Alabama State Health Officer Dr. Scott Harris said Thursday that the spike in new COVID-19 cases over the last two weeks is not totally attributable to increased testing and that the Alabama Department of Public Health believes there is ongoing, widespread community transmission of the virus.
“We’re extraordinarily concerned about the numbers that we have been seeing,” Harris said. “We know that ADPH and partners we work with have managed to increase the number of tests we’re doing throughout the state, but that doesn’t account for the case numbers that we’re seeing, or certainly doesn’t completely account for it.”
Harris said the state has identified a number of growing hotspots, including in Montgomery County, Tuscaloosa County and Walker County, where spikes in cases are not attributable to increased testing but rather outbreaks connected to businesses, nursing homes and widespread community transmission.
“We know that we continue to have community transmission going on in many parts of the state,” Harris said on a Facebook town hall with U.S. Rep. Terri Sewell. “We certainly identified many hotspots. …Sometimes we understand the reasons. Sometimes we do not. But clearly there’s a lot of disease transmission still going on.”
Harris said the increased daily case counts — which are increasing faster than 46 other states — should serve as a reminder that social-distancing recommendations must be followed, people must wear masks when out in public and people should avoid large crowds, even if those actions are not mandated by the government.
“Now more than ever, now that people are out in public, this is the time when they really need to follow those rules, those guidelines,” Harris said. “We need people to stay six feet apart, or more, from folks who aren’t in their own household. When people are going out into public, and particularly in indoors, perhaps into businesses or in other places, where they’re mixing with other people, face coverings, mask of some kind, are imperative and absolutely everyone needs to do that.”
The state health officer, who leads Alabama’s Department of Public Health, said the state was very concerned by photos and videos of massive crowds not wearing masks on Alabama’s beaches and Gulf restaurants over Memorial Day weekend.
“We did not like that at all,” Harris said. “I had conversations with local officials there about them and they certainly recognize and understand the dangers of that as well. They have done their best to use law enforcement to try to enforce that to the extent they can. But ultimately, we need the public to accept this. And to do this, we need the public to buy in and understand.”
Over the past two weeks, Alabama has confirmed an additional 5,080 cases, bringing the total number of confirmed cases up to 16,181. About a third of the state’s cases have been confirmed in the two weeks since the state relaxed restrictions on bars and restaurants on May 11.
Seven- and 14-day rolling averages, used to smooth out daily variability in reporting, are higher than during any point in the outbreak, meaning more new cases per day are being confirmed than ever before.
There has been no comparable increase in testing. Alabama broke 200,000 total tests performed on Thursday. But over the past 14 days, about 4,004 tests per day have been performed, on average. Over the previous 14-day period, ending May 14, the average number of tests per day was roughly the same at 4,032.
Meanwhile, the percent of tests that are positive has been rising after dropping to as low as 3 percent on May 1, based on 7-day averages of increases in tests and cases. The same metric rose to 10 percent by Wednesday.
Over the last 14 days, at least 117 people have died from COVID-19. On Thursday, the number of deaths attributable to the virus rose to 590.
“Those numbers do sound like numbers, they’re statistics,” Harris said on another Facebook town hall with Sen. Doug Jones. “But it’s really important to remember that every one of those numbers is a person. They’re someone’s parent or child or brother or sister. And so we never want to lose sight of the fact that we are having Alabamians who are dying from COVID-19 disease.”
Harris said the rise in cases is worrisome, and the state expected some rise after lifting the state’s stay-at-home order and loosening restrictions on businesses and gatherings.
“We’re going to need people to be more careful than ever,” Harris said.
Harris repeatedly emphasized the importance of wearing masks when out in public and said maybe public health officials need to do more to emphasize the importance of masks.
“People feel like a mask just protects me, and if I’m not worried about getting sick, then why should I wear a mask?” Harris said. “But a mask is how you protect other people.”
A mask controls your own coughing or sneezing or other symptoms — or just transmitting it because you’re talking or yelling or spitting. Such precautions are important because at least a quarter of people and maybe as many as a third of people who are infected and can infect others won’t have any symptoms at all.
