Dr. Richard Carmona

Richard Carmona, MD, MPH, FACS
Administrative Medicine and Preventive Medicine/Public Health
17th U.S. Surgeon General
PCMS member

Guest Opinion: As Arizona COVID deaths top 20,000, we must come together
to defeat the virus. Dr. Carmona wrote this guest opinion for TucsonSentinel.com

When I advise Gov. Doug Ducey and the Arizona Department of Health Services on emergency preparedness, including the COVID-19 pandemic, I give the best guidance I can from my perspective as 17th Surgeon General of the United States. I offer frank opinions and honest assessments, however inconvenient they might be. 

And that's what I will do with you as Arizona rightfully focuses its attention on the tragic toll COVID-19 has taken on our state.

I say rightfully because we must never, ever lose sight of what this pandemic has meant to Arizona. The number of deaths, the number of cases, the number of hospitalizations – these aren't just numbers. They are our fellow Arizonans. They are men and women from every corner of our state. They are our loved ones, neighbors and colleagues. They have names. Having spent the better part of my adult life as a health care provider, this is very much not an issue of numbers. It's about people.

The emotion attached to the milestone we reached today is understandable. I feel it, too. I grieve for those lost to this virus. I'm heartbroken for the families and friends they leave behind. I'm frustrated and angry beyond words that COVID-19 still threatens not just lives but our economy, our jobs, our access to health care, our children's chances at the best possible education and our way of life.

I've told the governor and I will tell you, I view the public health challenge we face as a war. It's a winnable war, and public health is very much on the front lines. But like so many of the wars our nation has fought in the past, we can't defeat the enemy on our own.

Click here to read the full piece.

Richard Carmona, MD, MPH, FACS, specialties include Administrative Medicine and Preventive Medicine/Public Health, and he is a Pima County Medical Society member. He is also the 17th U.S. Surgeon General and COVID-19 adviser to Gov. Doug Ducey and Arizona Department of Health Services.

Federal judge pauses strict Texas law banning most abortions; federal appeals court reinstates two days later

The New York Times

A federal judge on Wednesday, Oct. 6 granted the Justice Department’s request to halt enforcement of the recently passed Texas law that bans nearly all abortions in the state while the legal battle over the statute makes its way through the federal courts.

In his 113-page ruling, Robert L. Pitman, a Federal District Court judge in Austin, sided with the Biden administration, which had sued to halt a law that has changed the landscape of the abortion fight and further fueled the national debate over whether abortion will remain legal across the country.

Judge Pitman used sharp language to criticize the law, known as Senate Bill 8, which was drafted to make it difficult to challenge in court by delegating enforcement to private individuals, who can sue anyone who performs abortions or “aids and abets” them.

Then late Friday, Oct. 8, a federal appeals court panel reinstated Texas’ restrictive abortion law, temporarily restoring a ban on virtually all procedures that had been blocked by a lower court two days earlier in a case brought by the Biden administration.

The decision by three judges on the U.S. Court of Appeals for the Fifth Circuit, in a terse two-page ruling granting a stay as it considers an appeal by the state of Texas, had been expected by many abortion providers. While at least six clinics in Texas had begun conducting abortions beyond the limits of the new law, most of the state’s roughly two dozen providers had opted not to take that step as the case moved through the courts.

Click here to read the full Wednesday, Oct. 6 story. Click here to read the full Friday, Oct. 8 story.

Arizona testing sites and numbers

Updated as of Thursday, Oct. 14, 2021, all 15 Arizona counties have confirmed cases with a combined total of 1,127,095 cases across the state and 20,453 deaths and 7,912,049 vaccinations administered.* In Pima County: 139,075 cases 2,664 deaths and 1,267,342 vaccinations administered.* For up-to-date numbers, click here.

(According to the CDC as of Thursday, Oct. 14, 78.2 percent of those 18 and older in Pima County had received at least one dose of a COVID-19 vaccine, and 69 percent were fully vaccinated.)

Click here for vaccine finder locations.

Arizonans are able to access COVID-19 testing at more than 600 various sites throughout the state. Click here to find information on where to find the COVID-19 testing sites, hours of operation and information about pre-registration. If you have a testing site you would like to be included on this list, please use this form to provide information about your site.

*Vaccination numbers are displayed by the county of vaccine administration. Vaccinations administered at State of Arizona vaccination sites (PODs) are included in the state totals but not the county totals. 

Arizona's vaccine management system honored
for state government IT innovation

The Arizona Department of Health Services (ADHS) vaccine scheduling and administration system developed for the COVID-19 vaccine rollout has been honored for a second time among state government information technology innovations.

Developed by ADHS and MTX Group and using Google Cloud, the system is one of 38 projects selected from among hundreds of entries worldwide for a Google Cloud Customer Award focusing on innovation and execution. Patients used this tool to book vaccination appointments at state-run sites and many other sites across Arizona.

“This system has helped millions of Arizonans get vaccinated while helping providers easily schedule events and enter critical information,” said ADHS Interim Director Don Herrington. “We’re extremely proud of our team for their work, which is continuing to save lives today.”

Click here to read the full news release.

Aspirin use to prevent first heart attack or stroke
should be curtailed, U.S. panel says

By Roni Caryn Rabin 
The New York Times

Doctors should no longer routinely begin prescribing a daily regimen of low-dose aspirin to most people at high risk of a first heart attack or stroke, according to new draft guidelines by a U.S. panel of experts. The proposed recommendation is based on mounting evidence that the risk of serious side effects far outweighs the benefit of what was once considered a remarkably cheap weapon in the fight against heart disease.

The U.S. panel also plans to retreat from its 2016 recommendation to take baby aspirin for the prevention of colorectal cancer, guidance that was groundbreaking at the time. The panel said more recent data had raised questions about the putative benefits for cancer, and that more research was needed.

On the use of low-dose or baby aspirin, the recommendation by the U.S. Preventive Services Task Force would apply to people younger than 60 who were at high risk of heart disease and for whom a new daily regimen of the mild analgesic might have been a tool to prevent a first heart attack or stroke. The proposed guidelines would not apply to those already taking aspirin or those who have already had a heart attack.

