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Supply shortages still inhibiting widespread testing in Alabama

Chip Brownlee | The Trace

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The total number of people tested for COVID-19 in Alabama, according to the Alabama Department of Public Health, jumped by more than 18,000 on Saturday. It was the single largest increase in the total number of tests reported in a day since the state began performing tests in early March.

The total number of reported tests jumped from 52,641 (about 1.07 percent of Alabama’s population) to 71,344 (1.46 percent of the population) in a single day. The large relative increase in total tests performed gave some people, particularly online, the impression that Alabama had begun to dramatically and almost miraculously expand its testing in the course of a few days.

But many of the negative tests reported Saturday in that large batch were weeks old, according to the Alabama Department of Public Health, some dating back to the first few days of expanded testing when drive-thru centers in Jefferson County began testing hundreds of people in mid-March.

“We had some reports from a couple of big labs who had not been recording negatives and just sort of sent in these bulk reports kind of all at once,” said State Health Officer Dr. Scott Harris in an interview with APR Monday. “All those tests didn’t occur on the same day or anything like that.”

While labs are required, by law, to report positive test results for COVID-19 within a few hours, negative results are a much different matter. In the early days of the outbreak, there was more focus on the positive results, but as discussion gears up surrounding efforts to “reopen” the state’s economy by lifting or easing Gov. Kay Ivey’s stay-at-home order, the total number of tests performed has become an increasingly important metric. To get that number, the state needs to be able to capture negative tests, too, not just the positive ones.

Public health experts — including researchers at the Harvard Global Health Institute and the University of Washington Institute for Health Metrics and Evaluation — have recommended that states need to drastically increase their testing capacity before a safe reopening can happen. Testing and contact tracing are imperative to being able to find, identify and contain new cases to prevent a second spike in infections.

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Without labs reporting their negative tests in a timely manner, it’s difficult to estimate how many people are being tested on a daily or even weekly basis in the state, Harris said.

The large batch of new tests reported Saturday shows just how hard it is for state officials to get a grasp around how many tests are being performed. For the public, it’s even harder to understand. A spike in new tests reported on a single day can be misleading when, in reality, those 18,000 tests were performed over the course of a month.

“For a lot of labs, for example, the pop-up labs that were in Jefferson County, the first drive-thrus, they were just keeping track of that on paper,” Harris said of the negative test results. “They have only just now started sending us negative results. And that’s one of the reasons the test number jumped so much in one day. We just got a box of papers, and people had to go in and manually input all those lab results, and we still don’t know if we’re getting them all.”

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The Alabama Department of Public Health, through an emergency order, has required labs reporting test results to include negative tests in their counts, but reporting has been sporadic from commercial labs, as evidenced by the dump of new tests on Saturday.

Harris said the state has also had trouble getting negative test results from out-of-state labs that are performing tests on samples collected in Alabama and tests on Alabama residents who had samples collected out-of-state. Other labs, including Diatherix in Huntsville, Synergy in Mobile and UAB’s pathology lab in Birmingham, have been much better about reporting tests in a timely manner.

“I say all of that to say that we don’t know how many tests are being done per day,” Harris said.

The Alabama Department of Public Health’s best estimate is that about 1,000 people a day are being tested in Alabama for COVID-19, which includes the state’s lab and dozens of other commercial and hospital labs performing tests.

That estimate makes even a five-day or seven-day rolling average look inaccurate. APR last week began providing a five-day average of new tests reported on our data dashboard page. After the new tests were reported Saturday, it caused the five-day average to jump to 5,000 tests per day, which is far too high, based on Harris’s estimate.

But Harris said there has been progress made on expanding testing. More people are getting tested now than a few weeks ago, he said. New testing sites are opening weekly in rural counties. UAB has expanded testing capacity available in the Birmingham metro area. And Harris said Alabama is aiming to get to 50,000 tests per week at some point in the near future. That would be about 1 percent of the state’s population tested per week, he said.

So far, about 1.5 percent of the state’s population has been tested since early March.

“The idea of 50,000 tests a week actually is doable, based on what people are reporting to us right now,” Harris said. “There’s enough capacity available in all of these labs to handle that volume. But practically speaking, we’re nowhere near that.”

