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Alabama health experts: State is not ready to fully lift stay-at-home restrictions

Chip Brownlee | The Trace

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As Alabama Gov. Kay Ivey is set to announce updates to her stay-at-home order Tuesday, the number of confirmed COVID-19 cases in the state has reached 6,539 with at least 118 new cases reported so far Monday.

Meanwhile, 25 public health experts surveyed by the Alabama Political Reporter say Alabama is not ready to fully or immediately lift the stay-at-home order.

Ivey has faced increasing pressure from conservative Republican lawmakers including Lt. Gov. Will Ainsworth, U.S. Rep. Mo Brooks, State Rep. Will Dismukes, who say the state needs to reopen immediately. Others, including U.S. Rep. Robert Aderholt, U.S. Rep. Terri Sewell and Sen. Doug Jones have said a reopening should be more gradual.  Ivey’s stay-at-home order is set to expire on April 30.

It’s unclear whether the governor will extend the order, alter it, or lift it entirely. It’s also possible the governor will keep a version of the stay-at-home order in place while exempting more business activity.

Of the 27 public health and infectious disease experts at UAB and UAB Health, the University of Alabama Huntsville, and Auburn University who filled out a questionnaire from APR over the weekend, 25 said Alabama needs to keep its stay-at-home order in place until at least May 1.

Combined, the experts surveyed have more than 400 years of experience in epidemiology, infectious diseases, nursing, public health, hospital administration and health policy.

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Twenty of the 27 health professionals said Alabama needs to keep a stay-at-home order in place until at least May 19, the date suggested by the University of Washington’s Institute for Health Metrics and Evaluation. Three said they were not sure. Four disagreed, citing concerns about the economy.

State Health Officer Scott Harris said Monday morning in an interview that the Alabama Department of Public Health and the governor’s office have spent the last week and into Monday discussing the future of the order, but a final decision had not been reached by Monday morning.

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As Ivey prepares to announce the future of stay-at-home restrictions in Alabama, it’s not entirely clear — even to public health officials and infectious diseases experts — whether Alabama has met the gating criteria from the White House, namely a “downward trajectory” of COVID-19 cases over a 14 period. That’s because “downward trajectory” has not been clearly defined.

“They did not specify that,” said State Health Officer Scott Harris. “They left us all to figure that out on our own. You would think that math wouldn’t be subject to speculation, guesswork, but you know, is it has been because of the language they chose to use.”

Alabama saw its largest daily increase in new cases on April 9, when 339 new cases of the virus were reported. The number of new cases declined over the next two days before spiking up again to 321. Then down again for two days before hitting 288 on April 15. Alabama then went six days without a day reporting more than 250 cases. But on April 22, the number rose again to 283 before beginning another gradual decline.

Whether that qualifies as a “downward trajectory” simply because the state hasn’t reached another peak of 300 cases per day is up for debate. But there has not been a consistent decline in new cases per day. Rather, it’s more like peaks and troughs along a line.

“Our numbers have been kind of fairly stable, to be honest with you,” Harris said. “We had one day a few days ago where we were almost at 300 again, and then we’ve had some that are around half that. And basically we are just bouncing on either side of this kind of fairly flat baseline. So I would say we’re kind of stable, at this point.”

We also asked those we surveyed whether Alabama has seen the curve of new infections flatten enough to safely reopen. A majority said no. Nineteen said the rate of new infections has not decreased enough to safely reopen. Another three said they were not sure. Five said the rate of new infections has declined enough to reopen.

Harris said he agreed that there wasn’t a consensus on whether Alabama has met the White House’s gating criteria, but that things do seem to be improving. Alabama is not facing an immediate hospital bed, ventilator or ICU bed shortage. The experts surveyed by APR were divided on whether Alabama has the hospital bed capacity and resources to safely reopen, but a majority agreed that the state’s hospitals do have the capacity to safely reopen.

Because the state seems to have reached a plateau in new cases, that has left some room for reassessing some restrictions, Harris said.

