Is “herd immunity” a reasonable strategy for Alabama? Evidence suggests it’s not
State Sen. Del Marsh suggested herd immunity may be the only strategy for Alabama going forward. The science behind such a strategy is still in question, and what evidence is available suggests it may be hard if not impossible to achieve.
Alabama Senate Pro Tem Del Marsh, R-Anniston, on Thursday caused an uproar when he told a reporter that he’d like to see more Alabamians get infected with COVID-19 so that we could “start reaching an immunity.”
Marsh, a member of Gov. Kay Ivey’s COVID-19 task force, was speaking to a CBS 42 reporter about what’s called herd immunity, which means a percentage of a population gets a disease, gets over it and then has an immunity that prevents them from getting it again for a period of time.
Marsh’s suggestion that herd immunity may be the best, if not the only strategy, for dealing with COVID-19 is not new. It’s been a topic of discussion since the early days of the pandemic. Some countries have even attempted it. But the science behind such a strategy is still in question, and what evidence is available suggests it may be hard if not impossible to achieve.
Reaching herd immunity essentially means that a population is generally protected from the worst of a disease because enough people have immunity. That can be achieved either through a vaccine or by allowing the virus to run its course until enough people have been infected. With more people infected and recovered, and with the assumption that fewer are susceptible to reinfection, transmission of the virus would slow significantly — only because there are fewer people to become infected.
Without a vaccine, herd immunity as a strategy would basically mean giving up on trying to contain the virus.
The topic of herd immunity has been brought up throughout the COVID-19 pandemic, but public health experts and scientists are quick to say they don’t yet fully understand the true strength of acquired immunity, and there have been some cases of people becoming infected with the virus more than once.
But that doesn’t stop some from arguing perhaps we should give herd immunity a try. Sweden did, and it went terribly, as Alabama’s State Health Officer Dr. Scott Harris told a reporter when asked about the Alabama lawmaker’s statements on herd immunity.
Marsh followed his original statement with a caveat about protecting those with pre-existing conditions and the elderly, yet it’s not clear how an open society bent on getting as many younger people infected as possible would do such a thing.
“I’m not as concerned so much as the number of cases, in fact, quite honestly, I want to see more people because we start reaching an immunity as more people have it and get through it,” Marsh said to CBS 42’s Reshad Hudson on Thursday. “I don’t want any deaths, as few as possible. I get it. So those people who are susceptible to the disease, especially those with pre-existing conditions, elderly population, those folks we need to do all we can to protect them.”
In Sweden, where officials initially allowed the virus to run its course, they were not able to protect more vulnerable populations from infection despite efforts to do so. Vulnerable populations do not live in a vacuum, and despite their best efforts to limit exposure, long-term care facilities still have some contact with the outside world.
It didn’t take long after Hudson tweeted out a video of Marsh’s statements for the backlash to set in. When asked by a CBS 42 reporter for his thoughts on herd immunity as a solution, Harris, the state health officer, said it would lead to many more unnecessary deaths.
“There is absolutely no reason to think at this point that getting infected will give you any degree of immunity. We simply don’t know that,” Harris said, pointing to the fact that scientists have not reliably determined how long immunity lasts or how strong it is.
“We’ve looked at countries like Sweden, who have tried to actually generate herd immunity among their population, and it’s been disastrous. They’ve had increased numbers of deaths much higher than their neighbors, in trying to keep their economy open. It does not work well at all,” Harris said.
Marsh tried to walk back his controversial statement the next day — sort of — but he still landed back on herd immunity as an avenue Alabama might take.
“It was a poor choice of words on my end, but ultimately what I was trying to say, and people can look at it, there are very few choices we have,” Marsh told WSFA on Friday. “Ultimately if there’s no vaccine, herd immunity is the only one I can think of that’s eventually going to take place.”