The U.S. task force also wants to strongly discourage anyone 60 and older from starting a low-dose aspirin regimen, citing concerns about the age-related heightened risk for life-threatening bleeding. The panel had previously recommended that people in their 60s who were at high risk for cardiovascular disease consult their doctors to make a decision. A low dose is 81 milligrams to 100 milligrams.

Study using 'brain games'
to prevent Alzheimer's disease now enrolling

Banner Alzheimer’s Institute is participating in a unique research study looking to improve memory and thinking in older adults through brain games. Enrolling in both Tucson and Phoenix, the Preventing Alzheimer’s with Cognitive Training (PACT) Study is working to understand if these brain games can help prevent the onset of dementia.

Banner Alzheimer’s Institute is one of several research groups across the country participating in PACT, which is led by the University of South Florida. The multisite study is expected to receive a total of about $44 million over 5 years from the National Institutes of Health National Institute on Aging. Study participants will be compensated for their time, which includes coming to the research facility twice at the beginning of the study. The brain games as part of the study will be done on a computer at their home or other convenient location if the participant does not have access to a computer or internet. Volunteers will be asked to return to the research facility about three years later for a third and final in-person study visit.

"We are excited to be one of six locations in the United States to take part in this study, and the only location in Arizona,” said Jessica Langbaum, PhD, principal investigator for the study at Banner Alzheimer’s Institute and director of the Alzheimer’s Prevention Registry. “The PACT Study leverages data from more than 18 other studies that found that a particular form of computerized brain games can improve older adults’ memory and thinking abilities as well as their ability to handle everyday activities and tasks. Non-pharmacological interventions such as the brain games being studied in PACT are an important complement to trials of investigational medications to identify ways to delay or prevent the onset of dementia.”

Arizona has the highest growth rate of Alzheimer’s disease in the nation. By 2025, the state is expected to have more than 200,000 people aged 65 and older diagnosed with the disease according to the Alzheimer’s Association. Recognizing the pressing need for Arizonans to have access to studies fighting to delay or prevent the symptoms of this devastating disease, Banner Alzheimer’s Institute is excited to participate in the PACT study and offer this unique opportunity to the community.

Click here to read the full press release. 

CDC chief overrules agency panel
and recommends Pfizer boosters for workers at risk

By Apoorva Mandavilli and Benjamin Mueller 
The New York Times

The director of the Centers for Disease Control and Prevention on Friday, Sept. 24 overruled a recommendation by an agency advisory panel that had refused to endorse booster shots of the Pfizer-BioNTech COVID vaccine for frontline workers. It was a highly unusual move for the director, Dr. Rochelle Walensky, but aligned CDC policy with the Food and Drug Administration’s endorsements over her own agency’s advisers.

The CDC’s Advisory Committee on Immunization Practices on Thursday, Sept. 23 recommended the boosters for a wide range of Americans, including tens of millions of older adults and younger people at high risk for the disease. But they excluded health care workers, teachers and others whose jobs put them at risk. That put their recommendations at odds with the FDA’s authorization of booster shots for all adults with a high occupational risk.

Dr. Walensky’s decision was a boost for President Biden’s campaign to give a broad segment of Americans access to boosters. The White House had come under criticism for getting ahead of the regulatory process.

The CDC’s statement arrived well past midnight, a sign of the complicated and confusing decision-making surrounding the boosters. The CDC advisers similarly spent two days debating who should get boosters and when, and could not agree on whether occupational risk should qualify as a criterion.

“I am surprised that Dr. Walensky overturned one of the four ACIP votes today, and I believe others will be as well,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford and the American Academy of Pediatrics liaison to the committee.

But the vote on boosters for occupational risk “was close,” Dr. Maldonado said, and agreed with Dr. Walensky’s decision.

“This addresses not only waning immunity but those at high risk of exposure,” Dr. Maldonado added.

Click here to read the full story. 

Next on FDA's agenda: Booster shots of Moderna, J&J vaccines

With many Americans who got Pfizer vaccinations already rolling up their sleeves for a booster shot, millions of others who received the Moderna or Johnson & Johnson vaccine wait anxiously to learn when it’s their turn.

Federal regulators have begun tackling that question.

On Thursday. Oct. 14 and Friday, Oct. 15, the Food and Drug Administration convenes its independent advisers for the first stage in the process of deciding whether extra doses of the two vaccines should be dispensed and, if so, who should get them and when. The final go-ahead is not expected until at least the week of Oct. 18.

After the FDA advisers give their recommendation, the agency itself will make a decision on whether to authorize boosters. Then the week of Oct. 18, a panel convened by the Centers for Disease Control and Prevention will offer more specifics on who should get them. Its decision is subject to approval by the CDC director.

The process is meant to bolster public confidence in the vaccines. But it has already led to conflicts among experts and agencies — and documents the FDA released Tuesday, Oct. 12 suggest this week’s decisions will be equally difficult.

In one earlier vaccine dispute, the CDC’s advisory panel last month backed Pfizer boosters at the six-month point for older Americans, nursing home residents and people with underlying health problems. But CDC Director Dr. Rochelle Walensky overruled her advisers and decided boosters should also be offered to those with high-risk jobs such as teachers and health care workers, adding tens of millions more Americans to the list.

Some health experts fear the back-and-forth deliberations are muddling the public effort to persuade the unvaccinated to get their first shots. They worry that the talk of boosters will lead people to wrongly doubt the effectiveness of the vaccines in the first place.

When the FDA’s panel meets to review the Moderna and J&J vaccines, experts will discuss whether a third Moderna shot should contain just half the original dose and what’s the best timing for a second shot of the single-dose J&J vaccine.

The panel will also look into the safety and effectiveness of mixing-and-matching different brands of vaccine, something regulators have not endorsed so far.

An estimated 103 million Americans are fully vaccinated with Pfizer’s formula, 69 million with Moderna’s and 15 million with J&J’s, according to the CDC. Regulators took up the question of Pfizer boosters first because the company submitted its data ahead of the other vaccine makers.

Click here to read the full story. 

Feds tell Ducey he can't use COVID money for anti-mask grants

COVID grant dollars cannot be used to penalize schools that impose mask mandates, a key federal official is telling Gov. Doug Ducey.

