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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.”

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.

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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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Health

Study: Those with COVID twice as likely to have dined in restaurants

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes. 

Eddie Burkhalter

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(STOCK PHOTO)

A recent study by the Centers for Disease Control and Prevention found that adults who tested positive for COVID-19 were twice as likely to have eaten in restaurants, which builds upon known factors about how the disease is transmitted, experts say, but the study has limitations.

The study surveyed 314 adults in 10 states and found that those who tested positive for COVID-19 were twice as likely to have eaten at restaurants within the previous 14 days. Researchers found that there was no significant difference between those who tested both positive and negative and who said they had gone to gyms, coffee shops, used public transportation or had family gatherings.

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes.

Dr. Bertha Hidalgo, an epidemiologist and associate professor at UAB’s School of Public Health, told APR on Wednesday that the study lends evidence to what the medical community knows are potential risks for contracting COVID-19, which include being indoors and unmasked, but there are nuances to each of those activities that can either increase or decrease that risk.

The study did not differentiate between indoor and outdoor dining, and infectious disease experts say being outdoors decreases the risk of contracting COVID-19.

“It’s also hard to know what policies are in place where these people were recruited from for this study,” Hidalgo said. “Whether they’re required to be masked or if there’s a decreased capacity in a restaurant.”

Monica Aswani, assistant professor at UAB’s School of Health Professions, said she would be cautious about interpreting the study through a causal lens.

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“People who are willing to dine in restaurants are also likely to engage in other risky behaviors, such as not wearing masks. Since this is a survey, there is not enough evidence to suggest that the source of exposure was restaurants without contact tracing to supplement it,” Aswani said. “Likewise, respondents may have misreported their behaviors, given the sensitive nature of the questions. The authors note this as a limitation and highlight how participants were aware of their Covid-19 test results, which may have influenced how they responded.”

Aswani also noted that the questions about dining did not differentiate between indoor versus outdoor seating, “which represent different levels of risk to exposure.”

“Participants who visited a restaurant on at least one occasion, regardless of the frequency, are also considered similar. Consequently, in the two weeks before they felt ill, someone who dined on a restaurant patio once and someone who ate indoors at five different restaurants are indistinguishable in their data,” Aswani said.

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Hidalgo said that while there are clear limitations to the CDC’s study, the findings do back up what the medical community knows about the transmission of the disease.

“I would very much look at this from the big picture perspective, and say we know that indoor activities are an increased risk for COVID-19. This study lends evidence to that,” Hidalgo said.

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Economy

Report: Transitioning to electric vehicles could save Alabama millions in health costs

Alabama would experience approximately 500 less asthma attacks per year, about 38 fewer premature deaths and prevent more than 2,200 lost workdays annually.

Micah Danney

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(STOCK PHOTO)

Alabama could save $431 million in public health costs per year by 2050, if the state shifted to an electric transportation sector between now and then, according to a new study by the American Lung Association.

Such a transition would reduce other health-related issues, said the organization, which used data on pollution from vehicles and from oil refineries to calculate its findings.

Alabama would experience approximately 500 less asthma attacks per year, about 38 fewer premature deaths and prevent more than 2,200 lost workdays annually.

The transportation sector is one of the main contributors to air pollution and climate change, said William Barrett, the association’s director of advocacy for clean air and the study’s author.

“We have the technology to transition to cleaner cars, trucks and buses, and by taking that step we can prepare Alabama for the future while also seeing the health and economic benefits forecasted in ‘The Road to Clean Air,’” Barrett said. “Especially as our state faces the impacts of climate change, such as extreme storms, this is a powerful and practical opportunity to take action to improve our economy, our health and our future.”

Trading combustion-powered vehicles for electric ones could result in $11.3 billion in avoided health costs across southern states by mid-century, the report estimated, and prevent roughly 1,000 premature deaths.

Nationally, Americans stand to save $72 billion in health costs and $113 billion in avoided climate change impacts, the ALA said.

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The path to that future depends on leaders factoring public health effects into decisions about transportation, Barrett said.

That involves steps like pursuing electric vehicle fleets when purchasing decisions are being made and supporting the creation of enough charging stations along highways, roads and at truck stops.

Investing in that infrastructure can drive wider economic benefits, Barrett said. He cited California’s increased manufacturing of electric vehicles.

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Tesla is the most well-known producer that has located there, but Barrett said that makers of trucks and buses have also chosen to locate their facilities in the state.

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Health

CDC director: Vaccine won’t be available to general public until mid-2021

Eddie Burkhalter

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CDC director Robert Redfield (VIA CSPAN)

The director of the Centers for Disease Control and Prevention during testimony Wednesday before a U.S. Senate Appropriations subcommittee said a vaccine won’t be widely available to the public until mid-2021. 

Wearing a mask is the most important public health tool we currently have in the fight against the deadly disease, he said.

“I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine,” CDC director Robert Redfield told lawmakers.

Asked during the hearing by Sen. John Kennedy, R-Louisiana, when a vaccine will be ready “to administer to the public,” Redfield said that he believes there will be a vaccine that will initially be available some time between November and December. 

“But very limited supply, and it will have to be prioritized,” Redfield said. “If you’re asking me when is it going to be generally available to the American public, so we can begin to take advantage of vaccine to go back to our regular life, I think we’re probably looking at late second quarter, third quarter 2021.” 

Redfield said it will take time to expand vaccinations out from those who need them most direly to the larger public, and said there are about 80 million people in the U.S. who have underlying health conditions that put them at greater risk and need the vaccine first. 

President Donald Trump has repeatedly said there will likely be a vaccine available to the public possibly before the November election or even sooner. 

