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Jefferson County Health Department: Nursing homes can take in COVID-19 positive residents

Jessa Reid Bolling

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A letter from the Jefferson County Department of Health informed nursing homes that they can take in residents who have been treated for COVID-19 and still test positive for the virus if they meet certain requirements.

The letter, sent to Jefferson County nursing homes, reads that there is a “possibility that our hospitals will not have the capacity to care for a large number of patients infected with COVID-19, and the impact of COVID-19 on Long-Term Care Facilities that house our most vulnerable patients” as the reasoning behind why nursing homes can take in COVID-19 patients who still test positive for the virus. 

The criteria for accepting COVID-19 positive patients requires that the patients must meet two steps of criteria:

  • At least 3 days (72 hours) have passed since recovery, defined as resolution of fever without use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and
  • At least 7 days have passed since symptoms first appeared

The letter also says that patients who have tested positive for COVID-19 may return to a long-term care facility prior to the above criteria being met as long as the facility uses contact precautions as outlined in “Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Setting.”

The elderly and those with conditions that can weaken the immune system are considered the most at risk of serious illness and death from COVID-19.

John Matson, communications director for the Alabama Nursing Home Association (ANHA) said that this decision “goes against sound medical advice.”

“For the past month, Alabama nursing homes have been doing everything they can to prevent COVID-19 from entering their buildings,” Matson said. “Now, Jefferson County Health Officer Dr. Mark Wilson wants nursing homes to accept patients who have tested positive for COVID-19 even though they still exhibit symptoms and have not fully recovered.

“That decision goes against sound medical advice,” Matson said. “Just last week, the American Medical Directors Association issued guidance stating that nursing homes should not admit a COVID-19 patient until the patient has two negative tests. Dr. Wilson’s decision places nursing home residents, those vulnerable to COVID-19, in great danger.”

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The ANHA said two weeks ago that visitations at nursing home facilities will be restricted at Alabama nursing homes during the COVID-19 outbreak to prevent the spread of the disease and that nursing homes will follow the CDC guidelines for screening symptoms of COVID-19.

Matson said that nursing homes need resources to prevent the spread of COVID-19, not “orders from government officials to bring this horrible virus into the very place where our most vulnerable citizens live.”

“While the health officer is concerned about the capacity of local hospitals to meet the demands posed by the COVID-19 crisis, he (Wilson) does not cite a single example of a local hospital that is currently experiencing a capacity problem,” Matson said. “Our nursing homes are being stretched to the breaking point and not one penny of the money allocated by the federal government to fight this virus has made its way to a nursing home.”

The JCDH issued a response to concerns surrounding the letter, saying they were endorsing existing guidance from the CDC, not giving orders to nursing facilities. 

“This letter was an endorsement, not a Public Health Order, of existing guidance issued from the Centers for Disease Control and Prevention (CDC),” the statement from JCHD said. “In this guidance, the CDC outlines a non-test-based strategy for when a person can be considered not to be infectious due to COVID-19 when there is limited ability for a local area to perform COVID-19 testing.”

The JCDH said that patients who do test positive can return to their facilities if the facility follows guidance issued from the CDC with regard to personal protective equipment and appropriate isolation to protect all residents at the facility. If a nursing facility does not have the appropriate equipment to provide the requirements laid out in the CDC’s guidelines, then there is no expectation that the facility should admit a COVID-19-positive patient. 

“COVID-19 cases continue to increase, and the peak need for hospital beds is expected around the 3rd week of April, and the JCDH is working with our community partners to allow for as many hospital beds as possible to care for what will be a much greater than usual number of patients seeking medical care. 

We want to do everything possible to allow Jefferson County to be able to provide high-quality care to all who need it; ultimately, we do not want a hospital to have to turn away any patient because of a lack of hospital beds.”

There have been eight confirmed cases of COVID-19 in six Alabama nursing homes across the state. 

