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Montgomery doctor: Where are we now with COVID-19?

Dr. David Thrasher, M.D.

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Dr. David Thrasher, M.D., is a Montgomery-area pulmonologist and the head of pulmonology at Jackson Hospital.

I’ve been asked by many people to give an update on where we are in Montgomery with the COVID-19 pandemic. First, let me say I cannot offer any medical advice or instructions online. Having said that, I do think there is a place to post factual information as there is so much false information, rumors and innuendos circulating.

I would like to quote President Abraham Lincoln: “I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts.”

Where are we in Alabama and in Montgomery?

Montgomery saw the first patient with COVID-19 in Alabama as well as the first patient to require intensive care and a ventilator in the state. Montgomery was relatively spared early on in the pandemic. Perhaps Montgomery was lucky. “We had been spared,” I thought.

I was wrong.

Over the last month, there has been a significant increase in the number of cases in Montgomery. The number of cases requiring hospitalization and treatment in intensive care units has significantly increased. Both major hospitals in Montgomery have enacted aggressive plans for handling the large number of COVID-19 patients.

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One of the hospitals has converted three of its intensive care units to COVID-only units. Both hospitals have COVID-only floors, and the emergency room is frequently used for overflow to take care of patients requiring vents.

As one of our CEOs said recently, “we are managing but this is not sustainable.” We have unbelievable nurses and respiratory therapists who are working around the clock to take care of these critically ill patients. It has definitely been a challenge for hospitals to continue to provide quality nursing and respiratory therapy personnel. We have had doctors, nurses, cleaning personnel and respiratory therapists become infected.

As I have said before these brave nurses and respiratory therapists are my true heroes.

There has been a minor controversy regarding the number of ICU beds available from time to time. It is not uncommon in the winter months for us always to have a shortage of intensive care beds. We will frequently turn another area of the hospital, including emergency rooms, into short-term intensive care units. That is occurring today.

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As I’ve said before, give me a good nurse, a ventilator and a monitor, and I’ll put you in the parking lot and provide you with an ICU. So how about ventilators? Last March, there was a shortage in certain cities. Again, this happens each winter, and there is a process for hospitals to borrow ventilators from other hospitals.

As of now, we have plenty of ventilators in the state of Alabama. As for Montgomery Pulmonary Consultants, I have six great partners. Our workload is double our normal capacity. All seven of us are putting in long hours especially on the weekends, which is especially difficult.

I want to brag on our great community. People have given gift cards, provided meals and other support for the hospital and first responders. Our local businesses have provided money so that entire COVID-units now have safe N-100 respirators. My biggest regret early on in the pandemic was not having adequate PPE equipment for our frontline people.

History

My partner, Dr. Lisa Williams, saw the first patient with COVID-19 in Alabama on March 11. Ironically, that was the day that the World Health Organization declared COVID-19 to be a pandemic. Ironically, it was also 102 years — almost to the day — that private Albert Gitchell of the U.S. Army reported to the hospital at Fort Riley Kansas complaining of cold-like symptoms of sore throat, fever and headache.

By noon, more than 100 of his fellow soldiers had reported similar symptoms, marking what is believed to be the first cases of the historic influenza pandemic of 1918. This would eventually be called the Spanish Flu. That flu eventually killed 675,000 Americans and an estimated 50 million people worldwide.

How did it get the name Spanish flu? Spain was neutral during World War I and, unlike its European neighbors and the United States, it did not impose wartime censorship of the press. The United States and our allies censored the press because they did not want the people to know how bad the death rate was as it was felt that reporting the devastating death rate would hurt the war effort.

Spain had no such limitations and kept reporting the news of a crippling virus that was sweeping through the country. Spain would eventually report 8 million deaths in that country. Therefore, the 1918 epidemic was deemed the Spanish Flu. Actually, it should have been called the American Flu or the Fort Riley Kansas Flu. Like COVID-19, the Spanish Flu would gradually sweep across America and, by the summer of 1918, it would kill approximately 100,000 Americans.

