monitors trends and other disease reporting.
Case numbers generally were relatively lower in the past couple of months, and public health experts estimate cases of the highly contagious omicron variant peaked in Arizona around mid-January.
The state data dashboard no longer shows key hospitalization information since Gov. Doug Ducey ended the COVID-19 emergency declaration March 30. State health officials said hospitals are no longer required to report some COVID-19 surveillance data to the state, meaning certain graphs showing weekly hospitalization levels for the disease and bed usage by COVID-19 patients are no longer updated.
At the time that data reporting stopped, hospitalizations for the disease had dropped steadily since late January.
The CDC still reports state hospitalization data for Arizona and showed a 14.3% increase in the seven-day average of COVID-19 hospital admissions during Nov. 21-27 compared with Nov. 14-20. Hospital admissions last week were down 74.4% from the peak seven-day average in early January 2021.
The number of known deaths in the state was at 31,751 as of Wednesday, after passing 30,000 known deaths in the May 4 update. The state surpassed 25,000 deaths on Jan. 13. Deaths are reported with a four-week lag.
The CDC places Arizona's overall pandemic death rate since early 2020 as the third-highest nationwide.
Health officials: Stay up to date on boosters
The state in December began publicly disclosing data on breakthrough COVID-19 infections, and state officials say the data underscores the effectiveness of the vaccine, especially for people up to date on all recommended COVID-19 doses, including boosters.
Data from September show that 42.7% of hospitalizations and 32.1% of COVID-19 deaths were among unvaccinated people, 52.4% of hospitalizations and 60.9% of deaths were among vaccinated but not up-to-date people, and 4.9% of hospitalizations and 7% of deaths were among people up to date on vaccination. (Most Arizonans are vaccinated.)
State health officials previously broke down hospitalization and death data for unvaccinated people and people with and without boosters, but said they changed the format in July to show the impact of staying up to date with a second booster shot plus future vaccine recommendations.
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Unvaccinated people ages 5 and older had an 8.6 times greater risk of hospitalization and 6.5 times greater risk of dying from COVID-19 in September compared with people who were up to date on their vaccination. Unvaccinated people were 8.7 times more likely to be hospitalized and 7.2 times more likely to die from COVID-19 compared with people who were vaccinated but not up to date, per the state’s September analysis.
“Stronger protection from hospitalization and death is seen in those who are up-to-date on COVID-19 vaccinations,” interim state health Director Don Herrington wrote in a blog post.
As of Oct. 12, there had been 2,308 breakthrough deaths in fully vaccinated individuals with the primary series, according to state health officials’ preliminary data, which works out to a breakthrough death rate of about 0.05% among all fully vaccinated people with the primary series. (The August breakthrough number state health officials previously provided was incorrect, officials said.)
Health officials emphasize the best protection against severe illness from COVID-19 is to remain up to date with recommended vaccinations, including CDC guidance that people ages 5 years and older receive one updated bivalent booster if it has been at least two months since their last COVID-19 vaccine dose, either an original booster or the primary series.
Case rates and death reports
Contagious omicron subvariants, particularly BA.5, are contributing to many of the cases in Arizona, according to results from sequencing labs. Sequencing data from the Translational Genomics Research Institute, or TGen, show an increase in recent weeks of "Omicron other," though most recently BA.5 appeared dominant.
Percent positivity, which refers to the percentage of COVID-19 diagnostic tests that are positive, varies somewhat based on how it's measured. It was high in the winter months, a sign of more community spread. Then it was much lower but began climbing upward in April, then back downward, and now again on an upswing.
Arizona's percent positivity for COVID-19 testing was at 3% for the week of April 3, and went up in subsequent weeks, reaching a high of 29% for the week of July 10. It was 10-11% through September, 10% for the week of Oct. 2, 11% for the week of Oct. 9, 13% for the week of Oct. 16, 13% for the week of Oct. 23, 17% for the week of Oct. 30, 21% for the week of Nov. 6, 24% for the week of Nov. 13 and 25% for the week of Nov. 20. The percentages are for all diagnostic tests conducted, rather than for unique individuals tested.
A positivity rate of 5% or less is considered a good benchmark that the disease's spread is under control.
The state's overall COVID-19 death and case rates since Jan. 21, 2020, still remain among the worst in the country.
The COVID-19 death rate in Arizona since the pandemic began is 435 deaths per 100,000 people as of Tuesday, according to the CDC, putting it third in the country in a state ranking that separates New York City from New York state. The U.S. average is 324 deaths per 100,000 people as of Tuesday, according to the CDC.
New York City has the highest death rate, at 513 deaths per 100,000 people, followed by Mississippi at 437.
Arizona's first known death from the disease occurred in mid-March 2020.
Many of the reported deaths occurred days or weeks before because of reporting delays and death certificate matching.
A total of 2,337,547 COVID-19 cases were identified across the state through Nov. 26.
Arizona is still behind the US vaccination rate
Arizonans ages 6 months and older are eligible for the Pfizer vaccine, while the Moderna vaccine is approved for children ages 6 months to 5 years and people 18 and older. The CDC has recommended the Johnson & Johnson vaccine on a more limited basis for people 18 and older. Many individuals are eligible for booster doses, too.
The state reported over 5.4 million people in Arizona — about 74.6% of the total state population — had received at least one vaccine dose through Nov. 26, with nearly 4.6 million residents fully vaccinated (completed the primary series) against COVID-19. The state’s data dashboard now separates out doses administered to Arizona residents versus all doses administered in the state.
