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Flagstaff’s Luis Jaramillo (34) hurdles over a Seton Catholic defender in the Walkup Skydome.

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FMC bears COVID-19 economic strains; restart of elective surgeries could help

Although it has been staying busy with COVID-19 patients, Flagstaff Medical Center has not been spared from the pandemic’s economic challenges.

Since elective surgeries were halted statewide March 19, Northern Arizona Healthcare (NAH), which runs FMC and the Verde Valley Medical Center (VVMC), saw a 16.7% decrease in net revenue for March and 30% in April, according to NAH leaders who commented on the matter throughout several weekly media briefings.

Ron Haase, chief administrative officer for VVMC, said both inpatient and outpatient surgeries are a primary source of revenue for the entire NAH system — essential surgeries make up only about 20 to 30% of overall procedures.

“When you cut your source of revenue by that amount, it has a serious impact on an organization. At the same time, because of the intensity we needed to be prepared to operate at during this crisis, our expenses have not gone down in a similar fashion,” Haase said.

Although COVID-19 care units do not necessarily cost more to establish than traditional intensive care units, Josh Tinkle, chief administrative officer for FMC, said the hospital is operating at a loss caring for COVID patients because of the additional personal protective equipment (PPE), pharmaceutical, physician and nursing resources required to care for these patients, who often have extended stays in the facility.

As of early April, NAH was also experiencing increased costs of PPE: N95 respirators that typically cost 69 cents jumped to $8 each, while surgical gowns increased from 50 cents to $5 per gown.

Tinkle said the organization had a good reserve in place to help withstand the crisis financially. Nevertheless, in response to these changes, NAH pushed out some of its contracts when possible to maintain cash flow and senior leadership took 10% pay cuts.

NAH CEO Flo Spyrow explained these salary reductions are not going back to hospital operations, but are instead being used for a “leadership fund” to help support hospital employees during the pandemic.

The organization has also now received federal support, both through Medicare and the Coronavirus Aid, Relief and Economic Security (CARES) Act. Medicare issued a cash advance that NAH must pay back in August, while NAH received its first of two phases of the CARES Act funding in April, plus an additional payment in May for being a high-impact hospital.

“There were about 395 hospitals that have treated more than 100 COVID patients and they got an additional payment out of the CARES Act for being high-impact providers,” Spyrow said. “We are really proud to be able to receive that.”

According to the Centers for Disease Control and Prevention (CDC), Flagstaff Medical Center received $14.5 million from the Provider Relief Fund for this high-impact service, which was paid the week of May 4. Tuba City Regional Health Care Center, which was awarded $8.7 million, was the only other Arizona provider to receive this funding.

“Those payments -- although we are very, very thankful for them -- are not making us whole or putting us in a status where we would normally be had operations continued, both based on the reduction or elimination of elective surgeries, procedures, ambulatory visits and the increased expenses that we’ve incurred in order to protect our employees at the highest level positive with personal protective equipment,” Spyrow said of the federal support received so far, adding that she hopes there will be a third round of CARES Act funding in the future.

For now, though, the return of elective procedures is likely to help.

In an executive order, Arizona Gov. Doug Ducey announced health facilities could resume elective surgeries on May 1 if they show they have implemented specific COVID-19 safety measures. NAH, still working on a plan to fully reinstate these procedures, began its first elective surgeries at its outpatient orthopedic surgery center starting May 13. FMC began some elective surgeries two days later.

Tinkle said reinstating these procedures will begin with appointments for patients at the lowest risk for COVID-19, such as those who are younger, before expanding into the next phase of patients within the next week or two.

“We believe we’re moving in a positive direction and hope for more positive stuff to come in the next few weeks,” he said.

If there were to be a surge in COVID-19 cases in the future, Tinkle said NAH would slow down its elective business again to make room for those patients.

Clinics are now running at about 80% capacity and although providers are seeing this spike due to what Tinkle called “pent-up demand” from the state’s stay-at-home order, NAH leaders are unsure how unemployment rates and patients’ loss of employer health benefits will affect this demand going forward.