And if Ducey doesn’t fix the problem, he is threatening to take back the federal money.

The funding, Arizona’s share of a $350 billion program in state and local relief dollars, were designed to finance “evidence-based efforts to stop the spread of COVID-19,” Deputy Treasury Secretary Adewale Adeyemo told Ducey in a letter on Tuesday, Oct. 5.

Instead, Adeyemo said, Ducey is distributing the money only to schools that do not require students and staff to wear face coverings during classroom hours and while on campus. And the governor also is using the cash to give out $7,000 vouchers to parents who want to pull their kids out of schools with mask mandates so they can instead go to private and parochial schools without such a requirement.

Only thing is, Adeyemo said, the purpose of the money is to “mitigate the fiscal effects stemming from the COVID-19 public health emergency.” And that, he said, includes supporting efforts to actually stop the spread of the virus.

What Ducey has done, the treasury official said, is actually discourage schools from following protocols that are designed to contain the virus. Adeyemo said that is “not a permissible use” of the federal funds.

Ducey and his aides are reviewing the letter and will respond, said C.J. Karamargin, a gubernatorial press aide. But he said that, as far as Ducey is concerned, he has done nothing wrong.

Click here to read the full story. 

Arizona judge strikes down bans on school mask mandates

By Jeremy Duda
Arizona Mirror

A Maricopa County judge struck down a ban on public schools imposing face mask mandates and a host of other policy changes that lawmakers inserted into the state budget, and with them, may have forced a fundamental change in the way the legislature does business when it passes its annual budget each year.

The ruling came on Monday, Sept. 27, two days before the mask mandate prohibition and various other changes to state law were to go into effect.

Even before a Maricopa County judge struck down the ban, Tucson Unified School District voted to keep its mask mandate in place even after the ban was to go into effect on Wednesday, Sept. 29. 

Along with the ban on face mask mandates, the ruling strikes down several other laws pertaining to COVID-19 mitigation measures and the operation of public schools. That includes laws banning "critical race theory" in K-12 schools, barring colleges and universities from requiring COVID-19 vaccinations or testing of students, prohibiting K-12 schools from requiring students to receive vaccines that have received emergency authorization from the U.S. Food and Drug Administration and barring cities and counties from requiring "vaccine passports."

And Superior Court Judge Katherine Cooper struck down an entire budget bill that included wide-ranging measures on election integrity laws and pandemic-related business regulations. That bill would have established rules for unprecedented "fraud countermeasure" security features on ballots, stripped Secretary of State Katie Hobbs of her ability to defend election laws in court, created a special committee to review the results of the so-called "audit" that Senate President Karen Fann commissioned of the 2020 election, required extensive reviews of the state's voter rolls and early voter lists, and imposed greater scrutiny of "federal only" voters who can't provide proof of citizenship.

The decision is a "huge relief," said Supervisor Sharon Bronson, chair of the Pima County Board of Supervisors.

"During a pandemic, governments should use every tool available to protect the public from the spread of the contagious disease. Face masks, distancing, quarantines and vaccines have worked before and they're working now. That's why it made no sense for the Arizona Legislature and Gov. Doug Ducey to handcuff schools and local governments with foolish prohibitions on sensible mitigation measures," said Bronson, a Democrat.

Click here to read the full story. 

Nursing shortages hindering
Arizona hospital transfers for all patients

Arizona’s nursing shortages are causing critically ill COVID-19 patients to wait longer for hospital transfers, which makes it even more difficult for non-COVID patients in rural areas to get needed care.

Throughout the pandemic, hospitals across the state have relied on a call-in system, or “surge line,” set up in spring 2020 by Gov. Doug Ducey’s administration to speed the transfer of the sickest COVID-19 patients to facilities with more staffing, bed space or medical expertise.

So far in September, the average placement time for a hospital needing help with a critically ill COVID-19 patient has been between four and five hours, whereas in August the average placement time was slightly above two hours, according to the Arizona Department of Health Services.

During the state’s recent surge of mostly unvaccinated COVID patients, some rural hospital doctors have not been able to transfer critically ill non-COVID patients to Tucson or Phoenix hospitals, and so they asked the state to expand its surge line to include all critically ill patients.

The Arizona Department of Health Services denied the request Tuesday, Sept. 21, citing the nursing shortages.

Click here to read the full story. 

Coronavirus in the United States

Coronavirus in the United States: The latest map and case count can be found by clicking here.  

OPINION: Accept it: COVID will be an endemic virus

By Vinay Prasad, MD, MPH 
MedPage Today

Each day we inch toward the end of COVID-19. The end is not when cases go to zero, but rather when we accept what has been true all along. Because of multiple animal reservoirs, because vaccinated people can still experience breakthrough infections and because billions of people globally have yet to be vaccinated, the truth is clear: SARS-CoV-2 is an endemic virus.

Over the next decade, give or take a few years, every single person on earth has a date with this virus. We will all be exposed, and the virus might replicate in some of our respiratory mucosa. A few of us might get very sick, while many of us may only get mild illness or not get sick at all from our encounter. I prefer to meet the virus on the best terms: after two doses of the COVID-19 vaccine (as I have gotten).

When we truly come to accept that avoiding the virus for decades is impossible, many things change. Our policy goals change, and the restrictions we place on society change.

If you are an adult and have neither been vaccinated nor have natural immunity, you should seek out vaccination. If you are in a location with limited vaccine availability – and you are older or vulnerable – you might want to shield yourself, as best you can, while you wait for a vaccine. Kids who aren't yet eligible for vaccines – and people in close contact with young kids or other unvaccinated people – may also choose to take precautions.

If instead you are among the majority of U.S. adults who have been vaccinated or have natural immunity to the virus, your choice is clear: You can continue to follow strict personal precautions (avoid weddings, skip parties, etc.) and delay your encounter with the virus, or you can loosen up those precautions and speed up the time to encountering it. What you can't do is avoid it forever.

Click here to read the full piece. 

This is a round up of COVID news,
which has occurred over the past month. 

Biden administration to lift restrictions on fully vaccinated
international travelers in November

The Biden administration will lift travel restrictions starting in November on those from abroad who are fully vaccinated against the coronavirus, ending a travel ban implemented to limit the spread of disease and reopening the United States to relatives who have been separated from families and employees from businesses.