Because we were in World War I, our troops were shipped to Europe. On the battlefield in France the virus spread very quickly. It gradually spread all over the world. As our troops began returning to America in the fall of 1918, a second, more deadly wave occurred.

While the global pandemic lasted for two years, the vast majority of deaths were packed into three especially cruel months in the fall of 1918. We now believe that the fatal severity of the Spanish Flu’s second wave was caused by a mutated virus spread by wartime troop movements.

Like the seasonal flu, the Spanish Flu was especially hard on the young and otherwise healthy 25- to 35-year-olds in the prime of their life. At the time, the medical establishment could not understand why so many young men were dying of pneumonia-like symptoms. Only decades later were scientists able to explain the phenomenon now known as “Cytokine Storm.” When the human body is attacked by a virus, the immune system sends messenger proteins called cytokines to promote helpful inflammation.

Some strains of the flu — as well as COVID-19 — trigger a dangerous immune overreaction in healthy individuals. In those cases, the body is overloaded with cytokines, causing severe inflammation and fatal buildup of fluid in the lungs. British military doctors conducting autopsies on soldiers killed by the second wave and described the lungs as akin to the effects of chemical warfare.

The rapid spread of the Spanish Flu in the fall of 1918 was at least partially to blame for public health officials unwilling to impose quarantine during wartime. The public health response to the crisis in the United States was further hampered by a severe nursing shortage of thousands of nurses that had been deployed to the military camps and the front lines.

The shortage was worsened by the American Red Cross refusal to use trained African-American nurses until the worst of the pandemic had already passed. But one of the chief reasons that the Spanish Flu claimed so many lives in 1918 and 1919 was that we simply did not have the tools to develop a vaccine for the virus. The virus would eventually peter out in 1919 after it killed almost 50 million people worldwide.

The Origin of COVID-19

COVID-19 originated in China, most likely in November or December of 2019. COVID-19 is just another instance in the long history of the so-called zoonoses-diseases that jump from animals to humans. The domestication of the horse led to the virus responsible for the common cold in humans as well as the Spanish Flu. The domestication of chickens gave humans chickenpox, shingles and various strains of the bird flu. Pigs were the source of influenza, measles and smallpox. Tuberculosis emerged from cattle.

When a virus successfully jumps species from an animal to human, and that version of the virus, in turn, succeeds in making the jump to a second human, those two people become the first two human vectors of human-to-human virus transmission.

Three-quarters of infectious diseases are the result of zoonotic spillovers and the novel coronavirus is no exception. The term coronavirus refers to a family of viruses, shaped like a crown, and it accounts for about 10 percent of common colds in humans.

Novel coronaviruses have made the jump into the human population on three occasions in the 21st Century — each time causing a deadly pandemic: SARS, MERS and COVID-19. As early as 2007, the world was put on notice by an American Society for Microbiology Journal in which researchers warned “the presence of a large reservoir of SARS/COV-like viruses in horseshoe bats, together with a culture of eating exotic mammals in southern China, is a time bomb. The possibility of the emergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.” But ignored it was.

Morbidity and mortality — who gets COVID-19?

I get frustrated and actually mad when I hear people say that COVID-19 is no more deadly or dangerous than the seasonal flu. These statements clearly come from people who’ve never treated patients in an intensive care unit with COVID-19 patients. I’ve heard this from physicians as well as laypeople. I have treated every seasonal flu episode since 1983. This is not close to seasonal flu.

We experienced a tough winter when the H1N1 swine flu came through, and it was unusually lethal but nothing like what we’re seeing today with COVID-19. I started following this in February as I was working an event in Austria. At that time, I predicted that 100,000 to 200,000 Americans would die before we had a vaccine.

Today, I think that my estimation will probably be too low. As of today, the worldwide and U.S. death rate is approximately 5.7 percent of confirmed cases. Sweden’s death rate of confirmed cases is 10.4 percent — with their experiment with the concept of herd immunity and refusal to do any lockdowns.

