November 2, 2021 - What's Next?

What's Next?

November 2, 2021

It has been five days since the data dump on October 27-28 and Alabama’s trend line in new daily cases continues to improve. Over the last 5 days, ADPH reported 2,220 new cases, compared to 3,351 cases for the same 5 days last week, a decline of 33.7%. In fact, each of the last 5 days has reflected a drop in cases compared to the same day last week. According to ADPH, Alabama’s positivity rate is now 5%.

Although cases continue to drop, our hospitalization rate may be flattening out. As of today, there are 413 confirmed patients in 102 reporting hospitals (4.1 patients per hospital). On October 27, the date of my last letter, the hospitalization rate was 4.4 patients per hospital. The ultimate lagging indicator - daily deaths - have actually risen since October 27 - from 17 to 29 deaths per day.

During the last week, an average of 15.9K doses per day were administered in Alabama, a 74% increase over the week before. It is unclear to what extent this increase is attributable to booster shots because ADPH doesn’t seem to be recording the distinction. The increased vaccination rate does not include children aged 5-11, whose eligibility is expected to be made final by the CDC later this week. As of now, the CDC’s dashboard reflects that approximately 2,197,549 Alabamians have been fully vaccinated, or about 44.8% of the State’s entire population.

We are now into November. So far, Alabama has avoided the pattern it followed last year of worsening infections as the weather gets colder. The situation in Jefferson, Mobile and Montgomery counties, three of the most populous counties in the State, is particularly encouraging. According to the ADPH dashboard, all three counties now show “Moderate” levels of community transmission - Montgomery (9 daily cases per 100K); Mobile (8 daily cases per 100K); and Jefferson (7 daily cases per 100K). For fully vaccinated people, the “Moderate” designation is significant due to the CDC’s guidance that vaccinated people should wear masks indoors when a county’s transmission level is deemed to be “High” or “Substantial”, but not necessarily when the transmission level is “Low” or “Moderate”.

Which raises this important question: As infection rates decline in the U.S., how will we know when it is safe to lift restrictions? The answer to that question seemed simpler when we thought we could reach herd immunity through vaccination. But, the arrival of the Delta variant and anti-vax resistance, together with discovery of waning immunity requiring boosters, are reminders that we likely must learn to live with the coronavirus forever. What are the appropriate metrics for determining when life can get back to normal in a world where the virus constantly mutates? Should hospitalization rates be the controlling factor? Vaccination rates? If the virus becomes endemic, like the flu, the U.S. could be facing tens of millions of infections every year, some mild or asymptomatic, others severe. Those states with the lowest vaccination rates, like Alabama, are likely to respond with the fewest mitigation measures unless reasonable metrics are put in place.

In all candor, I don’t know the answer to this question but I know it must be asked and answered in the weeks and months ahead. Over 5 million people have died throughout the world, including over 750,000 Americans. We cannot afford to go through this all over again. The totals:

10/20 - 665

10/21 - 1,065

10/22 - 1,598

10/23 - 945

10/24- 414

10/25 - 301

10/26 - 943

10/27 - 7,393

10/28 - 2,141

10/29 - 376

10/30 - 488

10/31 - 394

11/1 - 217

11/2 - 745