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Alabama health officer: Numbers “are not headed in the right direction”

Chip Brownlee | The Trace

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People must remain vigilant and careful as more businesses reopen and people return to more normal activity, Alabama’s top public health officials say, because the threat from COVID-19 has not dissipated.

“I would say we’re really concerned,” said State Health Officer Dr. Scott Harris in an interview with APR. “The numbers are not headed in the right direction, especially in some parts of the state.”

Harris pointed to the rising number of confirmed cases in Montgomery County and other areas of the state, and the high number of hospitalizations and rising death toll in Mobile County as remaining areas of concern.

Testing has increased across the state, Harris said, which is contributing in part to more positive cases being identified. By Sunday, more than 156,000 people had been tested in Alabama, up from 95,000 on May 1.

But the increase in testing, while it may explain rising case counts, does not explain stubbornly high hospitalization numbers and the rising death toll.

Over the last seven days, nearly 2,000 new COVID-19 cases have been confirmed in Alabama. On Thursday alone, the state reported more than 400 new cases for the first time, the largest single-day increase since the state confirmed its first case. Over the last week, seven- and 14-day averages of new reported cases have remained higher than any previous point.

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Meanwhile, the percent of tests that are positive has remained relatively stable.

“This disease has not gone away,” Harris said. “We’re not out of the woods. We have got a long way to go.”

As of Sunday afternoon, more than 11,700 people in Alabama have tested positive for the virus. At least 488 have died.

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“There are clearly outbreaks that are going on, and we have a lot of concern about that,” Harris said. “Mobile is still seeing a lot of patients. All of those are really worrisome.”

Harris said as more businesses and other things reopen, people need to continue to adhere to social-distancing guidelines and good hygiene. Businesses should follow sanitation guidelines if they are open.

“We just need people to be really careful about following social distancing guidelines and good sanitation and hygiene, and stay at home when you’re sick,” Harris said. “The same messages we’ve been saying for months.”

Staying at home, if you can, even if you’re not sick, is still the best way to avoid contracting or spreading the virus. Many people who have the virus show no symptoms but are still able to infect other people.

Those who are particularly vulnerable — older people and those with underlying health conditions — should continue to stay at home.

If you do go out, avoid large crowds, stay at least six feet from other people and wear a mask. Wash your hands often and for at least 20 seconds with warm water and soap.

“These are the only tools we have, and we need people to pay attention to them,” Harris said.

Jefferson County Health Officer, Dr. Mark Wilson, said in an interview that his biggest concern going forward is the variable of individual behavior.

“I think, by and large, the people that are in charge [of businesses and churches] are being very careful to follow guidelines and take all the precautions they possible can — short of not doing it in the first place,” Wilson said. “But they cannot control someone doing something foolish. I think that’s where I mainly am concerned.”

Larger events — like church services, graduations and the like — pose a larger risk, Wilson said.

“I think the larger the event is, the more chances of either non-compliant people doing something they shouldn’t do, or accidents occurring, just by the odds of it,” Wilson said.

Both Wilson and Harris underscored the importance of wearing a mask or another face covering when leaving the home — not to protect you, but to protect other people.

“There might be a little bit of protection for you, but it’s certainly not reliable,” Wilson said. “It’s mainly to protect other people.”

If you do wear a mask, be sure to follow good practices for keeping your mask clean and removing it safely.

The right way to wear and clean your cloth face mask

“What we’re all banking on, across the whole state, is for people to understand that we’re responsible for one another,” Wilson said. “We have to do our part to be good citizens, good neighbors, to care about one another. If we can’t get that, we’re going to fail.”

Flouting social-distancing guidelines, refusing to wear a mask and refusing to follow other good practices doesn’t just affect one person.

“There are people that say, ‘I’m willing to get sick. I’ll take the risk,'” Wilson said. “That is not a thing. You’re putting other people at risk.”

Wilson said the risk will not go away anytime soon. It could take at least another year, if not longer, to get a working vaccine.

“I think one of our biggest challenges is that people are already sick and tired of all of this, and they really want it to go away,” Wilson said. “Some people are just trying to wish it away. And I’m really worried about how we keep people motivated for many, many months.”

Some have suggested that the summer heat and humidity will cause the virus to disappear. UAB infectious diseases expert, Dr. Mike Saag, an associate dean at the UAB School of Medicine, said that is wishful thinking.

Even if heat or humidity reduces the rate of transmission to some degree, which has not been proven, the virus will not disappear completely and is likely to return in the fall.

