The new coronavirus in Arizona
Arizona Gov. Doug Ducey puts a face covering back on after speaking about the latest coronavirus data at a news conference on June 25, 2020, in Phoenix.
Ross D. Franklin/Associated Press
The new coronavirus in Arizona
Arizona Gov. Doug Ducey uses hand sanitizer as he wears a face covering prior to speaking about the latest coronavirus data at a news conference on June 25, 2020, in Phoenix.
Ross D. Franklin/Associated Press
The new coronavirus in Arizona
Arizona Gov. Doug Ducey and Arizona Department of Health Services Director Dr. Cara Christ wear face coverings as they arrive for a news conference to report the latest Arizona coronavirus data on June 25, 2020, in Phoenix.
Ross D. Franklin/Associated Press
The new coronavirus in Arizona
Customers wear masks as they wait to enter a store in Tempe on June 17, 2020.
Matt York/AP
The new coronavirus in Arizona
The Arizona Department of Transportation posts new signage on along highways urging the public to wash hands due to the recent surge in coronavirus cases on June 21, 2020, in Phoenix.
Ross D. Franklin/AP
The new coronavirus in Arizona
Emelia Rhine wears a mask as she plays in the water of a splash pad at Desert Breeze Park in Chandler on June 22, 2020.
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The new coronavirus in Arizona
Bob Anderson walks his dog Gates through a neighborhood in downtown Phoenix as the temperature approached 110 degrees on June 22, 2020.
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The new coronavirus in Arizona
Customers wear masks as they wait to enter a store in Tempe on June 17, 2020.
Matt York/AP
The new coronavirus in Arizona
The entrance to the H Mart Groceries & More store posts several signs letting customers know that face masks are required to enter the store on June 17, 2020, in Mesa.
Ross D. Franklin/AP
The new coronavirus in Arizona
People with masks on make their way around Mill Avenue in Tempe on June 20, 2020.
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The new coronavirus in Arizona
People without masks on make their way around Mill Avenue in Tempe on June 20, 2020.
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The new coronavirus in Arizona
People without masks on make their way around Mill Avenue in Tempe on June 20, 2020.
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The new coronavirus in Arizona
People gather to eat and drink on a Saturday night on Mill Avenue in Tempe on June 20, 2020.
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The new coronavirus in Arizona
Gov. Doug Ducey along with Dr. Cara Christ, director of Arizona Department of Health Services, and Maj. Gen. Michael McGuire walk to a room to update the state on COVID-19 during a news conference in Phoenix on June 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Gov. Doug Ducey updates the state on COVID-19 during a news conference in Phoenix on June 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Maj. Gen. Michael McGuire puts his mask on after speaking to reporters on COVID-19 during a news conference in Phoenix on June 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Dr. Cara Christ, director of the Arizona Department of Health Services, puts her mask on after speaking to reporters on COVID-19 during a news conference in Phoenix on June 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Gov. Doug Ducey puts his mask on after speaking to reporters on COVID-19 during a news conference in Phoenix on June 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Gov. Doug Ducey updates the state on COVID-19 during a news conference in Phoenix on June 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
A person is brought to a medical transport vehicle from Banner Desert Medical Center as several transports and ambulances are shown parked outside the emergency room entrance, Tuesday, June 16, 2020, in Mesa.
Ross D. Franklin/AP
The new coronavirus in Arizona
Berto Cortez, a CVS pharmacy technician, shows how COVID-19 tests are processed in a testing area set up by CVS at St. Vincent de Paul medical clinic on June 15, 2020, in Phoenix.
Ross D. Franklin/AP
The new coronavirus in Arizona
Signage in Spanish at the entrance to a local post office suggests social distancing and wearing PPE, Tuesday, June 16, 2020, in Phoenix.
Ross D. Franklin/AP
The new coronavirus in Arizona
A customer stops at a drive-thru self-swab coronavirus test site at a CVS Pharmacy location on June 14, 2020, in Phoenix.
Ross D. Franklin/AP
The new coronavirus in Arizona
Berto Cortez, a CVS pharmacy technician, shows how COVID-19 tests are processed in a testing area set up by CVS at St. Vincent de Paul medical clinic on June 15, 2020, in Phoenix.
Ross D. Franklin/AP
The new coronavirus in Arizona
Signage at the entrance to a local post office suggests social distancing and wearing PPE on June 16, 2020, in Laveen.
Ross D. Franklin/AP
The new coronavirus in Arizona
In this May 13, 2020 file photo guests dine in-house at a restaurant in Phoenix.
Matt York/AP
The new coronavirus in Arizona
In this June 1, 2020 file photo, Kristina Washington, special education staff member at Desert Heights Preparatory Academy, walks past a series of desks and chairs at the school in Phoenix, returning to her classroom for only the second time since the coronavirus outbreak closed schools.
Ross D. Franklin/AP
The new coronavirus in Arizona
Arizona Republican Gov. Doug Ducey answers a question after announcing the latest coronavirus numbers and recent spike in cases during a news conference Thursday, June 11, 2020, in Phoenix.
Ross D. Franklin, AP
The new coronavirus in Arizona
Dr. Cara Christ, Director of Arizona Department of Health Services, answers a question after Arizona Republican Gov. Doug Ducey announced the latest coronavirus numbers and recent spike in cases during a news conference Thursday, June 11, 2020, in Phoenix.
Ross D. Franklin, AP
The new coronavirus in Arizona
A patron with an appointment lines up at the St. Vincent de Paul Clinic to get a coronavirus test as the clinic has partnered with CVS Health to provide the testing Tuesday, June 9, 2020, in Phoenix.
