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Alabama health officials urge restaurants, churches to limit capacity, events

Eddie Burkhalter

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State Health Officer Scott Harris delivers a press update on Monday, March 16, 2020.

The Alabama Department of Public Health on Monday issued more restrictive guidance, cautioning against gatherings of more than 50 people and none if a person cannot stay at least 6 feet from others.

The new recommendations also included a suggestion that the public should consider canceling or delaying out-of-state travel plans.

The department’s recommendations come as confirmed cases of COVID-19 continue to mount across the state. As of Monday morning there were 22 confirmed cases, with 12 in Jefferson County.

The Alabama Department of Public Health’s recommendations are:

  • No mass gatherings of 50 persons or more, or gatherings of any size that cannot maintain a consistent six-foot distance between participants (with exceptions noted below). This may include festivals, parades, assemblies, or sporting events.
  • Senior adults or those with chronic health problems should avoid gatherings (outside of close family) of 10 or more persons, and should avoid travel by air, train or bus.
  • For retail business, including restaurants, limit patronage at any one time to 50% of the normally allowable capacity. Restaurants should maintain a six-foot distance between tables.
  • Public buildings should consider whether visitation may be limited. Hospitals, nursing homes and assisted living facilities are encouraged to implement visitation policies that protect vulnerable persons.
  • All persons should consider whether out-of-state travel plans may be delayed or canceled.
  • Participants in religious services or events, weddings, funerals and family events should exercise prudence and maintain consistent six-foot distance between participants if possible or conduct online services.

While workplaces should attempt to heed to these recommendations whenever possible, it is understood that exceptions may be needed for essential government functions, municipal and state legislative bodies, and health care facilities including clinics, hospitals and pharmacies. Consider using means for electronic or video meetings in workplaces if possible.

ADPH continues to work with the Centers for Disease Control and Prevention (CDC) and other agencies to provide guidance regarding COVID-19. To help prevent the spread of respiratory viruses including COVID-19, the public is urged to continue practicing social distancing and other precautionary measures, including:

  • Wash hands with soap and water.
  • Use alcohol-based hand sanitizers if handwashing is not possible.
  • Cover your mouth and nose with a tissue, or cough or sneeze into your elbow.
  • Avoid touching your eyes, nose or mouth with unwashed hands.
  • Stay home when sick.
  • Stay away from people who are sick.
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Alabama Power working with UAB, Alabama Productivity Center to aid health care workers

Bill Britt

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Families across the state are under a stay-at-home order. Imagine a family of four stuck at home. Mom and Dad go to the garage to clean the clutter of boxes that have accumulated over the years, they turn on the lights, they don’t even think about where the energy came from, it’s automatic. A teenage daughter plugs in her smartphone after texting distant friends all day, where does the charge come from, does she care? A son still on his game console late into the night isn’t thinking about the power that enables his game, he just wants to play.

Now think about a medical professional caring for a COVID-19 patient in an ER, she needs a face-shield. It should be there, but maybe it’s not.

Alabama Power keeps the lights on, so the house is illuminated, the smartphone charges and the game console keeps humming, but recently the company stepped out of its usual role and is now making medical face shields in a partnership with The Alabama Productivity Center, and the UAB School of Engineering.

An email from within the Alabama Power Company landed in Scott Bishop’s inbox two weeks ago. Bishop is a team leader at APC’s Technology Application Center. “I received an email that asked did we know anyone who could do 3D printing to make headbands for face shields,” said Bishop.

Bishop knew immediately that within the companies network, there were resources with 3D printing capabilities that could possibly make medical face shields.

“In our network of people, some of those resources reside at UAB and the productivity center,” said Bishop. “So we looked at our capabilities and we had a printer and UAB had printers and so did the productivity center,  so we started printing headbands for UAB Hospital.”

From that initial email, a small network is now producing 100 face shields a day with more production ramping up as the days go by.

“Healthcare workers’ faces have been reported to be the body part most commonly contaminated by splashes, sprays and spatter of body fluids,” notes the National Center for Biotechnology Information.

