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State officials’ remarks to Alabamians on COVID-19

Chip Brownlee

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Below is a transcript of State Health Officer Scott Harris’ and EMA Director Brian Hastings’ press conference on Monday, March 16, about COVID-19.

State Health Officer Scott Harris

On the current situation: We wanted to spend a little bit of time just updating you on the situation in Alabama with regards to COVID-19 and wanted to cover some new guidance that we’re issuing today for Alabamians. As you may be aware, as of midnight last night, we had 22 cases identified so far in the state through testing. We continue to have test results that come in. I do not know of any new positive test results so far this morning. But we had 22 last night, a little over half of those were found in Jefferson County. I would say that that’s not surprising given the population of Jefferson County, but also because Jefferson County has had the most access to testing. As you may be aware, there are a couple of drive thru test sites or screening sites and test sites there. And so I think probably most of the people who have been tested in the state are from that part of the state. So we still have a total of 22 cases so far.

On testing capacity: We continue to work on increasing our testing capacity in the state. Besides these drive thru sites, and besides our Alabama State lab, we know that there are other commercial providers that are able to provide these tests. And I know many of our health care facilities are using organizations like Quest and LabCorp to carry out this testing. At this time, we do not have any issues with test capacity. We’re able to test all assembled we receive on the day that we receive them assuming they come in early enough in the day for that run. So we don’t have any concerns about capacity right now.

You may be aware that we have been working on a plan to set up screening sites around the state. Our partner, the Alabama Hospital Association, and the Medical Association of the state of Alabama has also been working with us to identify these sites and get them up and running. We have 20 sites that are identified. We’re not making that publicly available at this moment because we still need to be able to get those staffed and get those adequately equipped, but you’re probably aware there are some hospital locations in the state that have opened up their own drive through a screening clinic starting today, at least a couple that I’m aware of.

We will release more information. Hopefully later today on on how this system will work. Generally speaking, what we expect to have are testing sites, or screening sites, rather where people may call our 1-800 number, learn where’s the closest screening facility in their area, and then they can travel to that site to consult with a provider on that site to determine whether screening and testing is necessary. And then that specimen can be collected and sent for testing. And we’ll give you again, we’ll give you more information on that when we have that available.

On new social-distancing guidance: Because of the situation with COVID-19 disease throughout the country, the CDC has issued new guidance to us and so I want to share that with you today. This is not 100% equivalent to CDC guidance, but essentially is and with just a few subtleties for, for our state. At this time, the public health would like to direct Alabamians, to not be involved in mass gatherings of 50 or more people. We would direct Alabamians not to be in any gathering that cannot maintain a six foot distance between participants, with some exceptions that I’ll discuss in just a moment. This would include certain things like festivals, parades, assemblies, sporting events, and the like. Obviously, there are some essential functions in which this may not be maintained, which I’ll cover. In particular, we would issue guidance that our senior adults and those with chronic health problems, be particularly cautious about crowds and our advice would be to avoid gatherings of more than 10 people other than family gatherings. Seniors should avoid travel if at all possible and certainly should avoid travel by air, train or bus where they might be in a confined space with other people.

On retail and restaurant limitations: For retail businesses, including restaurants, the guidance that we are issuing would ask them to limit patronage to about 50% of their normal allowable capacity. Obviously, there could be some, some leeway there, depending on the size of the facility and how closely people are situated together. Restaurants ought to maintain a six foot distance between tables regardless of how many people they have in their facility. But we believe 50% of the normal allowable capacity is a pretty reasonable starting place. Public Buildings ought to consider whether visitation should be limited, or terminated. Hospitals, nursing homes and assisted living in assisted living facilities are encouraged to implement the visitation policies to protect their vulnerable people. We are asking hospitals to consider at least the possibility of delaying or canceling elective procedures, which would prevent certain vulnerable people from being in those facilities but also conserve their capacity to take care of other sick people if needed. I think all Alabamians should consider whether any out of state travel plans are truly necessary. If these are not necessary, then they ought to be delayed or canceled.

