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Closure of rural hospitals places Alabama at disadvantage in COVID fight

Chip Brownlee

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Whether Alabama’s health care system will be able to handle the coronavirus pandemic will depend on its people.

The infectious disease specialist leading the UAB Medicine’s response to the coronavirus outbreak urged Alabamians to take social-distancing measures seriously to blunt the exponential growth of coronavirus cases in the state so as to not overload health care facilities.

An unmitigated spread of the virus—not to be alarmest—could cripple Alabama’s hospitals and leave doctors and other medical workers in horrible situations. Blunting the number of new cases in the near term by limiting social interaction and practicing good hygiene is the only way to prevent a health care crisis, experts warn.

On a call with reporters Monday, Dr. Jeanne Marrazzo from UAB said the closure of rural hospitals, the growth in the number of cases in the state and the potential for a ventilator or ICU bed shortage if the growth curve of COVID-19 cases isn’t blunted is “frightening.”

“In Italy, they don’t have enough,” Marrazzo said. “They are actually having to make decisions about taking people they believe are not going to survive off ventilators to reassign them to people. We do not want to be placed in that excruciating situation. It’s about the worst possible thing I can imagine as a physician, talking to a family about that or dealing with that. I don’t believe there’s any indication we’re going to get there. But again, my assurance is all based on my belief that we can deflect this curve and not be where Italy is right now.”

Marrazzo said UAB has about 300 ventilators ready for use, which should be enough if the number of cases is limited through social-distancing measures.

But there remains a larger question about the state, and whether the state as a whole has enough ventilators and ICU beds to deal with the COVID-19 epidemic.

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“We well know that many rural hospitals have been closing, right,” Marrazzo said. “We’ve been losing a lot of our smaller hospitals. Even those that have remained open may not have a deep staff to take care of critically ill patients. That’s when things do get frightening, and you do need to think about expanding your capacity at a place like UAB or a central place. We have contingency plans that we have been discussing. So this is basic disaster preparedness that people are actively pursuing. But I want to reassure people, we’re definitely not there. And we will be keeping very close, close track of this and updating you all as it comes on.”

Earlier Monday, Alabama Department of Public Health state health officer Scott Harris and Emergency Management Agency director Bill Hastings urged the state to take extra precautions to avoid spreading the disease any further.

“This is a human disease that is going to require a human response, which is going to require a whole of government response, which will require a whole of society response,” Hastings said. “A mobilization of all Alabamians, all U.S. citizens to reduce and slow the transmission of COVID-19. So it stays at or below or around the max capacity of our health care system. That is the fight that we’re in right now.”

The Department of Public Health is monitoring the total number of intensive care beds available and ventilators available for use in the state. Hospitals are required to report their numbers to the ADPH daily—sometimes more often. That number is not publicly available, but some estimates have placed the ICU bed capacity in Alabama’s hospitals at between 1,000 and 1,600. In total, there are about 16,000 hospital beds in Alabama. Most of those are already at use today, and a growing outbreak of coronavirus will undoubtedly put a strain on Alabama’s hospital system.

Just how bad that strain will get is not yet known. Experts have said that more than 50 percent of the population could become infected with COVID-19—some have placed that number higher at 70 percent. Research out of China indicates that about 15 percent of people who are infected require hospitalization and about five percent require intensive care. Alabama has a population of 4.8 million. So at some point, 120,000 could require intensive care in the state and 360,000 could require hospitalization.

Of course, all of those cases won’t happen at once, but the number illustrates the importance of reducing the rate at which cases multiply across the state.

Harris, during the press conference on Monday, said there is no reason to be worried yet.

“Do we have enough beds and ventilators? Yes, we have been tracking the number of our bed capacity and our ventilators for about a week now using the Alabama Incident Management System,” Harris said. “At this time, we do not have any hospitals that are having issues with surge capacity that we’re aware of. And we track that daily. So we don’t think that’s an issue at the moment. Clearly, that’s always a concern when you’re dealing with a respiratory illness like this, and so we’ll continue to monitor that.”

This story will be updated.