“So, it’s certainly possible that you can be infectious to other people and not even know it,” Harris said. “So that’s what a mask is for. A mask, in my mind, is good manners. A mask is how you show that you care about people in your family or in your community, particularly those people who are very vulnerable, or seniors or people with chronic health problems.”
Masks are also important even when not around vulnerable people because you could spread the virus to someone else, who then unwittingly could spread it to a nursing home or extended care facility.
In Tuscaloosa County, DCH Health System has seen the number of hospitalizations from COVID-19 more than double over the course of a week, in part because of an outbreak at a long-term care facility in the county and in part because of community spread, Harris said.
Similar outbreaks at long-term care facilities in Elmore County, Butler County and a workplace in Walker County and Franklin County have contributed to rising numbers, Harris said.
“Some of those are outbreaks,” Harris said, “and yet again, those are still attributable to community spread. The people in the nursing home didn’t go out into the community and catch it. Someone brought it into them. There has to be transmission going on in the community for that to happen. We need to find a way to get people to take this seriously.”
Harris said the Department of Public Health is not aware of any particular origin for the rising cases in Montgomery County, however, and that officials believe the rise is largely due to widespread community transmission and in part due to increased testing.
But the increase in cases also accompanies a rise in the percent of tests that are positive in Montgomery County, despite increased testing there. There has been some controversy about Montgomery Mayor Steven Reed saying no ICU beds were available in the city, but Harris said he was “absolutely correct.”
“There were no ICU beds available,” Harris said. “We talked to the hospitals immediately upon learning about that. I think their response was that that’s correct. However, they do have some internal capacity, when they need to do it, to expand the space that they have available and take care of critically ill patients.”
In Montgomery, that has involved treating critically ill patients in emergency rooms and retrofitted ICU units, a Montgomery area doctor told APR earlier this week. But there remains a shortage of ICU beds.
“I think that the message that we want to be careful about putting out there is: clearly those hospitals have higher numbers, they have you know their normal beds filled, and yet the public sometimes hears that and thinks well if I have a heart attack, I don’t have a place to go or they’re going to turn me away if I show up because the hospital’s full, and that’s not the case,” Harris said. “And so we want people to understand they certainly still can continue to seek care, just as they always would for any kind of a problem. They should do that. They certainly shouldn’t try to sit at home if they’re concerned about a certain thing.”
But if numbers continue to rise, the situation could become a dire problem.
“If numbers go up, they can’t do that forever, and then we’ll have to have to make other arrangements,” Harris said.
Madison County seeing surge of COVID-19 hospitalizations, ambulance calls
A surge of COVID-19 cases in Madison County troubles the CEO of Crestwood Hospital, who said the public needs to take the virus seriously and do what’s needed to slow the spread by wearing masks and practicing social distancing.
Madison County added 66 new COVID-19 cases Wednesday, when the county’s total case count hit 1,620. Though Madison County had largely been spared through the early months of the pandemic, with very low case counts and deaths, over the last week, the county has reported 563 new cases — a 53 percent increase.
“Our county cases continue to climb,” said Crestwood Hospital CEO Dr. Pam Hudson, speaking at a briefing Wednesday.
“We have to flatten the curve again,” Hudson said.
Hudson said the percentage of tests that are positive in the county used to be much lower, but are now in line with the state’s current percent positivity rate of 9.92 percent. The percent positivity was 13.52 percent on Wednesday, based on fourteen-day averages of case and test increases. She said the county’s hospitals are very busy.
“We were already busy before we had this uptick,” Hudson said.
There were 1,110 COVID-19 patients being cared for statewide Wednesday, the highest number since the start of the pandemic.
Paul Finley, the mayor of the city of Madison, said there were 163 COVID-19 patients Wednesday in the Crestwood and Huntsville Hospital systems, which is a 31 percent increase from last week.
“There’s no question that these numbers continue to rise,” Finley said.
Hudson said, on average, the hospital is running at between 80 and 90 percent capacity.
“Our ambulances yesterday had their greatest number of runs since this started,” Hudson said, 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.”
A face mask order for the public went into effect Tuesday in Madison County. Similar orders are in effect in Jefferson County, Montgomery, Mobile, Selma and Tuscaloosa.