“There’s a lot of ways that we’ve improved,” Harris said. “As far as the risk of opening back up, I think we’re going to get some idea about that as we see. Clearly we can’t stay shut down forever. I think everybody agrees that there needs to be a measured and extremely gradual approach to what we do.”

Such a “gradual” lifting of restrictions, Harris said, may mean an intermediate approach between where Alabama is now — with a full stay-at-home order — and the White House’s phase one reopening, which includes opening restaurants, theaters and other large venues with social-distancing requirements.

“We’ve left grocery stores open and that makes sense, but we’re not ready to have, you know, giant concerts inside of an auditorium right?” Harris said. “So there are different levels of response, and I think we just try to do it gradually and respond. And then if we have to dial back, we dial back. And if we are doing okay, we continue gradually easing restrictions.”

Ivey is expected to announce changes to her public health order Tuesday morning at a press conference.

“People certainly have to work and make a living and we just can’t stay shut down forever,” Harris said. “At the same time, the things that we do have to make sense, and they have to protect our most vulnerable people. … We’re just going to have to have to try to make the best decision we can with the information we have.”

Experts who have spoken with APR over the last several weeks — including the head of the Alabama Hospital Association, infectious diseases experts at UAB and others — have raised the concern that a second wave of infection is likely to emerge if stay-at-home restrictions are lifted too quickly and people do not adhere to social-distancing guidance when they go out.

“Hopefully we don’t lose our guard with this, because we are concerned that we may see a second wave,” said Dr. Rachel Lee, an epidemiologist at UAB. “We have to think through what is safe and what is careful for our family and our community.”

Social distancing, wearing masks in public and good hand hygiene are going to be with us for some time, Lee said.

“The thing that is important about this as we begin to try to understand how best to open things back up, so to speak, is we have to always come back to some key facts about the virus and one is that there’s very little immunity out there,” said Dr. Wesley Willeford, the medical director of diseases control at the Jefferson County Department of Health. “And then we’re still not even 100 percent scientifically sure if a person is indeed protected against reinfection.”

It’s likely that those who have recovered from the virus will have acquired immunity, based on previous experience with coronaviruses like SARS and MERS, but it has not been scientifically proven because the virus has been with us for such a short period of time. On top of that, no one is sure how long that immunity lasts.

“We have a very large population that essentially can be infected with the virus if a person inhales the virus through typical contacts,” Willeford said. “So it’s a very susceptible population of people. We may make it down very low but if we begin to increase the number of interactions that people have, we may see a resurgence in the virus.”

The experts surveyed widely agreed that Alabama has not expanded testing enough to safely reopen the state. Twenty-one of the 27 experts surveyed over the weekend said testing is not widely available enough to effectively contain new infections if restrictions are lifted too soon.

In our interview Monday, Harris said the state is not yet at the point where it can begin testing widely those without symptoms.

“It’s a slow process but we have seen improvement certainly from where we were even a few weeks ago,” Willeford said of testing. “But the question I have is, these are just the cases we know about, so what about all of the cases that we don’t know about?”

Several studies have shown that a large percentage of those who are infected have no symptoms or are able to spread the virus before they develop symptoms.

“I think that’s the hardest part is because if a person says they feel fine or they’re not really having any issues, and they don’t really have the alarm flags to say I need to be evaluated,” Willeford said. “I think that’s the part that we’re going to struggle with the most.”

In the interview Monday, Harris said the state would like to get to 50,000 tests per week, which would give the state the capacity it needs to begin testing asymptomatic and presymptomatic people.

Currently, though, he said Alabama is testing about a thousand people per day between the state’s lab and commercial labs that are reporting their tests. Tests are still being prioritized for those with symptoms severe enough that they need medical treatment, those who have had known exposure, people in long-term care facilities and health care workers. Shortages of needed supplies like reagents, test platforms and swabs have made expanding testing widely difficult.

Eighteen of the 27 said Alabama is not able to perform enough contact tracing to safely reopen. Harris said the state has moved staff from other divisions like tuberculosis and sexually transmitted diseases to focus on COVID-19 contact tracing, but in the future, the department will likely need a division solely dedicated to COVID-19 contact tracing. They’ve already begun recruiting medical students, public health students and others to volunteer to help with contact tracing.

