south 4th avenue in yuma, arizona tested positive for the disease resulting in a temporary closure in order for deep sanitation to take place. on july 8, the daughter of mark urquiza published an obituary blaming politicians' poor handling of the crisis for his death. she invited gov. ducey to the funeral, but he did not respond. on july 9, governor doug ducey issued an executive order directing restaurants to operate at 50% of dine in capacity as the death toll reached 2,000 and the total number of cases surpassed 112,000. on july 16, ducey issued an executive order extending the moratorium on residential evictions and other protections until october 31, 2020, and expanding rental assistance. on july 23, the governor issued an executive order extending the temporary closure of certain businesses for an additional two weeks. the executive order also prohibits organized gatherings of more than 50 people and pauses issuance of special events permits, statewide. august 2020 on august 27, the university of arizona announced that wastewater testing at a dormitory led to the identification of two asymptomatic cases. october 2020 on october 12, san tan foothills high school in pinal county was closed due to a cluster of cases. on october 13, maricopa county public health reported 21 outbreaks in county school districts, with 77 cases. nineteen schools with outbreaks remained open. an outbreak is defined as "two or more covid-19 positive cases that don't live in the same household." on october 19, a campaign rally by then-u.s. president donald trump near tucson international airport drew over 2,000 supporters. few masks were worn, despite requests by tucson mayor regina romero to heed local public health ordinances. another rally was held at the prescott regional airport in prescott. on october 22, during the presidential debate, trump stated "there was a very big spike in arizona, it's now gone." however, the newspaper arizona republic disagreed, reporting that "the disease is now spreading at its fastest rate here since june, just before the state became a covid-19 epicenter this summer. in arizona, daily case counts, hospitalizations, percent positivity, ventilators in use and the rate at which the virus spreads have all increased in recent weeks." arizona national guard service members prepare and collect covid-19 test samples, july 15, 2020, in cibecue, arizona. november 2020 on november 23, yuma regional medical center would not permit an emergency physician, cleavon gilman, to work as they had raised concerns regarding the lack of icu beds in the state of arizona at the time. on november 27, members of the university of arizona covid-19 modelling team sent a letter to the az dhs chief of public health statistics recommending shelter-in-place and police enforced mask mandates (among other measures) or the state "...risks a catastrophe on a scale of the worst natural disaster the state has ever experienced." december 2020 on december 7, the arizona state legislature was forced to close for at least a week after lawyer rudy giuliani, who had tested positive for covid-19, testified without a facemask for eleven hours about allegations of voter fraud. as of december 10, arizona had the highest rate of virus spread in the nation. yavapai, apache and navajo counties all have two consecutive weeks where all three indicators of viral spread have gone into the "red zone," and the statewide rate of infection is 500 per 100,000. governor ducey decides not to close businesses, because his administration believed that most of the spread comes from family gatherings. after years of tight budgets and skimping on public health, arizona communities are facing a shortage of health workers to distribute covid-19 vaccines. maricopa county has about 133,000 vaccine doses for its 125,000 front-line health care workers, but through december 31 only about 44,000 people had gotten their initial vaccinations. statewide only about 20% of the available doses have been distributed. january 2021 on january 11, a 24/7 covid-19 vaccination site opened at the state farm stadium in glendale. on january 19, in contradiction to doomsayers, the state is "doing relatively well" in distributing vaccines, according to dr. christ, director of azdhs. "we're about 16th in the nation for the number of doses vaccinated, and that's even before you look at adding the state farm stadium vaccination site," she said. while some want you to believe, "after years of tight budgets and skimping on public health, arizona communities are facing a shortage of health workers to distribute covid-19 vaccines," reality paints a different picture. the azdhs has unfilled appointments for vaccinations. "thousands of arizonans prioritized to receive covid-19 vaccinations can still register for february appointments at state farm stadium in glendale. further, "as of 2:40 p.m., there were still more than 36,000 appointments available at state farm availability from feb. 1 through feb. 6." by 7 p.m., there were 10,000 appointments still available at state farm stadium, which is currently in operation 24/7. march 2021 in early march 2021, gila county opened up vaccinations to any resident age 18 or older. epidemiology and public health response initial exposures and spread the first confirmed case of covid-19 in arizona was reported on january 26, 2020, in tempe. the patient, a 20-year-old male arizona state university (asu) student, had returned from wuhan, china. the second confirmed case was reported on march 3, 2020, in maricopa county in a 20-year-old male who had traveled outside the state. on march 6, adhs reported the third case, a woman in her 40s, who represented the first identified case likely caused by community spread. community spread is thought to have begun around early march with a doubling time of cases between march 17–24 of 1.7 days. on march 26, adhs updated the community transmission level of covid-19 to widespread. clusters of cases have been linked to assisted living and long-term care facilities as well as other congregate settings. the first cases linked to such settings were reported the week of march 22, 2020. hospitalization and hospital capacity according to adhs, 5% of covid-19 cases have been hospitalized. of these, native americans and african americans have been disproportionately represented in maricopa county. to increase hospital capacity and