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As a PPE, face shields play an essential role in keeping healthcare workers safe when dealing with infectious deceases like COVID-19.

What started as a project to manufacture headbands has grown to crafting the full face shields.

Last week, the Alabama Productivity Center took to Twitter to showcase the face shields.

“Thank you to all of our partners and volunteers for helping out producing these shields! We have more & more request for the need of these shields. Please DM us if you can help! Here is what the final product looks like. #COVID19 #3DPrintedFaceShield.”

As part of the Culverhouse College of Business at UA, the Alabama Productivity Center is known as a premier source of innovative sustainable solutions to improve efficiency, effectiveness and profitability of Alabama business and industry.

APC offers student internships with businesses throughout the state giving students ability to explore career options, understand the nature of the industry world, and acquire valuable skills not taught in the classroom. Most students are juniors, seniors or graduate students with majors such as engineering, operation management, information technology, marketing and other disciplines, according to information provided by the university.

The UAB School of Engineering spread across five academic departments, provides undergraduate students with a solid foundation in engineering. With more than 15 graduate degree programs and tracks to choose from at the master and Ph.D. level, as well as a variety of certificate programs, UAB offers highly adaptable programs that range from traditional M.S./Ph.D. pathways to online master of engineering degree tracks for working professionals, according to the school curriculum.

Justin Koch at the UAB School of Engineering and Jody Beck at the Alabama Productivity Center are leading the charge at their respective institutions efforts to produce face shields.

UAB Hospital is supplying materials for the face shields; the teams at Alabama Power, UAB and UA are donating their time.

Alabama Power’s TAC facility serves as a demonstration and test facility that investigates ways to reduce production costs, improve energy efficiency and productivity while addressing environmental concerns.

“I look at it from our group’s perspective; we are helping our customers,” Bishop said. “In this case, our customer in the hospital’s staff. We are still helping our customers, just in a different way.”

“The Alabama Productivity Center, a non-profit organization, is an outgrowth of a 1983 joint venture of the University of Alabama and General Motors to save a Tuscaloosa GM plant from closing,” according to the center’s website. “The positive experience utilizing university faculty and students to save Alabama jobs led to the establishment and sponsorship by Alabama Power Company and the University of Alabama.”

“Safety has always been our top priority,” said APC spokesperson Katie Bolton. “As the pandemic has unfolded, this is one of the small ways we can take something that’s important to us and use our resources to help provide some safety for the frontline healthcare workers,” she continued. “We want these important health care workers to return home to their family’s and loved ones safely. That’s part of Alabama Power’s core value system.”

These types of private, university and state partnerships are increasingly becoming the backbone to fighting the COVID-19 pandemic.

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Opinion | It’s make or break time: The math behind social distancing

John Atkinson

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John Atkinson is the public relations and marketing director at East Alabama Medical Center.

On March 31, EAMC’s Chief of Staff Michael Roberts, M.D. used the Penn Medicine CHIME tool to look at where East Alabama Medical Center—and its collective communities—stand regarding the COVID-19 coronavirus and social distancing.  After sharing the resulting data with his colleague, Ricardo Maldonado, M.D., infectious disease specialist, the two knew it was make or break time.

“Social distancing is the number one denominator,” says Dr. Roberts, EAMC’s chief of staff.  “If we do a poor job of that—50 percent or less—then we’re in a situation where our hospital simply cannot handle the influx of ICU patients we will see or the number of ventilators we will need, and many people will die as a result. This includes even those without COVID-19 because we simply will not have the staff and equipment to keep up.”

When asked recently by a local official what percentage he thinks we are at currently, Dr. Roberts hesitated before answering. “I don’t know if I can put a number on our current performance,” said Dr. Roberts. “The website unacast.com recently gave the state of Alabama a grade of ‘D’ on social distancing, representing only a 55 percent decrease in non-essential visits. Lee County was a little better with a grade of ‘B minus,’ and Chambers County received a ‘D.’ If we really want to save lives and return to a sense of normalcy, we need to shoot for an ‘A,’ with 75-100 percent social distancing—not just in Lee County, but in all of the surrounding areas.”