Statewide, Alabama nursing homes have reported eight confirmed cases of COVID-19 in six Alabama nursing homes. Two cases were reported at two separate nursing homes in Jefferson county. 

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Crime

Confirmed COVID-19 cases among Alabama prison workers reaches 51

Eddie Burkhalter

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The number of prison workers in Alabama who’ve tested positive for coronavirus ticked up to 51 on Tuesday.

The Alabama Department of Corrections said just a single inmate has an active case of the virus. 

The Alabama Department of Corrections in a press release Tuesday said three more workers at the Julia Tutwiler Prison for Women self-reported positive test results for COVID-19, bringing the total confirmed cases among staff in that facility to seven. 

There were also two additional confirmed cases among workers at the Frank Lee Community Based Facility and Community Work Center, ADOC said in the press release, bringing the total of infected staff there to eight. 

One worker at the Kilby Correctional Facility, one at the Bullock Correctional Facility and another at the Ventress Correctional Facility also tested positive for COVID-19.

Kilby prison has had four confirmed cases among staff, Bullock prison two and at Ventress prison there have been 11 workers to self-report positive test results. 

While the number of confirmed cases among staff have continued to rise in recent weeks, cases among inmates have not.

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Of the nine inmates in seven state facilities who’ve tested positive, just one had an active case as of Tuesday, according to ADOC. 

Of the approximately 22,000 state inmates, 143 had been tested for coronavirus as of May 22, the last day ADOC has updated testing numbers. 

ADOC’s announcement Tuesday of more cases among staff comes after Alabama saw its largest single-day increase on COVID-19 cases on Monday when 646 new cases were confirmed. 

ADOC halted visitation and volunteer entries at state facilities on March 19 to help prevent outbreaks in the state’s dangerously overcrowded facilities, but the department is working on a plan to resume “some facility operations thoughtfully, including visitation and volunteer entry, but has not yet established a definitive timeline,” according to the release. 

“Once established, the Department’s intent is to keep the public apprised of our anticipated plans and timeline to resume these activities safely in a manner that minimizes the risk of exposure to the virus,” the statement reads. “A primary goal and concern of the ADOC is protecting the safety, security, and well-being of our inmates, staff, and the public during these unprecedented times. We continue to monitor COVID-19’s evolving impact closely on our correctional system, the state, and the country while we assess and analyze additional data in order to make informed and strategic operational decisions.”

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Health

Birmingham’s mask ordinance to expire Friday

Eddie Burkhalter

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Birmingham’s ordinance requiring citizens to wear masks while in public is set to expire Friday. 

Birmingham Mayor Randall Woodfin in a statement Tuesday cautioned the public against letting their guard down, however, and said despite the expiration of the ordinance, the public should continue to wear masks while out to help prevent the spread of coronavirus. 

“The City of Birmingham implemented the mandatory face covering ordinance as an additional level of protection as the state began the phased re-opening process. I want to thank the people of Birmingham for following the law. The ordinance raised the level of awareness to the importance of wearing a face covering when in public and within six feet of other people,” Woodfin said in the statement. “While the ordinance is set to expire on Friday, we must not let our guard down. Public health leaders say covering your nose and mouth is a critical tool to help reduce the spread of coronavirus. I urge everyone to keep social distancing, wear face coverings in public, and do what you can to limit the spread.” 

City employees and guests to city facilities will still be required to wear face coverings after the ordinance expires Friday, according to Woodfin’s statement.

The Birmingham City Council, with one dissenting vote, approved the ordinance on April 28  requiring the wearing of masks while in public, which went into effect May 1. Failure to comply with the ordinance could result in a fine of up to $500 and/or 30 days in city jail. Failure to comply with the ordinance could result in a fine of up to $500 and/or 30 days in city jail. 

The ordinance had been set to expire May 15, but City Council members later agreed to extend the measure until May 29. 

The Birmingham City Council’s decision to require the wearing of masks came after Gov. Kay Ivey replaced her “stay-at-home” order with a less restrictive “safer-at-home” order, which allowed some businesses to reopen with social-distancing restrictions.

