By Jason Johnson and Dale Liesch
Despite the recent spike in COVID-19 cases, hospitalizations and deaths, local nurses, doctors and first responders on the frontlines remain confident Mobile’s medical and emergency systems are prepared for the projected peak of the outbreak as it draws closer over the next seven days.
“We’re definitely seeing an uptick in cases throughout the hospital already,” Dr. Brian Sumrall of Springhill Medical Center (SMC) said Monday. “It’s impossible to tell whether this is the peak. I pray that it is, but if we’re not there, we’re certainly headed in that direction.”
The “peak” Sumrall referred to is the point at which epidemiologists believe hospitals will be under the most strain from an influx of patients. According to a widely cited pandemic model created by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), Alabama is projected to hit its peak somewhere between April 18 and 22.
As Lagniappe has reported, the IHME model has also shown some significant drops in its projections as new data has been introduced by researchers. Last week, in a little less than 24 hours, IHME showed Alabama’s projected deaths plummeting from more than 5,000 to less than 500. But with regard to when the cases and deaths in Alabama were expected to start climbing, the IHME has been far more consistent.
When asked about the positive shift in projections for the state, Sumrall cautioned against relying on a single model to forecast a pandemic. He also said, regardless of when Mobile’s peak occurs or what it ends up looking like, hospitals will continue to prepare for a “worst-case scenario.”
“It’s like a hurricane. You prep and you prep and pray that it just misses you, or if it does hit you that it’s a Category 1 instead of a Category 4,” Sumrall said. “[Shifts in models] aren’t going to change anything about what we’re doing because we still don’t know what’s going to happen here. I think it would be a bad idea for us to let our guard down just because some numbers somewhere changed. Don’t get me wrong, I’m happy they’re down, but we want to stay prepared. We hope that we’ll be overprepared.”
Fresh off a 10-day run at SMC’s COVID-19 unit, Sumrall said Monday he’d seen a steady increase of patients hospitalized with the disease over the past week. There are at least 25 COVID-19 patients at SMC currently, including 10 who have filled up the first of two dedicated intensive care units. Sumrall said those numbers are likely higher, but there are some hospitalized patients still awaiting test results.
The increase in local COVID-19 patients lines up with increased cases and deaths seen statewide.
As of this publication’s press deadline, the Alabama Department of Public Health (ADPH) was reporting more than 3,800 confirmed COVID-19 cases statewide, 457 hospitalizations and 103 suspected deaths. In Mobile County, the most recent data indicated there were 491 confirmed cases and 17 reported deaths.
While the recent spike in local numbers is jarring, officials from the Mobile County Health Department (MCHD) have also noted the rate of infections among Mobile County residents is lower than in several other counties. Many variables, such as availability of testing and patient populations, can impact this data.
According MCHD epidemiologist Dr. Rendi Murphree, the current rate of infection for Mobile County, which has a population of 413,000, is roughly 110 positive cases for every 100,000 persons. Chambers County only has 212 confirmed cases, but with a population of just over 33,000, its rate of infection — 589 cases for every 100,000 persons — is the highest in Alabama by a significant margin.
Statewide, some of the growth in the number of cases could be due to the growing availability of testing, but the doubling of hospitalizations and deaths over the past week is a strong indicator Alabama’s outbreak is worsening. And with the number of reported deaths nearly doubling over the weekend, Mobile County now has more reported fatalities attributed to COVID-19 than any other county in Alabama.
Sumrall said that is not the kind of data point he likes to hear but said it’s impossible to speculate about why it’s happening at this point. Though he couldn’t speak for other hospitals, he did say SMC is using the same standard of care and treatments being used by clinicians around the United States.
“We’ve actually had the advantage of being a few weeks behind some of these other places that were having to figure it out on the frontline,” Sumrall said. “The most frustrating thing about this disease is that you can cross every T, dot and I and do everything you’re supposed to to the nth degree and some patients will just get sicker no matter what you do. Now, that’s not every patient, though. The vast majority who do contract this will be OK, but for those people who do get very sick, they tend to get very, very sick.”
