From: Anthony J. SantiagoTo: BOD; Executive Staff Distribution Group; Viji Murugavel; Patrick V. Peterson; Yan GanCc: Stephen R. Lewis; Robert Stone; Carol Schurz (NTS); Arzie Hogg (NTS); Bruce Harvey; Candalerian Preston; Kevin D. Knight; Jennifer Allison (NTS); James De La Rosa (NTS); Monica Antone (NTS); Isaac SalcidoSubject: Data Update 12/11/2020Date: Friday, December 11, 2020 6:43:04 AMAttachments: image027.png

image001.pngimage002.pngimage003.pngimage004.pngimage005.pngimage006.pngimage007.pngimage008.pngimage009.pngimage010.pngimage011.pngGRHC COVID-19 Data Dashboard 2020-12-11 0600 AM.pngGRIC COVID-19 Data Dashboard 2020-12-11 0600 AM.pngPediatric COVID-19 Data Dashboard 2020-12-11 0600 AM.pngCopy of GRHC Patients COVID Outcome Report.xlsxCopy of GRHC Pediatrics COVID Report (004).xlsx

Today’s data update includes our GRHC testing cohorts with percent positive test rates; our attached GRHC Daily and Weekly Dashboards; and,important trends for your review.

Yesterday we learned that the 2 Caring House Residents for whom we were concerned tested positive on Surveillance tests earlier this week haveeach tested negative twice on subsequent retests; neither has developed any clinical symptoms suggestive of COVID-19 11 days after potentialexposure. Both are doing well but remain in our B Unit Isolation ward for continued clinical monitoring and out of an abundance of caution tomitigate any potential for transmission to others. At this time, we believe the positive test results were falsely positive. Yesterday, the Vaccines and Related Biological Products Advisory Committee (VRBPAC), an independent body of scientific experts in the field ofvirology and infectious disease, recommended to the FDA to approve Pfizer-BioNTech’s vaccine candidate for COVID-19 – BNT162b2 – forEmergency Use Authorization. The FDA and CDC must formally approve, but it is anticipated they will, and distribution of the vaccine in anticipated.

Yesterday, we provided the Phoenix Area Office (PAO) Distribution Plan for Phase 1a your review.The PAO will receive 2925 of the Pfizer vaccine (assuming approval today), of which GRHC will receive 1060 doses – the most of the 35 sitesreceiving vaccine – with PIMC second with 1007 doses.The initial allocation of 1060 doses are for the first dose for 1060 individuals – the PAO will then distribute an additional 1060 doses of the Pfizer

vaccine in time for those individuals to receive their 2nd dose of vaccine – thus 1060 individuals fully vaccinated. It is anticipated that Moderna will also receive approval later this month, at which time GRHC will receive an additional allocation of doses for Phase1a. Phase 1b and Phase 1c distribution plans have yet to be finalized, but GRHC has requested a total of 120,000 doses for Phase 1 allocation to fullyvaccinate 60,000 individuals (please note that there will be subsequent Phase 2 and Phase 3 distributions as well). We await further details and willshare those with you once we receive them.

The Caring House registered with the National Healthcare Safety Network as a Long-Term Care Facility (LTCF) eligible for direct receipt of COVID-19vaccine independent of our IHS allocation, coordinated thru Walgreen’s Pharmacy; based on communication yesterday from the Arizona HealthCare Association, vaccine distribution should begin for LTCFs the week of December 27. We requested enough to vaccinate all Residents and Staff(300 individuals / 600 doses). This will supplement our IHS allocation allowing us flexibility as to whom else to prioritize.

Global cases are at 69.7M cases and 1.585M deaths; in the US there are 15.8M cases and greater than 292K deaths; and in AZ greater than 387Kcases and nearly 7154 deaths @ 0545.

There were 697,739 new cases and 12,476 deaths globally on 12/10.There were 224,452 new cases and 2768 deaths in the US on 12/10.There were 4,928 new daily cases and 73 deaths in AZ on 12/10. There are currently at 107,258 patients with COVID-19 in a US Hospital with 21,023 in an ICU and 7,,442 on a Ventilator; on 11/1 the number in thehospital was 47,531 with 11,120 in and ICU and 2,977 on a Ventilator.

