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“We can’t handle much more”: Doctors sound alarm as COVID-19 surges in Alabama

Chip Brownlee | The Trace

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Some 7,283 cases of the coronavirus have been reported in Alabama since June 1, or about 29 percent of the state’s total confirmed case count, and while many of those who’ve tested positive may not be sick enough to be hospitalized, a doctor treating the sickest COVID-19 patients in Montgomery says he’s not sure how much more he and his colleagues can handle.

“Our seven-man group cannot handle much more at all,” said Dr. David Thrasher, the head of pulmonology at Jackson Hospital.

Thrasher and his six partners at Montgomery Pulmonary Consultants handle nearly every critically ill COVID-19 patient in the River Region who requires a ventilator or treatment in an ICU. That’s on top of their normal caseload of patients requiring critical pulmonary care.

“We’re twice our capacity, okay?” Thrasher said. “We’re working very, very long hours. Emotionally, it’s very, very stressful on everyone. We will do what it takes. We’re not going to give up. But there is a limit to what the human body can do.”

In an interview, Thrasher essentially begged the public to take the virus seriously and wear a mask when in public. And to not go out if you don’t have to.

“I’m a conservative guy,” Thrasher said. “I don’t like the government telling me what to do. But this is the only way we can control this until we have a vaccine. It needs to be done universally.”

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Over the past week, as Alabama confirmed at least 5,000 cases of COVID-19, Montgomery reported about 15 percent of the state’s cases.

At least 68 people have died in Montgomery County — at least 28 of them in the past two weeks. Neighboring Butler and Lowndes counties have the second- and third-highest per capita number of deaths in the state.

[For this data and more, check our COVID-19 data and mapping dashboard.]

“It’s bad,” Thrasher said. “The hospitals are darn near at capacity. We’ve got a lot of patients. It’s just steadily gone up the last week. The number of cases. People on ventilators. It’s bad. Unfortunately, it’s going to continue to get worse, I’m afraid.”

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At least 737 people have tested positive for COVID-19 in Montgomery County in the last seven days — the most of any county in the state. The percentage of tests that are positive in Montgomery County over the past week, on average, has been nearly 27 percent. Sunday saw the largest daily increase in new cases in Montgomery County.

Despite having a much smaller population than Jefferson County or Mobile County, which until now had the highest numbers of COVID-19 cases, Montgomery County now has the most cases of any county in Alabama. At least 2,791 people have tested positive since March.

What is most concerning about Montgomery, experts say, is how few of the cases have been linked through contact tracing to any particular facility, work place or business. Few of the cases in Montgomery have been in nursing homes or long-term care facilities.

State health officials say most of the transmission in Montgomery has not been epidemiologically linked, meaning most new infections are through community transmission as people go about their day-to-day lives and come into contact with someone who is infected.

“This is a bit like a forest fire, where if you have an isolated area, you can have the firefighters surround and isolate it off so it doesn’t spread any further,” said Dr. Michael Saag, a renowned infectious diseases expert at UAB. “When it’s very widespread, it’s an uncontrolled fire that we are really trying desperately to bring under control.”

It’s much easier to control isolated outbreaks through contact tracing and isolated quarantines. When new cases arise through community transmission, spread is much harder to contain.

Hospitals in Montgomery serve not just the state’s capital city and the county, but much of Central Alabama’s River and Black Belt regions. Neighboring Lowndes, Butler and Bullock counties have the high per capita rates of infection in Alabama.

While hospitals in Montgomery say they have more capacity to handle and treat more coronavirus patients, their capacity is already stretched.

The biggest hospitals in Montgomery — Baptist health and Jackson Hospital — have faced ICU bed shortages for weeks, and have managed, but how much more of a surge they can handle is a concern.

“I wish you could have a picture of these ICUs,” Thrasher said. “It’s like nothing I have ever seen. Normally, I cut up. I’m a funny guy. I keep everyone laughing. But these ICUs are like death chambers.”

Thrasher said he is increasingly concerned that nurses, doctors and respiratory therapists will face post-traumatic stress disorder. “It’s going to be bad,” he said. Dozens of health care workers have also tested positive. Statewide, nearly 3,000 have tested positive.

“It’s space,” Saag said. “Do we have enough room at the inn? But it’s also, at some point, going to be personnel burn out — the ability to keep pace with just the number of very sick people.”

Critically ill patients who otherwise would be treated in ICUs have been regularly placed in emergency room beds. While treating some patients in ERs instead of formal ICUs is not uncommon during bad flu seasons, the number of patients requiring ICU care and ventilators is unprecedented for the summer months.