Dr. Maldonado agreed, and did not mince words. “If we are not pro-active today, we won’t see light anytime soon.”

75 or 100 Percent

Looking at the social distancing percentages, if 75 percent of people comply, the peak number of COVID patients at EAMC at one time would be 74, with 28 of them in ICU and 21 of them on ventilators.  Those numbers are manageable, but the problem is that the peak is not until June 15, meaning that the 75 percent of people doing the right thing will have to do it for more than two more months.  “And that only gets us to the peak,” states Dr. Roberts. “We would still have COVID-19 in the community.”

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Using the following assumptions: population of 180,000, first hospitalization on March 16 and 64 patients currently hospitalized, the predictive modeling clearly shows that 100 percent social distancing is by far the best option.  Hopefully, the “stay at home” order put in place by Governor Kay Ivey, effective Saturday, is the catalyst to reach that 100 percent mark.

“Likely have thousands of cases in our area”

Some people point to the number of confirmed cases in the community and believe the situation is not so dire. Dr. Maldonado says that does not paint an accurate portrayal.  “The number of positive cases does not tell us the number of people with COVID-19 infection,” says Dr. Maldonado. “We are testing less than 100 a day while we get almost 1,000 calls daily at 528-SICK. If we tested all 4 million people in Alabama at once, we could then know how many have it,” he says, followed by a disclaimer.  “Even if we did that, the next day, the number could multiply by 2 or 3 easily. The number of reported cases is just the tip of the iceberg.”

Dr. Maldonado goes on to say that 20 percent of adults will need to be hospitalized, “but this calculation does not include children who are likely the ones that have only mild symptoms or no symptoms at all; and they will continue to infect other people.”

The bottom line, says Dr. Maldonado, is that “we likely have thousands of cases in our area if we include children. Each person can infect between two and three, or much more in large gatherings that include handshakes and touching.”

“The only real option”

Dr. Maldonado, who has 16 years of infectious disease experience, including 11 years at EAMC, says there is no time to waste. “We can see the top of the peak in less than three weeks if we practice 100 percent social distancing starting right now!  That means businesses can open back up sooner, people can spend time with friends and loved ones, and churches can meet sooner. The only real option—where this lasts the least amount of time and where the least amount of people die—is when we see 100 percent of our community practicing social distancing.”

What exactly is Social Distancing?

The term social distancing has been used a lot, but what exactly does it mean to practice social distancing.  Here are the key things to know:

  • Stay inside your home as much as possible.
  • If someone in your home shows symptoms of COVID-19 (cough, shortness of breath, fever of 100 or more), isolate them immediately and do not allow any non-family members into the house.
  • If you go outside to exercise or for other reasons, stay a minimum of 6 feet away from anyone and do not touch surfaces that others may have touched.
  • Use hand sanitizer before going back into your home. Or, wash your hands immediately inside your home and then sanitize your door and faucet handles.
  • Limit outings to food, healthcare, pharmacy and gas.
  • In those settings, stay a minimum of 6 feet away from anyone and do not touch surfaces that others may have touched.
  • Use hand sanitizer after opening doors, touching grocery carts, handling money of any form, and any surfaces that others may have touched.
  • Do not touch your face with your hands, especially your eyes, nose or mouth.
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Federal law strengthens food stamps during COVID-19 pandemic

Eddie Burkhalter

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The COVID-19 pandemic has left thousands of Alabamians without work and in desperate need of food assistance, and the federal Families First Coronavirus Response Act signed into law in March strengthened food assistance just as the public is being told to stay home to prevent the virus’s spread. 

Alabama Arise, a statewide nonprofit that advocates for low-income families, released a statement Friday highlighting aspects of changes to the Supplemental Nutrition Assistance Program (SNAP), known as food stamps. 

Among the changes: 

Suspension of time limits

The new federal law includes a temporary suspension of SNAP’s three-month assistance time limit for able-bodied adults under age 50 and without children in their SNAP household. 

