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“We’re not out of the first wave yet:” Alabama’s chief medical officer

Chip Brownlee | The Trace

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Alabama’s chief medical officer said Wednesday the Department of Public Health needs more resources and staff to be able to handle the current wave of COVID-19 and prepare for what could come next.

“I don’t know how long we’re going to be here, as far as in this role, but we’ve been told to expect a second wave. We’re not out of the first wave, yet,” said chief medical officer Dr. Mary McIntyre, one of the state’s top public health officials. “That in itself is scary, and we’ve got people unfortunately retiring. So we need to be able to replace them but also hire additional people to be able to continue to do this and the next thing that comes up.”

Supply chain disruptions, a lack of supplies needed for testing, not enough resources and limited staff are hampering the Alabama Department of Public Health’s ability to expand the testing and contact tracing efforts needed to bring COVID-19 under control, she said.

“Despite what you’ve all heard from the federal level, the ability to even now get the reagents that we need continues to be hit and miss,”  she said. “We will have reagents within the state lab, and then there will be issues. We get an order, and we may get enough to test for a day and a half.”

The difficulty in obtaining reagents — the substances used to perform tests for COVID-19 in the state’s lab — has made it impossible for the state to consistently up its testing capacity even as the number of cases in the state continues to rise.

“We actually speed up the processes to be able to do them quickly, and then we have to drop back to a manual process in order to wait for the reagents to come in,” McIntyre said.

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Over the last week, the state has reported more deaths from COVID-19 than at any point prior. Hospitalizations remain high and more new cases have been confirmed per day over the last week than during what was expected to be the peak in mid-April.

“The numbers continue to climb,” McIntyre said. “The numbers are not decreasing. Our numbers continue to go up.”

Private commercial labs and clinical labs like UAB have been able to boost testing across the state, but they have faced the same shortages of needed supplies to varying degrees. Even with boosted testing capacity from private labs, the number of tests performed per day is still far below the levels recommended by the Harvard Global Health Institue, public health experts at UAB’s School of Public Health and others.

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Supply shortages of chemical reagents, personal protective equipment, viral transport media and swabs needed to collect samples and perform tests have been persistent since the pandemic arrived in Alabama in March. McIntyre said some shortages have improved, but reagents remain an issue.

“We can get the swabs. We can get the ice pack packs and the kits for people to be able to ship us this stuff,” McIntyre said. “What we can’t get and that we’re still running into issues with is the reagents.”

It’s been an issue not just for Alabama, but across the country, even as President Donald Trump has routinely claimed that the United States has the best track record for testing.

The federal government’s early response and lack thereof contributed to the slow rollout of testing in Alabama, where still less than 2.8 percent of the state’s population has been tested even as the number of tests performed has increased over the last few weeks.

“We couldn’t get swabs. It took us three weeks to get swabs within the state,” McIntyre said. “We called everybody. We were calling the federal government. We were calling on every vendor we could think of, but the vendors had been told not to sell to the states. And basically the federal government was pulling those swabs.”

The lack of support from the federal government and the persistent supply chain problems forced the state’s lab to develop its own reagents and viral transport media, the materials used to transport test samples from collection sites to labs, but that process took time, money and people that could have been working on other things.

“If you’ve looked at anything with the numbers with staffing, we over the years have gone down,” McIntyre said of cuts to the Department of Public Health’s staff and funding. “This has proved to be very challenging from the standpoint of being able to do what it is we do. The staff, our employees, when I say they have gone over and beyond. They worked 16-hour days or more. They worked seven days a week.”

Now the department faces an even more unprecedented challenge without having fully solved the issue of testing: hiring hundreds of contact tracers to help find, question and isolate positive cases to avoid more widespread transmission. As cases continue to rise, that means even more staff will be needed to isolate the cases.

“We do need several hundred more to assist with just trying to get to people and explain to them how to protect themselves,” McIntyre said of hiring more staff to perform contact tracing. “We really need to be doing contact tracing more, we’re doing it with the staff we have, but we’re not doing it as timely as we want to do it.”

Finding and isolating cases quickly is as important as doing it at all. Peak transmission can occur in the first few days of infection before a person realizes they have the virus or before they develop any symptoms if they ever do.