Such an increased level of mass testing would require about 7,100 tests per day, seven days a week.

That’s about the same as the level recommended by the researchers at Harvard, who said states should get to 152 tests per 100,000 people per day by May 1.

Even more conservative recommendations, like the one from public health officials included in Rep. Terri Sewell’s advisory group report, say Alabama needs to test about 11,200 people a week to be able to safely reopen with appropriate containment and contact tracing.

“So, we’re not there yet either,” Harris said. “But that’s probably conceivable.”

What are the barriers to more testing?

The Alabama Department of Public Health’s State Bureau of Clinical Laboratories is able to perform about 350 tests on a good day, “when everything’s perfect,” Harris said. He said it’s unlikely that the state lab will be able to scale up much more given its current resources and capacity.

“I really think that one big perception issue around testing is that the feds have made it clear that state public health labs are not going to be the ones doing the bulk of testing, even when we would like to be,” Harris said. “They’ve made it very clear that we need to be augmenting the private capacity. That’s what we’re trying to do, and we’re trying to recruit people to do that.”

The state has been reaching out to private labs over the last few weeks, asking them to report their current level of capacity and how many tests they think they will actually be able to perform going forward. The numbers look good, at first glance, Harris said — maybe even enough to get to 50,000 tests per week pretty quickly.

“In theory, we have an idea that we could do what we need to do,” Harris said. But the practical reality is much different.

Testing supply shortages are still inhibiting more widespread availability of testing, Harris said.

“In some of the national news conferences, they say, there’s plenty of testing out there,” Harris said. “And that’s technically true if you add up all the available capacity in all the labs. There’s enough empty slots in the laboratory to handle millions of tests. But just practically speaking, it’s just not evenly distributed and not everybody has all the equipment they need to get that done.”

Labs have reported to the Alabama Department of Public Health that they are facing shortages of testing kits, reagents and other materials needed. A lab may be able to perform thousands of tests before reaching their capacity, but that does not mean they have the supplies they need to do so.

Jordan DeMoss, the vice president of Clinical Operations at UAB, and Dr. Rachael Lee, an epidemiologist at UAB, at a press conference Monday, echoed Harris’s comments about supply shortages affecting the availability of testing statewide and at UAB, where their lab has been able to expand testing in recent weeks.

“Jordan and his team, they’re constantly calling for more swabs and more reagents in order to test,” Lee said. “If we could test all patients regardless of their symptoms, we would. That’s what limits us the most.”

On top of supply issues, Harris said another aspect limiting the availability of testing is the geographical disparities of available testing. Reliance on commercial laboratories has made that a more difficult problem to fix.

“A lot of it is just the uneven distribution of testing around the state,” Harris said. “If you’re in Jefferson County, and you go to your doctor today, and you need a test, you can almost certainly get one. But if you’re in one of our many rural counties, that’s just not possible. … There’s just not the same availability if you’re in the Wiregrass or the Black Belt.”

The Department of Public Health is working to use community health centers and county health department offices to make up for the lack of testing in the Black Belt, the Wiregrass and other rural areas of the state.

“I think just about every clinic has done some testing, but most of them have a lot more capacity,” Harris said.

To ramp up testing, the centers need personal protective equipment and testing materials. Harris said he hopes that some of the new funding included in Congress’s latest COVID-19 bill will help expand testing at the community health centers and health department offices. But that won’t solve all of the issues, he said.

“Even though we have county health departments that are doing testing throughout the state, but especially in the Black Belt, it’s still not convenient,” Harris said, noting that people would have to drive a long way to reach a county seat where the county health department office is located.

On top of engaging county-level health departments and community health centers, Harris said the state is working with UAB to expand testing at their lab so that UAB can be tapped to handle some tests if outbreaks emerge in more rural areas — like the outbreaks in Marshall County, Chambers County and Tallapoosa County.

When will people without symptoms be able to get tested?

So far, states across the country have prioritized people most at risk of having the virus including those in long-term care facilities like nursing homes and assisted living facilities, health care workers, people with moderate to severe symptoms, hospitalized patients and people who have been around others who have tested positive.

