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Takeaway: Arizona has a real problem; Florida and South Carolina not as much; testing is the new labor issue

Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans. CLICK HERE to get daily COVID-19 analysis and alerts from our research team and access our related webcasts.

Politics, Policy & Power | Crises, Real and Imagined - 6 23 2020 9 21 22 AM

"Never let a crisis endure more than six to eight weeks lest your people start questioning your leadership"
- Anonymous


Immigration, legal and not, the third rail of American politics lurks in the background as case counts have risen in Arizona and Texas.

It is a topic no one want to discuss, especially in a battleground state with a hot Senate race like Arizona.

Republicans don't want to get dragged into debating immigration with a wild card in the White House and Democrats want to avoid offending their base while they hastily forget charges of xenophobia leveled at the president in the early stages of the pandemic. 

Yuma County, located along the border with Mexico, has a about 1,600 cases per 100,000 in population, an amount similar to that of New Orleans. In addition to the magnitude, the caseload defies patterns established over the last few months.

Rural areas were largely spared as the disease hit hard densely populated urban areas. Similarly, El Paso, TX and Dona Ana Co., NM, both located at the Juarez crossing, have also experienced large caseloads.

Politics, Policy & Power | Crises, Real and Imagined - Slide1

Politics, Policy & Power | Crises, Real and Imagined - Slide2

These anomalies could be explained by cross-border movement of infected individuals, possibly with family to shelter them in the US.

If so, it would be a competely sensible thing to do. The US health system offers the advanced care needed in terms of medical devices as well as trained respiratory therapists and pulmonolgists unmatched in most of the world, save perhaps Germany.

The result has been a rising number of cases and a corresponding increase in hospitalizations, making Arizona's COVID-19 outbreak look different than what we are seeing in Florida and South Carolina.

The Arizona response illustrates how a COVID-19 outbreak could be handled differently in those places where the next few rounds become similarly severe.

Arizona's emphasis has been more on hospital capacity, testing and contact tracing than on behavioral changes such as wearing face masks or closing businesses.

This approach represents a return to a more accepted historical public health standard where the prime objectives are to keep hospitals functioning normally, deaths at a minimum and the economy operating at full speed.


News outlets have been full of stories over the weekend about spikes in daily case volumes in Florida and South Carolina. Indeed, daily confirmed cases increased dramatically over the last several days.

In keeping with the narrative promoted by CNBC talking heads like former FDA Commissioner Scott Gottlieb, who should know better, and others, the conventional wisdom is that these states allowed bars, restaurants and beaches to open "too early." 


A spike in cases almost six weeks after a relaxation of restrictions on commerce and assembly seems implausible, especially in two states where the rules were mostly honored in the breach. More likely, it is the resumption of activities in Orlando, Amelia Island and other resorts in Florida and in Kiawah, Myrtle Beach and Charleston in South Carolina.

But it is probably not what you think.

Employee safety and customer comfort are the primary concerns expressed about reopening. The safer everyone feels the more likely a normal activity level is reached sooner. To help things along DGX, as one example, launched their workforce testing program on May 27. 

In the last two weeks, the percentage of Florida's cases confirmed in Jacksonville have tripled; those in Orlando have almost doubled. Meanwhile, south Florida which has been the center of disease spread in the state, has played less of a role.

Certainly, other factors could be at work but is appears workplace testing may be the best explanation.

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In fact, Disney Springs opened on June 16th. Seaworld and Universal Studios are schedule to open today with the rest of the park following suite in July. 

Supporting this theory is the limited impact on hospitalizations. Florida does not disclose their COVID hospitalizations like other states but according to data from the CDC 6.3% of Florida inpatient beds were occupied by COVID patients on June 10. Today it is 5.9%

A more typical pattern would be that followed by Arizona which has more confirmed positive cases, more testing AND more hospitalization.

Politics, Policy & Power | Crises, Real and Imagined - Slide3

Florida's Governor has tied himself up like a pretzel trying to explain the caseload increase; first attributing it to more testing then to agricultural workers - probably also true - and then just conceding it was a younger, healthy population of people testing positive and steps would be taken to encourage social distancing at bars and restaurants.

The poor messaging is being attributed to management misstep but it can also be true that the last thing anyone wants to say is that xx number of Disney or Orange County Convention Center workers tested positive for COVID-19.

Assuming the trend holds - more positive cases, a higher positive rate and little serious illness - Governor DeSantis' strategy of isolating and protecting the vulnerable - older, more frail adults - will be vindicated, politics permitting.

No matter what case volumes do this summer or fall, the possibility of any more economic self-immolation is remote. However, political pressure has forced governors to capitulate on things from stay-at-home orders to face masks and it will be applied again in the face of large scale increases in cases.

Florida's program to protect the frail and let everyone else carry on gives less panicky governors a credible path to managing the disease.


The need to assure employees and customers it is safe to return to work gives labor the kind of leverage they haven't seen in years.

Two unions representing Las Vegas casino workers, Unite Here! and the Culinary Workers Union have demanded testing of workers before returning to work and periodically thereafter.

Quite a few have agreed. Health care workers, at significantly more risk than hotel and casino laborers, have made similar demands.

Management will now be in an interesting and more vulnerable position than pre-COVID. While an operator may have control over transmission within his facility, he does not have control over it elsewhere.

Contact tracing seems to suggest that household and congregate living are the most common paths for transmission; less true for work places. Public perception and union commitments will dictate the outbreak response which could include temporary closures and other business interruptions.

For the first time in many years, management may have to develop worker incentives to limit behaviors during non-work hours that could compromise operations.

It will be a new world for contract negotiations.