“It’s not going to just disappear because of the heat,” Saag said last week. “Sorry, that is not going to happen. It’s going to be with us for the summer, or probably be with us into the winter, and it may be with us by this time next year. So, we need to get our heads around that and start making plans on how we’re going to manage it and not let it control us.

That plan will include contact tracing and expanding testing even further, Saag said.

Harris said the Alabama Department of Public Health is working with federally qualified health centers across the state to increase available testing in more rural areas. But the state’s lab and commercial labs across the state have struggled to get the reagents needed to perform tests.

Contact tracing is posing a big challenge, too. Harris said the state has moved staff to handle contact tracing, but will need to hire dozens, if not hundreds, more people to handle the load. And those they’ve already moved will eventually have to go back to their day jobs in the state’s sexually transmitted diseases and tuberculosis divisions.

After moving staff around, Harris said the department has about 60 full-time ADPH staff working on contact tracing. They’re also working to contract with outside call centers, school nurses and public health students who can help with contact tracing.

“But all that is contingent on if we’re going to have the money,” Harris said.

The state has been able to investigate positive cases, get in contact with those people and find out who they’ve been in contact with, and notify them that they may need a test and should isolate.

But the challenge has been “active monitoring,” which involves contacting those people who are positive, regularly, for the next two weeks, or longer, to get an update on their condition. The state does not have the staff to do that part of contact tracing as things currently stand.

“We’re doing the first two parts,” Harris said. “We investigate every case. And then we do all the contact tracing and find out who’s connected, and we touch base with them, or try to.”

But after that, ADPH doesn’t have the staff to keep up, Harris said.

“We don’t have any more information on really any of these people after that [initial contact],” Harris said. “That’s why it’s been so hard to answer the question of the recovery rate because you have to do that active monitoring to know when people get well. … But that third part we have not been able to do because we’ve got 11,000 cases and each one of those cases has many contacts.”

Over the last month, the Department of Public Health has received $5 million from the state to respond to COVID-19 and $8 million from a CDC grant. It has not yet received any money from the $1.8 billion in federal CARES Act funding for Alabama, which has been caught up in a legislative battle in Montgomery.

The Legislature will decide Monday what to do with the money.

“What we are looking at these other funds for is testing and tracing and other kinds of capacity building and responding when we have outbreaks,” Harris said. “We’d love to do some more productive things with you know nursing homes testing.”

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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CDC confirmed expanded “close contact” definition to Alabama officials in August

It is unclear why the CDC waited until late October to update or clarify its public-facing guidance on its website.

Eddie Burkhalter

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(STOCK PHOTO)

New federal guidance on how a person is determined to have been in close contact with someone infected by COVID-19 won’t impact how Alabama works to mitigate the disease, said the state’s top health official. That’s because the state was already aware of the expanded definition in August before the change was made public last week.

It is unclear why the CDC waited until late October to update or clarify its public-facing guidance on its website when it was giving more precise definitions to at least one state health department and receiving questions from public health officials about the definition.

The delay in announcing the change is raising questions about how state health officials nationwide have been determining the public’s possible exposure to the deadly disease and if contact tracing and mitigation efforts will be made more time- and resource-intensive with the more inclusive definition in place.

The CDC on Wednesday expanded the definition of “close contact” to mean a person can be at risk of contracting COVID-19 if that person is within six feet of an infected person for a period of at least 15 minutes over a 24-hour period.

The previous definition stated a person should quarantine if they were within six feet of an infected person for at least 15 minutes. Alternately, in other areas of the CDC’s website, the language stated “a total of 15 minutes” in the definition of close contact.

“What they changed their definition to is something they had verbally confirmed to us months ago, and we have always been using that definition,” said Alabama State Health Officer Dr. Scott Harris, speaking to APR on Friday.

Harris said a support team from the CDC was in Alabama in July as the Alabama Department of Public Health was preparing plans to reopen schools. Harris said the question was asked of CDC staff because his department was getting questions on the definition of close contact from school officials.

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APDH staff took the definition then of “a total of 15 minutes” to mean that there could be several exposures over a period of time equaling that 15 minute threshold, so they asked CDC to clarify that assertion.

“When those folks were here we asked the CDC people directly. Can you confirm for us what that means, and they said, it adds up to a total of 15 minutes in a 24-hour period,” Harris said. “And we even got somebody to commit to that in an email somewhere.”