“At one of the hospitals, three of their five ICUs are totally consumed with COVID patients on ventilators,” Thrasher said. “If you’re not on a ventilator, we put you on a COVID floor.”

The other ICUs, though, are not empty. People are still having other medical complications and accidents that require intensive care treatment.

“When I left, we had several of the COVID patients in the emergency room on ventilators, and two Saturdays ago, we had 30 patients in the emergency room waiting for COVID beds at one of the hospitals,” Thrasher said.

While the rise in cases and hospitalizations over the past two weeks has been particularly pronounced in and around Montgomery County, statewide, numbers are also on the rise. On Sunday, Alabama reported more than a thousand cases of the virus in a single day for the first time.

While testing has increased, so has the percentage of tests that are positive. By Sunday, the percentage of tests that are positive reached 13 percent for the first time since mid-April — a concerning sign that the state is not performing enough testing and that the virus is still spreading through community transmission.

“We’re in trouble,” Saag said. “It’s growing almost exponentially. It should be sounding alarms all the way from the city governments to the state.”

Tuscaloosa County, Mobile County, counties throughout the state’s Black Belt and in North Alabama are seeing rising case counties.

Madison County, home to Huntsville, which until this point had been spared from large case increases, is beginning to see rising daily case counts.

Fueled by outbreaks at several skilled nursing facilities and a state psychiatric hospital, Tuscaloosa County is also seeing a continuing surge of cases. But Tuscaloosa Mayor Walt Maddox said new cases recently have not just been limited to the most at-risk groups.

“We are beginning to see increased numbers of 18 to 23 [year-olds] contracting the virus,” he said on Twitter. “Please continue to exercise caution & common sense.”

Hospitalizations statewide remain at record-high levels, according to the department of health. At least 647 people were in hospitals with a positive case of COVID-19 on Thursday, the highest total to date.

Fewer hospitals report hospitalizations on Fridays and weekends, so the numbers are less reliable, but the total Friday was still at least 622.

Since reopening on April 30, the average daily increase in confirmed cases has risen 309 percent from 177 cases per day on April 30 to 724 cases per day by Sunday. Average tests per day, by contrast, have increased only 7 percent.

Earlier this week, the Alabama Department of Public Health issued a statement calling on Alabamians to heed advice from public health officials who say everyone should wear a face covering in public.

“COVID-19 spreads quickly, and your actions affect others. More than ever since the pandemic began, we need people to social distance, wear face coverings in public, and practice good respiratory hygiene,” State Health Officer Dr. Scott Harris said in a statement.

The Department of Public Health said some increases in cases have been connected to outbreaks as a result of large gatherings that occurred during the Memorial Holiday, and at other times.

“With ongoing community transmission, it is safer to be at home,” the department said in a statement.

But so far, no statewide requirement to wear a face covering has been put in place.

Thrasher said when he’s at the gas station or at a restaurant, he sees very few people wearing masks.

“It seems like nobody is doing the right thing,” Thrasher said. “Everybody is looking at me like I’m a freak in my mask. This epidemic is going to go on for a long time.”

On the ground, the doctors said they have been disillusioned and somewhat angry about how often they see people not wearing masks while out in public.

“I think it’s going to be one of those things where we’re going to see a fair amount of suffering before people wake up to the reality,” Saag said. “I’m concerned because it’s the combination of the number of cases, the rise in hospitalized cases and the relative lack of concern in the general population — at least from what I can see. And that doesn’t add up well to a happy outcome.”

So far, 768 Alabamians have died from COVID-19, according to the Alabama Department of Public Health. Nearly 2,300 have been hospitalized since March.

“I’m afraid that by the time the numbers get to a point where it’s becoming almost catastrophic, it might be the time when people change, but in some ways it’s too late,” Saag said. “Because whatever change we make for the better, we won’t see the effect on numbers for two to three weeks after that.”

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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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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(STOCK PHOTO)

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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(STOCK PHOTO)

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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UAB doctor to public on surging COVID-19: “Don’t give up on us. We’re tired.”

The head of UAB’s emergency management committee said hospitals across the state are seeing increases in COVID-19 hospitalizations.

Eddie Burkhalter

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Dr. Sarah Nafziger, co-chair of UAB’s Emergency Management Committee, speaking during a press conference Friday.

A UAB physician pleaded with the public Friday to wear masks and practice social distancing, as hospitals across Alabama are filling up with COVID-19 patients and public health officials prepare for what could be a series of deadly surges after upcoming holidays. 

