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We weren’t ready for mental, physical toll of COVID-19, experts say — and it’s not over yet

Eddie Burkhalter

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When Dr. Ken Duckworth learned that a reporter interviewing him was from Alabama, the first thing he thought of was college football. 

“The absence of college football is not a mental health problem, but it takes away one of my favorite things in life,” said Duckworth, chief medical officer at the National Alliance on Mental Illness and a professor at Harvard University’s Medical School. 

For many, the COVID-19 outbreak is impacting people through the loss of favorite rituals and events, and for young people, the loss of opportunity, Duckworth said. 

There’s also concern that the nationwide mental health field, and the ability to test and conduct contact tracing, aren’t yet up to the task of a second or third round of COVID-19, Duckworth and medical experts said recently. The toll on mental and physical health from the virus has been great, and it isn’t over yet, he said. 

Testing will have to improve if states are to control any future waves of COVID-19 as many reopen and residents begin to head back out into workplaces and social events, according to infectious disease experts who spoke during a live-streamed press briefing Tuesday, hosted by the Infectious Disease Society of America. 

Since the first cases of COVID-19 infection were identified in the U.S. in January there have been about 1.5 million confirmed cases across the country and about 90,000 deaths, said Dr. Preeti Malani, Chief Health Officer at the University of Michigan, professor of medicine of Infectious Diseases at the university and an Infectious Diseases Society of America fellow. 

“And of course we don’t know the actual numbers. They’re probably many folds higher because of challenges early on with testing and asymptomatic infection,” Malani said. 

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Malani said that everyone is worried about a second and potentially third wave, but that physicians also accept that coronavirus is something we’re all going to have to live alongside as we try to get back to some normalcy. It will be about trying to control outbreaks and the most vulnerable among us, she said, especially those in prisons and jails, nursing homes and who work in close contact with others, such as meat-packing plants. 

“My hope is that we can try to share responsibility in this situation, where my behavior affects everyone else around me,” Malani said. 

The issue will come down to testing, she said, so that cases don’t go undiagnosed and allow a person to spread the deadly virus widely. 

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Dr. Leonard Mermel, professor of medicine at Brown University, director of the Department of Epidemiology and Infection Control at Rhode Island Hospital and another Infectious Diseases Society of America fellow, said during the briefing that health experts are learning by looking at cities that tried to open too quickly without the capacity to control future outbreaks. 

“We have to be particularly careful about our highest-risk individuals,” Mermel said. “I would also add homeless individuals into that population.” 

Mermel also said that the public health infrastructure at the state and federal level “has been pretty much decimated over the last several decades in our country.” 

The country needs to ensure state and local health departments have the resources necessary to do the testing and contact tracing to track those who’ve been exposed “to try to contain things quickly before it gets out of hand.” 

In Alabama, the number of new COVID-19 cases, hospitalizations and deaths continue to rise, and state public health officials are working to hire many more contact tracers. Testing, while it has increased in recent weeks, still isn’t as broad statewide as medical experts believe is needed to fully see the problem and prevent the virus’s spread.

For many, the uncertainty of what may happen, of the probable loss of something due to coronavirus, can impact a person’s mental health,  Duckworth said. 

“Goals, proms, friendships, and of course the remote possibility that you might lose somebody you love, which is also a real risk,” he said. 

One in five Americans had a mental health diagnosis before the COVID-19 pandemic, Duckworth said, and the U.S. was already in a suicide and drug overdose death crisis before the first coronavirus case in the country was confirmed. 

Mental health professionals are now working nearly entirely via telemedicine, where they meet with patients via videoconference on laptops and phones, Duckworth said. He doesn’t know a single provider who’s met with a patient in person in their office since the crisis began. 

“Mental health is not a quick-moving team, and they know that there’s gonna be trauma effects, first responder effects, health care worker trauma,” Duckworth said. “This is not a quick hit. The challenge is, of course, that as demand continues to increase, how do we help with supply?”

Duckworth said the mental health field hasn’t yet done enough to grow the supply of providers to meet the needs during this unprecedented health crisis. 

But one thing is clear, he said. The switch to teletherapy has been quick and broad. 

