February 11, 2023
I am writing to alert you to a significant recent spike in Covid cases in Alabama, particularly in the Birmingham metropolitan area. On December 15, I wrote about a notable increase in reported cases in advance of the holidays. That earlier spike peaked on January 4 and then gradually declined throughout January.
Then, this Thursday, ADPH reported 9,820 new statewide Covid cases for the week of February 8, which is a 34% increase over the prior week. It is the 2nd highest weekly total since early last September and confirms a lot of anecdotal reports I’m hearing of a spike among persons diagnosed with Covid for the first time. It must be frustrating, even alarming, to experience Covid after managing to avoid it for nearly three years.
Before discussing the latest report, I’d like to first put it in context. Below is the average of weekly reported cases in Alabama during the last four months:
October ‘22 = 2,732 cases per week
November ‘22 = 3,423 cases per week
December ‘22 = 7,717 cases per week
January ‘23 = 7,530 cases per week
Now, let’s compare these numbers to the last two winters. Below are the weekly averages for reported cases in Alabama in the months shown:
November ‘20 = 13,844 cases per week
December ‘20 = 27,486 cases per week
January ‘21 = 23,134 cases per week
February ‘21 = 8,364 cases per week
November ‘21 = 2,472 cases per week
December ‘21 = 9,716 cases per week
January ‘22 = 72,945 cases per week
February ‘22 = 16,642 cases per week
March ‘22 = 3,546 cases per week
I believe there are at least three takeaways from the data shown above. First, Covid loves the winter in Alabama; it should be no surprise that our Covid cases are elevated in wintertime. Second, monthly case counts can be extremely volatile, though the arrival of Omicron last winter was perhaps unique. Finally, the winter of 2022-23 - this winter - has seen a significant improvement compared to prior winters.
While I believe the latest ADPH report showing a 34% spike in cases must be taken very seriously, it is no cause for panic. ADPH has given no indication of a data dump so we must assume the report is accurate. The total for the week (9,820 cases) is equal to 29 daily cases per 100K population, which is, by far, the highest per capita rate of any state in the nation. However, our neighboring states of Mississippi, Georgia and Florida actually witnessed a decline in cases during the exact same week. Most importantly, our hospitalization rate remains low.
When you drill down to the county level, the latest report reveals that the spike is confined primarily to the Birmingham metropolitan area. For the week, Jefferson, Shelby and St. Clair Counties were responsible for 47% of the statewide total (4,643 cases combined), more particularly as follows:
Jefferson = 3,075 cases (150% increase vs prior week)
Shelby County = 1,229 cases (134% increase)
St. Clair County 339 cases (88% increase)
To repeat, each day last week, Alabama reported the equivalent of 29 cases for every 100,000 of its residents, which is more than double the national average of 12 daily cases per 100K population. However, Alabama’s infection rate ballooned largely because Shelby County had 83 daily cases per 100K of its residents, Jefferson County had 67 cases per 100K and St. Clair 55 cases per 100K. The source(s) of this localized outbreak may be impossible to identify. And it may disappear just as quickly as it appeared.
If you live in or around Birmingham, given the recent data (particularly if you are immune-deficient or of a certain age), you need to be especially vigilant. You may wish to wear a mask again in confined spaces. However, the best way to protect yourself is to get the bivalent booster shot if you have not already done so. According to a recent CDC study, bivalent boosters demonstrated protection against symptomatic illness from both the BA.5-related variants (52%) and XBB/XBB.1.5-related variants (48%). In another recent study, Israeli researchers found the boosters accounted for high levels of protection (81%) against hospitalization in older adults.
By the way, if you received the bivalent booster this fall and wonder if you should get a second shot, stay tuned. We may get more clarity on that subject during the next ACIP meeting scheduled for February 22.