“Long term, we’re going to need a lot more,” Harris said. “It would require more staff on our part. We would like to see if we can find an economic way that we can fully flesh out the numbers that are going to be needed.”

The experts, in comments on our survey, said if stay-at-home restrictions are lifted, it must be made clear that people cannot abandon social-distancing restrictions and good hygiene because the virus is not gone. As long as it remains, the risk of a resurgence remains.

“The virus has still not been eradicated and probably won’t be fully eradicated,” Willeford said. “Even as we begin to relax things, I hope that a lot of the behaviors that we’ve adopted during this time, people will continue to do — being diligent about washing your hands, keeping your distance from people, using non-touch greetings, really trying to do our best to prevent the possibility of spread.”

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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Judge orders Alabama to change voter requirements over COVID-19 concerns

In his 197-page ruling, the judge wrote that “the plaintiffs have proved that their fears are justified.”

Eddie Burkhalter

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(STOCK PHOTO)

A federal judge ruled in favor of plaintiffs in a case challenging aspects of Alabama’s voting requirements amid the COVID-19 pandemic.

U.S. District Judge Abdul Kallon’s Wednesday ruling orders the principal defendant in the lawsuit, Alabama Secretary of State John Merrill, to allow curbside voting, in the counties that choose to do so, but only for the Nov. 3 general election. The judge’s rulings pertain solely to the Nov. 3 election.

Kallon also ordered the state to do away with the requirement for voters to have two witnesses or a notary sign their absentee ballot, if the voter submits a statement that they have an underlying medical condition that puts them at a heightened risk from COVID-19 and thus, they cannot safely get those additional signatures.

In addition, Kallon ruled that voters 65 and older with an underlying medical condition won’t need to submit a copy of a photo ID with their absentee ballot, so long as the voter provides other identifying information, such as their driver’s license number or last four digits of their Social Security number.

In his 197-page ruling, Kallon wrote that “the plaintiffs have proved that their fears are justified” and the voting provisions challenged in the lawsuit “unduly burden the fundamental Constitutional rights of Alabama’s most vulnerable voters and violate federal laws designed to protect America’s most marginalized citizens.”

“That is for three reasons,” the judge continued. “First, because the Challenged Provisions only marginally advance the State’s interests in maintaining them while significantly burdening the right to vote, all three provisions violate the First and Fourteenth Amendments during the pandemic.”

“Second, because the photo ID requirement and the de facto curbside voting ban make voting inaccessible for voters with disabilities, both those provisions violate the Americans with Disabilities Act during the pandemic. Finally, because the witness requirement interacts with Alabama’s history of discriminating against Black citizens to deny Black voters’ their right to vote, that provision violates the Voting Rights Act during the pandemic.”

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The lawsuit, filed by the NAACP Legal Defense and Educational Fund, Southern Poverty Law Center, American Civil Liberties Union, ACLU of Alabama and Alabama Disabilities Advocacy Program, was brought on behalf of several Alabamians with underlying medical conditions.

“This decision is a huge win for Alabama voters, especially voters of color and voters with disabilities,” said Deuel Ross, senior counsel at LDF, in a statement. “Given COVID-19, Alabama’s draconian voting rules needlessly place the health and voting rights of Alabamians in danger. No one should be forced to risk their safety to exercise their constitutional right. State and local election officials have a responsibility to ensure that voting is easy and accessible for everyone in the pandemic.”

Caren Short, senior staff attorney for the SPLC, applauded Wednesday’s decision.

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“Today’s decision provides  crucial relief in Alabama’s absentee voting process, allows for curbside voting in counties that wish to provide it, and ultimately will create a better public health situation in Alabama as it conducts an historic election,” Short said. “We’re deeply hopeful that the secretary of state and county election officials will accept the court’s ruling and begin educating Alabama voters on how they can vote safely and easily for the general election.”

