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Around Auburn, where officials had trouble controlling bars, a growing number of cases

Chip Brownlee

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UPDATE: The owner of the largest bar in Auburn has said they will not reopen this week, according to The Auburn Plainsman.

Lee County, Alabama—the home of Auburn University, where officials have been having trouble discouraging young people from visiting bars—now has the second-highest number of COVID-19 cases in Alabama.

The Alabama Department of Public Health reported four new cases in Lee County Wednesday, bringing the county’s total up to seven. While it’s unclear where the cases were reported within the county, Auburn is the largest city.

The city is also home to a growing retirement community and thousands of college students who, according to data from outbreaks around the globe, are more likely asymptomatic carriers of the virus. Young people tend to survive the infection, but can spread it more easily.

One new case was reported in Calhoun County. Two new confirmed cases are in Jefferson County, which has a total of 23 confirmed cases and the state’s largest number. But these numbers have a lag time. It’s taking at least 24 hours and sometimes several days to get results from the time when people are tested.

A lot of people have been having trouble getting access to tests. The testing centers in Birmingham are so swamped that they’ve closed just a few hours after they opened. A testing site in Tuscaloosa at DCH Regional Medical Center has been having better luck.

EAMC, the hospital nearest Auburn, has been getting hundreds of calls a day but, by Tuesday night, had only been able to test 100 people because of limited supplies and high demand.

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Gov. Kay Ivey and the Department of Public Health announced Tuesday that six Central Alabama would face more restrictions. Bars and restaurants are now limited to take-out service and all private schools and daycares have been closed. So far, these restrictions have not been extended to Lee County, but officials are likely to re-evaluate and expand them across the state if spread continues.

Videos have been posted of some of the largest bars in Auburn measuring temperatures using an infrared thermometer as young people enter the bar.

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But officials have warned that those who are infected can be contagious for more than a week before they begin to show symptoms, which include a fever. The average incubation time between infection and the emergence of symptoms is five days, according to the World Health Organization.

Dr. Deborah Birx, the White House’s coronavirus response coordinator, said Tuesday that young people are getting sick and disproportionately infected in Europe. Many are being hospitalized. Birx said it appears to be because young people heard that the elderly are more vulnerable—a data point based on data out of China—and they are ignoring public health guidance.

“We are aware that there are several businesses in Auburn that are promoting St. Patrick’s Day celebrations,” City Manager James Buston told WSFA. But “the city council of the City of Auburn does not have the authority to force them to close.”

Mayor Anders encourages at-home St. Patrick's Day celebrations

"I ask you tonight, as you consider what your plans are for St. Patrick's Day, to please, do not go out and be in groups of more than 10 people. …Our welfare sometimes depends on your welfare, and we need you to help us keep Auburn a healthy community."Watch Mayor Ron Anders For Auburn's full video encouraging community members to stay home for St. Patrick's Day celebrations 👇

Posted by City of Auburn, AL – City Government on Tuesday, March 17, 2020

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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Is “herd immunity” a reasonable strategy for Alabama? Evidence suggests it’s not

State Sen. Del Marsh suggested herd immunity may be the only strategy for Alabama going forward. The science behind such a strategy is still in question, and what evidence is available suggests it may be hard if not impossible to achieve.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama Senate Pro Tem Del Marsh, R-Anniston, on Thursday caused an uproar when he told a reporter that he’d like to see more Alabamians get infected with COVID-19 so that we could “start reaching an immunity.” 

Marsh, a member of Gov. Kay Ivey’s COVID-19 task force, was speaking to a CBS 42 reporter about what’s called herd immunity, which means a percentage of a population gets a disease, gets over it and then has an immunity that prevents them from getting it again for a period of time.

Marsh’s suggestion that herd immunity may be the best, if not the only strategy, for dealing with COVID-19 is not new. It’s been a topic of discussion since the early days of the pandemic. Some countries have even attempted it. But the science behind such a strategy is still in question, and what evidence is available suggests it may be hard if not impossible to achieve.

Reaching herd immunity essentially means that a population is generally protected from the worst of a disease because enough people have immunity. That can be achieved either through a vaccine or by allowing the virus to run its course until enough people have been infected. With more people infected and recovered, and with the assumption that fewer are susceptible to reinfection, transmission of the virus would slow significantly — only because there are fewer people to become infected.

