B-roll of Banner Estrella Medical Center in west Phoenix where more than a thousand COVID-19 patients have been successfully treated during the pandemic.

Pritesh Patel, MD, speaks about what it was like to provide ongoing care for COVID-19 patients and families at Banner Estrella Medical Center in west Phoenix.

Sarah Asel, RN, talks about what it is like to care for COVID-19 patients and the joy she experiences as one returns to thank her and colleagues for their care.

Debbie Olsen, a former COVID-19 patient, returns to say thank you to the "life-saving'' doctors, nurses and staff who treated her for this life-threatening virus.

Both Banner Estrella and Banner Thunderbird Medical Centers celebrated 1,000+ lives saved from COVID-19. Each hospital reached that milestone within a few days of each other.

Interview with Medical Director Steven Erickson, MD, as well as a physical therapist and a patient about COVID-19 effects on myocarditis, including diagnosis and treatment.

Marjorie Bessel, MD, chief clinical officer at Banner Health, provides a system-wide update on Banner's response to the COVID-19 surges in many of the states it serves.

Marjorie Bessel, MD, chief clinical officer of Banner Health, talks about the pandemic, increasing numbers of hospitalizations and what to expect in coming weeks

Marjorie Bessel, MD, chief clinical officer of Banner Health, provides the latest updates on how the health care system is caring for a patient surge during the COVID-19 pandemic.

Marjorie Bessel, MD, chief medical officer of Banner Health, provides an update about how the six-state healthcare system is handling teh COVID-19 surge.

Marjorie Bessel, MD, chief clinical officer of Banner Health, gives an update on how the health system is dealing with the pandemic and the importance of masking up to contain the spread of COVID-19.

Marjorie Bessel, MD, chief clinical officer of Banner Health, gives an update on how the health care system is managing the COVID-19 surge in six states.

Marjorie Bessel, MD and other metro Phoenix health leaders discuss how their health systems are handling the challenges of Arizona's record number of cases.

Marjorie Bessel, MD, chief medical officer of Banner Health, talks about the need for vaccination and social distancing as Arizona experiences slightly fewer COVID-19 cases.

Marjorie Bessel, MD, chief clinical officer of Banner Health, talks about how Banner is handling with the COVID-19 pandemic and that the health system has vaccinated more than 125,000 people

(PHOENIX) -- Hospitals in Arizona are seeing an intense wave of new coronavirus cases, doctors at the Banner University Medical Center in Phoenix told ABC News on Monday, and it is filling up their intensive care units and pushing their nurses to the brink.

Preparing for a surge; Banner warns that things could be worse than in the summer.

Banner Health Chief Clinical Officer Dr. Marjorie Bessel told media Friday that intensive care units in Arizona were very busy.

Some doctors around the state are sounding the alarm on the number of available hospital beds - or lack thereof - as coronavirus cases surge.

The story describes the difficulties of dealing with emergencies during the pandemic time and how social isolation negatively affects one's ability to weather these emergencies.

My daughter is attending 3 weeks of summer school for PACE training. It's basically a test to determine if your child deserves extra resources for gifted students. When she goes to campus on Monday, she won't need a mask unless she's within 3 feet of other students. It's incredible to see how dramatically policies and infection rates have shifted behaviors. The vaccine seems to be keeping infection rates low. She has the chance to regain a little bit of normalcy.

--Reflections on the Pandemic Archive-- Looking back over my experience with the “Journal of the Plague Year” COVID-19 archive, my prevailing emotion is gratitude. This opportunity granted me experience that few historians earn, and the remote, asynchronous work schedule allowed me to collaborate with my colleagues in ways that maximized our respective contributions. The breadth and depth of our individual experiences and perspectives tremendously improved our collective process and products. I spent enough time in the Arizona State Archives last year to recognize such collections as historical treasure chests, but I have now participated in processing an archive’s content and navigating the ethical dilemmas those submissions sometimes create. Archivists and curators are the history profession’s truly unsung heroes, and their work facilitates society’s perception of itself. My background in police work and public safety drew me to the archive’s existing Law Enforcement collection. In taking on that subset, I succeeded in reshaping the collection’s parameters to now include stories about police and law enforcement. I wanted to diversify the collection to encompass perspective of both the police and the public with whom they interact and serve. While some overlap exists between the Law Enforcement and Social Justice collections, each remains distinct. Through my contacts and writing, I promoted a Call for Submissions to an international audience of law enforcement professionals to reduce their relative silence within the archive. Within the archive’s content, I recognized that one’s location might shape their pandemic experience, and I created and designed an Arizona-based exhibit to explore that. Further research and discussion with my mentors and colleagues ensured the exhibit illustrated these differences without excluding visitors whose diverse experiences could further enrich the archived and exhibited content. I am proud of my “Arizona’s COVID-19 Pandemics” exhibit, particularly because of its compressed, one-month incubation period. Beyond displaying images, data, and stories representative of the diverse pandemic experiences within the state, the ACP exhibit offers visitors numerous levels of interaction and engagement to became active participants and create their own exhibit experience. Visitors can complete opinion surveys, add a story to the archive, explore additional content related to the displayed pieces, view ever-changing results from pre-defined archival content searches, conduct their own archival search, view collective visitor survey results, and apply to join the staff. The exhibit’s searches will include the archive’s future submissions, which reshapes both the exhibit and the experience visitors may have with it. A more detailed explanation of my ACP exhibit may be reviewed here: https://covid-19archive.org/s/archive/item/43037 Because of Dr. Kathleen Kole de Peralta and Dr. Mark Tebeau, I stand prepared to join research, curation, and exhibition teams and immediately contribute to their work products. Despite my gratitude for this experience and the opportunities it presented, I look forward to the day COVID-19 is no longer part of humanity’s daily vernacular. James Rayroux 22 April 2021

Disposable mask along the riverwalk on the north bank of Rio Salado near the volleyball courts.