Click here to read the full story.

~The New York Times~

U.S. COVID-19 death toll surpasses 700,000

The United States surpassed 700,000 coronavirus-related deaths on Friday, Oct. 1, according to a Reuters tally, as officials roll out booster doses of vaccines to protect the elderly and people working in high-risk professions. (Updated as of Thursday, Oct. 14, CDC says there are 718,681 coronavirus-related deaths in the U.S.)

The country has reported an average of more than 2,000 deaths per day over the last week of September, which represents about 60 percent of the peak in fatalities in January, a Reuters analysis of public health data showed.

The United States still leads the world in COVID-19 cases and deaths, accounting for 19 percent and 14 percent of all reported infections and fatalities, according to Reuters tally. Globally, the pandemic is set to surpass 5 million deaths.

The highly transmissible Delta variant has driven a surge in COVID-19 cases that peaked around mid-September before falling to the current level of about 117,625 cases per day, based on a seven-day rolling average.

That is still well above the 10,000 cases a day that top U.S. infectious diseases expert Dr. Anthony Fauci has said needs to be reached to end the health crisis.

Click here to read the full story.

~Reuters~

AstraZeneca seeks U.S. approval for drug cocktail to prevent COVID

AstraZeneca has requested emergency approval from U.S. regulators for its antibody cocktail, the first protective shot other than vaccines against COVID-19, another potential major step in the global fight to combat the virus.

While vaccines rely on an intact immune system to develop targeted antibodies and infection-fighting cells, Astra's biotech compound known as AZD7442 contains lab-made antibodies designed to linger in the body for months to contain the virus in case of an infection.

The AstraZeneca therapy, designed to last several months to a year, could protect people who do not have a strong enough immune response to COVID-19 vaccines because of, for instance, chemotherapy or anti-rejection drugs after organ transplants.

Click here to read the full story.

~Reuters~

Merck applies for emergency authorization for what would be first pill to treat COVID

Merck said on Monday, Oct. 11 that it had submitted an application to the Food and Drug Administration to authorize what would be the first antiviral pill to treat COVID.

Clearance for the drug, molnupiravir, would be a milestone in the fight against the coronavirus, experts said, because a convenient, relatively inexpensive treatment could reach many more high-risk people sick with COVID than the cumbersome antibody treatments currently being used.

The Biden administration is preparing for an authorization that could come within weeks; the pill would likely to be allocated to states, as was the case with the vaccines. States could then distribute the pills how they wish, such as through pharmacies or doctors’ practices, senior administration officials said.

If the pill wins authorization, tens of millions of Americans will most likely be eligible to take it if they get sick with COVID — many more than the supply could cover, at least initially. The federal government has placed an advance order for enough pills for 1.7 million Americans, at a price of about $700 per patient. That is about one-third the price that the government is paying for the monoclonal antibody treatments, which are generally given via intravenous infusion.

Click here to read the full story.

~The New York Times~

U.S. to reopen land borders in November to fully vaccinated

The U.S. will reopen its land borders to nonessential travel next month, ending a 19-month freeze because of the COVID-19 pandemic as the country moves to require all international visitors to be vaccinated against the coronavirus.

Vehicle, rail and ferry travel between the U.S. and Canada and Mexico has been largely restricted to essential travel, such as trade, since the earliest days of the pandemic. The new rules, announced Wednesday, Oct. 13, will allow fully vaccinated foreign nationals to enter the U.S. regardless of the reason for travel starting in early November, when a similar easing of restrictions is set to kick in for air travel into the country. By mid-January, even essential travelers seeking to enter the U.S., like truck drivers, will need to be fully vaccinated.

Homeland Security Secretary Alejandro Mayorkas said he was “pleased to be taking steps to resume regular travel in a safe and sustainable manner” and lauded the economic benefits of it.

Click here to read the full story.

~Associated Press~

Get your flu shot now

• In the 2019-2020 flu season, influenza sent up to 400,000 people to the hospital and caused an estimated 22,000 deaths in the U.S.
• In past flu seasons, 9 out of 10 adults hospitalized with the flu have had at least one underlying health condition.
• Over the course of 50+ years, hundreds of millions of Americans have safely received flu shots.

Pfizer asks FDA to authorize COVID vaccine for those 5-11

By Sharon LaFraniere and Noah Weiland 
The New York Times

Pfizer and BioNTech asked federal regulators on Thursday, Oct. 7 to authorize emergency use of their coronavirus vaccine for children ages 5 to 11, a move that could help protect more than 28 million people in the United States.

The companies say they are submitting data supporting the change to the Food and Drug Administration. The agency has promised to move quickly on the request and has tentatively scheduled a meeting on Oct. 26 to consider it. A ruling is expected between Halloween and Thanksgiving.

“With new cases in children in the U.S. continuing to be at a high level, this submission is an important step in our ongoing effort against COVID-19,” Pfizer said on Thursday, Oct. 7.

Parents across the United States are anxiously awaiting the regulators’ decision, which could affect family life and the operation of schools. Clearance depends not only on the strength of the clinical trial data, but on whether the companies can prove to regulators that they are able to properly manufacture a new pediatric formulation.

Pfizer has proposed giving children one-third of the adult dosage. That might require adding more diluent to each injection or using a different vial or syringe. The company was expected to describe the method it intended to use in its submission to the Food and Drug Administration.

Click here to read the full story. 

FDA authorizes Pfizer booster shots for older and at-risk

By Noah Weiland and Sharon LaFraniere 
The New York Times

After weeks of internal strife at the Food and Drug Administration, the agency on Wednesday, Sept. 22 authorized people over 65 who had received Pfizer-BioNTech’s coronavirus vaccine to get a booster shot at least six months after their second injection.

The FDA also authorized booster shots for adult Pfizer-BioNTech recipients who are at high risk of becoming severely ill with COVID-19 or are at risk of serious complications from the disease because of frequent exposure to the coronavirus at their jobs.

The authorization sets up what is likely to be a staggered campaign to deliver the shots, starting with the most vulnerable Americans. It opens the way for possibly tens of millions of vaccinated people to receive boosters at pharmacies, health clinics, doctors’ offices and elsewhere.

