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

John Atkinson

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

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

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

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

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

75 or 100 Percent

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

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

“Likely have thousands of cases in our area”

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

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

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

“The only real option”

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

What exactly is Social Distancing?

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

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

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Education

Alabama declines to release COVID-19 data associated with child care centers

APR has asked for that data and whether ADPH was aware of the number of cases associated with child care centers statewide.

Eddie Burkhalter

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(STOCK PHOTO)

It was unclear Tuesday the number of confirmed cases of COVID-19 there have been among staff, children and relatives associated with child care facilities in Alabama, because the Alabama Department of Public Health declined to release that data.

“All cases of COVID-19 are required to be reported to the Alabama Department of Public Health under notifiable disease laws. ADPH is aware of cases in entities such as child care but does not report separately from other data,” said Dr. Karen Landers, assistant state health officer, in a message to APR on Tuesday.

APR has asked for that data and whether ADPH was aware of the number of cases associated with child care centers statewide.

Landers noted that ADPH does provide the percentage of cases among age ranges, however. There had been approximately 2,628 confirmed COVID-19 cases among Alabama children 4-years-old and younger as of Monday, according to ADPH’s dashboard, but the department doesn’t specify which of those cases are associated with child care centers, and it was unclear how many cases there have been among relatives or workers connected to child care centers.

While children 10-years-old and older can efficiently transmit COVID-19 to others, the Centers for Disease Control and Prevention in a recent report note that “limited data are available on SARS-CoV-2 transmission from young children, particularly in child care settings.”

The Sept, 18 CDC report looked at three COVID-19 outbreaks in child care facilities in Salt Lake County, Utah, during April 1 through July 10, and found that the 12 children who contracted the disease spread it to at least 12 others outside the centers, and one parent was hospitalized with coronavirus.

In one facility, researchers confirmed five cases among workers and two among children. One of those children, aged 8 months, transmitted COVID-19 to both parents, the report notes. Many of the children had mild symptoms or none at all, researchers found.

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“COVID-19 is less severe in children than it is in adults, but children can still play a role in transmission,” the report reads. “The infected children exposed at these three facilities had mild to no symptoms. Two of three asymptomatic children likely transmitted SARS-CoV-2 to their parents and possibly to their teachers.”

While Alabama’s Department of Public Health isn’t releasing data on cases associated with child care centers, many other states are, including Texas, South Carolina, North Carolina, California, Minnesota and Massachusetts.

There have been 332 confirmed cases, two deaths and 14 separate outbreaks associated with child care centers in North Carolina, according to the North Carolina Department of Health and Human Services.

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Health officials in California’s Sonoma County traced 30 cases of coronavirus to one child at a child-care center in the county, where 16 students, 11 relatives and three workers tested positive, according to The Los Angeles Times. In addition to that outbreak, there have been 62 other cases at 13 child-care facilities in the county, including 27 family members, 10 workers and 25 students, with 381 cases of children younger than 17 still under investigation, the newspaper reported on Sept. 21.

Reopening child care centers can be done safely, according to an Aug. 28 report by the Centers for Disease Control and Prevention, which that found that in Rhode Island, which reopened child care centers on June 1, there were just 52 confirmed and probable cases among staff, children and relatives across 29 centers between June 1 and July 31.

The report noted that Rhode Island at first limited centers to 12 or fewer students, required staff and students to not move between groups in centers and “universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines.”

Alabama State Health Officer Dr. Scott Harris on March 19 issued an order closing child care centers through April 5, with exceptions for facilities that provided services to first responders and other workers deemed essential. Harris on March 27 issued a supplemental order allowing centers that cared for 11 or fewer children to reopen.

The Alabama Department of Public Health on Monday published a press release touting the number of open child care centers across Alabama. According to the department, 76 percent of all child care facilities in Alabama are open.

“Alabama is well on our way to reopening the necessary number of child care facilities to enable parents to return to work and resume a more normal schedule,” said Alabama DHR commissioner Nancy Buckner, in a statement. “This is the sixth survey we have conducted and each one has shown tremendous growth in the numbers of open facilities. We have worked hard to encourage child care providers to open by providing support in the form of grants and supplies.”