AZ is now designated a Severe Outbreak – the highest threat level – and is currently experiencing the highest daily case rate since the pandemicbegan 277 days ago – 81.1 cases/100K residents – with a 7-day average of new daily cases of 5902 and 7-day average percent positive test rate of24.1% with high testing levels, a sign of many undetected cases. AZ Hospitalizations continue to rise, with both ICU and Adult Inpatient Bed Occupancy at greater than 90% - with 3,408 hospitalized with aCOVID-19 diagnosis and an additional 800 in an ICU with COVID-19. 

From 12/1-12/11 at 0600 AZ – there have been 67,351 new cases detected in AZ – and at the state Hospitalized rate of 8% - that equals aprojected 5388 patients needing hospitalization for just the last 10 days of cases.Currently, of those hospitalized,  80% require an Inpatient bed and 20% an ICU bed – thus just for the last 10 days of new cases that is aprojection of 4310 inpatient admissions and 1078 ICU admissions. 

At this time there is a limited number of beds available (880 Inpatient beds and 169 ICU beds) – hospital systems are making adjustments suchas doubling up in rooms, utilizing traditionally non-clinical areas for patient care, putting up Field Hospitals – but given the trends, it isprojected we will see cases exceed capacity in December. The tertiary hospital systems in the Valley (i.e. Banner, Dignity, etc.) are adoptingCrisis Standards of Care and will utilize triage metrics (Sequential Organ Failure Assessments) for determining who to accept on transfer.

mailto:ajsantiago@GRHC.ORGmailto:BOD@GRHC.ORGmailto:ExecutiveStaffDistributionGroup@GRHC.ORGmailto:vmurugavel@GRHC.ORGmailto:Patrick.Peterson@gric.nsn.usmailto:ygan@GRHC.ORGmailto:Stephen.Lewis@gric.nsn.usmailto:Robert.Stone@gric.nsn.usmailto:carol.schurz@gilariver-nsn.govmailto:Arzie.Hogg@gilariver-nsn.govmailto:Bruce.Harvey@gric.nsn.usmailto:Candalerian.Preston.THD@gric.nsn.usmailto:Kevin.Knight@gric.nsn.usmailto:Jennifer.allison@gilariver-nsn.govmailto:James.Delarosa@gilariver-nsn.govmailto:Monica.Antone@gilariver-nsn.govmailto:Isaac.Salcido@gric.nsn.us

GRHC Patients COVID Outcome Rep

GRHC Patient COVID-19 Outcome Report

Report Run 12/11/2020 6:00:09 AM

Current StatusPatients Confirmed at GRHCPatients Confirmed Outside GRHCTotal

Current Hospitalization25328

Deceased482270

Followed Up - Status Not Specified272047

Non Followed Up1270127

Projected Asymptomatic15015

Quarantine Ended13013

Quarantine OnGoing93093

Recovered1,724351,759

Symptom Improving1294133

Symptom New/Additional516

Symptom No Change1985203

Symptom Resolved64367

Symptom Worse19120

Total2,487942,581

HospitalizationPatients Confirmed at GRHCPatients Confirmed Outside GRHCTotal

Hospitalized26878346

Non Hospitalized2,219162,235

Total2,487942,581

DeceasePatients Confirmed at GRHCPatients Confirmed Outside GRHCTotal

Hospitalized372057

Non Hospitalized11213

Total482270

Sheet1

GRHC Pediatrics COVID-19 Report

Report Run 12/11/2020 6:00:13 AM

Test ResultInitial TestsOther TestsTotal

Cancelled171027

Inconclusive132841

Invalid235

Negative4,4984,1048,602

Pending36138174

Positive65593748

Rejected336

See Comment202

Total5,2264,3799,605

Percent Positive12.7%2.2%8.0%

Percent Positivity Calculation: Test over Test - used by CDC = (# of positive tests) / (# positive tests + # negative tests)Initial Tests include one test per person, the very first positive test of positive cases and the very first test of negative cases.The Percent Positive rate in Initial Tests is equivalent to: People over People = (# of people with positive tests) / (# of peope with positive tests + # of people with negative tests)The indeterminate results (cancellation, rejection, comment, invalid, inclusive, pending) were excluded from the denominator.