Click here to read the full story.

FDA authorizes additional OTC home test
to increase access to rapid testing for consumers

On Monday, Oct. 4, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the ACON Laboratories Flowflex COVID-19 Home Test, an over-the-counter (OTC) COVID-19 antigen test, which adds to the growing list of tests that can be used at home without a prescription. This action highlights our continued commitment to increasing the availability of appropriately accurate and reliable OTC tests to meet public health needs and increase access to testing for consumers.

The Oct. 4 authorization for the ACON Laboratories Flowflex COVID-19 Home Test should significantly increase the availability of rapid, at-home tests and is expected to double rapid at-home testing capacity in the U.S. over the next several weeks. By years end, the manufacturer plans to produce more than 100 million tests per month, and this number will rise to 200 million per month by February 2022.

Since March 2020, the FDA has authorized more than 400 COVID-19 tests and sample collection devices, including authorizations for rapid, OTC at-home tests. The FDA considers at-home COVID-19 diagnostic tests to be a high priority and we have continued to prioritize their review given their public health importance. 

Click here to read the full news release. 

Oregon doctor loses license for not wearing mask
and spreading misinformation

By Cheryl Clark
MedPage Today 

An Oregon physician has lost his license because he refused to wear a mask while treating patients and because he spread misinformation about masking, according to an Oregon Medical Board order.

In the 25-page order signed Thursday, Sept. 2, the board revoked the license of Steven Arthur LaTulippe, MD, a family doctor who had practiced in Dallas, Oregon, and specialized in pain and addiction medicine.

LaTulippe regularly told his patients that masks are ineffective in preventing the spread of COVID-19 and referred his patients to a YouTube video that said masks are ineffective, according to the order. He also regularly advised patients that masks were dangerous to their health, the order stated.

The Oregon board's revocation was also based on investigations that found LaTulippe mismanaged numerous patients he had been treating for pain or opioid addiction.

Click here to read the full story.

Risk Advisor

Our Risk Management Team is here to help you minimize and mitigate
Medical Professional Liability risk. 

Debunking HIPAA Security Myths

From Risk Advisor (A quarterly publication from MICA Risk Management)

The HIPAA privacy and security rules have been around long enough to generate legends and myths. Local and national headlines continuously announce legendary numbers of cyberattacks affecting patients and their medical records. MICA Risk Management Consultants hear HIPAA myths from callers to the Risk Management Services Hotline. Dispelling the myths, especially about the mandatory security risk analysis, could lead to fewer legends.

Myth: The HIPAA security risk analysis (SRA) is optional for small or solo medical offices or practices. They do not have to complete a SRA.

Fact: Physicians, advanced health care professionals, medical offices and practices and other HIPAA covered entities must perform a SRA regardless of size or specialty. Any physician, provider or other health care practitioner billing electronically is considered a covered entity.

Myth: My practice has a HIPAA certified EHR; therefore, we do not have to perform a SRA.

Fact: There is no such thing as a HIPAA seal of approval or a HIPAA compliant certification. An EHR vendor can only provide satisfactory assurances, usually in the form of a business associate agreement, the vendor is appropriately safeguarding protected health information (PHI) it creates, receives, maintains or transmits for you/your practice in accordance with the HIPAA rules and regulations. The Office of the National Coordinator for Health Information Technology (ONC) has a list of EHRs tested and certified under the ONC Health IT Certification Program. Also, HIPAA requires covered entities and business associates conduct a SRA of all electronic PHI, not just the PHI in the EHR.

Myth: Since my practice is small, I must contract with someone to perform a SRA.

Fact: Practices of any size or specialty can perform a SRA or work with a SRA vendor. The Office of the National Coordinator for Health Information Technology (ONC) offers a downloadable SRA tool for small and medium size practices. However, some practices will be more comfortable using an experienced outside professional for the SRA.

Myth: My practice can use a one-page SRA checklist to comply with the HIPAA SRA requirement.

Fact: There are pages and pages of SRA questions to be answered. Performing and documenting a SRA on one page would be difficult, if not impossible.

Myth: A SRA is one-and-done. Once the practice has completed one the practice has complied with the SRA requirement.

Fact: The SRA is a continuous process so applying a tool and assessing one time is not enough. The SRA involves regular and periodic reviews, tracking, detection and evaluation. A SRA should support adoption of an EHR and adapt to an existing EHR and practice operational changes. Small practices can use Reassessing Your Security Practices in a Health IT Environment – A Guide for Small Health Care Practices.

Click here to read what the above information is based on.

Senior Risk Management Consultants are ready to help with questions and provide more information. You can reach a Consultant Monday-Friday 8:30 a.m.-5 p.m. MST at (800) 352-0402  Ext. 2137, (602) 808-2137, or rm_info@mica-insurance.com.

Mutual Insurance Company of Arizona (MICA) is a Friends of the Society member.

NIH director to end tenure by end of year

Francis S. Collins, MD, PhD, on Tuesday, Oct. 5 announced his decision to end his tenure as the director of the National Institutes of Health by the end of the year. Dr. Collins is the longest serving presidentially appointed NIH director, having served three U.S. presidents over more than 12 years.

“It has been an incredible privilege to lead this great agency for more than a decade,” said Dr. Collins. “I love this agency and its people so deeply that the decision to step down was a difficult one, done in close counsel with my wife, Diane Baker, and my family. I am proud of all we’ve accomplished. I fundamentally believe, however, that no single person should serve in the position too long, and that it’s time to bring in a new scientist to lead the NIH into the future. I’m most grateful and proud of the NIH staff and the scientific community, whose extraordinary commitment to lifesaving research delivers hope to the American people and the world every day.”

A physician-geneticist, Dr. Collins took office as the 16^th NIH director on August 17, 2009, after being appointed by President Barack Obama and confirmed by the U.S. Senate. In 2017, he was asked to continue in his role by President Donald Trump, and in 2021, by President Joe Biden. Prior to becoming the NIH director, Dr. Collins served as the director of the National Human Genome Research Institute (NHGRI) from 1993-2008, where he led the international Human Genome Project, which culminated in April 2003 with the completion of a finished sequence of the human DNA instruction book.