The number of new confirmed cases of coronavirus across Alabama last week was higher than during any other week since the pandemic began and increase faster than in 46 other states and the District of Columbia, according to an APR analysis of data from The COVID Tracking Project.

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The Centers for Disease Control and Prevention recommends that, because of the virus’s approximately two-week incubation period when a person could have coronavirus but show no symptoms, people should practice social distancing by keeping 6 feet from others and wear face masks while in public.

Doing so not only helps protect the wearer of the mask, but also all those around them. 

“It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus,” the CDC’s website states.  “CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.”

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Guest Columnists

Opinion | With COVID-19 policy, don’t blame your umbrella. The rain got you wet

Monica S. Aswani, DrPH, and Ellen Eaton, M.D.

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Monica S. Aswani, DrPH, is an assistant professor of health services administration and Ellen Eaton, M.D., is an assistant professor of infectious diseases.

Editor’s note: The opinions expressed in this perspective are those of the authors.


As states re-open for business, many governors cite the devastating impact of physical distancing policies on local and state economies. Concerns have reached a fever pitch. Many Americans believe the risk of restrictive policies limiting business and social events outweighs the benefit of containing the spread of COVID-19.

But the proposed solution to bolster the economy — re-opening businesses, restaurants and even athletic events — does not address the source of the problem.

A closer look at the origins of our economic distress reminds us that it is COVID-19, not shelter-in-place policy, that is the real culprit. And until we have real solutions to this devastating illness, the threat of economic fallout persists.

Hastily transitioning from stay-at-home to safer-at-home policy is akin to throwing away your umbrella because you are not getting wet.

The novelty of this virus means there are limited strategies to prevent or treat it. Since humans have no immunity to it, and to date, there are no approved vaccines and only limited treatments, we need to leverage the one major tool at our disposal currently: public health practices including physical distancing, hand-washing and masks.

As early hot spots like New York experienced alarming death tolls, states in the Midwest and South benefited from their lessons learned.

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Indeed, following aggressive mandates around physical distancing, the number of cases and hospitalizations observed across the U.S. were initially lower than projected. Similarly, the use of masks has been associated with a reduction in cases globally.

As the death toll surpasses 100,000, the U.S. is reeling from COVID-19 morbidity and mortality. In addition, the U.S. has turned its attention to “hot spots” in Southern states that have an older, sicker and poorer population. And to date, minority and impoverished patients bear the brunt of COVID-19 in the South.

Following the first COVID-19 case in Alabama on March 13, the state has experienced 14,730 confirmed cases, 1,629 hospitalizations and 562 deaths, according to health department data as of Monday afternoon.

Rural areas face an impossible task as many lack a robust health care infrastructure to contend with outbreaks, especially in the wake of recent hospital closures. And severe weather events like tornadoes threaten to divert scarce resources to competing emergencies.

Because public health interventions are the only effective way to limit the spread of COVID-19, all but essential businesses were shuttered in many states. State governments are struggling to process the revenue shortfalls and record surge in unemployment claims that have resulted.

The Coronavirus Aid, Relief and Economic Security Act, or CARES Act, allocated $150 billion to state governments, with a minimum of $1.25 billion per state. Because the funds were distributed according to population size, 21 states with smaller populations received the minimum of $1.25 billion.

Although states with larger populations, such as Alabama and Louisiana, received higher appropriations in absolute terms, they received less in relative terms given their COVID-19 related medical and financial strain: the CARES Act appropriations do not align resources with state need.

As unemployment trust funds rapidly deplete, these states have a perverse incentive to reopen the economy.

Unemployment claimants who do not return to work due to COVID-19 fears, per the Alabama Department of Labor, can be disqualified from benefits, perpetuating the myth of welfare fraud to vilify those in need.

The United States Department of Labor also emphasized that unemployment fraud is a “top priority” in guidance to states recently.