We know that there is a large percentage of asymptomatic cases — perhaps 25 percent or even higher. By the time the virus burns out, I predict that the overall mortality rate will be between 1.3 and 2 percent. That sounds low, but this is opposed to the seasonal flu mortality rate of 0.1 percent.

There are more than 350 million Americans, so you can do the math, but it is imperative that we contain this virus and develop a vaccine as soon as possible. I do know that many of the people that survive will be left with significant and permanent organ damage — especially in the lungs and kidneys.

Who is affected? These change daily, but as of June 11, 2020, in Alabama:

  • 58 percent of cases are female, and 42 percent are male.
  • 42 percent of cases are black, 37 percent are white, and 10 percent are Hispanic.
  • 46 percent of deaths are female, and 54 percent are male.
  • 45 percent of deaths are black, and 49 percent are white, while 2 percent are Hispanic.

What are the ages?

  • Ages 0 to 4 represent 1.4 percent of the cases.
  • Ages 5 to 24 represent 14 percent of the cases.
  • Ages 25 to 49 represent 41 percent of the cases.
  • Ages 50 to 64 represent 23 percent of the cases.
  • Ages greater than 65 represent only 20 percent of the cases.

Who dies?

  • Ages 0 to 4 represent 0.1 percent of deaths.
  • Ages 5-24 represent 0.3 percent of the deaths.
  • Ages 25-49 represent 3.9 percent of the deaths.
  • Ages 50-64 represent 16.7 percent of the deaths.
  • Ages 65 and older represent 79.1 percent of the deaths.

Health care workers represent 11.4 percent of Alabama’s total cases, while health care workers, long-term care facility employees and long-term care facility residents represent 25.2 percent of all cases. Roughly 48 percent of deaths in Alabama have been among those who are residents of long-term care facilities.

Treatments

I am not going to go into specific treatment modalities in this paper but suffice it to say we are using cutting edge treatments. At Montgomery Pulmonary Consultants, my partners Dr. Lorino, Dr. Williams, Dr. Ensminger, Dr. Saliski, Dr. Noriega and Dr. Vyas have been in contact with UAB as well as several other cutting-edge institutions regarding therapies.

Currently, numerous studies have been conducted not only at UAB but other institutions. I must say that UAB is on the cutting edge of this pandemic. Remdesivir, the only FDA approved treatment for the virus, was developed in coordination with UAB and Dr. Rich Whitley.

Some of the trials have used various medications late in the disease when people were on the ventilator. There is a growing belief that treating this illness sooner than later will have beneficial results and hopefully prevent patients from developing fatal lung damage.

Flattening the curve

You’ve all heard this phrase. What does it mean? Early on, our mayor in Montgomery, our governor and our president called for various forms of lockdowns or sheltering in place. The reason for this was to “flatten the curve.” Why do we do this? As a fisheries biology major in college, I will use my fishpond example.

If you put a Lilly pad in a fishpond and it doubles every day it takes 60 days to completely fill up the pond. At first, it is a slow process. At day 54, only 1 percent of the pond is consumed. At day 59, half of the pond is consumed. By the next day, the entire pond is consumed.

The point I’m making is that it takes time for the virus to work through the population. If we spread out this process lives can be saved. We know that in the end, flattening of the curve only spreads out the infectious process and the total number of people infected remains the same at the end of the pandemic. However, lives are saved by flattening or spreading out the rate of infection. If large numbers get infected at the same time, the health care system is overloaded — the intensive care units, the number of ventilators, number of Pulmonary/Critical Care doctors simply cannot handle the surge and lives will be lost if that happens. We’ve seen that happen in Italy.

Economic considerations

I am asked frequently, “should we protect lives or businesses?” I have to wear two hats — a medical hat and a business hat. We cannot shut down America or we will die as a nation. We could completely eliminate this virus in 30 days if we did shut down everything. This virus has to move on from one living creature to another every 14 to 21 days. If everyone in the world would isolate for 30 days, the virus would go away.