Melissa Morrison, CDC’s career epidemiology field officer working at the ADPH in Montgomery, in an Aug. 13 email to ADPH’s director of the office of governmental affairs, quotes a statement Morrison attributes to her CDC colleague, CDC public health advisor Kelly Bishop. Harris shared the email with APR.

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“Yes, I did get a response from the contact tracing team. The 15 minutes for a close contact is cumulative, and they said ‘The time period for the cumulative exposure should start from 2 days before the cases’ illness onset (or, for asymptomatic patients, 2 days prior to positive specimen collection date) until the time the patient is isolated,” Morrison quotes Bishop in the email.

In the August email, Bishop goes on to say, as attributed by Morrison, that “as of now there is no established upper limit on the time period (i.e. 48, 72 hours etc).”

The CDC’s expanded definition was reflected in an Aug. 20 statement from the Alabama Department of Public Health.

“The 15-minute time is a cumulative period of time. For example, a close contact might be within 6 feet of a COVID-19 positive person for 5 minutes each at 8 a.m., noon and 5 p.m. This is a standard based on guidance from the CDC,” the statement reads.

In an email to APR on Friday, Harris said he’d discussed the matter with Morrison on Friday who “emphasized that the guidance this week from CDC was NOT a change but rather a clarification. They simply used the MMWR corrections story as a convenient time to make the point.”

Harris was referring to a CDC’s Morbidity and Mortality Weekly Report released Wednesday that detailed findings by Vermont health officials showing that a prison worker contracted COVID-19 during an eight-hour shift in which the worker had 22 close contacts with an infected inmate totaling 17 minutes.

The CDC in statements to numerous news outlets, and to APR, cite that Vermont study in connection to Wednesday’s definition change.

“That’s kind of why they said it out loud,” Harris said of the study and the Wednesday announcement. “But I have to say, when I saw that updated guidance I thought, ‘I can’t believe anybody ever thought otherwise.’”

Different pages on the CDC’s website on Saturday defined close contact as both being “a total of 15 minutes or more” and “a total of 15 minutes or more over a 24-hour period,” confusing the matter further, and numerous other state health departments had not yet updated their websites Saturday to reflect the CDC’s expanded definition.

A CDC spokesman in an email to APR on Wednesday noted the Vermont study on the prison worker and said “CDC clarified the amount of time it would take for someone to be considered a close contact exposed to a person with COVID-19.”

“The CDC website now defines a close contact as someone who was within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period. Previous language defined a close contact as someone who spent at least 15 minutes within 6 feet of a confirmed case,” CDC spokesman Scott Pauley told APR by email Wednesday.

Pauley didn’t respond to APR’s question on Friday asking why the CDC waited until Wednesday to update its guidance online, given that ADPH had confirmed the definition of close contact in August. He also didn’t respond to a request to verify the statement Morrison attributed to her CDC colleague in the August email.

“To us, we thought if it says a total, that means you must be adding up smaller amounts to get to 15 minutes, or you wouldn’t use the word total,” Harris said. “When they changed it this week, I don’t know the details of why that happened, but I think, obviously, everybody didn’t have the same message everywhere.”

Dr. Bertha Hidalgo, an epidemiologist and assistant professor at UAB’s Department of Epidemiology, told APR on Friday that her understanding prior to Wednesday’s expanded definition was that a contact was defined as someone who was exposed to the COVID-19 positive individual for at least 15 min or more at a time and explained that the updated guidance complicates how public health officials will engage in contact tracing.

“This means significant efforts for contact tracing moving forward, in effect needing to identify every person that person came into contact with during the possible exposure timeframe,” she said.

It was unclear Monday how the definition change impacts Alabama’s Guidesafe COVID-19 exposure notification app, which notifies a user if they come into close contact with an infected person. The app was developed by ADPH and University of Alabama at Birmingham, thanks to a partnership between Apple and Google’s combined development of the technology, and alerts users to possible exposure while keeping all users’ identities anonymous.

Sue Feldman, professor of health informatics, UAB School of Health Professions, in a message to APR on Friday said that due to the anonymity of the app, it would be difficult, but not impossible, to update the app to take into consideration the CDC’s expanded guidance.

“We are taking this into consideration for our next update,” Feldman said in the message.

Also unclear is how many other states that have similar exposure notification apps, also using Google and Apple’s technology, aren’t yet using the expanded definition of a “close contact.” Colorado is to roll out that state’s app on Sunday, and according to Colorado Public Radio News the app will notify a user that they’ve been exposed if they come “within six feet of the phone of someone who tested positive for at least ten minutes.”

