The COVID-19 model that has been widely cited by officials in Alabama and the White House’s coronavirus task force has been updated again, delivering a dire new projection that Alabama could see an eight-fold increase to its death toll by August and a new peak by late June or early July.
But for Alabama, in particular, the model has a wide range of uncertainty.
Previous iterations of the modeling from the University of Washington’s Institute for Health Metrics and Evaluation have projected a total death toll for Alabama as high as 7,500 before being revised downward several times to as low as 294 in the model’s April 29 revision. Every model has had a wide range of uncertainty.
Alabama, and the United States, have blown past the model’s most recent average projections. Alabama reached 298 deaths Monday, a death toll not projected to be reached until August, according to the model. IHME now estimates that Alabama could see 2,308 deaths by August, which is nearly eight times the previous estimate.
“The revised projections reflect rising mobility in most US states as well as the easing of social distancing measures expected in 31 states by May 11, indicating that growing contacts among people will promote transmission of the coronavirus,” the institute said in a statement. “Increases in testing and contact tracing, along with warming seasonal temperatures – factors that could help slow transmission – do not offset rising mobility, thereby fueling a significant increase in projected deaths.”
The White House frequently cited the IHME model, and officials in Alabama have said the model has been helpful in determining when the state could see peak resource usage and hospitalizations.
The national death toll has also surpassed the death toll projected by the iteration of model released on April 17, when it estimated 60,308 deaths by August. Nationwide, more than 60,000 people have already died from COVID-19, according to The New York Times and Johns Hopkins University. The model now estimates a death toll twice that of its previous version — 135,000 deaths in the United States by August.
IHME, in documentation explaining the changes to the model, lists Alabama as one of twelve states with significant changes to the average projected total death toll. Alabama doesn’t have the largest absolute adjustment but relative to previous projections, Alabama has one of the most significant increases.
Other states with significant adjustments include Georgia, Florida, Indiana, Illinois, California and Texas.
“This new model is the basis for the sobering new estimate of U.S. deaths,” said Dr. Chris Murray, the director of IHME. “The model will allow for regular updating as new data are released on cases, hospitalizations, deaths, testing, and mobility. It can also be used to identify what may be the trajectory to progressively relax social distancing while still limiting the risk of large-scale resurgence.”
IHME cites Alabama as one of twelve states with really significant changes to the (average) projected total death toll.
Alabama doesn't have the largest absolute adjustment, but the new projected death toll is about 8x that of the April 29 projection. pic.twitter.com/GZ0v8CW99y
— Chip Brownlee (@ByChipBrownlee) May 5, 2020
The model’s projections for Alabama have varied wildly over the past month and a half, and the uncertainty in the model for Alabama’s projected death toll is still massive and is one of the larger ranges of uncertainty for any state.
Based on this update to the model, Alabama could have as few as 479 or as many as 11,264 deaths by August 1, but the model’s average projection is 2,308. But it is not the only model that projects a worsening crisis.
An internal Trump administration model — developed by the Federal Emergency Management Agency and obtained by the New York Times — also projects a steady rise in the number of deaths over the next months. President Donald Trump has also revised his own personal estimate of the death toll, saying Sunday that the U.S. could reach 100,000 deaths, twice as many as he forecast two weeks ago.
What led to the change in the IHME model? The updated modeling now takes into account cell phone mobility data and easing of social distancing measures — as well as the observed death toll, which has exceeded previous projections. The other is an update to the model that now estimates longer projected peaks and slower downward trajectories.
“Based on the latest available data and updated models, most of these states are currently experiencing or have yet to experience their epidemic peaks – all of which appear to be lasting longer and declining more slowly after their peaks,” the modelers wrote in their update notes. “Further, for a subset of states, the easing of social distancing policies has begun and mobility patterns are on the rise (or even started increasing before easing actions occurred).”
Alabama is listed as one of the states that has seen a marked increase in travel based on cell phone location data from Google, Facebook and other sources — even before Gov. Kay Ivey lifted her stay-at-home order last week.
“At the same time, many states are seeing mobility rise now – and these increases appear to have begun even before policies were eased,” the modelers wrote. “These patterns have been observed in Alabama, Florida, Georgia, Idaho, Louisiana, Minnesota, Montana, and Texas, among others.”
Ivey’s new “safer-at-home” is a more measured and conservative reopening than the reopening plans announced in neighboring Georgia and Tennessee, where restaurants have been allowed to reopen. But public health experts have warned that any easing of social-distancing restrictions is sure to lead to increased rates of transmission of the virus. Dramatic increases in testing and contact-tracing, public health experts have told APR, are needed to stave off a worsening situation.
State Health Officer Scott Harris and Gov. Kay Ivey, when announcing their decision to lift some restrictions last week, said Alabama had not met the White House’s gating criteria of two weeks of declining new cases but that a modest reopening was still in order.
“We are just bouncing on either side of this kind of fairly flat baseline,” Harris said in an interview with APR the day before announcing the new safer-at-home order. “So I would say we’re kind of stable, at this point.”
