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 2019 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.

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.

UAB Hospital exceeded its April peak of 63 COVID-19 inpatients in late June, when 74 patients receiving care.

Official prevention responses

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.

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.

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. 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.

"Re-Opening"

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.

Treatments and research

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.

One of the drugs used on a trial basis for the treatment of COVID-19 patients was remdesivir, a drug under development at the Antiviral Drug Discovery and Development Center under UAB's Richard Whitley. During the 2020 pandemic, UAB Hospital participated in a clinical trials with remdesivir, as well as a separate clinical trial of the use of nitric oxide in ventilators for those whose lung function was severely compromised. Nitric oxide had earlier shown some promise with SARS patients. Cardiologists Pankaj Arora and Vibhu Parcha led that study.

UAB also 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. Mohanraj Thirumalai led the development of the tool with assistance from citizen-science advocate Sarah Parcak and health informatics specialist Sue Feldman, along with several university departments and research centers.

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.

On April 24 UAB began administering antibody tests, blood tests which can determine if an individual has been exposed to SARS-CoV-2. The antibody test can not determine if an infection is active or if the individual is immune to re-infection. The major use of the test was expected to be in identifying candidates who could donate convalescent plasma, and as part of larger-scale epidemiological studies. That clinical study, in collaboration with Johns Hopkins University and the Mayo Clinic, was led at UAB by Sonya Heath.

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.

The Hugh Kaul Precision Medicine Institute at UAB contributed to development of trials at VA Medical Centers in West Los Angeles and elsewhere to measure the effectiveness in male patients of the androgen deprivation drug Firmagon (degarelix), which may suppress production of a certain protein in the lungs that COVID-19 utilizes.

Robert Kennedy of UAB's Center for Clinical and Translational Science, Eric Ford of the UAB School of Public Health, and Jennifer Croker of the UAB School of Medicine 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.

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.

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.

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 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.

Other implications

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

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 cancellation of the 2020 Minor League Baseball season, including the 2020 Birmingham Barons season.

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.