Tim Crawford, a Mobile Fire-Rescue Department (MFRD) medic, and his partner have a system they use to cut down on time wasted during infectious disease calls. One medic puts on personal protective equipment (PPE) and enters the home of a potential patient before the other one suits up and goes in, he said.
“One of us will suit up and go in and then come back to the door,” Crawford said. “Then you have to hurry up and do it.”
This new system on Rescue 3 was put in place to save the equipment in cases where the initial infectious disease call, or signal 99, turns out to not be as serious. Crawford said that happens more than you’d think because when someone is on a call with dispatch, they can start to get frustrated by all the questions and begin just answering “yes” to everything, causing a false alarm.
“I’ve been on calls that were dispatched as signal 99, but that never transpired,” he said.
The COVID-19 crisis has changed the 42-year-old’s perspective, though. He takes it seriously and admits it makes the job he signed up for tougher.
“It ain’t no fun,” Crawford said. “It’s a great cause for concern.”
To prevent the spread of disease to family and friends, Crawford’s routine hasn’t changed much from what he would normally do. He makes sure to change clothes and shoes before walking in the door. This, of course, comes with one understandable exception.
“You’ve got to get out of those clothes and get a shower,” he said. “Unless I’ve got to cut the grass, I go straight to that.”
While some Mobilians work from home and only leave the house for groceries or activities deemed essential, first responders like Crawford continue to do jobs that put them in harm’s way on a daily basis. These workers are not immune to the human condition and as the number of infectious disease calls increase, it’s understandable these men and women would be apprehensive about them.
As Mobile County nears the peak of infections, MFRD is seeing an explosion in signal 99, or infectious disease, calls. In a recent one-week period, Executive Director of Public Safety James Barber said the department received 39 such calls. To put that in perspective, Barber compared it to another typical month before the crisis started in which the department received only two such calls.
Seth Blitch, a driver on MFRD’s Engine 3, said the pandemic has made him a bit more hesitant when the crew is dispatched to a signal 99 call.
“I’m a lot more vigilant of signs and symptoms now,” he said.
To protect his wife and 4-year-old child, Blitch takes off his clothes and boots in the family’s garage. It’s a similar process to what he’s done for more than eight years with MFRD.
“I jump in the shower to make sure it doesn’t spread anywhere,” he said. “You’re exposed to a lot of things, especially in flu season.”
While the 34-year-old said there’s always “viruses going around,” he admits COVID-19 has him more on edge than normal.
“You kind of want to observe and ask questions before you jump in now,” he said. “We’re so used to just jumping in and intubating a patient.”
Nearly 900 police officers and firefighters were tested for COVID-19 using a rapid serum test designed to detect antibodies in the blood. The presence of antibodies suggests a patient has either started to mount a defense against the virus, or has recently fought it off.
Of the 895 first responders tested for the antibodies, 38 tested positive. Of those 38, four tested positive for the active virus, Barber said. Those who test positive for the virus through a nasal swab have been quarantined. The others have returned to work, Barber said.
Like their counterparts in MFRD, officers with the Mobile Police Department have also changed up what they do on a daily basis in order to deal with the virus. Roderick Cotton, a patrolman in the city’s third precinct said officers now wear masks on certain calls and keep as great a distance as possible.
“We’re not going in houses unless we have to,” he said. “We’re wearing latex gloves and eye protection, especially in hands-on encounters. I try to disinfect my car every day.”
While Cotton, who has been an officer for 15 years, admits danger is inherent in the job functions of a police officer, he pointed out the number of deaths from COVID-19 is greater in Mobile now than the number of homicides.
“The danger still persists,” he said. “This has killed more people than we’ve had killings.”