Without a vaccine, herd immunity as a strategy would basically mean giving up on trying to contain the virus.

The topic of herd immunity has been brought up throughout the COVID-19 pandemic, but public health experts and scientists are quick to say they don’t yet fully understand the true strength of acquired immunity, and there have been some cases of people becoming infected with the virus more than once. 

But that doesn’t stop some from arguing perhaps we should give herd immunity a try. Sweden did, and it went terribly, as Alabama’s State Health Officer Dr. Scott Harris told a reporter when asked about the Alabama lawmaker’s statements on herd immunity. 

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Marsh followed his original statement with a caveat about protecting those with pre-existing conditions and the elderly, yet it’s not clear how an open society bent on getting as many younger people infected as possible would do such a thing.

“I’m not as concerned so much as the number of cases, in fact, quite honestly, I want to see more people because we start reaching an immunity as more people have it and get through it,” Marsh said to CBS 42’s Reshad Hudson on Thursday. “I don’t want any deaths, as few as possible. I get it. So those people who are susceptible to the disease, especially those with pre-existing conditions, elderly population, those folks we need to do all we can to protect them.”

In Sweden, where officials initially allowed the virus to run its course, they were not able to protect more vulnerable populations from infection despite efforts to do so. Vulnerable populations do not live in a vacuum, and despite their best efforts to limit exposure, long-term care facilities still have some contact with the outside world.

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It didn’t take long after Hudson tweeted out a video of Marsh’s statements for the backlash to set in. When asked by a CBS 42 reporter for his thoughts on herd immunity as a solution, Harris, the state health officer, said it would lead to many more unnecessary deaths. 

“There is absolutely no reason to think at this point that getting infected will give you any degree of immunity. We simply don’t know that,” Harris said, pointing to the fact that scientists have not reliably determined how long immunity lasts or how strong it is.

“We’ve looked at countries like Sweden, who have tried to actually generate herd immunity among their population, and it’s been disastrous. They’ve had increased numbers of deaths much higher than their neighbors, in trying to keep their economy open. It does not work well at all,” Harris said.

Marsh tried to walk back his controversial statement the next day — sort of — but he still landed back on herd immunity as an avenue Alabama might take. 

“It was a poor choice of words on my end, but ultimately what I was trying to say, and people can look at it, there are very few choices we have,” Marsh told WSFA on Friday.  “Ultimately if there’s no vaccine, herd immunity is the only one I can think of that’s eventually going to take place.” 

In Sweden, where they gave herd immunity a shot, deaths in the country have been eight times higher than in neighboring Denmark and 19 times higher than in Norway, according to The Washington Post. One study found that after months of infections and deaths, less than 10 percent of the population had developed antibodies.

In Denmark and Norway, along with most of the European Union, many restrictions have been lifted because governments there have been able to get the virus under control using testing and contact-tracing.

In Spain, one of the hardest-hit countries in Europe, just 5 percent of people had developed antibodies, according to another study in the journal Lancet. That means that at least 95 percent of the Spanish population would still be susceptible to the virus despite the country recording 28,000 deaths and 250,000 cases.

In New York City, where 32,000 people have died from COVID-19, the state tested some 28,419 people in an attempt to determine how many people had developed antibodies. That survey suggested that roughly 21.6 percent of New York City residents had antibodies. That’s in New York — widely viewed as the hardest-hit city in the world.

The science of herd immunity in a virus as new as COVID-19 is murky, because researchers still don’t know important details about how the coronavirus behaves, and every geographic location is different, with varying cultures and health outcomes, but since Marsh threw it out there, let’s see what getting to herd immunity would look like in Alabama. 

Dr. Michael Saag, an infectious disease expert at UAB and prominent HIV/AIDs researcher, told APR in May that to get the epidemic under control we’ll need at least 70 percent of the population to have immunity. Epidemiologists have estimated that between 60 percent to 80 percent of a population would need immunity before “herd immunity” is reached, and the virus can no longer spread widely in that community.