Click here to read the full news release. 

Fentanyl overdoses are leading cause of death
among young Tucsonans

Fentanyl overdoses have now replaced car accidents as the leading cause of death for people 19 and younger in Pima County, as 2021 moves toward being a record year for all overdose deaths.

So far, 18 in that age group have died of fentanyl overdoses here this year, said Mark Person, program manager of Community Mental Health and Addiction for the county. Health authorities expect more than 30 deaths in the 19-and-younger group for 2021.

“It’s so deceptive, this tiny little pill that’s at all the parties,” said Person. “If you are a parent, you really need to know about it, or if you have a loved one who struggles with addiction, you really need to know about it.”

Fentanyl is cheap and common here, and some teens might be deceived into thinking the tiny pill is relatively harmless compared to injecting drugs like heroin, Person said.

“It doesn’t look all that dangerous or intimidating,” he said, “but it’s up to 100 times more potent than heroin or morphine.”

Social isolation and hardships brought on by the pandemic have compounded the crisis, Person said.

Click here to read the full story. 

Standing vaccination PODs

COVID-19 vaccine eligibility available to those 12 and older. (Pfizer is for ages 12 and older. Moderna and Johnson & Johnson are for those 18 and older. Pfizer is the only booster available at this time.)

While there are no more restrictions on eligibility other than age, only the Pfizer vaccine has been approved for 12 and older. Pfizer is available at county health clinics, mobile vaccination clinics and at local pharmacies.

Those younger than 18 who are getting vaccinated need a parent or legal guardian with them to complete the consent forms. The only exception is if an accompanying adult brings a notarized letter stating that the parent allows the accompanying adult to complete the consent forms.

Free COVID testing

Pima County Health Department has changed its criteria for free COVID-19 testing. Please read criteria below. Because of high demand for COVID-19 testing, University of Arizona students and employees are encouraged to schedule their free test through the University’s testing program.

Click here for list of testing centers and hours and more information.

Pima County placing limits on who can get free COVID tests

With the intent to promote vaccination over routine testing for unvaccinated individuals, the Pima County Health Department has changed its criteria for free COVID-19 testing.

Those presenting COVID-19 symptoms or who believe they’ve been in close contact with someone who tested positive for the virus can access the county’s testing program, but not those seeking tests for work-related reasons or those who’ve had a test within the past 14 days and don’t have COVID-19 symptoms.

“Our goal is to get people vaccinated, so we do not want to be the provider of testing for those occupational or work-related situations that enables people to defer vaccinations,” said Dr. Theresa Cullen, director of the Pima County Health Department. “From a public health perspective, our goal is to get people vaccinated, so that is the primary reason why we have elected to not allow people seeking occupational work-related testing.”

The other reason, Cullen said, is the cost of testing; the county’s using its own federal relief dollars to subsidize the tests.

In late August, the county decided to use its federal allocation from the American Rescue Plan to continue funding its free testing program — which it says has cost more than $50 million since the start of the pandemic — after the state pulled out of the county’s contract with its largest testing contractor, Paradigm Laboratories.

Pima County closer to employee vaccine mandate

The Pima County Board of Supervisors has started the process to potentially impose a vaccine requirement for county employees, but it rejected a motion to mandate masks in schools Tuesday, Oct. 5 as the board considered an array of COVID-19-related policies.

In August, the board turned down the same two proposals because of a slew of state laws banning local governments from taking such actions.

Those laws would have taken effect on Sept. 29, but a Maricopa County Superior Court judge struck them down in a Sept. 27 ruling, making the state laws unenforceable as the decision waits for review in the Arizona Supreme Court.

That change led Supervisor Dr. Matt Heinz, a staunch advocate of COVID-19 mitigation policies and physician at Tucson Medical Center, to bring the motions the board previously rejected back up for consideration.

Supervisors told County Administrator Chuck Huckelberry to outline potential policies for an employee vaccine mandate but again rejected a school mask mandate, favoring leaving the decision to local school boards instead.

Click here to read the full story.

County offering Pfizer COVID booster shots to those eligible

The Pima County Health Department is now offering third-dose (booster) Pfizer-BioNTech COVID-19 vaccinations to eligible individuals at its health clinics, vaccination PODs and mobile clinics.

In addition, all vaccine types, including the Pfizer booster, were available Monday, Oct. 4 on the first floor of the Abrams Public Health Center, 3950 S. Country Club Road. To accommodate the increased demand for boosters, Abrams’ last day of COVID-19 testing was Saturday, Oct. 2.

Third shots are only available to individuals who have received the Pfizer vaccination series. Boosters for the Moderna and Johnson & Johnson vaccinations are still awaiting authorization from the Food and Drug Administration and the Centers for Disease Control and Prevention. Anyone who received the Moderna or Johnson & Johnson vaccine should not receive the Pfizer booster.

“While breakthrough cases of COVID-19 remain rare among vaccinated individuals, they happen, so we’re pleased to be able to offer this added layer of protection to those most at-risk,” said Dr. Theresa Cullen, Pima County Health Department director. “On any given day, residents of Pima County can find literally dozens of sites in which they can get their first, second or third dose of this life-saving vaccine.”

Most pharmacies also have ample booster shots available. Check on locations and vaccine type available on the Arizona Department of Health Services webpage.

Click here to read the full news release. 

Study in Arizona shows effectiveness of mask-wearing
in K-12 schools

Pima County co-authored a study published Friday, Sept. 24 by the Centers for Disease Control and Prevention (CDC) that shows universal mask wearing in Arizona K-12 schools considerably reduces the likelihood of a school-associated COVID-19 outbreak.

The investigation included 999 K-12 public non-charter schools in Pima and Maricopa counties, finding that schools without a mask requirement were 3.5 times more likely to experience a COVID-19 outbreak.

Pima County Health Department Director Dr. Theresa Cullen and the department's Schools COVID-19 liaison Brian Eller were among seven authors in the study, led by Arizona State University.

"The findings reinforce and give credence to the existing guidance from the CDC and Pima County: Universal mask wearing in schools is absolutely an essential part of a layered mitigation strategy against the spread of COVID-19," Dr. Cullen said.

