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Sewell urges Trump to work across the aisle on healthcare

Brandon Moseley

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Tuesday, Congresswoman Terri A. Sewell (D-Selma) urged President Donald J. Trump (R) to, “Work across the aisle to make real, positive change-to make health care more affordable and accessible.”

“I challenge the President tonight not to make empty promises,” Sewell said. “Work across the aisle to achieve real, positive change – to make health care more affordable and accessible, bring more opportunities to rural and underserved communities and unify the American people.”

Rep. Sewell released her statement on Tuesday just a couple of hours ahead of President Trump’s State of the Union address. Sewell has been critical of Pres. Trump. Sewell sits on the House Intelligence Committee and voted to impeach Trump, both in committee and on the House floor.

“Dr. Maya Angelou famously once said, ‘When someone shows you who they are, believe them the first time,’” Sewell quoted. “The Trump Administration has showed the American people over and over what they stand for: stripping health care protections for the more than 2 million Alabamians with pre-existing conditions, slashing funding for hungry families and children, separating families, cutting taxes for the ultra-rich and supporting policies that make it more difficult for Americans to cast their vote on Election Day.”

“We will always protect patients with pre-existing conditions,” the President did say during the State of the Union.

Congresswoman Sewell represents Alabama’s Seventh Congressional District. Sewell is the only Black woman to represent Alabama in Congress in the history of the state.

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Elections

Sessions attacks Tuberville’s views on China

Brandon Moseley

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Former Sen. Jeff Sessions, R-Alabama, rolled out an ambitious, comprehensive plan to hold the Chinese government accountable for what Sessions called a cover-up of the coronavirus that has killed tens of thousands of people and devastated economies worldwide.

In an interview Thursday on the Matt & Aunie radio show on Talk 99.5 in Birmingham, for Auburn head football Coach and current GOP Senate candidate Tommy Tuberville expressed his views on China.

Matt Murphy asked: What do you see happening with China?

“Well, we can’t worry about China right now…” Tuberville responded.

“You say you don’t need to worry about China, but this came from China and our economy depends on China,” Murphy asked on follow up. “Specifically how to overcome some of that dependence on Chinese goods and specifically in the pharmaceutical industry because right now we’re dependent on the country that covered this up.”

“Now we’re seeing firsthand the results of letting everything go to China,” Tuberville said. “The good thing about this is we’ll have manufacturing come back and drugs and all those things….we’re headed in that direction, just the simple fact that we can’t control our own destiny. Everything’s controlled by China. But that’ll take care of itself.”

During the show, Tuberville also characterized the Wuhan Virus, which has killed over 53,000 people and infected more than 1 million people across the globe, which then including over 1,300 people in Alabama, as “just a virus.”

Jeff Sessions issued a statement critical of Tuberville on Friday in response.

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“Amazingly, Tommy Tuberville said yesterday, ‘We can’t worry about China right now,”” Sessions quoted. “China is where the virus is from, and their deliberate lies hid the danger and resulted in a pandemic that never should have happened. We must take on China now and win, not run scared like Tommy Tuberville.”

“There are over 1 million infected with the Wuhan Virus, and more than 1,300 in Alabama already,” Sessions continued. “This is serious. But Tommy Tuberville said yesterday that ‘this is just a virus.’ What planet is he on? Tuberville is clueless. No wonder he’s scared to debate me. We must stop relying on China for our critical medicines and equipment. I have a detailed plan to fix it. Amazingly, Tuberville also said yesterday, ‘Everything’s controlled by China, but that’ll take care of itself.’ Wrong! We must lead with action, this will not ‘take care of itself.’”

On Thursday, a U.S. intelligence report claimed that China understated the damage that the coronavirus was doing in their country.

“Alabama’s next Senator must be a leader who has the drive and determination to push a Congress that is too often unwilling to confront the critical issues of our time,” Sessions continued. “I have proven my willingness and preparedness to lead from Day One. Tuberville is weak: all talk and no action.”

Sessions is a former Senator, U.S. Attorney General, Alabama Attorney General, Chairman of the Alabama Republican Party, U.S. Attorney, asst. U.S. Attorney, and U.S. Army Captain.

