Arizona isn't deploying the National Guard to contain the new coronavirus like New York is, but the state has a playbook of far-reaching actions it may take for severe outbreaks.

Those actions could include dramatic steps such as halting public transportation, closing facilities like theaters and schools, rationing medicine and canceling mass gatherings such as concerts, festivals and conferences.

So far, none of that has happened, though some organizers of local events have chosen to cancel large gatherings.

Arizona Gov. Doug Ducey on Wednesday declared an emergency and signed an executive order to fight the spread of COVID-19.

Ducey's declaration will let Arizona tap into $500,000 in emergency money and procure medical goods and services while putting the Arizona Department of Health Services in charge of coordinating the emergency response.

Ducey's executive order makes insurance companies and health plans cover out-of-network medical providers, eliminates all co-pays, co-insurance and deductibles for new coronavirus testing and bans "price-gouging" related to COVID-19.

"Arizonans should not panic — our approach will be calm and steady," Ducey said in a written statement. "This Emergency Declaration and Executive Order continue our effort to protect public health and save lives.”

Arizona's playbook says he also has authority to issue orders that:

Mandate medical examinations for exposed persons.

Ration medicine and vaccines.

Provide for transportation of medical support personnel and ill and exposed persons.

Provide for procurement of medicines and vaccines.

In a state of emergency, law enforcement in Arizona and the National Guard could be called upon to enforce the governor's orders, the playbook says.

"State law provides a number of tools for the governor to address public health issues, including measures to engage the National Guard," an emailed statement from Ducey spokesman Patrick Ptak confirmed.

"Right now, our focus is on prevention and mitigation, ensuring the public is informed and able to take all necessary precautions."

State can restrict movement

As of Wednesday, Arizona had nine confirmed or presumed positive cases of COVID-19 infection, which is a much smaller number than New York, where Gov. Andrew Cuomo this week deployed the National Guard to contain an area deemed the center of that state's outbreak.

The New York State Department of Public Health as of Tuesday was reporting 173 positive cases.

In Arizona,three patients with positive cases have been hospitalized. The others were either recovering or have already recovered at home. There have been no deaths.

But Arizona turned a corner last week when "community spread" of COVID-19 illness occurred in a health care worker in her 40s who had not traveled to one of the areas affected by the disease and also had no known contact with an infected person.

The case means the new coronavirus is most likely circulating in the community, and Arizonans need to be vigilant about washing their hands and avoiding contact with people who are sick.

Unlike seasonal influenza, there's no vaccine for COVID-19 and no antivirals that have been proven effective to treat it.

On Monday, Ducey and Arizona Department of Health Services Director Dr. Cara Christ said they were prepared to see more cases here. They advised older Arizonans and people with underlying health conditions such as lung disease, diabetes and heart disease to avoid crowds and to stock up on medications, groceries and other household supplies.

State health officials are concerned about residents and workers in long-term care facilities and are recommending visitor screening and extra precautions.

The state's "Non-Pharmaceutical Interventions Playbook" — an ever-evolving document, public health officials stress — envisions the precise scenario Arizona is facing. It refers to a disease-related emergency involving a previously unknown virus, where a well-matched vaccine and effective medications to treat the illness are not available.

The interventions that the state takes may vary, depending on the severity and type of event, the 31-page playbook says. There are different interventions for possible scenarios including bioterrorism, measles, infectious diseases and natural disasters such as severe floods, heat waves and wildfires.

In the event of a biological or infectious disease outbreak, the possibilities in the playbook include:

Isolation and quarantine.

Restrictions on movement, such as telling people to shelter in place.

Travel advisories/warnings.

Halting public transportation.

Evacuation and relocation (including patient relocation).

School and childcare closures.

Mass gathering postponement/cancellation.

Recommendations to avoid crowded places.

External decontamination.

Environmental decontamination.

The playbook says "clear and consistent lines of communication" are important during a public health response "to inform the public not only of the specific interventions being implemented (e.g. which schools/businesses/events are closed) but the rationale behind these measures."

Adjusting patient-to-staff hospital ratios

In addition to the playbook, Arizona has a 490-page pandemic influenza plan that was updated in 2019. The state's planning for a flu pandemic is what would drive its response to a possible new coronavirus pandemic.

"A new virus subtype will likely emerge in a country other than the United States, although a novel strain could first emerge in the United States," the plan says. "Although there may be isolated pockets, the pandemic could affect all geographic areas of the state."

The plan says increased demand for health care services may require discharging of all but critically ill hospital patients; adjusting the patient-to-hospital staff ratio; relaxing health care provider licensing requirements as deemed appropriate; using general population shelters and alternate care sites as temporary health facilities; expanding the capacity of mortuary services.

Other highlights of the influenza plan:

Secondary bacterial infections following influenza illness may strain antibiotic supplies.

In an influenza pandemic, there will likely be a shortage of medical personnel and resources such as vaccines, antivirals and hospital bed space. Ethical considerations will become apparent as decisions regarding which people receive scarce resources will be made.

If there's a bi-national public health emergency, the state health department's Office of Border Health will be a conduit with the Sonoran state health department in Mexico.

Travel strategies range from distribution of travel health alert notices to

isolation and quarantine of new arrivals, to restriction or cancellation of nonessential travel.

Health care facilities need to plan for additional security during a pandemic, given the increased demand for services, long wait time for care and because triage of treatment decisions may leave people feeling like they aren't receiving the level of care they think they require.

Hospital staff need to be reminded of potential crimes within the facility that may be committed during times of overcrowded conditions and staff distractions.

Understaffed skilled nursing facilities may face flu outbreaks among fragile patients and home health care services may be critically challenged, leaving many vulnerable clients without services.

Community health centers and urgent care centers will be a critical resource for many patients.

Separate sites for people with signs or symptoms of illness may be established away from primary care, emergency departments and hospitals. Those alternate care sites could be schools, gymnasiums or other sites identified by the Arizona Department of Health Services and local health departments.

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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