References

• West, Ty (March 15, 2020) "Birmingham Strong Fund launched to help small businesses impacted by coronavirus." Birmingham Business Journal
• Yurkanin, Amy (March 16, 2020) "No dining in bars or restaurants in Birmingham area for one week, county health officer orders." The Birmingham News
• Koplowitz, Howard (March 17, 2020) "As coronavirus fears close Birmingham area restaurants, workers face hard times." The Birmingham News
• Robinson, Carol (March 17, 2020) "Birmingham coronavirus testing site shut down as US 280 traffic snarls" The Birmingham News
• "Mayor Woodfin’s $15 million COVID-19 Response Plan Approved by the Birmingham City Council." (March 17, 2020) birminghamal.gov press release
• Pierre, Janae (March 17, 2020) "Alabama COVID-19 Testing Rife with Delays and Uncertainty" WBHM - via BirminghamWatch
• Fiscus, Kirsten (March 19, 2020) "Gov. Ivey shuts down restaurant dine-in services, day cares and closes Alabama's beaches." Montgomery Advertiser
• Quinn, Stephen (March 24, 2020) "UAB hospital reports 18 patients on ventilators, overwhelming evidence of community spread." ABC3340.com
• Hrynkiw, Ivana (March 25, 2020) "Birmingham hospitals now facing first wave of coronavirus patients, 57 being treated, 18 on ventilator." The Birmingham News
• Thornton, William (March 27, 2020) "‘A call to action’: Alabama companies stepping up to fill pandemic hospital needs." The Birmingham News
• Gore, Leada (March 27, 2020) "All ‘non-essential businesses’ closed statewide until April 17; Ivey doesn’t issue shelter-in-place." The Birmingham News
• Whites-Koditschek, Sarah (March 30, 2020) "UAB doctor helps feed hospital workers with BHMcares." The Birmingham News
• Brownlee, Chip (March 30, 2020) "Over the last week, COVID-19 cases in Alabama increased faster than 40 other states." Alabama Political Reporter
• Dunigan, Jonece Starr (March 31, 2020) "Birmingham’s homeless get hand washing stations to help fight pandemic." The Birmingham News
• Wright, Erica (April 2, 2020) "Mark E. Wilson, Jefferson County’s Top Doc, On Reducing The Coronavirus." The Birmingham Times
• Beahm, Anna (April 3, 2020) "Birmingham extends coronavirus shelter in place to April 30." The Birmingham News
• Sheets, Connor (April 5, 2020) "Alabama prison system’s COVID-19 plan anticipates widespread infection, deaths, National Guard intervention." The Birmingham News
• Beahm, Anna (April 5, 2020) "Coronavirus stalls Birmingham’s rebound, cripples small businesses." The Birmingham News
• Brownlee, Chip (April 6, 2020) "Behind the model that projected 5,500 deaths in Alabama — and why it changed" Alabama Political Reporter
• Thornton, William (April 6, 2020) "Alabama economy could be among least affected by coronavirus: Moody’s." The Birmingham News
• Gore, Leada (April 7, 2020) "Alabama’s coronavirus stats: 61% deaths in Alabama are age 65 plus; 315 healthcare workers diagnosed" The Birmingham News
• Whites-Koditschek, Sarah (April 8, 2020) "Coronavirus deaths may be undercounted in Alabama, doctors say." The Birmingham News
• Sheets, Connor (April 8, 2020) "Alabama had a ventilator and PPE stockpile, but it was depleted before COVID-19 hit." The Birmingham News
• Pillion, Dennis (April 8, 2020) "UAB testing new coronavirus treatment on its sickest patients." The Birmingham News
• Whites-Koditschek, Sarah (April 11, 2020) "Some Alabama coroners think coronavirus claimed lives earlier this winter, others do not." The Birmingham News
• Yurkanin, Amy (April 13, 2020) "Early, but promising results for coronavirus drug developed at UAB." The Birmingham News
• Robinson, Carol (April 14, 2020) "Domestic violence calls jump amid COVID-19 stay-at-home order, Jefferson County sheriff says." The Birmingham News
• Gore, Leada (April 16, 2020) "4,249 coronavirus cases in Alabama: Leading underlying medical conditions among COVID-19 deaths." The Birmingham News
• Koplowitz, Howard (April 17, 2020) "Alabama creates new National Guard unit to prevent coronavirus in state-run veterans homes." The Birmingham News
• Gore, Leada (April 18, 2020) "Number of coronavirus cases in Alabama dropped since yesterday: Here’s why." The Birmingham News
• "Alabama's shelter-in-place order to remain in place through at least April 30." (April 21, 2020) Birmingham Business Journal
• Patchen, Tyler (April 21, 2020) "UAB opens new clinic focused on COVID-19." Birmingham Business Journal
• Gore, Leada (April 21, 2020) "Alabama coronavirus test numbers are shrouded in mystery." The Birmingham News
• Koplowitz, Howard (April 23, 2020) "64 veterans, 23 staff at state-run home test positive for COVID-19 as testing ramps up." The Birmingham News
• Beahm, Anna (April 28, 2020) "Birmingham makes it law: Masks required in public." The Birmingham News
• Gore, Leada (April 29, 2020) "Alabama’s new coronavirus order: What’s open, what’s closed? Beaches, restaurants, salons and more." The Birmingham News
• Windsor, Matt (April 29, 2020) "Coronavirus antibody testing now is available at UAB. Here’s what that means — and what it doesn’t" UAB Reporter
• Beahm, Anna (April 30, 2020) "Birmingham shelter in place now in effect 10 p.m. to 5 a.m." The Birmingham News
• Edwards, Levi (May 3, 2020) "Air Force plans flyovers at Alabama hospitals for those "at the front line battling COVID-19”." The Birmingham News
• Gore, Leada (May 5, 2020) "Almost 2,500 of Alabama’s coronavirus cases no longer show symptoms, officials say." The Birmingham News
• Logan, Michelle (May 6, 2020) "‘Birmingham Service Industry United’ delivering gourmet meals to laid-off workers." CBS42.com
• Gore, Leada (May 7, 2020) "ADPH expands criteria for coronavirus testing." The Birmingham News
• Yurkanin, Amy (May 8, 2020) "Health officer in Birmingham recommends two more weeks without large gatherings for Jefferson County." The Birmingham News
• Whites-Koditschek, Sarah (May 10, 2020) "Outbreak taking toll on African-Americans in Alabama." The Birmingham News
• Dunigan, Jonece Starr (May 12, 2020) "UAB doctor recovering from COVID-19 says reopening a ‘horrible’ idea." The Birmingham News
• Patchen, Tyler (May 15, 2020) "UAB collaborating with Mayo Clinic, Johns Hopkins on plasma therapy research for Covid-19." Birmingham Business Journal
• Koplowitz, Howard (May 18, 2020) "44,000 pounds of food given away Monday to needy families in Jeffco." The Birmingham News
• Gainer, Holly (June 9, 2020) "Study aims to determine the number of undetected COVID-19 cases in the United States." UAB News
• Patchen, Tyler (June 11, 2020) "UAB finds possible drug candidate for Covid-19." Birmingham Business Journal
• Gore, Leada (June 29, 2020) "CDC team arrives in Alabama to help state with COVID response." The Birmingham News
• Patchen, Tyler (June 29, 2020) "UAB and ADPH unveil new Covid-19 initiatives supported by $30M in CARES Act funding." Birmingham Business Journal
• Vollers, Anna Claire (June 30, 2020) "UAB Hospital sees new high in coronavirus patients." The Birmingham News
• Gore, Leada (June 30, 2020) "Ivey extends Safer at Home order; beaches remain open." 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