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“Why are we retreating when our caseload is increasing?”: UAB infectious diseases expert

Chip Brownlee

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One of the world’s top infectious diseases experts, doctor and renowned HIV researcher Michael Saag of UAB, sounded shocked when he picked up the phone to talk with me Friday afternoon.

“I don’t know what to say,” Saag said.

Alabama Gov. Kay Ivey on Friday, in a press conference at the State Capitol, announced new changes to her “safer-at-home” order. It’s been a little more than a week since that order took effect on April 30.

“It’s not nearly enough time,” Saag told me, noting that it would take at least two weeks to see any effect in the data from lifting the stay-at-home order. “Oh my goodness. This is exactly what I worried about.”

With the changes Ivey announced Friday, Alabama is joining a handful of Southern states — states with growing outbreaks — in opening restaurants, bars, barbershops, salons and other close-contact businesses that infectious diseases experts like Saag warn are major risks for transmission of COVID-19.

The new order also lifts a 10-person limit on non-work-related gatherings, which could put larger groups of people together, in places like church worship services and other events, raising the risk of spreading the virus. State officials said at least 50 deaths in East Alabama and several hundred confirmed cases were linked, either directly or indirectly, to a church event in March.

Over the last week, Alabama has confirmed more new cases of COVID-19 than during any previous seven-day period since the outbreak began, according to APR‘s analysis of ADPH’s data.

“The premise of the relaxation of the order is that our caseload is decreasing. That really isn’t true,” said Saag, an associate dean for global health at UAB and a pioneer of major antiretroviral therapies now used to treat HIV and other viruses across the world.

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Thursday was the largest single-day increase in newly reported cases since Alabama confirmed its first case of the virus in mid-March.

“Based on what I’m looking at, it’s the highest level we’ve ever had in the state,” Saag said. “So why are we retreating when our caseload is increasing? That’s the first problem.”

Dr. Michael Saag

Part of the increase in new cases could be chalked up to more testing. Alabama is testing far more than in March or early April. A little less than 2.5 percent of the state’s population has been tested.

Though testing has increased over the last three weeks, the amount of new tests being performed per day, based on 7-day averages, has stabilized over the last two weeks, while the number of new cases per day has increased over the last week.

After a decline in the percent of total tests that have returned positive in late April, that number is now ticking back up as well. By Friday, it reached 7 percent, up from 3 percent on April 30.

“Test numbers have been, over the past several days, fairly flat,” said State Health Officer Dr. Scott Harris. “Yet there’s still disease transmission going on at the community level.”

Regardless, increased testing does not explain other worsening metrics — like the state’s death toll and rising hospitalization numbers.

But at least 375 people have died in Alabama. Eighty-six of the deaths were reported in the last seven days.

“You can say we’re testing more, so we’re detecting more,” said Dr. Jeanne Marrazzo, the head of the division of infectious diseases at UAB in a press call on Friday. “And I think that’s definitely part of the explanation, but when we’re still seeing deaths accumulating like that, that means there are significant increases in the rate of infection overall.”

Alabama State Health Officer Dr. Scott Harris said Friday that at least 602 people are currently hospitalized with the virus. That’s up from less than 540 in mid-April, according to newly released data from the Alabama Department of Public Health, though state officials including Harris have said that hospitals, at least for the state as a whole, have not had too much trouble handling the caseload so far.

Harris and Ivey said they are relying on the people of Alabama to take caution and use personal responsibility going forward.

“Because I know how the people of Alabama are responding and paying attention while heeding the good public safety and health warnings, Dr. Harris and I are comfortable that we’ll be able to continue a measured approach,” Ivey said during a press conference Friday. “Let me be crystal clear to the people of Alabama. The threat of this disease continues to be active, and it is deadly.”

But the experts at UAB warned that there just has not been enough time to gather data and assess whether lifting the stay-at-home order has not led to a major increase in transmission.