But the evidence is clear that a sizeable portion of the people infected with COVID-19 do not show any symptoms or symptoms so mild they do not need medical treatment. While that is good news in that it lowers the virus’s mortality rate, it makes it difficult to contain the virus’s spread.

A preliminary study testing for antibodies indicated that as many as 2.7 million New Yorkers were infected without realizing it, Gov. Andrew Cuomo said last week. Another small study of pregnant women in New York found that 15 percent tested positive for the virus, and 80 percent of them had no symptoms. Of more than 800 cases aboard the U.S. Navy carrier Theodore Roosevelt, 60 percent were asymptomatic.

Yet, all of those people are still able to spread the virus, meaning that such precautions as temperature checks at workplaces and other symptom screenings may only be partially effective in limiting the virus’s spread.

Harris said the department would like to be able to test those without symptoms, but that the capacity is just not there yet. It will be a while before the health department recommends testing for those without symptoms.

“I think we would want to do that,” Harris said. “But are we in the position to do that? We’re not.”

In the few populations that have had expanded testing — like long-term care facility residents and employees, and health care workers — the number of cases is higher than the general population. That could be because they are at higher risk of exposure, but at least part of it is expanded testing. As of Monday, at least 1,793 people in those three groups had tested positive for the virus, or about 28 percent of Alabama’s confirmed cases.

Those groups, along with those who have been exposed and around other vulnerable people, will likely be the first to have access to testing for asymptomatic or pre-symptomatic people.

“And so if we start testing asymptomatic people on a large scale, I think we would want to start with those groups,” Harris said.

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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Lieutenant governor calls for end to mask order

“Masks should be voluntary, not mandatory. We have to Make America Great Again,” Ainsworth said.

Brandon Moseley

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Lt. Gov. Will Ainsworth speaks during a video message. (LT. GOVERNOR'S OFFICE)

During the presidential debate Tuesday, President Donald Trump argued for opening up the economy and a loosening of coronavirus restrictions. His opponent, Vice President Joe Biden, has said that he favors stronger measures to bring the virus under control. Alabama Lt. Gov. Will Ainsworth seized on the moment to support the president and added that Alabama’s mask mandate should not be extended.

“I agree with President Trump,” Ainsworth said. “Shutdowns don’t work. People want their schools open, their businesses operating, and their jobs protected. Masks should be voluntary, not mandatory. We have to Make America Great Again.”

Alabama Gov. Kay Ivey, with the support of Alabama State Health Office Dr. Scott Harris, imposed a statewide mask order on July 15 when the state’s coronavirus cases were peaking, hospitals were reaching a breaking point and COVID-19 deaths were soaring.

The governor has since extended that mandatory mask order. It is currently in place through Friday, Oct. 2,

The mask order is being credited by public health officials with improving the coronavirus situation in the state, allowing the state to open its universities and play both high school and college football seasons.

It is not known, at this point, whether Ivey will further extend the mask order.

White House Coronavirus Task Force Member Dr. Deborah Birx came to Alabama just last week and urged Ivey to extend the mask order. A number of epidemiologists and doctors in the state have come forward to echo that call to extend the mandate.

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Ainsworth was one of the first public officials to call for an economic shutdown to combat the coronavirus. He was also one of the first public officials to call for reopening the economy after the governor actually did order an economic shutdown.

The Alabama Department of Public Health announced 16 more COVID-19 deaths on Tuesday to take the state’s total death toll to 2,517. Alabama currently has 86,854 active cases of the virus.

The state remains under a statewide “safer-at-home” order. Citizens who don’t have to leave their home are urged not to leave their homes and practice social distancing and wear a mask when they do have to go out.

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At least 1,013,469 people worldwide have already died in the COVID-19 pandemic including 210,797 Americans.

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Coronavirus task force’s Dr. Deborah Birx says Alabama should extend statewide mask order

Eddie Burkhalter

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Dr. Deborah Birx, coordinator of the White House’s coronavirus task force, met with Gov. Kay Ivey and State Health Officer Dr. Scott Harris Thursday.

