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Alabama’s Black Belt lacks access to health care, report finds

Researchers with the University of Alabama’s Education Policy Center found that physical access to health care is a luxury fewer and fewer rural Alabamians enjoy.

Eddie Burkhalter

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(STOCK PHOTO)

People living in Alabama’s Black Belt counties have less access to physical health care, which is impacting their health, according to a report released Tuesday. 

Researchers with the University of Alabama’s Education Policy Center found that physical access to health care is a luxury fewer and fewer rural Alabamians enjoy. 

The report, titled “Health Care: A Key Challenge in Alabama’s Black Belt,” is the latest in EPC’s Black Belt 2020 series, and states that the Black Belt counties Lamar, Lowndes, Perry and Pickens, have no hospitals. 

“The data suggests that black belt is largely underserved in terms of physical access to health care, and specifically it indicates that blackbelt residents lack physical access to health care systems,” said Jonathan Bowen, a graduate student and research associate at EPC, speaking with reporters on Monday. “In some cases, the closest hospital could be over an hour away, making it extremely difficult to get to a health care provider in a timely manner.” 

The Education Policy Center defines the Black Belt as comprising of 24 counties. Of those, 17 have fewer than the statewide average of 3.9 hospital beds per 1,000 people, according to the report. 

The report notes that as of February, seven rural hospitals have closed statewide, and transportation to hospitals elsewhere can be problematic for many. 

“One Black Belt mayor, Jerome Antone, was recently hospitalized 65 miles away from his town of Georgiana,” the report reads. 

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Emily Grace, another EPC researcher and a co-author of the report, said that in their research they found that from 2008 to 2017, only seven Alabama counties saw a decrease in premature death rates, which is defined as deaths before the age of 70. Of those counties, four were Black Belt counties. 

“But overall, Black Belt counties are fairly evenly distributed across this dataset,” Grace said. “Which suggests that this is a problem facing all of Alabama, regardless of rural, urban, Black Belt or not.” 

Emily Jacobs, a graduate research assistant at EPC, told reporters Monday that the state of health care access for rural residents was tenuous before the coronavirus pandemic.

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“Now, Alabamians who were already struggling to access health care are under more strain than ever,” Jacobs said. 

Jacobs said that unlike Alabama, hospitals in states that chose to expand Medicaid were 84 percent less likely to close. Former Gov. Robert Bentley chose not to accept federal aid under the Affordable Care Act to expand Medicaid. Jacobs said a study by the University of Alabama at Birmingham found that if Alabama were to expand Medicaid, it would provide health care coverage for an additional 300,000 Alabamians. 

“That same study also estimated that Alabama tax revenue would have enjoyed an additional $1.7 billion in added revenue,” Jacobs said. 

“Robert Bentley’s choice not to take the ACA funding in 2014, when the federal government was offering such generous matching inducements, is easily the single worst decision made by an Alabama governor since George Wallace’s infamous stand in the schoolhouse door to bar African Americans from entering the University of Alabama in 1963,” said Stephen Katsinas, EPC’s director. 

Sen. Doug Jones, D-Alabama, speaking with reporters during Monday’s briefing on the report, agreed with Katsinas, and said Bentley’s decision not to expand Medicaid was “the worst decision that we have seen and generations in this state.” 

“And it was all for purely political reasons. Let’s just get that out on the table,” Jones said. 

Alabama is one of the unhealthiest states in the country, and the economic and health outcome benefits from an expanded Medicaid were clear in 2014, Jones said. 

“Robert Bentley famously told a group of legislators, back in 2013 or 2014, that he would refuse to do it because he was concerned about his reelection,” Jones said. “He was concerned about a primary challenge from the right, and he was not going to do it.” 

Jones discussed his bill, which would give states that haven’t yet expanded Medicaid 100 percent reimbursement for the costs of doing so for three years, then would stair step that reimbursement down to five percent and then to 10 percent. 

