In her little more than a year in the Senate, Sen. Kyrsten Sinema has established herself as one of the chamber's most reserved members with a political brand based on cross-party collaboration, not confrontation.

A big part of the Sinema mystique has been that less is more, at least when it has come to speaking to the media and weighing in on hot-button news developments and controversies.

But the alarming spread of the new coronavirus prompted Sinema to directly take on Arizona Gov. Doug Ducey in a public way over the state's response to pandemic.

Sinema is using social media to implore Ducey to take a more aggressive approach while also offering public health advice.

She also went directly to Arizona mayors to push them to go further in curbing nightlife and dining in their cities; several mayors credit Sinema's intervention for prompting them to do so.

And even after Ducey announced a series of more stringent steps on Thursday, Sinema said it still wasn't good enough.

“There are many parts of Arizona that are not adhering to these (U.S. Centers for Disease Control and Prevention) guidelines, and it is the government’s responsibility to ensure we are adhering to these guidelines to reduce the loss of life that is coming,” Sinema said in an interview Wednesday with The Arizona Republic.

On Monday, the White House, in conjunction with the CDC, issued stricter guidelines to stop the spread of the virus than previously offered. Those guidelines included avoiding groups of more than 10 people, discretionary travel, and avoiding eating or drinking at bars, restaurants and food courts. People were told to do take out.

Ahead of Thursday's announcement, Ducey had recommended postponing or canceling gatherings of 10 people or more, and discouraged dine-in.

That wasn't enough, Sinema said.

Ducey should order temporary closure of entities where people tend to gather, such as bars, nightclubs and gyms, she said. He should also order that restaurants statewide move to pickup and delivery orders only. She noted actions taken by Ohio Gov. Mike DeWine, who issued an order closing all bars and restaurants, and New York Gov. Andrew Cuomo, who announced the state would temporarily close movie theaters, gyms and casinos and allow bars and restaurants to offer only takeout.

Without stricter measures, she said, more people could die.

Late Thursday afternoon, Ducey announced an executive order requiring restaurants in counties with confirmed COVID-19 cases to scale back operations to "dine-out" only. The order closes all bars, movie theaters and gyms in those counties.

Among other steps, Ducey also is deploying the National Guard to help grocery stores and food banks restock empty shelves.

Sinema quickly took issue with Ducey's decision to limit the restrictions on restaurants, bars, movie theaters and gyms to the counties with cases.

As of Thursday evening, eight of Arizona's 15 counties had cases: Maricopa, Pima, Coconino, Graham, Pinal, Navajo, Yavapai and Santa Cruz.

"It should apply to the whole state. Waiting until the cases show up is too late. We should protect all Arizonans," Sinema said in a Twitter message.

After Sinema took the lead Mondayin criticizing Ducey, other Democrats in the state’s congressional delegation challenged the response to the outbreak at the state and federal level.

Their pleas, critiques and suggestions highlight the tension between lawmakers and the Republican executives tasked with heading an emergency response.

Rep. Ruben Gallego, D-Ariz., called on Ducey to seek a special waiver for Arizona that would allow the state to relax standards for care, coverage and administrative deadlines for its Medicare, Medicaid and child-health service program.

Many people are quickly losing their jobs or seeing their income fall rapidly, changing their eligibility for different types of aid, Gallego said.

“You don’t want people to fall into these loopholes,” said Gallego, who has also criticized Trump for what he sees as a slow response to the crisis.

Florida received such a waiver on Tuesday, and other states have already made similar requests to Trump.

Rep. Greg Stanton, D-Ariz., suggested Tuesday that Ducey call on the National Guard to “step in and take life-saving action to curb the effects” of the coronavirus.

“Lives are on the line and we cannot afford to wait longer,” Stanton said in a written statement. “Members of Arizona’s National Guard are trained experts in crisis response. We need their support today, and in the weeks to come, and we shouldn’t delay another moment without mobilizing them to help.”

However, Stanton appeared to envision the National Guard providing logistical support to the health care industry, not grocery stores and food banks.

Stanton, a former Phoenix mayor, was an early critic of the White House response to the outbreak, pointing out defective test kits and the lack of testing generally.

For her part, Sinema began her public campaign arguing in English and Spanish for more forceful actions on Monday, saying the governor could save lives by temporarily closing bars, gyms and other places where people congregate, and asking restaurants to shift to take out and delivery.

So far, Ducey’s approach has been less aggressive than actions taken by other governors. On Sunday, for example, he ordered the state’s schools closed through the end of the month, but only after governors elsewhere and superintendents in Arizona had already done so.

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On March 11, after the World Health Organization called the outbreak a pandemic, Ducey declared an emergency. Health officials stopped short of calling for the cancellation of large events during the state's bustling tourism season.

The declaration allowed the state to tap into emergency funding, gave officials broader powers to procure medical supplies and waived licensing requirements to allow health care officials to take steps such as setting up new hospital beds.

The governor said Thursday of criticism from Sinema and others: "I want to make certain that everyone knows the state's going to speak with one voice."

Ducey said the state has been following federal health guidelines. "We have been hand in glove ... this guidance has changed over time. It will continue to change," he said.

Ducey added: "I'm going to be guided by the facts and the situation on the ground in Arizona."

Later Thursday, Ducey announced the new actions.

The Governor’s Office, through social media, has emphasized the bipartisan collaboration by Ducey, Kathy Hoffman, the Democratic state superintendent of public instruction, Katie Hobbs, the Democratic secretary of state who oversaw the primary election amid the outbreak, and others in recent days.