In Alabama, that would mean 3,340,000 people in total would have to become infected, and at our current approximate death rate of 2.2 percent, that would mean 75,460 Alabamians would likely die in the process. But 1,077 people have already died in Alabama from COVID-19, so to get to a theoretical herd immunity, 74,383 more people in the state would likely die from the virus. The death rate could spike if more infections happen at once, overwhelming the state’s health system.

Because we’ve got statistics on COVID-19 deaths in Alabama, we can look and see what that would mean for those yet to die. Of those 74,383 potential deaths, 58,762 would likely be 65 years of age and older. Those aged 50-64 would make up 12,654 of the deaths to come, while 2,975 would be between 25 and 49 years old, based on current death demographics.

Black people would likely continue to die in greater numbers per capita than white people. Although Black people make up just 27 percent of Alabama’s population, they make up 44 percent of all COVID-19 deaths.

It’s important to note that none of these estimates are reliable because researchers still don’t know for certain how long a person is immune after recovering from the virus — and how strong that immunity is. It’s also not clear how accurate or precise antibody tests are.

Columbia University virologist Dr. Angela Rasmussen told The New York Times that the “magical number of 60 percent for herd immunity” assumes that everyone infected has complete protection from a second infection.

“But what about people with partial protection?” she asked. “They may not get sick, but they can get infected and pass it along.”

The recent study in Spain published in The Lancet found that herd immunity with COVID-19 may be unachievable. The study, which looked at more than 61,000 people, found that 14 percent of those who tested positive for coronavirus antibodies, which means they had the virus and recovered, no longer tested positive for the antibodies in subsequent tests weeks later. 

“Immunity can be incomplete, it can be transitory, it can last for just a short time and then disappear,” said Raquel Yotti, the director of Spain’s Carlos III Health Institute and one of the authors of the study, according to Reuters.

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Alabama’s daily COVID-19 deaths second highest since start of pandemic

In the past two weeks the state recorded 190 coronavirus deaths, a 38 percent increase from the previous two weeks.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama saw 35 deaths from COVID-19 on Friday, the second highest daily number of deaths since the pandemic began. 

The previous record daily high was May 12, when the state recorded 37 coronavirus deaths. Prior to that, the high was on April 22, when Alabama saw 35 deaths from the virus. In the past two weeks the state recorded 190 coronavirus deaths, a 38 percent increase from the previous two weeks.

While cases have been surging since mid-June, deaths have largely remained stable. Deaths are considered a lagging indicator, meaning that it takes longer for deaths to begin rising after cases and hospitalizations begin rising.

“The fact that we’re seeing these sharp increases and hospitalization in cases over the past week or two is really concerning,” said UAB expert Dr. Jodie Dionne-Odom earlier this week. “And we expect, given the lag that we know there is between cases and hospitalization — about a two-week lag, and a three-week lag between cases and deaths — that we’re on a part of the curve that we just don’t want to be on in our state.”

It’s unclear whether this new rise in deaths will become a trend, or whether it is a one-day anomaly, but the 14-day average of deaths per day is now nearly as high as the previous peak on May 14 — weeks after the state hit its first “peak” in cases per day in late April. The previous high of the 14-day average of deaths per day was 16 on May 14. The average is now at 14 deaths per day, on average.

The uptick in deaths comes after days of record-high new daily COVID-19 cases and hospitalizations. The state added 1,304 new COVID-19 cases Friday, down from Thursday’s record-high of 2,164, but the trend of rising daily cases has continued largely unabated since early June. 

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The 14-day average of daily tests was at an all-time high Friday, at 8,125, which was 308 more tests than the previous high, set Wednesday. The percent of tests that were positive also increased, however, so the new cases can’t be attributed solely to more testing. 

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The 14-day average of the percent positivity was 14.22 on Friday. Excluding Thursday’s figure, because the Alabama Department of Public Health didn’t publish total tests administered on Thursday, which threw  off percent positive figures, Friday’s 14-day average was the highest it’s been since the beginning of the pandemic. 

There were a few higher 14-day average percent positivity days in April, but those numbers were skewed as well, because ADPH wasn’t able to collect all testing data from commercial labs during that time period. 

Along with surging new cases, the number of COVID-19 patients hospitalized on Thursday was higher than it’s been since the beginning of the pandemic. On Thursday 1,125 coronavirus patients were being treated in state hospitals, which was the fifth straight day of record current hospitalizations. 