Mask policies and school-associated outbreaks in nearly 1,000 schools were included in this study during the period of July 15 to Aug. 31, 2021.

Schools with mask requirements were categorized as having early mask requirements if the mandate was in place at the start of the school year, or late mask requirements if the mandate was initiated after the start of the school year. Of 191 school-associated outbreaks, 8.4 percent occurred in early mask requirement schools, 32.5 percent in late mask requirement schools, and 59.2 percent in schools without a mask requirement.

A school-associated outbreak was defined as the occurrence of two or more laboratory-confirmed COVID-19 cases among students or staff members at the school within a 14-day period and at least seven calendar days after school started.

The Pima County Health Department has and continues to work closely with all county K-12 schools – public, charter, and private – assisting in COVID-19 mitigation, testing and vaccinations. The health department continues to support CDC guidelines, which recommend that K-12 schools implement universal indoor masking as part of a layered prevention strategy. 

Click here to read the full news release.

Early Cats Takeaway Testing shows promising results

By Kyle Mittan 
University Communications

Week 6 Sept. 27 update: New cases of COVID-19 are on a downward trend on the University of Arizona campus

The most recent day of results for the meeting were from Friday, Sept. 24, with 13 positives from 966 tests, a positivity rate of 1.3 percent, down from 1.7 percent two weeks ago, University of Arizona President Dr. Robert C. Robbins said during a virtual briefing on Monday (Sept. 27) morning.

About 10 percent of the latest testing data is from the university's new Cats Takeaway Testing program, showing that the program has increased students' access to COVID-19 tests, Dr. Robbins said.

The takeaway tests, which launched the week of Sept. 13, involves swishing and gargling a saline solution before spitting it into a tube. It can be completed anywhere and then returned to a designated campus location for analysis. No appointment is required.

Booster shots for COVID-19 vaccines were available to members of the campus community at Campus Health beginning on Monday. Oct. 11. More information, including details about how to book an appointment for a booster shot, are available at Campus Health's COVID-19 vaccine webpage.

Dr. Richard Carmona, 17th U.S. Surgeon General and PCMS member and University Distinguished Professor of Public Health who has joined Dr. Robbins on the weekly virtual briefings, spoke of his own experience receiving a booster shot as a participant in a university-led study on COVID-19 vaccine immunity.

"The booster is a good thing," said Dr. Carmona. "If you fall into the high-risk group, if you're a transplant patient, if you have cancer, please speak to your doctor or primary care provider to see if you should get a booster and when you should get a booster."

Click here to read the full story.

Cancer patients undergoing chemotherapy are likely
not fully protected by COVID-19 vaccine, study finds

The COVID-19 pandemic has been an especially stressful time for cancer patients undergoing chemotherapy, which attacks not only the cancer, but also the immune cells needed to defend the body from infections. New research at the University of Arizona Health Sciences found that patients undergoing active chemotherapy had a lower immune response to two doses of the COVID-19 vaccine, but a third dose increased response. 

"We wanted to make sure we understand the level of protection the COVID-19 vaccines are offering our cancer patients, especially as restrictions were being eased and more contagious variants were starting to spread,” said Rachna Shroff, MD, MS, chief of Gastrointestinal Medical Oncology at the UA Cancer Center and director of the Cancer Center Clinical Trials Office. 

To answer this question, Dr. Shroff, a PCMS member, and a team of UA Health Sciences researchers looked at 53 Cancer Center patients on immunosuppressive active cancer therapy, such as chemotherapy. They compared the immune response following the first and second dose of the Pfizer-BioNTech COVID-19 vaccine with that of 50 healthy adults. Their results were published online in the journal Nature Medicine. 

After two vaccine doses, most of the cancer patients showed some immune response to the vaccine, meaning they had antibodies for SARS-CoV-2, the virus that causes COVID-19.

"We were pleasantly surprised,” said Deepta Bhattacharya, PhD, professor of immunobiology in the College of Medicine – Tucson and a member of the Cancer Center and BIO5 Institute. “We looked at antibodies, B cells and T cells, which make up the body’s defense system, and found the vaccine is likely to be at least partially protective for most people on chemotherapy.”

However, the immune response was much lower than in healthy adults, and a few of the patients had no response to the COVID-19 vaccine. This translates to less protection against SARS-CoV-2, especially the Delta variant that is now the dominant strain in the United States. 

Click here to read the full story.

Newest primary care physician scholars

The University of Arizona Health Sciences welcomed 23 new future primary care physicians into its Primary Care Physician Scholarship Program for the 2021-22 academic year. 

Now in its third year, the Primary Care Physician Scholarship program aims to address two critical issues in health care: Arizona’s shortage of primary care physicians and the rising amount of debt for medical students.

“The Primary Care Scholarship Program will further solidify my roots in the ground of primary care and provide me with a cohort of like-minded individuals who will shape the next century of rural and underserved medicine,” said Muhammad Arif, a fourth-year College of Medicine – Tucson student who grew up in Pakistan.

“Growing up in a village informs my identity,” Arif said. “I want to become a competent physician and mentor others to follow a similar path.”

Earlier this year, the Primary Care Physician Scholarship Program expanded its eligibility to students specializing in general surgery. Arif is one of the students interested in general surgery, along with Aseel Ibrahim, a first-year student at the UA College of Medicine – Tucson. 

“I am committed to breaking the glass ceiling for underserved populations as a general surgeon, above and beyond the operating room,” Ibrahim said.

Arif and Ibrahim are among 11 new scholarship recipients at the College of Medicine – Tucson. Combined with 12 recipients at the UA College of Medicine – Phoenix, this year’s class of 23 students brings the total number of Primary Care Physician Scholarship Program students to 82.

The scholarships, awarded annually, are available to incoming and current students at the Colleges of Medicine in Tucson and Phoenix. They allow medical students to pursue careers in the traditionally lower-paying primary care practice areas without worrying about how they will repay their medical school debt.

Scholarships are available for students who intend to pursue residency training in family medicine, general internal medicine, geriatric medicine, general pediatrics, psychiatry, obstetrics and gynecology, and general surgery. Each scholarship recipient agrees to practice medicine in a federally designated underserved community for at least two years and up to four years after graduation and residency training.