Transcript of the Q&A

Q: This is Chip Brownlee with the Alabama Political Reporter. Dr. Marrazzo, I was wondering if you were—how you feel about the way that the state has handled this so far. And also, what’s your read on the preparedness level in terms of ventilators? I know you just talked about that. But do have any concerns, for Alabama in particular, that we’ll have enough ICU beds and ventilators to handle the cases?

Marrazzo: Sure. Great, great questions. I think that the governor has taken it very seriously. She’s convened a task force of which I’m a member and Dr. Harris is the leader. We’ve met several times in the last several days and I have a call actually, at one o’clock today. They have been—the leadership has been incredibly receptive to our suggestions and our feedback. So I think based on the state of emergency that was declared last Friday, the administration has been very responsive. I do think that as you’ll hear more emphasis particularly, particularly from local health departments like Jefferson County, on some of the more aggressive social-distancing measures, that the state government is going to need to amplify those messages.

You know, you saw all the pictures of people partying this weekend for St. Patrick’s Day, all the invulnerable people out there at the bars. I’m happy for them. But I’m very worried for us. I really don’t think people should be out doing that right now. And we all have to give a little bit to protect our community. So that’s a really important message. And I think the governor will be very on board with that, given the data.

Your second question about ventilators is a great one. We have, for example, at UAB hospital, I think it’s about 300 ventilators. So we have a lot. Is that going to be enough? In Italy, they don’t have enough. They are actually having to make decisions about taking people they believe are not going to survive off ventilators to reassign them to people. We do not want to be placed in that excruciating situation. It’s about the worst possible thing I can imagine as a physician talking to a family about that or dealing with that. I don’t believe there’s any indication we’re going to get there.

But again, my assurance is all based on my belief that we can deflect this curve and not be where Italy is right now. There are I like your question about the rest of the state though because we well know that many rural hospitals have been closing, right. We’ve been losing a lot of our smaller hospitals, even those that have remained open, may not have a deep staff to take care of critically ill patients. That’s when things do get frightening, and you do need to think about expanding your capacity at a place like UAB or a central place. We have contingency plans that we have been discussing. So this is basic disaster preparedness that people are actively pursuing. But I want to reassure people, we’re definitely not there. And we will be keeping very close, close track of this and updating you all as it comes on.

Q: This is Chip again, I’m wondering what you think about—some people have suggested that some of the hospitals across the state that have closed might need to be reopened. I’m wondering, given your experience, how likely you think that would be to happen, like, what would, what would those places have to do to reopen to deal with this?

Marrazzo: Yeah, I mean, it’s a great question and I think anything’s on the table right now. If we come to that point, and again, we should have much more data in hand over the next week, I would say. If we come to that point, you know, what that means is we’re looking at capacity beyond our immediate medical systems. That means either repurposing existing facilities or creating temporary new facilities, which is also a pretty heavy lift. What would have to happen is you’d have to obviously make sure the infrastructures were capable. And you’d have to more importantly, almost staff them up with people who are capable and willing to do that. So that’s a pretty big step people are, I know, in active discussions about that contingency planning as part of the disaster preparedness response. It’s really no different than thinking about a mass casualty like you might have with a hurricane or an earthquake or something like that. Unfortunately, you have an infectious disease, so it’s a little bit more dynamic and ongoing than either of those things. But I do know that people are talking about it and we will be updating you all as those discussions proceed and if they do proceed to anything more concrete.

Chip Brownlee is a political reporter, online content manager and webmaster at the Alabama Political Reporter. You can email him at [email protected] or reach him via Twitter.

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Alabama reports 1,750 new COVID-19 cases ahead of July 4th

The seven-day average of cases per day surpassed 1,000 for the first time Friday.

Brandon Moseley

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Since the first coronavirus case was identified in Alabama in early March, 41,362 Alabamians have tested positive for COVID-19.

Heading into the Fourth of July holiday weekend, Alabama is reporting more cases of COVID-19 than ever before as hospitalizations continue a worrisome surge and the state’s death toll rises.

