COVID-19 Update for the August 10, 2021 Board of Supervisors Meeting

Date: August 5, 2021

To: The Honorable Chair and Members From: C.H. Huckelberry Pima County Board of Supervisors County Administrator

Re: COVID-19 Update for the August 10, 2021 Board of Supervisors Meeting

Pandemic Update After a nadir at the end of May which experienced 244 cases that week, the number of cases has risen during each week in July, and is now estimated at 1,098 cases the last week of July. During that time COVID-19 test positivity has increased from 3 percent the last week of May, to 9 percent last week. The increase in cases has occurred almost exclusively among the unvaccinated portions of our population, impacting predominantly the 15 to 19 and 20 to 40 age groups.

Variants of concern, including the Alpha and Delta variants, have been detected among 68 percent of the specimens forwarded to the State for variant analysis as part of our limited surveillance. Among these Alpha and Delta variants continues to predominate and is identified in 59 percent of positive tests that are sequenced. Notably, the Delta variant in Pima County has increased every week since mid-June. National surveillance has identified Delta as the predominant variant in the U.S., and that is likely to happen here locally in the very near future. We have become aware that the State Health Department will be unveiling a landing page reporting on variant distribution and we will transmit that information to the Board as soon as it its available.

COVID-19 infections occurring among fully vaccinated individuals (breakthrough infections) remain a small but concerning fraction of the cases occurring in Pima County. At this time, they represent 0.1 percent (648 of 549,178) of all cases diagnosed in this community. What is more concerning, is that the number of breakthrough cases has doubled from 122 in June to 253 in July, probably reflecting the impact of the more transmissible variants now circulating in this community. What is also clear from our review of local data is that even when breakthrough cases occur, hospitalization (0.2 percent or 16 of 7,480) and death (0.08 percent 2 of 2,459) are extremely rare among the vaccinated population. It bears repeating that COVID-19 vaccination remains the most important tool that needs to be leveraged in our pandemic response if we are to prevent needless hospitalizations and deaths in Pima County.

Hospital Capacity Our Health Department monitors hospital capacity on a daily basis, by calling each facility within the jurisdiction to assess current volumes in the inpatient medical surgical units and in intensive care. This voluntary self-reporting by our partner hospitals has been invaluable for the regional management of precious hospital resources.

The Honorable Chair and Members, Pima County Board of Supervisors Re: COVID-19 Update for the August 10, 2021 Board of Supervisors Meeting August 5, 2021 Page 2

COVID-19 positive inpatients peaked at 760 on January 7 of this year, and had been steadily declining to its lowest point on May 29 with 34 inpatients reported that day. Inpatients had remained relatively flat, but are now consistently increasing. Most recently COVID-19 inpatients peaked on July 30 at 97 inpatients that day.

COVID-19 ICU bed usage reached its peak of 343 on January 11, 2021, reaching its lowest occupancy of 14 on May 21 and leveling off in the low twenties. This last week, COVID-19 ICU patients have ranged from 30 to 37 per day.

At this time hospital capacity is not expected to be an issue, but we remain vigilant of the overall impact the increased number of cases is having on the overall delivery of health care services throughout Pima County.

Pediatric Population Update Approximately 19,863 COVID-19 cases have occurred in the population of 0 to 19 year olds in Pima County. This represents just over 16 percent cases of COVID-19 since the beginning of the pandemic. (Please note that a statistical coding error led us to overstate the fraction of cases in this age group in my prior memorandum of July 13.)

Similarly, there were 7,567 hospitalizations of Pima County residents since the onset of the pandemic, but only 3 percent have occurred in the 0 to 19 age group. Significantly, there have been no COVID-19 related deaths in this age group among Pima County residents.

The dynamics of infections among young people have followed those of the community at large, peaking in early January 2021 and now waning. (This level of detail is provided by week and month in Attachment 1 for the entire course of the pandemic.)

The rate of infection among young people may be changing however, as the return to school will bring back thousands of unvaccinated children into school environments that are now limited in their ability to require universal mandatory masking through the recent actions of the Governor and the State Legislature as part of the conclusion of the budgetary process. The Health Department’s estimate of the population with at least a single dose of vaccine suggest that only 26 percent of the 10 to 14-year population and 49 percent of 15 to 19- year population have received at least a single dose of vaccine. Since the start of the school year and related summer athletic training activities, schools have reported 85 cases of COVID- 19 in the month of July.

