Coronavirus cases in Montgomery County have more than doubled since the beginning of May, a trend alarming local officials and landing the county on an internal White House coronavirus report as a "place to watch."
Montgomery began May with 355 coronavirus cases, according to data compiled by the Alabama Department of Public Health. Two weeks later, 753 people had been diagnosed, a number that continued to rise overnight. As of noon oFriday, May 15, 765 people in the county had been diagnosed.
And severe coronavirus cases increased at an even higher rate, according to partial hospitalization numbers released within the county, with a significant number of patients requiring ICU care and mechanical ventilation treatment.
"We aren't in safe territory yet," said Mayor Steven Reed on Thursday. "People have to be reminded that we are not out of this, [though] there is probably COVID-19 fatigue."
Montgomery was cited in the internal White House report, reported by NBC News this week, which denoted Alabama's capital city as a "location to watch," as the area had seen a precipitous increase of cases in a week-to-week increase.
The report cited a more than 100% week-to-week increase in new cases in the Montgomery area. The report was dated May 7, just a day before Gov. Kay Ivey released a new coronavirus order, walking back previous restrictions on things such as dine-in restaurants and hair salons, despite previous comments state officials made about waiting to see a 14-day decline in statewide cases, per White House guidelines.
When asked if he would have relaxed coronavirus restrictions to the level Ivey did on May 8, Reed gave a succinct answer.
"Not yet," Reed said. "... There is still danger that exists. And there is more danger for vulnerable populations, whether that be our seniors or people with underlying health conditions. We're still trying to find a way out of this pandemic. We're not at that point yet. We have to continue what many people were doing about a month ago. People may have loosened up a little bit, but we've got to tighten up our protocols."
Dr. Wick Many, an infectious disease physician in Montgomery who served on the faculty of the UAB School of Medicine Montgomery campus for 32 years, said the current rise in infections likely occurred prior to the loosening of restrictions. Given the long incubation time of COVID-19, it can take weeks for a person infected to fall ill.
But Many conveyed deep concern at the public messaging around the coronavirus in Alabama and Montgomery, calling it "dismaying" to go out in public and see people walking around without masks or disregarding other recommendations from doctors and scientists.
"This was building as the restrictions were being lifted," Many said. "The problem is when the word came that we were relaxing restrictions, people thought we were over it. 'Let's get back to normal,' whatever normal is. Personally, I think the public is not getting the right message. ... The absolute number of critically ill patients is increasing "
Reed acknowledged the economic pain the pandemic has brought on business and individuals, and said he understands the frustrations as a mayor of a city that relies on things like tax revenue in the hospitality sector.
"But we don't want to put the wealth of the community over the health of the community," Reed said. "There is no easy fix for this. It's uncharted waters, and we're still trying to feel our way through. We may be seeing numbers that are taking us to our peak. We're trying to be proactive in managing that so people don't unnecessarily becoming affected and certainly don't die because of a premature return."
Despite restrictions being lifted, Many urged Montgomery-area citizens and all Alabamians to follow the advice of experts and not to downplay the risk of this global pandemic.
"Overnight, there were 23 new deaths in a 24-hour period. 473 deaths in Alabama. That's in a little bit over three months," Many said. "If you had any other infectious disease, if you reported today there were 473 new tuberculosis deaths in Alabama, people would be screaming it from the rooftops. I'm concerned that the message is not being consistently delivered to the general public. This is still a problem, we still have to follow the guidelines."
The Montgomery Advertiser on Friday asked Gov. Kay Ivey if, given spiking numbers in the capital city and a continuing upwards trajectory of case in Alabama, she was still comfortable with her May 8 order re-opening Alabama, if she is reconsidering implementing any additional restrictions or if a certain threshold of new cases would trigger additional restrictions.
In an emailed statement, Ivey acknowledged coronavirus diagnoses and deaths, as well as mentioned the "more than 400,000 people" who have filed for unemployment in recent weeks, "more than the previous two years combined."
“Alabamians are hurting, and I am committed to helping these hundreds of thousands of people and every Alabama family restore their livelihoods. For that reason, we have been taking steps to safely reopen our state’s economy," Ivey said. “Let me be abundantly clear: the threat of COVID-19 remains. Montgomery, Alabama has been identified as a spot to watch as COVID-19 cases rise, and the virus continues to be present across the state. This health crisis is not behind us. I urge Alabamians to stay smart and vigilant as we continue practicing social distancing guidelines to combat this virus. Let us do our part and practice personal responsibility. Alabamians have made sacrifices over the last couple of months, and each of us must continue doing all we can to stay safe and protect our own health, as well as our neighbors’ health. We are in this together, Alabama.”
'Emotionally and physically exhausted'
An increase in cases is to be expected as access to testing, which Alabama was comparatively slow to roll out, continues to increase. But Reed and hospital officials in the Montgomery area are concerned about the increase in hospitalizations and strain it is putting on resources and health care workers already caring for non-coronavirus patients.