To protect his family, Cotton said he uses hand sanitizer and, like the firefighters who were previously mentioned, he takes his clothes off “at the front door” before entering the house.
“There’s a danger to it,” Cotton said. “It has changed the perception of how to handle calls and interact with people.”
Health care workers
It’s 2 p.m., 85 degrees and the nurses from University Hospital testing patients for COVID-19 at Ladd-Peebles Stadium have been in plastic hazmat suits, gloves, face masks and face shields for hours.
This type of PPE has been in short supply in some of the areas hardest hit by the disease, and with the peak of cases coming, nurses aren’t running the risk of contaminating or wasting it. That means, at similar testing sites around the city, most stay in full gear throughout their shifts with few if any breaks to use the bathroom or drink water.
Because the majority of people who contract a confirmed case of COVID-19 aren’t hospitalized, those nurses may be the last medical professional they see. Behind the scenes in hospitals, respiratory specialists, ICU and ER nurses and emergency medical specialists take care of the sickest patients.
They also have PPE, but are still at risk because their exposure to COVID-19 patients is prolonged. Across Alabama more than 550 health care workers have contracted COVID-19, though it’s unclear exactly how many have locally.
In the early stages of the outbreak, at least one USA Health employee tested positive for COVID-19; and at least 12 staff members have tested positive at SMC since March. In a press briefing announcing the number of COVID-19 positive employees last week, SMC President Jeff St. Clair told reporters he wanted to be transparent and let the community know “what we’re facing here.”
“Springhill is doing its level best to take care of not only our patients but also our greatest resources, our employees, but nobody is immune. We fully expected that at some point in time we’d have employees who tested positive,” St. Clair said. “Of the dozen who have tested positive, all 12 have recovered at home with the exception of one who was briefly hospitalized and is now fine as well.”
Lagniappe has tried over the last three weeks to reach out to various nurses working on COVID-19 units in Mobile, but most have declined to be interviewed or said they were instructed not to discuss hospital operations with the media. In various social media posts, some local nurses have expressed a concern as the peak approaches, though others have expressed pride and seem excited about stepping up to the challenge.
One thing that’s been a common thread is the continued urge for those who can to stay home and adhere to state and local health orders meant to increase social distancing. Sumrall, of SMC, said he knows people are tired of hearing “wash your hands” and “stay home,” but there’s a reason doctors and nurses keep saying it.
Still, if you ask local hospitals, most believe they’re prepared for the surge of cases coming in Mobile.
Last week, Dr. Bill Admire, chief medical officer at Mobile Infirmary, said an entire floor of its facility in Mobile is dedicated to COVID-19 patients, though he didn’t say how many there were. He did say there is still plenty of additional bed capacity, though, and more patients could easily be taken on.
Admire said the primary goal right now is making sure there is adequate PPE and ventilator capacity.
“We’re still ordering [PPE], and we’ll need more for what we expect to see over the next four weeks, but we have enough now,” Admire said. “As for ventilators, we have more than 100 in our hospital alone, though we’ve continued to send orders for additional devices. So, if they’re needed, we’ll have them.”
Those ventilators are crucial for treating the most severe COVID-19 patients experiencing respiratory failure. Along with PPE, they have been difficult to procure in states like New York and Louisiana, which have been hit with significantly larger outbreaks of COVID-19 than Alabama is projected to see.
Like Mobile Infirmary, Sumrall said SMC’s staff still has access to the PPE they need and he isn’t currently concerned about not having the bed or ventilator capacity to respond to a surge in patients. It’s also worth noting current models suggest Alabama has more ventilators and hospital beds than it will need statewide, though isolated shortages in certain areas are still a possibility.
“Right now, we have the supplies we need. The horror stories you’ve heard coming out of New York and Baton Rouge [Louisiana] have not hit here, and I don’t believe that’s going to be the way it is here,” Sumrall said. “Obviously, we’re being careful with supplies and not being wasteful to make sure we can keep going.”
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