“And then to use that money and invest in our people. Invest in our health care,” Jones said. “Those are the kind of things that we should do.” 

Rep. Kyle South, R-Fayette, told reporters during the briefing that the state should continue to focus on recruiting young health care professionals to work in rural areas  “because we have a almost a crisis point of recruiting.” 

South said one good thing that has come out of the COVID-19 pandemic is federal reimbursements for telemedicine, which has increased health care availability in those rural areas. 

Jones said there needs to be more dialogue on the problem, and political partisanship needs to be put aside. 

“At the end of the day we are still ranked low in terms of health outcomes. We are still ranked high in poverty,” Jones said. “We’ve got to figure out how to do that, to do something better than we’ve been doing for a while. We got to make sure that we can lift all boats.”

Eddie Burkhalter is a reporter at the Alabama Political Reporter. You can email him at [email protected] or reach him via Twitter.

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At least 248 COVID deaths reported in Alabama in October

The cumulative death toll in Alabama has risen by 248 to 2,788 in October and by 124 in the last week alone.

Brandon Moseley

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(STOCK PHOTO)

We’re a little more than halfway through the month of October and the Alabama Department of Public Health has already reported at least 248 deaths from COVID-19.

The cumulative death toll in Alabama has risen by 248 to 2,788 in October and by 124 in the last week alone.

At least 378 deaths were reported in the month of September, a rate of 12.6 deaths per day over the month. In the first 17 days of October, the rate has been 14.6 deaths per day, a 15.9 percent increase from September.

Deaths were higher in July and August. The cumulative death toll increased by 582 in August and 630 in July, the worst month of the pandemic for the state.

On Saturday, ADPH reported that 1,288 more people in the state were confirmed positive with the coronavirus, and on Sunday the count increased by 964. The number of confirmed cases in Alabama has risen to 172,626.

There have been 17,925 new cases Alabama in October alone. The state is averaging almost 996 cases per day in October, which is up from September.

The state had 28,643 new coronavirus cases in September, 38,335 cases new cases in August, and 49,678 cases in July. Public health officials credit Alabama Governor Kay Ivey’s statewide mask order on July 15 with slowing the spread of the virus in the state, but the virus has not gone away.

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ADPH reported 823 hospitalizations for COVID-19 on October 17, the most recent day for which we have data. While hospitalizations for COVID-19 are down from the peaks in early August in Alabama have risen from Oct. 1 when 748 Alabamians were hospitalized, a 10 percent increase from the first of the month.

The state of Alabama is continuing to struggle to protect its most vulnerable citizens. At least 6,497 residents of long term care facilities in Alabama have been diagnosed with the coronavirus, 247 of them in October.

There have also been 3,362 cases among long term care workers in Alabama, including 197 in the month of October. Some 9,819 Alabama health care workers have also contracted the coronavirus.

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Most people who test positive for the novel strain of the coronavirus, SARS-CoV-2, are asymptomatic or have only minor symptoms, but in about one out of five cases it can become much more severe.

For older people or people with underlying medical conditions like obesity, heart disease, asthma, cancer, diabetes or HIV, COVID-19 can turn deadly. COVID-19 is the abbreviated name for the medical condition caused by the SARS-CoV-2 virus.

Some 1,115,600 people worldwide have died from COVID-19 worldwide, including 224,284 Americans. There are 8,972,704 known active cases in the world today.

Public health officials warn citizens that coronavirus remains a present danger in our community. Social distancing is the best way to avoid spreading the virus. Avoid venues with large groups. Don’t shake hands or hug persons not living in your household.

Avoid leaving your home as much as possible and wear a mask or cloth face covering when you do go out. Avoid touching your face and wash your hands with soap frequently. Hand sanitizer is recommended.

A coronavirus vaccine may be available in the coming months, but we don’t yet know when or how effective it will be.

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Alabama inmate tested positive for COVID-19 after his death

Testing data from the department shows there was an outbreak of the disease in the prison around the time he was taken to a hospital. 

