HEALTH

Arizona COVID-19 updates: 2 school districts brace for teacher sickout in protest of in-person learning

Arizona Republic

Arizona continues to see a surge in COVID-19 cases and record numbers of hospitalizations as efforts begin Monday to bring the vaccine to staff and patients in long term care facilities across the state.

Notable stories Thursday and from earlier this week: 

Follow coverage of the COVID-19 pandemic by Republic and USA TODAY Network reporters here.

7:15 p.m. Friday: When can you get the COVID-19 vaccine in Arizona? What you need to know

Although COVID-19 vaccinations have been off to a slow start, the process is gearing up. 

Arizonans want to know when it’ll be their turn. There’s been a lack of information and plenty of confusion about when and how people who fall into various groups will be able to sign up for vaccine appointments and where they’ll get vaccinated.

The state and its 15 counties are currently working through the first priority phase, mostly health care workers, and will turn next to older Arizonans and essential workers.

Those groups likely will be able to be vaccinated starting in mid- to late January.

About 57,000 Arizonans had been vaccinated with first doses as of Tuesday, using a small portion of the more than 314,000 doses shipped to the state. The process has been slow, even for this well-defined group.

We know you have questions about who comes next and where, when and how individuals will be notified and vaccinated. Much is still being worked out by the state and county health departments.

Here’s what we know now.

— Alison Steinbach

5:30 p.m. Friday: 2 East Valley school districts are bracing for teacher sickouts amid COVID-19 surge

Gilbert and Chandler unified school districts are facing potential teacher sickouts next week when school resumes. 

Gilbert Public Schools plans to put substitute teachers on standby in case teachers call in sick to protest teaching in-person. The first day of school for the district is Tuesday. 

"Our goal will be to ensure appropriate coverage for all classes and no disruption to student learning," Dawn Antestenis, a spokesperson for Gilbert Public Schools, wrote in a statement. "We will keep our parents and families informed as needed." 

Chandler Unified teachers may also call in sick, according to a statement from the district's teacher association, the Chandler Education Association.

"Many of our educators agree with state and county health officials that it’s worth the temporary challenges to follow other East Valley districts and temporarily shift to full-time virtual instruction to allow for COVID to come back under control," educators wrote in the statement.

Both districts are reopening for in-person instruction school immediately following winter break. Gilbert is partially reopening in a hybrid model where students alternate what days they're on campus. Chandler is opening in-person, but it has given families the option of going virtual for the first two weeks, in case they opt to quarantine after traveling for the holiday.

However, many other districts across metro Phoenix, like Mesa, are starting school virtually in light of spiking COVID-19 case numbers.

Chandler's administration plans to meet the day before school is set to begin, on Monday, to "review metrics, gather input, and discuss COVID mitigation strategies," according to a letter sent to district parents. A school board meeting has also been scheduled Wednesday. It's unclear what action district officials will take, or how many teachers would need to call in sick to force schools to close.

The Chandler Education Association reported that 65% of 1,200 staff members surveyed did not feel comfortable returning to school in-person on Tuesday. 

Ultimately, the decision to go back in-person is up to individual school leaders. The state's optional metrics show substantial COVID-19 spread statewide. With substantial spread, state leaders recommend schools operate through a virtual model. 

Teachers throughout the pandemic have said they're uncomfortable working in crowded classrooms when case counts are high. 

And the teachers have leverage: Arizona is in a dire teacher shortage. Districts across metro Phoenix have boosted substitute teacher pay in recent months and have put out calls for community members, including parents, to become substitute teachers.

 — Lily Altavena

4:30 p.m. Friday: AZ reports new ventilator usage record on New Year's Eve, 10,060 new COVID-19 cases

Arizona set a record for the most ventilators in-use for COVID-19 in the state on New Year's Eve as the COVID-19 surge continues, with more than 10,000 new cases and 151 new known deaths reported on New Year's Day. 

The state data dashboard shows 93% of all ICU beds and 93% of all inpatient beds in Arizona were in use Thursday, with 61% of ICU beds and 52% of non-ICU beds occupied by COVID-19 patients. Statewide, there were 123 ICU beds and 559 non-ICU beds available. 

Arizona's seven-day new-case average ranks fourth-highest in the nation, and public health experts expect the virus to spread further because of personal contact over the holidays.

