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โ€œWeโ€™re surging:โ€ Alabama reports largest COVID-19 increases to date

Coronavirus virus outbreak and coronaviruses influenza background as dangerous flu strain cases as a pandemic medical health risk concept with disease cells as a 3D render

Alabama saw its largest single-day increase in new COVID-19 cases Monday, according to the state, as daily case counts continue an upward trend and hospitals across the state report increasing hospitalizations.

Alabama blew past 15,000 confirmed cases of the virus on Monday, according to the Department of Public Healthโ€™s daily case count. The state had confirmed more than 3,200 new cases in the last seven days, according to APRโ€˜s tracking.

By Tuesday evening, the total reached 15,650. The rising case counts are concerning doctors and public health experts who worry the public is not taking the virus as seriously since the state lifted restrictions.

โ€œIโ€™m afraid that weโ€™re going to have to go through some pretty tough times to drive the message home that this virus is still here, and itโ€™s not going away,โ€ said Dr. Michael Saag, an infectious disease expert at UAB.

More than 400 new cases were confirmed daily, on average, during the week heading into Memorial Day, the highest level since the pandemic began and much higher than during the second and third weeks of April, when Alabama was under a stay-at-home order and expected to reach what was then thought to be a peak.

Gov. Kay Ivey lifted the stateโ€™s โ€œstay-at-homeโ€ order on April 30, replacing it with a โ€œsafer-at-homeโ€ order that loosened restrictions. Since then, the state has twice more relaxed restrictions, allowing more businesses, churches and entertainment venues to reopen with social-distancing restrictions and sanitation guidelines.

The state saw its largest single-day increase in new cases Monday at 646 new cases, according to the Alabama Department of Public Healthโ€™s daily case totals, a little more than three weeks after the stay-at-home order expired on April 30 and two weeks after the state allowed restaurants and bars to reopen on May 11 with social-distancing restrictions.

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The number of cases confirmed per day has been rising since April 30, showing no sign of slowing. Over the past week, new cases rose faster than in 46 other states with no comparable increase in testing.

APR uses 7- and 14-day rolling averages to smooth out daily variability in reporting. APRโ€˜s daily totals vary from ADPHโ€™s because APR tracks only the daily change to the cumulative case count.

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Both our rolling averages and the averages calculated by the Department of Public Health are higher than they ever have been, meaning that more new cases are being confirmed per day than ever before.

At least 580 people have died from COVID-19 in Alabama. At least 76 deaths have been reported in the last seven days.

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โ€œWe had done a pretty good job of avoiding the surge in cases that concerned us a month ago about overwhelming the hospital,โ€ Saag said. โ€œBut now weโ€™re headed right back to where we were on April 1, and I donโ€™t think thereโ€™s any appetite among the general population nor of our political leaders to do much more about it.โ€

Testing has increased since May 1, more than doubling from 94,406 total tests performed on May 1 to nearly 194,000 by Tuesday evening.

But the number of tests reported per day has remained relatively flat since the beginning of the month at between 3,500 and 4,500 tests per day, based on 7- and 14-day averages, which is still far below the level of testing public health experts say is needed.

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Public health experts who spoke with APR said the increase in new cases is concerning and is not simply the byproduct of increased testing.

โ€œWe know that if weโ€™re testing the right number of people that the percentage of positive tests should be about 5 percent or so,โ€ Saag said. โ€œSo if weโ€™re in an area like a lot of our counties in Alabama, where the percent positive test rate is 20 percent or 13 percent, that means that there are a lot more cases out there for whom there are no tests available. So, if anything, weโ€™re underestimating the caseload.โ€

The percent of tests that are positive, based on 7-day averages of new tests and new cases, was as low as 3 percent on May 1, but has since increased to more than 10 percent.

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Those who say the situation is under control and increased testing is the only cause for the rise in cases are just simply wrong, Saag said.

โ€œThe fact is that theyโ€™re not walking through the hospital like I am, or all the other nurses and doctors are, and seeing the entire ICU just loaded with only COVID patients on ventilators and full units in our hospital that have only COVID patients,โ€ Saag said.

If you test more, youโ€™re going to find more, but only if the virus is still there.

โ€œYou can test until the cows come home,โ€ Saag said. โ€œThe problem is, thereโ€™s a lot of cases here that are undiagnosed.โ€

In addition to looking at the percentage of tests that come back positive, which has been climbing in the last two weeks, hospitalizations also provide are a more timely indicator of how the pandemic is progressing.

Over the last week, the number of COVID-19 positive inpatients at DCH Health System in Tuscaloosa County has doubled from 35 on May 19 to 74 Tuesday. At least 20 of those patients are in intensive care units and 10 are on ventilators.

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โ€œWhen the hospitalization rates increase. Itโ€™s a reflection of the overall cases going up,โ€ Saag said.

Statewide, hospitalization numbers are not yet available for this week, but last week hospitals reported their highest number of COVID-19 hospitalizations since the pandemic began.

