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Study: COVID-19 infection rates more than double without lockdowns

Infection and fatality rates would have been higher without stay-at-home orders, a new UAB study found.

Micah Danney

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(STOCK PHOTO)

New research from the University of Alabama at Birmingham says that if there had been no stay-at-home orders issued in the U.S. in response to the coronavirus pandemic, the country would have experienced a 220 percent higher rate of infection and a 22 percent higher fatality rate than if such orders were implemented nationwide.

Seven states never imposed stay-at-home orders, or SAHOs. The study analyzed daily positive case rates by state against the presence or absence of statewide SAHOs between March 1 and May 4, the period when such orders began to be implemented. Twelve states lifted their SAHOs before May 4.

The researchers defined SAHOs as being in effect when a state’s governor issued an order for residents of the entire state to leave home only for essential activities and when schools and nonessential businesses were closed.

“During March and April, most states in the United States imposed shutdowns and enacted SAHOs in an effort to control the disease,” said Bisakha Sen, the study’s senior author. “However, mixed messages from political authorities on the usefulness of SAHOs, popular pressure and concerns about the economic fallout led some states to lift the restrictions before public health experts considered it advisable.”

The research also sought to determine if the proportion of a state’s Black residents was associated with its number of positive cases. It found that there was.

“This finding adds to evidence from existing studies using county-level data on racial disparities in COVID-19 infection rates and underlines the urgency of better understanding and addressing these disparities,” said study co-author Vidya Sagar Hanumanthu. 

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The research can help advance a greater understanding of racial disparities in the health care system as a whole, and help leaders make future decisions about shutdowns as the virus continues to spread, Sen said.

“While the high economic cost makes SAHOs unsustainable as a long-term policy, our findings could help inform federal, state and local policymakers in weighing the costs and benefits of different short-term options to combat the pandemic,” she said.

The study was published Friday in JAMA Network Open.

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

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Alabama breaks daily COVID-19 case, hospitalization record again Thursday

Coronavirus hospitalizations reached another record high for the fourth time in so many days.

Eddie Burkhalter

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An aerial view of Huntsville and Huntsville Hospital, where medical staff are treating a record number of COVID-19 patients.

For a second straight day, Alabama’s daily COVID-19 case count was at a record high on Thursday, and coronavirus hospitalizations reached another record high for the fourth time in so many days.

The Alabama Department of Public Health reported 3,531 new cases Thursday, and the state has averaged 2,461 cases each day for the last two weeks, a 28 percent increase over the previous two weeks. 

The latest White House Coronavirus Task Force state report for Alabama, released Sunday, shows that shows 90 percent of Alabama counties had moderate or high levels of community transmission last week, while 64 percent had high transmission levels. The state ranked 19th highest in the percentage of tests that were positive. 

Coronavirus is surging across the country, with cases per day increasing more than seven times the levels seen in the U.S. before the summer surge, and hospitalizations are three times as high now as then, according to the report. The U.S. reported record high cases and deaths Wednesday. 

“It must be made clear that if you are over 65 or have significant health conditions, you should not enter any indoor public spaces where anyone is unmasked due to the immediate risk to your health,” the report states. “You should have groceries and medications delivered.” 

The report warns that for those under 40 “you need to assume you became infected during the Thanksgiving period” if you gathered beyond your immediate household. 

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“Most likely, you will not have symptoms; however, you are dangerous to others, and you must isolate away from anyone at increased risk,” the report continues. 

The number of people in Alabama hospitals with COVID-19 on Thursday reached 1,827. That’s nearly 40 percent higher than two weeks ago. Huntsville Hospital had a record-high 338 COVID-19 patients on Thursday, after a string of record-setting daily hospitalizations. UAB Hospital was caring for a record 127 COVID-19 patients Wednesday and 125 on Thursday.

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Testing statewide remains low. The average positivity rate over the last week was 34 percent. Public health experts say it should be below 5 percent to ensure adequate testing is being done to prevent cases from going undetected. 

The state averaged 8,517 tests each day over the last two weeks, down from the two week average of 9,407 recorded on Nov. 26.