In Sweden, where they gave herd immunity a shot, deaths in the country have been eight times higher than in neighboring Denmark and 19 times higher than in Norway, according to The Washington Post. One study found that after months of infections and deaths, less than 10 percent of the population had developed antibodies.
In Denmark and Norway, along with most of the European Union, many restrictions have been lifted because governments there have been able to get the virus under control using testing and contact-tracing.
In Spain, one of the hardest-hit countries in Europe, just 5 percent of people had developed antibodies, according to another study in the journal Lancet. That means that at least 95 percent of the Spanish population would still be susceptible to the virus despite the country recording 28,000 deaths and 250,000 cases.
In New York City, where 32,000 people have died from COVID-19, the state tested some 28,419 people in an attempt to determine how many people had developed antibodies. That survey suggested that roughly 21.6 percent of New York City residents had antibodies. That’s in New York — widely viewed as the hardest-hit city in the world.
The science of herd immunity in a virus as new as COVID-19 is murky, because researchers still don’t know important details about how the coronavirus behaves, and every geographic location is different, with varying cultures and health outcomes, but since Marsh threw it out there, let’s see what getting to herd immunity would look like in Alabama.
Dr. Michael Saag, an infectious disease expert at UAB and prominent HIV/AIDs researcher, told APR in May that to get the epidemic under control we’ll need at least 70 percent of the population to have immunity. Epidemiologists have estimated that between 60 percent to 80 percent of a population would need immunity before “herd immunity” is reached, and the virus can no longer spread widely in that community.
In Alabama, that would mean 3,340,000 people in total would have to become infected, and at our current approximate death rate of 2.2 percent, that would mean 75,460 Alabamians would likely die in the process. But 1,077 people have already died in Alabama from COVID-19, so to get to a theoretical herd immunity, 74,383 more people in the state would likely die from the virus. The death rate could spike if more infections happen at once, overwhelming the state’s health system.
Because we’ve got statistics on COVID-19 deaths in Alabama, we can look and see what that would mean for those yet to die. Of those 74,383 potential deaths, 58,762 would likely be 65 years of age and older. Those aged 50-64 would make up 12,654 of the deaths to come, while 2,975 would be between 25 and 49 years old, based on current death demographics.
Black people would likely continue to die in greater numbers per capita than white people. Although Black people make up just 27 percent of Alabama’s population, they make up 44 percent of all COVID-19 deaths.
It’s important to note that none of these estimates are reliable because researchers still don’t know for certain how long a person is immune after recovering from the virus — and how strong that immunity is. It’s also not clear how accurate or precise antibody tests are.
Columbia University virologist Dr. Angela Rasmussen told The New York Times that the “magical number of 60 percent for herd immunity” assumes that everyone infected has complete protection from a second infection.
“But what about people with partial protection?” she asked. “They may not get sick, but they can get infected and pass it along.”
The recent study in Spain published in The Lancet found that herd immunity with COVID-19 may be unachievable. The study, which looked at more than 61,000 people, found that 14 percent of those who tested positive for coronavirus antibodies, which means they had the virus and recovered, no longer tested positive for the antibodies in subsequent tests weeks later.
“Immunity can be incomplete, it can be transitory, it can last for just a short time and then disappear,” said Raquel Yotti, the director of Spain’s Carlos III Health Institute and one of the authors of the study, according to Reuters.
Alabama’s spike in daily COVID-19 deaths Tuesday result of process delays
The Alabama Department of Public Health on Tuesday recorded 48 new COVID-19 deaths in the state, bringing the total number of coronavirus deaths over the last two weeks to 335, the third-highest two-week total since the start of the pandemic.
In June, at least 296 Alabamians died from coronavirus, the Alabama Department of Public Health reported, and in July there were 605 COVID-19 deaths, the most recorded in any month since the pandemic began. This summer, Alabama’s death count from the disease skyrocketed after periods of relatively flat daily death counts.