Eddie Burkhalter

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(STOCK PHOTO)

An Alabama inmate who died on Aug. 1 tested positive for COVID-19 after his death, the Alabama Department of Public Health announced Friday, and testing data from the department shows there was an outbreak of the disease in the prison around the time he was taken to a hospital. 

According to the Alabama Department of Corrections (ADOC), Scottie Johnson, 45, who had preexisting medical conditions, was taken from Bullock Correctional Facility to a local hospital on July 31, “for care ostensibly unrelated to COVID-19.” He tested negative for COVID-19 at the hospital, ADOC said in a statement, but tested positive during an autopsy. 

In just more than two weeks time, after Johnson was taken to the hospital, 41 inmates and two workers at Bullock prison also tested positive for COVID-19, according to the department’s regular COVID-19 updates. Another inmate at Bullock just recently tested positive as well, the Alabama Department of Corrections (ADOC) announced Friday. 

Wanda Payton, Johnson’s mother, told APR on Friday that she last spoke to her son by phone on Monday, July 27. He was taken to the hospital four days later. Both her sons were born with severe allergies, Payton said, and the prison kept the drug epinephrine on hand in the event he had a severe allergic reaction, as he had once during high school. 

“He was saying his throat felt scratchy,” Payton said, adding that her son said it felt like it did when he had the severe reaction in high school. 

She told him to go to the prison’s infirmary and get help, Payton said. Although he called her almost every day, she didn’t hear from him for the rest of the week. She was going to call the prison on Saturday but said a chaplain called her that morning before she could. 

“He said ‘I hate to tell you this, but we just lost your son, Scottie’ and I just went into shock,” Payton said. “I told him, ‘what do you mean?’ and I just started screaming and hollering.” 

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Eric Johnson, Scottie’s brother, told APR that he’s concerned about what happened between the time his mother talked to him that Monday, and when he was taken to the hospital on Friday. 

“Between that Monday and Friday he had to show some symptoms,” Johnson said. “I hope they would just let him sit there and pass out and have a hard time breathing before they decided to rush him to the hospital.” 

Subsequent questions to ADOC late Friday evening weren’t immediately responded to. APR will update the story once those responses are sent. 

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A COVID-19 update from ADOC on Aug. 11 announced that 22 inmates at Bullock prison had recently tested positive for COVID-19. In the weeks prior to that announcement, but after Johnson was sent to a hospital, another inmate and two workers at the prison also tested positive for COVID-19. On August 18, ADOC announced that an additional 18 inmates at Bullock tested positive for the disease. 

During the months of August and September, there were confirmed coronavirus cases among 43 inmates and 9 workers at Bullock prison. So far in October, another 5 workers at the prison have tested positive for coronavirus. 

Since the pandemic began, 453 inmates and 427 prison workers have tested positive for COVID-19. Johnson’s death brings the total number of inmates who have died after testing positive for coronavirus to 29. Two prison workers died after testing positive for the disease.

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White House COVID-19 report put Alabama in red zone last week

Alabama’s number of new cases last week rose by 14 percent from the previous week, while the number of tests performed statewide dropped by 11 percent.

Eddie Burkhalter

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A White House Coronavirus Task Force report listed Alabama in the "red zone" for coronavirus spread.

Alabama was a so-called “red zone” last week, and 79 percent of the state’s counties have moderate or high levels of community spread, according to the latest state report from the White House Coronavirus Task Force.

The report, which APR obtained from the Alabama Department of Public Health on Friday, notes that Alabama had 138 new cases per 100,000 people last week, compared to the national average of 100 new cases per 100,000.

The state ranked 19th highest in the nation for the number of new coronavirus cases.

Alabama’s number of new cases last week rose by 14 percent from the previous week, while the number of tests performed statewide dropped by 11 percent, according to the report.

Dr. Karen Landers, assistant state health officer with the Alabama Department of Public Health, told APR by phone Friday that the drop in testing is due in part to a large number of tests that came into the system in batches during the previous weeks, which skewed the data.

