February 27, 2022
The rate of new Covid infections in Alabama is rapidly approaching pre-Omicron levels. The 7-day rolling average of new reported cases has fallen to 896 cases per day, a level last seen on December 22. The positivity rate has dropped to 6.6%, a decline from 10.6% on this day last week. The prevalence of at-home testing probably affects these numbers to some degree, but it is nevertheless encouraging that Alabama’s per capita rate of daily reported cases (18 per 100K population) is now lower than the national average (20 per 100K).
Hospitalizations also have declined, but it is concerning that the rate of decline seems to be slowing. There are now 1,044 statewide patients, according to the U.S. Dept of Health & Human Services. On February 1, total hospitalizations reached an Omicron peak of 3,188 and then declined by approximately 100 patients each day thereafter until February 24, when they reached 1,150 patients. In the ensuing 3 days, they have dropped by just 35 per day. While it is too early to declare that hospitalizations have leveled off, it is something to keep an eye on.
It actually stands to reason that the decline in hospitalizations might be slowing in Alabama. The Omicron variant has proven to evade both vaccine-induced and natural immunities to some extent, but the vaccines have done a good job of preventing severe infection. Given Alabama’s low vaccination rate, I anticipate that hospitalizations may remain problematic even as Omicron infections recede in the State. That could be what we’re starting to see.
The big news on Friday was the change in CDC’s guidance on mask-wearing. The CDC’s new metrics are predominantly based on Covid hospitalizations and hospital capacity instead of daily case counts. In making the change, the CDC adopted the idea that the risk to society should correlate with severe infection, rather than positive tests. While I agree with the premise for the change, the revised guidance may result in an interesting unintended effect in Alabama.
Take Jefferson County, for instance, an urban county with the 4th highest vaccination rate in the State (57%). The home of Birmingham, Jefferson County now has a positivity rate below 5% and a reported case count of about 55 cases per 100K population over the last 7 days. Those numbers are not so bad, but Jefferson County’s hospital data will likely cause it to be considered “high” risk for quite some time - not because Jefferson County’s own population is so much at risk but rather, because its hospitals are bearing so much of the burden for supporting a neglected rural public health system in an extremely unvaccinated state.
There are slightly fewer than 1,700 ICU beds in Alabama and Jefferson County has 526 of them. About one-third of Alabama’s counties - 22 of them - have zero ICU beds. Mobile, Madison and Tuscaloosa are the only counties, besides Jefferson, with more than 100 ICU beds. With the highest percentage of unvaccinated residents, Alabama has had more than its share of severe Covid cases which land people in hospitals. Who do you suppose ends up treating most of those individuals? It’s the hospitals located in Jefferson County and, to some extent, Madison County (home of the City of Huntsville).
Therefore, even though Jefferson County (and Madison County) have higher vaccination rates and lower infection rates than other parts of the State, they will likely be deemed “high risk” areas for longer than those other areas because of their hospital admissions … and indoor masking will remain in place longer than it would otherwise. That’s what happens when hospitalizations supersede daily cases as the primary driver of public policy. The totals:
2/14 - 724
2/15 - 2,136
2/16 - 1,975
2/17 - 2,108
2/18 - 1,440
2/19 - 1,163
2/20 - 484
2/21 - 392
2/22- 639
2/23 - 1,232
2/24 - 1,225
2/25 - 1,157
2/26 - 1,169
2/27 - 358