The totems on Highway 89A wear face masks as a reflection of the COVID-19 pandemic on Tuesday at sunset.

The totems on Highway 89A wear face masks as a reflection of the COVID-19 pandemic on Tuesday at sunset. Infection rates on the Navajo reservation continue to be some of the highest in the nation as measured per capita.

Maskless Trump visits Mich.

YPSILANTI TOWNSHIP, Mich. — Pandemic politics shadowed President Donald Trump's trip to Michigan on Thursday to highlight lifesaving medical devices, with the president and officials from the electoral battleground state clashing over federal aid, mail-in ballots and face masks.

Trump visited Ypsilanti, outside Detroit, to tour a Ford Motor Co. factory that had been repurposed to manufacture ventilators, the medical breathing machines governors begged for during the height of the COVID-19 pandemic.

But his arrival came amid a long-running feud with the state's Democratic governor and a day after the president threatened to withhold federal funds over the state's expanded vote-by-mail effort. And, again, the president did not wear a face covering despite a warning from the state's top law enforcement officer that a refusal to do so might lead to a ban on Trump's return.

Also Thursday, signs of renewed activity are surfacing across the country as states gradually reopen economies and some businesses call a portion of their laid-off staffers back to work. Yet with millions more Americans seeking unemployment aid last week, the U.S. job market remains as bleak as it's been in decades.

More than 2.4 million laid-off workers filed for jobless benefits last week, the government said Thursday, the ninth straight week of outsize figures since the viral outbreak forced millions of businesses to closer their doors and shrink their workforces.

And while the number of weekly applications has slowed for seven straight weeks, they remain immense by any historical standard — roughly 10 times the typical figure that prevailed before the virus struck. Nearly 39 million people have applied for benefits since mid-March.

An additional 1.2 million people sought aid last week under a new federal program for self-employed, contractor and gig workers, who are now eligible for jobless aid for the first time. These figures aren’t adjusted for seasonal variations, so the government doesn’t include them in the overall number of applications.

In Michigan, state Attorney General Dana Nessel said that mask wearing isn't just Ford's policy but it's also the law in a state that's among those hardest hit by the virus. Nessel said that if Trump refused to wear a mask Thursday "he's going to be asked not to return to any enclosed facilities inside our state."

"If we know that he's coming to our state and we know he's not going to follow the law, I think we're going to have to take action against any company or any facility that allows him inside those facilities and puts our workers at risk," Nessel told CNN. "We just simply can't afford it here in our state."

Trump has refused to wear a face mask in public, telling aides he believes it makes him look weak, though it is a practice that federal health authorities say all Americans should adopt to help slow the spread of the virus.

"I don't know, we'll look at it," Trump said when asked before leaving if he would wear one.

Ford said everyone in its factories must wear personal protective equipment, including masks, and that its policy has been communicated to the White House. At least two people who work in the White House and had been physically close to Trump recently tested positive for the virus. Trump is tested daily; he said Thursday he tested negative that morning.

An executive order issued by Gov. Gretchen Whitmer requires factories to suspend all nonessential in-person visits, including tours, though Nessel said her office would not bar Trump.

The Republican president and Whitmer have clashed during the coronavirus outbreak over her criticism of the federal government's response to the state's needs for medical equipment, like ventilators, and personal protective gear, such as gloves, masks and gowns.

Earlier, Trump on Thursday said he met with Senate Majority Leader Mitch McConnell, R-Ky., at the White House to discuss the next steps on an aid package.

At least one Republican, Sen. Cory Gardner of Colorado, pledged to try to prevent the Senate from recessing unless it votes on more aid, particularly to states and cities facing layoffs.

McConnell argued that his side of the Capitol led passage of an earlier package that cost $2 trillion. It's better to assess how that money is being spent, he said, before approving more. He rejects the new $3 trillion package approved by the Democratic-led House last week as a “liberal wish list.”