Harris told APR last week and NBC’s Meet the Press Sunday that Alabama could “dial back” easing of restrictions if the situation worsens.
“So there are different levels of response, and I think we just try to do it gradually and respond,” Harris said. “And then if we have to dial back, we dial back. And if we are doing okay, we continue gradually easing restrictions.”
On average, Alabama has reported 10 new deaths per day for the past seven days. As of May 4, 298 people in Alabama have died from COVID-19. That’s an increase of 70 new deaths since April 27. At least 8,112 people have tested positive. On average, 225 new cases per day have been reported over the last seven days.
We are tracking all of the latest data and trends on our data and mapping dashboard.
Coronavirus task force’s Dr. Deborah Birx says Alabama should extend statewide mask order
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.
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.”
“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.
UAB doctor urges public get flu vaccine as COVID-19 continues to spread
As the flu season nears, Alabama health care providers are encouraging the public to get flu vaccines to prevent stressing hospitals, which continue to care for COVID-19 patients.
“We just are really encouraging everyone to go ahead and get vaccinated,” said Dr. Erin DeLaney, assistant professor in the department of family and community medicine at UAB’s School of Medicine, speaking to reporters on Thursday.
DeLaney said physicians are encouraging flu vaccinations, regular hand washing and social distancing because they’re not sure what flu and COVID could look like together.
“We know that there are other respiratory pathogens that together, combined with the influenza virus, can have poor outcomes,” DeLaney said. “And we know that the flu and COVID separately can have poor outcomes, so we’re hoping to protect as many people as we can.”
DeLaney also discussed what will likely be the challenge for the public in attempting to determine whether they have the flu or COVID-19, which would prompt them to seek coronavirus testing.
“Unfortunately, coronavirus and influenza, they will share a lot of the same symptoms,” DeLaney said. “The only thing that’s going to be completely different would be the loss of sense of taste and smell, is specific to COVID.”
DeLaney said the medical community will have to rely on testing to determine between a case of influenza or COVID-19, and recommended that if a person isn’t able to get a coronavirus test they should assume they have COVID-19 and self-quarantine for 14 days.
Taking a clue from areas of the world that have already seen the start of the flu season, DeLaney said it appears that the spread of flu in those areas has been lighter this year, most likely because of what’s being done to protect people from COVID-19, including the wearing of masks, social distancing and regularly washing hands.
“We are hopeful that would also be our same experience as we enter our flu season — that if people are vigilant with COVID that it would protect us from not only the flu but other respiratory pathogens as well,” DeLaney said.
Speaking about the upcoming Halloween holiday, DeLaney said if families decide to go door-to-door with their children, eager for candy, masks should be worn. Masks that come with costumes do not provide protection, however, and DeLaney said they don’t recommend placing cloth masks over costume masks either. Medical providers are encouraging kids to wear Halloween-themed cloth masks instead.
The Centers for Disease Control and Prevention encourages families giving out candy on Halloween not to put the candy in a bowl for children to reach into, but instead suggest placing candy into separate bags and to place the bags outside the home.
She also recommended other outdoor activities in lieu of door-to-door candy gathering.
“So an outdoor pumpkin carving. Playing some Halloween music outside or having different types of activities where people are not going to be gathering closely, or not all touching the same things, would be ideal,” DeLaney said.
There have been 148,206 confirmed cases of COVID-19 in Alabama as of Thursday, when the state added 1,052 new cases, according to the Alabama Department of Public Health. As of Thursday, 2,506 people have died in Alabama from COVID-19, 18 of which were added on Thursday.
Alabama declines to release COVID-19 data associated with child care centers
APR has asked for that data and whether ADPH was aware of the number of cases associated with child care centers statewide.
It was unclear Tuesday the number of confirmed cases of COVID-19 there have been among staff, children and relatives associated with child care facilities in Alabama, because the Alabama Department of Public Health declined to release that data.
“All cases of COVID-19 are required to be reported to the Alabama Department of Public Health under notifiable disease laws. ADPH is aware of cases in entities such as child care but does not report separately from other data,” said Dr. Karen Landers, assistant state health officer, in a message to APR on Tuesday.
APR has asked for that data and whether ADPH was aware of the number of cases associated with child care centers statewide.
Landers noted that ADPH does provide the percentage of cases among age ranges, however. There had been approximately 2,628 confirmed COVID-19 cases among Alabama children 4-years-old and younger as of Monday, according to ADPH’s dashboard, but the department doesn’t specify which of those cases are associated with child care centers, and it was unclear how many cases there have been among relatives or workers connected to child care centers.
While children 10-years-old and older can efficiently transmit COVID-19 to others, the Centers for Disease Control and Prevention in a recent report note that “limited data are available on SARS-CoV-2 transmission from young children, particularly in child care settings.”
The Sept, 18 CDC report looked at three COVID-19 outbreaks in child care facilities in Salt Lake County, Utah, during April 1 through July 10, and found that the 12 children who contracted the disease spread it to at least 12 others outside the centers, and one parent was hospitalized with coronavirus.
