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Alabama reports largest single-day increase in new COVID-19 cases

Chip Brownlee

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Alabama reported nearly 2,000 new COVID-19 cases over the last seven days — the highest number of new reported cases over a seven-day period since the outbreak began. Thursday also showed the largest single-day increase in new reported cases.

The increase comes as the governor is coming under increasing pressure from business groups and Republican state lawmakers to lift more of the state’s public health restrictions and “reopen” the economy.

Using a seven-day rolling average, Alabama is now reporting more cases per day than at any point since the state confirmed its first case on March 13. Over the last seven days, the average number of new cases per day was 283.

The highest the seven-day rolling average has gotten before Thursday was 257 on April 13. The seven-day rolling average had decreased to 181 by April 30, its lowest point since early April, before beginning its current rise.

Compared to April 30, the seven-day average — a key metric used by public health officials to monitor the outbreak — has risen by 56 percent from 181 cases per day, on average, to 283.

The seven-day average is considered a better metric for measuring daily case growth and assessing trends than day-by-day increases because labs have inconsistent reporting times.

“One day to the next is not the best way to look at it,” said State Health Officer Dr. Scott Harris in an interview with APR. The Alabama Department of Public Health also uses three- and 14-day averages when assessing COVID-19.

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Harris told APR that the rise in new cases over the last week has been concerning.

“We’re still working out why that is,” Harris said. “I mean, obviously, one possibility is we just have more disease, and we’re trying to figure out if that could be the case.”

Another possibility is that the state is performing more tests, causing the number of cases found to be higher than at previous points in the outbreak. As of Thursday afternoon, at least 116,319 people — or 2.37 percent of the state’s population — have been tested.

Of course, it would be ideal if the number of tests was increasing and the number of new cases continued its decline. That would be a clear sign that transmission of the virus in Alabama has slowed. Instead, the reality may be more of a mixed bag, with both more transmission and more testing contributing to the rise in new cases.

“There are two possible explanations, and it might be some combination of those two things,” Harris said.

In Alabama, even as the number of tests performed has increased, testing has remained largely limited to symptomatic cases and those in high-risk groups like health care workers and long-term care facility residents and employees. As of Thursday, about 31 percent of the state’s positive cases were among those three groups.

Other metrics can be helpful to understand how the virus is spreading. One is the percent of total tests that are positive, dubbed the “positivity rate.”

Determining the percent of tests that are positive has been difficult for Alabama, Harris said, because it has been difficult to get private commercial labs to report their negative test results consistently if at all, skewing the denominator of total tests.

Earlier in the pandemic, fewer commercial labs consistently reported their negatives, meaning that the positivity rate could have been artificially higher earlier in the pandemic because the state wasn’t capturing all the negative tests being performed. The positivity rate was as high as 23 percent on April 12, in part because the state was not capturing all negatives.

To get an accurate “positivity rate” you need all tests — not just the positive ones.

Harris said he is confident that over the last few weeks that the state has started capturing nearly all negative tests performed by labs, making it possible to calculate a somewhat reliable positivity rate.

Based on our analysis, using seven-day averages, the positivity rate in Alabama got as low as 3 percent on April 30, before starting an increase again.

We used seven-day averages to calculate positivity rates here, too, for the same reasons given above. There have been a number of days when the state reported no change to the total number of tests performed, but hundreds of new positives. And other days when the state reported 9,000 or 18,000 new tests and less than 200 new cases.

Again, smoothing out the data over seven days paints a more accurate picture.

The rise in new cases comes as the number of hospitalizations in the state has remained stubbornly higher than public health officials would like, Harris said, though hospital capacity statewide has not been exceeded. Some hospitals, including East Alabama Medical Center in Opelika, have had trouble dealing with the surge in COVID-19 patients at earlier points in the outbreak.

The Alabama Department of Public Health has not regularly published the current number of hospitalizations, instead opting for a cumulative total number of hospitalizations. That number lags behind, too, because epidemiologists gather that data through contacting each positive case, which takes time.

The Alabama Incident Management System provides a current number of hospitalizations, but it is not perfect, in part because Alabama is one of two states without a statewide hospital discharge database.

