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

Chip Brownlee

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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.

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

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“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.

“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 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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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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