It takes somewhere between two days and 14 days for symptoms to develop after exposure to someone infected with the virus.

“So, if someone got infected last week, they may not have symptoms right now and therefore won’t turn up for testing,” Saag said. “And then even if they get tested, it can take a day or two to get that result back and then to get reported. So I would have put off any further relaxation of the stay at home order until I had at least two to three weeks of observation and seen the trajectory clearly go down.”

Marrazzo, who has been a member of Ivey’s coronavirus task force, said she was not aware of the changes announced Friday before they were announced, but that throughout the crisis “dialogue has been very good” between health experts and Ivey’s office. She said she believes Ivey is trying to balance public health and the health of the economy.

“The governor is facing immense pressure,” Marrazzo said.

Jefferson County Health Officer Dr. Mark Wilson echoed that, saying he was not envious of Ivey’s position as the person who has to make the call.

“So it’s a balancing act,” Wilson said. “It’s a really tough balancing act. I think I can safely say that this new step that we’re taking does make me nervous. I don’t think there’s any way to avoid that. We have to eventually open business back up. And if it were now or if it were three months from now, I’d still be nervous about it.”

“And that’s why we’re really, really, urging everybody to be very, very careful as we open business,” Wilson said Friday at a press conference.

Dr. Jeanne Marrazzo speaks at a press conference Friday.

But Marrazzo also said that there is clear evidence of “sustained, ongoing transmission” and not enough time has gone by to assess the effects of policy changes.

“There is no question that as long as the number of new cases is rising, we are seeing ongoing sustained community transmission,” Marrazzo said. “Can I forecast what that means for a ‘second wave?’ We know absolutely not enough. The biggest thing to consider about a second wave is going to be how quickly we take away the measures that have been so successful in containing the virus.”

Regardless of whether the number of cases is going up or down, as long as there are new cases being found, loosening restrictions and sending more people back out into the public is likely to increase the rate of community transmission.

How bad the next few months turn out depends on what safeguards people take on their own to prevent becoming infected. Recommendations include wearing a mask, practicing good hand hygiene and staying home when at all possible.

“If everybody just starts acting like it’s a normal summer, then I suspect that we will see a very bad fall ahead, especially as we face the respiratory virus season that we have all the time, which influenza and other related viruses,” Marrazzo said. “Regardless, I don’t feel good about the trends that are occurring right now.”

So far in Alabama, testing has been limited to those with moderate to severe symptoms, people who are hospitalized and at-risk groups like health care workers and long-term care facility residents and employees. Those groups that have had the most access to testing now make up nearly a third of the state’s confirmed cases.

A large percentage of those infected with the virus show no symptoms. Exactly what proportion of those who are infected show no symptoms isn’t clear, but some studies have shown that more than half of people infected with COVID-19 are asymptomatic. Both asymptomatic people and those who are infected but have not yet developed symptoms are still able to infect other people.

“We never really feel like we have an adequate, fully representative assessment of what the disease burden is in the community,” Marrazzo said.

That means that people could return to normal life, not knowing they’re infected and could spread the disease to more people. That’s why wearing masks and following social distancing guidelines is so important. But it’s not clear that will happen.

“As people get tired of following and adhering to these guidelines, and they start to go out, you’re going to see more mixing. You’re going to see more transmission,” Marrazzo said. “And then, as you loosen the guidelines, that’s going to ratchet that up another exponential notch. I think the writing’s on the wall, and, unfortunately, we’re conducting a very big national experiment with a lot of smaller subsets. It’s going to be painful to see how this plays out with differing approaches.”

Both of the experts expressed concern about lifting restrictions in the middle of an upswing in cases — that the stay-at-home orders and social-distancing measures put in place across the country are what have kept the virus at bay.

“Let’s take a worst-case scenario, that the reopening leads to not just a gradual increases in cases, let’s say, by June 1, but a genuine doubling of cases per day compared to what we’re seeing now,” he said. “Then what do we do? We retreat back to a stay-at-home, perhaps?”