According to data from Baptist Health, which operates two Montgomery hospitals and a third nearby in Autauga County, hospitalizations doubled in two Montgomery hospitals between May 1 and May 14. A third Montgomery hospital, Jackson Hospital, has declined to make its data public, though it says it is following mandatory reporting guidelines to state officials.
In Baptist East and South, 32 patients were hospitalized on May 1. By May 14, 68 were hospitalized in the two Montgomery hospitals. Eight were hospitalized in the Prattville hospital.
Of those, nearly 30% were in ICU care and about 26% were on mechanical ventilation.
According to the FY2019 Annual Reports for Hospitals and Related Facilities, Montgomery County hospitals have a 92-bed ICU capacity: 12 at Baptist Medical Center East, 30 at Jackson Hospital and 50 at Baptist Medical Center South.
By comparison, UAB Hospital in Jefferson County, which has 481 more confirmed cases than Montgomery, was caring for 45 coronavirus patients as of May 15.
"The hospitals have the physician and nursing expertise," and aren't yet overwhelmed, Many said. "But they are having to be very mindful of the conservation of [personal protective equipment.] In some circumstances, they're having to come up with novel ways to safely reuse the PPE. They are becoming emotionally and physically exhausted."
As the coronavirus pandemic begin sweeping the country earlier this year, a prevailing fear in the health care community was the availability of critical care space and ventilators, the mechanical treatment that would help severely ill patients breathe while their body fought the illness. Places such as Italy saw the devastating effects of rationing ventilators, an issue later seen in hard-hit New York City.
Many said Montgomery's hospitals are not at that threshold, but health care providers are already having to make hard choices.
"They are having to make some very difficult decisions, decisions I never had to make in 40 years of practicing medicine in the Montgomery area," Many said, pointing to the limited doses of an experimental treatment drug that have recently been distributed to Alabama hospitals. "If they have one dose and two patients left, how do you decide which patient? I have never had to make that decision. It strikes me as being incredibly painful."
And Montgomery physicians aren't just serve county citizens. Montgomery's hospitals are, in some cases, the closest medical institutions for nearby counties. Montgomery abuts Lowndes County, which is currently charting the second highest per capita infection rate in the state at nearly 120 infections per 10,000 people.
Lowndes has only been outpaced by Butler County, its southwest neighbor, which currently sits at 128 infections per 100,000. Butler's 59-bed medical center only has capacity for seven ICU beds, according to the most recent state data, while Lowndes has no hospital at all.
"The smaller community hospitals look to Montgomery, particularly the more complex hospitals such as Baptist South, because of their size and lack of pulmonary physicians," Many said. "Physicians will refer their patients of Montgomery."
Local restrictions
Though Reed said Alabama and the Montgomery area have more resources available to fight coronavirus than in previous months, he would like to see increased testing made available to potential asymptomatic carriers who may be unknowingly spreading the virus, in addition to additional "contact tracing," which tracks and identifies the spread of infections to find emerging hot spots or areas of concern.
"Any way you look at it, the numbers aren't favorable to us," Reed said Thursday. "They aren't where I'd like us to be as the governor eases restrictions in Alabama. I think there is more we have to do before we're fully ready to open up."
Reed said he and other city officials have discussed possible restrictions they could take at a city level if numbers continue to increase. Montgomery currently remains under a state of emergency order and is still implementing a nightly curfew. When asked if he would consider a face mask requirement, as Birmingham has implemented, Reed said the city was studying plans other cities have implemented to see what might work for Montgomery, practically and legally.
"We're trying to let people know that in this community that we aren't at a point where we can let our guard down," Reed said.
Many urges Alabamians to continue to stay at home and social distance unless absolutely necessary.
"The challenge in our part of Alabama is a lot of folks cannot work from home. If you work in a plant, for example, you can't work from home," Many said. "But if you don't have to get out, if you don't have to go out for something, don't. Stay home, it's safe there. There will be time in the future to go and party, to go to a dinner in a nice restaurant, to have a wedding reception. There will be time for that in the future. Now is not the time. You stay home unless you absolutely have to get out."
If you must leave the house, Many pointed to the recommended guidelines of handwashing, social distancing and face masks that he says everyone should follow to help slow the spread of infections.
"Montgomery is fortunate in that we do have some highly professional, dedicated health care workers, physicians, nurses, respiratory therapists, who are putting their own personal safety at risk to serve their community," Many said. "Any time you have a chance to say thank you, say thank you. And since they're putting themselves at personal risk, we have an obligation to do these things. If you're not going to do it for yourself, do it for those health care professionals who are putting their safety at risk."
Contact Montgomery Advertiser reporter Melissa Brown at 334-240-0132 or mabrown@gannett.com.
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