Ross D. Franklin, AP
The new coronavirus in Arizona
The scene outside the emergency room at Banner Desert Medical Center in Mesa on June 9, 2020. Banner Health, Arizona’s largest health system, has about half of the state’s hospitalized COVID-19 on any given day.
David Wallace/The Republic
The new coronavirus in Arizona
Matthew Garcia, owner of Arizona Bio-Fogging Disinfection Services, uses a propane powered bio-fogger to disinfect the Jabz Boxing studio at 3136 E. Indian School Road in Phoenix, as the boxing fitness center for women prepares to reopen following their closure in mid March because of the COVID-19 pandemic, on May 14, 2020.
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The new coronavirus in Arizona
Father Andres Arango distributes Holy Communion while wearing a mask amid COVID-19 at Gordon Hall at St. Gregory’s Catholic Church in Phoenix on May 10, 2020.
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The new coronavirus in Arizona
Bartenders Chase Watts, right, and Luke Valenzuela make drinks at Culinary Dropout in Phoenix on May 22, 2020.
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The new coronavirus in Arizona
Arizona Gov. Doug Ducey Dr. Cara Christ, Director of Arizona Department of Health Services, left, depart after speaking about the state’s most recent coronavirus data during a news conference Thursday, May 28, 2020, in Phoenix.
Ross D. Franklin, AP
The new coronavirus in Arizona
Customers drink at the bar as masked employees work at Culinary Dropout in Phoenix on May 22, 2020.
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The new coronavirus in Arizona
A phone case and repair kiosk employee relaxes in between customers at Chandler Fashion Center mall in Chandler on May 23, 2020.
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The new coronavirus in Arizona
Greg Neises, a bartender, wipes down the bar after serving a guest at the Hotel Valley Ho in Scottsdale on May 22, 2020. With demand starting to pick back up at the Hotel Valley Ho, the hotel has implemented procedures such as partitions, limiting capacity and having staff wear masks during the COVID-19 pandemic.
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The new coronavirus in Arizona
Rianna Vallecillo receives her diploma from principal Sarah Tolar during a senior sendoff celebration on May 21, 2020, at Marcos de Niza High School in Tempe, Ariz.
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The new coronavirus in Arizona
Actor Sean Penn records a video on a community member’s phone at a food distribution point before the start of a weekend-long curfew in Coyote Canyon, New Mexico, on the Navajo Nation on May 15, 2020.
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The new coronavirus in Arizona
Al Duberchin (right, medical tech) monitor employees temperatures, including Mark Walsh (left), May 19, 2020, as they enter the Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, Arizona.
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The new coronavirus in Arizona
Volunteer Tuqa Alfatlawi, help Muslim community mostly from Syria, during the Food distribution at the Islamic Community Center of Phoenix. Families in need came for a drive-through service due to coronavirus for safety.
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The new coronavirus in Arizona
Parishioners attend Mass at St. Luke Catholic Church in Phoenix May 17, 2020. The church resumed services limited to 25% capacity after state restrictions due to the coronavirus were allowed to expire.
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The new coronavirus in Arizona
Mountain View students laugh and react to cars passing by during the Mountain View High School senior parade salute in Mesa, Ariz. on May 16, 2020.
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The new coronavirus in Arizona
Graduating seniors toss their caps at 7:15pm during the Mountain View High School senior parade salute in Mesa, Ariz. on May 16, 2020.
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The new coronavirus in Arizona
Tubers float down the Salt River during the COVID-19 pandemic in Mesa, Ariz. on May 16, 2020. Arizona Governor Doug Ducey lifted his stay-at-home order Friday, the 15, and the day after Salt River Tubing reopened with some guidelines in place to promote safety during the pandemic.
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The new coronavirus in Arizona
Local residents go for evening outing at Tempe Town Lake on May 14, 2020.
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The new coronavirus in Arizona
James Landry (left) and Coy Vernon train while others chill having picnic at Scottsdale Civic Center on May 14, 2020.
Nick Oza/The Republic
The new coronavirus in Arizona
Erin Walter, from left, Angelica Kenrick and Sheri Rearick, all with the Professional Beauty Association, participate in an online work meeting at Kenrick’s home in Phoenix on May 14, 2020. Walter and Rearick surprised Kenrick on her birthday by coming to her home, to work from home. The three employees had not seen each other in weeks.
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The new coronavirus in Arizona
May 12, 2020; Scottsdale, Arizona, USA; No spectators allowed signs at the club house during round one at the Scottsdale AZ Open at Talking Stick Golf Club’s OÕodham course. This is the first semi-significant sports event to take place in the Valley since the sports shutdown in March due to the coronavirus (COVID-19) pandemic. Mandatory Credit: Rob Schumacher-USA TODAY Sports
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The new coronavirus in Arizona
People pack into CASA Tempe on the first day of dine in reopening in Tempe on May 11, 2020.
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The new coronavirus in Arizona
People pack into CASA Tempe on the first day of dine-in reopening in Tempe on May 11, 2020.
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The new coronavirus in Arizona
Lo-Lo’s Chicken & Waffles offers dine in services after more than a month of take out only due to COVID-19 in Phoenix, Ariz. on May 11, 2020. Many restaurants around Arizona began reopening dining services as Arizona Governor Doug Ducey lifted some restrictions under the COVID-19 lock down.