Black disposable face mask floating in the Rio Salado River near Tempe Beach Park.

While working as a curatorial intern on ASU's 'A Journal of the Plague Year' COVID-19 archive, I created this exhibit on the pandemic experience within the state. In addition to obvious, overarching realities such as socioeconomic status and immediate access to healthcare systems, I initially believed one of the greatest deciding factors that determined one's experience in Arizona was an individual's residence in either predominantly urban or rural environments. The proposed exhibit had been originally titled "A Tale of Two Arizonas" to pay respect to Charles Dickens and the differing realities experienced here. To test my proposed hypothesis, I went about finding data, stories, and submissions that substantiated or disputed my premise. Within a short time, I had identified four distinct environmental drivers of personal pandemic experiences; to me, that indicated the existence of many more I hadn't yet found or had overlooked along the way. My evidence suggested a minimum of four pandemic locales: Urban, Rural, Border, and Tribal within the State of Arizona and its fifteen counties. The recorded health data and personal experiences demonstrated the naivete of my initial hypothesis, and I retitled the exhibit: "Arizona's COVID-19 Pandemics." The Exhibit Background section illustrates the vast dichotomies within Arizona in terms of population density and access to healthcare facilities. Given the virus's respiratory nature, these factors seemed especially relevant to driving diverse local experiences. I chose to include a flyer from the Coconino County Health and Human Services' "Face It! Masks Save Lives" campaign. The flyer included a specific line to "Stay Home When Sick" that seemed to illustrate a different public health paradigm than the broader "stay home" orders from Maricopa and Pima county. This section also features an image of Sedona's red rocks and a portion of The Wave to remind visitors of the wide-open rural areas accessible to all, as well as those with cultural significance to the Native American tribes and limited access to the general public. The next section asks a short, five-question survey in which visitors may participate. The Silver Linings piece features a short audio clip of a father and husband discussing some unexpected benefits of the pandemic. Visitors may explore additional Silver Linings stories and submit their own experience. The Tséhootsooí Medical Center piece seeks to illustrate the different pandemic experience on the state's tribal lands. I hoped to inspire some relevant emotional turmoil for the visitors through the piece's visual presentation. I wanted to create a series of waves with quotes from the medical center's healthcare workers. I hoped visitors' attention would be drawn to the large, bolded key words, and that they would first experience the segments out of sequence because of that. After potentially feeling a sense of chaos, they might settle themselves into a deliberate reading of the texts and find their own order within the experiences provided here. This piece allows further exploration of Native submissions and topics, a review of an additional related news article, and a submission prompt that invites visitors to offer guidance to hospital managers. The next piece illustrates the differences between mask mandates in communities across Arizona. In addition to hearing an audio clip of interviews with mayors and a public health official, visitors can explore additional submissions related to mask mandates and submit their thoughts on statewide mandates. The Arizona Department of Health Services provides zip-code specific infection data on its website, and the wide array of known case infections therein further illustrates potential dichotomies across the state. In working to include and represent this data in a consumable way, I encountered inconsistencies with tribal data. The nation's Indian tribes are overseen by Indian Health Services, a federal public health agency, and it does not collect or report data in the same manner as the State of Arizona or its counties. At first glance, the data would seem to suggest that tribal areas had less severe pandemic experiences than the rural and urban areas, which was not objectively true. I wanted to offer the unedited data to visitors, allow them to drawn their own conclusions, and invite them to offer their thoughts on what potential misunderstandings might emanate from these reporting differences. Visitors may also choose to review the foundational data from this piece, as well. I used the following two sections to offer submission prompts about the visitor's overall pandemic experience as a function of their location, as well as what they might have done if placed in charge of their city, county, or state during this pandemic. A diverse Search section allows visitors to explore additional topics of interest to them. 23 hyperlinks offer pre-defined search parameters. An Advanced Search link allows self-defined research, and a Join The Staff link connects visitors with opportunities to work within the JOTPY archive. A final section asks visitors to provide feedback on the exhibit, its content, and the pandemic in general. Both surveys within the exhibit will display overall results to visitors who participate in them. Through this process, I found incredible amounts and diversity of data outside the archive that spoke to these generally localized experiences, but not that much yet within the archive explained what Arizonans had experienced outside the state's urban environments. I created a call for submissions and delivered it to fifty rural entities that might help support the effort to collect and preserve more rural Arizona stories. Between all the local libraries, historical societies, museums, small-town mayors, and county health officials to whom I asked for help, I am optimistic the archive will better represent all Arizonans in the coming months and years. Despite the exhibit having been created, I ensured its internal search features would include future submissions and allow the exhibit to remain relevant long after its release.