“This ruling recognizes the hardships these laws place on Black Alabamians and those at particular risk for COVID-19. This decision will help to ease those burdens in the midst of this deadly pandemic,” said Davin Rosborough, senior staff attorney with the ACLU’s Voting Rights Project.

Merrill, in a statement to APR after the ruling, said he plans to appeal the verdict, which he likened to “judicial activism.”

“I am extremely disappointed in today’s ruling in the case of People First of Alabama v. Merrill relating to the November 3 General Election. Judge Kallon’s ruling to disallow the Secretary of State from prohibiting an illegal activity known as ‘curbside voting’ undermines the integrity of the elections process and the ability for Alabamians to cast a secret ballot as the chain of custody is then broken,” Merrill said. “It is important to remember that counties are in no way required to offer the illegal activity known as ‘curbside voting.”

Kallon in his ruling noted that “No provision of Alabama law expressly prohibits curbside or drive” but that there’s also no provision in state law allowing for the practice, and that Merrill then believes curbside voting to be illegal. Kallon also wrote that several states do allow for curbside voting, and that the Centers for Disease Control and Prevention recommends states allow curbside voting to comply with social distancing rules and in limiting personal contact during in-person voting.

“In addition, the photo ID and witness requirement components are necessary deterrents for those wishing to illegally influence elections,” Merrill continued. “We look forward to successfully appealing this decision as we continue fighting for safe and secure elections – free from voter fraud and judicial activism.”

Alabama Attorney General Steve Marshall in a statement said he will ask for an appeal of Kallon’s verdict.

“Back in June, the district court in this case enjoined these important protections for the primary runoff.  But the U.S. Supreme Court stepped in, staying that injunction and allowing the State to enforce its laws.  We will ask the 11th U.S. Circuit Court of Appeals and, if necessary, the Supreme Court, to do the same again,” Marshall said. “Voting began weeks ago. And every Alabama voter is entitled to vote under the same laws, not new ones written by a federal court in the middle of voting.”

 

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Gov. Kay Ivey extends statewide mask order, allows limited nursing home visitations

“This mask ordinance is working. It works, and we have evidence of that,” State Health Officer Scott Harris said.

Eddie Burkhalter

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Gov. Kay Ivey held a Coronavirus update Press Conference Wednesday September 30, 2020 in Montgomery, Ala. (Governor's Office/Hal Yeager)

Gov. Kay Ivey on Wednesday extended Alabama’s statewide mask order, citing the upcoming general election and a reduction in the spread of the virus since her order went into effect in July. Ivey’s new order also allows for limited visitations in state nursing homes, and keeps all other previous social distancing restrictions in place.

“I’d hate to see us pull back too quickly and negate the progress that we’ve made in our daily positive numbers and our hospitalization rates by risking another spike due to a false sense of security, the upcoming winter months, the flu season and a host of other reasons,” Ivey said during a press conference Wednesday. 

Ivey said that with the Nov. 3 Election Day nearing “it’s important to have a safe environment where our poll workers poll watchers, and those of us who would like to vote in person.” 

Ivey said that voters aren’t required to wear a mask to vote in person, “I’m certainly going to wear my mask because I want to protect the poll workers and others that are going into the polls as well.” 

via Governor’s Office

Alabama State Health Officer Dr. Scott Harris said state hospitals are caring for about half the number of COVID-19 patients than were hospitalized in late July, during a surge in cases, hospitalizations and deaths, and just before the mask order was issued. 

“This mask ordinance is working. It works, and we have evidence of that,” Harris said. “There have not been any additional restrictions imposed on our state since this Stay at Home order at the end of April.” 

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Harris noted an August study released by the South Carolina Department of Health and Environmental Control that looked at that state’s jurisdictional mask orders, and found that in the 40 percent of jurisdictions that have mask orders COVID-19 cases were reduced by nearly half, compared to an increase in cases by 30 percent in jurisdictions without mask orders.  

