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

Chip Brownlee

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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.

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 political reporter, online content manager and webmaster at the Alabama Political Reporter. You can email him at [email protected] or reach him via Twitter.

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Fauci calls on governors in states with surging cases to issue mask orders

As COVID-19 deaths in Alabama passed 1,000 on Tuesday, Dr. Anthony Fauci called on governors to issue face mask orders to slow the spread of the virus.

Eddie Burkhalter

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Dr. Anthony Fauci speaks during a video press conference with Sen. Doug Jones, D-Alabama.

As COVID-19 deaths in Alabama passed 1,000 on Tuesday, a member of the White House’s coronavirus task force called on governors to issue face mask orders to slow the spread of the virus.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases and a member of the White House’s coronavirus task force, when asked by APR whether he’d like to see governors in states with surging cases institute statewide orders to wear masks, said yes.

“I do believe a statewide mask order is important because there is a variability in people taking seriously or even understanding the benefit of masks,” Fauci said during a press conference, hosted by U.S. Sen. Doug Jones, D-Alabama on Tuesday. “Masks make a difference. It is one of the primary fundamental tools we have.”

Alabama Gov. Kay Ivey on June 30 extended her “safer-at-home” order until July 31, but declined to institute any further mandates despite surging new cases and hospitalizations.

Fauci also said that social distancing and the closure of bars are important to communities looking to slow the spread.

“Fundamental things like masking, distancing, washing hands, closing bars — if you do that, I think it will be a giant step toward interfering with the spread in your community,” Fauci said.

At least 1,007 people have died statewide from COVID-19, according to the Alabama Department of Public Health.

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New daily COVID-19 cases in Alabama dipped below 900 for the first time in six days, but just barely, with 888 new cases on Tuesday. Thirty-one percent of the state’s total confirmed cases have come within the last two weeks.

Alabama’s hospitals on Monday were caring for more COVID-19 patients than at any time since the pandemic began.

UAB Hospital had 86 coronavirus patients on Monday, the highest the hospital had seen. Huntsville Hospital had 72 COVID-19 patients on Monday, and the surge in cases prompted the hospital to cancel elective surgeries and convert three surgical floors to COVID-19 care, according to AL.com.

At East Alabama Medical Center in Opelika there were 41 COVID-19 patients on Monday, which was the highest the hospital has seen in weeks and not far from the hospital’s peak of 54 patients on April 11.

The average age of those becoming infected with coronavirus has dropped by 15 years since the beginning of the pandemic, Fauci said, which has lowered the overall death rate due to the virus, as younger people usually fair better, but not if that young person has an underlying medical condition.

“We are now getting multiple examples of young people who are getting sick, getting hospitalized and some of them even requiring intensive care,” Fauci said, adding that even those young people who have coronavirus but are asymptomatic can spread the virus to others, who may be more compromised.

Fauci warned against pointing to the overall declining death rate and becoming lax about coronavirus, and said that “it’s a false narrative to take comfort in a lower rate of death.”

“There’s so many other things that are very dangerous and bad about this virus. Don’t get yourself into false complacency,” Fauci said.

Dr. Don Williamson, president of the Alabama Hospital Association, told APR on Monday that it may take several weeks to learn whether the increasing number of those hospitalized in Alabama will worsen and require ICUs and ventilators, and possibly lead to a rise in deaths.

“We just don’t know yet. We don’t know which way we’re going to go,” Williamson said Monday. “We just know we got a whole lot more cases than we had a month ago, and we’ve got a lot more hospitalizations than we had a month ago.”

Asked about his thoughts on the state of the virus in Alabama, Fauci said that what’s alarming is the slope of the curve of new daily cases.

“When you see a slope that goes up like that you’ve got to be careful that you don’t get into what’s called an exponential phase, where every day it can even double, or more,” Fauci said. “You’re not there yet, so you have an opportunity, a window to get your arms around this, and to prevent it from getting worse.”

Speaking on what’s become the politicization of the wearing of face masks, Fauci said that politicization of any public health matter has negative consequences. President Donald Trump does not wear face masks in public, prompting concern from many that by doing so he’s suggesting to the public that masks aren’t needed. The issue is divided rather sharply along partisan lines.

In a recent Quinnipiac University poll, two-thirds of voters, 67 percent, said Trump should wear a face mask when he is out in public, but while 90 percent of Democrats and 66 percent of independents say the president should wear a mask in public, just 38 percent of Republicans said the same.

“I mean, obviously today, it’s no secret to anybody who lives in the United States that we have a great deal of polarization in our country, unfortunately,” Fauci said. “We hope that changes, but there’s no place for that when you’re making public health recommendations, analysis of data, or any policies that are made. That will always be a detriment to do that.”