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The new coronavirus in Arizona
From left, Kiaya Stearns, Cae Stearns, Heather Stears and Landen Stearns wave to their grandparents above, Harry and Jeanne Sharkey, during a drive-by Mother’s Day parade at LivGenerations, a senior-living community in Ahwatukee, on May 10, 2020. Seeing their grandparents’ reaction to the parade said it all, they said. “It felt amazing,” Heather Stearns said.
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The new coronavirus in Arizona
Sarah Lawrence gets tested for COVID-19 by a Dignity Health medical worker at a drive-up testing site at State Farm Stadium from Dignity Health and the Arizona Cardinals in Glendale on Saturday, May 9, 2020.
Eli Imadali/The Republic
The new coronavirus in Arizona
Dignity Health medical workers Stephanie Tyrin and Shannon Miller relax in between patients at a drive-up coronavirus testing site at State Farm Stadium from Dignity Health and the Arizona Cardinals in Glendale on Saturday, May 9, 2020.
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The new coronavirus in Arizona
From left, manager David Grady and owner Mimi Nguyen do mother and daughter customers Tonna and Elaina Yutze’s nails at AZ Nails Spa 101 near the P83 Entertainment District in Peoria on May 8, 2020.
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The new coronavirus in Arizona
Matthew Gallegos (left) cuts Justin Beam’s hair (right) inside of his shop Matt’s Barber Parlor in Phoenix, Ariz. on May 8, 2020. After Arizona Governor Doug Ducey allowed salons, barbershops, and other retail stores to resume businesses many barbershops and salons in Phoenix began taking clients by appointment only.
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The new coronavirus in Arizona
Jets sit parked near the run way at Phoenix Sky Harbor International Airport on May 7, 2020.
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The new coronavirus in Arizona
Volunteers, including Andy Torres (center) wait to load food boxes, May 6, 2020, during a St Mary’s Food Bank mobile distribution at the Gila River Arena, 9400 West Maryland, Glendale.
Mark Henle/The Republic
The new coronavirus in Arizona
President Trump tours Honeywell International’s mask-making operation in Phoenix May 5, 2020. Honeywell added manufacturing capabilities in Phoenix to produce N95 face masks in support of the governments response to COVID-19.
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The new coronavirus in Arizona
Arizona Gov. Doug Ducey (front), Sen. Martha McSally (back left) and Rep Debbie Lesko (right) wear masks while waiting for President Trump to speak at Honeywell International’s mask-making operation in Phoenix May 5, 2020. Honeywell added manufacturing capabilities in Phoenix to produce N95 face masks in support of the governments response to COVID-19.
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The new coronavirus in Arizona
Phoenix Fire Department helped Bea Markow celebrate her 100th birthday, while keeping social distancing in mind.
Phoenix Fire Department
The new coronavirus in Arizona
The staff of Hood Burger outside Cobra Arcade Bar in downtown Phoenix on May 2, 2020. Hood Burger, a nonprofit pop-up eatery, is offering food to help the Arizona Coalition to Arizona Coalition to End Sexual & Domestic Violence.
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The new coronavirus in Arizona
Demonstrators listen to speakers during a rally for the governor to open the state at Wesley Bolin Plaza in Phoenix. Organizers of the event say that quarantine is for the sick and not the healthy. May 3, 2020.
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The new coronavirus in Arizona
Derick Asturias gets tested for the novel coronavirus during the testing blitz at Valle del Sol, a testing site in Phoenix on May 2, 2020.
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The new coronavirus in Arizona
Jets with Luke Air Force Base and the Arizona National Guard fly over the valley near Luke Air Force base to honor people fighting on the front lines of the COVID-19 virus in Ariz. on May 1, 2020.
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The new coronavirus in Arizona
Healthcare professionals take a selfie outside Valleywise Health Medical Center as they wait for a flyover from the Arizona National Guard to honor essential workers in Phoenix, Ariz. on May 1, 2020.
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The new coronavirus in Arizona
Brandy Nieman, on left, and Jill Cunningham rides in a bus in downtown Phoenix. Valley Metro Transit System will be reducing their services due to Covid-19.
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The new coronavirus in Arizona
Arizona Cardinals wide receiver Larry Fitzgerald speaks to the media before dropping off food to medical workers April 29, 2020. Fitzgerald was dropping off food from Ocean 44 Restaurant to various health care workers helping with COVID-19.
Michael Chow/The Republic
The new coronavirus in Arizona
Quyen Bach (left) and Chris French have their photos taken by Kim Ly at Papago Park in Phoenix on April 29, 2020. Both are graduating from A.T. Still University Arizona School of Dentistry.
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The new coronavirus in Arizona
Jamie Doles lays with her daughter Paisley, 3, as they watch the Book of Life at the Digital Drive-In AZ in Mesa, Ariz. on April 20, 2020.
Patrick Breen/The Republic
The new coronavirus in Arizona
A health care worker stands in counter protest as people march towards the Arizona State Capitol in protest of Gov. Doug Ducey’s stay-at-home order to combat the coronavirus April 20, 2020. They were urging the governor to re-open the state.
Michael Chow/The Republic
The new coronavirus in Arizona
The copper dome and Winged Victory statue over the Arizona State Capitol is illuminated with blue light in Phoenix during the “Light It Blue” campaign across the United States to honor essential front-line workers and health care professionals during the coronavirus COVID-19 pandemic.
Rob Schumacher/The Republic
The new coronavirus in Arizona
United Food Bank volunteers and National Guard soldiers distribute care packages to families on April 17, 2020, at the Mesa Convention Center in Mesa, Ariz.
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The new coronavirus in Arizona
Melissa Read breaks down cardboard boxes while United Food Bank volunteers and National Guard soldiers distribute care packages to families on April 17, 2020, at the Mesa Convention Center in Mesa, Ariz.
