Long-term care facilities in Maricopa and Pima counties have over the past week seen a spike in COVID-19 cases, and now account for nearly half of all coronavirus-related deaths in Maricopa County.

As of Tuesday, Maricopa County had 198 cases at 42 long-term care facilities, a 200% percent increase in just over a week. Sixty-five have been hospitalized, and 32 have died of COVID-19, the respiratory disease caused by the new coronavirus. That represents half of the county's 60 total deaths.

"These are the people who are most vulnerable to severe disease and why we’re really putting our efforts, focusing on keeping them safe," said Dr. Rebecca Sunenshine, medical director for disease control at Maricopa County Department of Public Health.

Another 110 cases have been reported among staff at long-term care facilities in Maricopa County, a category that includes skilled nursing homes, assisted living, rehabilitation and hospice. Maricopa County has about 500 such facilities.No deaths have been reported among staff.

The sharp increase in cases and deaths at long-term care facilities in the state's most populous counties comes as Gov. Doug Ducey's administration has refused to identify facilities where the number of infections is soaring.

In Pima County, a Tucson nursing home that last month reported two dozen residents had tested positive for COVID-19, has seen its numbers double in a few weeks.

Sapphire of Tucson Nursing and Rehabilitation now has 50 residents and 24 staff members testing positive, spokeswoman Jeanine L'Ecuyer said. Eleven patients have since returned from the hospital after receiving care.

She said no employees have died but declined to say whether residents have died.

Thousands of deaths nationwide

Across the country, residents of long-term care facilities are among the most vulnerable populations to the highly infectious virus. Many are elderly and have underlying health problems. Federal and state officials have issued several mandates since early March, including banning nearly all visitors and requiring stringent infection control.

More than 3,600 deaths nationwide have been linked to COVID-19 outbreaks in nursing homes and at long-term care facilities, an alarming rise in the past two weeks, according to The Associated Press.

The AP's tally is based on media reports and state health departments. The latest count of at least 3,621 deaths is up from about 450 deaths 10 days ago. The true toll is likely much higher, experts say, because most states don’t include in their counts the people who died but were never tested for COVID-19.

On Tuesday, New York Gov. Andrew Cuomo said the number of deaths in nursing homes has been an “increasing issue,” accounting for 133 of the state's 778 deaths from the illness on Monday.

"We’ve been worrying about nursing homes from Day One," he said.

Little information in Arizona

Arizona, unlike many states, has not released statewide figures on the number of COVID-19 cases in nursing homes. But under an executive order signed by Ducey last week, nursing homes are now required to report to the state weekly the number of residents who test positive for COVID-19 and how many are hospitalized. The executive order does not require them to report how many staff tests positive.

In a statement Monday, the governor's spokesman, Patrick Ptak, said the state Department of Health Services "is in the process of gathering this information and making it available to the public."

But the piecemeal information that's currently available shows a spike in COVID-19 cases at nursing homes in Maricopa and Pima counties. Last week, Maricopa County officials said they will prioritize long-term care facilities as they distribute personal protective equipment to guard against the new coronavirus.

Sunenshine, of Maricopa County, said the county has systems to identify COVID-19 cases in long-term care facilities. She said county officials are in touch weekly with facilities to find out whether residents have respiratory illnesses and how many have been diagnosed with COVID-19.

She said county officials work closely with the facilities to get residents with respiratory illnesses tested and to make sure the facilities are following infection-control strategies, restricting visitors and checking people for symptoms and fever. She said the county also provides templates of letters for facilities to notify residents and families if there's a confirmed case of COVID-19.

She said families should also feel empowered to contact the facility where their relative lives and ask "have you had any case or do you have any cases"?

Health officials in many rural Arizona counties say they have not received reports of COVID-19 cases at long-term care facilities.

The counties that say they have no reports of COVID-19 at long-term care facilities include, Mohave, Santa Cruz, Yuma, Gila, La Paz, Coconino, Cochise, Graham and Apache.

Yavapai County Public Health has been notified of one case in a facility, with no spread at this time, said Terri Farneti, a spokeswoman for the health department.

Pinal County declined to release information on nursing home cases, while Navajo County said it did not yet have data. Greenlee County did not respond to requests for information.

Arizona Department of Health Services has not released the number of residents in long-term care facilities who have tested positive for COVID-19 and has declined to identify nursing homes with coronavirus cases. Arizona counties are also not identifying the nursing homes.

Calls for transparency

The lack of information about a vulnerable population prompted the state's largest advocacy group for retirees to ask the governor on Monday to make the facility names available to the public. Dana Marie Kennedy, state director for AARP Arizona, wrote in a letter to the governor that many AARP members have expressed concerns about cases of COVID-19 in Arizona's long-term care facilities.

"What we do not know, and what Arizonans with family members in long-term care facilities are desperate to know, is which facilities have reported cases," the letter said. "We ask that the state make the names of these facilities available to the public."

At a news conference Tuesday, Arizona Department of Health Services Director Dr. Cara Christ was asked why the department has not released information about nursing homes that house large numbers of people and have positive COVID-19 cases.

Christ said she considers that "protected health information" and "it's not information the department can give out."

She added that the department will be working with the facilities to make sure "they are working with their residents and the families and the loved ones to let them know about what’s going on within that facility."

The AARP's Kennedy, however, has maintained that providing information about facilities does not violate federal law that protects individual patients' medical records.

And a growing number of states are already disclosing which long-term care facilities have confirmed cases of COVID-19, according to a survey by the Wall Street Journal. Minnesota and Oklahoma are among the states listing facilities with residents who have tested positive for COVID-19.

Arizona on Sunday released ZIP code-specific information on cases of COVID-19. But state officials refused to disclose how many cases in each ZIP code are attributed to the hospital that treated the patient or the patient’s home. That lack of detail makes it impossible to know how many cases stem from nursing homes.

An Arizona Republic analysis of the data, however, found that ZIP codes with nursing homes had higher rates of infection than those without, both on average and by median.

The state did not provide exact numbers for ZIP codes with one to 10 cases, and it suppressed data for ZIP codes where more than 50% of the population is tribal residents. Because of that, it’s impossible to make a valid comparison of all affected areas.

But among ZIP codes with at least 11 cases, those with nursing homes have on average 0.75 cases per 1,000 residents.

Among ZIP codes without nursing facilities That number is 0.63.

Only a handful of ZIP codes with nursing homes had no cases.

Have you heard reports of Arizona nursing homes with cases of COVID-19? Contact reporter Anne Ryman with your tips at anne.ryman@arizonarepublic.com or 602-444-8072. Follow her on Twitter @anneryman.

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