Recognizing the vulnerability of unvaccinated youth in the COVID-19 pandemic and given the difficult position that schools find themselves regarding the mixed messaging on mitigation from the State, the Pima Health Department updated its guidance to schools as they start the new academic year. (Attachment 2). This document emphasizes the critical role of vaccination for age-eligible children, as well as families, faculty and staff. Consistent with the CDC guidance for COVID-19 prevention in K-12 schools, it also stresses the need for consistent and correct face covering use by unvaccinated individuals, including all children less than 12 years of age. At my direction, and in consultation with the County Attorney’s The Honorable Chair and Members, Pima County Board of Supervisors Re: COVID-19 Update for the August 10, 2021 Board of Supervisors Meeting August 5, 2021 Page 3

staff, Dr. Theresa Cullen has provided all school districts (and subsequently charter and private schools) a legal order clarifying the legal authority the Health Department will exercise to protect the health and well-being of the children in Pima County. (Attachment 3) Of note, the order was updated on August 4, 2021 to correct a scrivener’s error.

Vaccine Coverage Though progress has significantly slowed in the last two months, Pima County continues to make steady improvement in COVID-19 vaccination coverage. Indeed, in every age category currently reported by the CDC COVID-19 Data Tracker, Pima County continues to have better coverage than the State and the Nation.

Population Percent with Partial (1-dose) and Full COVID Vaccine Coverage by Age threshold for Pima County, Arizona and the U.S. Partial (1-dose) Coverage Complete (Full) Coverage Pima Arizona United States Pima Arizona United States County County

>12 years 70.1% 62.7% 67.9% 61.1% 53.3% 58.3% >18 years 72.1% 65% 70.2% 63.3% 55.7% 60.7% >65 years 93.8% 86.1% 90.1% 84.1% 74.5% 80.2% Total 60.7% 53.5% 58% 52.9% 45.5% 49.8% population Vaccinated (635,758) (3,893,533) (165,614,017) (553,852) (3,309,350) (165,334,987)

To date the strategy of micro-targeting census tracts, schools, and community organizations continues to reach the unvaccinated segments of our county. Through this effort the Health Department and its partners have conducted more than 455 mobile and pop-up events that have reached nearly 40,000 individuals across our community. One indicator that these mobile efforts are reaching the underserved population is evidenced by the racial/ethnic breakdown of those served by these efforts (48 percent Hispanic, 37 percent White, 4 percent African American, 3 percent Asian/Pacific Islander, and 1 percent American Indian).

Per the Arizona State Department of Health Services, Pima County has the second highest vaccination coverage (after Santa Cruz County). It also reports a significantly more diverse vaccinated population compared to the rest of the state; reporting Pima County vaccine recipients as 42 percent are white, 22 percent Hispanic, 2 percent African American and 2 percent American Indian.

Our own data confirm that first dose coverage exceeds the 60 percent threshold for every ten-year age group beginning at 30. The reservoir of unvaccinated population remains the The Honorable Chair and Members, Pima County Board of Supervisors Re: COVID-19 Update for the August 10, 2021 Board of Supervisors Meeting August 5, 2021 Page 4

lower age groups, with only 26 percent of 10-14, 49 percent of 15-19, and 47 percent of 20-29 year olds having the lowest first dose vaccination rates.

Conclusion It is clear Pima County is experiencing its fourth surge. This one associated with the return to school exacerbated by the continued loosening of personal mitigation practices, and the circulation of viral variants especially among the unvaccinated fractions of the community. Despite this, the Health Department’s steady progress in vaccination will likely mean that the impact on hospitals is likely to be more modest compared to the holiday surge. The policy question that confronts the Board is whether reinstatement of the emergency declaration is merited by the current state of the pandemic. Such a declaration would be largely symbolic, since the recent actions of the governor and the legislature have effectively eliminated most of the public health tools that could be brought to bear by Pima County.

Given that reality, at this time, our only recourse is to redouble our efforts to vaccinate as much of the population in Pima County willing to accept this intervention, and to continue to call for consistent mask use indoors especially among the unvaccinated for their own protection and the protection of immune-compromised and 0 to 11 years of age who cannot yet be vaccinated.