“Don’t give up on us. We’re tired,” said Dr. Sarah Nafziger, co-chair of UAB’s Emergency Management Committee, speaking during a press conference Friday. 

Nafziger said hospitals across the state are seeing increases in COVID-19 hospitalizations and explained that the extra care those patients require takes a toll on hospital staff. 

Hospitals are also discussing the possibility of having to order postponements of elective procedures as coronavirus hospitalizations continue to increase, Nafziger said. UAB has once again begun converting hospital beds meant for other patients for use by COVID-19 patients, she said, explaining that doing so can strain the hospital’s equipment and staffing resources. 

“Until recently, we’ve been very successful in keeping the employee cases down to a minimum,” Nafziger said, but added that community spread of the disease has impacted the hospital’s workers and they’re beginning to see staffing shortages as a result. 

“This is why it is so important that we all do our part. To be responsible. Stop the spread of the virus,” Nafziger said, pleading with the public to wear masks and practice social distancing. 

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“We’re not gonna quit on you. We’re gonna be here for you. We’re gonna take care of you, so please do your part to help us stop the virus so that we can be available to provide all the care that you need. Not just care for COVID,” Nafziger said. 

Alabama added 2,463 coronavirus cases on Friday, and hospitalizations reached 1,329. The state hasn’t had that many coronavirus patients in hospitals since Aug. 13, during the summer surge. Huntsville Hospital’s coronavirus hospitalizations were a record-high 235 on Friday. 

The state’s 14-day average of new daily cases was a record-high 1,976 on Friday, and the percentage of COVID-19 tests that were positive, averaged over two weeks, was nearly 23 percent. Public health experts say it needs to be below 5 percent or there isn’t enough testing being done and cases are going undetected. 

Alabama’s average new reported COVID-19 deaths over the last week is also a record-high of 31. As of Friday, 3,451 people have died from the disease in Alabama, 17 percent of which have been reported within the last month.

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Dr. Mark Wilson, Jefferson County’s health officer, speaking to reporters Friday said the county has had more than 30,000 cases and is approaching 300 coronavirus deaths. 

“These are people that are loved. It’s a really sad fact going into our holiday season,” Wilson said. 

Wilson said the county is averaging more than 300 new cases per day, which is three times the level Jefferson County had in September, “and it is now the highest number per day that we’ve had since the beginning of this pandemic,” he said.

Through contact tracing, it’s clear the rising cases are due to private gatherings, such as parties, receptions and outbreaks within households. He cited recent modeling from Georgia Tech that estimates that with Jefferson County’s current numbers if 10 people gathered there would be a one in five chance one of them would spread coronavirus. 

“Fifteen people gathering, that’s one in four who can spread the virus. If there’s a large gathering, like 50 people, there’s a two out of three chance that one of the people in that group is going to spread COVID-19,” Wilson said. 

“The rules have not changed. We still know that mask-wearing, social distancing, hand sanitation and avoiding these larger gatherings that are not from your own household are still the most effective ways to keep this virus from spreading,” Wilson said. 

Wilson said gathering indoors, in an area with poor ventilation and with people not wearing masks “is simply not a good idea right now.” Wilson said while two vaccines look promising, and the first shipment could soon arrive, supplies will be limited and will go to health care workers most at risk.

 “Vaccination for the general public is still a ways off,” Wilson said. “Several months. Maybe even into the late spring or summer.” 

Dr. Micheal Saag, infectious disease professor at UAB, speaking during the briefing said the state is seeing a “spike” not a surge.

“The number of new cases, just in the last couple of weeks, has been staggering,” Saag said. “I don’t use that word lightly.” 

Saag said many predicted a surge would come after Thanksgiving and Christmas, “but what we didn’t anticipate was the spike before Christmas and before Thanksgiving.” 

Cases during a spike are followed by hospitalizations and deaths, Saag said, and if people don’t change behaviors the concern is there will be continued spikes after the upcoming holidays. 

“And I’m a little bit overwhelmed, to be honest with you, at what that might look like,” Saag said. 

Saag urged the public to wear masks, avoid crowds and gatherings of more than five to 10 people, which is especially important around the holidays. 

“I’ve gotten comments from a lot of you who said ‘How can you tell me what to do on my Thanksgiving in my home?’” Saag said. “I’m really not telling you what to do. I’m simply saying that we know our current situation, and we know what works in terms of protecting ourselves.”

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Alabama Hospital Association president: COVID-19 “utterly out of control”

Not since Aug. 14, during the state’s summer peak, has Alabama had such a high number of hospitalizations.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama continued to set new COVID-19 records on Thursday when the state’s 14-day average for new daily cases was a record-high 1,911. The last record was set on July 25, during the heart of the state’s summer surge. 