White House Coronavirus Task Force Member Dr. Deborah Birx during a visit to Alabama last week urged Ivey to extend the mask order. Birx had praised Ivey’s statewide mask mandate during a previous visit to the state in July, when nine of the first 13 days of that month saw daily case increases in COVID-19 cases statewide of more than 1,000. 

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Ivey’s amended “safer-at-home” order also states that beginning Friday, hospitals and nursing homes shall ensure that each patient or resident can have one caregiver or visitor at a time, with some exceptions. 

Ivey’s order states that the changes are “subject to reasonable restrictions imposed on the entrance of persons because of the COVID-19 county positivity rate, the facility’s COVID-19 status, a patient’s or resident’s COVID-19 status, caregiver/visitor symptoms, lack of adherence to proper infection control practices, or other relevant factors related to the COVID-19 pandemic, consistent with the following guidance from the federal government,” and goes on to list links to Centers for Medicaid and Medicaid Services guidance for the different facilities. 

Ivey said during the Wednesday press conference that none of her previous statewide orders prevented anyone from accompanying a loved one into a hospital, and said despite that, there has been some confusion on the matter. She said her amended order made that fact clear.  

Dr. Don Williamson, president of the Alabama Hospital Association, told The Montgomery Advertiser in June that hospitals have control over visitations. Hospitals statewide have enacted individual varying rules on visitations since the start of the COVID-19 pandemic. 

Harris also discussed the work being done to ready the state for disbursement of a vaccine, if and when one becomes available. Harris said a plan for doing so must be given to the U.S. Department of Health and Human Services by mid-October. 

“Obviously, we’re following very closely the safety data and efficacy data so that we are sure that we have a vaccine product that’s going to be safe and effective,” Harris said. “And I’m confident that information will be available for us, and then we can make a really good decision on that as we start to receive this vaccine.” 

Harris said the supply of a vaccine will initially be limited, and state health officials will have to prioritize disbursement for high-risk people, including health care workers, but that the state will release its plan to do so to ensure openness in the process.

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Alabama ABC Board rescinds alcohol sales curfew

On Tuesday, the Board approved a new order, which notes that the 50 percent occupancy requirement remains in place.

Eddie Burkhalter

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(STOCK PHOTO)

The Alabama Alcoholic Beverage Control Board on Tuesday voted to rescind a previous order that forced bars and restaurants to stop serving alcohol after 11 p.m. The measure went into effect immediately upon their vote. 

Board members on July 27 unanimously voted to enact the 11 p.m. alcohol sales curfew as cases of COVID-19 were surging statewide and Alabama’s ICU beds were filling with patients stricken with the disease.  

On Tuesday, the Board approved a new order, which notes that the 50 percent occupancy requirement remains in place. Customers and workers must also wear masks, if not eating or drinking, and remain six feet from others, according to the order. 

The Board’s decision to rescind the curfew comes as the number of new COVID-19 cases in Alabama have declined following Gov. Kay Ivey’s statewide mask order in mid-July, but public health officials remain concerned that the number of COVID-19 patients in state hospitals remains too high. 

Alabama State Health Officer Dr. Scott Harris told APR on Tuesday that while the state has made improvements since a surge in cases in July, and the number of hospitalized coronavirus patients in Alabama is about half what it was in early August, “they’re still a lot higher than they were back in the spring, so I wish we would continue to see more improvement, but I think we’re definitely much better than we were a couple of months ago.”

Dr. Deborah Birx, the coordinator of the White House’s coronavirus task force, suggested to Ivey and Harris on her July visit to the state that Alabama close its bars, which health officials say can be breeding grounds for the spread of COVID-19. 

One of Ivey’s advisors suggested closing the state’s bars, but the board was instead tasked with finding a different solution, board administrator Mac Gipson told board members during the July 27 meeting prior to the vote to enact the curfew. 

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The plan at first was to cut off alcohol sales at 10 p.m., Gipson said at the July meeting, but bar owners contacted the board over concerns about potential losses in revenue, so it was pushed back to 11 p.m.

Tuscaloosa Mayor Walt Maddox on Saturday issued a warning that tickets would be issued for bars that exceeded the city’s 50 percent occupancy limit. 

