From: Anthony J. Santiago To: BOD; Executive Staff Distribution Group; Viji Murugavel; Patrick V. Peterson; Yan Gan; Veronica Z. Vaughn; Ryan S. Southworth; Roberto Jackson Cc: Stephen R. Lewis; Monica Antone; Carol Schurz (NTS); Arzie Hogg (NTS); Bruce Harvey; Candalerian Preston; Kevin D. Knight; Jennifer Allison (NTS); James De La Rosa (NTS); Isaac Salcido Subject: RE: Data Update 01/06/2020 Date: Wednesday, January 6, 2021 8:59:23 AM Attachments: image008.png
image009.png image016.png image017.png image018.png image020.png image021.png image026.png image027.png image029.png image046.png image052.png image057.png image058.png image059.png image060.png image062.png image063.png image066.png image001.png image002.png image003.png image004.png image005.png image006.png
   
GRHC.ORG
Office: 602-528-1382 Mobile: 520-610-8534 ajsantiago@grhc.org
Viola L Johnson - Administration Building 534 West Gu U Ki Street Sacaton, Arizona 85147
   
AZDHS Update as of 0845:  
   
GRHC.ORG
Office: 602-528-1382 Mobile: 520-610-8534 ajsantiago@grhc.org
Viola L Johnson - Administration Building 534 West Gu U Ki Street Sacaton, Arizona 85147
   
From: Anthony J. Santiago  Sent: Wednesday, January 6, 2021 7:00 AM To: BOD <BOD@GRHC.ORG>; Executive Staff Distribution Group <ExecutiveStaffDistributionGroup@GRHC.ORG>; Viji Murugavel <vmurugavel@GRHC.ORG>; Patrick V. Peterson <Patrick.Peterson@gric.nsn.us>; Yan Gan <ygan@GRHC.ORG>; Veronica Z. Vaughn <vvaughn@GRHC.ORG>; Ryan S. Southworth <rsouthworth@GRHC.ORG>; Roberto Jackson <Roberto.Jackson@gric.nsn.us> Cc: 'Stephen R. Lewis' <Stephen.Lewis@gric.nsn.us>; 'monica.antone@gric.nsn.us' <monica.antone@gric.nsn.us>; 'Carol A. Schurz' <carol.schurz@gilariver-nsn.gov>; 'Arzie Hogg' <Arzie.Hogg@gilariver-nsn.gov>; 'Bruce Harvey' <Bruce.Harvey@gric.nsn.us>; 'Candalerian Preston' <Candalerian.Preston.THD@gric.nsn.us>; Kevin D. Knight <Kevin.Knight@gric.nsn.us>; 'Jennifer Allison' <jennifer.allison@gilariver-nsn.gov>; 'James De La Rosa' <James.DeLaRosa@gilariver-nsn.gov>; 'Isaac Salcido' <Isaac.Salcido@gric.nsn.us> Subject: Data Update 01/06/2020  
Today’s data update includes our GRHC Testing Cohorts and percent positive test rates; our attached GRHC Daily Dashboards; Children with COVID-19 State Report; UA School of Public Health COVID- 19 Forecast Model; and, important trends for your review. Multiple COVID-19 variants are circulating globally. In the United Kingdom (UK), a new variant has emerged with an unusually large number of mutations. This variant seems to spread more easily and quickly than other variants. Currently, there is no evidence that it causes more severe illness or increased risk of death. This variant was first detected in September 2020 and is now highly prevalent in London and southeast England. It has since been detected in numerous countries around the world, including the United States and Canada. In South Africa, another variant has emerged independently of the variant detected in the UK. This variant, originally detected in early October, shares some mutations with the variant detected in the UK. There have been cases caused by this variant outside of South Africa. This variant seems to spread more easily and quickly than other variants, and is a little more worrying. It has mutations in one particular place on the spike protein, E484, that affect whether the immune system can neutralize the virus. Several studies found mutations there can reduce the neutralization activity by as much as 10-fold ( https://www.biorxiv.org/content/10.1101/2020.12.31.425021v1.full.pdf) Currently, there is no evidence that it causes more severe illness or increased risk of death. Another variant recently emerged in Nigeria. CDC also is monitoring this strain but, at this time, there is no evidence to indicate this variant is causing more severe illness or increased spread of COVID-19 in Nigeria. The CDC is providing up-to-date information on the variants (https://www.cdc.gov/coronavirus/2019- ncov/more/scientific-brief-emerging-variant.html).   Both Pfizer and Moderna are reported to be testing their vaccines against the new variant as are other potential vaccine candidates; the alterations in the Spike Protein receptor binding domains – the site of vaccine-induced antibodies – are not believed to render the antibodies ineffective – we will monitor the trials and report any interim progress reports as available.  
The CDC has updated their vaccine totals on 01/05/2021 @ 0600 AZ – these are the latest figures available – the number administered is higher at this time. The CDC has reported a total of 13 cases of severe allergic reaction to those receiving a COVID-19 vaccination – 3 with the Moderna Vaccine candidate. The NIH has initiated a trial to investigate the higher than expected rate – commonly, a severe allergic reaction to a vaccine is 1 per 1M vaccinations – with the data to date the incidence with a COVID-19 vaccine is 1 per 372K. There are additional studies reviewing whether it is due to an inert ingredient called Polyethylene Glycol, which is used to coat and stabilize the fatty molecules surrounding the active drug in the vaccine, the mRNA that codes for the Spike Protein on the SARS-CoV-2 virus that prompts the recipient to create antibodies to ward off a future infection with the virus.  
Updated 01/05/2021 @ 0600 AZ  
 