“Everybody is getting experience in tele-treatment, teletherapy and telepsychiatry and almost everybody likes it. Patients show up on time. They don’t have to drive. They don’t have to pay for parking. It’s interesting,” Duckworth said. 

With the growth of telemedicine during the coronavirus pandemic comes the concern, however, that for many lower-income people, especially in rural areas, there’s not the same access to the Internet, laptops and smartphone technology needed to get the care. Even flips phones can work in some cases, Duckworth said, but there are other unknowns. 

Will mental health care provided through things like flip phones continue to be covered by insurance providers and employers as the health crisis continues to impact the economy? 

“The question is, will the universities and other big employers want to foot the bill to make it easier for people who have commercial insurance to get that kind of access?” he said. “And that’s a question that is an unknown, because those businesses are going to be facing new pressures.” 

Duckworth also had advice for people who may be experiencing the stress and anxiety of living through such a difficult time. 

“First of all, take care of your own self. Not everybody needs a therapist,” Duckworth said. Get exercise, don’t use substances to excess, and put down all media after dinner, he said. 

“Talk to people. Stay connected. Don’t be a loner. Connect with cousins. Zoom calls with nieces and nephews. Really work the family, friendship angle. Really work it,” Duckworth said. 

But for those who may be having trouble functioning, or who are having active thoughts about harming oneself, Duckworth said they should reach out to medical professionals or help. 

“We are all in this together,” he said. “It’s giant test of resilience, and we weren’t ready for this pandemic. I don’t think that’s very controversial. In terms of our response and psychologically. People hadn’t been stressed in this way.” 

The two infectious disease experts had advice for the public as states continue to reopen more segments of public life and commerce. 

“Ramping down was pretty easy,” Malani said. “Although it didn’t feel like it at the time, we basically flipped the switch. Reopening is going to be much more complicated.” 

Employers should make certain workers aren’t coming in sick, she said, cleaning protocols should be strengthened and there should be strong guidelines for the wearing of personal protective equipment such as masks and gloves. 

“Memorial weekend is coming up and a lot of us want to plant flowers in our garden. If you drive up to the nursery and you see that there are hundreds of cars in the parking lot, it might not be a safe time to shop,” Malani said 

It’s important for the public to continue wearing masks when in the public, and to maintain social distancing by staying at least six feet away from others,  Dr. Mermel said

Asked about states are reopening despite not having met the Centers for Disease Control and Prevention’s criterion for doing so, which include that new confirmed cases drop for at least 14 straight days, Malani said it’s been encouraging that we’ve not seen massive outbreaks but that “we’re a little early.” 

“And in terms of seeing cases, I’m interested in hospitalizations and, of course, deaths,” Malani said. “And I think the jury’s still out. Hopefully, we’re doing this responsibly, but also if you’re not testing and tracking you might not see it.”

Eddie Burkhalter is a reporter at the Alabama Political Reporter. You can email him at [email protected] or reach him via Twitter.

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Alabama’s daily COVID-19 deaths second highest since start of pandemic

In the past two weeks the state recorded 190 coronavirus deaths, a 38 percent increase from the previous two weeks.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama saw 35 deaths from COVID-19 on Friday, the second highest daily number of deaths since the pandemic began. 

The previous record daily high was May 12, when the state recorded 37 coronavirus deaths. Prior to that, the high was on April 22, when Alabama saw 35 deaths from the virus. In the past two weeks the state recorded 190 coronavirus deaths, a 38 percent increase from the previous two weeks.

While cases have been surging since mid-June, deaths have largely remained stable. Deaths are considered a lagging indicator, meaning that it takes longer for deaths to begin rising after cases and hospitalizations begin rising.

“The fact that we’re seeing these sharp increases and hospitalization in cases over the past week or two is really concerning,” said UAB expert Dr. Jodie Dionne-Odom earlier this week. “And we expect, given the lag that we know there is between cases and hospitalization — about a two-week lag, and a three-week lag between cases and deaths — that we’re on a part of the curve that we just don’t want to be on in our state.”

It’s unclear whether this new rise in deaths will become a trend, or whether it is a one-day anomaly, but the 14-day average of deaths per day is now nearly as high as the previous peak on May 14 — weeks after the state hit its first “peak” in cases per day in late April. The previous high of the 14-day average of deaths per day was 16 on May 14. The average is now at 14 deaths per day, on average.