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When asked about Redfield’s statements that one won’t be available to the public until the summer or early fall of 2021, Trump said during a press conference Wednesday that Redfield was mistaken. 

“I think he made a mistake when he said that. It’s just incorrect information,” Trump said. “And I called him, and he didn’t tell me that. I think he got the message maybe confused. Maybe it was stated incorrectly. We’re ready to go immediately as the vaccine is announced, and it could be announced in October. It could be announced a little bit after October.” 

Trump refuted the CDC head, and said the vaccine will be made available to the general public “immediately” once one is approved. Asked for Trump’s timelines as to when a vaccine will be ready to administer to the wider public, an official at the press conference seated near Trump said that will likely occur by the end of March. 

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The Trump administration on Aug. 14 announced that the McKesson Corporation would be the central distributor of COVID-19 vaccines in the U.S. The company distributed the H1N1 vaccine during the 2009-2010 pandemic. 

AstraZeneca’s COVID-19 vaccine trials were put on hold worldwide on Sept. 6 after a volunteer in Britain experienced a serious health problem. The company’s vaccine trials resumed in the United Kingdom on Saturday.

The company in a statement said it was working with global health authorities to “be guided as to when other clinical trials can resume.” 

The drugmaker Pfizer Inc. on Tuesday announced that those enrolled in the clinical trial for the company’s own COVID-19 vaccine were experiencing mild to moderate side effects, but that an independent monitoring committee has not yet recommended pausing the study.

There have been 2,392 COVID-19 deaths in Alabama since the pandemic began, according to the Alabama Department of Public Health.

At least 193,000 people in the U.S. have died from coronavirus, according to The Washington Post.

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Health

Jones: Trump, Senate GOP leadership not serious about another round of COVID-19 relief

Eddie Burkhalter

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Incumbent U.S. Sen. Doug Jones during a livestreamed press conference. (VIA DOUG JONES CAMPAIGN)

Sen. Doug Jones, D-Alabama, on Friday said it’s unclear whether Senate Republican leadership or the White House will work with Democrats to draft another round of meaningful COVID-19 relief for a country in need.

Jones, speaking to reporters during a Facebook Live press briefing, said Sen. Mitch McConnell’s paired-down bill, which he and all other Democrats, and one Republican Senator, voted against on Thursday was a “political stunt” by McConnell and did far too little for individuals, businesses, schools and local governments.

Democrats passed the $3 trillion COVID-19 relief bill in May, but McConnell declined to take it up in the Senate or use it as a starting point for negotiations with Democrats, Jones said.

Democrats later agreed to drop the price of that aid down to just more than $2 trillion, Jones said, but the Trump Administration refused to budge and talks fell apart. Trump then signed a series of executive orders to provide aid in piecemeal.

Jones said that he does not believe Trump was acting in good faith and wanted to strike a deal with Democrats, and instead used the crisis for personal political gain.

“Democrats who were trying to do this were talking about things that are important to help the American people. He would refuse to budge because he wanted to issue those executive orders and have a photo op with his big signature on those executive orders that he issued. I am absolutely convinced of that,” Jones said.

Jones was also asked about a statement in opponent in the upcoming November election made regarding revelations that President Trump lied to the American people about his knowledge of the deadliness of COVID-19. Former Auburn coach Tommy Tuberville told a reporter this week that while he hadn’t watched the news on the matter, he believed it was “fake news.”

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The Washington Post journalist and author Bob Woodward in his latest book wrote that Trump told him on Feb. 7 that the disease was “deadly” and that it was “more deadly than your strenuous flu” while spending the next month telling the public that COVID-19 was no more dangerous than the regular flu. Woodward this week released segments of his recordings of those interviews with Trump saying those words.

The President should have been doing more in February, March and April to ready the country for what was to come with coronavirus, Jones said “but instead he was saying that was going to miraculously disappear.”

Jones noted that for the last several months Jones has hosted press briefings inviting top infectious disease experts at the University of Alabama and other top health officials on, to speak about the pandemic and take questions from the media and the public. Jones said Tuberville’s defense of Trump’s comments undermines Alabama’s ability to get information to the public.

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“If we’re still undermining that competency, if we’re still doing things to support and defend comments that are not supportable and not defensible, what we’re going to see is a problem when we do actually have a vaccine,” Jones said.

“I think that Coach Clueless’s comments really reflect the fact that he’s always going to support Donald Trump no matter what,” Jones said, referring to Tuberville. “We see it all too often up there right now. People will not stand up and speak out even when they know the President is wrong, and he should be called to account for it.”

Rep. Chris England, D-Tuscaloosa, also spoke to reporters during Jones’s press briefing, and both he and Jones urged the public to go ahead and cast absentee ballots for the November election. Alabama is already accepting ballots by mail, or in person, at local Courthouses.

“What’s unique about our current situation, and the tragedy of the pandemic, is that we now have what is essentially early voting in Alabama,” England said.

Sending in an absentee ballot by mail can be confusing, England explained, and requires a copy of a photo ID and for two witnesses or a notary to sign the ballot application. England said people can also simply visit their local county courthouse with their photo ID, ask for a ballot application, fill it out and fill out their ballot and cast their vote on the spot.

“Get up. Get your ID. get your mask. Go to your local county courthouse. Request your absentee ballot application. Fill out that and the ballot and cast your vote,” England said.

Jones encouraged the public to visit onealabamavotes.com to learn more about how to vote, by mail or in person.

“We’ve got a chance in Alabama to get numbers up through this process, and that’s a good thing,” Jones said.

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