The coronavirus outbreak has prompted a "public health emergency" declaration by Arizona Gov. Doug Ducey, allowing the state to request federal funds and deal with medical price-gouging.

"This is a proactive measure," Ducey said.

At least nine people have been diagnosed with the COVID-19 virus in Arizona, officials said Wednesday, with 32 more tests pending.

Two Pinal County cases were added to the tally on Wednesday, following Monday's announcement that there was a case in Pima County.

Related: University of Arizona to cancel in-person classes due to coronavirus

"While our state is not currently facing the number of cases we've seen in some other states, we are anticipating additional positive cases — and we're not taking any chances," Ducey said in announcing his emergency declaration. "Arizonans should not panic — our approach will be calm and steady."

Ducey also ordered insurance companies to cover out-of-network providers and cover 100 percent of the cost for coronavirus care. He also announced that nursing homes and elder care facilities will begin implementing new visitor policies and enhanced symptom checks for staff members and visitors.

Ducey and Dr. Cara Christ, director of the Arizona Department of Health Services, speaking at a news conference Wednesday afternoon, downplayed suggestions that large gatherings be banned.

"At this time we are not recommending canceling mass gatherings in Arizona," Christ said. "So we are working right now with the CDC on brand-new community mitigation guidance that they just put out and we are not at a point where we would recommend those type of things, but we are constantly evaluating to see if those measures do take sense, but at this time we're not."

Ducey said that workers who are sick "should not be going on work," noting that some employers have been updating policies regarding sick time.

Tests still limited

Christ said that state health authorities have a limited number of testing kits available.

Related: ASU cancels classes, public events over coronavirus

"I understand and my numbers may be a little but outdated, we had enough to run 225 samples, we have not reached that capacity and we are expecting if we haven't already gotten another test kit in for another 150," she said Wednesday.

Tests are being limited because of the small supply, Ducey and Christ said, despite President Trump's statement earlier this week that anyone who wants a test can get it.

"If you're symptomatic and you're in a position where you're part of the vulnerable population, that's where you would qualify for the test," the governor said.

Christ said that some patients require multiple test kits. "It's hard to determine how many patients that is because there's so many different factors that play a role in how many samples are getting utilized for each patient," she said.

Monday, Dr. Bob England, interim director of the Pima County Health Department, told TucsonSentinel.com that at least eight control tests are required for each individual who is tested.

Single positive Pima County test

One Pima County resident has been "presumptively" diagnosed with COVID-19, officials said Monday afternoon. The patient, who had recently traveled to an area with "community spread," is "not severely ill" and is recovering at home.

"The patient is a resident of unincorporated Pima County. This individual is not severely ill, is currently recovering at home in isolation, and has been fully cooperative with public health monitoring," officials said.

Ducey's declaration "doesn't currently affect the County Health Department's response to the outbreak," county Chief Medical Officer Dr. Francisco Garcia said Wednesday. "The emphasis on encouraging more telemedicine and the order requiring visitation restrictions at nursing homes and long-term care facilities are very positive actions by the governor and the county fully supports them."

As of Wednesday morning, 100 people in Arizona have been tested for COVID-19 — the novel coronavirus that was first diagnosed in people late last year — with the two confirmed positive cases and seven "presumptive positive" cases the only ones in the state. Another 32 tests were pending results, and 59 people have been ruled out, officials said.

The virus has caused the deaths of at least 37 people in the United States, with more than 1,200 people diagnosed as having the virus. There have been more than 4,000 deaths worldwide, with the World Health Organization declaring a pandemic Wednesday.

The Arizona Department of Health Services and Pima County Health Department are "investigating any close contacts that may have been exposed while the person was infectious. Any individuals who have been identified as having been exposed will be contacted directly. These individuals will be monitored for fever and respiratory symptoms in collaboration with PCHD and medical providers."

There are no other patients in Pima County who have tests pending, England told TucsonSentinel.com on Monday afternoon. Ten individuals have been tested here, of about 120 who were screened as potentially carrying COVID-19.

Federal health officials sent about 300 testing kits to Arizona last week. The test takes about a day to produce results, but shipping samples around has added time to the process. England said that the Pima patient was tested on Friday, and the results came Monday, but that he wasn’t sure what caused the delay over the weekend.

County officials refused to give any other details about the person who tested "presumptively" positive, only saying that they lived in unincorporated Pima County and had returned from traveling from an area known to be infected with COVID-19.

"We're keeping the details close because we don't want people to suspect their neighbor," England said.

'Common sense' urged

Earlier Monday, local officials urged residents to use "common sense" solutions against the COVID-19 virus, reminding people to wash their hands regularly, and stay home when they're sick. At that point, no positive tests had been announced in Pima County, but cases in Pinal County were evidence of "community transmission" there.

"That means it's only a matter of time before it's here," said Supervisor Richard Elías during a press conference Monday morning.