 

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Governor awards $18 million for COVID-19 testing in nursing homes

Eddie Burkhalter

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Gov. Kay Ivey on Tuesday awarded $18.27 million of federal COVID-19 relief money to the Alabama Nursing Home Association Education Foundation for coronavirus testing and surveillance in the state’s nursing homes.  The Coronavirus Relief Fund money is to be used to test and monitor both nursing home staff and residents, according to a press release from Ivey’s office Tuesday.

“During the pandemic, it is critical we take care of our seniors and most vulnerable residents,” Ivey said in a statement. “Some of our largest outbreaks of COVID-19 were within nursing homes, and we must do everything possible to contain the spread within their walls. Protecting these vital members of the community, as well as the dedicated staff who take care of them, is precisely the intent of the Coronavirus Relief Fund.”

The $18.27 million for testing in nursing homes comes from Alabama’s approximately $1.9 billion in federal Coronavirus Aid, Relief, and Economic Security Act funds.

“I am extremely grateful to Governor Kay Ivey and her administration for supporting the ongoing testing of residents and staff in our facilities,” said Brandon Farmer, president and CEO of the Alabama Nursing Home Association, in a statement. “This virus is not like anything we’ve ever seen and has hit our nursing homes and staff exceptionally hard. I am relieved to know we will have assistance to contain the spread of this virus and hopefully be able to eliminate it from our nursing homes.”

John Matson, communications director for the Alabama Nursing Home Association, told APR by phone Tuesday that testing for COVID-19 has been a financial burden on nursing homes “and this will go a long way in helping cover that and relieve that strain that our members are experiencing.”

There’s already been a great deal of testing among staff and residents across Alabama’s nursing homes, and the federal aid will only increase that testing and ensure that the cost of future tests will be reimbursed, Matson said. The organization continues to work out details of a plan to implement the testing and surveillance, and once those plans are ready the association will reach out to all nursing homes statewide to communicate that information, he said.

The nonprofit Alabama Nursing Home Association Education Foundation, is to provide a testing strategy and screening protocols and administer the federal aid, according to the release.

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There had been 1,794 confirmed COVID-19 cases among residents in Alabama nursing homes as of June 21, the latest data made available by the Centers for Medicare and Medicaid Services.

Of those cases, 336 residents have died, according to the federal agency.

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COVID-19 testing delays becoming a concern for nursing homes: survey

Fifty-six percent of nursing homes and assisted living communities report that lab processing was the top barrier for access to testing.

Brandon Moseley

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A woman is tested for an infection. (Stock photo)

A recent survey conducted by the American Health Care Association and National Center for Assisted Living of its members shows that the amount of time it is taking labs to process COVID-19 tests of staff at nursing homes and assisted living communities is becoming a major concern for providers.

Fifty-six percent of nursing homes and assisted living communities report that lab processing was the top barrier for access to testing. This is the top issue now in access to testing, followed by the cost of the testing as the second major barrier.

Eighty-seven percent of nursing homes and assisted living communities report that obtaining test results back from the lab companies is taking two days or longer, and 63 percent of them report that it is taking two to four days — while nearly a quarter report getting the results in five days or more.

Studies Harvard Medical School and Brown University show that the level of infection in the community surrounding a nursing home is the top precursor to an outbreak at a facility, which can quickly turn deadly.

The number of COVID-19 cases in Alabama is continuing to rise. 14,705 Alabamians have tested positive for the coronavirus in the past two weeks and the percentage of positive tests has nearly doubled since May to 14 percent.

As the number of cases in the communities surrounding our nursing homes soar, the threat of bringing the coronavirus into the nursing homes continues to rise. These new survey results on testing are very concerning. The longer the amount of time to process tests of nursing home and assisted living residents and staff the more delayed the response and the increased likelihood of spread within the facility.

“The amount of time it is taking to receive testing results is hurting the ability of long term facilities to fight the virus,” said Mark Parkinson, the president and CEO of the American Health Care Association and National Center for Assisted Living. “Regular testing of nursing home and assisted living staff is a vital step in controlling the spread of COVID-19, but is not effective without obtaining timely test results. For nursing homes and assisted living communities to protect residents and staff, we need on-site testing with reliable and rapid results. With a recent uptick in COVID-19 cases among the general population, we are concerned labs will get overwhelmed and receiving results for long term care residents and staff will take even longer to obtain.”

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As of Monday, there have been 2,627 residents of Alabama long-term care facilities who have tested positive for the novel strain of the coronavirus. Additionally, 1,696 employees of Alabama’s long-term care facilities have tested positive for the virus.