Saag said he worries that lifting the restrictions will lead to another potential “surge” in cases, and what that will mean for the economy.

“The fits and starts of implementing stay-at-home and relaxing stay-at-home,” Saag said. “That seems much worse than a more controlled approach where we actually have a concrete plan to replace the stay-at-home order with a more surgical approach, increased testing and contact tracing.”

Saag said he’s all for relaxing restrictions — but under the right circumstances.

“And I don’t sense that we’re doing that right now,” Saag said. “It feels like we’re in too big of a hurry.”

Both experts were very clear that what happens next is not predetermined. If people follow social-distancing suggestions, reliably wear masks and stay at home of their own accord, the virus may not rage out of control. If people take this as a return to normal, it could be much worse.

“No one can predict the future,” Saag said. “But this doesn’t feel like it’s going to have a good outcome.”

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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Governor

Alabama AG warns against nursing homes taking stimulus checks

Eddie Burkhalter

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Alabama’s top law enforcement officer on Friday warned against nursing homes intercepting federal stimulus payments to long-term care residents who are Medicaid recipients, but the state’s Nursing Home Association says it’s not aware that is happening, and it hasn’t been contacted by the Alabama Attorney General’s Office over the matter. 

Alabama Attorney General Steve Marshall in a press release Friday said that federal stimulus checks from the CARES Act cannot be seized by nursing homes to pay for care. 

“We are now beginning to receive a few reports of concern that some Alabama nursing homes may be attempting to take stimulus checks from residents who are Medicaid recipients. If this is happening, it needs to stop now,” Marshall said in a statement. “These stimulus checks are rightfully and legally the property of the residents and must be returned. Confiscation of these checks is unlawful and should be reported to my office.”

Mike Lewis, spokesman for the state Attorney General’s Office, in a message to APR on Friday said that all concerns reported to the office will be reviewed and investigated.

“There have been four such reports thus far,” Lewis said in the message.

Alabama Nursing Home Association President Brandon Farmer in a separate press release Friday said that since the federal government’s announcement of the stimulus payment, the association advised members that any stimulus payment deposited to the accounts of nursing home residents was not to be used to reimburse the facility “and is the sole property of the residents.”

“We urge Attorney General Steve Marshall to let us know if he has any reports of diversion of residents’ stimulus payments so that we may clarify any misunderstanding that may exist,” Farmer said. “At this time, we are unaware of any facility where such diversion is occurring.

Farmer said the association has encouraged Marshall to contact them any time he has a concern about nursing homes, or has information he wants to pass along to our members.

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“As we have done throughout this pandemic, we stand ready to work with local, state and federal leaders to support Alabama’s nursing home residents and employees,” Farmer said.

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Legislators briefed on coronavirus crisis

Brandon Moseley and Nicole Jones

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Alabama Gov. Kay Ivey and her team on Thursday briefed state legislators on the latest developments on the coronavirus crisis that has gripped the state for the last ten weeks.

State Public Health Officer Dr. Scott Harris told legislators that the state has 13,058 confirmed cases of coronavirus infection. 528 Alabamians have died from COVID-19 COVID-19 related. More than 250 of those deaths have occurred in nursing homes.

Harris said, “So far, we have been able to fulfill all requests for medication in hospitals.”

Kelly Butler is the Alabama State Finance Director.

“The department is working diligently with each entity to provide aid/reimbursement throughout the state to responsibly use the CARES Act funding,” Butler said.

Butler said that new guidelines that the federal government issued regarding the funding are extremely detailed. Legislators will be given a special form to provide input as to what category or entity they see has the greatest need. Counties and cities will be issued guidelines to know what they can and cannot apply for regarding reimbursements.

Butler said that a website is being worked on to provide updates regarding applying for funds. For now, this information can be found on the governor’s website.

