PHOENIX (AP) — Arizona hospitals are hiring out-of-state nurses, squeezing in more beds and preparing for the possibility of making life-and-death decisions about how to ration care as they get ready for an expected surge of coronavirus patients in one of the nation's worst hot spots.
Meanwhile, parents, teachers, businesses and their customers are hunkering down for at least another month of state-imposed closures in a belated effort to slow the spread of the virus and limit overcrowding at hospitals.
Arizona and several other states, including Texas and Florida, that were reopening their economies have clamped back down over the past week as they eclipsed records for infections and hospitalizations. Republican Gov. Doug Ducey, however, went further than other states by ordering gyms and movie theaters to close and postponing the start of school until mid-August.
Texas shut down bars and reduced restaurant capacity, while Florida, where some beaches have been closed, banned alcohol consumption at bars. In contrast, Ducey shut down all bars for 30 days, including in Scottsdale, where employees and young customers crammed into nightclubs without wearing masks or practicing social distancing.
Like Texas Gov. Greg Abbott, Ducey ordered tubing businesses to close after images over the weekend showed large numbers of tubers on the Salt River without masks. While Texas limited the number of people who could be at water parks, Arizona closed them altogether for 30 days.
Tom Hatten, founder and chief executive of Mountainside Fitness, a chain of about 20 gyms across metro Phoenix, expressed frustration at the order to close. He questioned why the governor didn't shut down all businesses.
"I ask the governor: Where is the proof that this decision came from any evidence of what's happening in any healthy club here in Arizona or across the country?" Hatten told reporters late Monday.
At least one Mountainside location in Phoenix was defying the ban, with a half-full parking lot and customers visible inside Tuesday. Lifetime Fitness officials also said they would not close their Arizona locations.
The governor has asked local authorities to enforce his orders.
In another sign of upheaval, cities are canceling Fourth of July fireworks shows following the governor's orders, among them Peoria, Chandler and Marana. Others had already made plans to cancel.
Vice President Mike Pence is scheduled to visit Phoenix on Wednesday and meet with Ducey at the airport before speaking to reporters. It was not clear if he had other plans in Phoenix before returning to Washington.
Pence's last-minute trip to Phoenix replaces a planned campaign event in Tucson and meeting with Ducey in Yuma.
Another 44 people have died from COVID-19, bringing the total since the beginning of the outbreak to 1,632, the Arizona Department of Health Services reported. There were nearly 4,700 new coronavirus cases reported Tuesday, an inflated number due to an undercount in Monday's report.
Arizona has seen skyrocketing infections this month after Ducey allowed his stay-at-home order and his first round of business restrictions to expire on May 15. Over the past seven days, nearly one in four coronavirus tests has been positive, a rate far higher than any other state. The positivity rate is a measure of how widespread the disease is in the community.
Preparing for an influx of patients, hospitals are activating plans to add more beds and staff. State officials have authorized "crisis standards of care," which tell hospitals which patients should get a ventilator or other scarce resources if there is a shortage.
If there are more patients than can be cared for at ideal levels, patients are given a score based on their life expectancy and the likelihood their organs will fail. Hospitals are told not to consider factors like race, gender or sexual orientation or rely on stereotypes or assumptions about the quality of life of people with disabilities.
Emergency rooms are not yet overwhelmed, but COVID-19 is still taking its toll, said Dr. Frank DelVecchio, who works in emergency rooms at several Phoenix-area hospitals, including Valleywise Health. Nurses take a significant amount of time suiting up to protect themselves while caring for coronavirus patients and can't quickly jump from room to room, he said.
"This is just off the charts, sick patients. We're letting people go home that we'd never let go home if they were this sick," including patients with low oxygen, DelVecchio said. "We're trying to get you home oxygen. We're trying to tell you to come back if worse. Because there's not much we can do for you."
People who have attempted or considered suicide are getting stuck for a day or more in emergency rooms because psychiatric facilities won't accept them until they have COVID-19 test results. Because suicidal patients require constant monitoring, they're sometimes placed in hallways or less private areas while awaiting results, DelVecchio said.
Dignity Health, which operates several hospitals in the Phoenix area, is converting more areas to treat COVID-19 patients and preparing to put multiple patients in private rooms, spokeswoman Carmelle Malkovich said. It's bringing nurses from underutilized hospitals in its system to Arizona and hiring traveling nurses and respiratory therapists throughout July.
HonorHealth, another big hospital chain in the Phoenix area, is prepared to implement the first phase of its surge plan as soon as this week, officials said in a statement. They did not explain what that means.