Asked whether the department is aware of the number of COVID-19 cases among children, staff or relatives associated with child care centers, a DHR spokesperson responded in a message to APR on Monday that “We don’t track that.”

While child care plays a critical role for working parents across the country, the pandemic and subsequent shutdowns have put a strain on the businesses, according to a July 13 study by the National Association for the Education of Young Children, which surveyed more than 5,000 child care facilities in every state.

Among the child care centers surveyed, two out of five said they would have to close without more public assistance, while half of the minority-owned centers said they have to close without more aid, according to the report. A quarter of child care workers said they’d applied for or received unemployment benefits, and 73 percent of centers said they have or will begin laying off workers and/or make pay cuts.

An Aug. 26 study by the Washington D.C.-based nonprofit Bipartisan Policy Center found that 32 percent of parents polled said their child care centers were closed, 14 percent of them permanently, and 22 percent of the parents said they could not return to work in person without childcare.

Even when child care is available to parents, many are worried about sending their children back while COVID-19 continues to spread. Of those asked, 77 percent of parents said they were concerned that sending their kids back would increase the risk of exposing their family to COVID-19.

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Crime

SPLC report: Despite COVID-19 deaths, Alabama isn’t releasing older, at-risk inmates

Eddie Burkhalter

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(STOCK PHOTO)

A report by the Southern Poverty Law Center published Tuesday found that almost 200 older state inmates, at greater risk from COVID-19, were eligible for parole, but either had no hearing or were denied parole over the summer. 

Alabama’s three-member Board of Pardons and Paroles denied parole for 44 people who were 65 and older over the summer, SPLC’s report states, and a dozen of the more than 1,100 older inmates identified in a previous SPLC report have since died, either from COVID-19 or other illnesses. 

“Despite confirming the deaths, it remains unclear whether the cause could have been COVID-19 as ADOC would not provide information about those individuals in response to a public records request, citing ongoing internal investigations,” the report reads. 

The SPLC and several other criminal justice reform groups urged the Alabama Department of Corrections and the Alabama Bureau of Pardons and Paroles to take steps to release at-risk inmates as the coronavirus pandemic began, through medical parole, medical furloughs and judicial sentence reviews, but to date, no such larger push to release inmates has taken place. 

According to ADOC, 22 inmates have died after testing positive for COVID-19.

SPLC’s report notes that many of the inmates who died had underlying health conditions, which were well known to prison officials. 

The Parole Board denied parole to more than three dozen inmates 65 or older since restarting parole hearings in May, according to the report. 

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“The BPP stopped paroles starting in March, against the demands of activists and legislators who pointed out that hearings could be done virtually. Hundreds of scheduled parole hearings were cancelled. After its hiatus, the BPP scheduled relatively few hearings throughout the summer compared to years past,” authors of the report wrote.

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Health

Alabama has fourth highest rate of coronavirus cases

Alabama has the fourth-highest per capita rate of COVID-19 cases in the country, trailing only fellow Southern states Louisiana, Florida and Mississippi.

Brandon Moseley

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(STOCK PHOTO)

Alabama has the fourth-highest per capita rate of COVID-19 cases in the country, trailing only fellow Southern states Louisiana, Florida and Mississippi.

Alabama has so far recorded at least 29,896 cases per million people, which amounts to 2.9 percent, nearly 3 percent, of the people in Alabama.

The Alabama Department of Public Health on Monday reported that 818 more Alabamians have tested positive for the coronavirus. This takes our state up to 145,780 diagnosed cases. At least 61,232 Alabamians have recovered from the virus.

But 82,109 Alabamians have active coronavirus cases. This is the ninth-highest raw total in the nation, trailing only Florida, California, Georgia, Arizona, Virginia, Maryland, Missouri and Texas — all states with higher populations than Alabama.

Alabama’s high rate of infection is not due to the state doing more testing. ADPH announced 5,500 more tests on Monday, taking the state up to 1,059,517 total tests.

Alabama is 40th in the nation in coronavirus testing.