The uptick in deaths comes after days of record-high new daily COVID-19 cases and hospitalizations. The state added 1,304 new COVID-19 cases Friday, down from Thursday’s record-high of 2,164, but the trend of rising daily cases has continued largely unabated since early June. 

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The 14-day average of daily tests was at an all-time high Friday, at 8,125, which was 308 more tests than the previous high, set Wednesday. The percent of tests that were positive also increased, however, so the new cases can’t be attributed solely to more testing. 

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The 14-day average of the percent positivity was 14.22 on Friday. Excluding Thursday’s figure, because the Alabama Department of Public Health didn’t publish total tests administered on Thursday, which threw  off percent positive figures, Friday’s 14-day average was the highest it’s been since the beginning of the pandemic. 

There were a few higher 14-day average percent positivity days in April, but those numbers were skewed as well, because ADPH wasn’t able to collect all testing data from commercial labs during that time period. 

Along with surging new cases, the number of COVID-19 patients hospitalized on Thursday was higher than it’s been since the beginning of the pandemic. On Thursday 1,125 coronavirus patients were being treated in state hospitals, which was the fifth straight day of record current hospitalizations. 

UAB Hospital’s COVID-19 Intensive care units were nearing their existing capacity earlier this week. The hospital has both a COVID ICU and a COVID acute care unit designated to keep patients separated from those who don’t have the virus, but it has more space in other non-COVID units should it need to add additional bed space.

Hospitals in Madison County this week are also seeing a surge of COVID-19 patients. Paul Finley, the mayor of the city of Madison, told reporters Wednesday that local hospitals were reporting record numbers.

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Stay safe but don’t delay cancer treatment or screenings, UAB doctors warn

Micah Danney

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Barry Sleckman, director of the O’Neal Comprehensive Cancer Center, and Monica Baskin, a professor in UAB’s Division of Preventive Medicine.

Healthcare workers are seeing fewer people getting routine cancer screenings for fear of coming into contact with the novel coronavirus. With no end to the pandemic in sight, doctors are urging people to get screened and move forward with treatment if they have a diagnosis.

Not delaying treatment is of paramount importance, said Barry Sleckman, director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham.

“If you have a cancer diagnosis, you need to do everything possible to work with your physician to initiate treatment in a safe environment,” he said.

Sleckman said that steps are being taken to ensure the safety of patients who may be anxious about visiting a hospital and being exposed to the virus. Visits are being done by telemedicine, or video tools that are HIPAA compliant, if an in-person exam is not required. 

Monica Baskin, a professor in UAB’s Division of Preventive Medicine, said that her colleagues around the state are hearing from people who are afraid to make physical visits. They are advising people to contact their local healthcare providers first to determine the best course of action, and to learn what specific steps their local cancer center is doing to keep patients safe.

Rates of screenings have been trending downward nationally, according to the National Cancer Institute. Alabama does not keep a statewide database, but workers in the field say they have noticed a reduction over the last three months – much of it in medically underserved communities that experience higher rates of cancer.

Investigators at the NCI recently created a detailed national model of breast and colorectal cancers showing that more than 10,000 people might die over the next 10 years due to delayed cancer screenings because of the pandemic. Most of the deaths would occur in the next two years, according to the projections.

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About 26,000 Alabamians are diagnosed with cancer each year, according to the American Cancer Society.

People with cancer and other conditions that make them immunocompromised are especially vulnerable, but Sleckman urged caution among everyone else who are making decisions based on what risk factors they think they may not have. The scientific community is still trying to figure out how the virus behaves, and death or recovery aren’t the only possible outcomes. 

Strokes have been seen in younger people who are infected, and scientists are warning of serious brain damage occurring in some patients who only experience mild symptoms while they are sick. It’s on everyone to slow the spread in order to protect others because there’s no telling how the virus will affect one person to the next.

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“As a very good friend of mine who’s an infectious disease physician said, ‘The only thing we really know about this virus is it’s not good to have it,’” Sleckman said.

 

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Alabama lawmaker suggests more should become infected with COVID-19

The leader of Alabama’s State Senate suggested to a reporter that he’d actually like to see more people become infected to build the state’s overall immunity to the virus, a claim that would require thousands more deaths to become a reality.