Dr. Deborah Birx, coordinator of the White House’s coronavirus task force, said Thursday that Gov. Kay Ivey should extend her statewide mask order, set to expire on Oct. 2. She also responded to a CNN report that cited those close to her as saying she’s “distressed” with the direction the White House coronavirus task force is taking and is unhappy with what she sees as her diminished role in the group. 

Birx, speaking at Auburn University, said she met with Ivey and Alabama State Health Officer Dr. Scott Harris earlier in the day to discuss COVID-19 and how the state is responding.

“So we really talked about the importance of continuing mitigation,” Birx said of her talk with Ivey and state officials earlier on Thursday, adding that Ivey was one of the first governors in the South to enact a statewide mask mandate, which she said clearly decreased the spread of the disease.

Birx pointed to numbers, such as the test positivity rate, that have improved since July, but said “we’ve got to do even more.” Asked if the statewide mask mandate was one of the mitigation efforts she suggests continuing into the fall, Birx said she does. “Because if you look at what happened within two weeks of the mask mandate you can see the dramatic decline in cases here in Alabama,” Birx said. 

Birx said that when she last visited Alabama in July, the state was suffering from too many new cases of COVID-19. 

“I think when I was last here at the beginning of July, it was a very difficult time in general for Alabama. We saw nearly 95 to 100 percent of every county in Alabama, rural or urban, that had more than 10 percent test positivity to COVID-19,” Birx said, adding that today, around 20 percent of the state’s counties have positivity rates above 10 percent. 

Public health experts believe positivity rates above 5 percent mean that there isn’t enough COVID-19 testing being done and cases are likely going undetected. 

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In a statement to APR on Thursday, a spokeswoman for Ivey said Ivey and Dr. Scott Harris would provide an update on the statewide mask order ahead of its Oct. 2 expiration date. 

“It is evident that Alabamians are doing considerably well in modifying their behaviors to take the COVID-19 pandemic seriously, and we all remain optimistic that a successful vaccine will be coming soon,” said Gina Maiola, Ivey’s press secretary, in a statement to APR on Thursday. “Our state’s success is largely in part to Alabamians stepping up to the plate when it comes to cooperating with the mask ordinance.” 

Maiola said Ivey is leading the way on several fronts “including getting students and teachers back in the classroom, college students returning to campus and businesses remaining open — in fact, Alabama has one of the country’s lowest unemployment rates.” 

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“This success is a reality because Alabamians are wearing their masks and maintaining social distancing precautions. Governor Ivey and Dr. Scott Harris will continue closely monitoring our progress and provide an update ahead of the October 2nd expiration,” Maiola continued. 

Speaking to reporters at Auburn, Birx was also asked about a CNN report on Wednesday that cited sources close to Birx as saying she is unhappy with what she sees as her diminished role on the White House coronavirus task force, that she’s not certain how long she can serve in her position and that she is “distressed” with the direction the task force is taking. 

CNN also reported that Birx, who is no longer a fixture at White House coronavirus briefings, views Dr. Scott Atlas, a recent addition to the task force, as an unhealthy influence on President Donald Trump.

Atlas, a neuroradiologist with little experience in public health or epidemiology, has expressed support for the so-called herd immunity “strategy,” which infectious disease expert roundly dismiss as unattainable and a move that would cost millions more lives.  

Instead of being a regular presence at White House coronavirus briefings, Birx has spent recent months traveling the country and speaking with governors and university administrators about coronavirus. 

Asked Thursday about CNN’s reporting, Birx pushed back. 

“Because they wrote that without even speaking to me,” Birx said. “Do I look like a person that’s diminished?” 

CNN reported Wednesday that Birx had not responded to requests for comment on the story. 

“Yes, I have been on the road. I’ve been on the road not as a spokesperson, but on the road to really understand what’s happening across the country, to be in deep dialogue with mayors, with communities, with governors, with administration school and faculty,” Birx said. 

“I’m asked here because I am supposed to be here,” Birx said. “I haven’t been in Washington, and nor was I asked about that, but I’ve actually never been called diminished.” 