CHH/dym

Attachments

c: Jan Lesher, Chief Deputy County Administrator Carmine DeBonis, Jr., Deputy County Administrator for Public Works Francisco García, MD, MPH, Deputy County Administrator & Chief Medical Officer, Health and Community Services Theresa Cullen, MD, MS, Director, Health Department

ATTACHMENT ATTACHMENT 1

Demographics of Pima County COVID-19 Cases by MMWR Week

Chart 1: Pima County COVID-19 Cases by Age Groups and MMWR Week

COVID-19 Cases by Age Groups and MMWR Week

5000 3995 3647

4000 3487 3329 3024 2879

3000 2517 2293 1662 1626 1560 Count 2000 1292 1248 1217 1164 1196 1137 1122 1075 1062 1062 1015 1003 999 903 831 798 734 730 685 658 631 602 252 240 342 584 587 207 435 473 463 287 456 1000 449 258 430 413 272 138 356 252 355 130 421 212 299 286 274 271 257 292 250 280 243 240 248 254 229 221 215 213 208 168 168 166 165 164 159 156 155 150 126 125 122 120 119 115 113 110 104 103 99 93 88 85 83 81 81 76 75 73 69 65 63 62 61 58 55 54 53 53 52 49 49 47 46 45 41 41 37 35 35 32 29 27 26 25 23 22 22 21 21 14 10 4 2 1 0 0 2020-10 2020-12 2020-14 2020-16 2020-18 2020-24 2020-26 2020-28 2020-30 2020-32 2020-34 2020-36 2020-38 2020-40 2020-42 2020-44 2020-46 2020-48 2020-50 2020-52 2021-01 2021-03 2021-05 2021-07 2021-09 2021-11 2021-13 2021-15 2021-17 2021-19 2021-21 2021-23 2021-25 2021-27 2021-29 2020-20* 2020-22* MMWR Week 0-19Y 20-44 45-54 55-64 65Y+ Unknown

2020-20* (Stay at Home Order Lifted): 5/10/20-5/16/20—2020-21: 5/17/20-5/23/20—2020-22 (Memorial Day): 5/24/20-5/30/20—2020-23: 5/31/20-6/6/20—2020-24: 6/7/20-6/13/20—2020-25* (Mandatory masks): 6/14/20-6/20/20—2020-26: 6/21/20-6/27/20—2020-27: 6/28/20-7/4/20—2020-28: 7/5/20 – 7/11/20—2020-29: 7/12/20-7/18/20—2020-30: 7/19/20 – 7/25/20—2020-31: 7/26/20 -- 8/1/20—2020-32: 8/2/20 – 8/8/20—2020-33: 8/9/20-8/15/20—2020-34: 8/16/20-8/22/20—2020-35 8/23/20 – 8/29/20—2020-36: 8/30/20 – 9/5/20—2020-37*(Labor Day): 9/6/20 – 9/12/20—2020- 38: 9/13/20 – 9/19/20—2020-39: 9/20/20-9/26/20—2020-40: 9/27/20-10/3/20—2020-41: 10/4/20-10/10/20—Week 42: 10/11/20-10/17/20-- Week 43: 10/18/20 – 10/24/20--Week 44: 10/25/20- 10/31/20—Week 45: 11/1/20-11/7/20—Week 46: 11/8/20-11/14/20—Week 47: 11/15/20-11/21/20—2020-48: 11/22/20-11/28/20—2020-49: 11/29/20-12/5/20—2020-50:12/6/20-12/12/20—2020- 51*(Curfew/Vaccine-Phase 1A): 12/13/20-12/19/20—2020-52: 12/20/20 – 12/26/20—2020-53: 12/27/20-1/2/21—2021-01: 1/3/21-1/9/21—2021-02*(Vaccine-Phase 1B): 1/10/21-1/16/21—2021-03: 1/17/21-1/23/21—2021-04: 1/24/21-1/30/21-2021-05: 1/31/21-2/6/21--2021-06*(Super Bowl):02/7/21-2/13/21—2021-07:2/14/21-2/20/21—2021-08:2/21/21-2/27/21—2021-09: 2/28/21-3/6/21— 2021-10: 3/7/21-3/13/21—2021-11: 3/14/21-3/20/21—2021-12: 3/21/21-3/27/21—2021-13: 3/28/21-4/3/21—2021-14: 4/4/21-4/10/21—2021-15: 4/11/21-4/17/21—2021-16: 4/18/21-4/24/21— 2021-17: 4/25/21-5/1/21—2021-18: 5/2/21-5/8/21—2021-19: 5/9/21-5/15/21—2021-20: 5/16/21-5/22/21 -- 2021-21 5/23/21 – 5/29/21 – 2021-22 5/30/31 – 6/5/21 -- 2021-23 6/6/21 – 6/12/21 2021- 24 6/13/21 – 6/19/21 -- 2021-25 6/20/21 – 6/26/21 2021-26 6/27/21 – 7/3/21 2021-27 7/4/21 – 7/10/21 -- 2021-28 7/11/21 – 7/17/21 -- 2021-29 7/18/21 – 7/24/21