Only California, Tennessee and Rhode Island had higher rates over the past week, according to the Centers for Disease Control and Prevention's COVID Data Tracker.

Phoenix-area hospitals have started temporarily closing to incoming emergency transports and hospital transfers because of overwhelming patient counts. Hospital leaders say they are in the worst position since the pandemic began.

The number of patients hospitalized in Arizona for known or suspected COVID-19 cases was at 4,501 on Thursday, down from 4,564 on Wednesday. By comparison, the highest number of COVID-19 hospitalizations in a single day during the summer surge was 3,517 on July 13.

The number of patients with suspected or known COVID-19 in ICUs across Arizona was at 1,072 on Wednesday, down slightly from the record high 1,076 on Tuesday. During the summer surge in mid-July, ICU beds in use for COVID-19 peaked at 970.

Arizonans with confirmed and suspected COVID-19 on ventilators tallied 759 on Thursday, setting a record for the most ventilators in use for COVID-19 in the state so far. During the summer surge, July 16 was the peak day for ventilator use with 687 patients.

Thursday saw 2,304 emergency room visits for COVID-19, just shy of Tuesday's single-day record of 2,341 positive or suspected COVID-19 patients seen in emergency departments across the state. 

New cases in Arizona have eclipsed 4,000 for 26 of the past 30 days.

California has been the nation's worst hot spot, with the seven-day average rate of 91.9 cases per 100,000 people as of Thursday, according to the CDC's numbers. By comparison, Arizona's rate was 77 per 100,000 people. The national average was 54.4.

Friday's 10,060 new cases brought the total number of identified COVID-19 cases in the state to 530,267. As of Thursday, 9,015 Arizonans are known to have died from the disease, according to the data dashboard from the Arizona Department of Health Services. 

— Lily Altavena

1 p.m. Thursday: Gov. Ducey again extends order to protect health care workers during pandemic

Gov. Doug Ducey on Thursday again extended an executive order that aims to protect health care workers from liability for their response to the COVID-19 crisis.

The so-called “Good Samaritan” order, first implemented in April, seeks to “ensure our medical professionals are protected when acting in good faith in emergency situations,” according to the governor. It will remain effective through March 31. 

Ducey last renewed the directive in late June, when Arizona experienced one of the world’s worst COVID-19 outbreaks. The state now faces an even worse surge exacerbated by the holiday season, with more than 8,800 Arizonans lost to the disease to date. 

Climbing caseloads have overwhelmed hospitals, spurring some Phoenix-area facilities to temporarily reject incoming emergency transports and hospital transfers. In a statement Thursday, Ducey said the extended order would "help maintain staffing levels in our hospitals and ensure our medical professionals are protected when acting in good faith in emergency situations."

In protecting front line workers and volunteers, the order makes it harder for families to sue health care institutions — including nursing facilities — over COVID 19-related care. It does that by raising the bar for civil lawsuits from “negligence” to "gross negligence or reckless or willful misconduct.” 

In other words, to have a shot at a successful legal claim families would have to prove administrators or employees knowingly and voluntarily disregarded reasonable care standards or were recklessly indifferent to the result or the rights and safety of their loved ones.

— Maria Polletta

12 p.m. Thursday: Hospital beds 93% full as AZ reports more than 7,700 new COVID-19 cases

Arizona has just 7% of all hospital beds available as the COVID-19 surge continues, with more than 7,700 new cases of the virus and 146 new known deaths reported Thursday.

The state data dashboard shows 93% of all ICU beds and 93% of all inpatient beds in Arizona were in use Wednesday, with 58% of ICU beds and 53% of non-ICU beds occupied by COVID-19 patients.

Statewide, there were 121 ICU beds and 581 non-ICU beds available, the fewest number of available hospital beds since the pandemic began.

Arizona's seven-day new-case average ranks third-highest in the nation, and public health experts expect the virus to spread further because of personal contact over the holidays.

Only California and Tennessee had higher rates over the past week, according to the Centers for Disease Control and Prevention's COVID Data Tracker.

Phoenix-area hospitals have started temporarily closing to incoming emergency transports and hospital transfers because of overwhelming patient counts. Hospital leaders say they are in the worst position since the pandemic began.

The number of patients hospitalized in Arizona for known or suspected COVID-19 cases was at 4,564 on Wednesday, up from 4,526 on Tuesday and a new record high. By comparison, the highest number of COVID-19 hospitalizations in a single day during the summer surge was 3,517 on July 13.