Asked if she was planning to leave the task force, Birx said, “I have strong tenacity, and I’m very resilient, and we’re in the middle of a pandemic that’s affecting Americans, and as an American, I think I can do the best service to my country right now by serving in this role, working across the agencies, because that’s the experience that I have.” 

Asked to clarify whether she planned to step down from the task force, Birx said “no.” 

Asked if she was distressed about the direction the task force is taking, Birx said, “well that would be on me, if I was distressed, right, because I’m supposed to be coordinating the groups.” 

“So that would be an indication that I’m not doing my job, and I believe that I do my job pretty well every day. I can always learn to do better,” Birx said.

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Education

Governor announces the Alabama STEM Council

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Gov. Kay Ivey on Monday announced that she has signed Executive Order No. 721 establishing the Alabama STEM Council. The council will advise state leadership on ways to improve STEM-related education, career awareness and workforce development opportunities across the state.

“Alabama has continued to grow into an advanced manufacturing, aerospace engineering and cybertechnology center of excellence and as a result, the demand for qualified labor in these sectors has skyrocketed,” Ivey said. “The Alabama STEM Council will play a vital role in ensuring that our state’s future leaders have the opportunity to learn STEM-based skills that will help them transition into successful career pathways upon graduation.”

Science, technology, engineering and mathematics workers play a key role in the sustained growth and stability of Alabama’s economy. As companies continue to relocate or expand in Alabama, the state must develop an adept workforce that is prepared to adequately meet growing labor demands.

Ivey has appointed Dr. Neil Lamb, vice president for educational outreach at HudsonAlpha Institute for Biotechnology, as chairman of the council.

“Our great state is home to several quality STEM-focused education and workforce initiatives. However, we lack a common system to weave these initiatives together into a network that reaches all learners across the state and expands the workforce pipeline,” Lamb said. “Establishing a statewide Council was a key recommendation from the Governor’s Advisory Council on Excellence on STEM, and I am thrilled to see that recommendation become reality through the Alabama STEM Council.”

State Rep. Terri Collins, R-Decatur, who chairs the House Education Policy Committee, sponsored a bill in the 2020 Regular Legislative Session that sought to create the Alabama STEM Council as an independent state entity within the Alabama Department of Commerce. Although HB293 passed in the house with unanimous consent, it failed to advance in the Alabama Senate due to the COVID-19 pandemic.

“I’m extremely pleased the governor is taking the lead with the Executive Order to form the STEM Council,” Collins said. “Having the math and science experts from Alabama set high quality standards and guiding student growth in achievement will make a positive difference. Thank you, Governor Ivey, for prioritizing education!”

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Deputy Commerce Secretary Ed Castile, who also serves as the director of the Alabama Industrial Development Training Agency, has played a substantial role in the development of the council.

“The state of Alabama is rapidly evolving in science and technology with new job opportunities developing daily that require a STEM education as a basic foundation. So, STEM education is rapidly becoming the new ‘basic education’ that Alabama jobs require,” Castile said. “With new tech companies developing, manufacturing moving to digital ‘smart factories’ and numerous job opportunities that support these businesses, we must have a workforce that will meet the demands.  The STEM Council will be crucial in working with K-12 education as they develop their STEM programs to align with Community Colleges and Universities to assist students move along the STEM pathways needed by our developing businesses. We, in the Department of Commerce are excited to assist with administrative support of the STEM Council and will be a natural link to the business and commerce of our state.”

The council will hold an initial organizational meeting within 90 days after the issuance of this order.

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Members of the council include:

  • Dr. Neil Lamb, Vice President for Educational Outreach, HudsonAlpha Institute for Biotechnology
  • Dr. Charles Nash, University of Alabama System
  • Terry Burkle, Baldwin County Education Foundation
  • Dawn Morrison, Alabama State Department of Education
  • Charisse Stokes, Montgomery Chamber of Commerce
  • Dr. Vicky Karolewics, President, Wallace State Community College
  • Sheila Holt, AMSTI Director, University of Alabama in Huntsville
  • Liz Huntley, Lightfoot, Franklin & White
  • RaSheda Workman, Stillman College
  • Dr. Eric Mackey, State Superintendent of Education
  • Dr. Barbara Cooper, Secretary, Alabama Department of Early Childhood Education
  • Jimmy Baker, Chancellor, Alabama Community College System
  • Dr. Jim Purcell, Executive Director, Alabama Commission on Higher Education
  • Fitzgerald Washington, Secretary, Alabama Department of Labor
  • Greg Canfield, Secretary, Alabama Department of Commerce
  • Tim McCartney, Chairman, Alabama Workforce Council
  • George Clark, President, Manufacture Alabama
  • Dr. Ken Tucker, President, University of West Alabama
  • Dr. Kathryn Lanier, STEM Education Outreach Director, Southern Research
  • Dr. Tina Miller-Way, Dauphin Island Sea Lab
  • Amy Templeton, President and CEO, McWane Science Center
  • Kay Taylor, Director of Education, U.S. Space and Rocket Center
  • Dr. Mary Lou Ewald, Director of Outreach, Auburn University College of Sciences and Mathematics
  • Paul Morin, Alabama SMART Foundation
  • Dr. Adreinne Starks, Founder and CEO, STREAM Innovations
  • Dr. Calvin Briggs, Founder and Director, Southern Center for Broadening Participation in STEM
  • Josh Laney, Director, Alabama Office of Apprenticeship
  • Keith Phillips, Executive Director, Alabama Technology Network
  • Jimmy Hull, Career and Technical Education Director, Alabama State Department of Education
  • Sean Stevens, Career Coach, Alabama State Department of Education
  • Tina Watts, Community Investor, The Boeing Company
  • Daryl Taylor, Vice President and General Manager, Airbus America 
  • K-Rob Thomas, Power Delivery General Manager, Alabama Power 
  • Dr. Lee Meadows, Associate Professor, Department of Curriculum and Instruction, University of Alabama at Birmingham
  • Dr. Tim Wick, Senior Associate Dean, School of Engineering, University of Alabama at Birmingham
  • Dr. Robin McGill, Director of Instruction, Alabama Commission on Higher Education
  • Elisabeth Davis, Assistant Superintendent of the Division of Teaching and Learning, Alabama State Board of Education
  • Dr. Jeff Gray, Professor, Department of Computer Science, University of Alabama
  • Dr. Cynthia McCarty, District 6 Representative, Alabama State Board of Education
  • Dr. Andre Harrison, Vice President, Cognia
  • Brenda Terry, Executive Director, Alabama Mathematics, Science, Technology, and Engineering Coalition for Education
  • Tammy Dunn, Program Director, A+ Education Partnership

A copy of Executive Order No. 721 is available here.

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Governor awards grant to expand court facility dog program

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Gov. Kay Ivey has awarded $1.17 million to continue and expand a statewide program that helps children and others who have been victims of crime feel more at ease when testifying in court or undergoing other crime-related interviews.

The grant to the Alabama Office of Prosecution Services will enable that state agency to continue its facility dog program.

The program uses specially trained dogs to calm traumatized victims when they are called into the courtroom or interview room to recount details of often horrific crimes committed against them.

“I cannot imagine what victims, especially children, have to go through when they are called before strangers to recall what is often a very personal and sensitive tragedy that they have difficulty even relaying to family members,” Ivey said. “This program has proven beyond successful and has been admired and modeled by other states. I am pleased to support its continuation and expansion here in Alabama.”

Facility dogs have been used more than 1,000 times including forensic interviews, court hearings, medical examinations and other case-related matters. The dogs are based in several counties, but according to the Office of Prosecution Services, are available for use throughout the state.   

The Alabama Department of Economic and Community Affairs is administering the grant from funds made available to the state from the U.S. Department of Justice.

“The facility dog program has been vastly successful and well received throughout the state,” said ADECA Director Kenneth Boswell. “Although we would prefer that there would be no reason for this program to even exist, ADECA joins with Gov. Ivey in assisting with its continued success.”

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Ivey notified Barry Matson, executive director of Prosecution Services, that the grant had been approved. 

ADECA administers a wide range of programs that support law enforcement, victim programs, economic development, water resource management, energy conservation and recreation.

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