The Republican primary runoff has been moved to July by Alabama Governor Kay Ivey (R) due to fears of the coronavirus. The virus is believed to have originated in Wuhan City, Hubei Province, China in late 2019.

As of press time, 10,943 Americans have died from COVID-19 including 53 Alabamians. 367,650 Americans have been diagnosed with COVID-19, including 2,006 Alabamians. At this point, only 240 Alabamians are confirmed hospitalized with COVID-19.

COVID-19 is the medical condition caused by a strain of coronavirus first identified late last year in Wuhan City, Hubei Province China, SARS-CoV-2. Since then it has spread across the globe infecting 1,346,566 persons that we are aware of killing 74,697 people.

The winner of the Republican primary runoff will then face Senator Doug Jones (D-Alabama) in the November election.

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Congress

Roby: Stay-at-home order has potential to drastically slow spread of virus

Brandon Moseley

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Congresswoman Martha Roby, R-Montgomery, said Monday that Alabama Gov. Kay Ivey’s stay-at-home order has the potential to drastically slow the spread of the coronavirus in Alabama.

Roby emphasized the importance of social distancing and that the governor’s order puts the safety of Alabamians first.

“t’s important that Alabamians are prepared to follow the advice and guidance of officials who are working day and in light in response to the Coronavirus (COVID-19) outbreak,” Rep. Roby said. “Governor Kay Ivey on Friday issued a statewide stay-at-home order effective until Thursday, April 30. The Governor said that she along with many state government and public health officials thoroughly reviewed all possible COVID-19 response options, and they determined that a statewide stay-at-home order put the safety of Alabama’s people first. I believe this public health order does just that and will be beneficial as we continue to fight COVID-19 and practice mitigation among our communities.”

“As the Governor’s statewide order recently went into effect and currently lasts until the end of the month, we have the potential to drastically slow the spread of the virus among our Alabama communities,” Roby said. “Please remember to continue to follow the Administration’s “30 Days to Slow the Spread” social distancing guidelines, wash your hands, disinfect your home, and avoid social gatherings in order to protect yourself and those around you from infection.”

“It is vital to the health and well-being of those in our communities that Alabamians all across the state follow the guidance of state and healthcare officials.” Roby continued. “The people of Alabama remain united, and together we will combat COVID-19. Read more from my Weekly Column here.”

“I have added a “COVID-19 Resources” tab to my official website that includes materials ranging from general health and prevention methods from the Center of Disease Control and Prevention (CDC), to economic support for individuals and businesses from federal and state agencies like the Small Business Administration (SBA) and the Alabama Department of Labor (ADOL).,” Roby stated. “Visit my website for more information.”

There is an enormous shortage of personal protection equipment (PPE) for healthcare workers.

“ADPH’s Office of Oral Health is accepting donations of personal protective equipment such as masks, gloves, and gowns for distribution to local healthcare personnel,” Roby stated.

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For details on how you can donate:

https://www.alabamapublichealth.gov/infectiousdiseases/assets/oralhealth-ppedonations.pdf

As of press time, 10,943 Americans have died from COVID-19 including 53 Alabamians. 367,650 Americans have been diagnosed with COVID-19, including 2,006 Alabamians. At this point, only 240 Alabamians are confirmed hospitalized with COVID-19.

COVID-19 is the medical condition caused by a strain of coronavirus first identified late last year in Wuhan City, Hubei Province China, SARS-CoV-2. Since then it has spread across the globe infecting 1,346,566 persons that we are aware of killing 74,697 people.

Congresswoman Martha Roby represents Alabama’s Second Congressional District. Roby is in her fifth term; but is not seeking a sixth term in the House of Representatives.

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How Alabama is tracking COVID-19 hospitalizations

Chip Brownlee

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Alabama on Saturday started publicly reporting the number of people hospitalized because of COVID-19 on its data dashboard. As of Monday morning, 240 people have been hospitalized since March 13, according to that data.

