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Is Alabama ready to ease COVID-19 restrictions? A look at the data

Chip Brownlee | The Trace

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It’s been 39 days since Alabama confirmed its first cases of COVID-19 on March 13. Now, more than a month later, the number of people who have tested positive for the coronavirus is nearing 5,000.

Tracking the coronavirus as it has spread in Alabama has been difficult. Testing has been limited. Data, at times, has been unreliable. Yet, officials appear to be paving the path toward reopening the state’s economy as some models suggest the state is at or past the peak of the outbreak.

But are we ready to safely reopen — and to stay open?

This is a virus that is evasive, with a sizeable percentage of people who contract it going without any symptoms at all or symptoms so mild they don’t seek or can’t get a test.

When Boston tested a sample of its homeless population, it found a “stunning” number of asymptomatic cases. The same happened in New York when hospitals tested a sample of pregnant women. Eighty-seven percent of the women who tested positive for COVID-19 had no symptoms when they were tested.

Nearly 60 percent of the sailors who tested positive for COVID-19 aboard the U.S. Navy aircraft carrier Theodore Roosevelt had no symptoms at the time they tested positive.

The high number of asymptomatic or pre-symptomatic cases found in these few isolated situations, while not conclusive, raises numerous questions about the extent to which our testing — mainly of just those people who are suspected of having the virus, those people who are symptomatic or those who are health care workers most at risk of contracting COVID-19 — is reliably capturing the extent to which the virus has spread among the public.

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For so many people, COVID-19 is mild, even negligible, but for others, it is deadly. At least 165 Alabamians have died after testing positive. Of those, 113 have been investigated by epidemiologists and confirmed as deaths caused primarily by COVID-19. Across the United States, the number has surpassed 35,000, according to the COVID Tracking Project.

More than 640 people have been hospitalized with positive cases of the virus since March 13, according to the Alabama Department of Public Health’s data. But the number is surely higher. And many more are hospitalized with suspected cases of the virus, awaiting test results.

COVID-19, according to public health officials like Dr. Anthony Fauci and experts in Alabama at UAB, is the rare kind of virus with a mortality rate and transmissibility in the sweet spot that makes it fast-spreading, deadly and hard to contain. It’s deadly enough to kill a lot of people, but not too deadly that it kills its hosts before they spread it to more people.

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This perfect combination of being highly contagious and deadly enough but not too deadly is what has forced public health officials, mayors and governors to implement stay-at-home orders to slow the spread and “flatten the curve.”

The stay-at-home orders appear to be working. The growth in the number of new infections appears to be slowing, even as the absolute number of new lab-confirmed cases gets higher. But the reality is that easing stay-at-home orders will mean a resurgence of the virus. Whether the state is capable of tracking, handling and containing the new cases without closing the state down again is a different question.

It’s been two weeks and a few days since Gov. Kay Ivey issued her stay-at-home order. But public health officials have cautioned that it is too early to tell if the virus is really under control. Ivey and State Health Officer Scott Harris have said they hope to know, beginning this week, the order’s full effect.

It can sometimes take up to two weeks for someone to present symptoms after being exposed to the virus. The lag time between when a person’s symptoms present and when they can get a test can add days. The turnaround time on test results adds even more time, sometimes up to a week, though the average is 72 hours, according to the Department of Public Health.

But the numbers appearing to improve has prompted state leaders — including Ivey and Lt. Gov. Will Ainsworth — to pivot toward efforts to re-open the economy as the number of people out of work because of the shutdown has skyrocketed. The total number of people who have filed unemployment claims since the week ending March 14 is up to 279,431, or about 12.5 percent of the state’s total labor force in February 2020.

Ivey said last week she is establishing a group to tackle the topic of safely reopening the economy, and Ainsworth — who has been a prominent advocate of strict public health measures to curb the virus’s spread — has been leading a committee that Friday recommended immediately reopening some businesses like retail and restaurants. Others could begin reopening on May 1 after Ivey’s stay-at-home order expires.

The governor hasn’t said yet what she plans to do, and that public health experts will guide her decision, but she has said that whenever the state does begin reopening the economy, it will have to be “reasoned” and “targeted.”

The numbers do appear to be hopeful. Looking at a moving average of new lab-confirmed cases, the curve looks like it may be flattening. Since April 12, the five-day average of new confirmed cases has been flat — if not slowly and intermittently declining — meaning that there are fewer new cases being confirmed.

The growth rate also appears to have slowed. On Thursday, the number of new confirmed cases grew by only 4 percent over the day before, down from 14 percent on April 9 and 15 percent on April 2. As Ainsworth said Friday, “That’s linear growth. That’s not exponential.”

While this data is hopeful — and Alabama does not appear to be on track for an outbreak as severe as Louisiana or New York — there are a number of ways to interpret the slowing numbers.