UAB Hospital’s COVID-19 Intensive care units were nearing their existing capacity earlier this week. The hospital has both a COVID ICU and a COVID acute care unit designated to keep patients separated from those who don’t have the virus, but it has more space in other non-COVID units should it need to add additional bed space.

Hospitals in Madison County this week are also seeing a surge of COVID-19 patients. Paul Finley, the mayor of the city of Madison, told reporters Wednesday that local hospitals were reporting record numbers.

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Stay safe but don’t delay cancer treatment or screenings, UAB doctors warn

Micah Danney

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Barry Sleckman, director of the O’Neal Comprehensive Cancer Center, and Monica Baskin, a professor in UAB’s Division of Preventive Medicine.

Healthcare workers are seeing fewer people getting routine cancer screenings for fear of coming into contact with the novel coronavirus. With no end to the pandemic in sight, doctors are urging people to get screened and move forward with treatment if they have a diagnosis.

Not delaying treatment is of paramount importance, said Barry Sleckman, director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham.

“If you have a cancer diagnosis, you need to do everything possible to work with your physician to initiate treatment in a safe environment,” he said.

Sleckman said that steps are being taken to ensure the safety of patients who may be anxious about visiting a hospital and being exposed to the virus. Visits are being done by telemedicine, or video tools that are HIPAA compliant, if an in-person exam is not required. 

Monica Baskin, a professor in UAB’s Division of Preventive Medicine, said that her colleagues around the state are hearing from people who are afraid to make physical visits. They are advising people to contact their local healthcare providers first to determine the best course of action, and to learn what specific steps their local cancer center is doing to keep patients safe.

Rates of screenings have been trending downward nationally, according to the National Cancer Institute. Alabama does not keep a statewide database, but workers in the field say they have noticed a reduction over the last three months – much of it in medically underserved communities that experience higher rates of cancer.

Investigators at the NCI recently created a detailed national model of breast and colorectal cancers showing that more than 10,000 people might die over the next 10 years due to delayed cancer screenings because of the pandemic. Most of the deaths would occur in the next two years, according to the projections.

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About 26,000 Alabamians are diagnosed with cancer each year, according to the American Cancer Society.

People with cancer and other conditions that make them immunocompromised are especially vulnerable, but Sleckman urged caution among everyone else who are making decisions based on what risk factors they think they may not have. The scientific community is still trying to figure out how the virus behaves, and death or recovery aren’t the only possible outcomes. 

Strokes have been seen in younger people who are infected, and scientists are warning of serious brain damage occurring in some patients who only experience mild symptoms while they are sick. It’s on everyone to slow the spread in order to protect others because there’s no telling how the virus will affect one person to the next.

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“As a very good friend of mine who’s an infectious disease physician said, ‘The only thing we really know about this virus is it’s not good to have it,’” Sleckman said.

 

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Alabama lawmaker suggests more should become infected with COVID-19

The leader of Alabama’s State Senate suggested to a reporter that he’d actually like to see more people become infected to build the state’s overall immunity to the virus, a claim that would require thousands more deaths to become a reality.

Eddie Burkhalter

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Senate Pro Tem Del Marsh speaks to CBS 42. (Reshad Hudson/Twitter)

East Alabama Medical Center’s critical care beds on Thursday were at 90 percent capacity, and COVID-19 hospitalizations statewide on Thursday were at another record high for the fifth straight day. Administrators at EAMC sounded the alarm Thursday that if things don’t change soon, the exponential growth of COVID-19 cases could stress the hospital to the breaking point.

UAB Hospital’s COVID-19 intensive care and acute care units were approaching their existing capacity Tuesday, when the hospital was caring for 92 coronavirus patients. The hospital had 91 inpatients who had been diagnosed with COVID-19 on Wednesday. Jefferson County has added more than 1,000 COVID-19 cases over the last week.

Alabama has experienced numerous record increases in cases and hospitalizations in the last several weeks, as the state continues to grapple with a growing pandemic and stressed hospitals.

Despite that, the leader of Alabama’s State Senate — and member of Gov. Kay Ivey’s COVID-19 task force — suggested to a reporter that he’d actually like to see more people become infected to build the state’s overall immunity to the virus.

