COVID-19 pandemic

A sign posted on the morning of March 17 announcing that the overwhelmed drive-up COVID-19 testing site off Cahaba River Road would close for the rest of the day

The 2020 Coronavirus pandemic was a worldwide pandemic spread by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), a "novel Coronavirus" that was first reported in December 2019 in the city of Wuhan in China's Hubei Province. It quickly spread across the globe, defying efforts at containment. Individuals infected with the virus develop "COVID-19" (COronaVIrus Disease 2019), an illness which attacks pneumocytes, primarily in the lungs, leading to pneumonia, limiting the ability of the body to absorb and distribute oxygen to its cells. In severe cases the body's immune response can overwhelm the lungs or other organs. Though many cases are relatively mild, COVID-19 can linger and present complications, some capable of causing death, especially in older persons or those with compromised immune or respiratory systems.

As reports of the spread of the epidemic to the United States increased, many households began preparing by stocking up on hand sanitizer, disinfectant wipes, dust masks and toilet paper. First-hand accounts of panic buying and media images of empty shelves prompted additional waves of shoppers to descend on stores at the same time that health experts were recommending "social distancing" and regular hand-washing with regular soap and water as the most effective practices to prevent transmission.

In answer to recommendations from public health agencies to slow the spread of infection by limiting social contacts and postponing large-scale events, many public gatherings were canceled, including worship services. Offices asked workers to telecommute and colleges moved instruction to online services. This "social distancing", accompanied with widespread business closures, employee furloughs and lay-offs, was enforced for months, and led to a backlash of calls to "re-open" the economy even while the numbers of newly-confirmed cases were still increasing. Increasingly it was recommended that individuals wear face coverings in public as a way of limiting the risk of transmission. Reactions to these recommendations and mandates became a political issue in the United States with many prominent voices on the right arguing for more re-opening and suggesting that being asked to wear a mask in public was an attack on personal freedom.

As predicted, the relaxation of social distancing requirements and re-opening of businesses; notably of restaurants, bars and amusement parks; resulted in ever larger numbers of new cases, new hospitalizations, and new deaths being reported. That trend became evident in July as the public began focusing on whether schools would re-open in the fall, and whether football games would be played.

Reported cases

An Alabama Bio-Clean employee sanitizes a shower stall at the Vestavia Hills City Jail on April 16, after an inmate showed symptoms consisted with COVID-19. AL.com photograph by Joe Songer.

Likely due to a delayed capacity to carry out diagnostic testing, Alabama was one of the last states to report a confirmed case of COVID-19. Although it is likely the virus had begun spreading in the state beforehand, the first confirmed case in Alabama was reported on March 13, 2020, two days after the World Health Organization declared the outbreak to be a worldwide pandemic. Some county coroners later expressed suspicions that the disease had been responsible for an observed uptick in treatment-resistant pneumonia deaths during the winter, but public health experts see no evidence that the virus was being transmitted that early.

By Sunday March 15 the number of confirmed cases statewide reached 22, with 12 of those in Jefferson County. Two weeks later, there were 830 confirmed cases, of which 246 were in Jefferson County. The Alabama Department of Public Health recorded six deaths from COVID-19 by March 30, although other reports suggested the number was slightly higher.

On April 7, with nearly 2,200 cases reported statewide, the rate of infection appeared to be lower than some epidemiological models had predicted, likely due to the fact that county and local social distancing orders had not been factored in. There were also some suggestions that COVID-19 testing may be less effective in the early stages of infection.

The Department of Public Health reported that of those who had been diagnosed with COVID-19, 315 were health care workers and another 51 were residents of long-term care facilities. 272 cases required hospitalization, with 116 of those in intensive care and 75 on mechanical ventilation. In many cases it was not feasible to determine whether deaths apparently related to respiratory failure were actually caused by the Coronavirus, because of a shortage of testing resources and the impracticality of communicating with family members.

By April 16, the Department of Public Health had reported 4,249 COVID-19 cases across the state, of which 629 affected residents of Jefferson County. On May 6 the numbers of statewide cases had grown to 8,581, of which nearly 2,500 no longer showed symptoms. On June 16 the state's cumulative total of confirmed cases stood at 26,524, with 13,508 apparently having recovered. The state passed 80,000 confirmed cases on July 28, with 32,510 recoveries reported, along with at least 1,446 deaths.

By late June, Jefferson County had emerged as a "hot spot" of new cases, only partly because of the much larger number of tests conducted in the county. UAB Hospital exceeded its April peak of 63 COVID-19 inpatients in late June, when 74 patients receiving care. In July the hospital reported more than 100 inpatients.