Department of Senior Services Commissioner Jean Brown also addressed legislators. Brown said that GA Foods has placed a successful bid with the Farmers to Families program. The Farmers to Families foods will be sending free foods to Alabama. The delivery of meals will begin after Memorial Day and end on June 30.

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Alabama Department of Corrections Commissioner Jeff Dunn told legislators that 100,000 masks and 2,500 gowns have been produced by ADOC textile factory workers. The staff and inmates have been provided at least 4 masks for their protection. Inmates have also received individual bottles of soap and hand sanitizer provided thanks to community support.

Dunn said that as of May 20, 138 inmates have been tested for the coronavirus, with nine testing positive. One of those inmates has died due to a pre-existing health condition. The other eight have recovered. Each person that has tested positive has been properly quarantined.

Alabama Department of Labor Secretary Fitzgerald Washington briefed the group as well.

Washington said that more than $1 billion has been paid out in unemployment claims and that the department has processed 88 percent of COVID-19 related claims. Washington said that ADOL has paid out more in total benefits in the last three months than in the previous six years combined.

Washington said that unpaid claims are being looked at daily. Over 500,000 claims were filed in the last two months, more than the last two years combined.

Washington said that guidelines relating to issues such as “employees refusing to return to work when applicable” or “employee quits job instead of returning to work” may be addressed on the DOL website.

Washington warned that fraud claims and online scammers acting as ADOL online are happening and that citizens should be aware of such and report any fraudulent activity to ADOL immediately.

State Superintendent Dr. Erick Mackey addressed the group on the plans for the Alabama State Department of Education.

Mackey said that immediate guidance for reopening schools in June will soon be distributed. This would be for students in 7th grade and above. Students 6th grade and below will be able to attend school beginning in July.

Mackey said that the CDC guidelines that were released on Tuesday have not been adopted by ALSDE. Mackey said that some of these guidelines are not reasonable or doable in our state.

CDC issues new guidelines for schools reopening

“There are many moving parts to creating new procedures, etc., so please understand we are taking into consideration that not one size fits all,” Mackey said. “Our local schools will be making the final decisions as to what procedures are put in place for reopening.”

“We hope to issue recommendations to our schools by 19 June regarding reopening for the 2020-2021 school year,” Mackey told legislators. “We will be asking parents and students to implement new safety procedures, but these will be practical and easy to do.”

“We will leave the start date entirely up to each local superintendent,” Mackey continued. “We have asked that they assure they have time to prepare and adjust to the new procedures prior to opening.”

Mackey said that as of now, all school systems will be starting at some point in August. Distance learning for at-risk children is being looked at and there will be some sort of options for those needing this. Special Needs students needing therapies, etc. are also being looked at heavily.

“There are many moving parts to reopening, so we are working diligently to keep every student and every situation in mind,” Mackey said.

Later that afternoon, Ivey held a press conference to unveil the amended Safer At Home Order, which goes into effect at 5 p.m. today. The new orders, which opens many more businesses, will be in effect through 3 July.

 

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Ainsworth applauds Ivey for opening more businesses

Brandon Moseley

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Lt. Gov. Will Ainsworth released a statement applauding Thursday’s revised public health order that allows for the reopening of educational institutions, entertainment venues, youth sports, summer camps and other activities with proper enforcement of sanitation and social distancing

“I applaud Gov. Kay Ivey and State Public Health Officer Scott Harris for taking yet another step toward fully reopening businesses and putting Alabama’s economy back on the right track,” Ainsworth said. “After months of patient quarantining and with summertime fast approaching, reopening youth sports, movie theaters, bowling alleys, and other activities will provide both parents and children with much needed entertainment.”

“Allowing campuses to operate gives students of all ages the opportunity to resume their education and continue job training, which is especially important in this economic climate,” Ainsworth continued. “But all of this must be done with proper sanitation, social distancing, and safety measures firmly in place.”