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Tests as a percentage of the state’s population is just 22.8 percent. Louisiana on the other hand has 47 percent — the fifth highest rate of testing in the nation. Even Mississippi, at 26.4 percent, is testing at a higher rate than Alabama and are 29th in testing. Florida is 37th.

On Monday, ADPH reported two more Alabamians have died from COVID-19, taking the state death toll to 2,439. Alabama is 21st in death rate from COVID-19 at almost .05 percent.

New Jersey has had the highest COVID-19 death rate at .18 percent of the population. At least 257 Alabamians have died in September, though, to this point, September deaths are trailing both August and July deaths. At least 602 Alabamians died from COVID-19 in August.

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Hospitalizations from COVID-19 are also down. 780 Alabamians were hospitalized with COVID-19 on Sunday, down to levels not seen since before the July 4 holiday. At least 1,613 Alabamians were in the hospital suffering from COVID-19 on Aug. 6.

Alabama Gov. Kay Ivey’s July 15 mask order is being credited with decreasing the number of coronavirus cases in the state, which had soared to a seven-day average of 1,921 cases per day on July 19. The current seven-day average is 780 cases per day but is little changed in the last ten days.

The mask order expires next month, but most observers expect the mask order to be continued into November.

High school football and the Labor Day holiday weekend did not lead to a surge in cases; however, public health authorities remain concerned that colder weather and the return of flu season could lead to another surge in cases.

President Donald Trump has expressed optimism that a coronavirus vaccine could be commercially available this fall. A number of public health officials, including the CDC director, have expressed skepticism of that optimistic appraisal.

At least 969,611 people have died from COVID-19 globally, including 204,506 Americans.

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Health

Study: Those with COVID twice as likely to have dined in restaurants

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes. 

Eddie Burkhalter

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(STOCK PHOTO)

A recent study by the Centers for Disease Control and Prevention found that adults who tested positive for COVID-19 were twice as likely to have eaten in restaurants, which builds upon known factors about how the disease is transmitted, experts say, but the study has limitations.

The study surveyed 314 adults in 10 states and found that those who tested positive for COVID-19 were twice as likely to have eaten at restaurants within the previous 14 days. Researchers found that there was no significant difference between those who tested both positive and negative and who said they had gone to gyms, coffee shops, used public transportation or had family gatherings.

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes.

Dr. Bertha Hidalgo, an epidemiologist and associate professor at UAB’s School of Public Health, told APR on Wednesday that the study lends evidence to what the medical community knows are potential risks for contracting COVID-19, which include being indoors and unmasked, but there are nuances to each of those activities that can either increase or decrease that risk.

The study did not differentiate between indoor and outdoor dining, and infectious disease experts say being outdoors decreases the risk of contracting COVID-19.

“It’s also hard to know what policies are in place where these people were recruited from for this study,” Hidalgo said. “Whether they’re required to be masked or if there’s a decreased capacity in a restaurant.”

Monica Aswani, assistant professor at UAB’s School of Health Professions, said she would be cautious about interpreting the study through a causal lens.

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“People who are willing to dine in restaurants are also likely to engage in other risky behaviors, such as not wearing masks. Since this is a survey, there is not enough evidence to suggest that the source of exposure was restaurants without contact tracing to supplement it,” Aswani said. “Likewise, respondents may have misreported their behaviors, given the sensitive nature of the questions. The authors note this as a limitation and highlight how participants were aware of their Covid-19 test results, which may have influenced how they responded.”

Aswani also noted that the questions about dining did not differentiate between indoor versus outdoor seating, “which represent different levels of risk to exposure.”

“Participants who visited a restaurant on at least one occasion, regardless of the frequency, are also considered similar. Consequently, in the two weeks before they felt ill, someone who dined on a restaurant patio once and someone who ate indoors at five different restaurants are indistinguishable in their data,” Aswani said.

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Hidalgo said that while there are clear limitations to the CDC’s study, the findings do back up what the medical community knows about the transmission of the disease.

“I would very much look at this from the big picture perspective, and say we know that indoor activities are an increased risk for COVID-19. This study lends evidence to that,” Hidalgo said.

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