The day before ADPH began publishing the number of cumulative hospitalizations on its dashboard, I reported that 255 people were hospitalized with a confirmed case of COVID-19, and another 586 people were hospitalized with a suspected case of the virus awaiting test results.

The number I reported Friday night, which I got from State Health Officer Scott Harris, is not the same number that ADPH began publishing on its dashboard Saturday morning. They do not align.

It might look like he gave me wrong numbers, or that I reported them out incorrectly. That’s not the case. Let me explain why.

The number of hospitalizations displayed on the Department of Public Health’s data dashboard (240) is a cumulative total of hospitalizations since March 13. That number is obtained by ADPH’s epidemiologists as they investigate each confirmed case of the virus. The epidemiologists follow up with everyone who has tested positive for the virus and determine if the person has been hospitalized.

“The way that works is you have a positive test that comes through. Our epidemiology staff contacts the patient. They ask, ‘Hey, what is your story? How old are you? What’re your symptoms? And were you in the hospital?’,” Harris told me.

The epidemiology staff also perform contact-tracing, asking those who have tested positive who they were around, who they live with, where they work and a lot more. These investigations clearly take time.

“It’s a cumulative number because we can’t call these people every single day for the next two weeks to found out who’s still in the hospital and how many cases are hospitalized at the moment,” Harris said.

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The reality is that there are only so many investigators and a ton of confirmed cases. There will inevitably be a delay in reporting the cumulative total as epidemiologists investigate each positive case.

This brings us to the numbers I reported Friday night.

That data (255 confirmed, 586 suspected) was obtained from the Alabama Incident Management System, or AIMS. It’s the same system that is activated when there is a major hurricane, tornadoes or even an ice storm. Hospitals directly update these numbers daily, sometimes more.

The differences in the way the two numbers are obtained explain why the number I reported Friday night was higher than the cumulative total now displayed on the ADPH’s dashboard (and on our dashboard). It was simply more current.

But even the numbers from the Alabama Incident Management System are not perfect. Hospitals voluntarily report that data to the Department of Public Health.

Alabama does not have a law authorizing a statewide hospital discharge database, unlike 48 other states, Harris said, which makes tracking real-time hospitalization data difficult.

“We actually had legislation that we introduced this year to do that, but it doesn’t look like it’s going to happen now because the session is gone,” Harris said.

So the Alabama Department of Public Health has to ask hospitals to voluntarily report their hospitalization data in AIMS. Most of the state’s hospitals are doing so, Harris said. But it’s still possible that some hospitals are treating COVID-19 patients who are not reflected in the AIMS data.

While the state’s public-facing data dashboard is currently showing the cumulative total obtained by epidemiology staff at ADPH, Harris said the Department of Public Health will soon display the AIMS data instead.

“The question people want to know is not how many people have been in the hospital over the past week,” Harris said. “They want to know how many people are in the hospital today.”

When that switch happens, the number may appear to jump, but it’s really just a more current dataset.

 

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Health

Behind the model that projected 5,500 deaths in Alabama — and why it changed

Chip Brownlee

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Early last week it said 7,500 would die in Alabama by August.

This modeling from the University of Washington’s Institue for Health Metrics and Evaluation has been cited by the White House’s coronavirus task force.

This modeling — that last week suggested somewhere between 100,000 and 240,000 Americans could die — spurred President Donald Trump’s decision to extend social-distancing guidelines through April and served, at least in part, as a call to action for Alabama to issue its stay-at-home order Friday.

Then it was revised downward again to 5,500. As recently as this weekend, the model projected that Alabama would have the highest per capita death rate in the country and the fourth-highest total death toll.

But by Monday morning, it was adjusted again — this time projecting fewer than 1,000 will die by August from the novel coronavirus that causes COVID-19. Instead of the highest per capita death rate in the country, Alabama is now projected to fall somewhere in the middle — 22 out of 51.

The changing numbers and the shifting projections can tell us many things but one is this: that modeling a pandemic is hard, especially when how it pans out depends heavily upon how state governments and the people adhere to social-distancing guidelines. No one knows how this will end.