Elías said that he agreed with statement made by former U.S. Secretary of Health and Human Services, Kathleen Sebelius, that "now's the time for politicians to be kind of quiet and listen to the science guys," he said. "And, so that in part is what we're up to this morning and making sure that we have good quality of information out for everybody today."

The positive test "does not change Pima County's approach as discussed in the press conference earlier today. We have been preparing for this for several weeks. We are not recommending closing schools or canceling events," England said.

Elías was joined by Tucson Mayor Regina Romero, City Councilmen Richard Fimbres and Steve Kozachik, as well as Dr. England and Dr. Garcia.

Related: Tucson book festival called off over coronavirus fears

Tucson Police Chief Chris Magnus stood next to Charles Ryan, the new Tucson fire chief, along with other city and county employees, and leaders from the county's three major hospitals.

Officials outlined the county and city's response to the potential outbreak of the virus, and repeatedly highlighted what they called "common sense" solutions. Garcia said that he wanted people to follow three essential points, including "optimizing" personal health, focusing on protecting the vulnerable, and the creation of policies that would limit infection, as well as protect first responders and county health officials.

While "to date no cases have been confirmed in Pima County," Romero said in the morning press conference, officials are "fully prepared for when the virus eventually presents itself in our region."

"I want to emphasize that both the county and city have protocols in place to deal with exactly this kind of situation and are fully prepared and are ready to respond," she said.

'Focus on protecting the vulnerable'

"However, I want you to think about three things that are our most important messages," Garcia said earlier Monday. "Number one, this is the time to optimize your health and the health of your family. People who are healthy get over this virus, people who are unhealthy, or who are frail, who are elderly may have a harder time and it may have a more serious consequence," he said.

And, he said that people need to "focus on protecting the vulnerable."

"The vulnerable are the same vulnerable that are impacted every year during the flu season — these are our elders and medically frail individuals," he said, adding that they should stay our from crowds, including cruise ships and airplanes. "These folks need to be cocooned so that we can maintain their health," he said.

Garcia also said that the city and county should "settle-in for a long-term response," which includes making sure that employers allow people to stay home when they're sick.

England who also dealt with the county's response during the H1N1 outbreak in 2009, said that there hadn't been a positive result in Pima County, "but it really doesn't matter because it's going to be here, and it's going to transmit locally," he said. "and we need to begin treating it in that way as if we're expecting it."

"This is probably going to feel to us like a bad flu season, so just as we lose tens of thousands of Americans each and every year to the flu," COVID-19 "will tragically kill many people," said England. "There's no getting around that, but that' going to be something that we've all experienced every year because we go through the flu season every year," he said.

England said that while the illness might be deadly, testing in South Korea showed that COVID-19 might have a lower mortality rate than expected, running about 0.6 percent, or roughly one-fifth of the "often quoted figure that you see in the news."

"I'm sure we're much of the mild illnesses," he said, noting that cases from cruise ships showed that people were often "asymptomatic" and showed no signs of the disease, dragging the mortality rate down to the range of the flu. "We've got a lot to learn," he said, but he added that there were "good indications" for county and city officials to treat this in the same way that they treat influenza.

"So, I cannot foresee a circumstance under which we would close a school, or more the point all the schools," he said. "That would be terribly disruptive and the data just doesn't support it." He added that kids often have a less severe illness, and are often less likely to be infected by COVID-19.

"The feds are very cautious," and are still requiring that tests are sent to be confirmed by the CDC, England told TucsonSentinel.com on Monday afternoon. However, he expects that the second test will be abandoned once the feds are comfortable with state agencies. Two private providers have their own tests, which are not going through the CDC, and will soon be available through healthcare providers, England said. But those tests will take longer because samples have to be shipped to their respective labs out of state.

Garcia said that on reports Friday and Saturday that there were cases in Pinal County, officials entered a "new phase of the response." He said that in February, county officials set up a "virtual health emergency operations command," and are working with state and federal officials.

"It's not going to be here for a little while and then go away," said Elías. "We're going to be dealing with this illness for some time until it runs its course. So let's not panic about it or do things that are detrimental to our lives our culture and our economy—that won't help with the long run halt or slow the spread of this disease. So wash your hands, don't touch your face and that's harder to do than most of us think."

He added that the county was "encouraging" employees to stay home if they were sick, and "loosened up" policies on telecommuting, and he encouraged other regional employers to do the same.

During the event, Elias thanked Pima County Health Department employees for "working day and night" over the past two months getting ready for COVID-19. Romero repeated this point saying that she wanted to "emphasize" that city and county officials have "protocols in place to deal with exactly this kind of situation, and are fully prepared, and ready to respond when the virus presents itself in our region."