The number of patients with suspected or known COVID-19 in ICUs across Arizona was at 1,028 on Wednesday, down slightly from the record high 1,076 on Tuesday. During the summer surge in mid-July, ICU beds in use for COVID-19 peaked at 970.

Arizonans with confirmed and suspected COVID-19 on ventilators tallied 746 on Wednesday, just shy of 750 on Tuesday, the record for most ventilators in use for COVID-19. During the summer surge, July 16, with 687 patients, was the peak day for ventilator use.

Wednesday saw 2,304 emergency room visits for COVID-19, just shy of Tuesday's single-day record of 2,341 positive or suspected COVID-19 patients seen in emergency departments across the state. 

New cases in Arizona have eclipsed 4,000 for 26 of the past 30 days.

— Alison Steinbach

3 p.m. Wednesday: Banner Health to pause all elective surgeries

Arizona’s largest health system will pause all elective surgeries starting Jan. 1, because of the surge in COVID-19 patients.

“Due to the recent pressures on our health system brought on by the increase in patients, Banner Health has made the difficult decision to pause all elective surgeries,” Chief Clinical Officer Dr. Marjorie Bessel said at a news briefing Wednesday.

“Elective surgeries” can include serious procedures like cancer surgery or kidney stone removal.  

Banner Health is currently operating over capacity.

The hospital system reached 104% of licensed bed capacity on Tuesday, Bessel said.

Hospitals like Banner Estrella, Banner Desert, Banner Del E. Webb and Banner Thunderbird are at over 120% of licensed bed capacity.

Hospitalizations have increased at an “exponential rate” in recent weeks, Bessel said.

Bed occupancy grew by 150% in December, marking a 286% increase since Nov. 1.

Meanwhile, ICU bed occupancy by COVID-19 patients increased by 600% since Nov. 1, pushing ICUs to 170% of their peak usual winter volume, she said.

COVID-19 patients make up about half of all of Banner’s hospitalized patients. They typically require longer hospitalizations, putting pressure on hospitals for available beds and staff.

— Alison Steinbach

1 p.m. Wednesday: ASU to work with state on K-12 testing

Arizona State University is working with the state Department of Health Services to roll out COVID-19 testing for K-12 schools statewide.

“The goal is to get to everybody. We want to take care of all the schools,” Joshua LaBaer, director of ASU’s Biodesign Institute and leader of the university's COVID-19 research efforts, said during a Wednesday news briefing.

LaBaer said ASU and the state have been working with schools to get the program launched, starting with a mix of rural and urban schools and hopefully expanding across the state.

“The hope would be that we can routinely screen all the teachers and then provide testing availability to the students as needed. We’re trying to get that rolled out as quickly as possible so that we can help everybody stay healthy,” he said.

Testing likely will not take place in individual schools, but rather at common sites near schools for routine teacher testing and available testing for students and their families as needed, he said.

ASU has been active in COVID-19 testing for months by offering its free saliva diagnostic test at locations across Arizona.

— Alison Steinbach 

11 a.m. Wednesday: AZ public universities to get additional $115M in CARES Act funding

Gov. Doug Ducey will give Arizona’s three public universities an additional $115 million for pandemic-related expenses, his office announced Wednesday. 

The cash — funded by the federal Coronavirus Aid, Relief and Economic Security (CARES) Act — is expected to cover costs involving testing and mitigation efforts, distance learning, student outreach and furlough prevention, among other measures.

Arizona State University and University of Arizona will each receive $46 million, while Northern Arizona University will get $23 million. 

“Our universities continue to go the extra mile to fight the spread of COVID-19, protect our communities, and ensure students’ needs are met,” Ducey said in a statement. “The innovation and perseverance of our universities have resulted in testing with quick results, additional PPE (personal protective equipment) for health care workers, enhanced contact tracing, tests to detect antibodies and much more.”

Including Wednesday’s payouts, the state has provided more than $69 million to ASU, more than $53 million to UA and more than $24 million to NAU in response to the pandemic, according to the Governor’s Office.

— Maria Polletta 

9 a.m. Wednesday: Phoenix-Mesa Gateway Airport launches free COVID-19 testing

Travelers arriving at Phoenix-Mesa Gateway Airport will now have convenient access to free COVID-19 testing.