Hospitals voluntarily report the number of confirmed and suspected COVID-19 inpatients in their facilities. Many do not report on weekends, so that number fluctuates, too.

But AIMs is the best bet at providing a more accurate assessment of the current number of people in hospitals in Alabama. Most hospitals are complying with the Department of Public Health’s request that they input that data daily — if not multiple times a day.

Harris told APR that 568 people are currently hospitalized with a confirmed case of COVID-19 in Alabama, as of Thursday morning, according to the AIMS data. On April 6, the last time Harris provided APR with current hospitalization data, the number was 255.

“We’ve been at 400 or 500 quite a bit, and at one point, we got over 600,” Harris said, “that was a few days ago.”

As of Thursday afternoon, at least 1,118 people have been hospitalized in Alabama since March 13. At least 450, or 38 percent, have been treated in intensive care units. At least 266, or 22 percent of hospitalizations, have been placed on mechanical ventilators.

“We do continue to track ICU beds and ventilators and total beds and total inpatients,” Harris said. “We have adequate capacity right now. But we still have fairly high numbers of patients, or at least fairly stable numbers, of inpatients around the state. Most hospitals are doing fine handling that but you know that number has not decreased much if at all.”

The rise in new cases since April 30 could be a temporary blip, or it could be the start of another new peak in confirmed cases. It’s too early to tell. But public health experts have said to expect a rise in new infections once stay-at-home restrictions are lifted.

It’s also too soon to tell if lifting the stay-at-home order on April 30 has contributed to increased community transmission of the virus. While the new upward trend began just after Gov. Kay Ivey lifted her statewide stay-at-home order on April 30, that’s unlikely to be the cause of the increase in new cases reported over the past seven days.

Not enough time has gone by for the results of that decision to show up in the data. It generally takes two weeks for new transmissions to show up as a positive case in data because of the virus’s incubation period and testing delays.

As the state continues its ease back toward normalcy, with many people returning to work, the rise in cases is assuredly cause for concern. If the virus is still widespread, the rate of transmission could increase rapidly as people return to more normal activity.

Even as a number of restrictions remain in place, cell phone location data from Google shows that travel patterns are also trending upward from their lowest points in mid-April — and began rising before Ivey announced on April 28 that she would lift her stay-at-home order on April 30.

Cell phone location data analyzed by the University of Maryland shows a similar pattern. As of May 1, the percentage of people in Alabama who are staying at home is the lowest its been since March 16.

Meanwhile, the governor and the Alabama Department of Public Health are reviewing recommendations received this week from the state’s coronavirus task force and other groups about what policies should replace the current safer-at-home order, which expires May 15.

“I know that she’s got a lot of things to consider,” Harris said in an interview with APR. “What we do is just try to review all the recommendations to give her the best science we have as far as the implications of different things, and if we move forward, how do we do that safely?”

Rep. Will Dismukes, Lt. Gov. Will Ainsworth and a host of other GOP lawmakers have been calling on Ivey to fully reopen the economy immediately. “It’s past time,” Ainsworth has repeatedly said.

“I think everybody agrees that you can’t stay locked down forever, and you’ve got to have some return of normalcy, except there’s got to be a lot of safeguards in place and there’s got to be a lot of protection, especially for vulnerable people,” Harris said. “So we’re continuing to review that again and discuss that with her staff.”

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Health

Birmingham’s mask ordinance to expire Friday

Eddie Burkhalter

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Birmingham’s ordinance requiring citizens to wear masks while in public is set to expire Friday. 

Birmingham Mayor Randall Woodfin in a statement Tuesday cautioned the public against letting their guard down, however, and said despite the expiration of the ordinance, the public should continue to wear masks while out to help prevent the spread of coronavirus. 

“The City of Birmingham implemented the mandatory face covering ordinance as an additional level of protection as the state began the phased re-opening process. I want to thank the people of Birmingham for following the law. The ordinance raised the level of awareness to the importance of wearing a face covering when in public and within six feet of other people,” Woodfin said in the statement. “While the ordinance is set to expire on Friday, we must not let our guard down. Public health leaders say covering your nose and mouth is a critical tool to help reduce the spread of coronavirus. I urge everyone to keep social distancing, wear face coverings in public, and do what you can to limit the spread.” 