Increased assistance for most families

The changes also give people additional SNAP benefits up to the maximum amount allowed for their household size. Alabama Arise notes that while this will help thousands of Alabamians, the poorest families – who were already receiving the maximum benefit – will not receive an increase.

The increased benefits for March were added to participants’ EBT cards around the end of March. And participants will see this month’s increased benefits added to EBT cards around the end of April. DHR will approve new SNAP participants for assistance at the maximum level for their household size.

Replace school meals with SNAP and SNAP-like assistance

The new federal law also allows states to provide school meal replacement assistance of around $114 per child per month. This aid can come through SNAP or another mechanism if the children attend a school that is closed and otherwise would receive free or reduced-price school meals. This would include all children who are certified as eligible for free breakfast and lunch. It also would include all children who attend a school that provides free meals to all enrolled students through the Community Eligibility Provision.

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Since all public schools in Alabama are closed for the rest of the semester, households already receiving SNAP could simply see their SNAP assistance increased by the value of school meals that children in the family previously received. However, Alabama hasn’t yet decided how to give SNAP-like “issuances” to such families who are not already enrolled in SNAP. Participants cannot receive school meal replacement benefits until DHR and the state Department of Education agree on a plan and get approval from the USDA Food and Nutrition Service (FNS).

Reduced administrative burdens

The Families First Act allows states to request policy changes to streamline SNAP procedures to keep up with increased demand. For example, a state could ask to make certification periods longer or waive interviews with new participants. States also could seek to reduce the amount of information that must be verified and simplify the verification process. Alabama already has streamlined many procedures, but it should make additional SNAP administrative changes to reduce waiting time for approvals. Thus far, DHR has not requested any administrative waivers from FNS.

Alabama Arise noted however, that while advocates had hoped the third federal COVID-19 assistance bill, the Coronavirus Aid, Relief and Economic Security (CARES) Act, would include a 15 percent increase for SNAP, the legislation enacted March 27 did not include such an increase.

Alabama Arise and other advocates still encourage Congress to increase overall SNAP assistance and raise the minimum benefit levels. Congress also should prohibit the USDA from moving forward with proposed rule changes that would limit SNAP access and reduce benefits for most participants.

To file for food assistance online visit the Alabama Department of Human Resources website here.

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840 hospitalized with confirmed, suspected COVID-19 in Alabama

Chip Brownlee

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Stock Photo

More than 800 people are hospitalized in Alabama with a confirmed or suspected diagnosis of COVID-19, the disease caused by the novel coronavirus.

State Health Officer Scott Harris said Friday evening that 255 people are hospitalized with a confirmed positive case of the virus. An additional 586 people are hospitalized with a suspected case of the virus, pending results of a test.

The rising number of hospitalizations, confirmed cases in nursing homes and the number of infections among the state’s health care workers — which is as high as 200 cases — contributed to Gov. Kay Ivey’s decision to issue a stay-at-home order Friday evening.

With 255 hospitalized confirmed cases, that means about 17 percent of the state’s confirmed cases are hospitalized.

Not all of the patients in the group of suspected cases will end up testing positive for the virus, though, Harris said.

Some could be flu, pneumonia or some other unknown respiratory illness. Tests will need to be completed on those to determine if they truly have the virus, but hospitals are treating them as if they do have the virus.

By Friday evening, 1,535 people in Alabama have tested positive for COVID-19. There have been at least 38 reported deaths.

APR has been analyzing data released by Alabama hospitals or provided to APR for the past two weeks in an attempt to determine how many people are hospitalized in the state.

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Our analysis, as late as Wednesday, showed that about 120 people were hospitalized with confirmed cases.

The numbers from the state health officer today, reported by the Alabama Incident Management System, are higher than our highest estimates because our data only included ten of the state’s largest hospitals. The number of confirmed hospitalizations is also growing.

UAB said Friday afternoon that it is treating 62 positive inpatients, up from 52 at the beginning of the week.

In the middle of a severe outbreak in Chambers and Lee counties, East Alabama Medical Center said Friday that it has 32 positive patients and 20 more suspected patients. It’s already discharged 19 people from inpatient care.