Of course, that could never happen. All we can hope for is to slow down the spread, which we have hopefully done until they develop a vaccine. I hope that we will not have to have any more lockdowns. During the lockdown, our unemployment rate was close to 20 percent. We know that with every one percent increase in unemployment, we can see up to a 3.6 percent increase in overdoses and a 1 percent increase in suicides across the country.

I was coroner of Montgomery County for 13 years, and during the Great Recession, I saw an increase in suicides as well as overdoses because of financial considerations. The Federal Reserve of St. Louis has predicted a “worst-case scenario” of 32% unemployment. If that were to happen some 77,000 Americans could die in addition to those who were stricken with COVID-19.

How can we accomplish both? This is the million-dollar question. We have to protect our citizens who are most vulnerable. We know that people over the age of 60 years old represent the majority of deaths from COVID-19. If they are retired and have the ability, they should socially isolate as much as possible.

Having said that, is very important as Americans to be able to fellowship. I have not hugged or kissed my grandchildren since February. I have eaten with them — outside in a picnic-like environment and conversed with them as much as possible. It is important for Americans to be able to fellowship and not isolate totally, but we have to do it carefully. The 6-foot rule and masks are so important.

Churches 

I have had the privilege of conversing with several of Montgomery’s religious leaders during this pandemic. Montgomery is blessed with many wonderful pastors, and they have stepped up during this pandemic as well as the recent protests of the tragic death of George Floyd. People ask the question — where do the hotspots of pandemics originate?

You would say cruise ships, but you would be wrong. The three hotspots of pandemics are religious ceremonies, call centers and meatpacking plants. One of the largest and deadliest sparks in Alabama came from a religious ceremony in East Alabama. Another spark occurred on the West Coast and involved a super-spreader infecting an entire choir and several members died.

We know that singing, loud talking and laughing spreads the virus significantly. I’ve been asked how can you condone people going back to work and going to recreational activities but yet advise not having in-service religious ceremonies? As I have stated, we must support our local businesses, or they will simply not exist. We have to safely support those institutions.

Churches and synagogues on the other hand can exist without having the congregation gather in tight quarters. It is nearly impossible to maintain social distancing in church. Children frequently run through the halls, and it is common that we all hug and shake hands with our fellow congregants.

Bathrooms are another consideration and difficult to manage and keep clean during the condensed time frame that the services are conducted. We can all worship remotely or outside as far as that goes. We all long for the time we can gather again but this needs to be done when it is safe.

Historically in Montgomery, a congregation has many of its members over the age of 60. As I told leaders of the religious communities, people believe what they say. If they say, “come to church,” people believe them and know that it is safe. They have an enormous responsibility to protect their flock. We all look forward to the day that we can gather again in-person in our churches, synagogues and other religious institutions, but until the case numbers start to fall, I would prefer to do this remotely.

Masks

I know why there has been so much confusion over masks. To be honest, early on, the CDC, the president, the surgeon general, the governors and hospitals got this wrong. They said the reason was to keep the public from hoarding masks that were in such short supply when the PPE problem was so bad in March. Masks have been worn for decades in Asian countries when people felt that they were sick. We know that this helped stem the contagion in China as well as Korea. The Czech Republic also required masks early on and this helped them greatly as opposed to many other European countries who did not use masks.

Unfortunately, this has become such a political issue that it will lead to more infections and deaths. In a study published in April, in Nature, scientists showed that when people who are infected with influenza, rhinoviruses or a mild cold-causing coronavirus wore a mask, it blocked nearly 100 percent of the viral droplets they exhaled as well as many tiny aerosol particles.

Some governments and businesses are beginning to require or at least recommend that masks be worn in many public settings.

There is growing evidence that some kinds of masks may protect you from other people’s germs. If two people are in public and 6 feet apart and one person has COVID-19 and coughs or sneezes, there is a great chance that the other person will not become infected. Studies have shown the N95 mask is able to capture over 90 percent of viral particles and plain blue surgical masks block between 50 percent to 80 percent of particles, whereas a cloth mask blocks 10 to 30 percent of viral particles.