“Now that the worst threat of COVID-19 is behind us, Alabama can more fully focus on restoring old jobs and creating new ones, helping small businesses thrive once again, and rebuilding history’s greatest economy even better than it was before,” Ainsworth concluded.

Trump national campaign committee member former State Representative Perry O. Hooper Jr. similarly praised Ivey for her leadership and her decision to reopen more of the Alabama economy particularly athletic facilities on high school and junior high campuses for offseason football conditioning programs.

“We are very fortunate to have Donald J Trump as our Commander in Chief during this unprecedented time of crisis and Kay Ivey at the helm in Alabama,” Hooper said in a statement. “She showed true leadership once again today at her press conference. She is listening to her task force on re-opening Alabama and the states medical experts. She is developing a plan tailored to the unique needs of Alabama.”

“President Trump and Governor Ivey have worked hard to create the most dynamic economy in Alabama History,” Hooper continued. “We must have it up and running again as soon as possible in a safe responsible manner. I trust, and the President trusts, Kay Ivey to do just that.”

Hooper quoted President Calvin Coolidge: “After all, the chief business of the American people is business. They are profoundly concerned with producing, buying, selling, investing and prospering in the world.” “This is as true today as it ever was,” Hooper said. “This is what makes the United States the greatest country in the World.”

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Ivey continues to caution Alabamians that it is safer for them to shelter in their homes whenever possible, especially for Alabamians who are susceptible to a bad outcome from the virus: older Americans, the obese, diabetics, those with asthma, those with heart conditions, and those who are immune-compromised. Protecting ourselves and others requires adherence to the social distancing protocols.

“It takes all of us being vigilant and adhering to the social distancing to slow the spread of the coronavirus,” Ivey said in her press conference. “This disease is deadly and is not something to taken lightly. Things aren’t back to normal and frankly we do not know what the new normal looks like.”

“As we go back to work don’t forget we must continue to practice social distancing, refrain from hoarding food and other supplies, and continue to lend our fellow Alabamians a helping hand,” Hooper said. “Together we will make Alabama businesses and American made companies great again.”

96,363 Americans have perished since Feb. 27 due to COVID-19.

 

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Education

Governor announces Secretary Jeana Ross to retire

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Gov. Kay Ivey on Thursday announced that Jeana Ross is retiring as secretary of the Alabama Department of Early Childhood Education. She has served in this position since 2012.

“I am extremely grateful for Secretary Ross’ tireless efforts and dedication to our children,” Ivey said. “On behalf of our state, she deserves a ‘job well done’ for her work in expanding voluntary, high-quality pre-K to all 67 counties. She is leaving the Department of Early Childhood Education with a great legacy, and we thank her for her service.”

Under Ross’s leadership, the department has received national recognition for their work. For the 14th consecutive year, Alabama leads the nation in providing the highest quality early learning experiences for four-year-old children.

Ross and her team have grown the nation’s highest quality pre-K program by more than 470 percent: from 217 classrooms in 2012 to 1,250 classrooms located in all 67 counties of the state in 2020.

“It has been an honor and a privilege to serve as Alabama’s secretary of Early Childhood Education for the past eight years,” Ross said. “I appreciate Governor Ivey’s leadership and commitment to our efforts in ensuring as many children possible have access to a strong education foundation. For 14 years, Alabama’s program has ranked No.1 and serves as a model of excellence in early learning, and I am grateful to be a part of this achievement.”

In retirement, Ross will remain in Alabama and plans to consult for the Harvard Graduate School of Education and the Saul Zaentz Charitable Foundation as part of their efforts to promote the importance of early learning throughout the United States.

Ivey is appointing Dr. Trellis Smith to serve as acting secretary until Ross’ replacement is named. Smith has been employed with ADECE for 19 years, currently serving as the Alabama Head Start collaboration director.

She holds a bachelor’s and master’s degree in Family and Child Development from Auburn University and a doctorate in Child and Family Development from the University of Georgia.

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Her appointment is effective June 1, 2020.

 

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