On religious or family events: Participation in religious events or weddings, funerals or family events should just exercise prudence and common-sense precautions. Where it is possible a six-foot distance between participants ought to be encouraged. Again, certainly, that’s not possible in all cases, but we would consider, we would ask people to consider rescheduling or delaying events if that’s possible to do so. We certainly understand that religious events, in particular, are so important to so many people in our state. If there’s a possibility for meeting through webcams or video conferencing or teleconferencing, we would encourage people to do that particularly ours seniors who are most vulnerable for the disease.

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On workplaces: While workplaces may not necessarily be able to heed these recommendations, we would ask them to try to do so wherever possible. It’s certainly understood that there are some essential functions from the government for municipal and state legislative bodies from healthcare facilities like clinics, hospitals, and pharmacies that may not be able to heed these and that’s certainly understandable. Where possible, again, we would consider workplaces to consider using electronic or video meetings, when that’s an option. As you may be aware of the governor directed state agencies yesterday to implement some of these policies. We have at our agency, for example, today we have asked nonessential personnel to not come to work. We’re allowing people to work at home and telework to the extent that it’s possible to do that.

On anxiety: We certainly understand there’s a lot of anxiety. There’s a lot of uncertainty out there. Many people are unsure what will happen and what’s coming next. This is a very fast-moving situation. But I do want to remind Alabamians that you absolutely do have the power to protect yourself and to protect your family. The normal social distancing items that we’ve been mentioning for several weeks now are what you can do. In fact, it’s actually the most you can do. It’s the most that anyone can do. Please remember to practice good hygiene. Please remember to wash your hands. Please remember to avoid crowds, as we’ve mentioned, and certainly remember to stay home. If you’re sick, reach out to your healthcare provider and get further guidance. I think if we all cooperate, if we can all manage to do this, then we’ll have a have a little bit of time where we’re inconvenienced and uncomfortable, but I know that will come out okay on the other side.

That’s all the prepared remarks I have. I’m going to turn it over to Director Hastings at this time.

EMA Director Brian Hastings

Thank you, Dr. Harris. And I first want to start off and say I’m so appreciative to be a part of Governor Ivey’s cabinet and the policy and guidance that she has given to her staff, her cabinet, and the leeway to have those authorities to do what we need to do to protect our agencies. So I want to make sure that I speak to you today as a member of Governor Ivey’s cabinet and her authorized representative for all hazards coordination, I want to talk to you as a agency lead. And I also want to talk to you as a father.

Okay, so the first thing is, Gov. Ivey has allowed her cabinet—and we are trying to model the behavior that we’re asking for businesses, society, other functions of government—to reduce the human-to-human contact to reduce the transmission of the corona virus which results in the COVID-19 disease. And so as we’re doing that, we’re implementing some of the same measures that Dr. Harris is and the other cabinet members and our counties and cities are doing. But today was the last day that I gathered the entire agency together.

To let them know, respect this disease, respect this disease. We’re taking and implementing measures to preserve our workforce and capacity because Alabama is counting on us. So we’re going to be teleworking, we’re going to be splitting and shifting our shifts to minimize the six foot, human-to-human contact, and we’re going to try to do everything virtually remotely. And as we battened down to protect our workforce, our most precious resource our people, there may be a problem with a social recession. So we need to also think about those people who are the most vulnerable in our society as we eliminate that human-to-human contact. It doesn’t mean don’t have contact with them. It doesn’t mean don’t care for them, because 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—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.

So that was my discussion as a cabinet member and my appreciate an appreciation for the things that Governor Ivey has done to unleash the authorities of her staff during this national emergency, and Alabama public health emergency. And I want to remind everyone, this is not just a public health emergency. This is a national emergency of national security significance. All right. We don’t even have to declare a major disaster declaration. All we have to do is a federal-state agreement. We’re already there. It’s so challenging because of the nature of this disease. So now I’m going to talk to you as a father and a 27-year attack pilot.