In one facility, researchers confirmed five cases among workers and two among children. One of those children, aged 8 months, transmitted COVID-19 to both parents, the report notes. Many of the children had mild symptoms or none at all, researchers found.
“COVID-19 is less severe in children than it is in adults, but children can still play a role in transmission,” the report reads. “The infected children exposed at these three facilities had mild to no symptoms. Two of three asymptomatic children likely transmitted SARS-CoV-2 to their parents and possibly to their teachers.”
While Alabama’s Department of Public Health isn’t releasing data on cases associated with child care centers, many other states are, including Texas, South Carolina, North Carolina, California, Minnesota and Massachusetts.
There have been 332 confirmed cases, two deaths and 14 separate outbreaks associated with child care centers in North Carolina, according to the North Carolina Department of Health and Human Services.
Health officials in California’s Sonoma County traced 30 cases of coronavirus to one child at a child-care center in the county, where 16 students, 11 relatives and three workers tested positive, according to The Los Angeles Times. In addition to that outbreak, there have been 62 other cases at 13 child-care facilities in the county, including 27 family members, 10 workers and 25 students, with 381 cases of children younger than 17 still under investigation, the newspaper reported on Sept. 21.
Reopening child care centers can be done safely, according to an Aug. 28 report by the Centers for Disease Control and Prevention, which that found that in Rhode Island, which reopened child care centers on June 1, there were just 52 confirmed and probable cases among staff, children and relatives across 29 centers between June 1 and July 31.
The report noted that Rhode Island at first limited centers to 12 or fewer students, required staff and students to not move between groups in centers and “universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines.”
Alabama State Health Officer Dr. Scott Harris on March 19 issued an order closing child care centers through April 5, with exceptions for facilities that provided services to first responders and other workers deemed essential. Harris on March 27 issued a supplemental order allowing centers that cared for 11 or fewer children to reopen.
The Alabama Department of Public Health on Monday published a press release touting the number of open child care centers across Alabama. According to the department, 76 percent of all child care facilities in Alabama are open.
“Alabama is well on our way to reopening the necessary number of child care facilities to enable parents to return to work and resume a more normal schedule,” said Alabama DHR commissioner Nancy Buckner, in a statement. “This is the sixth survey we have conducted and each one has shown tremendous growth in the numbers of open facilities. We have worked hard to encourage child care providers to open by providing support in the form of grants and supplies.”
Asked whether the department is aware of the number of COVID-19 cases among children, staff or relatives associated with child care centers, a DHR spokesperson responded in a message to APR on Monday that “We don’t track that.”
While child care plays a critical role for working parents across the country, the pandemic and subsequent shutdowns have put a strain on the businesses, according to a July 13 study by the National Association for the Education of Young Children, which surveyed more than 5,000 child care facilities in every state.
Among the child care centers surveyed, two out of five said they would have to close without more public assistance, while half of the minority-owned centers said they have to close without more aid, according to the report. A quarter of child care workers said they’d applied for or received unemployment benefits, and 73 percent of centers said they have or will begin laying off workers and/or make pay cuts.
An Aug. 26 study by the Washington D.C.-based nonprofit Bipartisan Policy Center found that 32 percent of parents polled said their child care centers were closed, 14 percent of them permanently, and 22 percent of the parents said they could not return to work in person without childcare.
Even when child care is available to parents, many are worried about sending their children back while COVID-19 continues to spread. Of those asked, 77 percent of parents said they were concerned that sending their kids back would increase the risk of exposing their family to COVID-19.
SPLC report: Despite COVID-19 deaths, Alabama isn’t releasing older, at-risk inmates
A report by the Southern Poverty Law Center published Tuesday found that almost 200 older state inmates, at greater risk from COVID-19, were eligible for parole, but either had no hearing or were denied parole over the summer.
Alabama’s three-member Board of Pardons and Paroles denied parole for 44 people who were 65 and older over the summer, SPLC’s report states, and a dozen of the more than 1,100 older inmates identified in a previous SPLC report have since died, either from COVID-19 or other illnesses.
“Despite confirming the deaths, it remains unclear whether the cause could have been COVID-19 as ADOC would not provide information about those individuals in response to a public records request, citing ongoing internal investigations,” the report reads.
The SPLC and several other criminal justice reform groups urged the Alabama Department of Corrections and the Alabama Bureau of Pardons and Paroles to take steps to release at-risk inmates as the coronavirus pandemic began, through medical parole, medical furloughs and judicial sentence reviews, but to date, no such larger push to release inmates has taken place.
According to ADOC, 22 inmates have died after testing positive for COVID-19.
SPLC’s report notes that many of the inmates who died had underlying health conditions, which were well known to prison officials.
The Parole Board denied parole to more than three dozen inmates 65 or older since restarting parole hearings in May, according to the report.
“The BPP stopped paroles starting in March, against the demands of activists and legislators who pointed out that hearings could be done virtually. Hundreds of scheduled parole hearings were cancelled. After its hiatus, the BPP scheduled relatively few hearings throughout the summer compared to years past,” authors of the report wrote.