New York’s exposure notification app also appears to use the old CDC guidance, and will alert users if they come “within 6 feet of your phone for longer than 10 minutes,” according to the state’s website.

The updated definition, which health departments refer to when conducting contact tracing, is likely to have a serious impact on schools, workplaces and other group settings where personal contact may stretch over longer periods of time including multiple interactions.

It greatly expands the pool of people considered at risk of transmission. “It’s easy to accumulate 15 minutes in small increments when you spend all day together — a few minutes at the water cooler, a few minutes in the elevator, and so on,” Johns Hopkins Center for Health Security epidemiologist Caitlin Rivers told The Washington Post. “I expect this will result in many more people being identified as close contacts.”

The clarification comes as cases and hospitalizations are rising both in Alabama and nationwide. Alabama’s 14-day average of cases has increased 41.2 percent over the past two weeks. The percentage of tests that are positive has increased from roughly 13 percent to more than 20 percent over the past 14 days. The U.S. average of new daily infections is now at its highest point of the pandemic, with 481,372 cases reported in a week, according to CNN and Johns Hopkins University.

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Study: COVID-19 infection rates more than double without lockdowns

Infection and fatality rates would have been higher without stay-at-home orders, a new UAB study found.

Micah Danney

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New research from the University of Alabama at Birmingham says that if there had been no stay-at-home orders issued in the U.S. in response to the coronavirus pandemic, the country would have experienced a 220 percent higher rate of infection and a 22 percent higher fatality rate than if such orders were implemented nationwide.

Seven states never imposed stay-at-home orders, or SAHOs. The study analyzed daily positive case rates by state against the presence or absence of statewide SAHOs between March 1 and May 4, the period when such orders began to be implemented. Twelve states lifted their SAHOs before May 4.

The researchers defined SAHOs as being in effect when a state’s governor issued an order for residents of the entire state to leave home only for essential activities and when schools and nonessential businesses were closed.

“During March and April, most states in the United States imposed shutdowns and enacted SAHOs in an effort to control the disease,” said Bisakha Sen, the study’s senior author. “However, mixed messages from political authorities on the usefulness of SAHOs, popular pressure and concerns about the economic fallout led some states to lift the restrictions before public health experts considered it advisable.”

The research also sought to determine if the proportion of a state’s Black residents was associated with its number of positive cases. It found that there was.

“This finding adds to evidence from existing studies using county-level data on racial disparities in COVID-19 infection rates and underlines the urgency of better understanding and addressing these disparities,” said study co-author Vidya Sagar Hanumanthu. 

The research can help advance a greater understanding of racial disparities in the health care system as a whole, and help leaders make future decisions about shutdowns as the virus continues to spread, Sen said.

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“While the high economic cost makes SAHOs unsustainable as a long-term policy, our findings could help inform federal, state and local policymakers in weighing the costs and benefits of different short-term options to combat the pandemic,” she said.

The study was published Friday in JAMA Network Open.

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122,000 Alabamians could lose health coverage if ACA is overturned, study finds

President Donald Trump’s administration and 18 states, including Alabama, are asking the country’s highest court to strike down the law. 

Eddie Burkhalter

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At least 122,000 Alabamians and 21.1 million in the U.S. overall would lose health coverage if the U.S. Supreme Court strikes down the Affordable Care Act, according to a recent study. 

The Washington D.C.-based think tank Urban Institute’s analysis found that Alabama’s uninsured rate would increase by 25 percent if the court strikes down the Affordable Care Act. Oral arguments in a case against the landmark health care law are to begin on Nov. 10.  

President Donald Trump’s administration and 18 states, including Alabama, are asking the country’s highest court to strike down the entire ACA. 

Trump, speaking to CBS News’s Lesley Stahl in a recent interview, said he would like the Supreme Court to end the ACA. There’s concern among many that Trump’s pick to replace the late Justice Ruth Bader Ginsburg on the court, conservative Judge Amy Coney Barrett, could be a deciding factor in the repeal of the ACA when the Supreme Court hears the case just after the Nov. 3 election.

“I hope that they end it. It’ll be so good if they end it,” Trump told Stahl.

“Repealing the ACA would throw our health care system into chaos in the middle of a pandemic and a deep recession,” Alabama Arise executive director Robyn Hyden said in a statement. “Tens of thousands of Alabamians would lose health coverage when they need it most. And hundreds of thousands would pay more for coverage or lose protections for their preexisting conditions.”

