Hospitalizations of COVID-19 patients in Alabama on Monday crossed the 1,000 mark for the first time since Aug. 31 — a sign that Alabama may be headed for another peak in hospitalizations as the state prepares for winter and flu season.
The 1,001 patients in hospitals with COVID-19 on Tuesday is a 34 percent increase from a month ago, and the seven-day average of COVID-19 hospitalizations by day Tuesday was 917, a 21 percent increase from Sept. 27.
“Unfortunately, not surprised but frankly, depressed by our trends,” said Dr. Don Williamson, president of the Alabama Hospital Association and Alabama’s former state health officer, speaking to APR on Tuesday.
Work is under way to help hospitals prepare for another surge, ensuring there’s enough of therapies like Remdesivir, ventilators and personal protective equipment are in place, Williamson said.
Alabama on Monday had just 16 percent of the state’s ICU beds available, and since the start of the pandemic, with a few exceptions, Alabama hospitals have had less than 20 percent ICU availability, Williamson said. During the state’s last peak in mid-July, coronavirus patients were using 445 ICU beds, he said, and by Sept, 20 that had dropped to 274, where it hovered ever since.
On Monday, 292 COVID-19 patients were in ICUs, Williamson said.
Williamson said at the state’s worst point during July, Alabama had just 109 ICU beds available but that “the problem wasn’t beds. It was staff.” Without staff to care for the patients, empty ICU beds would do a patient no good.
A nurse can typically care for up to six patients, but only three or four COVID-19 patients, who require extra care, Williamson said. And there’s concern that fatigue among hospital staff will again become a challenge.
“You’re seeing it nationally now, in folks who are going through this second wave. Staff are just exhausted because they’ve seen it before. They know how somehow this is going to turn out for a significant number of patients,” Williamson said. “And part of it is just the incredible frustration that a lot of this was preventable.
As treatment options and the knowledge of how to better care for COVID-19 patients have improved, fewer coronavirus patients are taking up those ICU beds, but they’ve been replaced with people who come to hospitals sicker than before the pandemic.
Williamson said many of them may have put off going to the hospital during the state’s surge, and as a result, find themselves sicker than they would have otherwise been.
Alabama’s hospitalizations began dropping in the weeks after Gov. Kay Ivey issued a statewide mask order in July, which she has extended twice, but after dipping down as low 703 on Sept. 25, hospitalizations have been rising.
Williamson said looking at the rate of increase in recent weeks, he predicts the state could again see daily hospitalizations of 1,500 as in July, and said while current hospitalizations for seasonal flu patients are in the single digits, there’s concern that as flu season continues the combination of flu and COVID-19 patients will strain hospital staffing resources and bed space statewide.
Williamson said from personal observation he is seeing more people not wearing masks, or wearing them improperly, and said the state could dramatically reduce the risk of COVID-19 if the public regularly wore masks and wore them properly.
“The period between Thanksgiving and the first of the year could be really, really problematic, given what we’re now seeing with COVID,” Williamson said.
Alabama added 1,115 new confirmed and probable coronavirus cases on Tuesday, and the 14-day average of new daily cases hit 1,375. Over the last two weeks, the state added 19,244 cases, although 3,747 were older test results from labs that weren’t properly reporting to the Alabama Department of Public Health.
Alabama’s 14-day positivity rate is at nearly 21 percent, although those older test results skewed the figure higher than it otherwise would have been. Just prior to those older cases being added to the count, however, Alabama’s 14-day average of percent positivity was 15 percent. Public health experts say it needs to be at or below 5 percent of cases are going undetected.
ADPH reported 26 COVID-19 deaths on Tuesday. Over the last four weeks, ADPH added 391 coronavirus deaths to the state’s total, which stood at 2,892 on Tuesday.