The “data dumps,” as they’re often called, were from several new labs and other testing facilities that weren’t accustomed to reporting to ADPH, Landers said. There’s also been a decrease in the demand from the public asking to be tested, she said.

“In all of our counties we’ve had a decrease in demand, even in the public and the private sector, for testing,” Landers said.

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Of the state’s 67 counties, at least 16 are listed in the report as being in the red zone last week, which is an increase of two counties from the previous week. Another 17 counties were listed in the yellow zone. The colored zones are based on the number of new cases within the previous three weeks. The Anniston-Oxford area, Decatur and Fort Payne were the only localities in the red zone last week, according to the report.

Alabama added 1,212 new COVID-19 cases on Friday, and over the last two weeks, the state’s case count grew by 13,676. Over the last week, the state has average 987 cases per day, a 14 percent increase from two weeks ago.

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The percentage of tests that were positive statewide last week was 7.2 percent, according to the report, which was a slight .06 percentage point decrease from the previous week, but it’s still too high, Landers said.

Public health experts say the positivity rate needs to be at least 5 percent or there is continued community spread and cases are going undetected.

“I really won’t feel comfortable until we’re down to about 3 percent,” Landers said.

The Alabama Department of Public Health in the last three days reported an increase of 121 confirmed and probable deaths from COVID-19, which is the largest three-day count since the start of the pandemic. Landers said the recent uptick is due to a length of time it takes ADPH staff to confirm a death was due to COVID-19, and doesn’t reflect a recent rise in deaths statewide.

Still, the report notes that Alabama’s coronavirus death rate of 2.1 per 100,000 people was higher than the national average of 1.5 deaths per 100,000. Alabama’s 14-day average of COVID-19 deaths per day was 17 on Friday.

Hospitalizations of COVID-19 patients statewide reached a high of 862 on Wednesday and 859 on Friday, the highest the number has been since Sept. 4 when 863 people were hospitalized. Since Oct. 2, hospitalizations have increased some 16.8 percent.

“It’s looking a little bit like it’s going back up, because, and we have been seeing this, that people are becoming very tired of the message,” Landers said of hospitalizations.

That message, Landers said, is that the public needs to continue wearing masks, practicing social distancing, avoiding crowds, especially indoor gatherings, and continuing proper hand hygiene and cleaning of surfaces.

“That’s just all we have,” Landers said.

The number of new cases, hospitalizations and deaths began dropping in the weeks after Gov. Kay Ivey’s statewide mask order went into effect in mid-July, but Landers said “we’re not there yet.”

Landers also worries that as we head into colder weather people will want to congregate with family and friends indoors, which could set off numerous outbreaks. The White House report notes that danger, and found that such practices continue to impact Alabama’s numbers.

“We continue to see community spread initiated by social friends and family gatherings,” the White House report states. “People must remember that seemingly uninfected family members and friends may be infected but asymptomatic. Exposure to asymptomatic cases can easily lead to spread as people unmask in private gatherings.”

Landers said it’s incorrect to think one isn’t in danger of catching COVID-19 when around family members over the holidays or in gatherings, and warned that asymptomatic carriers of COVID-19 are very much able to pass it to others.

Landers said many people seem to be acting as if their family members can’t spread the disease to them, but said “your family can.” As much as 40 percent of COVID-19 cases are among those who don’t have symptoms, Landers said.

“When you’re looking at that broad a level and range of asymptomatic transmission, then that is a significant concern to me,” Landers said.

Nationwide, COVID-19 isn’t showing signs of slowing. More than 30 states experienced growth in new cases over the last two weeks, according to data from Johns Hopkins.

There were 63,610 new cases and 820 new deaths added in the U.S. on Friday.

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Sen. Doug Jones holds roundtable on Affordable Care Act

“When I talk about protecting the ACA I want everyone to understand this is not theoretical. This is not abstract. This is real life,” Jones said. 