The Alabama Department of Public Health set a goal of testing 0.8% of each county's population every two weeks, which would represent just over 2,800 tests per day statewide. By July 15, the state had expanded its COVID-19 test processing capacity to slightly more than 10,000 tests per day, but also saw the proportion of tests coming back positive inch higher, to more than 17%. The surge of community transmission through late July resulted in backlogs at the state's test processing laboratory, meaning that many people waited as much as a week before getting their results. A separate testing program for as many as 200,000 students returning to classes at the University of Alabama System in August was administered with a rapid-turnaround test protocol developed in-house at UAB, adding to the state's overall testing capacity. Those antigen tests became more widely available in institutional and clinical environments, but the procedures for reporting them to ADPH were not universally understood. The state recorded most antigen-test positives separately as "probable" cases, but clarified that they should be considered as positive cases.

Alabama exceeded the threshold of 100,000 reported cases on August 12, surpassing the total number of cases reported in Bolivia (population 11.35 million) or Israel (population 8.85 million). Of the 100,801 reported on that day, at least 1,800 had died. The state estimated that 12,000 of the 100,801 required hospitalization at some point, with 1,300 in intensive care and 700 placed on ventilators. Approximately 38,000 were presumed to have recovered.

In late fall, the state experienced a major "second wave" of COVID cases, with average daily counts of new cases surpassing 3,000 in early December and with more than 1,800 intensive care beds in use.

The first confirmed cases of a more transmissible variant of SARS-CoV-2, dubbed "Variant of Concern 202012/01," were reported in Alabama in January 2021.

Official prevention responses

Initial emergency orders

As part of a declaration of statewide emergency on Friday, March 13, Governor Kay Ivey ordered all public K-12 schools closed beginning on Monday March 16. Jefferson County and the City of Birmingham declared emergencies that Monday. Jefferson County Health Officer Mark Wilson imposed countywide rules restricting visitors to nursing homes, barring on-premises service at restaurants and bars, and closing private schools and pre-schools. His order also made it mandatory to obtain a permit to host an event with more than 25 attendees. His order took effect on Tuesday, March 17.

The order to suspend on-premises food and beverage service was expanded to Blount, Shelby, St Clair, Tuscaloosa, and Walker counties by the Alabama Department of Public Health that day. Governor Kay Ivey expanded that order statewide on March 19, including the closure of all beaches. Jefferson County raised the bar by ordering, "all nonessential businesses and services," (primarily places where people would gather for leisure) to close effective 5:00 PM Friday March 20 and to prohibit gatherings of more than 10 people.

Shelter-in-place

The City of Birmingham passed a "Shelter in Place" ordinance on March 24, establishing a city-wide curfew to encourage people to shelter in their homes and not to linger or congregate in public, with exceptions for essential business. The order, originally scheduled to expire on April 3, was extended to April 30. The council extended the order to May 15, but relaxed the curfew hours to remain in effect only from 10:00 PM to 5:00 AM. The evening curfew was lifted on May 15, though the remainder of the order was extended to May 22 and again to May 29. Some public parks were barricaded to aid in enforcement of the curfew.

On March 26 state officials announced that school buildings would remain closed for the remainder of the spring, with distance-learning replacing classroom instruction. Some systems continued to prepare meals for students' families to pick up. On March 27, with more than 500 confirmed cases in the state, Governor Ivey issued an order closing non-essential businesses statewide until April 17, and limiting non-work gatherings to no more than 10 people. President Trump declared Alabama a "major disaster area" on March 30, opening the way for additional forms of emergency relief.

After two weeks of expressing disinterest, Governor Ivey declared a statewide shelter-in-place order on April 3. The order for individuals to remain at home except when carrying out specific essential activities, took effect at 5:00 PM on Saturday April 4 and was set to remain in force through April 30. Birmingham's shelter-in-place order remained in effect through May 15.

Safer At Home

On May 1 Ivey issued a "Safer At Home" order which allowed most businesses to reopen and recommended the use of face coverings outside the home. Elective medical procedures were allowed to be rescheduled and beaches reopened to small groups. On May 8 state restrictions on gatherings were further relaxed, allowing churches, restaurants, bars, fitness centers, barber shops and salons to reopen with precautions for maintaining distancing and sanitation. An additional round of restrictions, on entertainment and sports venues, and child-care centers, were lifted on May 21.

Mask orders

The City of Birmingham began requiring face coverings in public places on April 28, and continued to renew its ordinance until Jefferson County issued a broader mask order on June 29. Governor Ivey announced a statewide mask order on July 16, which was extended several times through at least December.