“The scholarship means partial release from the financial constraints of affording a medical education, and trust from my community that I will serve Arizona’s underserved populations where primary care services are lacking,” said Kristie Nonyelu, a first-year student at the College of Medicine – Phoenix.

Once the Primary Care Physician Scholarship Program is fully implemented, approximately 100 students will be receiving free tuition at UA Health Sciences’ two medical schools. The effects will ripple throughout the state as the students complete their residencies and begin practicing in areas that most need medical care. 

The Primary Care Physician Scholarship Program was developed in partnership with and funded by a portion of $8 million approved by the Arizona Legislature and Gov. Doug Ducey in 2019. Fifteen scholarship recipients have completed their medical degrees and are in residency programs.

Click here to access the full story.

UA researchers focus on starving tumors, stunting cancer growth

A research team at the University of Arizona Cancer Center has discovered a new way of controlling blood vessel growth in tumors, a development that could make it easier to treat cancer patients.

“Tumors need blood vessels to deliver the oxygen and nutrients needed in order to grow,” said former graduate student Andrea Casillas. This process of new blood vessels forming is called angiogenesis, and it’s a way that cancer cells spread beyond the primary, or initial, tumor.

Assistant Professor Noel Warfel initiated this project, Casillas said, after studying the role of a pro-survival protein, Proviral Insert for the Moloney murine leukemia virus, or PIM1.

In his most recent research, Warfel — who specializes in cellular molecular medicine at the UA College of Medicine — identified how tumors with high levels of PIM1 were resistant to drugs that typically inhibit, or stunt, cancer growth. Tumors expressing PIM1, instead showed continued blood vessel growth in tumors.

Put simply: When you treat cancer cells with drugs that successfully block blood vessel expansion, it stops the blood flow and oxygen that’s necessary for growth. This leads to more PIM1, which restores blood flows and causes resistance to therapy.

Click here to read the full story. 

FDA authorizes e-cigarettes to stay on U.S. market for first time

By Matt Richtel and Sheila Kaplan 
The New York Times

The Food and Drug Administration for the first time on Tuesday, Oct. 12 authorized an electronic cigarette to be sold in the United States, a significant turn in one of the most contentious public health debates in decades.

In greenlighting a device and tobacco-flavored cartridges marketed by R.J. Reynolds under the brand name Vuse, the agency signaled that it believed that the help certain vaping devices offer smokers to quit traditional cigarettes is more significant than the risks of ensnaring a new generation.

“The authorized products’ aerosols are significantly less toxic than combusted cigarettes based on available data,” the FDA said in a statement announcing the decision.

The statement concluded, “The FDA determined that the potential benefit to smokers who switch completely or significantly reduce their cigarette use, would outweigh the risk to youth.”

Click here to read the full story. 

WHO recommends groundbreaking malaria vaccine
for children who are at risk

The World Health Organization (WHO) is recommending widespread use of new malaria vaccine, made by GlaxoSmithKline, among children in sub-Saharan Africa and in other regions with moderate to high Plasmodium falciparum malaria transmission. The recommendation is based on results from an ongoing pilot program in Ghana, Kenya and Malawi that has reached more than 800,000 children since 2019.

“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. More than 260,000 African children under the age of 5 die from malaria annually.

In recent years, WHO and its partners have been reporting a stagnation in progress against the deadly disease.

"For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”

Click here to read the full news release.

Ernesto Luis Aguilar 1945-2021

Ernesto Luis Aguilar, MD, an internal medicine physician who spent his entire medical career in Tucson, died on Sept. 24, 2021. He was 75.

Born in El Paso, Texas, Dr. Aguilar attended the University of Arizona as an undergraduate majoring in zoology and was a graduate of the College of Medicine in 1973. He continued his education and training in Tucson with an internship and residency in internal medicine from 1973-1976.

He was a member of the staff at El Dorado Hospital since it opened in 1978 and was named to its Board of Directors. He also was a consulting physician at St. Elizabeth of Hungary Clinic. He also worked as an instructor at the University of Arizona for many years starting in 1977.

Dr. Aguilar joined Pima County Medical Society in 1977. In 1984, he was named Secretary/Treasurer for one year on the Board of Directors and was a delegate to the Arizona Medical Association. He returned to the Board of Directors as Secretary/Treasurer in 1990 and Vice President in 1991. He stepped down as a PCMS officer in 1992. He was elected back to the Board of Directors and served two terms from 2004-2009 and was named Chair of the Board of Mediation.

He served on the Board of Directors for the National Hispanic Medical Association and Tucson International Mariachi Conference. He was active in the Rincon Rotary Club.

His service was recognized with awards from PCMS as the 2006 Physician Volunteer of the Year and in 2007 by the Ms. Rosa Parks Living History Maker Awards for working to improve the quality of life for all.

He is survived by his wife, Jennifer; sister, Rose-Yvette; daughters Christina, Mariana and Tiffany; granddaughters Ysa, Stella and Lucy; grandson, Gabriel; great-granddaughter, Kiani; and son-in-law, Huy. No public services have been scheduled.

44th annual THMEP Winter Conference in Telluride, Colorado

Thursday, Feb. 24-Saturday, Feb. 26, 2022

The 44th year of the annual Tucson Hospitals Medical Education Program Winter Conference is coming up. It will be Feb. 24-26, 2022 in Telluride, Colorado. This is one of the community's most popular medical and dental conferences every year.  And as always, the conference features speakers from several states and various specialties, offering stimulating and provocative educational programs on a wide variety of topics relevant to practicing physicians and dentists.

For our ski aficionados, we are expecting another fabulous year of snowfall to support the many winter sports activities that Telluride offers.

Recent information from our Telluride hotels have reported extensive early season reservations along with the numerous registrants from the Tucson medical and dental community!  (Last year we were sold out by late November for many of the rooms.)  

Once you register, you will be guaranteed a seat. Please do not wait, since the rates will gradually increase as we get closer to conference time. 

Click here for more information and to sign up.

For a listing of education opportunities, visit Pima County Medical Society's CME page by clicking here or Programs/Events page by clicking here.