Like others across the country, public officials in coastal Alabama are still scurrying to round up the supplies and equipment needed to safely triage, test and effectively treat patients with COVID-19.
The push for great testing comes as Alabama’s confirmed cases of COVID-19 have grown — at last count there were 215 statewide. However, the numbers in Mobile and Baldwin counties have lagged behind. As of this publication’s deadline, there were five confirmed cases in Mobile and two in Baldwin County.
State Health Officer Scott Harris recently said Mobile has “all of the factors that would make it a suspect for a greater number of cases,” including its population size and density, as well as its international seaport and proximity to neighboring states that have higher rates of infection currently.
The only Alabama county with a larger population, Jefferson County, has 96 confirmed cases and officials there have implemented the state’s most strict public restrictions. Mobile County has now been identified by the Alabama Department of Public Health (ADPH) as the area with the greatest need for additional screening.
But despite that, getting COVID-19 tests in this area has been difficult for a number of public agencies including the Mobile County Health Department (MCHD), Mobile County Commission and the city of Mobile, as private companies race to meet the demand for testing in states competing for limited supplies.
“We’re in the middle of a supply and demand crisis,” Mobile Mayor Sandy Stimpson said.
‘At the mercy of their suppliers’
Testing for COVID-19 in the U.S. has been marred with problems from the top down.
In the early stages, all tests were conducted by the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. When test kits were eventually sent out to health officials across the country, there were problems with one of the reagents, and many larger cities did not receive enough kits for weeks.
When President Donald Trump declared a national state of emergency on March 13, it was estimated only around 10,000 Americans had been tested for COVID-19. South Korea had already conducted more than 200,000 tests and Canada had tested nearly 40,000, according to the COVID Tracking Project.
Since then, the rate of tests conducted in the U.S. has increased significantly — more than 303,000 at last count. That is primarily due to the Trump administration removing federal barriers and allowing private companies to produce COVID-19 test kits and private labs to analyze the specimens collected.
But with the number of COVID-19 cases growing in all 50 states, the availability of tests and labs to analyze those tests is still catching up to the demand. Local health officials have also maintained that many of the tests they’ve requested through the Federal Emergency Management Agency’s (FEMA) Strategic National Stockpile have been directed to areas other than Alabama by the federal government.
On Monday, Harris said the lack of testing capacity “continues to be a concern for [Alabama].”
“The specimen collection kits, swabs and tubes used [for testing] are being sought by every state in the country, and we’ve been told we’re essentially on our own in terms of finding this equipment. Everyone is competing with each other,” Harris said. “The lack of screening materials has been the limiting step in terms of setting up the screening sites around the state.”
Currently, ADPH has established 17 testing sites around the state and hopes to have at least 25 ready to operate by next week. However, those sites still can’t test people if they don’t have the materials, which is a problem local agencies trying to set up testing sites in the Mobile area have run into as well.
Last week, Stimpson — seemingly frustrated with MCHD struggles to secure a significant number of COVID-19 tests — began publicly discussing efforts the city and Mobile County were making to bring test kits to Mobile through a private manufacturer.
The city has already set up two testing sites in Mobile so far: one at Ladd-Peebles Stadium and the other at The Grounds off Zeigler Boulevard. Stimpson has also announced a deal with Mobile-based Synergy Laboratories to produce tests for those sites. Previously, he said it’s possible as many as 10,000 tests could be ready to be administered by April 1, but he’s recently tempered expectations.
In a press conference this week, Stimpson noted Synergy Laboratories can only put together test kits if it’s able to secure the materials needed to make them. Ultimately, it’s facing the same shortage in supplies needed to create the test kits other labs are dealing with across the country.
“They are trying to find suppliers for whatever they need. They’re at the mercy of suppliers,” Stimpson said. “Almost all of those suppliers are in foreign countries and many are in places like Italy and China.”
Mobile County Commission President Jerry Carl has taken point on setting up possible testing sites outside of the city and told Lagniappe roughly 15 locations had been identified as of Monday. It’s unclear at this time whether the test kits produced by Synergy will be used at those locations as well.
Mobile County Health Officer Bert Eichold, who has also been working to secure mass testing equipment through the state and federal government, said this week that tests should still be reserved for those with symptoms of COVID-19 — not just offered to anyone worried they might have been exposed to it.