Over 5 million people worldwide have been confirmed infected, and about 330,000 deaths have been recorded, including more than 93,000 in the U.S., according to a tally kept by Johns Hopkins University.

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Police: Man who shot 3 at Arizona complex felt bullied

GLENDALE — A 20-year-old gunman who opened fire at a suburban Phoenix restaurant and retail complex, injuring three people, wanted to target people in his own age group in retaliation for being bullied, authorities said Thursday.

The shooting occurred Wednesday night after suspect Armando Hernandez scoped out Westgate Entertainment District in Glendale, returned to his car to make a social media video and loaded three rifle magazines, police said.

“I’m going to be the shooter of Westgate 2020,” Hernandez said in his Snapchat video, holding a beer in one hand. The footage also shows an AR-15-type rifle in the backseat of the car.

“Let’s get this done, guys,” he said.

Hernandez later surrendered, telling detectives that he intended to harm 10 people, though it’s unclear why he chose that number.

“He wanted to gain some respect, and he felt that he had been bullied in his life,” Glendale police Sgt. Randy Stewart said.

Police say Hernandez filmed the attack while holding a cell phone with his left hand and blasting away with the rifle in his right hand.

The first two victims were shot outside a restaurant. As the gunman moved through the complex, police said, he fired shots to intimidate people before shooting the third victim.

Hernandez surrendered without incident to one of the first officers who arrived at the complex adjacent to the stadium where the NFL’s Arizona Cardinals and NHL's Arizona Coyotes play.

Authorities say Hernandez wounded a 19-year-old man, who remained hospitalized in critical condition. A 16-year-old girl was taken to a hospital with injuries that were not life-threatening. A third victim, a 30-year-old woman, did not require hospitalization.

Hernandez, who lives in the neighboring suburb of Peoria, could face more than a dozen felony charges. It was not immediately known if he had a lawyer who could speak on his behalf.

It’s not yet clear how many shots were fired. Investigators say Hernandez moved around the complex during the attack, leaving spent shells in different spots.

“Armando stated multiple times he wanted to do this mass shooting for respect and spoke of interest in previous mass shootings that have occurred in recent years,” police said in court records.

Bystander video posted on social media showed people running from the area and embracing after being reunited.

Eliana Rivera, a sales associate at a pottery painting store, posted on Twitter that she and a co-worker heard police running and helicopters overhead as they huddled in the back of the business, the Arizona Republic reported.

“It’s just unreal,” Rivera said. “You see it on the news. It happens and you never really think that you would be put in that position. You just think, ‘What are the chances that that will happen?’ — and it did.”

State Sen. Martin Quezada was in his third floor home at Westgate when shots rang out and the power cut off after gunfire struck an electrical transformer.

From his window, he saw people running, then a man appeared to be reloading a gun while walking calmly toward his building. When he went outside, he saw two people laying in the street crying out in pain.

"To be honest, I don’t think a lot of it has really settled in yet about what I witnessed and what actually took place out there,” Quezada said.

The totems on Highway 89A wear face masks as a reflection of the COVID-19 pandemic on Tuesday at sunset.

Northern Arizona guard Jacey Bailey (11) shoots over a Portland State defender last season in the Walkup Skydome.

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Sunshine Rescue Mission to reopen men's shelter Monday

Like the story being told by many across the country, these past few months have been unprecedented for the Sunshine Rescue Mission.

The mission allowed seven of its guests to isolate in the downtown shelter for two weeks after four people tested positive. During that time, the shelter's doors were shut to the public to isolate those guests and prevent anyone that could be infected from coming and going. The women and children's shelter at Hope Cottage saw people bunker down during the coronavirus, and the mission's food program became strained during the national food shortages.

The last day of the downtown shelter's two-week isolation ended Wednesday. Now the shelter is looking to reopen its doors to its normal capacity Monday after the four people came back from quarantine at Hotel Aspen, according to Shaun Rost, director of the downtown shelter.

