September 1, 2021 - Dealing with the Consequences

Dealing with the Consequences

September 1, 2021

As relentless as Sherman’s march to the sea, the Delta variant continues to cut a wide swath through the Deep South. In descending order, the U.S. states with the highest per capita infection rates over the last 7 days are: Tennessee (103 per 100K population); South Carolina (100 per 100K); Alabama (99 per 100K); Florida (97 per 100K); Kentucky (94 per 100K); Mississippi (94 per 100K); Louisiana (92 per 100K); and Georgia (89 per 100K). Notably, Arkansas and Missouri, once Ground Zero for the Delta variant, have dropped to 68 per 100K and 37 per 100K, respectively.

On May 11, I wrote a piece called, “The India Variant”, referring to B.1.617 (a/k/a the Delta variant), which was dominating south Asia and rapidly spreading to the U.K. and Singapore. By June 9 (See, “The Delta Variant - A Deadly New Threat”), Alabama averaged just 321 new cases per day and 2 patients per hospital, but many counties had vaccinated fewer than 18% of their residents and daily shots had dropped to 2,800 per day statewide. Although Delta was responsible for only 6% of total U.S. cases at that time, experts were already warning that the variant posed a mortal threat to unvaccinated individuals.

Today, as the calendar turns to September, ADPH reported 4,691 new cases, following 5,206 more new cases yesterday. Alabama’s 7-day moving average is now 4,660 cases per day, 10% higher than the peak last winter. Alabama also has the 2nd highest per capita hospitalization rate in the nation (behind only Florida) and the highest per capita rate of ICU beds in use. According to the Alabama Hospital Association, the State ended August with 2,873 Covid hospital patients, including 55 children, and over 88% of the patients were unvaccinated. There are 88 more patients needing ICU care than there are ICU beds to care for them.

It is encouraging, however, to see vaccinations starting to pick up. In the last week, an average of 24.7K doses per day were administered in Alabama, a 28% increase compared to the prior week. Alabama has now administered one dose to 58.3% of the eligible age 12 and older population, and 49.8% of the State’s entire population (which percentage now leads 7 other states, including neighboring TN, LA & MS). We are no longer last in the nation in the percentage of fully vaccinated residents - at least 38.3% of our population is fully vaccinated, ahead of Mississippi (37.7%).

With the beginning of school, masks remain a hot-button topic, which is why I found it interesting to compare the early Covid experiences of 2 suburban Birmingham school systems - Mountain Brook and Vestavia Hills. According to niche.com, the Vestavia school system has 7,137 students in grades PK-12 and around 446 teachers. Mountain Brook’s system has 4,367 students in grades PK-12 and about 336 teachers (i.e. MB has 61% as many students and 75% as many teachers as VH). Mountain Brook adopted a mask requirement for all students, teachers & staff, but Vestavia did not.

During the week of August 10-16, 57 Vestavia students tested positive and missed at least one day of school. That number increased to 104 students the following week, and then rose to 142 students the week after that (the week ending August 27). Meanwhile, the number of positive Covid cases among MB students dropped from 78 cases (for the week ending August 20) to 48 cases the following week. In other words, after 3 weeks of school, Mountain Brook has one-third as many infected students as Vestavia and its rate is falling, while Vestavia’s rate is going in the opposite direction.

After 93 Vestavia students tested positive last Friday alone, the Vestavia school board reversed its policy and is requiring masks, effective today. Vestavia is a highly educated community with many doctors & nurses - indeed, researchers, pediatricians and infectious disease experts at Children’s Hospital of Alabama and UAB, as well as clinical psychologists who work with adolescents, were among the parents who addressed the school board, asking for masks to be worn in school. Their pleas fell on deaf ears until the schools’ infection rate quickly spun out of control.

The demise of trust in experts and institutions in some communities is difficult to understand … and even harder to accept. The notion that someone would choose to ingest a deworming medication commonly used on horses, but not vaccines approved by experts around the world - and administered 5.33 billion times throughout the world - is truly impossible to fathom.

In the final analysis, when there are not enough ICU beds for everyone, talking heads on television will never be held to account. It is doctors and nurses who must deal with the consequences. As the CEO of Decatur Morgan Hospital put it, “We are at the point now where we’re overwhelmed. We’re not at the point yet where we pick who lives and who dies, but I believe we’re not too far away from that as a state.” The totals:

8/20 - 5,526

8/21 - 3,305

8/22 - 3,315

8/23 - 2,588

8/24 - 3,701

8/25 - 4,086

8/26 - 4,998

8/27 - 6,207

8/28 - 5,016

8/29 - 3,433

8/30 - 3,072

8/31 - 5,206

9/1 - 4,691