January 8, 2022
On January 14, 2021, the United States recorded 142,273 Covid-related hospitalizations, a record that has stood for a full year, through the rise and fall of the Delta variant and the rise of the Omicron variant. Today, the U.S. has 138,073 hospitalizations, the highest number since that day last January, and just 3% below the record.
In contrast, Alabama’s record high for hospitalizations is 3,355, set on January 4, 2021. Since then, the closest we have come to that high point was on August 30, 2021, at the worst of the Delta crisis, when Alabama hospitals treated 3,116 patients. Although Covid hospitalizations in Alabama are rapidly rising again - 1,744 today - they remain well below both earlier peaks. What accounts for the difference?
The best explanation is that Omicron arrived in the U.S. just as Delta was spiking in the Northeast and Upper Midwest, causing hospitals there to quickly reach crisis levels. Alabama had the luxury of confronting the Omicron surge from a position of relative strength, when Covid hospitalizations were comparatively low (only 410 on Thanksgiving Day, for instance). When Alabama hospitals hit their peaks last January and August, they frequently reported I.C.U. occupancy rates in excess of 100%, but surely that can’t be true today, right?
Wrong. I was startled to read Ramsey Archibald’s interview yesterday of Don Williamson, CEO of Alabama Hospital Association in al.com. Williamson reported that hospitals in the Montgomery-Opelika region are already out of ICU beds - 12 more people there need critical care than there are staffed beds to put them. In the Birmingham area, only 28 of 514 ICU beds are currently available. “The real challenge is staffing,” Williamson said. “We’ve got hospitals with over 500 staff out with Covid... And it’s not just nurses, it’s not just people in nutrition, it’s not just people who admit people, it’s all of them.”
Nationwide, Omicron has shown that it typically spreads from urban to rural areas. And hospitals across the country are filled with unvaccinated patients who are 17 times more likely to be admitted and 20 times more likely to die than boosted individuals, according to CDC data. If these patterns hold in Alabama, that spells big trouble because rural Alabama is far less vaccinated than urban Alabama. Compared to 55% vaccinated residents in the Birmingham area, and 51% in Montgomery, nearly half the counties in Alabama - all rural - have vaccination rates below 40%.
So, when will this Omicron surge finally peak and burn out? That is the question Covid forecasters are attempting to answer, including UAB’s Dr. Russell Griffin. Dr. Griffin’s estimate, based on computer models, is that daily case counts in Alabama are actually peaking this week and that hospitalizations will peak around January 23.
As for cases, Dr. Griffin’s projection might be supported by the data. Daily reported cases have hit a 3-day plateau, followed by a decline today: 1/5 - 12,075; 1/6 - 12,626; 1/7 -12,972; and 1/8 - 8,332. While daily case counts are increasingly unreliable due to inadequate testing, the reported test positivity rates this week have exhibited the same pattern: 1/5 - 41%; 1/6 - 42.3%; 1/7 - 43.6%; and 1/8 - 42.3%.
Cases may be cresting this week, as Dr Griffin projected, but I would have more confidence in his forecast for hospitalizations and deaths if I knew his computer model accounts for the limitations resulting from hospital staff shortages. If, as Dr. Williamson stated, Montgomery’s hospitals and ICU’s are already full, and Birmingham’s are nearly full, that is a sign of profound and worsening capacity limitations. In the last two waves, Alabama hospitals treated more patients than they are capable of serving today - in some cases, maybe twice as many. When rural unvaccinated Alabama gets slammed by Omicron, as it surely will in the coming days, the result will be unprecedented. The totals:
12/25 - 2,449
12/26 - 863
12/27 - 1,679
12/28 - 3,705
12/29 - 5,975
12/30 - 8,526
12/31 - 8,051
1/1 - 7,577
1/2 - 5,400
1/3 - 4,014
1/4 - 7,572
1/5 - 12,075
1/6 - 12,626
1/7 - 12,972
1/8 - 8,332