During March and April 2021, I created an online exhibit from content within Arizona State University's "A Journal of the Plague Year" COVID-19 archive. Entitled "Arizona's COVID-19 Pandemics," the digital exhibit contained images previously submitted to the archive, along with several copyright-free images I found on pexels.com. I have attached all these images. Listed by their order of appearance within the exhibit, their sources are as follows: 1- "Face It" Campaign flyer: Coconino County Health & Human Services ( https://covid-19archive.org/s/archive/item/42998 ) 2- Red Rocks, Sedona: Courtesy of Gregory Whitcoe via Pexels.com 3- Online Learning: Courtesy of August de Richelieu via Pexels.com 4- Tséhootsooí Medical Center staff: Courtesy of FDIHB Marketing Department and Navajo Times newspaper ( https://covid-19archive.org/s/archive/item/41189 ) 5- Arizona's Mask Mandate Map: created by Sarandon Raboin ( https://covid-19archive.org/s/archive/item/26267 ) 6- Arizona COVID-19 Infection Zip Code Map: Courtesy of Arizona Department of Health Services ( https://covid-19archive.org/s/archive/item/42035 ) 7- Woman Shopping: Courtesy of Anna Shvets via Pexels.com 8- Woman on Rural Arizona Road: Courtesy of Taryn Elliot via Pexels.com 9- Masked Woman in Crowd: Courtesy of Redrecords via Pexels.com 10- The Wave: Courtesy of Flickr via Pexels.com (this image is found only in the PDF submission of the exhibit, not in the public-facing exhibit itself due to document formatting technicalities - the PDF version can be found at https://covid-19archive.org/s/archive/item/42998 )

The Coconino County Health & Human Services department created its "Face It" campaign in 2020 to promote the use of masks and face coverings in their communities. The following webpage is for the campaign's digital "toolbox" to give the public access to official signage for display to customers, the public, and employees to address mask use issues.

These eight documents are the eight Public Health Emergency Orders issued by the Navajo Department of Health issued through 19 April 2021.

Blue and white disposable mask trash caught in the shrubs off to the side of Priest and near Rio Salado.

This article focuses specifically on Arizona's efforts to provide students with internet/technology access in order to achieve online learning. It goes into detail about how several Phoenix schools dealt with the pandemic and online learning in the spring semester of 2020 as well as discusses how some students dealt with internet access issues in creative ways, either due to lack of internet or hotspot issues. Some examples are utilizing hotspots or through just going to public areas despite quarantine conditions to complete schoolwork.

what impact covid 19 has had on my son

PPE vending machines at the PHX airport

Disposable mask found along the north bank of rio salado, near the 202 loop and Priest.

Coronavirus in Arizona with Emphasis on local Pima County data: By: KGUN 9 On Your Side - Posted at 11:36 AM, Mar 21, 2020 and last updated 9:03 AM, Apr 14, 2021 TUCSON, Ariz. (KGUN) — Editor's note: This article was first published on March 21, 2020. It is updated daily and refreshed with the latest updates and cases throughout Arizona. Arizona Public Health officials are tracking the spread of coronavirus throughout the state. Here are the latest numbers provided by the Arizona Department of Health Services. Last updated on April 14, 2021 FULL SECTION: CORONAVIRUS IN ARIZONA Vaccinations in Arizona: New doses reported today: 46,744 Total doses administered: 4,213,938 Total number of people who have received at least 1 dose: 2,611,983 Total number of people who have received 2 doses: 1,745,928 Percent of population vaccinated: 36.3% Vaccinations in Pima County: New doses reported today: 9,029 Total doses administered: 578,853 Total number of people who have received at least 1 dose: 363,431 Total number of people who have received 2 doses: 242,638 Percent of population vaccinated: 34.8% Cases and Deaths through 04/14/2021: Number of deaths: 17,109 Number of cases: 851,265 New cases: 419 New deaths: 4 Total number of tests reported: 8,835,798 (Diagnostic and Serology) New tests reported: 17,381 Reported cases of COVID-19 by county: Maricopa: 529,471 Pima: 113,903 Pinal: 50,417 Navajo: 16,018 Coconino: 17,398 Yavapai: 18,642 Cochise: 11,769 Graham: 5,520 Santa Cruz: 7,882 Yuma: 36,943 Apache: 11,256 Mohave: 22,353 La Paz: 2,450 Gila: 6,855 Greenlee: 568 Breakdown of cases in Pima County: Total cases: 113,903 Deaths: 2,372 New cases: 81 New deaths: -1

"By Christopher Brito, March 5, 2021, CBSnews.com While a majority of states and cities are still vaccinating higher priority groups of people, one county in Arizona is now allowing any resident over the age of 18 to receive the COVID-19 vaccine. Gila County, which is located east of Phoenix, entered Phase 2 of their vaccine prioritization late last month, opening up eligibility to the general population. Part of the the decision to open vaccine eligibility is because Gila County has one of the lowest percentages of COVID-19 vaccine doses used in Arizona. Michael O'Driscoll, director of Public Health and Emergency Management for the county, told CBS affiliate KPHO-TV that they received permission from the state last week to offer the vaccine in a drive-thru clinic last weekend. "Prior to that, we were struggling to find enough people to make appointments to that, so the state gave me permission to offer it to any resident 18 and older," he said. About 56,000 people reside in the county. According to the Arizona's Department of Health Services, more than 13,000 people – or almost one fourth of residents – have received at least one dose of the COVID-19 vaccine. "We did a survey before to get a sense of how many people in Gila County would consider getting the vaccine, and our survey came back about 50-60% of the residents would choose to get the vaccine if available," O'Driscoll said. Based on the data, over 5,600 people under the age of 65 have received the vaccine, including 73 people under the age of 20. One of the younger recipients, 18-year-old Jacob Jost, told KPHO-TV that he was "excited" to get the shot. "I have a little nephew, a little baby, so having the vaccine puts a peace of mind for that," Jost said. First published on March 5, 2021 / 12:13 PM © 2021 CBS Interactive Inc. All Rights Reserved. Christopher Brito is a social media producer and trending writer for CBS News, focusing on sports and stories that involve issues of race and culture.

Conversation with Armani Richard and the impact of COVID-19 on Arizona education. Currently studying at Mary Lou Fulton Teachers College and fulfilling a promising career in the Army.