Maddox was responding to photos posted to the Facebook page of the band The Velcro Pygmies playing live at the Tuscaloosa bar Rhythm and Brews, where patrons were tightly packed together and not wearing masks. The post was later deleted after going viral. 

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Maddox in August ordered the city’s bars to shut down for two weeks in an effort to slow the spread of COVID-19.

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Governor: Alabama will get 1 million rapid antigen COVID-19 tests

The state is to receive the Abbott Laboratories BinaxNow rapid tests in phases over the next few months. The initial shipment is set to include approximately 96,000 tests. 

Eddie Burkhalter

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Abbott’s BinaxNOW™ COVID-19 Ag Card is highly portable, about the size of a credit card, and doesn’t require added equipment. (VIA ABBOTT)

Gov. Kay Ivey on Tuesday announced that the Trump administration is to send 1 million new rapid COVID-19 tests to Alabama, but the details on their use was still being worked out. 

Ivey’s office announced in a press release that the state is to receive the Abbott Laboratories BinaxNow rapid tests in phases over the next few months, and that the initial shipment is to be of approximately 96,000 tests. 

It was unclear Tuesday who will get the tests or whether the results will be required to be reported to The Alabama Department of Public Health (ADPH), however. In a statement Ivey said while we await a vaccine “providing Alabamians – especially our students and vulnerable citizens – with this free resource will be another critical tool in the toolbox to combat COVID-19.”

Our Office is working in coordination with Public Health as we firm up plans for distribution. We are working to ensure students and high-risk individuals have access to this resource,” said Gina Maiola, Ivey’s press secretary, in a response to APR’s questions Tuesday. 

Questions to ADPH on Tuesday weren’t immediately responded to. 

The U.S. Food and Drug Administration on Aug. 26 gave an emergency use authorization to Abbott laboratories for the rapid antigen tests, which is the first of its kind to require no lab equipment. 

The USDA on Sept. 18 reissued an emergency use declaration, changing wording to say that the tests are to be used “within the first seven days of the onset of symptoms” and that “testing facilities within the United States and its territories are required to report all results to the appropriate public health authorities.” 

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“Studies have shown that antigen levels in some patients who have been symptomatic for more than five days may drop below the limit of detection of the test. This may result in a negative test result, while a more sensitive test, such as RT-PCR, may return a positive result,” the Centers for Disease Control and Prevention said in guidance on the use of antigen tests

The Trump administration approved a $760 million contract with the company to produce about 150 million tests. 

“We’ll ship tens of millions of tests in September, ramping production to 50 million tests a month in October,” Abbott Laboratories said on the company’s website

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Other governors were making similar statements Tuesday about pending Abbott Laboratory tests coming to their states. 

President Donal Trump on Monday announced plans to ship 100 million of the tests to states based upon population. 

“Governors have the flexibility to use these tests as they deem fit, but we strongly encourage governors to utilize them in settings that are uniquely in need of rapid, low-tech, point-of- care tests, like opening and keeping open our K-through-12 schools; supporting critical infrastructure and first responders; responding to outbreak, specifically in certain demographics or locations; and screening of surveillance in congregate settings,” said Adm. Brett Giroir, the U.S. Department of Health and Human Services official in charge of COVID-19 testing for the White House’s coronavirus task force, speaking with Trump from the Rose Garden on Monday. 

The Abbott Laboratories rapid antigen tests, which use a swab and a small card and can provide results within 15 minutes, have some similarities to existing antigen tests now being used across Alabama, which use small machines to provide quick results. 

ADPH has struggled at times to get results from those existing rapid antigen tests, which are often used in non-traditional lab settings, such as nursing homes, universities and urgent care clinics, some of which aren’t accustomed to ADPH’s reporting process. 

Dr. Karen Landers, an assistant state health officer for ADPH, told Kaiser Health News last week that she was concerned about the undercounting of antigen test results, and that some providers were struggling to submit results.

“We can’t afford to miss a case,” Landers told the news outlet.

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