On young people: The nature of this disease is what is causing our younger population to say I don’t fear the COVID-19. And I’m glad we don’t fear it, because fear has no place here. All right. But what I’m asking you to do is respect this disease. Please respect this disease. Because even though our younger, healthier, healthy population can be asymptomatic, or have minor symptoms, they’re still transmitting the disease. Okay, that should be concerning, right? So we could be going about our daily activities and not reducing our human-to-human contact and kind of engineering our societal behaviors and norms to reduce the contact. This is an aerosol disease transmitted through coughs, sneezes, and mucus on hands and the virus is being transmitted. So the way we do things, I mean, as simple as did you push the elevator button with your fingertip or your knuckle? Did you open the door with your hands and did everyone else or do you do with your elbow or your back? Those are minor things. But everything matters. Okay? Everything matters.

So what I just described you is that the most efficient vector of this disease is the young and healthy population that may not know they have it. And then the most vulnerable is our elderly and those who have underlying conditions that we should be concerned about, we should be concerned about we need to protect our elderly. Alright, so we’re in this together. And we’re going to do our best to share information fast because it’s a fast evolving event. And the other thing I want everyone to understand that this is a disaster, okay, that’s why we have a national emergency, and it’s going to be multifaceted.

On cyber security: For instance, you may be wondering why the hurricane and weather guy is standing in front of you today talking about cyber during a healthcare crisis. Well, the HHS just received a cyber attack today, as they’re trying to mobilize and plan a whole of government response. So as we, collectively as Alabamians and the nation are trying to minimize our human-to-human contact, and we’re incentivizing teleworking, telecommuting, putting things on the web, we’re reducing our vulnerability to one virus, and increasing our vulnerability to another virus in the cyber realm. All right. So I’m asking everyone to take this seriously. And it’s going to take everyone’s action. And Governor Ivey has given us those authorities to mobilize Alabama and to talk to you to vote to make sure that you’re empowered to do those things that we need you to do to slow the transmission of the disease. This is no time for fear. It’s time for respect and believing you have a purpose in helping those around you. That’s the nature of a whole of government and whole of society response.

That’s all I have. But I appreciate the time that Dr. Harris has given to me. I appreciate the ability that Governor Ivey has given to all her cabinet members and the functions of government to, to work collaboratively to really think through the nature of the problem. And all those consequences and unintended consequences of actions that we need to work through to keep Alabama strong, to keep Alabama healthy, and to really keep our eyes on the future and where we want to go. So thank you.

Questions

Question: You mentioned last week recommendations about schools the state responded to your recommendation about schools. But what about daycares? There are a lot of people with young children who are wondering what they should do.

Scott Harris: Right. The the order to close schools did not directly affect these daycares. Our recommendation to them is that the same as we have for others gatherings, they need to be able to maintain a six foot distance. That’s probably not a practical recommendation for daycares. And so, if they’re not able to do that, then then our recommendation would be that they close. That’s a that’s a difficult recommendation to make that affects a lot of people, the parents in particular, but also the people who are employed in that in that facility. But we think that that’s the safest recommendation we can make.

Question: So we’re talking about kids, two kids, you know, they need to be six feet away from each other?

Scott Harris: The truth is, I don’t know that that’s a practical recommendation. I would say that that’s the model we’re asking people to think about. And if that doesn’t fit with what you’re doing, you need to consider canceling Yeah.

Question: Can you talk about testing in terms of where people can go to get information if they need to be tested? And also, what’s the turnaround time for testing?

Scott Harris: Sure. The testing as we’ve said, it has been continuing to ramp up we established last Friday, a 1-888 number that I think I gave to you on that day that people can call to get information about testing. That was actually stood up on Saturday morning, I believe. People who can call that number are directed if they have a provider to contact that provider. For those who do not have a provider relationship, there is some advice about places in their area that they can go. As we flesh out this plan to have a screening centers around the state, we certainly will flesh out that, that number as well, to make sure that we have more concrete guidelines for people, but at this time, we have been able to test those who need to be tested. As I’ve told you before, if a provider requests us to perform a test we will do that. We have stated, you know for about 10 days that our turnaround time is 24 to 72 hours. It’s probably significantly better than 72 hours and sometimes depending on when the sample comes in and when the test gets started it could even be same day but but 24 to 72 hours would be the turnaround time that we’re quoting.