Conversation with Kristina Erickson an Arizona K-12 educator. Ms. Erickson weigh-ins on the March 15th executive order, in-person instruction, COVID protocols and procedures, and the future of education in her community

On March 11, 2021, the Arizona State Health Department reported seven counties, including Maricopa, were coded as "substantial transmission rate", however, this rate is technically one level under the serious risk categories. The remaining counties (six) were deemed "moderate" and were set to reopen by March 15. The NPR article argues about the irrelevancy of the order because more than half of the schools in the county are offering some form of in-person instruction, this order didn't change much for that particular school. For some schools, Osborn and Cartwright, the order actually sped their reopening date. In the Osborn case, school officials pushed for reopening because they confirmed that more than half of their teachers had been vaccinated. In places like Coconino and Pinal counties where transmission levels are exceedingly high, the school districts are exempt from reopening. Again, the effectiveness of the March 15th executive order is questionable at best.

This is an oral history interview with Joan Church and Keith Sciarra. Keith gives his insight on how covid-19 has affected wildlife. Keith has many years working within wildlife, specifically with dolphins and ocean life. He gives us advice on how we can help the cause after covid and talks on the topic of ocean conservation.

This is the Arizona State University-specific COVID-19 resources for students. I wanted to include this University's specific resources because one of the people I interviewed attends ASU as a student and I want to provide this source as a supplement for some of the difficulty that he mentioned having in finding resources while living as a person experiencing housing instability. The website houses all messages and updates the university has sent to students with regard to the Coronavirus. The site focuses on health and staying healthy for students but seems to lack a clear guide on how to access resources and aid that students may qualify for.

The Navajo Nation has reinstated the “Stay-At-Home” order due to an increase of Covid-19 cases. Two weeks ago, there was one day with zero reported cases. On Friday, there were 26 reported new Covid-19 cases.

This text file shows data from the Arizona Department of Health Services for confirmed COVID-19 infections tied to the patient's residential zip code. The data runs through 04/08/2021 and can be searched by "Ctrl + F" and entering specific zip codes. AZDHS suppressed tribal data from this data file prior to its publication on the organization's website.

These screenshots show COVID-19 data from the Arizona Department of Health Services for each of Arizona's 15 counties and their cumulative state-wide total. The counties' respective case rate and death rate data are expressed as a percentage of their population and further demonstrate the dichotomies between pandemic experience by residential locale: Arizona statewide: 11.77% population infection rate (0.236% population fatality rate) Greenlee County: 5.47% (0.096%) Yavapai County: 7.91% (0.210%) Cochise County: 8.92% (0.214%) Mohave County: 10.26% (0.318%) Pima County: 10.84% (0.226%) Pinal County: 10.93% (0.188%) La Paz County: 11.08% (0.353%) Coconino County: 11.69% (0.221%) Gila County: 11.92% (0.402%) Maricopa County: 12.06% (0.222%) Graham County: 13.95% (0.200%) Navajo County: 13.96% (0.462%) Santa Cruz County: 14.77% (0.325%) Apache County: 15.60% (0.586%) Yuma County: 16.01% (0.357%)

Pilot Projects Artist Talk: "La Morena" is a conversation with Arizona-based muralist and painter Lucinda Yrene Hinojos and director Pita Juarez about the short film “La Morena,” on view Sept. 15–19, 2020 as part of Pilot Projects: Art. Response. Now. Lucinda talks about the process behind her murals, art and activism, and what she is working on next. The short film “La Morena” features Arizona artist, Lucinda Yrene Hinojos, who is claiming her roots and activism through her art. She brings all her love, inspiration and pain into creating murals with the guidance of her ancestors who energize her art. The result is a mural that focuses on the power of community, family and healing. This film was produced in association with Mango Skies and Poder in Action. To learn more about La Morena, check out: https://lamorenaart.com/ ***They discuss art during the pandemic, police brutality, social justice, how Covid-19 has affected their art.