This isn’t Republican versus Democrat or Auburn versus Alabama. We are all on the same team. Wearing a mask helps protect your neighbor. It doesn’t make you a criminal. It doesn’t make you a bank robber. It simply helps protect your neighbor. Some people tell me I don’t like to wear a mask because it’s hot. Believe me, if you don’t like wearing a mask, you are really not going to like my ventilator!

When will it be over?

The short answer is when a vaccine is available. Vaccines for a novel virus typically take 8 or more years to develop, but the whole world is working on this vaccine at warp speed. More than 53 companies are working on the vaccine that I know of. Reports that a vaccine may be available as early as this fall are coming out.

If that is the case, I will say “thank the Lord.” Personally, I think it would be a near miracle should a vaccine be approved and manufactured in sufficient quantities to vaccinate our citizens by year’s end. Short of a vaccine. I fear that we will be battling this virus well into next year. There are also concerns about mutations of the virus and acquired immunity fading, which could affect the effectiveness of a vaccine.

Dr. David Thrasher, M.D., is a Montgomery-area pulmonogist and the head of pulmonology at Jackson Hospital.

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“We’re not going to get a do-over:” Alabama health officer on Thanksgiving and COVID-19

There were 1,427 hospitalized COVID-19 patients in Alabama on Monday, the most since Aug. 11.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama State Health Officer Dr. Scott Harris on Monday pleaded with the public to avoid gatherings over Thanksgiving as COVID-19 continues to surge in Alabama and hospitals statewide are filling with coronavirus patients. 

“We don’t want this to be the last ever Thanksgiving for someone in your family, like your parents or your grandparents,” Harris said during a press conference Monday. 

Harris said Alabama’s numbers aren’t headed in the right direction and more than 230,000 Alabamians — roughly 4 percent of the state’s population — have been infected by the coronavirus. 

“We are adding a couple of thousand new cases a day, at least, that we are aware,” Harris said. “This is a time for people to be vigilant. This is a time to be careful and to think about what you’re going to be doing.” 

Alabama added 1,574 new coronavirus cases on Monday, and the state’s 14-day average for new daily cases was at a record high 2,087. In the last two weeks, the state has added 29,223 cases, the most cases in any two week period since the pandemic arrived in Alabama in March.

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There were 1,427 hospitalized COVID-19 patients in Alabama on Monday. The last time so many were hospitalized in the state was on Aug. 11, during Alabama’s summer surge. 

Harris said that he and his wife will be staying home for Thanksgiving instead of having his family’s regular large, intergenerational gathering. What happens with Alabama’s COVID-19 numbers over Thanksgiving will impact what the state’s December holiday and Christmas season will look like, Harris said. 

“Are we gonna be here a month from now trying to have the same conversation? I really, really hope not,” Harris said. 

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Dr. Mary McIntyre, the Alabama Department of Public Health’s chief medical officer, said during the briefing that her home usually sees between 15 and 20 family members arriving for Thanksgiving. They’ve limited this year’s Thanksgiving to three additional people from out of their household, for a total of seven people, she said.

Everyone must wear masks and have temperatures checked at the door, she said. 

Everyone will be seated six feet from one another and a Zoom video conference will be set up for those family members who won’t be attending in person, McIntyre said. They’ll use disposable plates, cups and utensils and have the ability, weather permitting, to eat outdoors.

“If we want to live to see another Thanksgiving, and I do, that it may mean stepping back this Thanksgiving and really limiting the number of people, and some of the things that we do,” McIntyre said. “Now is not the time to get out to do Black Friday shopping.” 

Dr. Kierstin Kennedy, UAB’s chief of hospital medicine, in a separate press briefing Monday echoed concern over the possibility of spikes following Thanksgiving and Christmas if the public doesn’t do what’s needed to keep themselves and others safe.

“We are very much worried about the potential spike in numbers. We’ve also seen some of our own staff getting sick,” Kennedy said. “And unfortunately that’s not been at work. It’s been because we are just like you. We’re tired. We’re lonely. We want to try to socialize, and some of us have let our guards down and, as a result, have gotten sick.”