Coronavirus hospitalizations across the state continued surging Thursday as well, reaching 1,315. Not since Aug. 14, during the state’s summer peak, has Alabama had such a high number of hospitalizations. The state’s seven-day average for daily hospitalizations on Wednesday was 44 percent higher than from a month before. 

“There’s just no other way to describe it than utterly out of control at this point,” said Dr. Don Williamson, president of the Alabama Hospital Association and former state health officer, speaking to APR on Thursday. 

“I don’t see anything to break the momentum of the pandemic. Not for the next two months at least,” Williamson said. “We’re going to go through Thanksgiving. We then roll right into the Christmas season. There will be Christmas parties. Christmas shopping. Then we roll into Christmas and then we roll into New Year’s.” 

Williamson shared a quote he’s heard used elsewhere recently that “family gatherings at Thanksgiving may result in funerals at Christmas.” 

Dr. Henry Walke, the Centers for Disease Control and Prevention’s COVID-19 incident manager, told reporters on Thursday that the CDC is recommending against travel for the Thanksgiving period. 

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Just 13 percent, or 213, of the state’s supply of intensive care beds were available on Wednesday, Williamson said, but it’s not just the availability of ICU beds that can present a problem. Staffing shortages due to COVID-19 illnesses are a problem in most hospitals now, he said, because community spread is so prevalent that many health care workers are becoming sick, likely contracting it from their communities and not from workplaces. 

Williamson said hospitals from Huntsville to Dothan are quickly filling with coronavirus patients, stressing resources and overburdening the already stressed health care workers. 

“It’s emotionally exhausting,” Williamson said of health care workers caring for so many coronavirus patients. “Because they know how some of this comes out, no matter what they do.” 

The state this week set four record-high seven-day averages for new daily cases, including a new record on Thursday, but Thursday’s record-setting 14-day average, which smooths out data and gives a clearer picture of rising cases, was a first since July. 

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Over the last two weeks, Alabama has seen a 23 percent increase in the number of new coronavirus cases compared to the previous two weeks, the Alabama Department of Public Health said in tweets Thursday morning. 

The increases are widespread across the state, with 53 of Alabama’s 67 counties (79%) affected (range: 0.7% – 51.9% increase). So as we approach this holiday season, be sure to take steps … to protect yourself, your friends, & your family from #COVID19,” ADPH said in the tweets. 

The positivity rate remains dangerously high in Alabama as well, a sign public health experts say means cases are going undetected. The 14-day average positivity rate was 22 percent Thursday and should be below 5 percent to ensure adequate testing is being conducted.  

“We haven’t seen numbers this high since our surge this summer. We continue to see increases in hospitalization and deaths in the state,” said Dr. Bertha Hidalgo, an epidemiologist and associate professor at UAB’s School of Public Health, in a message to APR on Thursday. 

Hidalgo also expressed concern over the state’s surging cases, hospitalizations and rising deaths as the holidays near and people may be making plans to gather indoors. She said the hope is that mitigation strategies such as masking, opening windows and doors to increase ventilation indoors, distancing and washing of hands will all help avoid additional transmission in our communities. 

“If, however, people don’t put those prevention strategies in place, we may see a continued increase in cases and positivity, which will only exacerbate the already tenuous hospitalization numbers and numbers of deaths we are seeing in the state,” Hidalgo said. 

“We are experiencing high rates of transmission in the community, so the odds of someone who is positive showing up at a family gathering over Thanksgiving is higher than it would be, for example, in the month of September, when our case counts and percent positivity was lower than it is now,” Hidalgo said. 

The Alabama Department of Public Health on Wednesday reported 72 new COVID-19 deaths, bringing the state’s 14-day average of deaths to a record-high 28. 

Deaths are lagging indicators of the spread of coronavirus and can take weeks and even months to occur after infection, and it takes the Alabama Department of Public health time to collect and analyze data to confirm a COVID-19 death. 

ADPH on Nov. 11 announced the department had begun reviewing a large number of older deaths from ADPH’s Alabama Center for Health Statistics, which may result in newly reported deaths that occurred in the past.

Williamson noted that while vaccines may be nearing emergency use approval, it will take many months before the vaccines are available to the wider public, and the new monoclonal antibody treatment  Bamlanivimab will be in short supply, once it starts being shipped out next week. He said there’s expected to be 300,000 doses available nationwide by the end of January. 

That sounds like a lot of drug until you realize we had 140,000 cases yesterday,” Williamson said of the daily count added across the country. 

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