Where is COVID-19 in Arizona? It's spreading all around you

Arizonans can’t avoid COVID-19 by avoiding certain cities or coronavirus "hot spots" in the state. The simple truth is, it’s too late for that.

Arizona is experiencing what’s called “community spread,” where the source of infection is unknown. Several of Arizona's 15 counties have reported evidence of community spread.

That means anyone may have a connection to a place where a COVID-19 patient has been, or may know a patient or someone who knows a patient. 

Statewide, community spread was deemed "widespread" by state health officials on March 26.  

Since then, the number of infections and deaths has steadily risen. Earlier, as the virus spread around the country, cases were connected through travel or close contacts of people who had known cases.

On Monday, Gov. Doug Ducey issued a statewide stay-at-home order preventing Arizonans from leaving their houses aside from food, medicine and other "essential activities" until April 30.

On Wednesday, the state reported more than 1,400 identified cases and 29 known deaths. The number of cases is likely much higher, as testing has been slow to arrive and minimally used.

No Arizona county is spared: All now have at least one identified case.

“There is really no safe place right now,” said Joe Gerald, a public health professor at the University of Arizona. “And that's why the governor has asked us to stay at home unless we're doing something that's absolutely essential because we can't be out amongst other people and recognize who is sick and who's not, who is safe and who's not.

"We have to work under the assumption that anyone that we encounter could potentially have this particular infection and could potentially spread it to us.”

What is community spread in Arizona?

The thread can start small.

Will Humble, the executive director for the Arizona Public Health Association, offered an example from his family: The pastor of his parents' church went on a ski trip and came down with COVID-19. Before he was symptomatic, weeks ago, the church still held services. Members of the choir became sick. They may have spread it to their networks of family, friends and co-workers. 

"The virus finds whatever opportunity it can find to find a new host, to identify a new host, to infect the new host, reproduce itself. ... That's the virus's goal: Find a new host and reproduce," Humble said. 

The first known case of community spread in Arizona came on March 6: A Pinal County woman in her 40s who works in health care. Public health officials couldn't identify how she became infected. 

It's not clear how many cases are now community spread or other types of known contact with the virus. 

On Monday, Cochise County announced that it now has community spread, the county’s health department said in a news release. An adult female who is hospitalized outside Cochise County had no recent travel history, leading the county to believe she is the first case of community spread in Cochise County.

Data on specific locations of each infection are not publicly reported. 

The state has cited privacy concerns as one reason why. They have also said COVID-19 isn’t like measles, where it stays very contagious and the public needs to be notified in case they were at a certain place at a certain time.

"To be honest, the data, even if it was readily available, and everyone knew exactly where the known cases are, that information isn't what's going to help you," Humble said.

"What's going to help you is changing your behavior and reducing the number of opportunities that you have to get infected, recognizing you're trying to ever get to zero."

Who can be carriers? Anyone

COVID-19 mainly spreads person to person through close contact or through respiratory droplets produced when people who have the virus cough or sneeze, according to the Centers for Disease Control and Prevention. 

But COVID-19 can spread from people who aren't yet showing symptoms, the CDC said. And it can spread through infected surfaces, such as doorknobs or countertops. 

The CDC says people are most contagious when they are the sickest, though. Asymptomatic spreading is not thought to be the main form of spreading, the CDC said, and neither is spread through contaminated surfaces. 

There are two ways to control infectious diseases, said Dr. Marjorie Bessel, chief clinical officer for Banner Health, the state’s largest health system.

Containment, the first method, works when there are small outbreaks and officials can trace each activity a person did. Then, affected people will isolate, she said.

Arizona has moved beyond those measures now. Instead, the state has moved into a mitigation phase, where it’s not possible to track and contain each person affected, she said.

"It's so much out there now that we can't possibly track each and every person and who they possibly interacted with and ask them to do social isolation,” Bessel said. “It has exceeded our ability to do that type of tracer activity and we move to social distancing instead."

Certain areas of the country have higher incidences of COVID-19 than others. Traveling to New York City would be a greater risk than traveling to Idaho, Gerald said. But some level of risk is everywhere. 

Part of the challenge is that you can't tell by looking at someone where they have traveled or who they have come in contact with, Gerald said. People in rural areas may travel to Phoenix and return home to their communities, he said. 

"That risk is not zero, just maybe lower in some of our counties, even though they're quite rural," he said. "They have quite a bit of local transmission."

Efforts to limit community spread through distancing

The first steps to containing a virus involve isolating the infected person and notifying those who have come in contact with them. With COVID-19 spreading widely, more drastic measures such as enforced social distancing come into play as a way to stop the spread. 

The idea behind social distancing involves cutting off community spread. On a given day, you see your family and co-workers regularly, but also a host of other people who are shopping in the same stores, eating in the same restaurants, touching the same gas pumps. 

These additional people present risks for virus transmission, Gerald said. People could come in contact with the virus in these community settings and bring it back to their social groups, possibly infecting their family members and co-workers, who in turn may infect others. 

The effects of social distancing measures are not immediate. It will be weeks before we can see how staying at home will affect the rising curve of cases in Arizona. 

Humble said he believes these measures will work. Already, the streets are much quieter. Grocery stores are spacing people out. People are giving each other space in public. 

"It's not going to be perfect, but the more compliance we get, and the more we get people to take it seriously for the next few weeks, the better off we'll all be," Humble said. 

Bessel said examples around the world show what can happen if the demands on the health care system exceed capacity. It could happen here. It can happen anywhere.

Social distancing helps slow the spread of transmission to “flatten the curve,” a term now widely used as a rallying cry to get people to stay at home. Social distancing is a "blunt tool," Bessel recognizes, but it's what we've got for now. 

“I'd ask all of us as good citizens of Arizona to take that very, very seriously," she said. "It's not necessarily always about yourself. It's about your grandmother, your grandfather, your neighbor and it's about the health care workers.

"In order for us to take care of as many Arizonans as we can and save as many lives as we can, we have to keep our health care workers safe."

Republic reporter Stephanie Innes contributed to this story. 

Reach reporter Rachel Leingang by email at rachel.leingang@gannett.com or by phone at 602-444-8157, or find her on Twitter and Facebook.

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