Kennedy said while there’s is concern over future spikes following the upcoming holidays “there is a way for all of us to help prevent that from happening.”

Kennedy said when Gov. Kay Ivey first issued her statewide mask order and social distancing requirements, the public masked up, businesses enforced the orders, and coronavirus numbers improved.

“It didn’t get nearly as bad as we thought, and we are really hopeful that the community is going to come together and do that again for us,” Kennedy said. “Because it’s more than just not having enough space for the COVID patients. It’s also those patients who do not have COVID that have other conditions. They rely on us for routine care, and we want to make sure that we’re available to provide that.”

Kenedy said UAB has an incredible group of staff members, who’ve proven themselves to be quite resilient, but that “the group is tired.”

“We’ve been doing this every single day since March, and so as you can imagine, people are very tired. It’s very emotional, especially as we see younger patients getting sick with this and getting sick in ways that we weren’t expecting,” she said.

Harris again urged the public to make smart decisions that will help slow the spread of coronavirus and save lives.

“Ladies and gentlemen, we’re not going to get a do-over on this,” Harris said. “This is a big national holiday, and we’re in the middle of a pandemic, and our numbers are worse than they have ever been during this entire response. Please be careful. Please be safe. And please try to take care of those people who are most vulnerable.”

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Governor allocates $3.6 million in CARES Act funds to food banks

The money is to go to the nonprofit Alabama Food Bank Association, which will administer the funds.

Eddie Burkhalter

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Gov. Kay Ivey on Monday announced that $3.6 million in federal CARES Act money will be used to reimburse food banks for COVID-19-related expenses. 

“Alabama is a state where neighbors help neighbors, even in the most difficult times,” Ivey said in a statement. “The Coronavirus pandemic presented significant challenges around the world, as well as here at home in our own state. Food banks in communities across Alabama have been a lifeline for those in need, and I am proud to be able to put these funds toward the Alabama Feeding Initiative. I have told Alabamians that I remain committed to getting these CARES Act funds into the hands of those who need it.”

The funds are to go to the nonprofit Alabama Food Bank Association, according to the memorandum of understanding. The association will administer the funds to eight participating food banks across the state, which can be reimbursed for the following: 

  • The purchase of food, packaging and related supplies to meet increased demand.
  • operational expenses, including fuel and maintenance, incurred due to handling a higher amount for food, as well as open-air distribution events. 
  • Rental costs of storage space and vehicles to handle increased volumes of food. 
  • To purchase PPE, screening equipment and decontamination services to prevent the spread of COVID-19.

Unless Congress extends the deadline, Alabama and other states have until Dec. 30 to spend CARES Act funds or the money reverts back to the federal government. Ivey has just under $1 billion left to spend before the deadline.

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Alabama Education Association, Board of Medical Examiners meet over excuses to break COVID-19 quarantines

Prior to the meeting, the AEA on Nov. 5 threatened legal action against the board over the matter. 

Eddie Burkhalter

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Officials with the Alabama Education Association and the Alabama State Board of Medical Examiners met on Thursday to discuss a concern the association has with doctors who write excuses to allow students to return to school before their mandated COVID-19 quarantine periods expire.

At the meeting between Theron Stokes, associate executive director of the Alabama Education Association, and William Perkins, executive director of the Alabama State Board of Medical Examiners, Stokes learned that the board wasn’t aware of the problem, the AEA said in a press release. 

“Both groups agreed to set up a meeting with educational and medical organizations on the front lines of the COVID-19 pandemic in Alabama,” the AEA said in the release. “A meeting should be held before the end of the year and will allow the AEA and the Board of Medical Examiners, as well as other educational and medical organizations, to review existing guidelines issued by the Alabama Department of Public Health and the Centers for Disease Control and ensure conformity in following those guidelines.” 

In a letter to Perkins on Thursday, Stokes wrote that it was AEA’s understanding that the board was aware of the problem, but he wrote that during their meeting he became aware that neither the board nor Perkins was aware of the problem. 