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The new coronavirus in Arizona
Bruce Forstrom, a volunteer with United Food Bank, prepares emergency food bags at the United Food Bank warehouse in Mesa on April 16, 2020. Despite the increased need because of the coronavirus pandemic, United Food Bank has seen an over 60 percent decrease in volunteers, also because of the pandemic, according to Tyson Nansel, United Food Bank director of public and media relations.
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The new coronavirus in Arizona
A rider wears a mask over her face while traveling east on the Arizona Canal Trail near Goldwater Blvd and East 5th Ave. in Scottsdale. Apr. 15, 2020
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The new coronavirus in Arizona
James Smith, with Balfour, the company that sells graduations caps and gowns, hands a cap, gown and grad box which includes graduation mailing announcements, to a Skyline high school graduating senior as they pick them up from their vehicle at Skyline high school in Mesa on April 14, 2020. Tom Brennan, principal of Skyline, says he is unsure what kind of graduation ceremony they will have, if any at all, because of the coronavirus pandemic.
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The new coronavirus in Arizona
Frances Rozzen, wearing a mask because of the coronavirus pandemic, looks at the near empty shelves of toilet paper and paper towels at the Safeway grocery store on 16th Street and Southern Avenue in Phoenix on April 13, 2020.
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The new coronavirus in Arizona
A masked golfer tees off on the 12th hole, April 13, 2020, at Arizona Grand Golf Course, 8000 S, Arizona Grand Parkway, Phoenix.
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The new coronavirus in Arizona
Kathy Jacobsen signals to her mother, Audrey Wilson, 80, who has dementia, through the glass pane of a door, at Arbor Rose Senior Center in Mesa on April 1, 2020. Jacobsen was taking her mother out of the facility because of concerns of a coronavirus outbreak within the facility. She is moving her mother in with her at her Gilbert home. Jacobsen had not be able to visit her mother inside the facility because of the coronavirus pandemic since early March.
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The new coronavirus in Arizona
Charlie and Stacy Derouen raise their hands as they listen to Pastor Jason Anderson during an Easter drive-in service at the Living World Bible Church in Mesa, Ariz. on April 12, 2020.
Patrick Breen/The Republic
The new coronavirus in Arizona
Friends catch up on conversation and practice social distancing in an empty shopping center in Phoenix on April 11, 2020.
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The new coronavirus in Arizona
Apr. 10, 2020; Phoenix, AZ, USA; A cross tops the steeple at Dream City Church in Phoenix during the sunrise on Good Friday. Most churches across the United States will be empty on Easter Sunday due to the coronavirus COVID-19 pandemic.
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The new coronavirus in Arizona
Damion Holliday (left) and Andrew Morales wait for their flight to San Diego at Terminal 4 on April 9, 2020, at Sky Harbor International Airport in Phoenix.
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The new coronavirus in Arizona
Airport employees touch their feet together at Terminal 4 on April 9, 2020, at Sky Harbor International Airport in Phoenix.
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The new coronavirus in Arizona
Chalk messages written on a sidewalk in a Tempe neighborhood, reference the coronavirus pandemic on April 8, 2020.
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The new coronavirus in Arizona
Bryan Harding, who works in real estate, works on his front porch in the Maple-Ash neighborhood of Tempe on April 9, 2020. Harding says he likes to work outside because it gives him his own space while his wife works inside.
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The new coronavirus in Arizona
People at Living Word Bible Church attend a “drive-in church service” in Mesa, Ariz. April 5, 2020. The coronavirus pandemic has forced churches to come up with new ways to hold service while social distancing. People are encouraged to honk for amen.
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The new coronavirus in Arizona
Zacona Michaux hands out lunches at Edison Elementary School in Mesa on April 9, 2020. Mesa school district is having trouble getting food supplies and is having to scale back on meal distribution. Edison elementary meal site is closing effective April 10. Starting April 13 meals can be picked up a Kino Junior High (Mondays, Wednesdays, and Fridays).
Cheryl Evans/The Republic
The new coronavirus in Arizona
Haim Ainsworth and his son, Jacob Shapiro-Ainsworth, 11, share a laugh during an online Seder during the first night of the Jewish holiday of Passover at their home in Tempe on April 8, 2020. The Seder which included members from Temple Emanuel was being held online because of the coronavirus pandemic.
David Wallace/The Republic
The new coronavirus in Arizona
Apr. 7, 2020; Phoenix, AZ, USA; The supermoon, also known as the pink moon rises over the Papago Park Buttes, it is the biggest and brightest supermoon of 2020. The coronavirus has changed our lives as social distancing is in our lives
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The new coronavirus in Arizona
Cowboy Club employee Jonathan Castillo wipes down a shelf in Sedona on April 7, 2020.
Thomas Hawthorne/The Republic
The new coronavirus in Arizona
More than 1,000 rental cars sit in a parking lot near Priest Dr. and Van Buren St. in Phoenix, Ariz. on April 6, 2020.
Patrick Breen/The Republic
The new coronavirus in Arizona
Vista Monterey Park in Mesa, Ariz. is closed because of the coronavirus pandemic April 5, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Dikeya Williams stands for a portrait outside Safeway in Phoenix on April 5, 2020. She’s worn her mask, complete with a stapled on image of teeth with grillz and fangs, for two weeks and works as a child care director and provider.
Eli Imadali/The Republic
The new coronavirus in Arizona
Mary Vale (left) and Becky Leuluai wait to give out care packages to hotel employees on April 3, 2020, at the Arizona Biltmore in Phoenix.