By Amanda Morris of the Arizona Republic: Arizona State University researchers have found a home-grown variant of the coronavirus emerging in Arizona that they say should be monitored closely because it carries a mutation known for weakening vaccines. In a non-peer reviewed study that published Sunday, researchers said they have detected 17 cases of the new variant since February, 15 of which were in Arizona. The other two cases were found in Houston in late February and New Mexico in early March, suggesting that the variant has begun to spread. "My hope is that we do not see more of these cases. The whole point of surveillance is to keep this from spreading," said Dr. Efrem Lim, an ASU virologist and assistant professor. The variant is known as the B.1.243.1 variant, and descends from a common lineage of the virus called B.1.243, which nationally makes up about 2.5% of all cases, according to David Engelthaler, director of the Translational Genomics Research Institute's infectious disease division in Flagstaff. "It's not dominant. But, there's a fair amount of that lineage that has been able to hang around," Engelthaler said. "It seems to have picked up this E484K mutation, what we call the 'eek!'" This E484K mutation has also been seen in the variants first detected in South Africa and Brazil, as well as one new variant recently discovered in New York. Numerous studies have shown that this mutation — located in the spike of the virus — lowers antibody responses to the virus and could weaken vaccines. Antibodies are one of the body's tool to recognize and fight the virus. The E484K mutation has been shown to weaken antibody responses. One study from Seattle showed that it caused the neutralizing effects of antibodies to decrease by tenfold, and numerous other studies have shown similar results. American vaccine development company Novavax reported that its COVID-19 vaccine was 96.4% effective against the original coronavirus strain and 86.3% effective against the U.K. variant, but was far less effective in South Africa, where the South Africa variant carrying this mutation is dominant. In the South Africa trials, the vaccine was shown to be 48.6% effective overall, and 55.4% effective in HIV-negative individuals. Moderna announced a sixfold reduction in antibody responses from its vaccine against the South Africa variant, and Pfizer observed a drop in vaccine-induced antibody responses against the South Africa variant. The Johnson & Johnson vaccine is reported to be 64% effective against moderate to severe COVID-19 in trials in South Africa vs. 72% effective in U.S. trials. Though the E484K mutation appears to reduce antibody response and possibly reduce vaccine efficacy, Lim stressed that vaccines still work well and said people should get their vaccines as planned. Scientists are monitoring mutations in the spike of the novel coronavirus. Community spread is a concern Though the new Arizona variant carries this mutation, it's still possible for the variant to fizzle out and stop spreading. Lim said researchers have found two other cases where viruses within the B.1.243 lineage independently picked up the E484K mutation, but did not spread. "In both cases, they never led to more transmissions," Lim said. Engelthaler has also tracked other lineages where the E484K mutation showed up, but those strains fizzled out. Overall, researchers have detected over 60 samples containing the E484K mutation statewide, according to TGen's Arizona COVID-19 sequencing dashboard. In order to continue spread, Engelthaler said variants need to be very "fit." "This mutation has popped up on multiple instances and then just goes away," he said. "This one mutation by itself doesn't give the virus superpowers." "It’s definitely a mutation of concern but time will tell if it will be a variant of concern," he added. If the mutation shows up in a more fit version of the virus, then Engelthaler said it becomes more of a concern. The new variant in Arizona is different than past cases because it has already spread from one person to another and could spread further, according to Lim. He said "one-off" mutations here and there are normal, but that the bigger question is about the transmission levels of this variant. A variant's ability to spread to others is also dependent on human behavior, Lim said. If people follow public health guidelines, they are less likely to spread variants to others. In total, Lim said the new Arizona variant has 11 mutations, which is "quite a bit more" than normal virus variations. These 11 mutations could be helping the virus survive or spread and could also act as a "fingerprint" to help researchers identify the new variant, Lim said. Another one of the 11 mutations is located in the spike that the virus uses to attach to and infect cells. Engelthaler said that because of the importance of the spike, any mutations in that area could affect things like how fast the virus spreads or how severe the related illness is. Both Lim and Engelthaler said it's too soon to tell whether the other mutations in this variant have any effect. Overall, this variant still seems to account for a very low percentage of overall cases in the state, according to Dr. Joshua LaBaer, the executive director of ASU's Biodesign Institute. ASU researchers wrote that it's still possible there are more undetected cases of the variant since there are limited efforts to genetically monitor the virus nationwide. In Arizona, roughly 1.3% of cases overall have been genetically sequenced, or analyzed, according to TGen's Arizona COVID-19 sequencing dashboard. In February and March, over 3% of cases were sequenced, higher than national rates of sequencing, which were below 1% in January. ASU is working with the Arizona Department of Health Services to monitor the new variant and hopefully prevent further spread through contact tracing and other public health measures, Lim said. California and UK variant cases rise Currently the Arizona variant is only considered a "variant of interest" and not a "variant of concern." These are different categories outlined by the CDC and used to assess the risk level of each variant. The CDC defines "variants of interest" as those that are associated with potential changes, whereas "variants of concern" have evidence showing actual changes such as increased transmission, more severe disease or antibody evasion. There are five variants of concern, which include variants first identified in the United Kingdom, South Africa, Brazil and California. Two variants from California were elevated from variant of interest to variant of concern this month and have rapidly spread in Arizona. "They're closely related to each other and have definitely been documented with increased transmissibility and some impact on some antibody treatment," Engelthaler said. In November 2020, both the California variants accounted for only 0.73% of Arizona's genetically sequenced samples. By March, they accounted for 31.64% of samples and are predominant variants statewide. One non-peer reviewed study from the University of California San Francisco showed weaker antibody responses against the California variants. Because of concerns that monoclonal antibody treatments may be less effective against these two variants, the U.S. Department of Health and Human Services announced two weeks ago that it would limit the distribution of one treatment to states with high levels of the California variant, including Arizona. The California Department of Public Health also recommended that the state stop distributing the treatment, which is made by American pharmaceutical company Eli & Lily. In a health alert, the department said this treatment was unlikely to be active against the California variants. The U.K. variant, which is highly contagious, has also been spreading statewide ever since it was first detected in late January. In March the U.K. variant accounted for 4.72% of genetically analyzed samples. Currently, Engelthaler said Arizona has over 100 cases of the U.K. variant and over 1,000 cases of the California variants. Arizona also detected its first cases of the South Africa variant last week. So far, Lim said that all of the variants of concern are manageable and have not risen to the level of "variant of high consequence," which the CDC defines as variants that are shown to significantly reduce the effectiveness of prevention and medical measures. "The risk is whether one of these current variants of concern acquire additional mutations that push it up to the next level," Lim said. To prevent further mutations, LaBaer said it's important to prevent spread of the virus by continuing to follow health guidelines and getting vaccinated. The more the community can prevent the spread of the virus, the less mutations will occur, he said. "We're kind of in this race right now between the developed dominance of these much more infectious variants that are now spreading throughout the country and getting people vaccinated," LaBaer said. "At the moment, I'm a little worried that the spread of this virus is so fast that that may outpace our ability to get vaccines in arms." He said it was theoretically possible that new variants could escape the vaccines, meaning that the public would move backward away from reaching herd immunity. But Lim said the vaccines can easily be updated to protect against new variants. Pharmaceutical companies like Pfizer and Moderna are already working on developing updated booster shots. In the meantime, researchers will continue to monitor the Arizona variant to see if it spreads further. Engelthaler said he expects the most fit variants of the virus to become more dominant statewide as people continue to get vaccinated and stamp out less successful strains. "There's a bit of a race here with the virus — a survival of the fittest race," Engelthaler said. "But what we don't want is to raise too much concern that things are going in the wrong direction...what we're doing is closely watching the evolution of a virus like we never have before. It's good that we have this capability, it's more important to put it into context." Amanda Morris covers all things bioscience, which includes health care, technology, new research and the environment. Send her tips, story ideas, or dog memes at amorris@gannett.com and follow her on Twitter @amandamomorris for the latest bioscience updates. Independent coverage of bioscience in Arizona is supported by a grant from the Flinn Foundation.