As part of its Stay Healthy, Fly Safe initiative, the airport announced its COVID-19 test site is operational as of Dec. 29. Paradigm Laboratories will administer the tests through a partnership with Arizona Department of Health Services. 

In November, Gov. Doug Ducey asked ADHS to work with Arizona's airports to make onsite testing available to the traveling public. The Centers for Disease Control and Prevention recommends getting tested for COVID-19 prior to and after travel.

Phoenix-Mesa Gateway Airport Executive Director Brian O'Neill believes the test site will also benefit airport employees and tenants along with travelers.

“The State of Arizona’s commitment to provide additional testing locations like the one at Gateway Airport will help reduce the spread of the virus until more of the population has an opportunity to receive the vaccine," O’Neill said in a statement from the airport. 

— Melissa Yeager

3 p.m. Tuesday: Fate of $2,000 coronavirus aid checks in doubt as McConnell blocks immediate action

The fate of President Donald Trump's call to increase pandemic aid checks to $2,000 was in doubt Tuesday as Senate Majority Leader Mitch McConnell blocked Democrats' initial attempt to approve increased payments. 

All eyes are on McConnell and whether he will allow a bill increasing the one-time payments from $600 to $2,000. The Kentucky Republican did not indicate whether any measure would be brought to the Senate floor. 

Instead, the GOP leader outlined three priorities the president demanded Congress examine, linking the increased payments with Trump's calls to repeal Section 230 that allows big tech companies legal immunity and an examination of election integrity after Trump's unproven claims of voter fraud after his defeat. 

"Those are the three important subjects the president has linked together. This week, the Senate will begin a process to bring these three priorities into focus," McConnell said on the Senate floor.

McConnell did not elaborate on how the chamber would look at the issues, or whether they would be combined in legislation. If Republicans link these contentious issues, it's likely to hinder any chances of passing increased aid checks as Democrats and Republicans differ on the issues of big tech immunity and election integrity.

— Christal Hayes/USA Today

12 p.m. Tuesday: Banner Health says Phoenix-area hospitals are diverting patients

Banner Health, Arizona’s largest health care system, said Phoenix-area hospitals have started to close to incoming emergency transports and hospital transfers to handle internal patient backlogs.

In a series of tweets on Tuesday morning, Banner said Arizona hospitals have reported a stream of patients in the last 48 hours that have caused several hospitals to go on “diversion” to restrict patient transports and transfers.

Six Phoenix-area hospitals are currently diverting patients, according to Banner. Ten area hospitals were diverting patients at the same time on Monday.

Banner said diversion does not apply to patients who walk into hospitals for emergency care. Diversion status can change quickly based on capacity and patient changes.

Hospitals sometimes go on diversion in the winter due to higher patient counts, but Banner said it’s “unusual” for so many hospitals to be diverting patients at the same time, a challenge worsened by the “length of stay and complexity of care for COVID-19 patients” in hospitals.

“This is a situation that must be quickly and carefully addressed through balancing of patients and resources between hospitals, increasing staffing, pausing elective procedures and expediting discharges for those who no longer need hospital care,” the hospital system wrote.

Banner said it has not yet activated the triage system of crisis standards of care. Patients who come to emergency rooms will receive care but may have longer wait times.

Banner urged people to still seek hospital care if they have life-threatening medical events.

— Alison Steinbach

11:30 a.m. Tuesday: Arizonans 75 and older will be prioritized in next vaccination phase

Arizonans 75 years old and older will now be prioritized during the second phase of COVID-19 vaccinations, a state panel decided Monday, bringing Arizona in alignment with federal recommendations for vaccine distribution.

Initially, that age group was combined with adults 65 and older to be vaccinated in Arizona's Phase 1C. Now, those 75 and older will be targeted in Phase 1B given their greater risk of adverse outcomes from contracting COVID-19 and the resulting toll on hospitals.

“One of Arizona’s top priorities since the start of the pandemic has been to protect our most vulnerable,” Gov. Doug Ducey said in a released statement. “This updated prioritization will get older Arizonans vaccinated sooner, further protecting those most at-risk and relieving the strain on our hardworking health care professionals.”

Adults ages 75-84 are eight times more likely to be hospitalized and 220 times more likely to die from COVID-19 than adults under 30, according to the U.S. Centers for Disease Control and Prevention. The risks increase even more for people 85 years old and older.