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Finance director: Alabama expects to spend nearly all of $1.8 billion in CARES Act funds

“I think we’ll be down to less than $10 million, and hopefully less than that,” the state finance director said.

Eddie Burkhalter

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Alabama State Finance Director Kelly Butler at a COVID-19 press conference. (VIA GOVERNOR'S OFFICE)

Alabama has until Dec. 30 to spend the $818 million that remains of $1.8 billion in federal CARES Act money allocated to the state, or the remaining funds revert back to the federal government, but the state’s finance director believes that’s possible, for the most part. 

“I think we’ll be down to less than $10 million, and hopefully less than that,” said Alabama State Finance Director Kelly Butler, speaking to reporters Wednesday. 

With new daily COVID-19 cases continuing to break records in Alabama and coronavirus hospitalizations reaching record levels this week, many have expressed concern that Alabama could leave millions on the table at a time when the money could do the most good. 

It’s not clear if lawmakers in Washington D.C. will agree in time to extend the deadline for states to spend the cash, and Butler said Wednesday that state officials had hoped the extension would come to pass but aren’t banking on it. 

“The reality is, if we’re going to be able to get the money out the door, we can’t wait on that any longer,” Butler said. “So we’ve got to put the pedal to the metal and assume that December 30 is a hard cutoff, and that’s the way we’re operating.” 

Butler explained that almost all of the CARES Act money to various state programs and entities are reimbursement programs, meaning those entities must show they spent the money on coronavirus-related expenses, as required by the federal government, then ask the state for reimbursement. 

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“This is particularly true for local governments, state government agencies, hospitals,” Butler said. 

Butler also explained that despite the many needs, the federal money comes with substantial limitations. 

“There is a perception out there that this money can solve everybody’s problem, and can be used for everything that people want it to be used for,” Butler said. “And the reality is that the Treasury guidance, particularly the audit guidance issued by the Treasury, it just does not allow us to do everything that everybody wants us to do, and the penalty, if we use the money outside the bounds outside the law and the regulations, is that the state has to repay the money.” 

Gov. Kay Ivey on Nov. 23 allocated $3.6 million in CARES Act funds to food banks statewide, Butler noted, and another $2 million to a program that provides counseling for veterans with PTSD. 

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“We have money out there for hospitals, nursing homes. We are in constant communication with them,” Butler said. “We have done before this latest grant program, we’ve done one small business grant program, a faith-based organization grant program, a nonprofit organization grant program, a medical provider grant program, an agricultural producer grant program, so we haven’t stopped since May.” 

Asked whether any of the federal aid has gone to the Alabama Department of Public Health to help set up the administration of COVID-19 vaccines, Butler said the state has allocated more than $30 million to the Department of Public Health, but most of that was done before it was clear Alabama could get a vaccine this month. 

Butler said until recently it wasn’t thought a vaccine would be available before the end of the year, and that “up until recently, it was not something that we were allowed to spend money on.” 

“We have allocated a small amount to a company in Huntsville called Aclinnate Genetics for vaccine education, particularly in the African American community throughout the state,” Butler said. 

There remains the possibility of reallocating unspent money to other programs, Butler said, as has been done twice before. That requires conversations between Butler, Gov. Kay Ivey and legislative leadership Butler said, adding that he anticipates at least one more reallocation before the deadline. 

“Our plans are to, as I’ve said daily, evaluate the programs and somewhere around the middle of this month, sort of do a final tally and go back to the Legislature and ask for reallocations so that we can allocate money to things that and programs that might need it,” Butler said. 

One possibility would be to allocate additional money to the state’s unemployment trust fund, Butler said. As much as $287 million could be reallocated to the fund, he said. 

“Health care, with the virus continuing, is also another definite possibility,” Butler said. 

Asked about concerns some local governments and other groups have had that the entities don’t have the money to spend, to then ask for reimbursement, Butler said that he has heard those concerns but that federal guidelines connected to the CARES Act funding are strict. 

“The reality is the Treasury guidance and the CARES act, we believe, prohibit us from sending the money out upfront,” Butler said. “And it’s just not something we believe we can do.” 

