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.
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.
“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.”
Alabama sees record number of COVID-19 hospitalizations Monday
“What we can still control is Christmas,” Dr. Don Williamson said. “We can still control what hospital beds are going to look like in January.”
Alabama on Monday saw a new record with more people in hospitals with COVID-19 than ever before and a new record number of COVID-19 patients in intensive care units as public health experts worry about what is to come after Thanksgiving gatherings.
The Alabama Department of Public Health on Monday reported 1,717 hospitalizations statewide, breaking the previous record of 1,613 set on Aug. 6. The state’s seven-day average of hospitalizations has increased each day for the last 41.
UAB Hospital on Monday had a record high 125 COVID-19 patients, breaking the previous record of 124 on Aug. 3. Huntsville Hospital had a record 264 COVID-19 patients Monday. Hospitals in Montgomery and Mobile are also seeing similar rising numbers but didn’t break records Monday.
Approximately one in five adults in general medicine beds in Alabama hospitals Monday were COVID-19 patients, said Dr. Don Williamson, president of the Alabama Hospital Association and former Alabama state health officer.
The state had a record high 491 COVID-19 patients in intensive care units Monday, and 244 coronavirus patients were admitted to hospitals Sunday, which was the highest number in several months, he said.
Williamson said that 11 percent of the state’s intensive care beds were available. It was the first time since Aug. 16 that fewer than 200 ICU beds were free, he said.
“It’s not the ICU beds I’m worried about,” Williamson said. “The overall trend is worse than I imagined it would be, with no impact [yet] from Thanksgiving.”
Williamson noted that Alabama’s seven-day average of hospitalizations increased by 217 from a week ago.
“That’s what I’m worried about,” Williamson said, adding that hospitals across the state Monday were either at their record highs in hospitalizations or very close to them. He also expressed concern over Alabama’s continued rise in new cases, a sign of unabated community spread and a harbinger of even more hospitalizations and deaths to come.
The state added 2,295 new cases Monday and has averaged 2,206 new cases each day for the last week, which is a 67 percent increase from a month ago.
The increasing case counts aren’t attributed to more testing. Alabama reported an increase of just 4,634 tests Monday, and the seven-day average of tests reported per day is up only 4 percent over the last month. This comes as the positivity rate over the last week was a record-high of 30 percent. Public health experts say that rate needs to be at or below 5 percent or there isn’t enough testing and cases are going undetected.
Williamson said staffing problems continue to be a major concern at hospitals statewide. Medical staff are contracting COVID-19 largely from their own communities and not while at work, Williamson has said recently, which is reducing the number of available workers. Fatigue is also impacting staffing levels.
“We are beginning that conversation about what do things have to look like going forward on staffing with an increase of say another 20 percent in hospitalization. What is it you’re doing now that you don’t do? How do you free up additional staff?” Williamson said.
There will also be conversations about looking for help from the federal government, Williamson said, noting that the U.S. Department of Defense sent medical personnel to El Paso, Texas, to help with overburdened hospitals there.
But Alabama’s growing COVID-19 crisis isn’t just an Alabama problem, Williamson said. The problem is nationwide, and Alabama will have to wait in line along with other states in requesting federal resources.
There has been discussion of opening up medical facilities outside of hospitals, such as the tent hospitals that have popped up in places hard-hit by coronavirus, but the staffing problem is paramount, Williamson said. Without people to work them, more beds are useless, and hospitals can and have found ways to increase bed space for coronavirus patients, he said.
There’s nothing that can be done to reverse whatever bad outcomes may result from Thanksgiving gatherings, Williamson said, and he expects that by the end of this week, the state’s case count will begin increasing even more, and by mid-December, the state should begin to see the impact of Thanksgiving on hospitalizations.
“What we can still control is Christmas,” Williamson said. “We can still control what hospital beds are going to look like in January.”
Mental Health Commissioner Lynn Beshear to retire Dec. 16
Under Beshear’s leadership, the Alabama Department of Mental Health launched Stepping Up Alabama, aimed at reducing the number of people in jails who have a mental illness.
Gov. Kay Ivey on Monday announced that Lynn Beshear, commissioner of the Alabama Department of Mental Health, will retire effective Dec. 16. Ivey has appointed Beshear’s chief of staff, Kim Boswell, to lead the department upon Beshear’s retirement.
“When Lynn was appointed, I knew that she would approach her role always thinking of what is best for the people of Alabama,” Ivey said in a statement. “She has created a collaborative team approach within the Alabama Department of Mental Health to solve intricate problems regarding delivery of services for mental illness, substance abuse disorder and intellectual disability. I am truly grateful for her service to our state and wish her best in her next chapter.”
“It is been an honor to serve as the Commissioner of the department,” Beshear said in a statement. “I am stepping into the next chapter of my life proud of the accomplishments of the department and am incredibly honored to have worked with such dedicated individuals who are committed to improving the lives of others. I profoundly thank Governor Ivey for her trust in me these last three years and have no doubt the department will continue to change the lives of the people of Alabama for the better.”
Under Beshear’s leadership, the Alabama Department of Mental Health launched Stepping Up Alabama, aimed at reducing the number of people in jails who have a mental illness, according to a press release from Ivey’s office. Alabama is the only state to expand the goal to include ER’s and substance use disorders, according to the release.
Ivey in October announced an $18 million project to create three new mental health crisis centers to be located in Mobile, Montgomery and Huntsville, which will reduce the number of people suffering from mental health crises who are hospitalized or jailed, Ivey said during a press briefing last month.
“When these facilities are open and fully staffed, these centers will become a safe haven for people facing mental health challenges,” Ivey said.
