PHOENIX (AP) -- Arizona hospitals are hiring out-of-state nurses, squeezing in more beds and preparing for the possibility of making life-and-death decisions about how to ration care as they get ready for an expected surge of coronavirus patients in one of the nation's worst hot spots.
Parents, teachers, businesses and their customers also are hunkering down for at least a month of new closures imposed by the state in a belated effort to slow the spread of the virus and limit overcrowding at hospitals.
Arizona and several other states that were reopening their economies have clamped back down over the past week as they eclipsed records for infections and hospitalizations. Republican Gov. Doug Ducey, however, went further than others by ordering gyms and movie theaters to close and postponing the start of school until mid-August.
Texas shut down bars and reduced restaurant capacity, while Florida, where some beaches have been closed, banned alcohol consumption at bars. In contrast, Ducey shut down all bars for 30 days, including in Scottsdale, where employees and young customers crammed into nightclubs without wearing masks or practicing social distancing.
Like Texas Gov. Greg Abbott, Ducey ordered tubing businesses to close after images over the weekend showed large numbers of tubers on the Salt River without masks. While Texas limited the number of people at water parks, Arizona closed them altogether for 30 days.
Tom Hatten, founder and chief executive of Mountainside Fitness, a chain of about 20 gyms across metro Phoenix, said Tuesday that he has no plans to shut down. He has filed court paperwork seeking an injunction against Ducey's closure order, calling it arbitrary and irrational.
Hatten also said several of his health club's facilities were cited by police Tuesday for being open.
Under Ducey's order, the citations carry a fine up to $2,500 if convicted.
Hatten said it doesn't make sense that casinos, restaurants and big-box stores can stay open, while gyms are forced to close.
“We are just as concerned about this virus as everyone. But singling out and closing health clubs, after we sat closed for two months, is not going to keep the virus from spreading,” Hatten said.
Ducey's executive order allows local police to enforce closures and government agencies to revoke business licenses.
In another sign of upheaval, cities are canceling Fourth of July fireworks shows, among them Peoria, Chandler and Marana. Others had already made plans to cancel.
Vice President Mike Pence is scheduled to visit Phoenix on Wednesday and meet with Ducey at the airport before speaking to reporters. It wasn't clear if he had other plans before returning to Washington. Pence's last-minute trip replaces a planned campaign event in Tucson and meeting with Ducey in Yuma.
An additional 44 people have died from COVID-19, bringing the total since the beginning of the outbreak to 1,632, health officials said. They reported nearly 4,700 new coronavirus cases Tuesday, an inflated number because of an undercount Monday.
Arizona has seen skyrocketing infections this month after Ducey allowed his stay-at-home order to expire on May 15. Over the past seven days, nearly one in four coronavirus tests has been positive, a rate far higher than any other state. The positivity rate is a measure of how widespread the disease is in the community.
Preparing for an influx of patients, hospitals are activating plans to add more beds and staff. State officials have authorized “crisis standards of care,” which tell hospitals which patients should get a ventilator or other scarce resources if there is a shortage.
If there are more patients than can be cared for at ideal levels, patients are given a score based on their life expectancy and the likelihood their organs will fail. Hospitals are told not to consider factors like race, gender, sexual orientation or disabilities.
Emergency rooms are not yet overwhelmed, but COVID-19 is taking its toll, said Dr. Frank DelVecchio, who works in emergency rooms at several Phoenix-area hospitals, including Valleywise Health. Nurses caring for coronavirus patients take a significant amount of time suiting up to protect themselves and can't quickly jump from room to room, he said.
“This is just off the charts, sick patients. We're letting people go home that we'd never let go home if they were this sick,” including patients with low oxygen, DelVecchio said. “We're trying to get you home oxygen. We're trying to tell you to come back if worse. Because there's not much we can do for you."
People who have attempted or considered suicide are getting stuck for a day or more in emergency rooms because psychiatric facilities won't accept them until they have COVID-19 test results. Because suicidal patients require constant monitoring, they are sometimes placed in hallways or less private areas while awaiting results, DelVecchio said.
Dignity Health, which operates several hospitals in the Phoenix area, is converting more areas to treat COVID-19 patients and preparing to put multiple patients in private rooms, spokeswoman Carmelle Malkovich said. It's bringing nurses from underutilized hospitals in its system to Arizona and hiring traveling nurses and respiratory therapists throughout July.
HonorHealth, another big hospital chain in the Phoenix area, is prepared to implement the first phase of its surge plan as soon as this week, officials said in a statement. They did not explain what that means.