The elderly are especially susceptible to poor outcomes from COVID-19. At least 770, or 78 percent, of the COVID-19 deaths in Alabama have been among persons aged 65 and over; 167, or 17 percent, of Alabama’s COVID-19 deaths have been among ages 50 to 64.

Just 43, or 4 percent, of the dead are aged 25 to 49. Only two of Alabama’s COVID-19 deaths have been between the ages of 24 and 5. Two Alabama children less than age 5 have died from COVID-19.

America remains in the grip of the coronavirus global pandemic. At least 50,588 Americans tested positive on Monday, including 925 Alabamians. 132,979 Americans, including 984 Alabamians, have died in the global pandemic that began in Wuhan City, Hubei Province, China late in 2019.

Alabama remains under a Safer at Home order through July 31. Citizens are advised to wash hands frequently, don’t hug or shake hands with anyone, avoid close contact with the sick even in your home, wear a mask or cloth face covering when out in public, practice social distancing, avoid crowds, and stay home whenever possible.

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Madison County mask order goes into effect Tuesday

Eddie Burkhalter

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Studies have shown that wearing masks reduces transmission of coronavirus.

Madison County’s health officer issued a face mask order to slow the spread of COVID-19, which goes into effect Tuesday at 5 p.m. 

Madison County Health Officer Dr. Karen Landers, who also serves as the assistant state health officer, issued the order, which requires those over the age of 2 to wear masks in businesses or venues open to the public, while on public transportation, in outdoor areas open to the public where 10 or more people are gathered and where maintaining 6 feet of distance from others is not possible. 

“We need to do all we can to limit the spread of COVID-19,” State Health Officer Dr. Scott Harris said in a statement. “Until we have a vaccine or treatment for COVID-19, wearing a face covering in public is a key measure we have available to prevent transmission of the virus.”

Huntsville Mayor Tommy Battle in a statement expressed support for the mask order. Madison County now joins Jefferson County, Montgomery, Mobile and Selma in requiring masks while in public. 

“This is a simple math problem. Since June 16, the number of positive cases in Madison County has tripled, and the number of hospitalizations has increased 660 percent,” Battle said in the statement. “We need to take precautionary measures, such as wearing face covers, distancing 6 feet, and handwashing to provide a safe environment for our citizens.” ​​

Madison Mayor Paul Finley also noted the surging cases and said he supports the order. 

“Since day one, we as elected officials have said we would work to find the balance of personal versus economic health. While personal responsibility is still paramount, our dramatic rising numbers dictate this step be taken to continue to support all citizens’ safety,” Finley said in a statement. 

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Medical experts believe COVID-19 is most often spread when an infected person, with or without symptoms, talks, coughs or sneezes. Studies have shown that wearing masks reduces transmission of coronavirus.

Other exceptions to Madison County’s mask order include:

  • Persons while eating or drinking.
  • Patients in examination rooms of medical offices, dental offices, clinics or hospitals where their examination of the mouth or nasal area is necessary.
  • Customers receiving haircare services, temporary removal of face coverings when needed to provide haircare.
  • Occasions when wearing a face covering poses a significant mental or physical health, safety or security risk. These include worksite risks.
  • Indoor athletic facilities. Patrons are not required to wear face coverings while actively participating in permitted athletic activities, but employees in regular interaction with patrons are required to wear face coverings or masks.
  • Private clubs and gatherings not open to the public and where a consistent 6-foot distance between persons from different households is maintained.

“Although not mandated, face coverings are strongly recommended for congregants at worship services and for situations where people from different households are unable to or unlikely to maintain a distance of 6 feet from each other,” the department said in a statement on the order.

This is a simple math problem. Since June 16, the number of positive cases in Madison County has tripled, and the number of hospitalizations has increased 660 percent."

Parents must ensure children over 2 years old wear masks in public, and childcare establishments and schools are to develop their face covering policies and procedures, according to the department.

The order also mandates that businesses and venues open to the public provide a notice stating that face coverings are required inside, and signage is required at all public entrances. 

“Wearing a face covering can help keep family, co-workers, and community safe,” Harris said. “This is the simplest act of kindness you can take for yourself, your family and your community, especially for those who are at high risk of contracting the virus.”

The Alabama Department of Public Health advises these actions to prevent the spread of COVID-19:

  • Wash your hands frequently with soap and water for 20 seconds
  • Social distance by staying 6 feet away from others
  • Avoid people who are sick
  • Stay home if you can; work remotely if possible
  • Cover your mouth and nose with a face covering when around others
  • Cover coughs and sneezes
  • Clean and disinfect frequently touched surfaces
  • Monitor your health

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