December 1, 2020 - Deciding Who Goes First

Deciding Who Goes First

December 1, 2020

Alabama’s daily case count - 3,376 (incl 1,362 probables) - appears shocking at first, but it is important to place it in context. On each of the last 7 days, except for Friday after Thanksgiving, new cases were reportedly between 2,100 and 2,800. But, there were just 917 cases last Friday, so a portion of today’s cases likely resulted from positive diagnoses made on Friday that were not reported until today. ADPH hinted to that when it noted, “Today’s increase represents a delay in reporting to ADPH due to the holiday weekend.”

Even so, the worsening trendline continues. With 9,495 tests, the single-day positivity rate now stands at 35.5%, while the current 7-day moving averages of new cases (2,291 per day) and positivity rate (30.3%) reached highs not previously seen in the pandemic. In addition, there were 60 deaths reported, the second highest reported total for a single day.

Rising hospitalizations also remain a primary concern. There were 1,785 statewide in-patients at 107 reporting hospitals, an increase of 68 patients from yesterday. With 15 more COVID patients, the Huntsville Hospital system reported 317 patients overall, more than ever before. Alabama’s statewide hospitalizations have increased 25% since last week, as per capita tests have declined by 25% over the same period. 

More troubling is that 85% of Alabama’s ICU beds are now occupied, according to HHS. We are now tied with Tennessee for the 4th highest utilization rate in the country, behind only North Dakota, Rhode Island and New Mexico. Diminishing ICU capacity, combined with overworked staff, led the Alabama Hospital Association’s director to confess, “I’ve frankly never been as worried about the integrity of our healthcare system as I am now”.

Meanwhile, a key federal advisory panel met this afternoon and recommended that the earliest vaccines be given to an estimated 21 million healthcare workers and 3 million residents and staff of nursing homes and other long-term care facilities. These groups were prioritized because they account for nearly 40% of recorded deaths from COVID-19. If approved by CDC Director Redfield, these recommendations will become the official federal guidance given to the states, which they are not required to follow, but most are expected to do so.

The advisory panel must meet again to decide who should be next in line. Several members hinted last week it would recommend prioritizing 87 million essential workers who are employed in food and agriculture, manufacturing, law enforcement, education, transportation, corrections, emergency response and other sectors. Those workers are at increased risk of exposure to the virus because their jobs preclude them from working from home. After essential workers, the priority groups likely to be recommended by the panel are adults with high risk medical conditions and people over 65. The 14-day totals:

11/18 - 2638

11/19 - 2424

11/20 - 2463

11/21 - 2335

11/22 - 1798

11/23 - 1574

11/24 - 2785

11/25-  2453

11/26 - 2639

11/27 -  917

11/28 - 2119

11/29 - 2236

11/30 - 2295

12/1  -  3376

Alabama has 67 counties and 61 of them now have 14-day positivity rates over 20%; 36 are over 30%; 9 are over 40%; and 1 county (Lamar) stands at 56.3%. North Alabama continues to see the worst outbreak. Of 22 counties located north of Birmingham, all but Madison County (home of Huntsville) reported 14-day positivity rates over 30%.