Since the first coronavirus case was identified in Alabama on March 30, 41,362 Alabamians have tested positive for COVID-19, according to the Alabama Department of Public Health.

The state reported at least 1,758 positive cases on Friday alone, the most since the pandemic began. In the past seven days, 7,645 cases have been reported, the most of any seven-day period since the pandemic began.

The seven-day rolling average of new cases — used to smooth out daily variability and inconsistencies in case reporting — surpassed 1,000 for the first time Friday.

Ahead of the holiday, the Alabama Department of Public Health is urging Alabamians to celebrate at home due to the coronavirus crisis.

On Friday, the Alabama Department of Public Health announced that another 22 Alabamians have died from COVID-19 just in the last 24 hours. That takes the state’s COVID-19 death toll to 983. Of those, 96 died in the last week alone (June 27-July 3).

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A few simple steps can greatly reduce your chances of being exposed and exposing others to COVID-19. Everyone should practice good hygiene, cover coughs and sneezes, avoid touching your face and wash hands often. Avoid close contact with people who are sick, even inside your home, and maintain a distance of at least 6 feet from others not in your household.

The use of cloth face coverings or masks when in public can greatly reduce the risk of transmission, particularly if the infected individual wears a mask. Many people are contagious before they begin to show symptoms — or may never develop symptoms but are still able to infect others.

Alabama reported an additional 22 deaths Friday, bringing the state’s COVID-19 death toll to 983, according to the Alabama Department of Public Health.

Of those, 96 died in the past seven days alone, or roughly 10 percent of the state’s total death toll. In the past 14 days, 171 people have died, or roughly 17 percent of the state’s death toll.

Even as the number of tests also increases — at least 430,000 have been tested — a larger percentage of tests are coming back positive compared to any other time period, according to the Department of Public Health and APR‘s tracking.

Roughly 15 percent of tests in the past week have been positive.

The large increases come as Alabama Gov. Kay Ivey on Tuesday extended the current “safer-at-home” public health order, which was set to expire Friday, to July 31.

The number of individuals hospitalized with COVID-19 is also at a new high, with at least 843 people hospitalized with the virus on July 2, the most since the pandemic began.

On Monday, in Jefferson County, where cases are increasing rapidly, residents were ordered to wear masks or cloth face coverings in an attempt to slow the spread of the virus. On Tuesday, the city of Mobile also began mandating masks or face coverings. The cities of Tuscaloosa, Montgomery and Selma have also implemented face covering orders.

Of the 7,645 cases confirmed in the last week, 1,321 — or roughly 17 percent — were reported in Jefferson County alone. Nearly 28 percent of Jefferson County’s 4,802 total cases have been reported in the last seven days. Since March, 152 people have died in Jefferson County.

A campaign rally for President Donald Trump that was planned for Mobile on July 11 has been canceled because of the rapidly worsening coronavirus situation there. Mobile County has had 633 newly diagnosed cases in the last week, or roughly 8 percent of the state’s cases this week. Mobile County has had a total of 3,904 cases and 134 deaths over the course of the pandemic.

Montgomery County reported 426 newly diagnosed cases in the last week. Overall Montgomery has had 3,947 total cases and 104 deaths thus far.

Tuscaloosa County has 393 new cases this week. The surging number of cases in Tuscaloosa and Lee Counties — where 276 tested positive this week — could potentially put the 2020 college football season in jeopardy. Tuscaloosa has had a total of 2,188 cases and 42 deaths, while Lee County has a total of 1,302 cases and 37 deaths.

Despite making it through several months with relatively moderate increases, Madison County is also experiencing a surge of new cases in recent weeks — with 407 cases in the last week alone. Madison has had 1,271 cases and seven deaths.

Many people are flocking to the beach for the Fourth of July holiday, where the coronavirus is also surging in Baldwin County with 328 new cases in the last seven days. Baldwin had been largely spared to this point with 828 cases in total and nine deaths. This week’s increase accounts for 40 percent of the county’s total case count.