Knowing the true extent of the virus’s spread, at this time, is an unanswerable question. The evidence is clear that far more than 4,900 Alabamians have the virus. A combination of limited testing and asymptomatic patients means that is surely the case.

If you aren’t a health care worker, a resident of a long-term care facility or very symptomatic, it’s still hard to get a test in Alabama. That’s not just true here but across the country. In Alabama, the rollout of testing was slowed as some supplies were seized by FEMA and the federal Department of Health and Human Services.

But among the three groups that have had more expanded access to testing — health care workers, long-term care residents and long-term care employees — the confirmed cases have been steadily rising.

People in those three groups now make up 28 percent of the state’s total cases. Though those groups tend to be more at risk of exposure, better access to testing for those among these groups could also explain the high number of infections. And it could be a signal that limited testing for the general population is resulting in an undercount of the total number of cases.

Alabama has not yet reached the level of “mass testing” recommended by public health experts, including those at the Harvard T.H. Chan School of Public Health, before stay-at-home orders are lifted. So knowing exactly how many people have the virus and how fast or slow it is spreading is difficult if not impossible.

On top of limited testing, which is the state’s clearest challenge at this point, data in our state has reliably been incomplete, thus unreliable. State law requires commercial labs to report their positive results within a set time frame but rules on reporting negative results are less strict. Some commercial labs are reporting their negatives but not all of them. It is not clear and the state has not said how many tests could be missing from the state’s “total tested” count.

The last two weeks have also shown that data, at this point, is still relatively unreliable. The state went nearly four days without reporting any new tests before dropping 8,000 new ones into the total on April 13. Since then, the number of new reported tests per day has been anything but stable, ranging from 1,400 to 4,700 per day. (That’s why we are using a five-day rolling average in the charts below to level out the inconsistencies.)

On top of that, a reporting error from a commercial lab caused a number of negative tests to be list as positives Friday and Saturday morning. When the error was discovered, it was quickly corrected, but the data problem caused the number of confirmed cases and reported deaths to decline Saturday, causing confusion.

Data like this, while it may seem unimportant, is imperative for gauging how prepared we are for reopening the state, public health experts say. Experts at Harvard’s School of Public Health say each state should be performing, at a minimum, 152 tests per 100,000 people each day.

That’s the level, Harvard’s researchers say, that would be needed to catch a majority of cases and perform contract tracing for at least 10 of each positive case’s contacts. If we can’t catch the positive cases and isolate them, the outbreak could spiral out of control again, leading to rolling shutdowns and more casualties.

The average for the last five days in Alabama is 47 tests per day per 100,000. The number of tests per day would need to more than triple by May 1 for Alabama to reopen safely, Harvard’s researchers say.

For Alabama to reach the level of testing needed to reopen safely, that would mean 7,448 tests per day. For the last week, Alabama has been in the range of 2,500 to 3,500 new tests reported per day, based on our rolling average. For the United States as a whole, the researchers say between 500,000 and 600,000 tests per day need to be performed to open up and stay open.

“All the evidence suggests that the number of cases will rise as social distancing is relaxed, even with rigorous testing and tracing,” the researchers wrote in their analysis. “And so, we will likely need many more tests. But, if we can’t be doing at least 500,000 tests a day [nationwide] by May 1, it is hard to see any way we can remain open.”

There are other statistics that can give us an idea of where we are and other reasons why the growth of lab-confirmed cases may be slowing. Testing, again, can give us an idea. The rate of growth in new confirmed cases is slowing in part because the growth rate in the number of tests being performed is slowing, too.

It is absolutely the case that we are testing more in Alabama as of late. The number of total tests performed jumped from 20,000 on April 9 to more than 45,712 by Monday. The number of new tests reported per day is also rising.

Beginning a couple of weeks ago, the Department of Public Health began asking commercial labs to report their negatives voluntarily, but not all have complied. It’s possible that some of the tests reported in the last two weeks are from commercial labs that previously had not been reporting their negatives.

Even with the jump in numbers — and assuming that all of those tests truly are new tests, not backlogged negatives from commercial labs — the growth rate of new tests being performed has essentially plateaued, too, just like the number of new cases. And the rates of growth are pretty tightly correlated.

The gist of this is that Alabama, yes, has expanded testing since the outbreak began. But it has not dramatically expanded testing. Less than 1 percent of the state has been tested.

Re-opening the economy means that the risk of the virus resurging will be real. There are still people in Alabama who have been infected with the virus but aren’t yet sick or won’t show any symptoms at all. So when the state does reopen, those people will go out into the world, not knowing they have the virus, and spread could begin again.

We have not defeated this virus, yet. Until a vaccine is developed, the risk of a resurgence will be there. And we still don’t have the testing capacity sufficient enough to find all the positive cases and isolate them.