Other efforts

The state's stockpiles of medical equipment apparently peaked around 2009, with inadequate funding provided to maintain or replace expired materials. The Alabama Department of Public Health has been able to distribute some notionally-expired personal protective equipment under an "Emergency Use Authorization" from the Federal Emergency Management Agency, but the 80 ventilators stockpiled in 2009 were no longer available for use.

The Alabama State Department of Corrections suspended transfer of inmates from county jails to state prisons on March 20. Prison conditions in the state, already unwholesome, were recognized as particularly unsuited to attempting to contain an epidemic, with inadequate capacity for distancing or protection for inmates or staff. By late July Jefferson County was holding 45 inmates under quarantine and had seen 16 deputies on jail duty test positive. By November 17, the state had recorded a relatively low rate of cases among prisoners, with 410 per 10,000, but among the highest death rates, with 17 per 10,000. Prison staff also suffered, with more than 600 COVID-19 cases reported.

The Alabama Department of Veterans Affairs worked with the Alabama National Guard to establish a "Task Force 31" to clean and disinfect its veterans' homes. Despite the precaution, testing at the first facility to be treated, the Bill Nichols State Veterans Home in Alexander City, revealed that 64 residents and 23 employees had been infected.

On April 28 the Birmingham City Council approved an ordinance requiring all persons more than 2 years old to use of face coverings when outside a personal residence or vehicle, and during any interaction with a person outside of his or her household, subject to specific exceptions beginning May 1.

Efforts to enforce social distancing and other measures in Tuscaloosa were reportedly undermined by groups of college students who organized "COVID-19 parties" aimed at spreading the disease.

The Alabama Department of Public Health entered July with only 150 "contact tracers," responsible for interviewing every person confirmed to have contracted the disease, attempting to determine how they may have been exposed, and notifying anyone who has come into close contact with them to urge them to isolate and get tested. The state expected to hire about 200 more through an outside vendor, but never came close to the more than 5,000 contact tracers estimated as necessary to perform an adequate job.

"Re-Opening"

A sign posted at UAB reminding students that a "clear" GuideSafe passport is required to enter the Commons on the Green dining hall

On April 21 as pressure from President Trump stirred up a number of small-scale "Re-Open" protests at state capitals, and several Republican governors and legislators began calling for businesses to be re-opened, Governor Ivey held a press conference in which she stated that insufficient testing capacity was available to begin planning to lift social distancing orders, and that the current order would remain in place through the end of the month, with the possibility of an extension if conditions did not allow scaling it back.

A week later, Governor Ivey announced a "Safer at Home" order to take effect on May 1 which loosened restrictions on some businesses and elective medical procedures, and re-opened state beaches, with requirements in place for social distancing and protections. The order strongly recommended face coverings in public, but did not make them mandatory. Birmingham's mask ordinance was extended to May 22 and again to May 29, with additional clarifications and an exception for eating. On May 29 the City Council voted unanimously to extend the mask requirement through June 12, with tweaks to the schedule of fines for noncompliance.

On May 8 Ivey announced a further step toward reopening to take effect on May 11 and expire on May 22, allowing gatherings of more than 10 people, including at churches; and allowing restaurants, bars, fitness centers, barber shops and salons to reopen; with precautions to maintain distancing and sanitation.

On May 21, Ivey further relaxed statewide shutdowns, allowing entertainment and sports venues, and child-care centers to reopen with hygiene and distancing procedures in place. That set of guidelines was extended to July 3, and then again to July 31. The revised order also set a June 1 reopening for educational programs and June 15 as the date on which sports competitions could take place. The following day, Jefferson County's Health Department issued revised guidelines which included keeping entertainment and recreation venues closed through June 6.

The University of Alabama Board of Trustees planned to reopen its college campuses for the fall semester. A portion of CARES Act funding was used to provide COVID-19 testing to all students before they reported for classes, and to implement the GuideSafe program for symptom tracking and contact tracing. University-administered re-entry and sentinel tests, analyzed independently from the ADPH laboratory, were included in statewide data reporting. Despite precautions, both Alabama and Auburn experienced large spikes in new cases after opening their campuses.

The statewide policy for reopening public K-12 schools in August 2020 recommended a "balance" of in-person and distance learning, while acknowledging that if a significant number of students have to be quarantined, that new school shutdowns were likely. Some systems opened with an option for in-person instruction in late August, with other using remote learning, at least for the first nine weeks.

Governor Ivey extended the statewide mask mandate several times, with the current extension due to expire on December 11. In early November the U.S. Centers for Disease Control reported that growing evidence supported the effectiveness of wearing cloth face coverings for personal protection as well as to control dispersion of respiratory droplets.

