Long-term care residents make up almost half of the deaths in Alabama due to COVID-19, according to the Alabama Department of Public Health.
As of Tuesday, 224 of the state’s 504 deaths, or 44 percent, were residents in the state’s long-term care facilities, the department told APR. On Wednesday, the total number of deaths statewide due to the virus increased to 517.
The death toll among the state’s long-term care residents Tuesday jumped 109 percent from two weeks prior, when 107 long-term care residents had died. ADPH includes both nursing homes and assisted-living facilities among long-term care deaths.
Statewide 1,239 long-term care residents have tested positive for coronavirus, and 811 long-term care facility employees have tested positive.
The department hasn’t publicly released which Alabama long-term care facilities have confirmed cases of COVID-19, citing privacy concerns, but that information is to soon be made public.
The Centers for Medicare and Medicaid Services on May 8 required nursing homes to begin reporting all suspected and confirmed COVID-19 cases to the Centers for Disease Control and Prevention. That information is to be posted to the CMS website by the end of May, according to the agency.
Getting enough coronavirus tests to be able to prevent more outbreaks in the state’s long-term care facilities has been a struggle for many weeks, according to the Alabama Nursing Home Association. The association told APR on May 3 that only a few facilities had been able to test every resident, and when those facilities did test everyone, they found a number of asymptomatic cases.
The CDC has recently loosened some restrictions allowing more long-term care residents to be tested, but to be tested a resident must still show symptoms.
Testing all residents at Alabama’s long-term care facilities won’t be cheap, however. To test every nursing home resident in Alabama — just once — would cost $7.5 million, according to an estimate by the American Health Care Association and National Center of Assisted Living released Wednesday.
Diagnostic tests are only a snapshot in time, and just because someone tests negative on one day, doesn’t mean they won’t test positive later. Multiple tests per person on a regular basis would likely be needed to fully contain outbreaks and prevent new ones from emerging.
“For months now, we have been advocating for expanded and priority testing in nursing homes to protect our residents and caregivers, but this is a significant undertaking and cost for nursing homes to shoulder on their own,” said Mark Parkinson, president of AHCA and NCAL, in a statement. “That’s why we have asked HHS to grant our request for a $10 billion emergency relief to help fund expedited testing and the additional staffing needed to respond to this unprecedented health crisis.”
AHCA and NCAL have also asked that the CDC allow testing for long-term care residents who are asymptomatic.
“Without expanded testing, it is virtually impossible for us to know who in our facilities, whether they are residents or caregivers, are COVID positive – making it extremely difficult to stop the spread of the virus,” the groups wrote to the U.S. Department of Health & Human Services on May 5.
Judge orders Alabama to change voter requirements over COVID-19 concerns
In his 197-page ruling, the judge wrote that “the plaintiffs have proved that their fears are justified.”
A federal judge ruled in favor of plaintiffs in a case challenging aspects of Alabama’s voting requirements amid the COVID-19 pandemic.
U.S. District Judge Abdul Kallon’s Wednesday ruling orders the principal defendant in the lawsuit, Alabama Secretary of State John Merrill, to allow curbside voting, in the counties that choose to do so, but only for the Nov. 3 general election. The judge’s rulings pertain solely to the Nov. 3 election.
Kallon also ordered the state to do away with the requirement for voters to have two witnesses or a notary sign their absentee ballot, if the voter submits a statement that they have an underlying medical condition that puts them at a heightened risk from COVID-19 and thus, they cannot safely get those additional signatures.
In addition, Kallon ruled that voters 65 and older with an underlying medical condition won’t need to submit a copy of a photo ID with their absentee ballot, so long as the voter provides other identifying information, such as their driver’s license number or last four digits of their Social Security number.
In his 197-page ruling, Kallon wrote that “the plaintiffs have proved that their fears are justified” and the voting provisions challenged in the lawsuit “unduly burden the fundamental Constitutional rights of Alabama’s most vulnerable voters and violate federal laws designed to protect America’s most marginalized citizens.”
“That is for three reasons,” the judge continued. “First, because the Challenged Provisions only marginally advance the State’s interests in maintaining them while significantly burdening the right to vote, all three provisions violate the First and Fourteenth Amendments during the pandemic.”