"Since this was a returning traveler, the Health Department had been in close contact with this fully cooperative individual and their family," County Administrator Chuck Huckelberry said in an afternoon memo to the Board of Supervisors.

"As with other illnesses, sticking to the basics can always go a long way," Romero said. "I'm speaking to you not just as a mayor of the city of Tucson, but also a mother of two children attending our public schools. My top priority will always be to maintain our community's public health, and ensure that everyone in this community has the information and resources to keep them in their loved ones."

'Be alert, not anxious' & 'Stay home if you're sick'

Pima County officials have downplayed any thought of closing schools and calling off events here.

"There have been calls by some in our community to close schools, shutter businesses, or cancel events because of the mere threat of the virus coming to Pima County, not just when (and it's likely going to be when, not if) there is a confirmed case here," said County Administrator Chuck Huckelberry in a memo to the Board of Supervisors last week. "Doing so will only cause severe economic and social disruption beyond what we will already experience and will have little to no effect on containing the spread of this virus."

"We do not close schools due to the flu, and we are going through a pretty bad flu season currently, and we should not close schools and the like for COVID-19," he said.

Huckelberry said the county is "prepared for changes as the situation evolves."

Seven regional health providers joined Pima County in issuing a joint statement late Friday afternoon, urging a measured public response to the coronavirus.

"Though the virus is quite contagious, the vast majority of infections are mild – sometimes asymptomatic – and not typically lethal (deadly). COVID-19 is most dangerous for many of the same people who are most at risk for the flu: older adults and those with chronic disease," said Friday's statement, which was backed by Tucson Medical Center, Carondelet Health Network, University of Arizona Health Sciences Center, Arizona Community Physicians, El Rio Health, Marana Health Center and Desert Senita Community Health Center.

The health care providers supported the county's position on closing schools and calling off events.

"One of the worst things we can do is over-react," Pima County's Dr. England said in a video update posted on Facebook on Friday morning. "COVID- 19, once it's widespread, will feel to all of us something like a bad flu season."

"It's really contagious, it'll spread among us, but only certain people are most likely to get into severe trouble from it," he said. "Same as with the flu: older adults, people with chronic heart and lung disease, people with diabetes, are the most at risk."

"The best thing we can do to protect the most vulnerable is to do the things we all know already to slow down the spread of that virus: Wash your hands frequently, keep your hands away from your face, avoid sick people if you can," he said.

"And stay home if you're sick," he emphasized. "Please don't go to work and don't send your kids to school if you're sick."

"The COVID-19 outbreak is rapidly evolving and based on events in other states, we expect additional cases and community spread in Arizona," Dr. Cara Christ, director of the Arizona Department of Health Services, said in a news release Friday.

"Keeping Arizonans safe and healthy is our number-one priority and we are confident the public health system in Arizona is well prepared to respond to the COVID-19 outbreak," Christ said.

The first case of coronavirus in Arizona was determined in late January. That patient, described by officials as a "member of the Arizona State University community," has recovered and is no longer infected with the disease.

COVID-19 is believed to spread mostly through respiratory droplets produced when a sick person coughs or sneezes. Signs and symptoms of COVID-19 include fever, cough, and shortness of breath. The best way to prevent COVID-19 and other respiratory diseases is to:

Avoid close contact with people who are sick.

Avoid touching your eyes, nose, and mouth.

Stay home when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently-touched objects and surfaces using a regular household cleaning spray or wipe.

Wash your hands often with soap and water for at least 20 seconds. If soap and water is not readily available, use an alcohol-based hand sanitizer.

Increased testing for coronavirus – Arizona officials can now check up to 450 samples daily – could reveal more diagnoses, Christ said Monday. But that is to be expected, she cautioned, and doesn’t necessarily mean coronavirus is worsening. Also, several samples can come from one person.

In response to a question about preparation on Monday, Christ and Ducey said they are not stockpiling food or water. Christ also advised against buying masks but urged people to take safety precautions by washing hands for at least 20 seconds, coughing into tissues and staying home from work or school if sick. The elderly and people with medical conditions are most at risk from the respiratory disease, with symptoms that mimic influenza and are spread person-to-person.

Still, she said, the fact the disease is spreading beyond those who had been exposed during travel to high-risk areas, particularly China, shows the need to remain alert. Arizona public health officials are working with K-12 schools, universities, health facilities and others to protect the public.

Christ urged businesses to create backup plans, such as coming up with an alternate list of suppliers and determining how they will operate with a reduced workforce or without key employees.

Officials understand that reports of the disease soaring across the globe “can cause fear and anxiety about how we can keep ourselves and our loved ones safe,” said Christ, who has three children.

The spread of COVID-19 has led to the U.S. instituting travel bans, advisories and new policies for entry into the country and international travel. The U.S. has banned entry into the U.S. by foreign nationals who have traveled to China or Iran, and travel advisories have been issued for parts of Italy and South Korea.

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