With adequate staff, the health department would be able to quickly identify positive cases, call them, find out who they’ve been in contact with, and warn those people to get a test and isolate before they unwittingly spread the virus further.

With limited staff, carrying out that process quickly enough to make a real impact has been difficult.

UAB’s Dr. Mike Saag, an expert in infectious diseases, said Wednesday that to perform effective contact tracing will first require an adequate level of testing, which he said the state has not reached yet.

“Then we can identify the people who have been in their local environment in the 24 hours especially before they got symptoms,” Saag said of the urgency of testing and contact tracing quickly. “Why? Because during that 24 hours is when the peak amount of transmission happens.”

Such a testing and contact tracing system is becoming even more important as the state shifts back into more normal economic activity with businesses and restaurants reopening and several school systems announcing plans for in-person graduation ceremonies.

“Someone can be totally asymptomatic and they feel great,” Saag said. “And they’ll sit, and they’ll be spewing a lot of virus into the environment.”

Without adequate testing, including testing of those without symptoms, Saag said the state is reopening too quickly.

“Without knowing who’s infected, we’re basically flying into this epidemic blind or worse,” Saag said, noting that a high proportion of cases never develop symptoms. “We’re flying into the fog blind. And we’re not going to be able to know where we are, or how we’re going to land the plane without information, and the best information we can get right now to see what’s going on is testing.”

For the past two months, testing has been limited to those who are hospitalized and those who are showing moderate to severe symptoms of the virus.

Just recently, the Department of Public Health began encouraging testing asymptomatic people in high-risk groups like nursing home residents and those with underlying health issues.

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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Vaccines should protect against mutated strains of coronavirus

Public health experts say it will be some time before vaccines are available to the wider public.

Eddie Burkhalter

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(STOCK PHOTO)

Multiple vaccines for COVID-19 are in clinical trials, and one has already applied for emergency use authorization, but how good will those vaccines be against a mutating coronavirus? A UAB doctor says they’ll do just fine. 

Dr. Rachael Lee, UAB’s hospital epidemiologist, told reporters earlier this week that there have been small genetic mutations in COVID-19. What researchers are seeing in the virus here is slightly different than what’s seen in the virus in China, she said. 

“But luckily the way that these vaccines have been created, specifically the mRNA vaccines, is an area that is the same for all of these viruses,” Lee said, referring to the new type of vaccine known as mRNA, which uses genetic material, rather than a weakened or inactive germ, to trigger an immune response. 

The U.S. Food And Drug Administration is to review the drug company Pfizer’s vaccine on Dec. 10. Pfizer’s vaccine is an mRNA vaccine, as is a vaccine produced by the drug maker Moderna, which is expected to also soon apply for emergency use approval. 

“I think that is incredibly good news, that even though we may see some slight mutations,  we should have a vaccine that should cover all of those different mutations,” Lee said. 

Researchers at the University of North Carolina at Chapel Hill and the University of Wisconsin-Madison found in a recent study, published in the journal Science, that COVID-19 has mutated in ways that make it spread much more easily, but the mutation may also make it more susceptible to vaccines. 

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In a separate study, researchers with the Commonwealth Scientific and Industrial Research Organisation found that while most vaccines were modeled after an earlier strain of COVID-19, they found no evidence that the vaccines wouldn’t provide the same immunity response for the new, more dominant strain. 

“This brings the world one step closer to a safe and effective vaccine to protect people and save lives,” said CSIRO chief executive Dr. Larry Marshall, according to Science Daily

While it may not be long before vaccines begin to be shipped to states, public health experts warn it will be some time before vaccines are available to the wider public. Scarce supplies at first will be allocated for those at greatest risk, including health care workers who are regularly exposed to coronavirus patients, and the elderly and ill. 

Alabama State Health Officer Dr. Scott Harris, speaking to APR last week, urged the public to continue wearing masks and practicing social distancing for many more months, as the department works to make the vaccines more widely available.

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“Just because the first shots are rolling out doesn’t mean it’s time to stop doing everything we’ve been trying to get people to do for months. It’s not going to be widely available for a little while,” Harris said.