Question: What can you tell people about grocery stores? This has been a weekend of people very close quarters inside a lot of grocery stores seem to have been incredibly crowded, things are selling out. Have you been in touch with the grocery store industry or anyone with the grocery stores? What can we do to prevent those types of crowds?

Scott Harris: Sure, our department has communicated through the Business Council and through others, indirectly with them. I have not personally met with them. But the same advice I would I would give to people who are doing their shopping is what we’ve given in every other realm. First of all, just remember to be prepared, but there’s no advantage to being over prepared. There is no shortage of food. There’s no shortage of things other than temporarily for paper products, as we all know about but but we have no concerns or issues that people won’t be able to access food if they need it. I would say in any type of closure activity throughout the world grocery stores have been exempted from that. And it would be no different, you know, in this state as well, grocery stores have to remain open because people have to be able to access that food. So just remember that routine preparedness is what we’re encouraging. Just like we say, when people have expect a hurricane or a tornado or an ice storm, you need to have some minimal preparation to make sure that you’re prepared. But it really doesn’t need to be anything excessive.

Question: Yeah, we talk a lot about who should be tested who should not be tested?

Scott Harris: There’s almost no reason to test a patient who does not have symptoms. Now, there may be some individual medical conditions or individual cases that a provider would decide to test someone who does not have symptoms. But if you’re someone who does not have these symptoms of fever or cough or shortness of breath, we really don’t want you to seek a test. First of all, even getting a negative test result today wouldn’t tell us anything about you tomorrow, you know

You could be negative today. And obviously we can’t test every person every day for as long as they want to be tested. But secondly, there is, you know, at some point, a total capacity of tests that we can do. So we would ask people who aren’t symptomatic to avoid getting tested so that we can test those people who are most at risk. And we can get those results back in a timely manner to those physicians and other providers that are taking care of vulnerable people that need those tests results quickly.

Question: Do we know how long a person that is asymptomatic would carry this?

Scott Harris: We don’t know for sure. There’s different data on that. Generally speaking, when someone is exposed, if they if they become infected, they may show symptoms anywhere between two days and 14 days. And that’s how we’ve arrived at this 14 day self isolation. But in terms of how long they carry the virus virus afterwards, there’s a lot of different data and it’s really new and there’s really no solid conclusions about it. Clearly, there are some people that shed some virus if you test them, you know, days and days after they’ve gotten well. But whether those people actually have enough virus to be infectious to others, we just don’t know right now.

Question: The private groups, for instance, Walmart and other groups that have been doing this testing, has that lifted a burden off of ADP?

Scott Harris: Oh, I would say that any group that’s doing testing is helpful. I mean, it allows more opportunities for testing. And it lets a provider have more more options, I guess. And we we think that’s a great thing. As you may be aware, HHS has a plan through FEMA to open some mass screening and testing sites as well. They announced that last night, we’re still not sure what that plan looks like in Alabama, but they’re certainly reaching out to all the states to see if there’s a need for or availability of locations to host those kind of sites. So we think the more testing options available, the better for everyone.

Question: Do you think limiting the capacity in restaurants and other public places do you think that goes far enough? Because as late as over the weekend, our Secretary of State’s considered postponing the runoff election.

Scott Harris: Yeah, right. I think I think that’s a question that we don’t know the answer to right now. And the truth is, with all of our guidelines, what we’re really trying to do or make guidelines that are going to be pertinent two weeks from now, and it’s really hard to see into the future and decide that, you know, we have 22 cases in a state of 4.8 million people. And that doesn’t sound like that much. And yet, we know that that’s a significant amount. We know there are many people that haven’t been tested that probably should be. So we’re doing our best to be responsible in what we recommend. We have to consider all the factors and on balance, I think that’s the right recommendation for this time.