Last week Madison County had 500 people who tested positive for COVID-19 and were under active quarantine and being tracked by the Alabama Department of Public Health, Hudson said. On Wednesday that number was 847.
“So things are not all well in our county,” Hudson said. “COVID-19 has gained, and is continuing to gain footholds in our community.”
Hudson said she believes the spike in cases and hospitalizations in the county comes down to people not wearing masks in public, not practicing social distancing and bars and restaurants, which are hotspots for the virus’s transmission.
Hudson reiterated a statement made by Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases and a member of the White House’s coronavirus task force, that up to 40 percent of coronavirus cases are caused by someone who is infected and has no symptoms, and one in 10 COVID-19 patients need hospitalization, Hudson said.
“So this is not a nothing disease. Thirty percent of those patients who are hospitalized will end up in an ICU,” Hudson said. “And of those, 30 to 40 percent will die.”
Local hospitals are “bumping up into some challenges” with the availability of ICU beds, Hudson said, and the medical staff is under strain and the threat of becoming infected themselves every day.
UAB expert: We can’t wait until it’s too late to act on surging cases
“We still are at a time point when we have an ability to intervene, and do something to reduce that case count, to reduce the eventual mortality,” UAB specialist Dr. Jodie Dionne-Odom said.
Alabama continues to see record numbers of new COVID-19 cases and hospitalizations, and the best way to turn the trend around is to wear face masks and practice social distancing, a UAB doctor says.
Dr. Jodie Dionne-Odom, an infectious disease specialist at UAB, told reporters in a press conference Wednesday that the seven-day average of new daily coronavirus cases in Alabama has increased fourfold over the past several weeks.
“We still are at a time point when we have an ability to intervene, and do something to reduce that case count, to reduce the eventual mortality,” she said. “You don’t want to wait until things are so bad that it’s difficult for us to reverse the trend at all.”
Dionne-Odom said she’s concerned that the window of time to turn the trend of increasing cases, hospitalizations and the impending deaths that will surely come is limited. Wearing masks in public and practicing social distancing are some of the best tools we have to do so, she said.
On Wednesday, the state added 1,161 new COVID-19 cases and 25 deaths from the virus. It’s killed 1,032 people in Alabama, the UAB physician said. At least 1,110 people were being treated in hospitals in the state Wednesday, according to the Alabama Department of Public Health, the most since the pandemic began.
The 14-day average of new daily cases was 1,057 — the highest it’s been since the start of the pandemic.
“The fact that we’re seeing these sharp increases and hospitalization in cases over the past week or two is really concerning,” Dionne-Odom said. “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.”
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.
Of those being treated in UAB’s COVID-19 ICU unit Tuesday, less than half were on ventilators, a UAB spokesperson, Bob Shepard, said in a message to APR on Tuesday. Ventilator usage is actually dropping, he said, a positive sign. 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.
“If we reach a point where we have more patients needing space in either unit, we will create more space in other areas of the hospital and designate additional beds for COVID patients,” Shepard said.
“The issue is that designating more beds for COVID care reduces the number of beds we have for patients with non-COVID illnesses, which can have a profound effect on the overall health of our community,” he said.
That flexibility was echoed by Dionne-Odom, who said that it is the type of system where they can create capacity as it’s needed.
“And we have units that we can open and close and take care of patients with COVID and staff who are familiar with the procedures of wearing PPE and gowning and keeping healthcare workers safe,” Dionne-Odom said. “So we’ve used everything that we’ve learned since March, working really hard to be able to take care of more patients. That said, you have to remember that every bed that we’re using today for someone with COVID can potentially be a bed that someone else would need, who’s having a stroke or having a heart attack.”
“These problems are continuing to happen, and they need ICU-level care too,” she continued. “So we don’t want to continue to see an increase in the COVID cases because that has the indirect effect of affecting how we care for all the other patients with serious diseases.”
Dionne-Odom said that they know from experience that some of those being hospitalized for the virus will die in the coming weeks, “so we’re all watching the next several weeks very cautiously.”
Testing across the state has increased in recent weeks, but so has the percentage of tests that are positive, a sign that not enough testing is being done, and cases are going undetected.