Prematurely opening the economy before a sustained decline in transmission is likely to refuel the pandemic and, therefore, prolong the recession. Moreover, it compromises the health of those who rely most heavily on public benefits to safely stay home and flatten the curve.

Some would counter this is precisely why we should reopen — for the most vulnerable, who were disproportionately impacted by stay-at-home orders.

The sad reality, however, is that long-standing barriers for vulnerable workers in access to health care, paid sick leave and social mobility pre-date this crisis and persist. And we know that many vulnerable Americans work on the frontlines of foodservice and health care support where the risk from COVID-19 is heightened.

A return to the status quo without addressing this systemic disadvantage will only perpetuate, rather than improve, these unjust social and economic conditions.

COVID-19 has exposed vulnerabilities in our state and nation, and re-opening businesses will not provide a simple solution to our complex economic problems.

No one would toss out their umbrella after several sunny days so why should America abandon public health measures now? After all, rain is unpredictable and inevitable just like the current COVID-19 crisis.

The threat of COVID-19 resurgence will persist until we have effective preventive and treatment options for this novel infectious disease.

So let’s not blame or, worse, discard the umbrella. Instead, peek out cautiously, survey the sky and start planning now to protect the vulnerable, who will be the first to get wet.

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Health

New COVID cases in Alabama increasing faster than 46 other states

Chip Brownlee

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Alabama reported more cases of COVID-19 last week than any other week since the pandemic began, and the increase in new cases reported last week compared to the previous week was higher than 46 other states and the District of Columbia.

An analysis of data collected by The COVID Tracking Project, a volunteer-run effort to track the pandemic, shows that only West Virginia, Maine and South Carolina reported a larger increase in new cases last week compared to the new cases they reported in the previous week.

According to The COVID Tracking Project’s data, Alabama recorded 2,556 new cases during the week ending Sunday, May 24, compared to 1,994 new cases during the previous week ending Sunday, May 17.  That’s an increase of 28 percent.

The Alabama Department of Public Health’s daily case totals show an increase of 17 percent last week over the previous week, which is still higher than 38 other states, according to the analysis performed on The COVID Tracking Project’s data.

COVID Tracking Project has a standardized method of capturing each state’s new cases from health departments, making it possible to compare the trajectories of each state. Twenty-four states and the District of Columbia saw new cases decline last week, while 25 states saw new cases increase last week compared to the previous week.

Compared to other states, testing showed no similar increase. The number of new tests reported in Alabama last week only grew 2 percent compared to the previous week, according to the COVID Tracking Project’s data. That’s lower than 31 other states.

APR‘s data showed an increase of 13 percent over the previous week, but that is still a smaller increase than 25 other states. Both our data and an analysis of The COVIDTracking Project’s data show the percent of total tests that are positive rose last week compared to the previous week.

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The Alabama Department of Public Health does not provide historical data for how many tests were performed on each day. Both APR and the COVID Tracking Project calculate test increases by tracking the change to the cumulative total of tests performed.

Several other Southern states also saw rising cases and no similar increase to tests performed. In Mississippi, new cases rose by 9 percent last week compared to the previous week while tests per week fell by 21 percent. In Tennessee, new cases rose 15 percent while tests per week declined 8 percent.

Georgia saw new cases rise 21 percent, but tests also rose by 22 percent. Florida, South Carolina and North Carolina also reported both rising cases and more tests compared to the previous week.

Cases have been rising in Alabama since the beginning of the month. Testing has also increased, and public health officials, including State Health Officer Dr. Harris, have said they are not sure if the increase in cases is directly attributable to more tests or more disease.

Some areas of the state, like Madison County and Lee County, have seen little or no rise in new cases, while others, like Montgomery County and Tuscaloosa County, are experiencing worsening outbreaks.

Gov. Kay Ivey lifted the state’s stay-at-home order on April 30 and has since relaxed restrictions twice more, saying the economics of the pandemic must be addressed. The state reported an unemployment rate of 12.9 percent last week, higher than during any point during the Great Recession.

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