Treatments and research

"Heroes Work Here" message projected onto the Quarterback Tower at UAB Medical Center. Photograph by Joe Songer for Al.com.

Because the SARS-CoV-2 was entirely new, no immunity or specific antidotes were available. Because of the ease of transmission, the first priority in hospitals was to seal off wards where COVID-19 could be treated and to establish protocols for the use of protective equipment by healthcare workers, in the context of local, national and global shortages.

The UAB School of Medicine's Division of Infectious Diseases opened a COVID Respiratory Clinic in the former Regions Bank branch in the Kirklin Clinic Parking Deck at 539 Richard Arrington Jr Boulevard South. The clinic conducted telephone or video consultations with UAB Health patients who have tested positive but are convalescing at home. In-person appointments could be made when warranted to determine if hospital treatment was required, without burdening emergency room capacity.

In early May the Alabama Department of Public Health broadened the criteria for processing COVID-19 tests in its laboratory to better address the need to test front-line healthcare workers and residents of long-term care facilities, whether or not they have symptoms of illness. UAB developed a "COVID-19 Symptom Tracker" which encouraged members of the general public to report any changes in possible symptoms over time, helping the university identify "hot spots" for public health intervention and to conduct research on the early indicators of the disease.

On April 24 UAB began administering antibody tests, primarily to help identifying candidates who could donate convalescent plasma, and as part of larger-scale epidemiological studies. UAB led a national serological study of blood samples for the National Institutes of Health to help shed light on the percentage of Americans who may have been infected with SARS-CoV-2 without knowing it.

Among the treatments for COVID-19 studied in Birmingham were nitric oxide, Firmagon (degarelix), tranexamic acid (TXA), and remdesivir, a drug already under development at the Antiviral Drug Discovery and Development Center under UAB's Richard Whitley.

UAB and Southern Research also conducted vaccine research, including preclinical trials of the "AdCOVID" trial nasal vaccine developed by Altimmune of Gaithersburg, Maryland and "TNX-1800" developed by Tonix Pharmaceuticals. UAB Hospital also enrolled volunteers in a large-scale human trials for a vaccine candidate developed by Oxford University and AstraZeneca.

The first vaccines to apply for FDA approval, those developed by Pfizer and Moderna, became available for the CDC to distribute through state health departments to healthcare providers and other critical populations in December 2020. In early December state health officer Scott Harris announced that the state was set to receive 40,950 doses of the Pfizer vaccine for distribution to frontline health-care workers later that month. The Moderna vaccine, approved on December 18, was made available shortly afterward. By January 22, 224,000 doses had been administered statewide and Alabama was receiving 50,000-60,000 doses per week. The restricted supply slowed the progress of vaccination beyond the initial group. A third vaccine from Johnson & Johnson was expected to become available in February, greatly expanding the rate of immunizations.

Economic relief

Though far from universally adopted, warnings to maintain social distance and self-isolate to slow the rate of infection, soon reinforced by state authority, caused a sudden and drastic decline in revenues for small businesses, non-profit programs, event venues, visitor attractions and transportation services. Low-paid service workers began experiencing job losses almost immediately. Birmingham Mayor Randall Woodfin announced the establishment of a "Birmingham Strong Fund" managed by the Community Foundation of Greater Birmingham to help mitigate the economic damage to small businesses.

On March 17 the Birmingham City Council approved Mayor Randall Woodfin's proposal to apply $15,165,333 from the city's general fund and investments toward protective equipment, supplies and overtime for first responders and city workers, and to plug expected shortfalls in tax collections. The Riverchase Galleria closed its interior public areas on March 23. On March 27 President Trump signed the "CARES Act", approving more than $2.2 trillion in federal stimulus to aid disease-fighting efforts and provide bailouts for businesses and individuals affected by the mass shutdown of economic activities. $1.9 billion in funds from that bill came to Alabama, of which $250 million was earmarked for health care delivery and related services. $115 million was allotted directly to Jefferson County. Another $300 million was used to replenish the state's unemployment insurance trust fund, which had dwindled from $750 million to under $100 million between March and September. $10 million went to the Alabama Department of Tourism to promote travel to the state. $35 million was put into a grant program to benefit medical practices and professionals affected by shutdowns.

Some manufacturers and individual craftspeople across the state began collaborating with healthcare officials to shift production to fill unmet demand for personal protective equipment such as face shields and fabric masks. One group put together a Birmingham Face Masks website and distributed more than 63,000 hand-made fabric masks through Christian Family Services. Red Mountain Makers and others used 3-D printers to manufacture face shields. Cullman textile manufacturer HomTex invested $5 million in shifting production to pleated surgical masks and later won a contract to supply washable masks to the U.S. Capitol.