Sean Logan/The Republic
The new coronavirus in Arizona
Dee Madden has her hair washed at The Savvy Stylist on a quiet Friday afternoon at the Tempe hair salon on April 3, 2020, just before Gov. Doug Ducey ordered hair and nail salons to be shut down by 5 p.m. on Saturday. Many people are avoiding hair care during the new coronavirus pandemic due to its hands-on nature.
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The new coronavirus in Arizona
Farmworkers harvest iceberg lettuce, April 2, 2020, in a Desert Premium Farms field, south of Welton, Arizona.
Mark Henle/The Republic
The new coronavirus in Arizona
Colton Williams with Crescent Crown Distributing, delivers beer to Tops Liquors in Tempe, Ariz., on April 2, 2020. Tops Liquors has seen an 40 percent increase in sales in the last two weeks.
Cheryl Evans/The Republic
The new coronavirus in Arizona
Isolation tents are set up for homeless persons showing symptoms of COVID-19 at the Central Arizona Shelter Services in Phoenix, Ariz. on April 2, 2020.
Thomas Hawthorne/The Republic
The new coronavirus in Arizona
The City of Phoenix closes park amenities due to the COVID-19 health crisis on the first day of Gov. Doug Ducey’s “stay at home” order at Steele Indian School Park in Phoenix.
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The new coronavirus in Arizona
A woman holds a baby outside of the lobby at Banner University Medical Center Phoenix on the first day of Gov. Doug Ducey’s “stay at home” order on April 1, 2020, in Phoenix.
Sean Logan/The Republic
The new coronavirus in Arizona
Paige Mulvey, 7, touches hands with her grandmother, Kathy Holcombe, 66, through a door window at her home on March 30, 2020, in Phoenix.
Sean Logan/The Republic
The new coronavirus in Arizona
A sign hangs at the front gate to Coyote Ranch, in Yuma, Ariz., Monday, March 29, 2020, during the COVID-19 pandemic.
Randy Hoeft, AP
The new coronavirus in Arizona
Gov. Doug Ducey listens to speakers on COVID-19 during a news conference at the Arizona Commerce Authority in Phoenix March 30, 2020. Gov. Ducey issued a stay at home order effective close of business March 31.
Michael Chow/The Republic
The new coronavirus in Arizona
Dr. Warren Stewart Sr., senior pastor, speaks during a live-streamed Sunday service at First Institutional Baptist Church in Phoenix on March 29, 2020.
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The new coronavirus in Arizona
U.S. Army National Guard specialist Frank Rezzano and U.S. Air Force technical sergeant Justin Emanuelson stock shelves at Basha’s grocery store in Scottsdale on March 28, 2020.
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The new coronavirus in Arizona
A heart of lighted rooms done by Sheraton Phoenix Downtown on March 27, 2020.
Patrick Breen/The Republic
The new coronavirus in Arizona
Timothy Leonard, 73, shops for groceries at Los Altos Ranch Market during the coronavirus pandemic in Phoenix on March 27, 2020.
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The new coronavirus in Arizona
Adam Hansen, a doctor from Redirect Health in Glendale, takes a swab from a patient in a drive-thru to test for flu and coronavirus on March 25, 2020. Medicare and some insurance plans will cover the testing (with normal co-pays and deductibles) or there is a $49 self-pay option. Experts say it’s important to get a test inside the first 48 hours of symptoms starting.
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The new coronavirus in Arizona
Medical assistant Mary Hermiz checks a sample from a patient at a Glendale drive-thru that tests for flu and coronavirus on March 25, 2020. Medicare and some insurance plans will cover the testing (with normal co-pays and deductibles) or there is a $49 self-pay option. Experts say it’s important to get a test inside the first 48 hours of symptoms starting.
Nick Oza/The Republic
The new coronavirus in Arizona
As many Phoenicians work from home due to the COVID-19 pandemic, Central Avenue appears empty and void of traffic in downtown Phoenix on March 25, 2020.
Michael Chow and Thomas Hawthorne/The Republic
The new coronavirus in Arizona
Spc. Sofia Pez (left) and Spc. Juan Sandoval load a box into a client’s vehicle on March 25, 2020, at the St. Mary’s Food Bank Alliance in Phoenix.
Mark Henle/The Republic
The new coronavirus in Arizona
Emily Miles has her temperature taken before being allowed to donate blood at a temporary blood bank set up in a church’s fellowship hall Tuesday, March 24, 2020, in Tempe, Ariz. Schools and businesses that typically host blood drives are temporarily closed due to precautionary measures in place to reduce the spread of the COVID-19 coronavirus leading to extremely low levels of blood availability throughout the state.
Matt York, AP
The new coronavirus in Arizona
Shawn Ray, owner of S2 Armament LLC, tells a customer that nearly all inventory of firearms and ammo are sold out at Patriot Nation Firearms and Accessories in Phoenix.
David Wallace/The Republic
The new coronavirus in Arizona
John White, 9, decorates his mother’s van before a parade for Val Vista Lakes Elementary School students in their neighborhoods on March 23, 2020, in Gilbert, Ariz.
Sean Logan/The Republic
The new coronavirus in Arizona
Banner UMC’s drive-up system in Tucson is for emergency room triage for a variety of illnesses and is not for random testing for COVID-19. It has been put in place to keep crowds from the ER and protect the health of patients and staff.
Josh Galemore/Arizona Daily Star
The new coronavirus in Arizona
Toliet paper offered with frame purchases at the downtown Farmer’s Market in Phoenix, Ariz. on March 21, 2020.