Arizona is currently in Phase 1A for vaccinations, focusing on health care workers, emergency medical services workers and long-term care facility residents and staff.

Phase 1B will include adults 75 and older plus education and child-care workers, protective services occupations, essential services and critical industry workers and adults with high-risk conditions living in congregate settings. That phase is expected to begin in mid- to late January statewide, although it may start earlier in some counties.

The recommendation to move up older adults was made by the Arizona Vaccine and Antiviral Prioritization Advisory Committee, a panel of state, local and tribal experts. A CDC advisory panel had recommended on Dec. 20 that people older than 75 and front-line essential workers be next in line for the vaccine.

— Alison Steinbach

11 a.m. Tuesday: AZ COVID-19 hospitalizations, ICU use hit new highs

The number of patients with suspected or known COVID-19 in intensive care units and hospital beds across Arizona reached record highs as the state reported about 2,800 new COVID-19 cases and 171 new known deaths on Tuesday. 

Arizona's seven-day new-case average ranks third-highest in the nation, and public health experts expect the virus to spread further because of personal contact over the holidays.

Only California and Tennessee have had higher rates over the past week, according to the Centers for Disease Control and Prevention's COVID Data Tracker.

The state data dashboard shows 91% of all ICU beds and 91% of all inpatient beds in Arizona were in use Monday, with 59% of ICU beds and 53% of non-ICU beds occupied by COVID-19 patients.

Statewide, there were 154 ICU beds and 765 non-ICU beds available.

The number of patients hospitalized in Arizona for known or suspected COVID-19 cases was at 4,475 on Monday, up from 4,390 on Sunday and a new record high. By comparison, the highest number of COVID-19 hospitalizations in a single day during the summer surge was 3,517 on July 13.

The number of patients with suspected or known COVID-19 in ICUs across Arizona was at 1,053 on Monday, a new record. During the summer surge in mid-July, ICU beds in use for COVID-19 peaked at 970.

Arizonans with confirmed and suspected COVID-19 on ventilators tallied 720 on Monday, a record for most ventilators in use for COVID-19. The previous single-day record was set Sunday, with 715 ventilators in use. Before that, July 16, with 687 patients, was the peak day for ventilator use.

New cases in Arizona have eclipsed 4,000 for 25 of the past 30 days.

California was the nation's worst hot spot, with the seven-day average rate of 97 cases per 100,000 people as of Monday, according to the CDC's numbers. By comparison, Arizona's rate was 80 per 100,000 people. The national average was 54.5.

Tuesday's 2,799 new cases brought the total number of identified COVID-19 cases in the state to 507,222. As of Tuesday, 8,640 Arizonans are known to have died from the disease, according to the data dashboard from the Arizona Department of Health Services. Of the 171 newly reported deaths, 148 are due to death certificate matching, per the department.

The state reported more than 10,000 cases on Monday, which the Health Department said was due to multiple days' worth of cases added to the dashboard after the holiday weekend.

— Alison Steinbach

3 p.m. Monday: House approves increasing stimulus checks to $2,000 for Americans, sends bill to Senate

The House on Monday approved giving Americans weathering the coronavirus pandemic $2,000 stimulus checks, substantially boosting payments from the $600 checks that were set to be given out as part of a COVID-19 relief package that President Donald Trump signed into law Sunday evening. 

The bill, which passed in a 275 - 134 vote, needed the support of two-thirds of House members present — a feat hard to reach in such a divided Washington. Republicans did not whip or pressure lawmakers on the vote, leaving it up to members to decide on the bill's fate after House Minority Leader Kevin McCarthy, R-Calif., last week blocked a unanimous consent request by Democrats to increase stimulus checks to $2,000. 

The measure will now head to the GOP-controlled Senate where its future remains unclear. Senate Republicans have for months stressed over increased government spending and are likely to oppose the measure despite Trump's demands.

— Christal Hayes/USA TODAY

1:15 p.m. Monday: AZ reports 10K new COVID-19 cases after holiday weekend

The number of patients with suspected or known COVID-19 in intensive care units across Arizona reached a record high as the state reported more than 10,000 new COVID-19 cases and 42 new known deaths on Monday. 

The number of new cases reported is higher than usual because the state added multiple days' worth of cases to its dashboard after the holiday weekend, according to the Arizona Department of Health Services.