Boswell has over 36 years of experience working with individuals with mental illnesses, substance abuse disorders and developmental disabilities, according to the release. She currently serves as chief of staff for Beshear and has been both associate commissioner for administration as well as director of human resources for ADMH.
“I’m pleased to announce Kim Boswell as Commissioner for the Alabama Department of Mental Health,” Ivey said. “She has spent the entirety of her professional career devoted to helping struggling individuals and I appreciate her willingness to serve in this new capacity. Her background as a mental health provider as well as administrator makes her uniquely qualified.”
Will vaccines protect against mutated strains of coronavirus?
Public health experts say it will be some time before vaccines are available to the wider public.
Multiple vaccines for COVID-19 are in clinical trials, and two drugmakers have already applied for emergency use authorization, but how good will those vaccines be against a mutating coronavirus? A UAB doctor says they’ll do just fine.
Dr. Rachael Lee, UAB’s hospital epidemiologist, told reporters earlier this week that there have been small genetic mutations in COVID-19. What researchers are seeing in the virus here is slightly different than what’s seen in the virus in China, she said.
“But luckily the way that these vaccines have been created, specifically the mRNA vaccines, is an area that is the same for all of these viruses,” Lee said, referring to the new type of vaccine known as mRNA, which uses genetic material, rather than a weakened or inactive germ, to trigger an immune response.
The U.S. Food And Drug Administration is to review the drug company Pfizer’s vaccine on Dec. 10. Pfizer’s vaccine is an mRNA vaccine, as is a vaccine produced by the drug maker Moderna, which applied for emergency use approval Monday. [Updated Dec. 1]
“I think that is incredibly good news, that even though we may see some slight mutations, we should have a vaccine that should cover all of those different mutations,” Lee said.
Researchers at the University of North Carolina at Chapel Hill and the University of Wisconsin-Madison found in a recent study, published in the journal Science, that COVID-19 has mutated in ways that make it spread much more easily, but the mutation may also make it more susceptible to vaccines.
In a separate study, researchers with the Commonwealth Scientific and Industrial Research Organisation found that while most vaccines were modeled after an earlier strain of COVID-19, they found no evidence that the vaccines wouldn’t provide the same immunity response for the new, more dominant strain.
“This brings the world one step closer to a safe and effective vaccine to protect people and save lives,” said CSIRO chief executive Dr. Larry Marshall, according to Science Daily.
While it may not be long before vaccines begin to be shipped to states, public health experts warn it will be some time before vaccines are available to the wider public. Scarce supplies at first will be allocated for those at greatest risk, including health care workers who are regularly exposed to coronavirus patients, and the elderly and ill.
Alabama State Health Officer Dr. Scott Harris, speaking to APR last week, urged the public to continue wearing masks and practicing social distancing for many more months, as the department works to make the vaccines more widely available.
“Just because the first shots are rolling out doesn’t mean it’s time to stop doing everything we’ve been trying to get people to do for months. It’s not going to be widely available for a little while,” Harris said.
Alabama hospitals nearing COVID-19 summer surge levels
Wednesday was the 18th straight day with more than 1,000 people in hospitals in Alabama with COVID-19.
Alabama hospitals reported caring for 1,483 people infected with COVID-19 on Wednesday, the highest number of patients since Aug. 11, when the state was enduring its summer surge. Wednesday was also the 18th straight day with more than 1,000 people in hospitals in Alabama with COVID-19.
The seven-day average of hospitalizations was 1,370 on Wednesday, the 36th straight day of that average rising. The Alabama Department of Public Health reported 2,453 new cases Wednesday. The 14-day average of new cases was — for the eighth day in a row — at a record high of 2,192.
Across the country, more than 80,000 people were hospitalized for COVID-19 on Tuesday, a record high and the 15th straight day of record hospitalizations nationwide, according to the COVID Tracking Project, a coronavirus tracking website.
The CDC this week recommended people not travel for Thanksgiving to help prevent the spread of coronavirus.
“The only way for us to successfully get through this pandemic is if we work together,” said Dr. Kierstin Kennedy, UAB’s chief of hospital medicine, in a message Tuesday. “There’s no one subset of the community that’s going to be able to carry the weight of this pandemic and so we all have to take part in wearing our masks, keeping our distance, making sure that we’re washing our hands.”
Kennedy said the best way she can describe the current situation is “Russian Roulette.”
“Not only in the form of, maybe you get it and you don’t get sick or maybe you get it and you end up in the ICU,” Kennedy said, “but if you do end up sick, are you going to get to the hospital at a time when we’ve got capacity, and we’ve got enough people to take care of you? And that is a scary thought.”
The Alabama Department of Public Health on Wednesday reported an increase of 60 confirmed and probable COVID-19 deaths. Deaths take time to confirm and the date a death is reported does not necessarily reflect the date on which the individual died. At least 23 of those deaths occurred in November, and 30 occurred in other months. Seven were undated. Data for the last two to three weeks are incomplete.
As of Wednesday, at least 3,532 Alabamians have died of COVID-19, according to the Department of Public Health. During November, at least 195 people have died in Alabama from COVID-19. But ADPH is sure to add more to the month’s tally in the weeks to come as data becomes more complete.
ADPH on Wednesday announced a change that nearly doubled the department’s estimate of people who have recovered from COVID-19, bringing that figure up to 161,946. That change also alters APR’s estimates of how many cases are considered active.
ADPH’s Infectious Disease and Outbreak team “updated some parameters” in the department’s Alabama NEDSS Base Surveillance System, which resulted in the increase, the department said.