By Amanda Morris of the Arizona Republic: When someone on the Fort Apache Indian Reservation receives a confirmed diagnosis of COVID-19, health care workers from the Whiteriver Indian Hospital jump into action. They personally visit the individual's home to test other household members, perform health evaluations on everyone there and trace any other potential contacts at risk for COVID-19 exposure. Health care workers in the community say that could be one reason why, even though the rate of confirmed COVID-19 cases among White Mountain Apache tribal members is nearly triple the state's rate, the death rate is much lower and continues to fall. Over 90% of COVID-19 cases in the White Mountain community are investigated within 24 hours of testing, according to Ryan Close, the director of the Department of Preventative Medicine at the Whiteriver hospital, which is the only hospital on the 1.67 million-acre reservation. "I feel like what we did made a huge difference," Close said. "We evaluated and admitted people aggressively and early. The tribe deserves an incredible amount of credit for mobilizing staff ... to make this response possible, because at some point it would have been very difficult to maintain without their considerable help." The quick response may have also helped the tribe turn the tide against rapid community spread of the virus, which scientists say could have been fueled by a single variant found only in the White Mountain tribal communities. The variant carried a mutation in the spike protein, which scientist theorize could have made it spread more rapidly than other strains of the virus. The number of confirmed COVID-19 cases among White Mountain Apache tribal members accounts for 24% to 28% of their population, according to Close, but the cumulative death rate among known cases is only 1.2%. By comparison, the statewide rate of infection was 11.5% with a 2% death rate among known cases. And over the winter, Close said the rate for the tribe dropped even lower, to about 0.5%. In a community with a high number of individuals with underlying health conditions, the low death rate and work of the tribe has been "remarkable," said David Engelthaler, director of the Translational Genomics Research Institute's infectious disease division in Flagstaff. The death rate also stands out as unusually low when compared with death rates in other Indigenous communities. Indigenous populations have been disproportionally affected by the pandemic. CDC data shows that Indigenous people are 3.5 more likely to be diagnosed with COVID-19 and almost twice as likely to die from COVID-19 than white people. Close credits a proactive strategy to combat COVID-19 that involved rapid contact tracing, in-person health evaluations and frequent outreach to high-risk COVID-19-positive individuals as well as early treatment with monoclonal antibodies and other antiviral therapies. Volunteers and health workers from the White Mountain Apache community were on the Whiteriver hospital's contact tracing team and high-risk COVID-19 outreach team, which Close said helped the team connect better with the people and work faster. One essential part of the team are the tribe's community health representatives, or CHRs, who are members of the community that serve as a cultural bridge between patients and medical establishments. JT Nashio, director of the Community Health Representatives for the tribe, said the "visceral connection" that CHRs have to the community helps them bring cultural awareness to the way questions are asked for contact tracing, which makes the process more effective and allows officials to better distribute information. "On top of that, quite simply, they know how to get around. It’s a big reservation and not all homes are easy to find," Nashio said. "But when you’ve lived here your whole life, you know where to find people. That became invaluable during the tracing and testing push during case surges." Virus mutation may have made it more transmissible When COVID-19 hit the White Mountain Apache nation, it spread rapidly. The community's first documented case was on April 1, 2020, from someone who had likely recently visited the Phoenix area, unknowingly caught COVID-19 and returned, according to Engelthaler. Within the first few weeks, Close said the community experienced a handful of deaths. "We soon had incidence rates that were skyrocketing. Case counts were going up very, very quickly," Close said. It's unclear why the disease spread so rapidly in the community, but the initial strain of COVID-19 that hit the community carried a mutation that Engelthaler believes could have made it more transmissible. "They were seeing the virus just rip through and have an 80 to 90 to 100 percent attack rate," he said. TGen partnered with the tribe and the U.S. Indian Health Services early on to provide tests to diagnose a case of COVID-19 and provide genetic analysis of the virus from each case. It showed one strain of the virus circulating in the tribal community that wasn't present anywhere else in the state. "This virus moved much faster than anything else we were seeing in Arizona at the time," Engelthaler said. "So we actually believe that we had one of these variant strains in Arizona that was causing very large numbers of cases, but it was secluded and maintained really only in that tribal population." The mutation, called the H245Y mutation, occurred in the spike of the virus, which Englethaler said is a "very sensitive" part of the virus where mutations can have a significant impact. Because of the low death rate, Engelthaler said TGen researchers would like to investigate the mutated strain of coronavirus seen among tribal members to see if it is also associated with a lower fatality rate. He acknowledged that other strains of the virus have since entered the community and that the actions of health care workers in the community and at the Whiteriver hospital is also responsible for the lower death rates. 'The earlier you treat an illness, the better' Close's biggest concern was that an outbreak would cause a "tsunami" of sick COVID-19 patients that would run the risk of overwhelming the Whiteriver hospital, which does not have an intensive care unit. Any patients that require intensive care need to be transported to other hospitals in the state. "We're a small hospital, we cannot take a wave of all very acute patients because there aren't enough ventilators in the hospital," Close said. "There aren't enough helicopters in the state to transport people out from our facility to a higher level of care." Within the first few weeks, Close said the community experienced a handful of deaths, and patients who had the poorest outcomes were the ones who self-presented at the hospital — often meaning they waited until they felt sick enough to go to the hospital. "People don't always bring themselves in early enough," Close said. "The earlier you treat an illness, the better." In response to this phenomenon, the hospital started a high-risk outreach program the third week of April. Health care workers regularly visited the homes of anyone who tested positive for COVID-19 and was at high risk for a poor outcome. Close recalls multiple days when he evaluated patients and found their oxygen levels dangerously low, even though they felt fine. It's a condition associated with COVID-19 known as "silent hypoxia," or "happy hypoxia." "They had no sense that they were even ill. They went on to get pretty sick in the hospital, but they survived and you can't help but think to yourself, 'Yeah, that's a life saved,'" Close said. "That person, if they had stayed home another day or another two days would not have done as well. They would have ended up on a ventilator or something." The Arizona Republic previously reported that the effects of the high-risk outreach program and contact tracing led to a fatality rate among tribal members of 1.6% last June, which was less than the state's rate of 2.5% and country's at 2.7% at the time. But the effect of the outreach program became even more pronounced over the winter, as the tribe and health workers gained access to monoclonal antibody treatments, according to Close. He said the high-risk outreach team started referring patients for antibody treatment in December as part of their protocol after the therapy received emergency use approval from the Food and Drug Administration. Hospital staff at the Whiteriver hospital then administered the antibody treatment. "We give that to people who are asymptomatic or mildly ill to prevent hospitalization," Close said. "The evidence currently suggests that reduces the risk that they're going to get sicker and get hospitalized and reduces the risk that they're going to die." Though there's no data proving the antibody treatments made a difference, Close said that after health care workers started using them, the community's COVID-19 death rate fell to 0.5%. Hospital workers also gave antiviral therapies, such as remdesivir, to patients early and often. "We probably overtreated some people," he said. "But the good news is it definitely led to significant reductions in mortality." Lessons for the future Close believes the different programs were so successful because health care workers were often able to test, trace, diagnose and treat individuals all in the same day — a feat he said was only possible because of how closely integrated hospital workers and community health workers were. "There were no barriers in communication between the public health arm of our response and the clinical care arm of our response," Close said. "It's really a case for an integrated health care system." As the tribe emerges from the pandemic and tribal members get vaccinated against the virus, Close said the hospital may start exploring other health conditions where it can use the high-risk outreach team, which is already trained and experienced in clinical evaluations. "The goal is to take what we've learned from COVID and now apply it to things that are not COVID-related," Close said. Another valuable lesson Close hopes to carry forward is how much of a difference visiting residents in their homes can make and how important building trusting relationships with the community is. Nashio said going door to door to trace and monitor COVID-19 cases was a natural step for CHRs, who had already gone door to door in the past for other community health campaigns. "We know firsthand how difficult it can be to not only connect with patients over the phone but communicate effectively over the phone," Nashio said. "When the community sees their CHRs coming to their door, it helps decrease the stigma of the disease." In addition to performing checkup evaluations and providing information, Nashio said CHRs can also provide food, medical supplies, cleaning supplies or services like grocery shopping and running basic errands. Not every tribal member has reliable internet or phone service, nor access to transportation, so Close said going door to door can be a good way to reach, and help, everyone. "Meeting patients where they are is invaluable," Close said. Amanda Morris covers all things bioscience, which includes health care, technology, new research and the environment. Send her tips, story ideas, or dog memes at amorris@gannett.com and follow her on Twitter @amandamomorris for the latest bioscience updates. Independent coverage of bioscience in Arizona is supported by a grant from the Flinn Foundation.