Patrick Breen/The Republic
The new coronavirus in Arizona
Sheena Williams of Nature’s Medicines announcing to keep a distance from each other from long lines for people who are in need with their medical card. Because of the new law on gathering, they were allowing five people at the time, and everyone was keeping a distance from themselves to get their Medicine.
Nick Oza/The Republic
The new coronavirus in Arizona
A tent for extra hospital beds is pictured at the Phoenix VA on March 19, 2020, in Phoenix.
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The new coronavirus in Arizona
Customers wait for the doors to open, March 17, 2020, at Target, 1818 E. Baseline Road, Tempe.
Mark Henle/The Republic
The new coronavirus in Arizona
Individuals are tested for COVID-19, also known as the coronavirus at a mobile clinic set up in the parking lot at the Mayo Clinic Hospital in Phoenix on the morning of March 18, 2020. Only Mayo Clinic patients with a doctor’s order could use the mobile clinic. A slow but steady stream of vehicles was passing through the mobile clinic on Wednesday morning.
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The new coronavirus in Arizona
Mar. 18, 2020; Grand Canyon National Park, AZ, USA; Two Taiwanese tourists wear N-95 masks while taking in the view at Mather Point at Grand Canyon National Park in Arizona. Due to the coronavirus COVID-19, park entrance fees are suspended, shuttle bus service is suspended and visitor centers are closed.
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The new coronavirus in Arizona
A customers grabs a package of toilet paper on March 18, 2020, at a Target store in Tempe. Target is only allowing one per customer.
Mark Henle/The Republic
The new coronavirus in Arizona
Customers grab toilet paper on March 18, 2020, at a Target store in Tempe. Target is only allowing one per customer.
Mark Henle/The Republic
The new coronavirus in Arizona
Hikers watch the sun set from the top of “A” Mountain in Tempe on March 17, 2020.
Michael Chow/The Republic
The new coronavirus in Arizona
Juliana Posso (L) and Evan Davis during the Brides of March bar crawl at the Churchill in Phoenix, Ariz. on March 13, 2020.
Patrick Breen/The Republic
The new coronavirus in Arizona
A sign announces that Major League Baseball has suspended the 2020 spring training season, this is in response to the COVID-19 virus health emergency on March 13, 2020 at Salt River Fields at Talking Stick in Scottsdale.
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The new coronavirus in Arizona
Robert Truman, with SSC Services for Education, uses an electrostatic sprayer to sanitize a classroom on March 12, 2020, at Kyrene de la Mirada Elementary School in Chandler.
Mark Henle/The Republic
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The new coronavirus in Arizona
Arizona Gov. Doug Ducey puts a face covering back on after speaking about the latest coronavirus data at a news conference on June 25, 2020, in Phoenix.
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Maricopa County public health officials aren’t conducting COVID-19 case investigations or contact tracing that meet federal guidelines, as cases in the county and state continue to rise and Arizona becomes a new national hotspot.
The county’s efforts to track cases rely on text messaging rather than direct phone calls for positive individuals. Those who test positive and receive a text are then asked to fill out a form that asks them to recall anyone they were in contact with rather than the county conducting a live interview.
Only about 20% of case investigations are being completed through this process, officials confirm. Those who don’t fill out the form receive a phone call from an investigator to complete the investigation and identify contacts.
The pared-down process has drawn criticism from U.S. Rep. Greg Stanton, D-Ariz., who said it leaves people vulnerable. He questions why more federal money provided to the county for responding to the pandemic wasn’t committed to tracing efforts early on, before the major spike hit.
“The County squandered this precious time,” Stanton wrote. “It acted slowly and only ‘started’ to ‘gear up’ in early May — and for a level of staff that was far below what experts predicted would be necessary to safeguard a population the size of Maricopa County.”
County health officials, who now are dealing with one of the biggest case spikes in the U.S., said they are prioritizing older and high-risk individuals with direct contacts and making sure all positive cases are notified so they can begin alerting people they may have been around.
When a person in Maricopa County tests positive for COVID-19, they receive an automated text message from public health officials asking them to fill out a form.
“Maricopa County Public Health recently learned that a person with this phone number tested positive for COVID-19,” the text message reads. “Public Health will be calling you if you are at high risk for severe illness from COVID-19 or if you live/work in a high risk setting.”
Positive individuals, many of them sick with the disease, are asked to fill out a form that details their living situation, if they live or work in congregate settings, if they have symptoms, if they’ve been hospitalized, or if they have underlying conditions.
They’re also asked to enter information for their close contacts, described on the form as anyone they have been within 6 feet of for longer than 10 minutes during the time they were contagious, which includes the two days before they developed any symptoms.
With this contact information, public health will then reach out to these close contacts and provide information.
“Please consider providing the names and phone numbers of your close contacts for this purpose only,” the form says.
Many positive cases in Maricopa County do not receive a phone call from public health workers. Neither do most close contacts of these positive cases. The county said it makes calls to only high-risk and older people who test positive.
Only about 20% of positive cases actually fill out the texted form, the county confirmed Friday.
“It’s much better than nothing, but I think that it’s far from ideal,” said Stephen Kissler, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health, of the county’s contact tracing method.
The way the county is operating isnot exactly how case investigations and contact tracing are supposed to work, according to guidelines from the U.S. Centers for Disease Control and Prevention and public health experts.
In a typical situation for an infectious disease, the positive case and all of their close contacts would receive phone calls from public health workers. The first phone call to a positive case can be lengthy, as they work through the places they’ve gone and the people they’ve seen. Contacts would be well aware that they had been around a positive case.