But Tuesday’s jump in single day reported deaths was the result of a delay in the process of collecting and reviewing necessary medical records, laboratory data and other information, and not a reflection of an overall increase in deaths, said Dr. Karen Landers with the Alabama Department of Public Health, in a message to APR on Tuesday.
The daily number of new confirmed COVID-19 cases, and the state’s seven-and 14-day averages of news cases, have been on the decline since late July, but daily testing numbers have been all over the map from day to day. The state’s seven-day average of new daily tests was at 8,611 on Tuesday, after five straight days in late July when the state was recording seven-day averages of new daily tests of more than 10,000.
ADPH on Monday announced that software vendor problems had thrown off some of the department’s COVID-19 testing numbers, and that the problem had been fixed and some lab data was being inputted into the system.
Meanwhile, ADPH on July 31 said the state was experiencing a rash of problems surrounding COVID-19 testing that was resulting in an average of seven days to get results, which public health experts have said renders the results nearly worthless.
The department said the lengthier turnaround time for test results is due to supply chain problems with test reagents, more demand for coronavirus tests nationwide, “and in some cases, increased numbers of unnecessary tests.”
ADPH spokesman Ryan Easterling, in a response to APR’s questions about the fluctuating daily test numbers, on Tuesday wrote in a message that many factors affect both the reporting and result times for COVID-19 tests, and that multiple entities are conducting coronavirus testing in Alabama, including commercial laboratories, clinical laboratories and ADPH’s one lab. Some doctor’s offices, urgent cares, hospital emergency rooms and Long Term Care facilities are also conducting rapid COVID-19 tests, he said.
“Some new laboratories or entities who have previously not been accustomed to reporting notifiable disease results are having to report, which requires their understanding the requirements and methods of electronic reporting,” Easterling said. “Ongoing supply chain issues, such as reagents and consumables necessary for testing, occur periodically and reduce turn around for testing.”
COVID-19 hospitalizations statewide have remained high since the state hit a record 1,642 hospitalized coronavirus patients on July 30. On Tuesday, there were 1,506 hospitalized COVID-19 patients across Alabama, ADPH reported, and the state’s seven-day average of hospitalizations was at 1,553 which was just slightly below the record high of 1,590 on Aug. 2.
The percent of COVID-19 tests that are positive – a sign that helps determine the current extent of the spread of the disease – began to dip slightly at the start of August, but it remains well above the five percent positivity rate that public health experts say it needs to be to ensure enough testing is being done and cases aren’t going undetected.
Alabama’s 14-day average of percent positivity on Tuesday was 16 percent, down from 18 percent a week before.
Gov. Kay Ivey issued a statewide mask order on July 15, and it can take weeks before seeing whether such a requirement is having an impact on the spread of the virus, public health officials have said.
There’s concern, however, that as the state’s K-12 schools and universities continue to reopen in the coming days, outbreaks could pop up across the state, sparking another wave of new COVID-19 cases, hospitalizations and deaths.
Governor announces $7 million in COVID-19 aid to bolster state’s mental health response
Gov. Kay Ivey on Tuesday announced $7 million in federal coronavirus relief funds to two programs aimed at strengthening mental health services in Alabama.
“COVID-19 has taken a toll on Alabamians in many ways, and that certainly includes their mental health. Like people around the globe, the people of our state are suffering, and I remain committed to providing the necessary support to get our state and her people back on our feet,” Ivey said in a statement. “These funds will go to support important mental health services that Alabamians are seeking in these difficult times. I am pleased to see the CARES Act funds continually being put to work for the people of Alabama.”
Of the $7 million in CARES Act funds for the Alabama Department of Mental Health, $1 million is to go toward ADMH’s Crisis and Recovery Services program for the development of a web-based, toll-free crisis hotline to help guide people, especially those impacted by COVID-19, to appropriate services, according to a press release from Ivey’s office.
The remaining $6 million is for a community provider reimbursement program in which ADMH will reimburse nearly 300 provider agencies that provide services to people with mental illness, substance use disorders and developmental disabilities.