Health care coverage losses could be even larger next year, as the COVID-19 pandemic and recession likely still will be ongoing, according to the study. 

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“The ACA has been a health lifeline for many Alabamians during the pandemic,” Hyden said. “It provides coverage options for people who have lost their jobs or seen sharp reductions in their income. And it ensures people aren’t denied insurance just because they got sick.”

Ending the ACA would also reverse gains made in reducing racial disparities in health care coverage, researchers in the study found, noting that overturning the ACA would strip health coverage from nearly one in 10 Black and Latino Americans under age 65, and more than one in 10 Native Americans nationwide would lose health insurance. 

People with pre-existing conditions would be charged higher insurance rates, or have their coverage dropped altogether, if the ACA is struck down, according to the study, which also found that the law’s repeal would harm people who have health insurance through their jobs. 

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Those who have health insurance from an employer could see their plans reintroduce annual and lifetime coverage limits, and requirements for plans to cover essential benefits and provide free preventive services would disappear, according to the study, as would the requirement for insurers to allow young adults to be covered through their parents’ plans.

While millions would lose health care if the law is repealed, the country’s top earners would receive tax cuts, according to a study by the Center on Budget and Policy Priorities, which found that the highest-income 0.1 percent of households, which earn more than $3 million annually, would receive tax cuts averaging about $198,000 per year. 

“A portion of these tax cuts — about $10 billion per year — would come at the direct expense of the Medicare Trust Fund, since the additional Medicare tax the ACA instituted for couples with earnings over $250,000 flows to the fund,” the Center of Budget and Policy Priority study reads. 

Pharmaceutical companies would pay $2.8 billion less in taxes each year, according to the study, while millions of seniors would pay billions more for prescription drugs due to the gap in Medicare’s prescription drug benefit if the ACA is repealed. 

“The ACA has left Alabama better equipped to fight COVID-19 and rebuild our economy after the recession,” Hyden said. “And those benefits would be even greater if Alabama would adopt Medicaid expansion.

“Striking down the ACA would harm the Alabamians who have suffered the most during the pandemic and the recession. It would deprive our state of the opportunity to save lives and strengthen our health care system by expanding Medicaid,” Hyden continued. “And it would shower huge tax cuts on rich people while making life harder for everyone else. Alabama officials should stop seeking to undermine the ACA and start investing in a healthier future for our entire state.”

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Alabama’s hospitalized COVID-19 patients Sunday at highest number since Sept. 2.

It’s a trend that has public health officials and hospital staff concerned that the state may be headed for another surge.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama hospitals on Sunday were caring for 920 COVID-19 inpatients, the highest number of patients since Sept. 2 and a 23 percent increase from a month ago. 

It’s a trend that has public health officials and hospital staff concerned that the state may be headed for another  surge just as the regular flu season begins to fill up hospital beds. 

Alabama state health officer Dr. Scott Harris by phone Friday called the rising new cases and hospitalizations “worrisome.”

Alabama’s seven-day average of daily hospitalized COVID-19 patients was 864 on Sunday, the highest it’s been since Sept. 8. State hospitals saw a peak of COVID-19 inpatients on Aug. 6, when 1,613 patients were being cared for. 

The state added 1,079 new confirmed and probable cases on Sunday, and Alabama’s 14-day average of new daily cases hit 1,358 Sunday, the highest it’s been since Aug. 13. Two “data dumps” to the Alabama Department of Public Health of older confirmed cases Thursday and Friday elevated the daily counts on those days, but after weeks of daily cases hovering around 700 and 800, the state now regularly sees more than 1,000 cases a day. 

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The older test results skew the state’s percent positivity, but Alabama’s 14-day average of percent positivity on Sunday was 20 percent. Just prior to the addition of those older cases, the 14-day average was 15 percent. Public health officials say it should be at or below five percent or cases are going undetected.

As cases continue to rise, the number of tests being performed statewide continue to decline, which is increasing Alabama’s percent positivity rate. The 14-day average of daily tests was 6,619 on Sunday — a 5 percent decrease from two weeks ago. 

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There have been 2,866 confirmed and probable COVID-19 deaths statewide. The state’s 14-day average of daily confirmed deaths was 14 on Sunday, up from 12 two weeks ago. 

The United States on Saturday recorded its second highest day of new cases since the start of the pandemic, with 83,718 new cases, according to Johns Hopkins University. Saturday’s peak was just 39 cases fewer than the country’s all-time daily high, set on Friday. As of Sunday, 225,061 people have died from COVID-19 in the U.S.

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