Eddie Burkhalter

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Sen. Doug Jones hosts a roundtable to discuss the Affordable Care Act. (VIA JONES CAMPAIGN)

The Affordable Care Act is under attack, said Sen. Doug Jones, D-Alabama, on Wednesday, speaking during an online roundtable to discuss the landmark legislation. 

“And again, we find ourselves defending it in the courts,” Jones said, during the Facebook Live video. 

The U.S. Supreme Court on Nov. 10 is to hear arguments in a case brought by the Trump administration and a slew of Republican state attorneys general, including Alabama Attorney General Steve Marshall, challenging the constitutionality of the Affordable Care Act. 

Jones said Republican lawmakers have tried numerous times unsuccessfully to do away with the ACA, and now hope the courts will do what they couldn’t. 

“When I talk about protecting the ACA I want everyone to understand this is not theoretical. This is not abstract. This is real life,” Jones said. 

Jones was accompanied in the roundtable discussion by three people, each impacted positively by the ACA. Among them was Joshua Hillman from Prattville, a University of Alabama graduate and law student at Harvard who was born with cystic fibrosis. 

“You never really know what’s going to come up,” Hillman said of his medical condition. “Whether it’s sinuses, your lungs, insulin. Anything.” 

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With those unexpected hospital stays and numerous medications, some rare and experimental, comes the cost, Hillman said. 

“Before the ACA, it was possible for people to not only be denied coverage, just for having cystic fibrosis, something that you’re just born with. Even if you’re lucky enough to get coverage, you could run up those price tags pretty quickly,” Hillman said. 

Hillman said the ACA helped prevent his family from “having to make, to the extent they would have, some incredibly hard choices.” 

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“And it’s let me and my brother stay on our parent’s insurance plans throughout college, and not forced you to immediately have to go out and find a first job to get paid simply because it offers healthcare coverage,” Hillman said. 

Dr. LaShelle Barmore, who runs a family medical practice in Trussville, speaking during the roundtable said she also specializes in treating those with diabetes, and is herself a type 1 diabetic, having been diagnosed as such since she was 2 years old.

Prior to the ACA, many diabetic patients couldn’t get the regular quality care they needed, which resulted in costly hospitalizations.  

“Not only just thinking of the lives lost and things of that nature, the bottom line is that underinsured and uninsured patients are the ones that are making health care costs be so significantly high,” Barmore said. 

Prior to the ACA, when Barmore was attending medical school in Kansas City, she lost her health insurance. 

“And I’m an insulin pump user and was not able to continue my insulin pump usage because supplies were not affordable without insurance,” Barmore said. “And as a result of that, trying to just scrape by, I was using samples of insulin that I was getting from my professors.” 

Because of the variability of her treatments, Barmore said she had two hypoglycemic seizures during that time. 

“So the bottom line is I get it, I get what my patients are going through and the fears that they have, if the ACA were to go away,” Barmore said. “And I just am prayerful and hopeful that we will be able to maintain this, because it’s made all the difference.” 

Ty Burden from Mobile said during the discussion that she was diagnosed with asthma when she was 6 months old, and throughout her life has struggled with breathing problems. As an adult, she could never afford health insurance, and a trip to the doctor could cost her nearly $300, so instead, she’d go often go without an inhaler. 

“There was a serious asthma attack where I ended up passing away in the ambulance. They brought me back, and I was in a coma for three days,” Burden said. The incident resulted in her becoming thousands and thousands of dollars in debt due to the medical bills, she said. 

“The ACA makes such a difference in my life and in my family’s life, because I had a chance to live again,” Burden said. 

Jones said he’s seen the political blow back the ACA got “because it was tied to President Obama. It was called Obamacare, and that created a partisan divide.” 

Jones encouraged the public to share their own stories about the ACA on social media using the hashtag #alforaca

“I hope that people listening to this will really take to heart what this ACA means. What we take for granted,” Jones said.

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