Dionne-Odom said many cities across the southeast have high testing positivity rates of between five percent and 15 percent, and in some cases as high as 20 percent.
“And what that number means is when you’re getting one of five tests back positive, is that there’s a lot of spreading infection in the community that you are not detecting,” Dionne-Odom said.
Alabama’s seven-day percent positivity rate was 14.69 on Wednesday. Public health experts say it should be at or below five percent or cases are going undetected.
In Jefferson County, as of Wednesday, the percentage was roughly 14 percent.
While the majority of hospitalized patients are older, UAB does have COVID-19 patients in their 30s who are very ill and in ICU units, Dionne-Odom said.
“So the message is still true that this disease tends to impact older adults more than younger adults, but if you’re 20, 30, 40, especially if you have an underlying condition, but even if you don’t, you’re not immune from this disease. You’re still at risk of having severe outcomes,” Dionne-Odom said.
Tenth state inmate dies after testing positive for COVID-19
As of Tuesday, 97 inmates had tested positive for COVID-19.
A tenth Alabama inmate has died after testing positive for COVID-19, according to the state.
Raymond Earl Allen, 59, who was serving at the St. Clair Correctional Facility died Monday at a local hospital, where he had been taken after exhibiting symptoms for coronavirus, the Alabama Department of Corrections said Tuesday.
Allen was considered high-risk because he had end-stage renal disease, according to ADOC.
ADOC also said another inmate at St. Clair has tested positive for COVID-19, bringing the total number of confirmed cases among inmates at the prison to 28. Six workers at the prison have also tested positive for the virus.
The department also announced that four workers at the Kilby Correctional Facility, two at the Fountain Correctional Facility and one at the Alex City Community Based Facility and Community Work Center also tested positive for COVID-19.
As of Tuesday, 97 inmates had tested positive for COVID-19, while 28 have since recovered. Of the state’s approximately 22,000 inmates, 490 have been tested. Of the 184 confirmed cases among prison staff, 100 have recovered.
Two prison workers at the Julia Tutwiler Prison for Woman have died after testing positive for coronavirus. There have been confirmed cases of the virus in 27 of the state’s 32 facilities.
COVID-19 kills 228 Alabamians in last three weeks as deaths pass 1,000
At least 1,007 Alabamians have died from COVID-19 since the first case was diagnosed in the state in mid-March.
The Alabama Department of Public Health reported Tuesday that more than 1,000 Alabamians have now died from COVID-19. At least 228 of those were killed in just the past three weeks.
At least 1,007 Alabamians have died from COVID-19 since the first case was diagnosed in the state in mid-March, according to the Alabama Department of Public Health. Another 26 deaths are listed as probably COVID-19 deaths.
By June 1, 18,246 Alabamians had tested positive. By June 17, 26,914 cases had been diagnosed in the state. In the twenty days that have followed, another 18,349 Alabamians have tested positive. As of Tuesday, 45,263 tested positive, with another 888 positive coronavirus tests announced on Tuesday.
Alabama’s coronavirus epidemic was expected to peak in April while the state was under a shelter in place order. By April 30, the state began lifting restrictions to reopen the economy.
On Tuesday, Dr. Anthony Fauci told reporters that Alabama and other states may have reopened their economies “too soon.” Since the Memorial Day weekend, cases of coronavirus have risen at an alarming pace. On Monday, hospitalizations for COVID-19 set a new record at 1,016.
The combination of a surge of cases, many Alabamians out and about without masks or face coverings, and large holiday gatherings over the Fourth of July weekend make many public health officials concerned that we could be seeing dramatically higher numbers of cases, hospitalizations, and even deaths moving forward into late July and early August.
Fauci told members of the Alabama press corps that 20 to 40 percent of people who are infected are not showing any symptoms, but they could still be spreading the virus.
Fauci said that wearing a mask or cloth face covering and staying at least six feet away from other people is the best way to avoid becoming infected with the coronavirus — or transmitting the virus to other people if you are already infected, but just don’t know it.
Several cities and counties in Alabama have already implemented a mask requirement.
State officials are urging Alabamians to take personal responsibility for their own health.
Thus far the global pandemic has killed 543,596 and known coronavirus cases are rapidly approaching twelve million.