“Second, because the photo ID requirement and the de facto curbside voting ban make voting inaccessible for voters with disabilities, both those provisions violate the Americans with Disabilities Act during the pandemic. Finally, because the witness requirement interacts with Alabama’s history of discriminating against Black citizens to deny Black voters’ their right to vote, that provision violates the Voting Rights Act during the pandemic.”
The lawsuit, filed by the NAACP Legal Defense and Educational Fund, Southern Poverty Law Center, American Civil Liberties Union, ACLU of Alabama and Alabama Disabilities Advocacy Program, was brought on behalf of several Alabamians with underlying medical conditions.
“This decision is a huge win for Alabama voters, especially voters of color and voters with disabilities,” said Deuel Ross, senior counsel at LDF, in a statement. “Given COVID-19, Alabama’s draconian voting rules needlessly place the health and voting rights of Alabamians in danger. No one should be forced to risk their safety to exercise their constitutional right. State and local election officials have a responsibility to ensure that voting is easy and accessible for everyone in the pandemic.”
Caren Short, senior staff attorney for the SPLC, applauded Wednesday’s decision.
“Today’s decision provides crucial relief in Alabama’s absentee voting process, allows for curbside voting in counties that wish to provide it, and ultimately will create a better public health situation in Alabama as it conducts an historic election,” Short said. “We’re deeply hopeful that the secretary of state and county election officials will accept the court’s ruling and begin educating Alabama voters on how they can vote safely and easily for the general election.”
“This ruling recognizes the hardships these laws place on Black Alabamians and those at particular risk for COVID-19. This decision will help to ease those burdens in the midst of this deadly pandemic,” said Davin Rosborough, senior staff attorney with the ACLU’s Voting Rights Project.
Merrill, in a statement to APR after the ruling, said he plans to appeal the verdict, which he likened to “judicial activism.”
“I am extremely disappointed in today’s ruling in the case of People First of Alabama v. Merrill relating to the November 3 General Election. Judge Kallon’s ruling to disallow the Secretary of State from prohibiting an illegal activity known as ‘curbside voting’ undermines the integrity of the elections process and the ability for Alabamians to cast a secret ballot as the chain of custody is then broken,” Merrill said. “It is important to remember that counties are in no way required to offer the illegal activity known as ‘curbside voting.”
Kallon in his ruling noted that “No provision of Alabama law expressly prohibits curbside or drive” but that there’s also no provision in state law allowing for the practice, and that Merrill then believes curbside voting to be illegal. Kallon also wrote that several states do allow for curbside voting, and that the Centers for Disease Control and Prevention recommends states allow curbside voting to comply with social distancing rules and in limiting personal contact during in-person voting.
“In addition, the photo ID and witness requirement components are necessary deterrents for those wishing to illegally influence elections,” Merrill continued. “We look forward to successfully appealing this decision as we continue fighting for safe and secure elections – free from voter fraud and judicial activism.”
Alabama Attorney General Steve Marshall in a statement said he will ask for an appeal of Kallon’s verdict.
“Back in June, the district court in this case enjoined these important protections for the primary runoff. But the U.S. Supreme Court stepped in, staying that injunction and allowing the State to enforce its laws. We will ask the 11th U.S. Circuit Court of Appeals and, if necessary, the Supreme Court, to do the same again,” Marshall said. “Voting began weeks ago. And every Alabama voter is entitled to vote under the same laws, not new ones written by a federal court in the middle of voting.”
Gov. Kay Ivey extends statewide mask order, allows limited nursing home visitations
“This mask ordinance is working. It works, and we have evidence of that,” State Health Officer Scott Harris said.
Gov. Kay Ivey on Wednesday extended Alabama’s statewide mask order, citing the upcoming general election and a reduction in the spread of the virus since her order went into effect in July. Ivey’s new order also allows for limited visitations in state nursing homes, and keeps all other previous social distancing restrictions in place.
“I’d hate to see us pull back too quickly and negate the progress that we’ve made in our daily positive numbers and our hospitalization rates by risking another spike due to a false sense of security, the upcoming winter months, the flu season and a host of other reasons,” Ivey said during a press conference Wednesday.
Ivey said that with the Nov. 3 Election Day nearing “it’s important to have a safe environment where our poll workers poll watchers, and those of us who would like to vote in person.”