Eddie Burkhalter

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Senate Pro Tem Del Marsh speaks to CBS 42. (Reshad Hudson/Twitter)

East Alabama Medical Center’s critical care beds on Thursday were at 90 percent capacity, and COVID-19 hospitalizations statewide on Thursday were at another record high for the fifth straight day. Administrators at EAMC sounded the alarm Thursday that if things don’t change soon, the exponential growth of COVID-19 cases could stress the hospital to the breaking point.

UAB Hospital’s COVID-19 intensive care and acute care units were approaching their existing capacity Tuesday, when the hospital was caring for 92 coronavirus patients. The hospital had 91 inpatients who had been diagnosed with COVID-19 on Wednesday. Jefferson County has added more than 1,000 COVID-19 cases over the last week.

Alabama has experienced numerous record increases in cases and hospitalizations in the last several weeks, as the state continues to grapple with a growing pandemic and stressed hospitals.

Despite that, the leader of Alabama’s State Senate — and member of Gov. Kay Ivey’s COVID-19 task force — suggested to a reporter that he’d actually like to see more people become infected to build the state’s overall immunity to the virus.

The state’s top health officials suggested Thursday that doing so would lead to unnecessary deaths.

Sen. Del Marsh, R-Anniston, told CBS 42’s Reshad Hudson that he’s not concerned with the growing number of COVID-19 cases.

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“I’m not concerned so much at the number of cases. In fact, quite honestly, I want to see more people because we start reaching an immunity, if more people have it and get through it,” Marsh said.

“I don’t want any deaths. As few as possible. I get it,” Marsh said, adding that we need to do all we can to protect those with preexisting conditions and the elderly. “But I’m not concerned. I want to make sure that everybody can receive care, but right now, to my knowledge as of today we still have ample beds.”

Marsh has said in interviews this week that he doesn’t predict a statewide mask order or a return to the restrictions that data shows slowed the virus’s growth.

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State Health Officer Dr. Scott Harris was asked by a CBS42 reporter about Marsh’s statement encouraging more infections.

“There is absolutely no reason to think at this point that getting infected will give you any degree of immunity. We simply don’t know that,” Harris said.

“We’ve looked at countries like Sweden, who have tried to actually generate herd immunity among their population, and it’s been disastrous. They’ve had increased numbers of deaths much higher than their neighbors, in trying to keep their economy open. It does not work well at all,” Harris said.

In Sweden, one study found that after months of infections and deaths, less than 10 percent of the population had developed antibodies to the virus. Public health experts believe at least 60 percent of the population would need to be infected for a population to reach herd immunity.

In reality, reaching a level of herd immunity that would be high enough to slow transmission would require tens of thousands more infections and thousands more deaths.

“The way to prevent illness and death, and to keep the economy open, quite frankly, is to keep people from getting this disease,” Harris said. ‘We need people to wear face coverings, to wash their hands, to stay home when they’re sick and to practice social distancing.”

Harris told CBS 42 that the state’s availability of ICU beds was at its lowest point since the start of the COVID-19 pandemic. Of around 1,400 ICU beds, less than 200 were available Thursday, he said.

Because of Sweden’s decision to attempt herd immunity, deaths in country have been eight times higher than in Denmark and 19 times higher than in Norway, according to The Washington Post.

Sweden has seen 543 deaths per million of its population, compared to just 105 per million in Denmark, according to the Worldometer.

 “I believe we’re at another pivotal point,” said EAMC President and CEO Laura Grill in a statement Thursday. “We had flattened the curve in our community, but due to relaxed state orders and an unwillingness by some people to follow the three simple guidelines needed to help control COVID-19, we are almost back to square one. It’s frustrating and quite demoralizing to our staff and physicians, and those in our community who are following the rules.”

On Thursday 259 of EAMC’s  314 beds were occupied, six nursing units were at 100 percent capacity and 27 of the 30 critical care beds were in use. 

“In other words, EAMC was having a ‘red census’ day for the second time this week. Patients with positive COVID-19 cases occupied 36 of the beds, with two other patients awaiting results,” the hospital said in a release. 

The 36 COVID-19 patients was less than the hospital’s peak of 54 on April 11, but at that time the hospital had 164 total patients, and Thursday hospital staff were treating 100 more than that. 