Sheet2

Surveillance TestingSymptomatic TestingTotal

ResultInitial TestsOther TestsTotalInitial TestsOther TestsTotal

Cancelled00017102727

Inconclusive00013284141

Invalid2350005

Negative1,7952,0973,8922,7032,0074,7108602

Pending99099274875174

Positive7027258591676748

Rejected3360006

See Comment0002022

Total1,8792,1954,0743,3472,1845,5319,605

Percent Positive3.8%0.1%1.8%17.8%4.3%12.6%8.0%

Percent Positivity Calculation: Test over Test - used by CDC = (# of positive tests) / (# positive tests + # negative tests)Initial Tests include one test per person, the very first positive test of positive cases and the very first test of negative cases.The Percent Positive rate in Initial Tests is equivalent to: People over People = (# of people with positive tests) / (# of peope with positive tests + # of people with negative tests)The indeterminate results (cancellation, rejection, comment, invalid, inclusive, pending) were excluded from the denominator.

Sheet3

Age GroupNo. of Positive Cases

Ages 0-4124

Ages 10-13142

Ages 14-19222

Ages 5-9167

Total655

Sheet4

DistrictGRICNon-GRICNon-NativeNo. of Positive Cases

AK CHIN1809

DISTRICT 1193022

DISTRICT 266012

DISTRICT 387121100

DISTRICT 4394043

DISTRICT 5486054

DISTRICT 66410074

DISTRICT 7191020

OTHER652479321

Total34829710655

On 12/10, there were 61 detected COVID-19 cases at GRHC, 21 (34.4%) were GRIC members.From 12/1 – 12/11 @ 0600 we have detected 376 COVID-19 cases, 161 (43%) are GRIC members. From 12/1 – 12/11 @ 0600 wehave detected 88 Pediatric cases, of which 50 (57%) are GRIC members.

GRHC Detected COVID-19 Cases from 12/1-12/11 @ 0600:  376                     GRIC Detected COVID-19 Cases from 12/1-12/11 @0600: 161

GRHC Detected Pediatric COVID-19 Cases from 12/1-12/11 @ 0600: 88        GRIC Detected Pediatric COVID-19 Cases from 12/1-12/11 @ 0600: 50

GRHC Patient COVID-19 Outcomes Report (see attached report) – highlights:13.4% Hospitalized Rate (346 of 2581)2.7% Fatality Rate (70 of 2581)74% Recovered Rate (1759 of 2379 known outcomes) GRHC Pediatric COVID-19 Weekly Report (see attached report) – highlights:

655 cases of which 348 (53%) are GRIC members and 325 (50%) reside within the 7 Districts72 cases of 4074 Surveillance Tests were positive (1.8% positive test rate)676 of 5531 Symptomatic Tests were positive (12.6%)   

GLOBAL 

Updated 12/11/2020 @ 0600 AZ:

 

US

Updated 12/11/2020 @ 0600 AZ:

ARIZONA:

Updated 12/11/2020 @ 0600 AZ: 

 

The test percent positivity reflects that despite a significant increase in testing only a fraction of positive cases in the population are beingdetected. 

Both the COVID Tracking Project and Johns Hopkins Coronavirus Resource Center document Native Americans as 4% of AZ population, 8% ofhospitalizations and 12% of deaths to date.AI/AN in AZ are 3x as likely to contract COVID-19 and 3.5x as likely to die from COVID-19 compared with non-Hispanic Caucasians. 