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Alabama hospitals nearing COVID-19 summer surge levels

Wednesday was the 18th straight day with more than 1,000 people in hospitals in Alabama with COVID-19. 

Eddie Burkhalter

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UAB Chief of Hospital Medicine Dr. Kierstin Kennedy.

Alabama hospitals reported caring for 1,483 people infected with COVID-19 on Wednesday, the highest number of patients since Aug. 11, when the state was enduring its summer surge. Wednesday was also the 18th straight day with more than 1,000 people in hospitals in Alabama with COVID-19. 

The seven-day average of hospitalizations was 1,370 on Wednesday, the 36th straight day of that average rising. The Alabama Department of Public Health reported 2,453 new cases Wednesday. The 14-day average of new cases was — for the eighth day in a row — at a record high of 2,192. 

Across the country, more than 80,000 people were hospitalized for COVID-19 on Tuesday, a record high and the 15th straight day of record hospitalizations nationwide, according to the COVID Tracking Project, a coronavirus tracking website.

The CDC this week recommended people not travel for Thanksgiving to help prevent the spread of coronavirus. 

“The only way for us to successfully get through this pandemic is if we work together,” said Dr. Kierstin Kennedy, UAB’s chief of hospital medicine, in a message Tuesday. “There’s no one subset of the community that’s going to be able to carry the weight of this pandemic and so we all have to take part in wearing our masks, keeping our distance, making sure that we’re washing our hands.” 

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Kennedy said the best way she can describe the current situation is “Russian Roulette.” 

“Not only in the form of, maybe you get it and you don’t get sick or maybe you get it and you end up in the ICU,” Kennedy said, “but if you do end up sick, are you going to get to the hospital at a time when we’ve got capacity, and we’ve got enough people to take care of you? And that is a scary thought.” 

The Alabama Department of Public Health on Wednesday reported an increase of 60 confirmed and probable COVID-19 deaths. Deaths take time to confirm and the date a death is reported does not necessarily reflect the date on which the individual died. At least 23 of those deaths occurred in November, and 30 occurred in other months. Seven were undated. Data for the last two to three weeks are incomplete.

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As of Wednesday, at least 3,532 Alabamians have died of COVID-19, according to the Department of Public Health. During November, at least 195 people have died in Alabama from COVID-19. But ADPH is sure to add more to the month’s tally in the weeks to come as data becomes more complete.

ADPH on Wednesday announced a change that nearly doubled the department’s estimate of people who have recovered from COVID-19, bringing that figure up to 161,946. That change also alters APR’s estimates of how many cases are considered active.

ADPH’s Infectious Disease and Outbreak team “updated some parameters” in the department’s Alabama NEDSS Base Surveillance System, which resulted in the increase, the department said.

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Average daily coronavirus cases in Alabama reach new highs as hospitalizations surge

“It’s incredibly important right now to maintain your bubble, to wear your mask, maintain distancing and wash your hands,” UAB’s Dr. Kierstin Kennedy said.

Eddie Burkhalter

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(APR GRAPHIC/ADPH DATA)

Alabama on Tuesday saw record-high seven and 14-day averages for new daily COVID-19 cases, and the second-highest number of new daily reported cases, following the record high set less than two weeks ago. 

The state added 2,785 cases Tuesday, less than 200 under the Nov. 13 record of 2,980. While the Alabama Department of Public Health on Oct. 23 reported 3,852 cases, 1,287 of those were older positive antigen tests conducted in June through October and submitted by a facility in Mobile, which skewed that day’s count higher. 

The state’s seven and 14-day averages for new daily cases were 2,288 and 2,164 respectively on Tuesday, and the average percentage of tests positive over the last two weeks was 22 percent — more than four times as high as public health experts say it needs to be to guarantee cases aren’t going undetected. 

Coronavirus hospitalizations in Alabama on Tuesday reached 1,428. That’s as high as they’ve been since Aug. 11. Huntsville Hospital was treating a record 270 coronavirus patients on Tuesday. 