Contact tracing is seen as a vital part of slowing the spread of the disease. If contacts of positive cases are informed quickly that they have been exposed, they can stay home and avoid spreading to others. In some Arizona counties, this traditional practice appears to be taking place.
Maricopa County intended to conduct fuller case investigations and contact tracing — county public health officials have said as much over the past few months. But their operation has not met CDC guidelines for full contact tracingfor months, even when the number of cases was much lower than it is now.
County officials said they were prepared to investigate about 500 cases per day. But the last few weeks have often seen more than 1,000 or even 2,000 new cases per day in the county.
As of Friday, Maricopa County had 39,626 known cases, per state data. Identified cases have increased by about 300% since June 1. More than one-third of all the county’s cases have been reported in the last week.
The county’s investigations and contact tracing process drew a strong response from U.S. Rep. Greg Stanton, who wrote a scathing letter to the Maricopa County Board of Supervisors detailing the various ways the county’s practices are falling short.
“The situation is a disaster. It is costing lives. It is inexcusable,” Stanton wrote.
County spokesman Fields Moseley said in an email to The Arizona Republic that the board of supervisors “appreciates the congressman sharing his opinion about Public Health operations.”
“Our Department of Public Health is dealing with the disease spread in real-time and making pragmatic decisions based on the ever-expanding body of knowledge about this new virus and the explosion of new local cases,” Moseley said.
What CDC recommends for investigations and tracing
The CDC outlines how case investigations and contact tracing should work. In a case investigation, public health staff reach out to a patient to help them remember everyone they have been in close contact with. Public health workers would then start contact tracing by reaching out to these contacts who were exposed to the positive case.
This should be done “as rapidly and sensitively as possible,” the CDC says. Contacts are only told they have been exposed to a positive case, not who the case is.
Contacts should be given “education, information and support to understand their risk.” They should be informed on how to monitor for symptoms and encouraged to stay home and maintain social distancing for 14 days after exposure to the positive case, the CDC says.
“To the extent possible, public health staff should check in with contacts to make sure they are self-monitoring and have not developed symptoms,” the CDC says.
On a Maricopa County website where positive cases are directed, the county says people will receive a call “within a few days” of submitting the form to follow up on responses and get more information.
But the county confirmed Friday that only high-risk people and those over age 65 are currently receiving phone calls.
Details of what the county does now
When positive tests results come in to the county, every case is sent a text message from the public health department asking them to fill out a survey. Positive cases soon receive an automated phone call as well.
Everyone older than 65 is called directly by a public health investigator, according to Sonia Singh, county health department spokeswoman. Others only get the text message, she said.
Public health employees look over the surveys and if any cases are high-risk, such as people who live in a congregate setting, they are directly contacted by a case investigator, Singh said. The others do not get a phone call.
The survey asks cases to list close contacts and their phone numbers. Those contacts are then contacted to enroll in the Sara Alert System, a public health app where individuals can monitor their symptoms and public health will be notified if they develop COVID-like symptoms.
Cases and contacts are also given a phone number they can call if they need resources to self-isolate.
“This process allow(s) for low risk individuals to be tracked in the system quickly and efficiently and allow Public Health to prioritize those who have the highest risk of severe disease and those who pose the most risk of spread to public health,” Singh said.
Singh said the text message system was rolled out in late May and since more cases have been in younger age groups, they’ve been more responsive to texts than calls, she said.
“Only very recently did we add an option for cases to opt out of a phone call and then began prioritizing high risk individuals for a follow up phone call,” Singh said.
But, few people actually respond to the survey and provide public health the information it needs to map the disease and understand its spread.
Singh said more than 20,000 people have received a text message with the survey. More than 35% of people open the questionnaire, and almost 20% complete it, Singh said. A case investigation via text and contact information is gathered for fewer than one in five cases.
Singh added that in addition to the texting process, people who don’t complete the questionnaire receive a phone call from an investigator to complete the investigation and identify their close contacts. It’s not clear how quickly that call happens.
County planned to do more, but didn’t
Other than in the earliest weeks of the pandemic, Maricopa County has never been at the point of conducting case investigations and contact tracing to CDC standards.
On April 23, when Arizona’s stay-at-home order was in place, Maricopa County assured the public it was ramping up its contact tracing efforts to be able to perform full traditional case investigations and contact tracing for every single positive case and their contacts. The county planned to call all those individuals.
The county announced it would expand capacity by up to 10 times its then existing staff of 25 disease investigators. Officials said details were still in the works.
Part of the point of the stay-at-home order was to buy time to expand capacity and prepare things like contact tracing so the public health system would be prepared for a potential surge of cases.
Maricopa County explained in late April that it had been performing “case-mediated contact tracing,” a less intensive form of the public health practice. Other than early on in the pandemic, when case numbers were relatively low, the county had not been calling each and every contact.
Instead, public health workers interviewed each case and then asked the case to reach out to their contacts themselves and provide information on potential exposure and symptoms to watch for. Public health did not contact the case’s contacts, as traditional contact tracing requires.
The county was scaling up employees so that it could return to “traditional contact tracing investigations,” Dr. Rebecca Sunenshine, medical director of disease control for the Maricopa County Department of Public Health, said at the time. Some funding for that would be from CARES Act dollars, she said.
“Right now, what we want to do to have more complete surveillance of the disease in our community is we staff up, we put this plan in place and we will have more people so we go back to directly contacting every person who is a potential contact,” county spokesman Fields Moseley said in late April. “So more thorough contact tracing.”