GRHC Testing Cohorts with Percent Positive Test Rates as of 12/10 @ 2300:GRHC Patient Tests (Surveillance & Symptomatic Testing) Surveillance

TestingSymptomatic

TestingTotal

Cancelled 0 95 95Inconclusive 0 157 157Indeterminate 0 1 1Invalid 10 0 10Negative 13,758 17,274 31,032Pending 387 260 647Positive 203 2,785 2,988Rejected 51 0 51See Comment 0 4 4Total Tests 14,409 20,576 34,985Total Tests with Determinate Results 13,961 20,059 34,020Test Positive Rate 1.5% 13.9% 8.8%

GRHC Patient Symptomatic Testing Symptomatic

TestingTotal

Cancelled 95 95Inconclusive 157 157Indeterminate 1 1Negative 17,274 17,274Pending 260 260Positive 2,785 2,785See Comment 4 4Total Tests 20,576 20,576Total Tests with Determinate Results 20,059 20,059Test Positive Rate 13.9% 13.9%

GRHC Patient Surveillance Testing(Exclude Dialysis East &West, DRS, GRIC RPY, TCH)

SurveillanceTesting

Total

Invalid 5 5Negative 9,086 9,086Pending 190 190Positive 178 178Rejected 21 21Total Tests 9,480 9,480Total Tests with Determinate Results 9,264 9,264Test Positive Rate 1.9% 1.9%

Dialysis East &West Patient Surveillance Testing Surveillance

TestingTotal

Invalid 3 3Negative 2,282 2,282Pending 50 50Positive 14 14Rejected 13 13Total Tests 2,362 2,362Total Tests with Determinate Results 2,296 2,296Test Positive Rate 0.6% 0.6%

DRS Surveillance Testing Surveillance

TestingTotal

Invalid 1 1Negative 1,818 1,818Pending 146 146Positive 8 8Rejected 8 8Total Tests 1,981 1,981

Total Tests with Determinate Results 1,826 1,826Test Positive Rate 0.4% 0.4%

RPY Surveillance Testing Surveillance

TestingTotal

Invalid 1 1Negative 96 96Pending 1 1Positive 1 1Total Tests 99 99Total Tests with Determinate Results 97 97Test Positive Rate 1.0% 1.0%

TCH Patient Surveillance Testing Surveillance

TestingTotal

Negative 475 475Positive 2 2Rejected 9 9Total Tests 486 486Total Tests with Determinate Results 477 477Test Positive Rate 0.4% 0.4%

GRHC Employee Tests (Surveillance & Symptomatic Testing) Surveillance

TestingSymptomatic

TestingTotal

Cancelled 0 19 19Inconclusive 0 4 4Indeterminate 0 3 3Invalid 21 0 21Negative 16,114 6,161 22,275Pending 127 261 388Positive 77 211 288Rejected 80 0 80Sample Leaked 4 0 4Total Tests 16,423 6,659 23,082Total Tests with Determinate Results 16,191 6,372 22,563Test Positive Rate 0.5% 3.3% 1.3%

GRHC Employee Symptomatic Testing Symptomatic

TestingTotal

Cancelled 19 19Inconclusive 4 4Indeterminate 3 3Negative 6,161 6,161Pending 260 260Positive 211 211Total Tests 6,658 6,658Total Tests with Determinate Results 6,372 6,372Test Positive Rate 3.3% 3.3%

GRHC Employee Surveillance Testing (Exclude Dialysis Employee and TCH Employee Surveillance Testing)

SurveillanceTesting

Total

Invalid 19 19Negative 12,798 12,798Pending 121 121Positive 64 64Rejected 53 53Sample Leaked 3 3Total Tests 13,058 13,058Total Tests with Determinate Results 12,862 12,862Test Positive Rate 0.5% 0.5%

Dialysis East &West Employee Surveillance Testing Surveillance

TestingTotal

Negative 1,069 1,069Positive 5 5Rejected 12 12Total Tests 1,086 1,086Total Tests with Determinate Results 1,074 1,074Test Positive Rate 0.5% 0.5%

TCH Employee Surveillance Testing Surveillance

TestingTotal

Invalid 2 2Negative 2,247 2,247Pending 6 6Positive 8 8Rejected 15 15Sample Leaked 1 1Total Tests 2,279 2,279Total Tests with Determinate Results 2,255 2,255Test Positive Rate 0.4% 0.4%