 

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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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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Economy

Report: Transitioning to electric vehicles could save Alabama millions in health costs

Alabama would experience approximately 500 less asthma attacks per year, about 38 fewer premature deaths and prevent more than 2,200 lost workdays annually.

Micah Danney

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(STOCK PHOTO)

Alabama could save $431 million in public health costs per year by 2050, if the state shifted to an electric transportation sector between now and then, according to a new study by the American Lung Association.

Such a transition would reduce other health-related issues, said the organization, which used data on pollution from vehicles and from oil refineries to calculate its findings.

Alabama would experience approximately 500 less asthma attacks per year, about 38 fewer premature deaths and prevent more than 2,200 lost workdays annually.

The transportation sector is one of the main contributors to air pollution and climate change, said William Barrett, the association’s director of advocacy for clean air and the study’s author.

“We have the technology to transition to cleaner cars, trucks and buses, and by taking that step we can prepare Alabama for the future while also seeing the health and economic benefits forecasted in ‘The Road to Clean Air,’” Barrett said. “Especially as our state faces the impacts of climate change, such as extreme storms, this is a powerful and practical opportunity to take action to improve our economy, our health and our future.”

Trading combustion-powered vehicles for electric ones could result in $11.3 billion in avoided health costs across southern states by mid-century, the report estimated, and prevent roughly 1,000 premature deaths.

Nationally, Americans stand to save $72 billion in health costs and $113 billion in avoided climate change impacts, the ALA said.

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The path to that future depends on leaders factoring public health effects into decisions about transportation, Barrett said.

That involves steps like pursuing electric vehicle fleets when purchasing decisions are being made and supporting the creation of enough charging stations along highways, roads and at truck stops.

Investing in that infrastructure can drive wider economic benefits, Barrett said. He cited California’s increased manufacturing of electric vehicles.

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Tesla is the most well-known producer that has located there, but Barrett said that makers of trucks and buses have also chosen to locate their facilities in the state.

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Health

CDC director: Vaccine won’t be available to general public until mid-2021

Eddie Burkhalter

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CDC director Robert Redfield (VIA CSPAN)

The director of the Centers for Disease Control and Prevention during testimony Wednesday before a U.S. Senate Appropriations subcommittee said a vaccine won’t be widely available to the public until mid-2021. 

Wearing a mask is the most important public health tool we currently have in the fight against the deadly disease, he said.

“I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine,” CDC director Robert Redfield told lawmakers.

Asked during the hearing by Sen. John Kennedy, R-Louisiana, when a vaccine will be ready “to administer to the public,” Redfield said that he believes there will be a vaccine that will initially be available some time between November and December. 

“But very limited supply, and it will have to be prioritized,” Redfield said. “If you’re asking me when is it going to be generally available to the American public, so we can begin to take advantage of vaccine to go back to our regular life, I think we’re probably looking at late second quarter, third quarter 2021.” 

Redfield said it will take time to expand vaccinations out from those who need them most direly to the larger public, and said there are about 80 million people in the U.S. who have underlying health conditions that put them at greater risk and need the vaccine first. 

President Donald Trump has repeatedly said there will likely be a vaccine available to the public possibly before the November election or even sooner. 

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When asked about Redfield’s statements that one won’t be available to the public until the summer or early fall of 2021, Trump said during a press conference Wednesday that Redfield was mistaken. 

“I think he made a mistake when he said that. It’s just incorrect information,” Trump said. “And I called him, and he didn’t tell me that. I think he got the message maybe confused. Maybe it was stated incorrectly. We’re ready to go immediately as the vaccine is announced, and it could be announced in October. It could be announced a little bit after October.” 

Trump refuted the CDC head, and said the vaccine will be made available to the general public “immediately” once one is approved. Asked for Trump’s timelines as to when a vaccine will be ready to administer to the wider public, an official at the press conference seated near Trump said that will likely occur by the end of March. 

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The Trump administration on Aug. 14 announced that the McKesson Corporation would be the central distributor of COVID-19 vaccines in the U.S. The company distributed the H1N1 vaccine during the 2009-2010 pandemic. 

AstraZeneca’s COVID-19 vaccine trials were put on hold worldwide on Sept. 6 after a volunteer in Britain experienced a serious health problem. The company’s vaccine trials resumed in the United Kingdom on Saturday.

The company in a statement said it was working with global health authorities to “be guided as to when other clinical trials can resume.” 

The drugmaker Pfizer Inc. on Tuesday announced that those enrolled in the clinical trial for the company’s own COVID-19 vaccine were experiencing mild to moderate side effects, but that an independent monitoring committee has not yet recommended pausing the study.

There have been 2,392 COVID-19 deaths in Alabama since the pandemic began, according to the Alabama Department of Public Health.

At least 193,000 people in the U.S. have died from coronavirus, according to The Washington Post.

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