“We are deeply grateful for Governor Ivey’s support of community providers and Alabamians with mental illness, substance use disorder and intellectual/developmental disabilities who have been disproportionately impacted by the pandemic,” said ADMH Commissioner Lynn Beshear in a statement. “Through the Governor’s leadership in establishing this grant program, access to behavioral health services will be enhanced, and organizations that care for some of our most vulnerable citizens will be reimbursed for unexpected expenses related to the virus.”
The $7 million is a portion of the overall $1.9 billion in federal CARES Act money appropriated to Alabama to help mitigate the COVID-19 pandemic.
According to the memorandum of understanding between Alabama’s Department of Finance and ADMH, a monthly report is to be submitted to the Department of Finance by ADMH that details how the money is being spent.
More than 1,000 Alabamians have died this summer from COVID-19
Through June, July and the first week and a half of August, the state has amassed an additional 1,103 dead from the coronavirus pandemic.
More than a thousand Alabamians have died from COVID-19 this summer as schools prepare to start back. Through June, July and the first week and a half of August, the state has amassed an additional 1,103 dead from the coronavirus pandemic.
Summers in Alabama are known for barbecue, beach adventures, days at the lake, watermelons, blackberries, golf weekends and long vacations. The summer of 2020 will also be remembered for more than 81,000 coronavirus cases and for the mounting death toll from the virus.
The state headed into summer with 630 Alabamians dead from COVID-19 on May 31. That number has since increased 1,733.
As Alabama reopened its economy, many Alabamians chose to ignore the governor’s statewide “safer-at-home” order and carried on with their activities without wearing a mask or practicing social distancing. Some of them paid for their mistake with their lives — or the lives of loved ones.
The Alabama Department of Public Health reported at least 296 deaths in June and 605 in July — the most of any month thus far in the pandemic. At least 202 Alabamians have died in the first 10 days of August.
On July 15, Gov. Kay Ivey and State Health Officer Dr. Scott Harris modified the “safer-at-home” order to mandate the wearing of masks in public and whenever you might be within six feet of another person not from your household. School systems that are reopening this month are doing so with mask requirements.
The public health emergency runs through the end of August, but will likely be renewed for September unless there is marked improvement in the number of cases.
Doctors and hospitals are doing a better job at saving COVID-19 patients or the death tolls would be even worse; however, the uptick in deaths in Alabama is due to the sheer number of people being infected.
As of Monday, 99,390 Alabamians had tested positive for the coronavirus. More than 80,000 of those cases were diagnosed just this summer since June 1. The sheer volume of people infected is leading to Alabama’s surging death toll.
At least 81,438 have been diagnosed over the summer with 1,655 being diagnosed on Monday alone. The seven- and 14-day averages of cases have been coming down since July 20 after coronavirus positives peaked on July 19 at over 1,850 cases per day, on average, in mid-July.
The current seven-day average is at 1,352 cases per day.
The surging number of coronavirus cases has led to higher numbers of Alabamians having to be hospitalized for the virus. On Sunday 1,595 Alabamians were hospitalized with the virus.
Alabama schools start back this month, though many systems have started back online due to concerns that in-person classes will only spread the coronavirus.
There are several things that citizens should do to protect themselves from the virus. The first is to stay at home rather than risk contracting the virus by going out. If you do go out, wear a mask or cloth face covering. Always stay six feet away from other people not from your household.
Do not shake hands or hug. Wash your hands frequently. Isolate sick members of your family from the rest of the household. Avoid parties and large gatherings. Don’t touch your face.
AARP Alabama asks for details on $50 million federal COVID-19 aid to nursing homes
The Alabama chapter of AARP is asking the state to ensure federal coronavirus relief funds are spent wisely and in the open. Gov. Kay Ivey on Friday announced $50 million in grants would go to state nursing homes to aid in the fight against COVID-19.