Demographics of COVID-19 Hospitalizations by MMWR Week Chart 2: Pima County COVID-19 Hospitalizations by Age Group and MMWR Week

COVID-19 Hospitalizations by Age Group and MMWR Week

300 245

250 227 217 211 198 198

200 175 156 137 150 135 Count 95 79 100 78 72 66 58 58 57 55 51 45 44 40 30 35 32 30 30 32

50 25 24 24 19 18 18 17 17 17 16 15 15 11 10 13 12 12 12 11 11 10 10 9 8 8 7 5 5 4 3 3 3 3 0 0 2020-24 2020-26 2020-28 2020-30 2020-32 2020-34 2020-36 2020-38 2020-40 2020-42 2020-44 2020-46 2020-48 2020-50 2020-52 2021-01 2021-03 2021-05 2021-07 2021-09 2021-11 2021-13 2021-15 2021-17 2021-19 2021-21 2021-23 2021-25 2021-27 2021-29 2020-20* 2020-22*

MMWR Week 0-19Y 20-44 45-54 55-64 65Y+ Unknown

2020-20* (Stay at Home Order Lifted): 5/10/20-5/16/20—2020-21: 5/17/20-5/23/20—2020-22 (Memorial Day): 5/24/20-5/30/20—2020-23: 5/31/20-6/6/20—2020-24: 6/7/20-6/13/20—2020-25* (Mandatory masks): 6/14/20-6/20/20—2020-26: 6/21/20-6/27/20—2020-27: 6/28/20-7/4/20—2020-28: 7/5/20 – 7/11/20—2020-29: 7/12/20-7/18/20—2020-30: 7/19/20 – 7/25/20—2020-31: 7/26/20 -- 8/1/20—2020-32: 8/2/20 – 8/8/20—2020-33: 8/9/20-8/15/20—2020-34: 8/16/20-8/22/20—2020-35 8/23/20 – 8/29/20—2020-36: 8/30/20 – 9/5/20—2020-37*(Labor Day): 9/6/20 – 9/12/20—2020- 38: 9/13/20 – 9/19/20—2020-39: 9/20/20-9/26/20—2020-40: 9/27/20-10/3/20—2020-41: 10/4/20-10/10/20—Week 42: 10/11/20-10/17/20-- Week 43: 10/18/20 – 10/24/20--Week 44: 10/25/20- 10/31/20—Week 45: 11/1/20-11/7/20—Week 46: 11/8/20-11/14/20—Week 47: 11/15/20-11/21/20—2020-48: 11/22/20-11/28/20—2020-49: 11/29/20-12/5/20—2020-50:12/6/20-12/12/20—2020- 51*(Curfew/Vaccine-Phase 1A): 12/13/20-12/19/20—2020-52: 12/20/20 – 12/26/20—2020-53: 12/27/20-1/2/21—2021-01: 1/3/21-1/9/21—2021-02*(Vaccine-Phase 1B): 1/10/21-1/16/21—2021-03: 1/17/21-1/23/21—2021-04: 1/24/21-1/30/21-2021-05: 1/31/21-2/6/21--2021-06*(Super Bowl):02/7/21-2/13/21—2021-07:2/14/21-2/20/21—2021-08:2/21/21-2/27/21—2021-09: 2/28/21-3/6/21— 2021-10: 3/7/21-3/13/21—2021-11: 3/14/21-3/20/21—2021-12: 3/21/21-3/27/21—2021-13: 3/28/21-4/3/21—2021-14: 4/4/21-4/10/21—2021-15: 4/11/21-4/17/21—2021-16: 4/18/21-4/24/21— 2021-17: 4/25/21-5/1/21—2021-18: 5/2/21-5/8/21—2021-19: 5/9/21-5/15/21—2021-20 : 5/16/21-5/22/21 -- 2021-21 5/23/21 – 5/29/21 – 2021-22 5/30/31 – 6/5/21 -- 2021-23 6/6/21 – 6/12/21 2021- 24 6/13/21 – 6/19/21 -- 2021-25 6/20/21 – 6/26/21 2021-26 6/27/21 – 7/3/21 2021-27 7/4/21 – 7/10/21 -- 2021-28 7/11/21 – 7/17/21 -- 2021-29 7/18/21 – 7/24/21 Demographics of COVID-19 Deaths by MMWR Week Chart 3: Pima County COVID-19 Deaths by Age Group and MMWR Week