Butler said the state has worked closely with local municipalities and groups, including the Black Belt Foundation, to help them apply for reimbursements and get the money returned quickly. 

A reporter asked about as-of-yet unpaid reimbursement requests of more than $850,000 from the Madison County Commission from August, and Butler said the state does have a backlog of requests, and that while the program was established on May 28, many local governments waited until August to submit applications.

Butler then said that he’s been told the Madison County Commission’s requests were being processed Wednesday and the commission should see that money soon. 

Butler said the state has received word from the U.S. Treasury that as long as those reimbursement requests are turned in before the Dec. 30 deadline “we will have a two to three month period to work out those prior bills as long as they were expenses incurred before December.”

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Alabama breaks daily case record, hospitalizations reach new high for third straight day

Rising cases and hospitalizations suggest the death toll will keep climbing in the weeks and months to come.

Eddie Burkhalter

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(STOCK PHOTO)

Alabama on Wednesday broke the state’s record for a single-day increase in coronavirus cases, and for a third straight day had record high COVID-19 hospitalizations. 

There were 1,801 hospitalized COVID-19 patients statewide on Wednesday, which was a 40 percent increase compared to two weeks ago. The rapid pace of rising hospitalizations is raising alarms among hospitals already overburdened with coronavirus patients, in addition to regular patients seeking other care.

Concern is also rising among public health experts and hospital officials that Thanksgiving gatherings will lead to the number only increasing in the days and weeks to come.

Dr. Jeanna Marrazzo, director of UAB’s Division of Infectious Diseases, told reporters Tuesday that there is a possibility that hospitals will have to set up mobile hospitals to care for the rush of patients, and that she worries hospitals may not have enough staff to care for “what might be a tidal wave of patients in the next month.” 

Centers for Disease Control and Prevention Director Robert Redfield made a dire prediction Wednesday during a U.S. Chamber of Commerce event, as cases, hospitalizations and deaths continue to surge across the country. More than 90,000 people in the U.S. were hospitalized for COVID-19 on Wednesday, Redfield said.

“The reality is December and January and February are going to be rough times. I actually believe they’re going to be the most difficult time in the public health history of this nation,” Redfield said.

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UAB Hospital was caring for a record 127 COVID-19 patients on Wednesday, the second straight record-high day for the hospital. Huntsville Hospital on Tuesday had a record 317 COVID-19 patients. The hospital hadn’t updated daily numbers as of Wednesday afternoon. There were no formal intensive care beds available in Mobile County on Tuesday. 

The Alabama Department of Public Health reported 3,928 COVID-19 new cases Wednesday but noted that 706 were older test results not reported to the department from an outside facility until Tuesday. Even without those cases included, the remaining 3,222 cases reported Wednesday amount to the largest single-day increase, excluding a similar but larger backlog of old test results reported Oct. 23. 

Alabama’s 14-day average for new daily cases was at 2,382 on Wednesday, which is a 29 percent increase from two weeks ago. 

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Rising daily cases can’t be attributed to more testing, however. Over the past week, roughly 35 percent of reported tests have been positive. Public health experts say that number — known as the positivity rate — should be at or below 5 percent otherwise cases may be going undetected and not enough tests are being performed.

ADPH also reported 73 more COVID-19 deaths Wednesday, bringing the state’s death toll to at least 3,711 deaths. Of those deaths added to the count today, 20 occurred during the month of November, 32 occurred in previous months, and 21 aren’t yet dated by the department, meaning they could be new deaths from late November or early December.

Of the 779 deaths added to the death toll in November, 34 percent died in the month of November, 56 percent died during previous months and the remaining 10 percent haven’t yet been dated. 

Deaths are lagging indicators, and it can take weeks, and sometimes months, for ADPH to review medical data and confirm a person died of COVID-19 and verify the date on which they died, so it will likely be many weeks before a clearer picture emerges as to how many Alabamians are currently dying from coronavirus.

Rising cases and hospitalizations suggest the death toll will keep climbing in the weeks and months to come.

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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.” 

Eddie Burkhalter

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(STOCK PHOTO)

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.

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“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.

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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.”

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