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Dr. Kierstin Kennedy, UAB’s chief of hospital medicine, told reporters Monday that hospitals are seeing much higher numbers both because of the influx of COVID-19 patients and non-coronavirus patients. 

“We are definitely seeing the highest numbers that I’ve taken care of in my almost 10 years of being a hospitalist here,” Kennedy said. 

Kennedy and other medical professionals in recent days have urged the public to take precautions during Thanksgiving and other upcoming holidays or risk spreading the disease further by infecting themselves or loved ones. 

Dr. Racheal Lee, UAB’s hospital epidemiologist, said Monday that Alabama’s positivity rate is so high that if 15 people gather there is between a 30 and 50 percent chance that one in the group has COVID-19 and could be without symptoms. 

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“If we think about that, 15 doesn’t sound like a lot of people, and that may be a small gathering for some, but we really need to remind ourselves that a lot of people are asymptomatic before they’re symptomatic,” Lee said. 

The Alabama Department of Public Health suggests that to cut disease transmission over Thanksgiving hold small dinners with only those living in your own household, have virtual dinners with those outside of your household and shop online rather than in person for Black Friday deals. 

“What I have heard is that we should expect some of the highest numbers actually in the third week of January, because of all of this commingling and intermingling of families,” Kennedy said.  “It’s incredibly important right now to maintain your bubble, to wear your mask, maintain distancing and wash your hands.”

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Last Conversations: Aunt Cheryl

“If there’s anything I’ve learned from her loss, it’s that she is right. Everyone does need help from time to time.”

Kristen Bolden

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Photos of Kristen Bolden and her Aunt Cheryl. (CONTRIBUTED)

“Everyone needs help from time to time.” That was the last text my Aunt Cheryl sent to me on Saturday, May 16, 2020, at 9:36 a.m. She sent a few others over the next week or so to our various group texts, but that was her last message to me personally. It was in reference to me arguing over my grandparents insisting on helping me pay for a new car after my old one had been totaled the week before. I couldn’t let them do that, but as she was told, I helped my grandparents out a lot, and they wanted to help me too. 

She didn’t know then — just like I didn’t know then — that a little over a month later, she would die in a hospital in Shelby County after contracting COVID-19. She didn’t know that her simple message to just accept help from my family would push me to actually seek professional help a few months later and sign up for therapy again.

My aunt was a bright and funny person. The joke was that my mom had her sister’s kids on accident. My aunt and I were a lot alike. She called me her travel buddy and would take me to New York with her. Once we were lucky enough to stand next to a group of German firefighters while watching the St. Patrick’s Day parade. Our group pictures are some of my favorites, and the moment became one of her favorites to share. She sent me and a friend to New Zealand one year. For our last big trip, she took me to Gatlinburg for the first time and stood by ready to drive our group back to the cabin after an impromptu moonshine tasting. While she didn’t like her moonshine, she loved her Talladega County muscadine wine.

My aunt taught me the finer points of traveling and, honestly, about a lot of life things. Things my mom was probably ok with her teaching me — like how to use humor to be charming or having another good model for being a hard worker. There were also things my mom was probably not ok with her teaching me — like driving fast down a winding Highway 78 from Leeds to Prescott or how to say “I know” every time someone would tell me how cute I was as a kid. (It’s a thing I still accidentally do at nearly 31. Thanks, Aunt C.)

Ever the dog lover, there were five running around her house at one point. “That’s what I want,” I would think to myself. “Dogs everywhere. Some land. And next to my grandparents.”

The house with all the dogs is where she lived with her then-husband after she returned to Alabama. They moved there just as I was about to graduate high school in 2008. At that point, I knew we had a relationship when I was very young, then she moved around the States a lot, and we didn’t see much of her. The places I can most remember her are in Arizona (we visited her in Tucson and fed a squirrel at the Grand Canyon), Seattle (where she met Harrison Ford), Alaska (where she lived near a glacier) and Minneapolis (where it’s just real dang cold). When she moved back, that’s when our relationship really took off. 

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I went to the University of Alabama, her favorite and my rival. Luckily, it didn’t cause too many issues as Alabama has a very good football team and Auburn has a pretty good football team. One time my car broke down, so she and my mom drove down to Tuscaloosa from Pell City so I could use her car for a few days. I’d end up driving her old green Suzuki a lot over the next few years. 