Ivey said that voters aren’t required to wear a mask to vote in person, “I’m certainly going to wear my mask because I want to protect the poll workers and others that are going into the polls as well.”
Alabama State Health Officer Dr. Scott Harris said state hospitals are caring for about half the number of COVID-19 patients than were hospitalized in late July, during a surge in cases, hospitalizations and deaths, and just before the mask order was issued.
“This mask ordinance is working. It works, and we have evidence of that,” Harris said. “There have not been any additional restrictions imposed on our state since this Stay at Home order at the end of April.”
Harris noted an August study released by the South Carolina Department of Health and Environmental Control that looked at that state’s jurisdictional mask orders, and found that in the 40 percent of jurisdictions that have mask orders COVID-19 cases were reduced by nearly half, compared to an increase in cases by 30 percent in jurisdictions without mask orders.
White House Coronavirus Task Force Member Dr. Deborah Birx during a visit to Alabama last week urged Ivey to extend the mask order. Birx had praised Ivey’s statewide mask mandate during a previous visit to the state in July, when nine of the first 13 days of that month saw daily case increases in COVID-19 cases statewide of more than 1,000.
Ivey’s amended “safer-at-home” order also states that beginning Friday, hospitals and nursing homes shall ensure that each patient or resident can have one caregiver or visitor at a time, with some exceptions.
Ivey’s order states that the changes are “subject to reasonable restrictions imposed on the entrance of persons because of the COVID-19 county positivity rate, the facility’s COVID-19 status, a patient’s or resident’s COVID-19 status, caregiver/visitor symptoms, lack of adherence to proper infection control practices, or other relevant factors related to the COVID-19 pandemic, consistent with the following guidance from the federal government,” and goes on to list links to Centers for Medicaid and Medicaid Services guidance for the different facilities.
Ivey said during the Wednesday press conference that none of her previous statewide orders prevented anyone from accompanying a loved one into a hospital, and said despite that, there has been some confusion on the matter. She said her amended order made that fact clear.
Dr. Don Williamson, president of the Alabama Hospital Association, told The Montgomery Advertiser in June that hospitals have control over visitations. Hospitals statewide have enacted individual varying rules on visitations since the start of the COVID-19 pandemic.
Harris also discussed the work being done to ready the state for disbursement of a vaccine, if and when one becomes available. Harris said a plan for doing so must be given to the U.S. Department of Health and Human Services by mid-October.
“Obviously, we’re following very closely the safety data and efficacy data so that we are sure that we have a vaccine product that’s going to be safe and effective,” Harris said. “And I’m confident that information will be available for us, and then we can make a really good decision on that as we start to receive this vaccine.”
Harris said the supply of a vaccine will initially be limited, and state health officials will have to prioritize disbursement for high-risk people, including health care workers, but that the state will release its plan to do so to ensure openness in the process.
Alabama ABC Board rescinds alcohol sales curfew
On Tuesday, the Board approved a new order, which notes that the 50 percent occupancy requirement remains in place.
The Alabama Alcoholic Beverage Control Board on Tuesday voted to rescind a previous order that forced bars and restaurants to stop serving alcohol after 11 p.m. The measure went into effect immediately upon their vote.
Board members on July 27 unanimously voted to enact the 11 p.m. alcohol sales curfew as cases of COVID-19 were surging statewide and Alabama’s ICU beds were filling with patients stricken with the disease.
On Tuesday, the Board approved a new order, which notes that the 50 percent occupancy requirement remains in place. Customers and workers must also wear masks, if not eating or drinking, and remain six feet from others, according to the order.
The Board’s decision to rescind the curfew comes as the number of new COVID-19 cases in Alabama have declined following Gov. Kay Ivey’s statewide mask order in mid-July, but public health officials remain concerned that the number of COVID-19 patients in state hospitals remains too high.
Alabama State Health Officer Dr. Scott Harris told APR on Tuesday that while the state has made improvements since a surge in cases in July, and the number of hospitalized coronavirus patients in Alabama is about half what it was in early August, “they’re still a lot higher than they were back in the spring, so I wish we would continue to see more improvement, but I think we’re definitely much better than we were a couple of months ago.”
Dr. Deborah Birx, the coordinator of the White House’s coronavirus task force, suggested to Ivey and Harris on her July visit to the state that Alabama close its bars, which health officials say can be breeding grounds for the spread of COVID-19.