But that appears to never have happened. Instead, case numbers became overwhelming and the practice devolved further, so that many cases never even received that initial phone call from public health, not to mention any public health employees’ reaching out to the contacts.
“Investigators are part public health, part detective and part social worker trying to establish rapport with this person that they’ve never met, and trust, and at the same time trying to cover as much information as possible without judgment,” Sunenshine said in late April.
Sunenshine said in late April that interviews could take between one and three hours. But now, unless an individual is considered high-risk, interviews are by and large not taking place at all.
Stanton: County has no thorough plan
The way the county has conducted contact tracing since late March violates core CDC principles for this process, Stanton wrote to the county supervisors Thursday.
“More troubling is that County public health officials have no plan to thoroughly contact trace all positive COVID-19 case, and do not yet know what it would take to put the nation’s fourth-largest county in a position to do so,” Stanton wrote.
Stanton questions why the county wasn’t prepared to properly trace more cases, how officials are using funding from the federal government and why the county hasn’t been forthcoming on its lack of preparedness.
The county was given $399 million from the federal government as part of the CARES Act to cover costs related to the pandemic. A press release from the county shows $175 million was set aside for “future needs.”
And $93 million went toward the response to the health emergency, with $25 million for testing, $15 million for “enhanced contact tracing and disease investigation,” $10 million for personal protective equipment and $5 million for long-term care facilities.
Other funds went to providing assistance to people and families, like rental programs and assisting people who are homeless. Some went to helping small businesses, while some also went to upgrades to spaces to make them safer, like handwashing stations.
Stanton said the county spent $15 million, less than 4% of what it received through CARES, on case investigations and contact tracing, while a bigger chunk of money, $25 million went to offset paid-time off for county employees
He shared estimates from health organizations that say the county should have more than 1,000 contact tracers, possibly as many as 8,500, in order to effectively do the job.
The Sara Alert system, he wrote, is helpful, and other public health agencies use it as a supplement to help patients and contacts track symptoms after they’ve already spoken to public health workers.
Marcy Flanagan, the county’s public health director, told Stanton’s office that she estimated the number of needed contact tracers based on an average of 200 cases per day during the stay-at-home order.
Essentially, Stanton concluded, the county wasted time during the stay-at-home order by not adequately preparing for its response when cases would rise. Flanagan told Stanton’s office that the county started in early May, well into the stay-at-home order, to prepare for about 500 cases per day.
“This is an exceptional breach of the public trust,” the congressman said.
The county has said multiple times that it has a partnership with Arizona State University to assist with contact tracing. Flanagan told Stanton’s office that more than 200 volunteers were contact tracing for the county as part of that partnership, the letter says.
But, he wrote in the letter, ASU told his office they do not have a contact with the county as of Thursday, and ASU is not doing contact tracing.
On Thursday, ASU professor Megan Jehn, who is working on the partnership efforts with the county, told The Republicvia an emailed statement that the university is supporting the county with case investigations, but not contact tracing.
The university is also helping the county with a large serological survey effort and hotspot investigations, Jehn said.
“We are in the process of standing up a large case investigation team (primarily global health, nursing and social work students) to provide surge support for the county. We anticipate that this will be a very large and sustained effort,” she said.
ASU spokesman Joseph Caspermeyer said the university has been in “recent discussions” with the county public health department about supporting a variety of efforts, including case investigations, testing, social support services, modeling and hotspot investigations.
“We anticipate a very large and sustained effort,” he said. “Case investigations will begin on Monday, June 29; ramping up to the county’s requested volume of 700 case investigations each week by mid-September.”
Stanton called on the supervisors to put more money toward case investigation and contact tracing. He said the county must come up with an immediate plan to trace every case.
Why isn’t more being done?
Flanagan defended the county’s current contact tracing system at a Wednesday press briefing.
She said in May, the county was able to contact 200 new cases each day, but with additional staff, that capacity rose to up to 500 new cases each day by June 10.
But the county has often recorded 1,000 or 2,000 new cases in a day since then — surely exceeding that contact tracing capacity.
Flanagan explained that except for the 5 to 7% of cases for which they never find contact information, the county makes contact with every single individual who tests positive. By and large, that’s through a text message and most individuals do not actually speak to a case investigator or public health employee.
“We are reaching out to every single positive case that we have contact information for within 12 to 24 hours of us receiving that test result,” Flanagan said Wednesday.
But the county is not “reaching out” in the traditional sense of a through case investigation and contact trace where a trained public health expert walks through all the details of a case and tells contacts all they need to know. Answering questions is an essential part of that, requiring a two-way conversation.
Kissler, the Harvard professor, said it’s easier to change people’s behavior and share information when people are contacted individually by a tracer instead of just sent information.
But, he acknowledged, what the county is doing may be all that’s possible at this time because tracing is so resource-intensive.
One of the hopes was that, with physical distancing, the numbers of cases would be brought down to more manageable levels for contact tracing, he said.
“And we never really reached that point, unfortunately. So I think that we’re kind of left with some of these stop-gap solutions in terms of contact tracing,” Kissler said.
Moseley said the text and automated phone call system was implemented to adapt to younger demographics. Contacts will soon also be getting a call and text.
“Part of CDC best practices is automating and digitizing the tracing process to reach thousands of cases more efficiently and for the majority of cases, texting is their preferred method of communication,” Moseley said.
“The investigation team is working seven days a week and must be sustained for at least the next year,” Moseley said. “It is important to train a team built for sustainability which is exactly the approach we are taking.”
Reach reporter Rachel Leingang by email at [email protected] or by phone at 602-444-8157, or find her on Twitter and Facebook.
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