The state’s top health officials suggested Thursday that doing so would lead to unnecessary deaths.

Sen. Del Marsh, R-Anniston, told CBS 42’s Reshad Hudson that he’s not concerned with the growing number of COVID-19 cases.

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“I’m not concerned so much at the number of cases. In fact, quite honestly, I want to see more people because we start reaching an immunity, if more people have it and get through it,” Marsh said.

“I don’t want any deaths. As few as possible. I get it,” Marsh said, adding that we need to do all we can to protect those with preexisting conditions and the elderly. “But I’m not concerned. I want to make sure that everybody can receive care, but right now, to my knowledge as of today we still have ample beds.”

Marsh has said in interviews this week that he doesn’t predict a statewide mask order or a return to the restrictions that data shows slowed the virus’s growth.

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State Health Officer Dr. Scott Harris was asked by a CBS42 reporter about Marsh’s statement encouraging more infections.

“There is absolutely no reason to think at this point that getting infected will give you any degree of immunity. We simply don’t know that,” Harris said.

“We’ve looked at countries like Sweden, who have tried to actually generate herd immunity among their population, and it’s been disastrous. They’ve had increased numbers of deaths much higher than their neighbors, in trying to keep their economy open. It does not work well at all,” Harris said.

In Sweden, one study found that after months of infections and deaths, less than 10 percent of the population had developed antibodies to the virus. Public health experts believe at least 60 percent of the population would need to be infected for a population to reach herd immunity.

In reality, reaching a level of herd immunity that would be high enough to slow transmission would require tens of thousands more infections and thousands more deaths.

“The way to prevent illness and death, and to keep the economy open, quite frankly, is to keep people from getting this disease,” Harris said. ‘We need people to wear face coverings, to wash their hands, to stay home when they’re sick and to practice social distancing.”

Harris told CBS 42 that the state’s availability of ICU beds was at its lowest point since the start of the COVID-19 pandemic. Of around 1,400 ICU beds, less than 200 were available Thursday, he said.

Because of Sweden’s decision to attempt herd immunity, deaths in country have been eight times higher than in Denmark and 19 times higher than in Norway, according to The Washington Post.

Sweden has seen 543 deaths per million of its population, compared to just 105 per million in Denmark, according to the Worldometer.

 “I believe we’re at another pivotal point,” said EAMC President and CEO Laura Grill in a statement Thursday. “We had flattened the curve in our community, but due to relaxed state orders and an unwillingness by some people to follow the three simple guidelines needed to help control COVID-19, we are almost back to square one. It’s frustrating and quite demoralizing to our staff and physicians, and those in our community who are following the rules.”

On Thursday 259 of EAMC’s  314 beds were occupied, six nursing units were at 100 percent capacity and 27 of the 30 critical care beds were in use. 

“In other words, EAMC was having a ‘red census’ day for the second time this week. Patients with positive COVID-19 cases occupied 36 of the beds, with two other patients awaiting results,” the hospital said in a release. 

The 36 COVID-19 patients was less than the hospital’s peak of 54 on April 11, but at that time the hospital had 164 total patients, and Thursday hospital staff were treating 100 more than that. 

Grill noted the record-breaking number of new COVID-19 cases statewide on Thursday and called for the public to do what’s needed to slow the spread. 

“This morning, Alabama announced 2,164 new cases in the past 24 hours—by far the most in a single day—and people are still debating the merits of wearing a mask, calling the virus a hoax and questioning qualified health officials on whether an asymptomatic person can spread the virus. It’s all very frustrating,” she said.

COVID-19 hospitalizations statewide on Thursday were 1,125, the highest it’s been since the start of the pandemic. Nine of the last 11 days the state has seen record high coronavirus hospitalizations. 

Regional Medical Center in Anniston, Marsh’s hometown in Calhoun County, on Thursday was caring for 15 coronavirus patients, a record high for the hospital, according to The Anniston Star.

Calhoun County on Thursday added 33 new COVID-19 cases, which was the second-highest single day of new cases the county has seen since the pandemic began. In the last week the county added 156 cases, or 35 percent of the county’s total coronavirus cases.

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