The number of hospitalized patients in Alabama is expected to grow until at least April 17, when modeling from the University of Washington’s Institute for Health Metrics and Evaluation suggests Alabama will reach its peak resource usage.

At that point, the modeling shows that Alabama could be short 20,000 hospital beds and short 5,000 ICU beds. Harris said the Alabama Department of Public Health has found the IHME’s modeling helpful for its timeline, but he’s hopeful that the numbers may not be so high.

“I’m not saying they’re wrong but I think that the timeline is the part that I really feel like has been most useful,” Harris said. “I think that’s the part where there’s the least amount of variability.”

via IHME

Alabama is already facing difficulty in finding new ventilators to bolster its surge capacity. Harris said Friday in an interview with APR that the state requested 500 ventilators from the national strategic stockpile, but the Department of Health and Human Services doesn’t appear likely to fulfill that request any time soon. The state has added a few hundred ventilators to its capacity by converting anesthesia machines and veterinary ventilators into ventilators that can be used for COVID-19 patients.

The U.S. Army Corps of Engineers is also looking at hospitals and other sites around the state that can be converted into field hospitals.

East Alabama Medical Center in Opelika, Harris said, is under particular strain already because of a large outbreak in Chambers and Lee County, contributing to its rising hospitalizations numbers.

“There’s no question that what’s going on in Opelika right now is related to Chambers County,” Harris said. “You know that hospital is really having a difficult time right now, and it is, by and large, connected to this outbreak that we’ve seen in Chambers County.”

Chambers County, by far, has the largest per capita number of cases in the state. The Montgomery Advertiser’s Melissa Brown reported Friday that the outbreak could be linked to church services. EAMC has said the same.

“There certainly seems to have been a church homecoming event that involved a large number of people,” Harris said. “It was before Jefferson County even issued their first order so you know it was kind of before it was on everybody’s radar locally in Alabama. And I think a lot of cases have been connected to that.”

East Alabama Medical Center also released its own modeling Friday, and it shows that in a worst-case scenario, that hospital alone could be faced with 1,750 patients on April 23.

That scenario is unlikely to play out because it assumes no social distancing, but even better-case scenarios suggest between 500 and 1,000 people could be hospitalized at EAMC alone if fewer 75 percent of the public adheres to social distancing.

via EAMC

“Social distancing is the number one denominator,” said Dr. Roberts, EAMC’s chief of staff.  “If we do a poor job of that—50 percent or less—then we’re in a situation where our hospital simply cannot handle the influx of ICU patients we will see or the number of ventilators we will need, and many people will die as a result. This includes even those without COVID-19 because we simply will not have the staff and equipment to keep up.”

If more than 75 percent of the population adheres by social distancing, EAMC’s modeling concludes, then the peak number of patients at the hospital at one time would be 74. But the peak wouldn’t be until June 15, so people would have to do the right thing for more than two months.

“And that only gets us to the peak,” Roberts said. “We would still have COVID-19 in the community.”

UAB’s director of infectious diseases, Dr. Jeanne Marrazzo, said Thursday that hospitals across the state are facing a near-term shortage of personal protective equipment — a situation she called “dire.”

“The situation is dire,” she said. “It is not just masks. It’s gloves. It’s hand sanitizer. It’s gowns.”

In some of the PPE categories, the number of days left before supplies run out is in the single digits. The hospitals may get new shipments of supplies, but if the situation deteriorates, the shortages might worsen.

“This is not a hypothetical scenario,” Marrazzo said. “This is real. And these are the people who are working to take care of you and your family in our communities every single day, who are being asked to be concerned, and sometimes even make decisions about who gets to use the various degrees of PPE.”

Alabama is one of a few states that is not regularly releasing hospitalization data. In the interview with APR Friday, Harris said the Alabama Department of Public Health is working to begin providing that data regularly.

“We are about to do that,” Harris said. “We’re not trying to not put it out. It’s just been an issue with our GIS people in trying to work it out.”

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