COVID-19 Deaths by Age Group and MMWR Week 200 154 137 150 136 120 119 112 95 100 91 82 Count 71 70 42 44

50 36 33 30 29 27 28 27 23 22 22 21 20 18 17 16 12 13 12 12 9 9 9 6 8 8 8 5 6 6 6 6 6 5 5 3 3 4 4 6 3 3 3 2 2 2 1 1 0 0 2020-24 2020-26 2020-28 2020-30 2020-32 2020-34 2020-36 2020-38 2020-40 2020-42 2020-44 2020-46 2020-48 2020-50 2020-52 2021-01 2021-03 2021-05 2021-07 2021-09 2021-11 2021-13 2021-15 2021-17 2021-19 2021-21 2021-23 2021-25 2021-27 2020-20* 2020-22* MMWR Week 0-19Y 20-44 45-54 55-64 65Y+

Pima County COVID-19 Demographics Demographics of COVID-19 Cases by Month

COVID-19 Cases by Age Group and Month 18000 16000 14661 14000

12000 11484 10000

Count 8000 6117 4918

6000 4716 4841 4408 4156 4043 3945 3928 3703 4000 3357 2497 2028 1989 2051 1696 1628 1585 1482 1713 1324 1111 1153 1097 1099 1080 1048 946 941 934 782 969 742 731 2000 724 629 562 530 511 394 497 494 657 425 378 377 370 358 920 341 341 301 288 266 261 334 247 244 234 227 209 200 198 188 166 163 156 152 152 440 145 126 126 122 116 112 107 94 92 68 43 3 0 33

Month 0-19Y 20-44Y 45-54Y 55-64Y 65Y+ Unknown

8/5/2021

Demographics of Hospitalized COVID-19 Cases by Month

COVID-19 Hospitalizations by Age Group and Month

1400

1200

1000 922 797 800 Count 600

400 391 336 316 259 253 225 231 217 198 187 155 159 149 117

200 137 122 102 118 92 90 86 84 81 73 70 45 65 58 58 49 47 46 44 44 41 113 38 38 37 35 33 33 32 30 30 26 26 26 26 26 24 23 20 19 19 17 17 17 16 15 15 14 14 13 12 12 11 10 10 10 9 9 6 4 4 3 2 2 1 33 0 19 0 36

Month

0-19Y 20-44Y 45-54Y 55-64Y 65Y+

8/5/2021

Demographics of COVID-19 Deaths by Month

COVID-19 Deaths by Age Group and Month

600 555

500 479

400

Count 300 197 200 152 96 96 84 100 79 68 67 65 62 27 26 29 28 27 19 22 18 18 18 17 16 10 9 8 7 7 6 5 11 4 4 4 4 4 4 3 3 3 3 3 3 3 2 2 2 2 1 1 1 1 1 1 0 0 0 5 7 3 18 1 11 14 1 3 0 5

Month

0-19Y 20-44Y 45-54Y 55-64Y 65Y+

8/5/2021

ATTACHMENT ATTACHMENT 2

Pima County 2021-2022 School Year COVID-19 Recommendations for K-12 Schools PCHD strongly recommends that people who have not been vaccinated get the vaccine.