In addition to all the other aspects that currently define my life, I can almost see the end of my first year of graduate studies in Arizona State University's Global History program. I returned to academia in the fall of 2019, wrapped up 34 undergrad credit in 9 months with a 4.1 GPA, and started my master's studies in the fall of 2020. I still have to work a dayjob to keep the lights on, and I have a side hustle ghost writing fiction novels and hosting a podcast on creative writing. Time is my most valued and least possessed commodity. My school schedule is generally comprised of 7.5-week courses, and the university recommends taking no more than one at a time. I couldn't avoid doubling up during the first two months of this spring semester, and, to be candid, I arrogantly denied the validity of the university's guidance. By the end of the first term, I desperately needed to remember what a weekend felt like. Because God blessed me with the Greatest Wife in The History of the World, she scheduled a four-day weekend for us in the White Mountains in eastern Arizona. For those unfamiliar with the area, eastern Arizona has the largest stand of Ponderosa pine trees in the world. Hunters consistently harvest trophy elk and deer from the White Mountains and Gila National Forest, which spans the Arizona-New Mexico border. Unlike Colorado's coniferous forest, eastern Arizona seems devoid of pine beetle kill. Nothing but healthy, evergreen forest and the scent of sun-warmed pine greets you. We stayed in a vacation home on the outskirts of Pinetop, brought our groceries from home, and largely intended on hiking, cooking, drinking, and doing a lot of nothing. When we arrived in Pinetop in early March 2021, I had already fully recovered from COVID-19 and had time for both of my Moderna vaccines to have taken full effect. My wife had neither protective barrier, but we had generally become comfortable with purpose-driven shopping (as opposed to "window shopping") and takeout dining. As such, we stopped into a bakery to get breakfast on the way out to the hiking trails as a vacation treat. To our surprise, many of the patrons weren't wearing masks while walking through the restaurant or waiting in line. That made us a little uncomfortable. Then, one of the employees walked out from the kitchen with no mask on and began working on filling orders at the front, cold-food storage counters. Both of us panicked a bit and considered cancelling our orders and leaving. My wife pulled up the Arizona Department of Health Services site and quickly found that entire county had endured only a little more than 560 cases. A quick bit of division translated that into an average of two infections per day for the entire pandemic year-to-date. The statistical odds of the unmasked clerk or patrons presenting a health risk to either of us fell to just north of zero. NOT zero, but we both felt we could see it from there. The ham, egg, and cheese croissants were delicious, by the way. In trying to be good guests, we continued to wear our masks whenever we ventured into public spaces and businesses. Less than half of those around did the same, and I didn't see or hear anyone confront each other about mask wearing. Our last venture out that weekend was to a beer garden with a prominent outdoor patio and seating area. We again wore our masks inside the establishment, but we immediately felt like outcasts for having done so. When we stepped inside, it looked as though the town villain had just stepped through the saloon doors: all activity inside the business stopped, and everyone seated inside turned around to look us up-and-down for few silent moments. If anyone had been playing piano, they would have switched to a minor key. NO ONE else inside wore a mask, and the interior tables didn't appear to have been spaced to comply with prevailing social distancing guidelines. Everyone stayed kind of quiet until we ordered beers and asked to sit outside. In hindsight, I wonder if they expected we were there from some government bureaucracy to issue citations, or just out-of-towners about to have a value-based hissy fit? I have been generally opposed to broad behavior mandates that typically justify compliance on urban problems, but that weekend compelled me to really consider the divergent pandemic realities Arizonans have endured for the past year. Further analysis of county-specific data seems to suggest at least four divergent pandemic experiences within Arizona: urban centers, border counties, rural counties, and Native American reservations. I hope to better understand the personal experiences of those who lived in these diverse regions and how the pandemic affected their perspective and reality.