Update on AZ Vaccines as of 01/05/2021 @ 0600 AZ: 419,175 vaccines distributed
68,707 1st doses of vaccine administered  
Update on GRHC Vaccines
 
The Caring House has their first scheduled vaccinations this Wednesday, January 6th. Walgreen’s staff will be onsite, partnered with our own team members and we will have translators on site to assist. EMS will also be on site in an abundance of caution. We expect to vaccinate at least 54 of our 65 Residents (9 have a medical contraindication to being vaccinated at this time). We will also
vaccinate nearly 50% of the staff during this first session. All will receive the Moderna vaccine and the second session is scheduled for February 3rd – where those previously vaccinated will receive
their second dose and those who had not yet been vaccinated their first.  There will be a third session, 3/3, to provide the 2nd dose to those completing their 2-dose regimen.  
We are completing our Phase 1a GRHC/GRIC Frontline employees and will beginning vaccinations for dialysis patients this week, expecting to finish by next week. We continue to reach out to Elders with Serious / High-risk conditions to educate and schedule their vaccinations. This one group of Phase 1a will take a few weeks to vaccinate in light of the number identified (1600) and the logistics of vaccinating this highly vulnerable population.  
We are placing our order for our 2nd allotment of 2,200 Moderna Vaccines today – this will complete the total number of Phase 1a doses received – 975 1st dose/975 2nd dose Pfizer and 2200 1st
dose/2200 2nd dose Moderna. We have requested that IHS expedite our Phase 1b vaccine doses for Essential Workers and Community Elders as we are prepared to vaccinate beyond Phase 1a recipients at this time. We will update as we receive further information.  
General Trends Global cases are at 86.5M cases and 1.87M deaths in 372 days; in the US there are 21M cases and nearly 358K deaths in 351 days; and in AZ nearly than 568K cases and 9,317 deaths in 303 days @ 0600 on 01/05/2021.  
   
AZ Hospitalizations: 4,789 hospitalized with a COVID-19 diagnosis and an additional 1096 in an ICU with COVID-19 and 761 on a ventilator. These are the highest totals since the pandemic began.  
Adult Inpatient Beds are at 92% occupancy with 666 available and 56% (4,789) occupied by a patient with COVID-19. Adult ICU Beds are at 92% occupancy with 136 available and 62% (1096) occupied by a patient with COVID-19.  
 
We have provided the UA COVID-19 Forecast Model updated on 12/28/2020 for your review – the following are a few highlights from the report:   **NOTICE** Arizona is experiencing a public health crisis where access to critical care services is limited due to shortages of space, personnel, and critical supplies. At this point, only shelter-in- place restrictions are certain to quickly and sufficiently curtail viral transmission. Because such restrictions impose substantial economic hardships, these measures should be augmented by state expansion of programs to provide direct economic assistance, reduce food insecurity, prevent foreclosure and evictions, and protect access to health services.  
Hospital Covid-19 occupancy continues to increase with each day setting new records for ward and ICU occupancy. By early-to-mid January hospital capacity could be overwhelmed by new Covid-19 cases.
Hospitals continue to postpone scheduled procedures to create additional capacity for Covid-19 patients at the expense of others with serious medical conditions. This coping mechanism could be exhausted soon if admissions continue to increase. Health professionals are being asked to work additional hours and assume new duties. Shortages and burn-out will degrade our capacity to provide critical care services over the coming weeks.
 
 
   
GRHC Trends As of 01/06 @ 0600, GRHC has completed 69,203 COVID-19 PCR tests; and, since 3/16/2020 has detected a total of 3,967 cases, of which 1,841 (46.4%) are GRIC members. 1,776 of those who have tested positive reside in D1-D7.  
Since 12/01 thru 01/06 @ 0600, we have detected 1694 cases – which represents 43% of all cases to date; the 834 detected GRIC cases represents 49.2% of all recently detected cases, and 45.3% of all GRIC cases to date. For additional perspective – it took GRHC 259 days to detect 2,273 cases (57%) and only 36 days to detect the next 1694 cases (43%).  
On 01/05 we detected 93 COVID-19 cases, and an additional 23 since midnight today. 51 (55%) yesterday’s cases were GRIC members.  
                                     
As of 01/06 @ 0600, GRHC has detected a total of 1,010 Pediatric cases, of which 579 (57.3%) are GRIC members. Pediatric cases account for 26% of all positive cases detected at GRHC, with a percent positive test rate of 17.0%; GRIC Pediatric cases (579) account for 31.5% of all positive GRIC cases.    Since 12/01 thru 01/06 @ 0600, we have detected 443 Pediatric cases – which represents 44% of all Pediatric cases to date; the 281 detected Pediatric GRIC cases represents 63.4% of all recently detected Pediatric cases, and 49% of all GRIC Pediatric cases to date.     
 