“It was not the intent of AEA to cause any unnecessary problems for you, the doctors you represent, or your organization regarding this matter,” Stokes wrote. 

Prior to the meeting, the AEA on Nov. 5 threatened legal action against the board over the matter. 

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“It is our firm belief that there exists no medical scenario under which these students could be written out of quarantine and that to do so is violative of ADPH and CDC quarantine recommendations,” Stokes wrote in the Nov. 5 letter. 

Stokes in his recent letter notes that both agreed in the meeting to bring together representatives of the other organizations to come up with a uniform procedure for following state and federal guidelines. 

“I agree with your plan to conduct this meeting and finalize our goals before the holidays,” Stokes wrote.

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Nearly 70 percent of Alabama’s pregnancy-related deaths in 2016 were preventable: report

Most pregnancy-related deaths are preventable, with women of color bearing the brunt of Alabama’s maternal mortality crisis.

John H. Glenn

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A report this month by the Alabama Maternal Mortality Review Committee found that nearly 70 percent of pregnancy-associated and pregnancy-related deaths in Alabama recorded in 2016 were preventable.

Mental health and substance use disorders were identified as key contributors in nearly half pregnancy-associated and pregnancy-related deaths. Patient-, family-, system- and provider-related factors were among the most frequently identified factors involved in pregnancy-associated and pregnancy-related deaths, the report found.

The researchers found cardiovascular conditions were the leading underlying causes in pregnancy-related deaths.

“The Medical Association of the State of Alabama commends the Maternal Mortality Review Committee (MMRC) for its diligence in researching the factors that impact maternal deaths, in hopes to mitigate and prevent future maternal deaths,” said Dr. John Meigs, president of the Alabama Medical Association. “It is very concerning for physicians throughout the state that 70 percent of the deaths reviewed by the MMRC were preventable and that women of color are disproportionately affected. Alabama mothers deserve the best medical care that we can offer.”

Preventability of deaths is a key component to maternal mortality reviews, as it is indicative of events that may have been avoided if reasonable changes could be made to the contributing factor or factors. It was found that nearly 70 percent of pregnancy-associated and pregnancy-related deaths were preventable. (VIA ALABAMA MATERNAL MORTALITY REVIEW COMMITTEE/ALABAMA DEPARTMENT OF PUBLIC HEALTH)

According to the report, maternal death and pregnancy-related mortality ratios steadily trended upwards between 2012 and 2015 with the largest increase being in 2016.

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Alabama ranks third in the nation for maternal mortality behind only Arkansas and Kentucky.

Data provided by the ADPH Center for Health Statistics reveal that both maternal deaths and pregnancy-related deaths trended upward between 2012 and 2016. Between 2012 and 2015, ratios increased steadily; however, in 2016 there was a marked leap in both ratios. (VIA ALABAMA MATERNAL MORTALITY REVIEW COMMITTEE/ALABAMA DEPARTMENT OF PUBLIC HEALTH)

According to the report, expanding Medicaid could help reduce the state’s high number of maternal deaths and pregnancy-related and -associated deaths.

“Expansion of Medicaid was an underlying, yet significant factor which permeated throughout the case reviews,” according to the committee’s report. “Research has shown that in states where Medicaid expansion was adopted, there were reduced maternal mortality rates and positive maternal health outcomes. Based on the findings of the committee’s review, Medicaid program expansion will allow women to receive needed healthcare before, during, and after pregnancies.”

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The MMRC recommends Medicaid expansion up to one year postpartum and improved reimbursement for providers, routine autopsies on maternal deaths, and increased mental health and substance use disorder treatments and services for women.

“Sadly, the Alabama Maternal Mortality Review Committee found that mental health and substance use disorders were identified as key contributors in almost half of pregnancy-associated and pregnancy-related deaths,” said Holly Caraway McCorkle, executive director of the Alabama Council for Behavioral Healthcare. “These deaths are preventable, and Medicaid expansion will offer women who suffer from mental health and substance use disorders life-saving coverage and access to critically needed resources and services before, during and after pregnancies.”

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