handle a potential surge in covid-19 patients, on march 30, adhs announced that st. luke's medical center which closed in november, 2019 would be reopened with the help of the us army corps of engineers and the arizona national guard. the initial plan included over 330 icu beds with a reopening date in late april; however, though ready, st. luke's has not been reopened, and adhs's current plan is to use it for a lower level of care if needed. on april 21, 2020, the adhs established the arizona surge line, a centralized statewide system for hospitals and medical providers, which enables coordination when covid-19 case levels become overwhelming. the system aims to facilitate patient transfer from one level of care to another, coordinate transfer of patients to balance patient numbers across hospitals when resources are scarce, and support clinicians who are treating cases. in tucson, patients have been transferred to phoenix and out of state when capacity was reached in early july. beginning june 27, 2020, hospitals in arizona requested implementation of 'crisis standards of care' to aid in decision making when and if resources are limited. as of july 2, 2020, however, no hospitals were having to triage patients under this plan. also on july 2, 2020, adult intensive care bed use first reached a high of 91%. hospital bed status is self reported daily to adhs as per executive order 2020–37. deaths the first confirmed death in arizona from covid-19 was announced on march 20, 2020. while the largest percentage of cases has been in younger age groups, the highest percentage of deaths has occurred among those over age 65. testing covid-19 testing site at south mountain community college in phoenix pcr testing for covid-19 by the arizona department of health services began on march 2. additional testing in arizona has been implemented by sonora quest laboratories, the mayo clinic in arizona, asu biodesign institute and the translational genomics research institute's division in flagstaff. on saturday, may 2, a testing blitz began with the goal of testing 10,000-20,000 people each saturday for three weeks and two additional weeks were added. as covid-19 cases continued to rise in june, testing capacity has struggled to meet demand. on july 9, ducey announced that testing capacity would be increased at sonora quest laboratories (with up to 35,000 tests processed per day by the end of the month and 60,000 tests per day by the end of august) and in a partnership between adhs and the asu biodesign institute to make their saliva based covid-19 test available in high demand areas. in addition, adhs announced that the number of sites that provide free covid-19 tests will increase to include new locations in maryvale and south phoenix funded by the federal government as well as the asu testing sites which are funded by adhs. on july 12, arizona was ranked last of the fifty states and washington dc for meeting a covid-19 testing target developed by the harvard global health institute. contact tracing local health departments are working to increase staffing for contact tracing of covid-19 positive cases. according to dr. cara christ, the director of the arizona department of health services, adhs has developed a system for contacts to monitor and report symptoms over a 14-day period via phone, text or online. on june 17, 2020, ducey announced that the arizona national guard would assist with contact tracing with 300 guard members requested. maricopa county department of public health has been criticized for not following cdc recommendations for contact tracing, for only having the capacity to contact trace approximately 500 cases per day, and for only calling high-risk and older patients who test positive. modeling and projections models that project the trajectory of the covid-19 pandemic in arizona are used by the adhs to forecast resource needs. initial models suggested that arizona would reach its peak in covid-19 cases in mid-april to late may. in april, adhs began working with a team of researchers at arizona state university and university of arizona to develop state specific models and projections. however, the modeling team was instructed to halt their work on may 4, 2020, and notified that they would no longer be allowed access to special data sets used for this work. the modeling team had recommended against reopening before the end of may, and the adhs notification coincided with the governor's decision to begin reopening. the state also announced that it would be using fema's model for covid-19 predictions, although the department also declined to reveal the results of the model. after criticism of their decision to stop working with the asu/ua modeling team, adhs announced on may 7, 2020, that it would continue the partnership. on may 26, adhs reported that they had been given permission to share the results of fema's model; however, on june 5, it was announced that this model may not be available to the state going forward. researchers at both the university of arizona and arizona state university are providing regular updates about arizona covid-19 trends and projections. these can be compared with state-level models and projections by organizations outside the state including the institute for health metrics and evaluation at the university of washington (the ihme model), and the covid actnow projections. additional forecasts of total deaths and total hospitalizations are received and compiled by the centers for disease control. as of july 15, county-level model from independent researchers at pandemic central provides daily new case projections to all arizona communities. impact economy in april 2020, arizona received $1.86 billion of federal relief funds from the cares act. from this amount, much of the funds were reallocated to cities and organizations/businesses: phoenix ($293 million), mesa ($90 million), tucson ($96 million), the mayo clinic ($29.6 million), scottsdale healthcare hospitals ($27.8 million), mesa air ($92.5 million). in that same month, the state unemployment rate reached a high of 12.6%, which included a loss of 276,300 jobs. the economic loss primarily occurred in leisure and hospitality, including bars/restaurants and travel accommodations. in may 2020, the state's joint legislative budget committee predicted a $1.1 billion budget shortfall through the 2021 fiscal year. the losses were