City employees and guests to city facilities will still be required to wear face coverings after the ordinance expires Friday, according to Woodfin’s statement.

The Birmingham City Council, with one dissenting vote, approved the ordinance on April 28  requiring the wearing of masks while in public, which went into effect May 1. Failure to comply with the ordinance could result in a fine of up to $500 and/or 30 days in city jail. Failure to comply with the ordinance could result in a fine of up to $500 and/or 30 days in city jail. 

The ordinance had been set to expire May 15, but City Council members later agreed to extend the measure until May 29. 

The Birmingham City Council’s decision to require the wearing of masks came after Gov. Kay Ivey replaced her “stay-at-home” order with a less restrictive “safer-at-home” order, which allowed some businesses to reopen with social-distancing restrictions.

The number of new confirmed cases of coronavirus across Alabama last week was higher than during any other week since the pandemic began and increase faster than in 46 other states and the District of Columbia, according to an APR analysis of data from The COVID Tracking Project.

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The Centers for Disease Control and Prevention recommends that, because of the virus’s approximately two-week incubation period when a person could have coronavirus but show no symptoms, people should practice social distancing by keeping 6 feet from others and wear face masks while in public.

Doing so not only helps protect the wearer of the mask, but also all those around them. 

“It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus,” the CDC’s website states.  “CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.”

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Guest Columnists

Opinion | With COVID-19 policy, don’t blame your umbrella. The rain got you wet

Monica S. Aswani, DrPH, and Ellen Eaton, M.D.

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Monica S. Aswani, DrPH, is an assistant professor of health services administration and Ellen Eaton, M.D., is an assistant professor of infectious diseases.

Editor’s note: The opinions expressed in this perspective are those of the authors.


As states re-open for business, many governors cite the devastating impact of physical distancing policies on local and state economies. Concerns have reached a fever pitch. Many Americans believe the risk of restrictive policies limiting business and social events outweighs the benefit of containing the spread of COVID-19.

But the proposed solution to bolster the economy — re-opening businesses, restaurants and even athletic events — does not address the source of the problem.

A closer look at the origins of our economic distress reminds us that it is COVID-19, not shelter-in-place policy, that is the real culprit. And until we have real solutions to this devastating illness, the threat of economic fallout persists.

Hastily transitioning from stay-at-home to safer-at-home policy is akin to throwing away your umbrella because you are not getting wet.

The novelty of this virus means there are limited strategies to prevent or treat it. Since humans have no immunity to it, and to date, there are no approved vaccines and only limited treatments, we need to leverage the one major tool at our disposal currently: public health practices including physical distancing, hand-washing and masks.

As early hot spots like New York experienced alarming death tolls, states in the Midwest and South benefited from their lessons learned.

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Indeed, following aggressive mandates around physical distancing, the number of cases and hospitalizations observed across the U.S. were initially lower than projected. Similarly, the use of masks has been associated with a reduction in cases globally.

As the death toll surpasses 100,000, the U.S. is reeling from COVID-19 morbidity and mortality. In addition, the U.S. has turned its attention to “hot spots” in Southern states that have an older, sicker and poorer population. And to date, minority and impoverished patients bear the brunt of COVID-19 in the South.

Following the first COVID-19 case in Alabama on March 13, the state has experienced 14,730 confirmed cases, 1,629 hospitalizations and 562 deaths, according to health department data as of Monday afternoon.

Rural areas face an impossible task as many lack a robust health care infrastructure to contend with outbreaks, especially in the wake of recent hospital closures. And severe weather events like tornadoes threaten to divert scarce resources to competing emergencies.

Because public health interventions are the only effective way to limit the spread of COVID-19, all but essential businesses were shuttered in many states. State governments are struggling to process the revenue shortfalls and record surge in unemployment claims that have resulted.

The Coronavirus Aid, Relief and Economic Security Act, or CARES Act, allocated $150 billion to state governments, with a minimum of $1.25 billion per state. Because the funds were distributed according to population size, 21 states with smaller populations received the minimum of $1.25 billion.