The number of patients hospitalized statewide for known or suspected COVID-19 cases was at 4,390 on Sunday, up from Saturday's 4,190, also setting a new record high. By comparison, the highest number of COVID-19 hospitalizations in a single day during the summer surge was 3,517 on July 13.

Ventilator use by COVID-19 patients also set a record high.

The state data dashboard shows 91% of all ICU beds and 90% of all inpatient beds in Arizona were in use Saturday, with 57% of ICU beds and 52% of non-ICU beds occupied by COVID-19 patients. Statewide, there were 166 ICU beds and 847 non-ICU beds available.

Arizona's seven-day new-case average ranks third-highest in the nation. Only California and Tennessee have higher rates over the past week, according to the Centers for Disease Control and Prevention's COVID Data Tracker. 

Public health experts expect the virus to spread further during the holidays.

New cases in Arizona have eclipsed 2,000 for 31 of the past 33 days, with 27 of those days seeing more than 4,000 new cases.

— Lily Altavena

10:30 a.m. Monday: Black, Latina and immigrant mothers are losing jobs as COVID-19 child care crisis grows

Serena Wills starts her day by helping her son log on to his virtual classroom. She spends the next eight hours making sure he keeps the video camera on at all times and stays focused when he attends small group teaching sessions for students with learning disabilities.

Since she lost her job managing invoices as an administrative assistant, Wills has devoted her days to making sure her child is safe and healthy. She feeds him, helps him learn and, when the holiday season began, she asked friends and family to buy him Christmas gifts because she couldn't afford all the things on his list this year.

“I feel like I’m the lunch lady and the IT support and the guidance counselor,” Wills, 45, said.

Wills’ transition from the workplace to her son’s side represents an alarming trend among Black and Latina moms since the pandemic started.

Since March, Black and Latina moms have stopped working, either voluntarily or due to layoffs, at higher rates than white moms. Many are single moms who need childcare but can’t access it during the pandemic. According to the Bureau of Labor Statistics, single moms had higher rates of unemployment than their childless counterparts in the second and third quarters of 2020.

The COVID-19 recession has affected groups in different ways. Black moms have been more likely than Latina moms and white moms to quit their jobs. Higher rates of layoffs affected immigrant moms most severely in 2020. Meanwhile, Latina moms were more likely to be laid off than white and Black moms. This is in part because Latinas were more likely to work face-to-face service positions, such as in restaurants and hotels. 

Experts forecast that loss of skills, tenure and income among women of color will shape the U.S. economy for years to come by making it more difficult for moms of color to re-enter the workforce, earn the same amount as their white counterparts and reach supervisor and management positions.

— Claire Thornton/USA Today

9 a.m. Monday: COVID-19 vaccines to begin today at Arizona nursing homes

With COVID-19 cases on the rise and hospitalizations at record levels, health care workers from two well-known pharmacies will begin fanning out across Arizona to administer long-awaited vaccines at nursing homes. 

The federal government is partnering with CVS Health and Walgreens to offer on-site vaccinations at nursing homes beginning Monday with assisted-living facilities to follow.

Arizona has an estimated 27,000 residents and staff at skilled nursing homes and another 67,000 in assisted-living facilities. 

Facilities were asked to choose either CVS or Walgreens as a vaccine provider. Details from Walgreens were not available, but both companies confirmed vaccines would begin in Arizona this week.

Each morning, CVS teams overseen by pharmacists will head out in separate cars to nursing homes, with Moderna vaccines packed into coolers. The Moderna vaccine, unlike a similar one made by Pfizer, does not need to be stored at ultra-low temperatures before use. 

A pharmacist from CVS will be on site along with nurses, pharmacy technicians and pharmacy interns wearing full protective gear. 

Each facility will get three visits: once to give the first vaccine, a second time to administer a booster 28 days later and a third visit to tie up loose ends.

Arizona has given priority for vaccines to long-term care facilities because of the devastating impact the virus has had on residents.

COVID-19, the highly infectious respiratory disease caused by the new coronavirus, can spread rapidly through such facilities, where residents often live close together and are cared for by the same staff. 

The vaccine has already arrived at nursing facilities on the Navajo Nation. Indian Health Services distributed 3,900 doses to several health care facilities, including a nursing home in Chinle.

In Maricopa County, more than 9,400 residents and staff have been infected at nursing homes and assisted-living facilities since March. More than 1,400 people have died.

— Anne Ryman