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In Jefferson County, hospitalizations are creeping back up after a lull throughout much of April, Jefferson County Health Officer Dr. Mark Wilson said last week. Cases are also rising again in Jefferson County.

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And in Montgomery County, where the mayor and hospitals have reported a shortage of ICU beds, the patient count remains high as the county reports an ongoing, worrisome spike in new cases.

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โ€œWe have places to put people, and we have got plenty of ventilators, but having said that, the intensive care scenario in the hospitals is definitely stretched,โ€ said Dr. David Thrasher, the director of respiratory therapy at Jackson Hospital whose respiratory therapy group works critical care at all of the Montgomery area hospitals.

โ€œThe weekend before, my partner and I rounded around 140 patients. And this morning, we had 145 patients,โ€ Thrasher said. โ€œThat is more than twice our normal volume. Normally, May is a slow month for us. The great majority of what weโ€™re seeing in the hospital is COVID patients.โ€

ICU units at Montgomery area hospitals have been dedicated to treating COVID patients, and those units have been full, and hospitals have been out or nearly out of formal ICU beds, though there are enough ventilators to equip other areas to retrofit as intensive care beds.

โ€œThis weekend, there were just a few ICU beds left, but having said that, there were three emergency rooms I know of that had patients down there that we were treating,โ€ Thrasher said.

Montgomery has seen its case count more than triple since the month began.

โ€œWeโ€™re surging,โ€ Thrasher said. โ€œWe have got a lot more cases than we had a month ago, and a heck of a lot more cases than we did during the first 30 days of this pandemic.โ€

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The increased patient load has put a physical and emotional strain on health care workers and staff, Thrasher said.

โ€œItโ€™s very difficult, very emotionally difficult for the doctors, the nurses, the therapists and of course the patientsโ€™ families,โ€ he said.

Typically, most patients come off a ventilator in a matter of days, depending on what the cause is. Thatโ€™s not the case with COVID-19.

โ€œThese patients, when they go ventilators, itโ€™s a very long time, and the mortality is very poor across the nation for patients once they are on the ventilator,โ€ Thrasher said. โ€œSo itโ€™s emotionally draining โ€” emotionally draining for the staff, the nurses, the respiratory therapists who are in there all day with them. Itโ€™s tough and itโ€™s taken an emotional toll on everybody.โ€

Statewide, the rising case counts also pose an additional concern as people headed out to beaches, pools, parties and other events to celebrate Memorial Day on Monday, potentially exposing thousands of tourists and party-goers to the virus.

โ€œIโ€™m not an alarmist, but Iโ€™m worried,โ€ Saag said. โ€œI look around and over the holiday weekend, I saw large crowds of people, and I could count the number of people wearing a mask on one hand. We could be headed for some really tough times by the first of July.โ€

The rise in cases over the course of this month did not stop people from going to the beach or throwing Memorial Day parties. And Googleโ€™s mobility data, which tracks cell phone locations, has shown a sustained rise in out-of-home travel since the beginning of the month.

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Wearing a mask, staying away from crowds and staying at home when you can is the best way to avoid getting and, more importantly, avoid spreading the virus if you donโ€™t know you have it.

โ€œYou can feel great today, cough and give it to me, and you may not even know you had it for two or three days, when you start to develop symptoms,โ€ Thrasher said. โ€œSo thatโ€™s the big problem we have. We donโ€™t know who hasnโ€™t until after the fact.โ€

Masks offer a limited amount of protection for the person who wears the mask. But masks and face covering are very effective at trapping the respiratory droplets from the person wearing the mask should they cough, sneeze or spit, thereby decreasing the chance of spreading the virus to other people.

โ€œWeโ€™re supposed to love our neighbor, and thatโ€™s one way to do it,โ€ Thrasher said. โ€œSomeone said, โ€˜Well I donโ€™t want to wear the mask because they are hot and makes me look bad.โ€™ Well, if you donโ€™t like wearing a mask, then you wouldnโ€™t like a ventilator at all.โ€

The majority of transmission is in the 24-hour period before someone actually gets physically ill, Saag said, meaning that youโ€™re more likely to spread the virus when you have no symptoms than once you get sick.

โ€œHow do we feel about the parents who send their child to school, knowing that theyโ€™re sick,โ€ Saag said. โ€œWe tend to not appreciate that very much. Well, us going out in public when we may be sick and spreading this virus to other people โ€” whether we want to take the risk for ourselves โ€” is the same situation as sending a child to kindergarten while theyโ€™re sick. Itโ€™s the same concept. Thereโ€™s a responsibility here to other people, to our friends and neighbors.โ€

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Wearing a mask is a critical way to slow the spread of the virus without another lockdown.

โ€œIf everybody did that, maybe we wouldnโ€™t have to stay at home so much,โ€ Saag said. โ€œThe stay at home was a hardcore effort to avoid a catastrophe in the hospitals and elsewhere. So, if we donโ€™t want to do that again, then at least we should be responsible enough to wear a mask in public.โ€

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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