Alabama is not alone in seeing surging case numbers. Forty of the 50 states reported rising coronavirus cases in the last week. On Thursday, 57,236 new cases were diagnosed and 687 Americans died. The U.S. death toll from the global pandemic has risen to 131,823.

Globally, there have been 11,092,229 cases diagnosed, though the real number is likely much higher. At least 526,450 people have died from COVID-19, and, with 208,860 new cases diagnosed on Thursday alone, there is no sign that this global pandemic will be over any time soon.

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Second Julia Tutwiler Prison worker dies after testing positive for COVID-19

The death comes as cases and deaths among inmates and staff continue to mount across the state’s prisons. 

Eddie Burkhalter

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A second employee at the Julia Tutwiler Prison for Women has died after testing positive for COVID-19, the Alabama Department of Corrections said Thursday. 

The worker recently tested positive for coronavirus and has since died, the Alabama Department of Corrections said in a press release, which doesn’t note when exactly the person tested positive or passed away. 

The death comes as cases and deaths among inmates and staff continue to mount across the state’s prisons. 

ADOC last week announced the first death of a prison worker at Tutwiler, while an outbreak of COVID-19 at the infirmary at the Staton Correctional Facility in Elmore County resulted in the deaths of two men serving there.

As of Thursday there have been 10 confirmed coronavirus cases among inmates and 30 cases among staff at Tutwiler prison. At Staton prison, there were 18 cases among inmates and 23 among workers. 

ADOC on Thursday also announced another worker at Tutwiler self-reported that they tested positive for COVID-19, as did a worker at the Bullock Correctional Facility and one at Limestone Correctional Facility. 

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Additionally, another inmate who was exposed at the infirmary at Staton prison, two and St. Clair Correctional Facility and two at Easterling Correctional Facility also tested positive for the virus. 

Confirmed cases among staff continue to outpace cases among inmates, and that likely comes down to access to testing. ADOC doesn’t offer free testing for staff, but ask that any worker who tests positive outside of work self-report the test results to the department. Inmates must either be exhibiting symptoms and be tested at the request of an ADOC physician, or they are tested at local hospitals while being treated for other conditions, which is how the majority of confirmed cases among inmates have been identified. 

Even though confirmed cases among inmates — 75 as of Thursday — remains much lower than confirmed cases among staff — 171 as of Thursday — nine inmates have died after testing positive for the virus, while two workers have died after learning they were positive for the virus. 

Of the approximately 22,000 inmates in Alabama prisons, 413 have been tested since the start of the pandemic, according to ADOC’s statistics.

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Jones urges public to heed surging COVID-19 cases, hospitalizations

Eddie Burkhalter

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U.S. Sen. Doug Jones, D-Alabama, on Thursday pleaded with the public to take COVID-19 seriously, especially now, as reopening of schools and Fourth of July celebrations near. Meanwhile, the state continues to see record numbers of new cases and hospitalizations. 

Alabama on Thursday saw a fourth straight day for record-high COVID-19 hospitalizations — and a record number of newly reported COVID-19 cases, when taking into account data collection problems that inflated Monday’s total.

As of Thursday afternoon, 843 people were being treated in Alabama hospitals for COVID-19, according to the state health department. That number is an increase of nearly 22 percent over this time last week, and a near 40 percent increase compared to the beginning of June.

At least “961 of our neighbors and family members have lost their lives to COVID-19, and we need to be cognizant of that as well, as those numbers continue to grow,” Jones said during a press briefing Thursday, also noting that over the last 14 days Alabama has seen 11,091 new cases of the virus, which is 28 percent of all the state’s COVID-19 cases. 

Jones said that while we’re testing more people in recent weeks, The Alabama Department of Public Health’s statistics show that a greater percentage of the tests are coming back positive.

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Based on a seven-day average, roughly 14 percent of the tests conducted in the state are now coming back positive. Public health experts believe that such a high percentage of positives is a sign that there continues to be community spread of the virus, and that there still isn’t enough testing being done. 

Jones said he’s concerned, too, about the timing of the surge in new cases, coming in the weeks after Gov. Kay Ivey lifted her more rigorous restrictions and after Memorial Day celebrations.  