The location on South San Francisco Street was the only shelter within their properties where people tested positive. The Sunshine Rescue Mission manages the men’s shelter downtown, their women and children’s shelter at Hope Cottage, and Dorsey Manor, which is being used as a place to isolate people vulnerable to COVID-19. The mission also uses their three properties to serve food, which has been in high demand as many people have leaned on nonprofits around the city for food, shelter and financial assistance.

“The people who stay with us have value. They are worth us doing everything we can to protect them and provide not just a bed and a meal, but safety and a safe place,” said Sharon Rose Wilcox, director of Hope Cottage.

In early May, 30% of the homeless people at Flagstaff Shelter Services tested positive for the coronavirus. The shelter was able to find enough funding to move people into 175 motel rooms for the time being to provide them the resources needed to safely maintain social distancing measures.

Many people who are housing insecure that tested positive were sent to Hotel Aspen for being asymptomatic or having mild symptoms, causing a spike in capacity.

The shelter

In response to similar fears of an outbreak, Sunshine Rescue Mission took early precautions by cleaning more and testing temperatures of people entering their facilities.

Additionally, the mission reopened their Dorsey Manor location to help their vulnerable population isolate safely, Rost said. The location was temporarily closed while the mission searched for the funds to remodel it.

No one at the Dorsey Manor location has tested positive for the coronavirus at this time.

The downtown shelter allowed guests to enter a voluntary isolation period for two weeks in their shelter after four guests tested positive at the South San Francisco location. In total, the group had tested more than 50 people, Rost said.

Rost said the shelter was unable to test all of their staff and homeless guests during their first round of testing. The shelter was eventually able to do more testing over the next few days. Anyone who had not been tested was unable to enter the shelter during the isolation period.

He said seven of the people who tested negative elected to be isolated in the shelter for the past two weeks, while others decided to leave.

"I'm very happy," Rost said. "I didn't like the [isolating] in the first place, but we felt it was the best thing to do to keep everything safe."

Food services

The Sunshine Rescue Mission uses 97 tons of food per year through donations.

But during the early weeks of the coronavirus pandemic, many people took to the grocery stores and left shelves bare. Because of the community’s food scarcity, for the first time since the mission was created in 1957, they were unable to rescue enough food for all the people they feed, according to executive director Kathie Knapp.

“We saw an 80% decline in food supply that is a vital lifeline for our existence, for everything we do,” Knapp said.

Knapp explained the mission did not want to rely on local food banks because they were already feeding so many in the area, so they turned to Phoenix. Mission drivers were making two trips to Phoenix per week to bring about 1,200 pounds of food at a time to serve the community. Since then, the community has begun to help them fill their need.

“We’ve seen various different organizations, individuals, churches that are bringing food, preparing food, calling us and saying what do you need? We know the need is high, what do you need?” Knapp said. “There’s been an incredible outpouring of support from all of northern Arizona.”

Hope Cottage

Sunshine Rescue Mission leaders report that no one at Hope Cottage has tested positive throughout this pandemic.

Wilcox said many of the women looking for emergency shelter recently have lost their jobs when the businesses closed their doors or shifted to skeleton crews.

The cottage only has the capacity for 60 to 65 women and children. Wilcox said last week there were 20 to 25 people using the cottage.

As news about the coronavirus was first spreading, many guests were scared to leave because they had nowhere else to go.

“For the first time in the organization’s history, we stayed the same. It was the same group of people that were together for an extended period of time,” Wilcox said. “We typically have people come, stay a few days, they leave, and somebody else comes. There’s normally a certain amount of turnover in the house. That was not happening.”

Similarly, Wilcox said its normal pool of volunteers was reduced after Northern Arizona University students left the campus and people decided to stay home. Wilcox said she would be happy to find work for any potential volunteers that would maintain social distancing.

Knapp said more volunteers and any financial support would help them manage the increased costs in facility maintenance and the increased reliance on their meal program. She said the community that has already donated has really helped them weather the crisis and continue to focus on their mission.

“Yes, we offer emergency shelter, but our driving force is to try to help people heal and recover from whatever it is that put them on the street in the first place,” Knapp said.