Emergency room doctor Brandon White organized a program for local restaurateurs to supply hospital staff with meals funded by donors. Several nonprofits, including Meals on Wheels, Greater Birmingham Ministries, and Neighbors for Nutrition, distributed donated meals to people in need. Be A Blessing Birmingham obtained eight temporary handwashing stations from the Atlanta-based nonprofit Love Beyond Walls to place at downtown parks for use by the public, including homeless individuals. Mujtaba and Alinah Syed launched Birmingham Service Industry United to prepare and deliver meals to unemployed service workers. On May 18 a large-scale produce giveaway at Cathedral of the Cross distributed 44,000 pounds of food to more than 2,000 households. The event was made possible through the U.S. Department of Agriculture's "Farmers to Families" program and coordination efforts by Forestwood Farm and LaShunda Scales. Additional distribution events were scheduled that week at Guiding Light Church, Crumly Chapel United Methodist Church, and Living Stones Temple. The Birmingham Police Department's Community Outreach and Public Education Division also conducted two food giveaways at Birmingham Police Headquarters in May.

On May 5 a KC-135R Stratotanker from the 117th Air Refueling Wing performed a fly-over of area medical centers as part of "Operation American Resolve", a national campaign to "show appreciation" to front-line healthcare workers and to "lift morale" during the public health and economic crisis. A pair of C-130 "Hercules" transports from the 908th Airlift Wing at Maxwell Air Force Base in Montgomery performed a similar flyover on May 12. In August digital media company Diversified produced a 67-foot projection on the UAB Quarterback Club Tower lauding healthcare professionals with the message that "Heroes Work Here".

Alabama also distributed $100 million in business relief through a "Revive Alabama" grant program, awarding $15,000 to small businesses on a first come-first serve basis. The City of Birmingham was awarded $6,272,092 in federal grant funding for Emergency Rental Assistance.

See Also: List of businesses that closed during the 2020 Coronavirus pandemic

Casualties and other implications

Some of the Delta airliners grounded at Birmingham-Shuttlesworth International Airport during the pandemic. AL.com photograph by Joe Songer.

Jenny McDonald of Jackson County was the first Alabamian to die from COVID-19 complications, on March 23. By August 17 at least 1,900 deaths had been attributed to the disease statewide.

The Jefferson County Sheriff's Office reported an increase in domestic violence calls from 111 in March 2019 to 141 in March 2020, coinciding with the first school closings, self-quarantines and stay-at-home orders. Delta Airlines used space at Birmingham-Shuttlesworth International Airport to temporarily house about 100 commercial airliners.

The pandemic resulted in the postponement of the 2021 World Games, as well as cancellation of the 2020 Birmingham Barons season, the 2020 Regions Tradition, and the 2020 Magic City Classic. The Southeastern Conference proceeded to play a limited schedule of football games in the fall. The 2020 Iron Bowl saw a modern record low attendance of 19.424, due to social distancing restrictions, and Alabama head coach Nick Saban was not allowed to attend after testing positive and showing symptoms of COVID-19, leaving Offensive Coordinator Steve Sarkisian as interim head coach.

The city's revenues from taxes and license fees dropped significantly due to shutdowns, while expenses for equipment and overtime increased. Mayor Randall Woodfin attempted to make up a large part of the deficit with cuts to personnel and city funding to outside agencies in the 2021 Birmingham budget.

Recovery

Moody's Analytics predicted on April 4 that Alabama's would be among the least-affected economies in the United States, based mostly on the proportion of tourism revenues, with the expectation that manufacturing and exports would resume pace overall by the end of the year.

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• Whites-Koditschek, Sarah (December 4, 2020) "Alabama health officer expects governor to extend mask order, calls current rise in cases “mind-boggling”." The Birmingham News
• Yurkanin, Amy (January 17, 2021) "Alabama crematoriums running ‘around the clock’ as deaths from COVID-19 mount." The Birmingham News
• Cason, Mike (January 22, 20210 "Dr. Scott Harris says Alabama not getting enough COVID-19 vaccine to expand eligibility for shots." The Birmingham News

External links

• Situation Summary at the Centers for Disease Control
• Coronavirus Disease 2019 at Alabama Department of Public Health
• Covid19 Cases by Zip Code Regions at Jefferson County Department of Health
• Live updates at AL.com
• Alabama coronavirus data and mapping dashboard at Alabama Political Reporter
• COVID-19 resources from Birmingham Public Library
• #BhamStrong website
• UAB COVID-19 Symptom Tracker website