2020 Coronavirus pandemic
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.
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.
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 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.
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. On the same day, 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 with additional clarifications and an exception for eating.
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. 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.
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.
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. 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.
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.
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.
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.
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- Situation Summary at the Centers for Disease Control
- Coronavirus Disease 2019 at Alabama Department of Public 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