Question: Can you talk a little bit more about your travel recommendations, this is spring break and going into spring break for a lot of people who are planning to leave the state? Be more specific about what would be considered a dangerous or potentially dangerous travel plan and what may not be?

Scott Harris: Yeah, so again, whatever strategies that we keep talking about it really comes down to a six foot rule. And I think that’s the most important thing. Traveling anywhere now could be considered a risk, because you know, most of our major cities have cases and have a number of cases. All the states, I think every state but one perhaps, has reported cases to this point. So there’s certainly some risk in different places. If you’re planning to fly, if you’re planning to take a bus, if you’re planning to travel in a in a closed in environment, I think that puts you at some risk. If you’re planning to be at a location where you’re congregating with lots of people in a tight environment, I think that puts you at some risk. So I think we can all imagine, you know, a vacation plan that doesn’t pose much risk. And I would just ask everybody to think very carefully about what their plans are, if it’s really necessary, if it could be delayed, or what kind of risks they’re going to face. And again, that’s particularly important for our most vulnerable citizens to think about.

Question: Do our hospitals have enough beds and ventilators?

Scott Harris: 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. Hospitals include that information every day updated at least daily or more often, if we request it. At this time, we do not have any hospitals that are having issues with surge capacity that we’re aware of. And, and we track that daily. So so we don’t think that’s an issue at the moment. Clearly, that’s always a concern when you’re when you’re dealing with a respiratory illness like this, and so we’ll continue to monitor that.

Update on Lee County case connected to East Alabama Medical Center: I just got one update. We have one particular case that we learned about last night which was in Lee County you might be aware of that was posted last night. It’s been announced today by the hospital there that that was a hospital employee. And so we’ve just had been on calls with that facility and they were wanting to make that statement which they have just publicly released. So we have staff that is actively investigating that and tracing those contacts, we they have a very good plan in place to make sure that facility is clean and make sure that any employee who was potentially in contact with this sick person is is monitored at home. This particular person is self monitoring at home at this time, and that is all the details that I have about that. I’ll be glad to get you some more as soon as we have that available.

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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Judge hears testimony over temporary abortion ban during COVID crisis

Eddie Burkhalter

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A federal judge on Monday heard testimony during the first hearing following the judge’s temporary restraining order last week, which temporarily barred Alabama from prohibiting abortions during the novel coronavirus outbreak.

U.S. District Judge Myron Thompson heard testimony from Alabama State Health Officer Dr. Scott Harris and Dr. Yashika Robinson, the named plaintiff in the case who operates an OBGYN office in Huntsville and conducts abortions at the Alabama Women’s Center, one of three abortion clinics in the state. 

The American Civil Liberties Union and the ACLU of Alabama filed the suit on behalf of Robinson, which argues that Alabama is restricting access to abortions under the guise of protecting the public from COVID-19. 

The state is defending Harris’s March 27 and April 3 public health orders, which prohibit elective medical procedures except those necessary to treat an “emergency medical condition” or to “avoid serious harm from an underlying condition.” 

Attorneys with the attorney general’s office argue the order’s purpose wasn’t to target abortion clinics but to prevent the spread of the virus and to save scarce personal protective equipment as health care workers fight the COVID-19 outbreak. 

Harris told the court during the teleconference hearing Monday just that, that his order banned elective procedures to limit the public’s exposure to the virus and to help preserve the state’s limited supply of PPE. 

Alabama Assistant Attorney General Jim Davis asked Harris whether the Alabama Department of Public Health defined what is and isn’t an elective procedure, to which Harris said, “We did not specify. We just said all procedures” and the department instead “left that to the discretion of the provider.” 

Harris told the court that it’s up to health care providers to determine if their patient meets one of the two of the exceptions spelled out in his April 30 order. 

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“Specifically,  can a woman who gets an abortion experience complications that require a followup?” Davis asked Harris, who said yes. 

Harris said one of the goals of his order was to prevent stress on the state’s health care system in the event an elective procedure requires emergency care. 