Maricopa County Pinal County
             Both the COVID Tracking Project and Johns Hopkins Coronavirus Resource Center document Native Americans as 4% of AZ population, 8% of hospitalizations and 12% of deaths to date. AI/AN in AZ are 2x as likely to contract COVID-19 and 3x as likely to die from COVID-19 compared with non-Hispanic Caucasians.
GRHC Testing Cohorts with Percent Positive Test Rates as of 01/05 @ 2300:  
GRHC Patient Tests (Surveillance & Symptomatic Testing) Surveillance Testing
Symptomatic Testing
Total
Cancelled 8 102 110 Inconclusive 2 175 177 Indeterminate 0 1 1 Invalid 285 0 285 Negative 15,502 20,744 36,246 Pending 350 355 705 Positive 268 4,107 4,375 Rejected 57 0 57 See Comment 0 5 5 Total Tests 16,472 25,489 41,961 Total Tests with Determinate Results 15,770 24,851 40,621 Test Positive Rate 1.7% 16.5% 10.8%
  GRHC Patient Symptomatic Testing Symptomatic
Testing Total
Cancelled 102 102 Inconclusive 175 175 Indeterminate 1 1 Negative 20,743 20,743 Pending 355 355 Positive 4,107 4,107 See Comment 5 5 Total Tests 25,488 25,488 Total Tests with Determinate Results 24,850 24,850 Test Positive Rate 16.5% 16.5%
  GRHC Patient Surveillance Testing (Exclude Dialysis East &West, DRS, GRIC RPY, TCH)
Surveillance Testing
Total
Cancelled 1 1 Inconclusive 1 1 Invalid 186 186 Negative 9,529 9,529 Pending 305 305 Positive 212 212 Rejected 26 26 Total Tests 10,260 10,260 Total Tests with Determinate Results 9,741 9,741 Test Positive Rate 2.2% 2.2%
  Dialysis East &West Patient Surveillance Testing Surveillance
Testing Total
Cancelled 3 3 Invalid 52 52 Negative 2,511 2,511 Pending 27 27 Positive 27 27 Rejected 13 13 Total Tests 2,633 2,633 Total Tests with Determinate Results 2,538 2,538 Test Positive Rate 1.1% 1.1%
  DRS Surveillance Testing Surveillance
Inconclusive 1 1 Invalid 22 22 Negative 2,465 2,465
Pending 8 8 Positive 22 22 Rejected 8 8 Total Tests 2,526 2,526 Total Tests with Determinate Results 2,487 2,487 Test Positive Rate 0.9% 0.9%
  RPY Surveillance Testing Surveillance
Testing Total
Cancelled 1 1 Invalid 1 1 Negative 127 127 Positive 1 1 Rejected 1 1 Total Tests 131 131 Total Tests with Determinate Results 128 128 Test Positive Rate 0.8% 0.8%
  TCH Patient Surveillance Testing Surveillance
Testing Total
Cancelled 3 3 Invalid 24 24 Negative 870 870 Pending 9 9 Positive 6 6 Rejected 9 9 Total Tests 921 921 Total Tests with Determinate Results 876 876 Test Positive Rate 0.7% 0.7%
  GRHC Employee Tests (Surveillance & Symptomatic Testing) Surveillance
Testing Symptomatic
Testing Total
Cancelled 4 29 33 Inconclusive 2 5 7 Indeterminate 0 3 3 Invalid 325 0 325 Negative 18,581 7,232 25,813 Pending 429 20 449 Positive 231 296 527 Rejected 82 0 82 Sample Leaked 4 0 4 Total Tests 19,658 7,585 27,243 Total Tests with Determinate Results 18,812 7,528 26,340 Test Positive Rate 1.2% 3.9% 2.0%
  GRHC Employee Symptomatic Testing Symptomatic
Testing Total
Cancelled 29 29 Inconclusive 5 5 Indeterminate 3 3 Negative 7,231 7,231 Pending 21 21 Positive 296 296 Total Tests 7,585 7,585 Total Tests with Determinate Results 7,527 7,527 Test Positive Rate 3.9% 3.9%
  GRHC Employee Surveillance Testing (Exclude Dialysis Employee and TCH Employee Surveillance Testing)
Surveillance Testing
Total
Cancelled 2 2 Inconclusive 2 2 Invalid 260 260 Negative 14,171 14,171 Pending 263 263 Positive 194 194 Rejected 54 54 Sample Leaked 3 3 Total Tests 14,949 14,949 Total Tests with Determinate Results 14,365 14,365 Test Positive Rate 1.4% 1.4%
  Dialysis East &West Employee Surveillance Testing Surveillance
Testing Total
Invalid 31 31 Negative 1,240 1,240 Pending 33 33 Positive 14 14 Rejected 12 12 Total Tests 1,330 1,330 Total Tests with Determinate Results 1,254 1,254 Test Positive Rate 1.1% 1.1%
  TCH Employee Surveillance Testing Surveillance
Testing Total