When I moved for my first job in the summer of 2014, she and my grandmother helped me pack the Penske and drive north to Peoria, Illinois. I wasn’t prepared in any way, shape or form for said move, but she got me there regardless. When I moved back to Alabama eight months later for my second job, yep, you guessed it: She rolled up in the Jeep with my grandparents in tow, ready to move me back.

Over the next four years, we saw each other regularly. She got me in touch with a family friend whose house I was able to rent, just two or three minutes from my grandparents. My Aunt Cheryl helped me set up the place where I’d live, sleep, eat, cry, binge watch TV, play with my dog and jokingly make cereal as my potluck dish for any get-togethers we’d have. I was pretty hopeless in the kitchen at the time.

Holidays felt like my childhood days again, with everyone at my grandparents’ house, laughing, eating and opening presents, being generally loud and joyful. I worry about the holidays feeling empty this year and perhaps every year from now on.

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In December 2017, I was able to travel to New York City with her again. This time, I’d be a witness to her wedding in Central Park. She married her last (and best) husband John just outside of the Bethesda Fountain. It snowed the day before (also my 28th birthday) and was perfect for pictures. John’s younger daughter Tiffany was also a witness. I imagine we both cherish the photos from that day differently now. 

John and my aunt were fun to watch together. They laughed a lot, smiled all the time, in turn making everyone else happy. I think that was her goal in life. They had a lovely little place on Logan Martin we’d go visit every now and then. They’d take my grandparents fishing on the boat while I tanned and read books on the dock. I know being there full-time was actually her goal in life.

I moved to Boise, Idaho, for a new job in March 2019. It was pouring rain, but she and John and our friend were there to help me pack up, clean up and get on the road. By this point, she told me she was too old to move me again and drag all my stuff around the country, but she’d help me get started. Driving away to a new place without her or anyone of my family members in sight was the strangest feeling. 

She was an avid NASCAR fan, but one of her favorite stories to tell didn’t even involve the racetrack. For a time, she worked at Bass Pro Shops in Leeds where they often had drivers come in on Talladega race weekends and do autograph signings. One year, Tony Stewart — her absolute favorite — came in for a signing. I went with her, and as she liked to put it, he made small talk with me while haphazardly signing the picture for her without even looking up. She then further backed up this claim by sharing that on our dinner date at Guadalajara post-signing fiasco, our server handed her the receipt without even asking who was paying — another sign of me being a regular charmer.

I was happy to have her on my hype team, even if it wasn’t totally accurate. 

I scored four Talladega tickets and pit passes for the October 2017 race — mine and my mom’s driver’s last one. We said goodbye to Dale Jr. as my aunt and John walked around enjoying the sights and sounds. By this point, my aunt had moved on to Kyle Larson. I don’t remember where Junior or Kyle finished that race, but I remember having a good time seeing my loved ones enjoy the day.

When she passed, that’s the picture I changed my Facebook icon to in memory of that moment. 

My family members gathered together near the end of May to work on my grandparents’ floors. I Skyped in with them that day because they were all together, and I had nothing to do as my car had just been totaled a few days before. We laughed. We caught up. We cut up. It was the last time we were all “together.” Everyone had been taking precautions because of my grandparents’ ages and my aunt’s cancer.

Four days later, I pulled into my parking spot outside my duplex in my new car and got a text from my aunt. John had tested positive for COVID. She was supposed to quarantine away from him, but I feel like it was too late at that point. She was waiting to start treatment after being diagnosed with breast cancer in early March, followed by surgery a few weeks later. She told my mom and me she was going to be furious if she had to put it off because of COVID. 

My grandmother would also test positive. After a few weeks, she and John both recovered. Only a couple of days after my aunt texted us, she was running a fever and had body aches. She was on a BiPAP machine at Shelby Baptist in Alabaster. A day later, she was intubated. She’d spend three weeks on a ventilator, her condition going up and down every few days, with doctors and nurses and pulmonologists doing everything they could think of to save her.