As Sinema has ramped up her criticism, Ducey has recruited support from Arizona Cardinals legend Larry Fitzgerald and the team's chairman and president, Michael Bidwill.

Ducey has not limited dining at restaurants or closed most gathering places in an effort to fight the spread of the lethal virus.

Sinema’s calls for more aggressive strategies were applauded by some. Others cast her calls as political opportunism, saying that in taking shots at Ducey, she also was trying to damage a possible future political rival. Some Republicans see Ducey as a natural choice to run for the Senate against Sinema.

Jon Gabriel, editor-in-chief of Ricochet.com, a website for "smart, civil conversation on the center right," referred to Sinema's calls for more action as "Such a cynical play."

Asked about that type of criticism, Sinema responded: “I would suggest that those people take a look at my history. I am a cautious person who is careful about making decisions. I am also not one to pick fights with others and that is not what I am doing here. What I am doing is trying to save lives. The data is very clear.”

She cited a dire report by British scientists that without stringent measures by government and individuals, 2.2 million Americans could die by mid-July.

The report says even with aggressive social distancing and implementing every guideline the federal government has listed, more than 1 million could still die.

"In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined," said the report, which has been shared with the White House. "In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB (Great Britain), and 1.1-1.2 million in the U.S."

Sinema said she laid out her concerns last Friday during a phone call with Ducey and Cara Christ, director of the Arizona Department of Health Services.

During that call, Sinema said she encouraged Ducey to close schools and shut down large events that were going to be occurring over the weekend, such as the Arizona Renaissance Festival.

“We had a difference of opinion at the time … on what the state’s role should be here,” Sinema said. “We continued to communicate over the weekend and I continued to share with him directly my very, very, very firm belief that Arizona has a duty to follow the guidelines that were laid out by the White House and the Centers for Disease Control on Monday.”

Sinema declined to characterize Ducey’s response, saying only, “You should ask him about that.”

On Sunday, Ducey and Hoffman announced Arizona schools would close through March 27, starting the following day. The governor and state officialswere only recommending restaurants in areas with known cases of the virus — including Maricopa, Pima and Pinal counties — discourage dining in.

But that wasn'ta mandate.

Deeming the state’s action too lax, Sinema began holding phone calls with mayors, county officials, business groups and collectives, tribal governments, individual businesses, banks, and others “to ask them to take action if the state will not do so because it is all of our duty to help save lives. We must — we must — implement these guidelines in order to bend down the curve of folks who will lose their lives in Arizona.”

Flagstaff Mayor Coral Evans was on Sinema’s call Monday with more than a dozen mayors. What she heard from Sinema was so alarming, she muted the call and beckoned city staff to begin drafting a proclamation then and there to limit dining at restaurants and closing most gathering places.

Sinema’s warnings were dire, said Evans, who had been grappling with what to do for a city of 75,000.

“That was the final straw,” she said of the call. “It really solidified, ‘Hey, I’m not waiting for the governor, I’m not waiting for the county, I’m not waiting for anybody. I’m going to go ahead and take care of my city. I don’t have to wait.’”

Other mayors followed, including Phoenix Mayor Kate Gallego, Tolleson Mayor Anna Tovar and Tucson Mayor Regina Romero.

Tovar said she had already begun drafting a state of emergency before the call.

“After the call with Senator Sinema, we took more of an aggressive approach in regards to the closure of bars, the closure of gyms," she said. "It definitely had an effect in regards to stepping up our preventive measures.”

The Phoenix City Council is weighing whether to roll back Gallego's declaration, news that prompted Sinema to weigh in on Twitter Wednesday evening as the council was holed up in executive session to discuss the matter.

Scottsdale declared a state of emergency, but stopped short of temporarily shuttering or restricting the city's thriving restaurant and bar scene.

Mesa Mayor John Giles said he "expects" people to voluntarily follow recommendations against on-site dining.

For her part, Sinema praised on Twitter the mayors who she said were “taking smart action” to slow the virus’ spread. And she gave shout-outs to business for making the decision to close on their own.

“Absent state action, companies like @HarkinsTheaters (and) @Lifetimefitness have shown great leadership by temporarily closing. Many Arizona restaurants have moved 2 takeout/delivery, doing their part … we will remember your commitment to our community.”

On Tuesday, Sinema participated in a virtual discussion from Capitol Hill with Arizona health care officials about the pandemic.

They painted a dire portrait of the challenges they face today, and the challenges that lie ahead.

They are running out of personal protective medical equipment and hand sanitizer. Others don’t have enough virus testing kits. And some are bracing for staffing shortages.

David Voepel, executive director of the Arizona Health Care Association, an industry group that represents skilled nursing facilities and assisted living communities, said hospitals are preparing for a surge in patients, which will have a ripple effect on nursing facilities.

“They are wanting us to pick up some of the folks that are in the hospitals and if we don’t have the necessary PPE (personal protective equipment), we can’t take care of people properly … Once COVID gets into a long-term care building like what happened up in Kirkland, (Washington), you have devastating results.”

With schools shut down, he said, the industry is facing problems getting enough staff to care for patients.

“It’s being depleted,” he said. “Our fear is, once COVID does come into a building, the workforce will disappear.”

The cascading effect that the spreading of the virus will have on health care systems is gravely concerning, Sinema said.

Marjorie Bessel, the chief clinical officer at Banner Health, said on the call that social distancing “is the only way for us to not exceed max capacity.” She would help Sinema amplify that message, she said.

Have news to share about Arizona's U.S. senators or national politics? Reach the reporter on Twitter and Facebook. Contact her at yvonne.wingett@arizonarepublic.com and 602-444-4712.

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