“We didn’t try to think of every possible procedure or every possible scenario, but I think, generally speaking, procedures do consume PPE,” Harris said. 

Alexa Kolbi-Molinas, an attorney with ACLU, asked Harris about an ADPH directive regarding the COVID-19 outbreak that state health care providers are to seek guidance from organizations including the American College of Obstetricians and Gynecologists.

“Were you aware that ACOG and other organizations have issued a joint statement stating that they do not support COVID-19 responses that cancel or delay abortion procedures?” Kolbi-Molinas asked Harris. 

“No. I’m not aware of that,” Harris said. 

Harris agreed during questioning that he cannot say how long his order barring elective procedures might last, and said that China’s ability to slow the spread of the virus was the result of strict travel restrictions that would be difficult to implement in Alabama.  

Kolbi-Molinas asked Harris about Alabama’s infant and maternal mortality crisis, which preceded the COVID-19 outbreak and noted that Alabama women die from childbirth complications at more than double the rate of women nationally, and rank third-highest in the nation in maternal death rates. 

Kolbi-Molinas pointed out through questioning that ADPH licenses abortion clinics and has the authority to take action against a clinic that violates an emergency order, and that prosecutors could also take action against them if ADPH declined to do so. 

Kolbi-Molinas asked Harris about the inclusion of gun stores as “essential” businesses in his April order, which allows the stores to remain open. 

“There are more than three gun stores in Alabama, aren’t there?” she asked. 

“I think you’re probably right about that,” Harris said. 

Kolbi-Molinas asked whether Harris knew if gun stores in the state are screening employees or customers for fevers, and Harris said that he did not. 

She asked if he was aware that the FBI conducted background searches for more than 100,000 gun purchases in Alabama during March, in which a customer must come into the store in person. Harris said he was unaware of that figure. 

“Would you say the decision to designate gun stores as essential retailers was driven by public health considerations?” Kolbi-Molinas asked. 

“I think the whole list of non-essential versus essential businesses was something that we’re trying to do as quickly as possible, and we really concentrated mostly on what we thought were close-contact professions,” Harris said. “Clearly, there are actually, literally hundreds of exceptions here, and we may not have gotten them all correct, but I think we were trying to do them as quickly as possible.” 

Dr. Yashika Robinson told the court that she has canceled some appointments during the COVID-19 crisis that she considers elective, including hysterectomies and tubal ligations. 

“They weren’t considered emergencies,” Robinson said. 

Asked why she hasn’t canceled abortions, Robinson said “they are time-sensitive. They cannot be delayed without causing harm.” 

Alabama law bans abortions beyond 21 weeks and six days, Robinson said. 

Robinson said complications from abortions are “less than one percent” and abortions are about ten times safer for women than carrying a pregnancy to term. 

Approximately 20 percent of pregnant women will miscarry, and about half of those will require medical attention, Robinson said. 

Robinson said women decide to have an abortion for a variety of reasons, from “a pregnancy that is just not developing correctly” and some “already have children” and decide to have an abortion so they can better care for the children they have.

“Some women, they just know it’s not the time for them to start a family, or increase their family size,” Robinson said. Most of the women she provides abortions for are low-income and many have no insurance. 

A delay in getting an abortion increases health risks for the woman, she said.  

“Every week matters for these patients,” Robinson said. 

Some women try and self-induce an abortion if they don’t have access to care, Robinson said, and can injure themselves badly doing so, requiring emergency room care. 

“Those patients usually require multiple days of hospitalization,” Robinson said, which uses more PPE than would an abortion in a clinic. 

The state filed an additional clarification with the court Sunday regarding how the state would determine which procedures are covered by one of the two exceptions.

“Defendants would clarify that while reasonable medical judgment of all healthcare providers will be treated with respect and deference, a health care provider’s assertion that a procedure meets one of the exceptions is not conclusive proof that the procedure meets one of the exceptions in the March 27 order or the current April 3 public health order,” the state’s filing reads.