PHYSICAL DISTANCING wear masks when outdoors. The CDC contact tracing is contingent upon Maintain at least 3 feet of physical recommends that people who are schools providing a list of “close distance between students within not fully vaccinated wear a mask in contacts” along with information classrooms, combined with indoor crowded outdoor settings or during needed to communicate with these mask wearing to reduce transmission. activities that involve sustained close individuals. When 3 feet of physical distance can’t contact with other people who are What’s a close contact? be maintained, layer other prevention not fully vaccinated. Pima County • Anyone within 6 feet of an strategies, such as: is currently in substantial COVID-19 infected person for a cumulative • Staying home when sick with transmission. (CDC, 2021) total of 15 minutes or more over a symptoms of infectious illness 24-hour period. including COVID-19 FOOD • An infected person can spread • Indoor masking There are currently no restrictions on: Covid-19 starting from 2 days • Testing • Food preparation (outside of food before they have any symptoms • Grouping students into cohorts handling guidelines and safety) (or 2 days before the positive • Improved ventilation • Cafeteria (hot and cold food) specimen collection date) • Handwashing and covering • Paying for and scanning lunch until they meet criteria for coughs and sneezes, cards discontinuing home isolation. • Regular cleaning to help reduce • Staff eating areas and breakrooms • Continued isolation and transmission risk • Staff pot lucks quarantine recommendations A distance of at least 6 feet is • High school lunches will be provided by PCHD recommended between students and through contact tracing and case teachers/staff, and between teachers/ TESTING investigation. PCHD will initiate staff who are not fully vaccinated PCHD supports the use of BINAX contact tracing. (CDC, 2021) in schools for testing symptomatic • PCHD will provide logistical contacts and recommends working support to schools who would MASKS with the state-approved vendor to like to provide on-site vaccination All staff and students 5 years or older implement pooled testing. events. should wear masks indoors unless medical or developmental conditions POSITIVE CASES* prohibit their use regardless of PCHD will conduct the contact vaccination status. (CDC, July 27, 2021) tracing and case investigation for In general, people do not need to positive cases. The ability to conduct

Wear a mask regardless of your vaccination status.

ATTACHMENT ATTACHMENT 3

Updated August 4, 2021

PIMA COUNTY HEALTH DEPARTMENT SANITARY MEASURE 2021-01 (Slowing the Spread of COVID-19 in Schools)

WHEREAS, the World Health Organization officially declared a pandemic due to COVID-19 on March 11, 2020; and

WHEREAS, prompt detection of cases and their close contacts, followed by rapid implementation of infection control measures, is necessary to control the spread of COVID-19; and

WHEREAS, the Pima County Health Department has identified an accelerated transmission of COVID- 19 throughout Pima County, including the increasing presence of the much more transmissible Delta variant; and

WHEREAS, any surge in cases will disproportionately impact unvaccinated people, among them children; and

WHEREAS, pursuant to Arizona Department of Health Services (ADHS) Emergency Measure 2020- 03, administrators of schools must submit a report to the local health department within 24 hours of the identification of an outbreak of COVID-19; and

WHEREAS, pursuant to A.R.S. § 36-624, a county health department may adopt quarantine and sanitary measures to prevent the spread of an infectious or contagious disease within its jurisdiction; and

WHEREAS, pursuant to A.R.S. § 36-630, any person who violates such a measure is guilty of a class 3 misdemeanor;

NOW, THEREFORE, IT IS ORDERED:

1. All schools within the jurisdiction of Pima County must report all positive cases of COVID- 19 to the Pima County Health Department.

2. Once identified, all known or suspected cases must be sent home as soon as possible. 3. Within 24 hours of confirmation of a case by the Pima County Health Department, schools must provide the names and contact information for individuals who were within 6 feet for more than 15 minutes of the confirmed case during a 24-hour period (“close contacts”).

4. Individuals who are confirmed cases must isolate for ten days; release from isolation occurs after ten days as long as the individual is asymptomatic.

5. Unvaccinated or partially vaccinated close contacts must remain at home and be excluded from school and extra-curricular activities. Unvaccinated or partially vaccinated close contacts who remain asymptomatic may return on or after day seven upon providing documentation of a valid negative COVID-19 test collected on or after day 5 of the quarantine.

6. Close contacts who can provide documentation of a completed COVID-19 vaccination series may return to school immediately if asymptomatic. Completed vaccination means 14 days from having received a single Janssen/J&J vaccine or the second dose of the Pfizer or Moderna vaccine. Individuals who are vaccinated should test for COVID-19 between day 3 and 5 of their exposure to someone who has been diagnosed with COVID-19, as well as continue to mask.

ORDERED ON THIS 30th DAY OF JULY, 2021

BY THERESA CULLEN, M.D. DIRECTOR, PIMA COUNTY HEALTH DEPARTMENT