Arizona's rate of people with a completed primary series out of the total population was 65.5%, which was behind the national rate of 68.8%, according to the CDC as of Nov. 24.
There's a wide range of vaccine uptake across the U.S. About 86.9% of the total population of Rhode Island had a completed primary series, which is the highest rate in the U.S. In Wyoming, which has the lowest rate, just 52.7% of the population had a completed primary series, per the CDC.
Out of people ages 5 and older, 69.5% of those in Arizona had a completed primary series, compared with 72.9% at the national level, CDC data shows.
Health experts strongly recommend booster shots for those eligible, especially with the omicron variant spreading. About 10.9% of Arizonans over the age of 5 had received an updated (bivalent) booster dose as of Nov. 24, similar to the national rate of 12.1%.
What to know about the latest numbers
Reported cases in Arizona: 2,337,547, as of Nov. 26.
Cases by county: 1,461,222 in Maricopa; 302,920 in Pima; 151,209 in Pinal; 68,749 in Yuma; 65,158 in Mohave; 57,390 in Yavapai; 51,314 in Coconino; 46,284 in Navajo; 37,525 in Cochise; 34,191 in Apache; 20,591 in Gila; 18,948 in Santa Cruz; 13,649 in Graham; 5,825 in La Paz; and 2,572 in Greenlee, according to state numbers.
The rate of cases per 100,000 people since the pandemic began is highest in Apache County, followed by Navajo, Santa Cruz, Gila, Graham and Coconino counties, according to state data. The rate in Apache County is 51,484 cases per 100,000 people. By comparison, the U.S. average rate since the pandemic began is 29,663 cases per 100,000 people as of Tuesday, according to the CDC.
The Navajo Nation reported 77,912 cases and 1,952 confirmed deaths as of Nov. 17. The Navajo Nation includes parts of Arizona, New Mexico and Utah.
The Arizona Department of Corrections reported 15,524 inmates had tested positive for COVID-19 as of Tuesday, the highest number at its Tucson facility with 2,468 confirmed positive cases. A total of 5,716 prison staff members have self-reported testing positive, the department said. Sixty-three incarcerated people in Arizona are confirmed to have died of COVID-19, with six additional deaths under investigation.
The race/ethnicity breakdown of cases since the start of the pandemic in 2020 is 40% white, 28% Hispanic or Latino, 5% American Indian, 4% Black and 2% Asian/Pacific Islander. Race/ethnicity of positive cases since the onset of the pandemic is unknown in 14% of cases and listed as other races in 6% of cases.
Of those who have tested positive in Arizona since the start of the pandemic, about 20% were younger than 20, 42% were 20-44, 13% were 45-54, 11% were 55-64 and 13% were age 65 or older.
Laboratories had completed 21,328,773 total diagnostic tests for COVID-19 as of Nov. 26, 12.7% of which have come back positive. That number includes both PCR and antigen testing.
Percent positivity was at 25% for the week of Nov. 20, an increase from recent weeks and the highest level since July. Percent positivity has been lower than the summer, though still at a high level. The state numbers leave out data from labs that do not report electronically.
The state Health Department includes probable cases as anyone with a positive antigen test, another type of test to determine infection. Antigen tests (not related to antibody tests) use a nasal swab or another fluid sample to test for current infection. Results are typically produced within 15 minutes.
A positive antigen test result is considered very accurate, but there's an increased chance of false-negative results, Mayo Clinic officials said. They say a doctor may recommend a PCR (polymerase chain reaction) test to confirm a negative antigen test result.
Arizona as of Tuesday had the 15th highest overall case rate of all U.S. states and territories since Jan. 21, 2020, per the CDC. Ahead of Arizona in cases per 100,000 people since the pandemic began are Rhode Island, Alaska, Kentucky, North Dakota, New York City, Guam, Tennessee, West Virginia, Florida, South Carolina, Utah, Wisconsin, Delaware and Arkansas, according to the CDC.
Arizona's infection rate is 31,936 cases per 100,000 people, according to the CDC. The national average is 29,663 cases per 100,000 people, although the rates in states hard hit early in the pandemic may be an undercount because of a lack of available testing in March and April 2020.
Reported deaths in Arizona: 31,751
Deaths by county: 18,125 in Maricopa; 4,060 in Pima; 1,746 in Pinal; 1,579 in Mohave; 1,311 in Yavapai; 1,220 in Yuma; 947 in Navajo; 630 in Apache; 610 in Cochise; 507 in Coconino; 402 in Gila; 239 in Santa Cruz; 184 in Graham; 152 in La Paz; and 39 in Greenlee.
People aged 65 and older make up 22,713 of the 31,751 deaths, or 72%. About 15% of deaths were among people 55-64 years old, 8% were 45-54 and 5% were 20-44 years old.
While race/ethnicity was unknown for 5% of deaths, 57% of those who died were white, 26% were Hispanic or Latino, 7% were Native American, 3% were Black and 1% were Asian/Pacific Islander, the state data shows.
The global death toll as of Wednesday was 6,633,907. The U.S. had the highest death count of any country in the world, at 1,079,913, followed by Brazil at 689,665 and India at 530,620, according to Johns Hopkins University.
Arizona's 31,751 deaths represent about 3% of COVID-19 deaths in the United States.
Republic reporter Stephanie Innes contributed to this article.
This article originally appeared on Arizona Republic: Arizona weekly COVID-19 update adds 12,987 cases, 42 deaths