My mom said she didn’t even look like herself because of all the IV fluid and illness, and we shouldn’t have to see it. I sometimes try to imagine it, but I can’t and don’t want to. 

The last time I saw her was December 2019 when I visited home for my birthday and Christmas. That’s how I want to remember her. With all of us and my grandmother’s giant Christmas tree. Laughing and catching up. Joking about how I probably have a line of people at my door, waiting to take me out on a date. 

She was taken off support and died at some point during the rain-delayed Talladega race on Monday, June 22. It’s so weird that the biggest personality in our family died during her favorite race at the biggest track in the NASCAR family. That’s a terrible analogy, but I think it would make her laugh.

When I posted my tribute on social media, the comments poured in from people she worked with all around the country, people she went to school with, people who knew her through others, dozens of comments talking about how shocking her death is. How funny she is. Her sweetness. Her sometimes brutal honesty. How they never expected this to happen to Cheryl. I would say “join the club,” but I don’t want them to go through this. Instead, I find comfort in their comments and that she was exactly who I thought she was — for better or for worse. I try to remember she was a tough lady who at one point drove an 18-wheeler. She could push through this, and so could I. 

After my mom first told our group chat how quickly my aunt’s condition was deteriorating, I asked if I should come home. Not a single person in our family would let it happen because it wasn’t safe to do so then, and five months later, it still isn’t safe. Instead, I would wait for daily updates around 9:30 a.m. while I was sitting at work. I’d get sick to my stomach after looking up at the clock to see it was nearly that time. I was 2,000 miles from home, unable to help, unable to do anything but sit at my desk before going home and lying in bed, hoping I would just go to sleep instead of staying awake and crying. I would “tweet thru the pain” as the kids say some nights, hoping someone would see it and know I was hurting. I was mostly doing fine living alone at that point, but from my aunt’s hospital admission to August, I’d never felt more alone in my entire life. 

I work in local television news so I’m used to working weird hours, spending holidays either alone or with fellow news orphans, and knowing I’m probably going to move at some point in the next few years. I’d already been terrified to move to Boise because I’m so used to worrying about my grandparents, but this was completely rattling. The stories I’d run in my newscasts about people being separated from family members or loved ones suffering from COVID, the stories I’d read online about people saying goodbye from miles and miles, even countries away from each other, were now about my life. 

Her service was held on Sunday, July 5, at Kilgroe Funeral Home in Leeds, the place next to the ever-changing restaurant on top of the hill I’d gone to to say goodbye to friends, family members and others I knew my entire life. Except this time, I couldn’t be there. I couldn’t give her a proper goodbye as she actually passed, and I couldn’t in the wake of her death. Instead, I walked my dog around the Boise State campus, stopping to cry on a bench or a set of stairs a couple of times when it all became too much. I didn’t care that I was in public. If someone had seen me and asked, I would’ve let them know what happened and told them to wear a mask. 

My aunt was cremated, another thing I still cannot wrap my head around. She and John’s dog Layla had to be put down earlier this year. Their ashes are now in his possession, something I’m grateful for as I know they’ll both be taken care of with love. 

I was able to go home the first week of October. I drove to Alabama from Idaho and back. I took every precaution. Nobody got sick. I was terrified for a month anyway.

It hurt so much to know I was there and I would see John, but I would not see her. The pain is apparent on everyone’s faces still, but there’s nothing to be done at this point. I spend time angry at people not taking measures to keep themselves or others safe, but I can’t stay angry forever and I’m mad about that too. 

I hate I can’t text her about a funny thing my dog did or that when I send a Christmas card, she won’t see it. If I do end up settling down, she won’t be there. Sometimes I think whoever I end up with might be lucky because they’ll skip her hazing, but I also know they would have loved her sense of humor. I hate that it’ll be the same way for my younger sister. I hate that my grandfather gets misty-eyed when he remembers her. I hate that my grandmother has to be so matter-of-fact about the loss of one of her children to accept it. I hate that my mother had to be the one to carry us all through it while losing her sister. 

In the end, I just miss my Aunt Cheryl. If there’s anything I’ve learned from her loss, it’s that she is right. Everyone does need help from time to time.

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