One of Ivey’s advisors suggested closing the state’s bars, but the board was instead tasked with finding a different solution, board administrator Mac Gipson told board members during the July 27 meeting prior to the vote to enact the curfew.
The plan at first was to cut off alcohol sales at 10 p.m., Gipson said at the July meeting, but bar owners contacted the board over concerns about potential losses in revenue, so it was pushed back to 11 p.m.
Tuscaloosa Mayor Walt Maddox on Saturday issued a warning that tickets would be issued for bars that exceeded the city’s 50 percent occupancy limit.
Maddox was responding to photos posted to the Facebook page of the band The Velcro Pygmies playing live at the Tuscaloosa bar Rhythm and Brews, where patrons were tightly packed together and not wearing masks. The post was later deleted after going viral.
Maddox in August ordered the city’s bars to shut down for two weeks in an effort to slow the spread of COVID-19.
Governor: Alabama will get 1 million rapid antigen COVID-19 tests
The state is to receive the Abbott Laboratories BinaxNow rapid tests in phases over the next few months. The initial shipment is set to include approximately 96,000 tests.
Gov. Kay Ivey on Tuesday announced that the Trump administration is to send 1 million new rapid COVID-19 tests to Alabama, but the details on their use was still being worked out.
Ivey’s office announced in a press release that the state is to receive the Abbott Laboratories BinaxNow rapid tests in phases over the next few months, and that the initial shipment is to be of approximately 96,000 tests.
It was unclear Tuesday who will get the tests or whether the results will be required to be reported to The Alabama Department of Public Health (ADPH), however. In a statement Ivey said while we await a vaccine “providing Alabamians – especially our students and vulnerable citizens – with this free resource will be another critical tool in the toolbox to combat COVID-19.”
Our Office is working in coordination with Public Health as we firm up plans for distribution. We are working to ensure students and high-risk individuals have access to this resource,” said Gina Maiola, Ivey’s press secretary, in a response to APR’s questions Tuesday.
Questions to ADPH on Tuesday weren’t immediately responded to.
The U.S. Food and Drug Administration on Aug. 26 gave an emergency use authorization to Abbott laboratories for the rapid antigen tests, which is the first of its kind to require no lab equipment.
The USDA on Sept. 18 reissued an emergency use declaration, changing wording to say that the tests are to be used “within the first seven days of the onset of symptoms” and that “testing facilities within the United States and its territories are required to report all results to the appropriate public health authorities.”
“Studies have shown that antigen levels in some patients who have been symptomatic for more than five days may drop below the limit of detection of the test. This may result in a negative test result, while a more sensitive test, such as RT-PCR, may return a positive result,” the Centers for Disease Control and Prevention said in guidance on the use of antigen tests.
The Trump administration approved a $760 million contract with the company to produce about 150 million tests.
“We’ll ship tens of millions of tests in September, ramping production to 50 million tests a month in October,” Abbott Laboratories said on the company’s website.
Other governors were making similar statements Tuesday about pending Abbott Laboratory tests coming to their states.
President Donal Trump on Monday announced plans to ship 100 million of the tests to states based upon population.
“Governors have the flexibility to use these tests as they deem fit, but we strongly encourage governors to utilize them in settings that are uniquely in need of rapid, low-tech, point-of- care tests, like opening and keeping open our K-through-12 schools; supporting critical infrastructure and first responders; responding to outbreak, specifically in certain demographics or locations; and screening of surveillance in congregate settings,” said Adm. Brett Giroir, the U.S. Department of Health and Human Services official in charge of COVID-19 testing for the White House’s coronavirus task force, speaking with Trump from the Rose Garden on Monday.
The Abbott Laboratories rapid antigen tests, which use a swab and a small card and can provide results within 15 minutes, have some similarities to existing antigen tests now being used across Alabama, which use small machines to provide quick results.
ADPH has struggled at times to get results from those existing rapid antigen tests, which are often used in non-traditional lab settings, such as nursing homes, universities and urgent care clinics, some of which aren’t accustomed to ADPH’s reporting process.
Dr. Karen Landers, an assistant state health officer for ADPH, told Kaiser Health News last week that she was concerned about the undercounting of antigen test results, and that some providers were struggling to submit results.
“We can’t afford to miss a case,” Landers told the news outlet.