I spoke with Dr. Ali Mokdad, one of the senior scientists at IHME and a former official at the Centers for Disease Control and Prevention. He helped develop the model. (We spoke before the model was revised downward for Alabama.)

IHME’s model is live. It is updated regularly. It was never meant to be interpreted as a comprehensive prediction of the future. It was intended as a planning tool to help policymakers, hospital officials and the public plan ahead. In fact, the people who made the model hope their projections at present are wrong — that they will be revised downward more.

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“By reducing the number of people who have infections by staying at home, you can help the medical system,” Mokdad told me. “And when the peak comes, that shortage that we are projecting will not be as big as we are seeing right now because social-distancing is working.”

The updated modeling shows how social-distancing is working, not that it was never possible that 5,000 or 7,000 people could have died. Had we not acted, had people not changed their behavior, had the state not implemented a stay-at-home order, that could have surely been the case — and it still could be.

State Health Officer Dr. Scott Harris said the model has been helpful in planning for the peak.

“I think the thing that’s been most helpful about that model is really the timelines,” Harris said in an interview with APR.

“The margin of error they have on there is tremendous,” Harris said. “I don’t necessarily think it’s incorrect, but you can almost read what you want to on there. We could have 50,000 deaths or 5,000 deaths or any number. But the timeline makes sense, seeing when we’re expected to have a surge. That was what was most useful to us.”

The shaded area indicates uncertainty in the modeling, ranging from 1 to 247 deaths per day on April 25.

A model is only as good as its inputs. Last week, IHME’s model for Alabama had little data to work off of. The state had only just begun to report deaths. And when the state changed its reporting of deaths, and the death toll spiked as a result, IHME’s model — which is primarily based on deaths per day — adjusted.

“So one day they just kind of flipped the switch, and suddenly our numbers changed dramatically in one day even though the situation on the ground was the same,” Harris said. “I am not saying they are wrong, but the timeline is most useful.”

Even though the number of deaths per day is still increasing, the state hasn’t seen a similar jump since last week. The model, as a result, has stabilized, too.

The shaded area indicates uncertainty in the modeling, ranging from 400 to 2,000 total deaths by August.

As more data becomes available, the model will adjust again. The projections could worsen if deaths begin to spike, or the projections could get better if deaths level off before the projected peak in mid-April.

“People are working tirelessly not only to make sure that we’re going to be able to handle the need for ventilators in the coming weeks but also that we have the surge capacity to figure out if we do exceed the number of beds that we have, how we can deal with that,” Dr. Jeanne Marrazzo, the director of the infectious diseases division at UAB, said last week. Marrazzo is also a member of Gov. Kay Ivey’s coronavirus task force.

There are a number of assumptions in the model, including complete adherence to social-distancing measures through August. If Alabamians flout the stay-at-home order that began Saturday evening, the projections could surely be wrong — the reality could be worse. The death toll could be much higher than nine hundred because Alabama remains particularly susceptible to the virus.

“When you look at Alabama, there are more people who have risk factors in Alabama and the Southeast in general,” Mokdad said. “More obesity, more high blood pressure, more diabetes and more cardiovascular disease, and more cancer there than really anywhere else.”

If we try to return to normal earlier, then the projections could be worthless because the model assumes social-distancing continues through August. If we stop social distancing, about 97 percent of the population would still be susceptible to the disease. The virus would surge again. Until a vaccine becomes available, the virus and the threat of mass casualties could return.

“Our bodies as a species, we have never seen this virus,” Marrazzo said. “And that’s why so many people are having such a hard time handling it after getting infected.”

That threat could be mitigated by a nationwide mass testing regime, which would enable widespread contact tracing and targeted quarantines. That testing regime would have to include the large number of people who show no symptoms. We are nowhere near the capability of testing the number of people we would need for that to work.

The revision of the death toll from 5,500 down to 900 should not be taken as an all-clear. The modeling is based on the actual death toll, which could change if our behavior changes.


Below is a Q&A of our conversation. It was edited for length and clarity.

Q: Why does the modeling look so bad for Alabama?

Dr. Mokdad: It doesn’t look good, but let me explain why. We are modeling mortality. We take the death rate and model off that. We project the death rate into the future.