"By Jon Johnson, jonjohnsonnews@gmail.com SAFFORD – Graham County has had very few new confirmed cases of COVID-19 in the past month, lowering its numbers to just 147 active cases as of Thursday. According to the Graham County Department of Health and Human Services, Graham County has had a total of 5,355 confirmed cases for the course of the pandemic, with 5,132 listed as being recovered, 147 active, and 76 deaths in more than a year. No new cases were recorded Thursday, and, according to the Arizona Department of Health Services COVID-19 school dashboard, Graham County had just a 1 percent positivity rate as of the week of March 14. That is good for a tie with Apache County for the second-lowest percent positivity rate out of Arizona’s 15 counties. Only Greenlee County, which registered a zero percent positivity rate from Feb. 27 – March 14, had lower. With the lower cases statewide and vaccine rollout, Governor Doug Ducey issued an Executive Order on Thursday, rolling back several COVID-19 mitigation measures involving businesses and gatherings. This comes as other states roll back their COVID-19 mitigation measures as well. The rollout of the various COVID-19 vaccines has picked up steam in the last month, with the state opening up the vaccine to anyone 16 years old or older for the Pfizer vaccine. Anyone 18 years old or older can be administered the Moderna and Johnson & Johnson vaccines. The San Carlos Apache Healthcare Corporation is holding a free, drive-through vaccine clinic on Saturday, March 27 at the San Carlos High School. No appointment is necessary. The clinic will be administering both the Pfizer and Moderna vaccines. Graham County and Greenlee County are also providing vaccination sites for those 18 and older, and provide the Moderna and Johnson & Johnson vaccines. Greenlee County: According to the Greenlee County Health Department, the county currently has just nine active cases of COVID-19. For the course of the pandemic, Greenlee County has had 568 confirmed positive cases (by far the lowest out of any of Arizona’s 15 counties), with 549 recovered cases, nine active, and 10 deaths."

"By Jon Johnson, jonjohnsonnews@gmail.com GREENLEE COUNTY – The Greenlee County Health Department reported Monday that the county had just two confirmed active cases of COVID-19. Greenlee County has tested more than 5,000 people for the course of the pandemic and has had a total of 568 cases, with 556 recovered and 10 deaths. The county offers the Moderna COVID-19 vaccine to all residents 18-years-old or older, and on Thursday (01-April-2021) Gila Health Resources will have a vaccine clinic for the one-shot Johnson and Johnson COVID-19 vaccine. Click here to learn more or to register. According to the Arizona Department of Health Services, 37.5 percent of Greenlee County’s residents have been vaccinated for COVID-19. That is the highest percentage out of Arizona’s 15 counties. Conversely, Graham County is listed as having just 18.1 percent of its population vaccinated, which is the third-worst out of Arizona’s counties behind Maricopa County at 17.5 percent and Apache County at 10.7 percent. Graham County: The Graham County Department of Health and Human Services reported three new confirmed positive tests for COVID-19 on Tuesday. While Graham County has had 5,364 total confirmed cases of COVID-19, as of Tuesday the county had just 138 confirmed active cases. Out of all its confirmed cases, 5,150 are listed as being recovered, and 76 have died. Graham County is also offering both the Moderna and Johnson & Johnson vaccines to all residents 18-years-old or older. Click here for more information."

A child's re-usable face mask with Cars 2 design found on the sidewalk across from Jaycee Park in Tempe, Arizona.