Although states with larger populations, such as Alabama and Louisiana, received higher appropriations in absolute terms, they received less in relative terms given their COVID-19 related medical and financial strain: the CARES Act appropriations do not align resources with state need.

As unemployment trust funds rapidly deplete, these states have a perverse incentive to reopen the economy.

Unemployment claimants who do not return to work due to COVID-19 fears, per the Alabama Department of Labor, can be disqualified from benefits, perpetuating the myth of welfare fraud to vilify those in need.

The United States Department of Labor also emphasized that unemployment fraud is a “top priority” in guidance to states recently.

Prematurely opening the economy before a sustained decline in transmission is likely to refuel the pandemic and, therefore, prolong the recession. Moreover, it compromises the health of those who rely most heavily on public benefits to safely stay home and flatten the curve.

Some would counter this is precisely why we should reopen — for the most vulnerable, who were disproportionately impacted by stay-at-home orders.

The sad reality, however, is that long-standing barriers for vulnerable workers in access to health care, paid sick leave and social mobility pre-date this crisis and persist. And we know that many vulnerable Americans work on the frontlines of foodservice and health care support where the risk from COVID-19 is heightened.

A return to the status quo without addressing this systemic disadvantage will only perpetuate, rather than improve, these unjust social and economic conditions.

COVID-19 has exposed vulnerabilities in our state and nation, and re-opening businesses will not provide a simple solution to our complex economic problems.

No one would toss out their umbrella after several sunny days so why should America abandon public health measures now? After all, rain is unpredictable and inevitable just like the current COVID-19 crisis.

The threat of COVID-19 resurgence will persist until we have effective preventive and treatment options for this novel infectious disease.

So let’s not blame or, worse, discard the umbrella. Instead, peek out cautiously, survey the sky and start planning now to protect the vulnerable, who will be the first to get wet.

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Health

New COVID cases in Alabama increasing faster than 46 other states

Chip Brownlee

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Alabama reported more cases of COVID-19 last week than any other week since the pandemic began, and the increase in new cases reported last week compared to the previous week was higher than 46 other states and the District of Columbia.

An analysis of data collected by The COVID Tracking Project, a volunteer-run effort to track the pandemic, shows that only West Virginia, Maine and South Carolina reported a larger increase in new cases last week compared to the new cases they reported in the previous week.

According to The COVID Tracking Project’s data, Alabama recorded 2,556 new cases during the week ending Sunday, May 24, compared to 1,994 new cases during the previous week ending Sunday, May 17.  That’s an increase of 28 percent.

The Alabama Department of Public Health’s daily case totals show an increase of 17 percent last week over the previous week, which is still higher than 38 other states, according to the analysis performed on The COVID Tracking Project’s data.

COVID Tracking Project has a standardized method of capturing each state’s new cases from health departments, making it possible to compare the trajectories of each state. Twenty-four states and the District of Columbia saw new cases decline last week, while 25 states saw new cases increase last week compared to the previous week.

Compared to other states, testing showed no similar increase. The number of new tests reported in Alabama last week only grew 2 percent compared to the previous week, according to the COVID Tracking Project’s data. That’s lower than 31 other states.

APR‘s data showed an increase of 13 percent over the previous week, but that is still a smaller increase than 25 other states. Both our data and an analysis of The COVIDTracking Project’s data show the percent of total tests that are positive rose last week compared to the previous week.

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The Alabama Department of Public Health does not provide historical data for how many tests were performed on each day. Both APR and the COVID Tracking Project calculate test increases by tracking the change to the cumulative total of tests performed.

Several other Southern states also saw rising cases and no similar increase to tests performed. In Mississippi, new cases rose by 9 percent last week compared to the previous week while tests per week fell by 21 percent. In Tennessee, new cases rose 15 percent while tests per week declined 8 percent.

Georgia saw new cases rise 21 percent, but tests also rose by 22 percent. Florida, South Carolina and North Carolina also reported both rising cases and more tests compared to the previous week.

Cases have been rising in Alabama since the beginning of the month. Testing has also increased, and public health officials, including State Health Officer Dr. Harris, have said they are not sure if the increase in cases is directly attributable to more tests or more disease.