Then we back-calculate the number of beds, ICU beds and ventilators that are needed. Because we know from hospitals right now how many people with COVID-19 showed up at the hospital, how many were on a ventilator, how many of them needed to be in an ICU bed, how many died and how many survived. So we can do that by calculation.

The reason we are modeling mortality and not how many cases we have is because we are concerned that we are not testing everybody who needs to be tested. So the number of confirmed cases that we are releasing as a country is not totally reflective of reality. And this is not a criticism of the country; it’s just the reality. But we are reporting as positive the people who came and got tested. And we have still a shortage of tests.

Second, there are people out there who may have COVID-19 but are asymptomatic. We have studies showing that they don’t have any symptoms. We know people who were tested here in our hospital, who were positive, but they never had any symptoms. They were tested and they were found out to be positive. But they can still pass the virus, even though they don’t have any symptoms. We also know that many have mild symptoms and may not require hospitalization. Or some who have symptoms but may think it’s something else, like allergies, especially in a state like Alabama, which is beginning its allergy season.

So we decided to model mortality. We project a peak of demand — demand of the medical system — in mid-April.

The reason why Alabama would be much worse than most other places is a number of factors. When you look at Alabama, there are more people who have risk factors in Alabama and the Southeast in general. More obesity, more high blood pressure, more diabetes and more cardiovascular disease, and more cancer there than anywhere else.

So we would expect people who are high risk to use more resources because they have conditions that would make mortality higher and there will be more demand for resources.

Q: Gov. Kay Ivey just issued a stay-at-home order. A lot of people have said that came too late. How does that play into this model?

Dr. Mokdad: So in our model, we monitor all of these decisions. We know that you closed schools. We know that you closed non-essential businesses and services should be closed. But at this time, we have not added the stay-at-home order. That happened today.

It’s really too late, unfortunately. From our perspective, it should have been done much earlier. We cannot change the past, but we can change the future. So the lesson here is that these orders should have been in place earlier, but from now on, what we really need to stress for people in Alabama, is by staying home and adhering to these social distancing guidelines, you can reduce the number of deaths. The most important part for Alabama is that it could have a shortage of facilities to take care of patients.

By staying at home, you can reduce the burden on the hospital system. You can allow your physicians to have at hand the resources they need to deliver the best medical care for everybody who needs it. By reducing the number of people who have infections by staying at home, you can help the medical system and when April 17 comes, that shortage that we are projecting will not be as big as we are seeing right now because social distancing is working.

Q: Can you talk about the timeline and why this might have come too late for the peak demand?

Dr. Mokdad: I’m not saying it’s too late to do anything. The decision was made too late. It should have been done much earlier. I’m not picking on Alabama. Even in Washington, I would have liked my governor to make that call much earlier.

I and everybody in this country, we saw a pandemic unfolding in China. We saw how aggressive their measures were. We know they suffered. We saw it. So why didn’t we prepare ahead of time for it? We knew this was coming in December or January. We had January and February.

We had over a month and a half to prepare. Let’s be realistic and say a month because the first case was in Seattle. So let’s say we had a month. Why are we having this discussion now about our capacity to produce ventilators? We are the United States of America. We have the best resources. We have the best minds here. We are a resilient population. If you inform the public and give them the right information at the right time, Americans love their country and want to protect each other. So they would have stayed at home. All of us should have made this call much earlier. It’s too bad that Alabama did it on April 4th, when other states started doing it in mid-March. Even those states should have done it earlier.

Q: What should people take away from your modeling?

Dr. Mokdad: We can still make a difference here by staying at home. We have to be very careful. At this time, especially in a state like Alabama, where I worked a lot with the CDC. I worked a lot in Alabama. We know the state has underserved populations. It has many minorities and vulnerable populations. We need to be compassionate.

It’s time for all of us right now, all of us in other states, to help Alabama. Alabama should not be left alone to deal with this burden. It’s time for us to focus on Alabama. I know New York is in the media, and they deserve that, but we should still not forget Alabama. You should not be left alone to deal with this.

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