Robinson told the court that she fears her medical judgment wouldn’t be recognized by the state were she to decide to conduct an abortion.

Assistant Attorney General Brad Chynoweth asked Robinson about screening procedures she’s adopted for patients at her clinic, which include her request for a patient who might present with COVID-19 symptoms to postpone the procedure. 

“You’re taking into account risk for others. Not just the patient herself, correct?” Chynoweth asked. 

“Absolutely,” Robinson said. 

Chynoweth asked if physical examinations are done before a medication abortion, and Robinson said they are and that appropriate PPE is used during the exams. 

Chynoweth noted during questioning that during surgical procedures 6 feet of distance between a doctor and the patient isn’t possible and PPE must be used. 

Chynoweth asked if she has any N95 masks at the clinic, and Robinson said “we have a few” but that they’ve not been used as she’s not seen any patients who presented with symptoms of COVID-19. 

Asked if any abortion could be postponed, Robinson said some abortions could be postponed, but any delay of weeks or even days could mean a higher likelihood of health complications for women. 

Judge Myron Thompson at the close of testimony asked attorneys on both sides about who or what agency would handle a criminal complaint resulting in the order, and was told the state Attorney General’s office has the authority to do so. 

Thompson asked for proposed opinions from both sides to be filed with the court by 8 a.m. Wednesday.

The Fifth Circuit Court of Appeals in Texas last week ruled that the state’s temporary ban on abortions amid the COVID-19 crisis could continue.

Judges in Ohio on Monday ruled that most abortions could continue following a lower court’s ruling that upheld the state’s temporary ban.

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Alabama COVID-19 cases surpass 2,000; 53 deaths reported

Chip Brownlee

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The number of confirmed coronavirus cases in Alabama surpassed 2,000 on Monday, marking another grim milestone in the outbreak.

At least 53 deaths have been reported.

Cases of COVID-19 have been confirmed by lab testing in 66 of the state’s 67 counties. At least five of the state’s counties have at least a hundred lab-confirmed cases. Jefferson County has reported 438 cases.

The number of cases per capita remains higher in some rural counties, though. Eleven counties have higher per capita cases than Jefferson County. Chambers County and Wilcox County have the highest number of cases per capita in the state at 289 cases per 100,000 people in Chambers County and 125 cases per 100,000 people in Wilcox County.

Of the counties with at least 50 cases, the number of cases has grown fastest in Mobile County, where testing was slow to get off the ground.

Over the last week, the number of cases in Alabama has grown by 112 percent.

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Cases jump in Alabama nursing homes, tests still scarce, association says

Eddie Burkhalter

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Confirmed COVID-19 cases in Alabama nursing homes have jumped in recent days, and delays in getting test kits and test results is putting lives at greater risk, according to the Alabama Nursing Home Association.

As of Monday, 31 nursing homes in 17 counties had confirmed COVID-19 cases, according to a statement from Alabama Nursing Home Association President Brandon Farmer.

The last update from ANHA on March 28 noted eight confirmed cases of COVID-19 in six nursing homes across the state.

John Matson, director of communications at ANHA, told APR in a message Monday that the organization was uncertain how many individual COVID-19 cases were currently in the 31 homes.

“These reports involve residents, staff members or both at nursing homes in rural and urban locations. These nursing homes are following the reporting guidelines and implementing isolation procedures,” Farmer said in the statement. “I predict the number of nursing homes with cases will grow as more tests are administered and the results are returned. As previously stated, the delays in receiving test kits and test results are beyond our control yet places our residents and employees at great risk.”

State nursing homes have stopped visitations and early on began screening staff for symptoms of the virus and strengthening infection control measures, Farmer noted in the statement.

“They continue to practice infection control guidelines from the Centers for Disease Control and Prevention and isolate residents who test positive or are believed to have been exposed to someone who is COVID-19 positive. Like other health care providers, nursing homes need a sufficient supply of personal protective equipment (PPE). Infection control measures will only be as effective as our ability to secure PPE,” Farmer said.

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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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