Some areas of the state, like Madison County and Lee County, have seen little or no rise in new cases, while others, like Montgomery County and Tuscaloosa County, are experiencing worsening outbreaks.

Gov. Kay Ivey lifted the state’s stay-at-home order on April 30 and has since relaxed restrictions twice more, saying the economics of the pandemic must be addressed. The state reported an unemployment rate of 12.9 percent last week, higher than during any point during the Great Recession.

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Economy

Talladega will hold GEICO 500 on June 21 without fans in the stands

Brandon Moseley

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The National Association for Stock Car Auto Racing (NASCAR) has announced that the GEICO 500, MoneyLion 300 and General Tire 200 automobile races have all been rescheduled for the weekend of June 20 to 21.

They will be raced without fans in attendance.

“We are excited that NASCAR has announced the rescheduling of our April race weekend to June 20-21,” said Talladega Superspeedway President Brian Crichton. “While we will have cars on track, in the interest of the health and safety of all involved, including fans, NASCAR will be running our three races – the GEICO 500, MoneyLion 300 and General Tire 200 – without fans in attendance in accordance with the State of Alabama, CDC and public health agency standards and protocols.”

The Cup Series GEICO 500 will be held on Sunday, June at 2:00 pm CST.

The Xfinity series MoneyLion 300 will be held on Saturday, June 20 at 4:30 pm CST.

The ARCA series General Tire 200 will be held on Saturday, June 20, 2020 at 1:00 pm CST.

“NASCAR, like Talladega Superspeedway, prides itself in being fan-friendly, and the fans drive everything we do,” Crichton said. “The decision to race without fans is focused on the long-term health of you and our sport. NASCAR has a great respect for the responsibility that comes with a return to competition, and after thorough collaboration with public officials, medical experts and state and federal officials, NASCAR has implemented a comprehensive plan to ensure the health and safety of the competitors and surrounding communities.”

“For our June 20-21 events, we hope you will enjoy watching and listening to the 3- and 4-wide racing at the sport’s Biggest and Most Competitive track via our broadcast partners FOX, FS1 and MRN Radio,” Crichton concluded. “We will persevere through this together.”

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Ticketholders may elect to receive a credit for the full amount paid plus an additional 20 percent of total amount paid to apply towards a future event, including, but not limited to, grandstand seating, infield, camping, fan hospitality, and Talladega Garage Experience. The 120 percemt event credit can be used in a single transaction during the remainder of the 2020 season and entire 2021 season for a NASCAR sanctioned event at any NASCAR-owned track, subject to availability. Elections for an event credit or refund must be submitted by June 14, 2020.
Ticketholders may apply here:
https://www.talladegasuperspeedway.com/Vanity-Pages/2020/Assistance.aspx

Motorsports are the only major pro sports league that has resumed play after the coronavirus global pandemic struck in mid-March. The NBA is considering a proposal to playout the remainder of their season and playoffs sequestered at the Wide World of Sports complex at Disneyworld in Orlando, Florida with no fans present. The NHL is in the process of considering a similar proposal to finish this year’s hockey season. Major League Baseball has not played a single game of their season yet. MLB owners have made a proposal that the league play an 80 game season without fans present. The idea is meeting with skepticism from MLB players due to a controversial proposal capping players salaries for this season in a 50:50 revenue sharing agreement. The proposal that would dramatically reduce MLB players’ salaries for this season. Horse racing and mixed martial arts have held some sporting events in recent weeks.

NASCAR has already held two races at Darlington and one at Charlotte after resuming racing on May 17. Kevin Harvik won the Real Heroes 400 driving a Ford and Denny Hamlin won the Toyota 500 driving a Toyota in the first two Cup Series races since NASCAR resumed racing after a ten week hiatus. NASCAR intends to run a 36 race season this year.

Motorsports are the only major professional sports league played at a major league level in the state of Alabama. In addition to the Talladega Superspeedway, the state is also home to the Barber Motorsports Parks near Leeds. The Barber facility hosts both professional motorcycle racing and the Honda Indy Grand Prix of Alabama, a NTT Indycar series event. That event was cancelled due to efforts to shut down the economy to fight the spread of the coronavirus.

The COVID-19 global pandemic has already killed 98,705 Americans through Sunday morning.

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