Grill noted the record-breaking number of new COVID-19 cases statewide on Thursday and called for the public to do what’s needed to slow the spread. 

“This morning, Alabama announced 2,164 new cases in the past 24 hours—by far the most in a single day—and people are still debating the merits of wearing a mask, calling the virus a hoax and questioning qualified health officials on whether an asymptomatic person can spread the virus. It’s all very frustrating,” she said.

COVID-19 hospitalizations statewide on Thursday were 1,125, the highest it’s been since the start of the pandemic. Nine of the last 11 days the state has seen record high coronavirus hospitalizations. 

Regional Medical Center in Anniston, Marsh’s hometown in Calhoun County, on Thursday was caring for 15 coronavirus patients, a record high for the hospital, according to The Anniston Star.

Calhoun County on Thursday added 33 new COVID-19 cases, which was the second-highest single day of new cases the county has seen since the pandemic began. In the last week the county added 156 cases, or 35 percent of the county’s total coronavirus cases.

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Alabama reports record-breaking 2,164 new COVID-19 cases

Thursday’s number of new cases hit 2,164 and blew past the previous daily record set on July 3 by 406 cases.

Eddie Burkhalter

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Thirty-two percent of the state’s 48,588 cumulative confirmed cases have been added within the last two weeks. (APR GRAPHIC)

New COVID-19 cases in Alabama on Thursday jumped by nearly double from the day before, and for the first time broke 2,000 in a single day, according to the latest data from the Alabama Department of Public Health.

Thursday’s number of new cases hit 2,164 and blew past the previous daily record set on July 3 by 406 cases. Both the seven-day and 14-day rolling average of new daily cases in Alabama were also at record highs Thursday. 

Thirty-two percent of the state’s 48,588 cumulative confirmed cases have been added within the last two weeks. 

The Alabama Department of Public Health did not publish Wednesday an update to the total number of tests performed, which throws off the day’s figures for the percentage of tests that are positive, but on average, over the last week, the state’s seven-day rolling average of percent positivity has roughly 15 percent. 

Public health experts say the percent positivity should be at or below 5 percent — otherwise there isn’t enough testing being done and cases are going undetected. 

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Along with surging new cases, the number of COVID-19 patients hospitalized on Wednesday was higher than it’s been since the beginning of the pandemic. On Wednesday 1,110 coronavirus patients were being treated in state hospitals, which was the fourth straight day of record current hospitalizations. 

UAB Hospital’s COVID-19 Intensive care units were nearing their existing capacity Tuesday. The hospital has both a COVID ICU and a COVID acute care unit designated to keep patients separated from those who don’t have the virus, but it has more space in other non-COVID units should it need to add additional bed space.

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Hospitals in Madison County this week are also seeing a surge of COVID-19 patients. Paul Finley, the mayor of the city of Madison, told reporters Wednesday that local hospitals were reporting record numbers.

Hospitals there were at 80 to 90 percent capacity.

“Our ambulances yesterday had their greatest number of runs since this started,” said Crestwood Hospital CEO Dr. Pam Hudson on Wednesday, adding that in about 20 percent of calls staff is having to wear full personal protective equipment. “That indicates that they are working with patients who have symptoms that could be compatible with COVID.”

Meanwhile, Madison County set a new daily record, adding 286 cases Thursday, the first time the county has surpassed 200 cases a day. The county was largely spared early on in the pandemic, with low case counts and low death rates, but roughly 42 percent of Madison County’s total case count since March has been reported in the last week as 803 new cases have been added.

Jefferson County and Madison County, over the last week, have accounted for 26 percent of the state’s new cases.

Jefferson County led the state in the most new cases Thursday with 343 and has added 1,498 cases in the last week. The county’s total cases increased by 33 percent from last week, and stood at 6,030 confirmed COVID-19 cases Thursday.

While Jefferson County and Madison County are seeing the state’s most intense increases, other large counties including Shelby County, Baldwin County and Tuscaloosa County have also seen record increases and rising percent positive rates.

At least 81 people have died from COVID-19 in the last week, and 162 people have died in the last two weeks.

At least 1,042 people have died from COVID-19 since March, and at least 26 other deaths are listed as “probable” COVID-19 deaths.

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