“People did not seem to get the message about social distancing and wearing masks, and we are seeing these numbers increase and increase and increase,” Jones said. 

Jones noted the state’s long lines for people seeking help with their unemployment applications, some even camping out overnight to get that help, and said he’s written a letter to Senate leadership asking for federal funding to state departments of labor to better service those in need. 

The senator also discussed Oklahoma’s recent expansion of Medicaid, and said that the action made clear state leaders there understand that during the pandemic they needed to get all the help they can to their fellow citizens. 

“It is my hope that Alabama will also do likewise. We continue to see a rise in the number of people that could benefit from expanded Medicaid,” Jones said, adding that he’s still working to get another round of incentives to states to encourage expansion of Medicaid. 

Asked if there would be another round of stimulus checks sent to individuals, Jones said “maybe.” 

Jones said the next round of COVID-19 legislation is being drafted behind closed doors by Sen. Mitch McConnell, the Republican Senate majority leader from Kentucky, and that it’s uncertain whether more direct payments to individuals will be included in the final bills. 

“I’ve heard mixed messages coming out of the administration and Senator McConnell’s office,” Jones said, adding that he’s for the additional payments and thinks it will be needed going forward. 

Montgomery Mayor Steven Reed, speaking during the press conference, said the Montgomery City Council could take up at the next council meeting a measure that would place guidelines on businesses within the city to be held accountable for helping enforce the city’s mask ordinance for the public. 

In the absence of a statewide mask order, local governments have been instituting their own in recent weeks. Wearing masks, staying home when at all possible and maintaining social distancing when one can’t are the best ways to reduce spread of the virus, public health experts say.

Montgomery currently has a mask order in place, which carries the possibility of a $25 fine for individuals not following the order. 

Reed said at the next meeting, council members may deliberate on a measure to require businesses help ensure the public adheres to the mask order or face possible suspension of their business license “for a couple of weeks, so that is yet to be voted on, and we will look at that.” 

Reed said that the point of the city’s mask order isn’t to fine people, however, but to encourage them to wear masks and help save lives. He noted that Montgomery’s mask order has been followed by similar orders in Mobile and Selma, as local municipalities make independent decisions to protect their fellow citizens.

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Alabama’s COVID-19 surge is not slowing

Eddie Burkhalter

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The number of patients in Alabama hospitals being treated for COVID-19 surged past 800 on Thursday, marking a fourth straight day of record-high hospitalizations as concerns grow over the possibility that hospitals could become stressed due to the influx of patients.*This story was updated throughout at 4 p.m. on July 2 to reflect updated hospitalization data for Thursday.

As of Thursday afternoon, 843 people were hospitalized with COVID-19, according to the Alabama Department of Public Health’s data. That’s more than any point prior and an increase of more than 20 percent compared to this time last week — and an increase of 40 percent compared to the beginning of June.

The number of newly reported COVID-19 cases also reached a new high Thursday, as the state added 1,162 cases. On Monday, there were 1,718 cases, but because of delays in data collection, Monday’s numbers included figures from Saturday and Sunday.

The previous daily high was June 25, when the state saw an additional 1,129 cases.

The seven-day and 14-day rolling averages of daily cases both reached record highs this week. The seven-day average reached 981 Tuesday, a record, and remains high at 979. The 14-day average reached 843 Thursday for the first time. Rolling averages are used to smooth out daily inconsistencies and variability in case reporting.

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Additionally, the number of tests that are positive remains high. Taking into account incomplete data in April that inflated the numbers then, on Thursday the seven-day average of percent positivity was at 13.64, the third highest percentage since the start of the pandemic. The 14-day average of percent positivity on Thursday of 12.16 was the highest it’s been, taking into account the inflated April numbers. 

Public health officials and experts believe the percentage of tests that are positive should be at, or preferably below, 5 percent. Any higher, and the data suggests that the state is not performing enough tests and many cases are still being missed.

At least 81 deaths have been reported in the last seven days, bringing the state’s death toll from COVID-19 to 961. In the last two weeks, 160 people have died from COVID-19.

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