“What I’m concerned about is if people are leaving the shelter of their home, and going to be engaged with other members of the community for the purpose of being tested may put them at greater risk than if they just stay at home,” Eichold said. “If you don’t have fevers, chills or are sick, then testing you right now is not going to really help.”
Stimpson has said a hierarchy of needs will determine who receives tests at the city’s testing sites, at least initially. The city plans to prioritize healthcare workers first, followed by first responders and then the elderly and immunocompromised — especially those in nursing homes and assisted living facilities.
According to Stimpson, testing at city sites will likely be based on referrals from area hospitals, private clinics or MCHD to help them manage the flow of patients being tested for COVID-19. In other areas, early mass-testing sites have been swamped and some even tested more than their labs could process.
“We will not be in control of the test itself,” Stimpson said. “We’ll provide the hardware, the refrigeration, bathrooms and crowd control mechanisms, but if we’re working with hospitals, we anticipate them having a nurse practitioner, a nurse or some of their employees there to actually take samples.”
Until this point, COVID-19 tests performed in Mobile and Baldwin counties have been conducted by private hospitals and clinicians on a case-by-case basis. Doctors have been reserving tests for patients at the greatest risk of complications from COVID-19 like those with respiratory problems, diabetes and the elderly as well as those already exhibiting symptoms like fever, dry cough and shortness of breath.
Those criteria have been relaxed somewhat as capacity has increased, but patients are still being screened.
Infirmary Health System had a soft rollout of “appointment only” testing sites in Mobile and Baldwin counties this week, and a Springhill Medical Center spokesperson told Lagniappe the hospital had performed at least 40 tests as of March 20. Two of those came back negative; the others are pending.
Greater Mobile Urgent Care launched a drive-thru testing site at its West Mobile location Monday and the owners told local reporters around 200 patients were tested the first day. The Franklin Primary Health Center in Mobile also began testing existing patients by appointment only on Monday.
Pre-screening is required for testing appointments at all of the locations mentioned above. ADPH has also launched a call center for those who think they may be infected with COVID-19, which can be reached toll free at 888-264-2256. Updated information on local testing sites is available at lagniappemobile.com.
Flattening the curve
One of the things early and adequate testing is supposed to do during a pandemic is show public health officials where the largest outbreaks are so they can deploy limited resources where they’re most needed. It can also help spare areas with low rates of infection from strict restrictions like the “shelter in place” orders in some states already.
Since last week, Alabama has banned “all gatherings of 25 persons or more, or gatherings of any size that cannot maintain a consistent six-foot distance between persons,” ordered bars and breweries to close completely and limited restaurants throughout Alabama to carry-out or curbside service only.
Jefferson County is the only area that has taken any further action, after public health officials there ordered all non-essential and retail stores to close earlier this week. It’s one of only two counties where a health officer has the authority to order such a shutdown outside of ADPH. The other is Mobile County.
Some states have ordered all citizens to remain in their homes and closed all non-essential businesses. That type of “shutdown” hasn’t been formally proposed in Alabama, and Stimpson has said he and mayors from other large cities like Birmingham, Montgomery and Huntsville are in favor of keeping it that way.
“We need to keep our cities open. We can’t let this health crisis become an economic crisis more than what it already is. There is a balance,” Stimpson said Monday. “There is almost no one who is not taking this seriously except for a few small groups, and every company is implementing some type of change in procedure in order to protect their employers.”
Still, Stimpson said he would support Gov. Kay Ivey if she issued stricter public health measures statewide. Speaking to reporters this week, Harris said ADPH has not recommended any kind of “stay at home” order and said that decision would be made in consultation with Ivey and other state leaders.
He also said mandatory health orders are not something ADPH takes lightly and he realizes they have an impact on the economy and, more importantly, on the lives and livelihoods of thousands of Alabamians.
“We spend time agonizing over these orders before they’re issued, and time will tell if we overreacted or didn’t act soon enough or maybe even got it right,” Harris said. “I think it’s clear from what’s happening in other parts of the world that this has a dramatic impact on economies, and what we hope to do is break the transmission cycle and get this over with as quickly as possible.”
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