COVID-19 pandemic

From Bhamwiki
Jump to navigation Jump to search
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 lead to 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.

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.

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. 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.

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.

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, which had been developed at the UAB Antiviral Drug Discovery and Development Center under Richard Whitley, as a potential treatment for Ebola. 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, a treatment that 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.

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.

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. 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.

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.

Other implications

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.

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
  • Starr Dunigan, Jonece (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
  • "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

External links

Retrieved from "http://bhamwiki.com/w/index.php?title=COVID-19_pandemic&oldid=166260"