It may not be long before the first doses of a COVID-19 vaccine arrive in Alabama, but that doesn’t mean the fight is over, public health experts said this week.
Alabama State Health Officer Dr. Scott Harris, speaking to APR on Wednesday, 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.
New cases, hospitalizations and deaths continue to rise in Alabama and across much of the country. Alabama on Wednesday set a new record high for the state’s seven-day average of new daily coronavirus cases.
The department’s plan calls for those most at risk, including health care workers, to get vaccinated first. Just which health care workers will be first in line — not all workers are exposed to COVID-19 to the same degree — is still being discussed, Harris said.
A team from the Centers for Disease Control and Prevention is in Montgomery this week discussing those plans with the ADPH staff, Harris said.
ADPH’s vaccine plan rolls out vaccines in three phases, with the first phase having a phase A (health care workers with potential for direct or indirect exposure to patient or infectious material) and phase B (other essential workers, people at higher risk of COVID-19 illnesses and people 65 and older). Phase two includes the remainder of phase one populations, critical populations and the general public and phase three would include all others.
“We have the big picture of priority groups, the phase one A, one B, and then two and three, but how it breaks down within those groups is something that we’re still working on,” Harris said. “We have pretty good detail so far but we’re still trying to think through all the implications of that.”
“I have no doubt that not everyone will be happy with the plan, and unfortunately that’s the situation you have when you have a scarce resource,” Harris said.
There was some concern that Pfizer and BioNTech’s vaccine requires ultra-cold storage using freezers not typically found in smaller medical settings, which could complicate disbursement of the drug throughout the state, but Harris said there’s been some good news on that front.
Harris said the CDC will ship Pfizer’s vaccine using dry ice packs, which the CDC will continue to supply and which are to be refreshed every five days if the more costly freezers aren’t available in some areas.
“So we recharge it on arrival, we recharge it on day five, and then on day 10,” Harris said. “And then on day 15, it can still go in the refrigerator, not in the freezer, for another five days.”
“So we think that gives us a lot more flexibility because we can spread it around to places that don’t necessarily have ultra-cold storage available,” Harris said.
Numerous Alabama hospitals do have ultra-cold storage capabilities, however, Harris said. The U.S. Department of Health and Human Services asked ADPH to identify strategic sites across the state that do have ultra-cold storage capabilities, where the vaccines will be shipped to first, and six such sites have been selected, he said.
As ADPH works on those plans, it’s becoming clear that the department may have more than one vaccine to handle at once, Harris said. He said the department learned today that Moderna’s application for emergency use approval from the U.S. Food and Drug Administration may be submitted sooner than had been thought.
“So it may be that we have both the Pfizer and the Moderna product pretty much at the same time, and as you know, the cold chain storage requirements aren’t as stringent for the Moderna product, so that will be helpful if that comes to pass,” Harris said.
Pfizer on Wednesday announced the company’s vaccine is 95 percent effective at preventing infection, up from an earlier estimate of more than 90 percent effective and just more than Moderna’s estimation that the company’s vaccine is 94.5 percent effective.
Both companies say no significant safety concerns have been reported for either vaccine.
Both vaccines will require two shots. The Pfizer vaccine requires a second shot 21 days out from the first, and it will take 28 days after the first dose of the Moderna vaccine before the second can be administered, Harris said.
ADPH’s plans call for reminders to be sent out to the public to ensure that the second dose isn’t missed.
Despite the good news about vaccines, Harris cautioned the public to remain vigilant and to continue wearing masks and social distancing.
“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,” Harris said. “It’s not going to be widely available for a little while,” Harris said.
Dr. Jeanne Marrazzo, UAB’s director of infectious diseases, told reporters during a briefing Wednesday that she would like the public to continue to behaving as if there are no vaccines.
“Because in reality, we don’t have a vaccine yet. We won’t have a vaccine for everybody probably until well into 2021,” Marrazzo said, adding that vaccine supply will be short at the start and will need to be carefully apportioned to first responders.
“There’s a lot of discussion about how that should be done ethically, and with the greatest impact for protecting people who are providing care for what we expect to be a continued surge of hospitalizations in particular, over the coming weeks,” Marrazzo said.
Alabama breaks daily COVID-19 case, hospitalization record again Thursday
Coronavirus hospitalizations reached another record high for the fourth time in so many days.
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.
“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.
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.
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.
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.
“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.
“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.”
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.
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.
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.
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.
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.”