Candi Williams, AARP’s Alabama state director, told APR on Monday that the organization, which advocates for the elderly, wants a better understanding of how that money will be spent and to ensure some is spent for ongoing COVID-19 testing.
A spokesman for the Alabama Nursing Home Association says details on how the money can be spent is already publicly available, however, and Ivey in early June announced the award of $18.27 million in federal CARES Act funds to be spent toward regular nursing home COVID-19 testing.
“What we’re looking for is specifics on how it will be used, and we want those specifics to be made publicly available,” Williams said.
Ivey on Friday said the money is to be administered by the Alabama Nursing Home Association Education Foundation. The Alabama Hospital Association is to administer up to $50 million in grants to state hospitals through another program.
“This allocation of up to $50 million will be for operational costs that are COVID-19 related, such as PPE, cleaning, personnel costs and other costs incurred related to the pandemic,” Ivey’s office said in a press release Friday.
“In partnership with the state of Alabama, the Alabama Nursing Home Association Education Foundation will administer the funds fairly and impartially on behalf of the people of Alabama, for all of Alabama’s nursing home facilities,” the statement goes on to say.
Williams said the public deserves to know how the federal funds will be used, and said Ivey’s office hasn’t yet signaled whether those details will be made public.
Ivey’s office, through a spokeswoman, declined to comment, and referred a reporter to the Alabama Nursing Home Association.
John Matson, communications director for the Alabama Nursing Home Association, told APR that AARP Alabama need only read the memorandum of understanding published along with Ivey’s announcement about the grants on Friday to see how the money must be spent.
According to the memorandum, the Alabama Nursing Home Association Education Foundation can only disburse the funds to nursing homes “for the purposes of responding to or mitigating the COVID-19 public health emergency” and details what facilities must do to receive the money.
Among the requirements, nursing homes in their applications must provide supporting documentation, which can include invoices, purchase orders, payroll records and financial records, according to the memorandum. The foundation must also provide the Alabama Finance Director’s Office with a detailed report on the 15th of each month noting how the money was spent, according to the document.
“I think it would be helpful for them to read that,” Matson said, referring to AARP Alabama and the memorandum of understanding.
AARP Alabama is also asking that the money be used for ongoing and methodical testing of all residents and staff in the state’s long-term care facilities.
“We’ve seen across the country that testing can be hit or miss, and testing frequency can vary,” Williams said. “We’ve seen in other states where that has helped curb the loss of life and helps protect residents.”
Matson noted that Ivey in early June also announced a separate $18.27 million in federal CARES Act funds to be spent toward regular nursing home COVID-19 testing and “proactive surveillance” through the end of the calendar year, which is also being administered by the Alabama Nursing Home Association Education Foundation.
Alabama’s long-term care ombudsmen, who are tasked with protecting residents’ rights and investigating health and safety concerns, have been largely banned from entering Alabama’s long-term care facilities since early on in the pandemic when the facilities ended visitations to help prevent the spread of the virus.
Williams said AARP would also like to see the safe reentry of ombudsmen into state facilities and for those details to be included in a publicly-released plan.
“We also have been advocating for transparency and real-time data about the COVID cases and death in Alabama nursing homes and long-term care facilities. That continues to be a struggle,” Williams said.
The Centers for Medicare and Medicaid Services is collecting that state data, but it’s weeks old by the time it’s published on the federal agency’s website, Williams said.
“Having that information would help us protect the residents, staff and surrounding communities, but also making sure families have that information,” Williams said.
The Alabama Department of Public Health has declined to release county-level or facility-level details on coronavirus in long-term care facilities and nursing homes, citing privacy concerns. Many other states do release that information, however.
According to CMS, there have been 3,841 confirmed COVID-19 cases and 562 deaths among residents in Alabama nursing homes as of July 26. AARP Alabama said COVID-19 deaths of nursing home residents make up approximately 42 percent of the state’s total coronavirus deaths.