Hospitalizations from COVID-19 have leveled off in the past week after rising sharply throughout July, but Alabamas ICUs remain nearly full. Many hospitals have added extra beds to meet demand and officials are concerned about what will happen as schools open in the coming weeks.
The good news is hospitalizations right now are more flat than theyve been recently, said Dr. Don Williamson, president of the Alabama Hospital Association. We can manage if things stay as they are. If we had a surge (of patients), we could manage that as long as they were distributed across the state, but thats not the way it works.
As of Monday, just 15% of Alabamas ICU beds were available, he said, which translates to 238 beds.
The numbers are better outside the ICU, said Williamson. About 29% of total adult hospital beds are available across the state, or 2,343 beds.
Williamson worries that even as hospitalizations have flattened recently, schools and colleges resuming in-person instruction could push the surge higher, straining already overloaded hospitals.
Im very worried that when school starts in a couple of weeks, were going to, by the end of August see some really unpleasant numbers in terms of hospitalizations, he said. I dont expect it necessarily to be children. But Im really worried about teachers, parents and grandparents.
On Monday, 1,529 Alabamians were hospitalized with COVID-19. And 18-19% of Alabamas COVID tests return positive over the past 10 days, compared with just 8% nationally.
That is very, very, very high, said Dr. Jeanne Marrazzo, an infectious disease physician at the University of Alabama at Birmingham, on Friday. Its worrisome, especially as we increase testing, when positivity doesnt budge, that means youre detecting more absolute numbers of cases.
Those case numbers, said Williamson, dont give me a lot of hope that we somehow turned the corner.
Across the state
Hospitals in Birmingham, Mobile, Tuscaloosa, Montgomery, Dothan and Opelika have already added beds and implemented surge plans.
I worry about individual communities, because thats how the outbreak affects people, he said. Any place in the state you have suddenly 100 new COVID patients who need hospitalization, thats a problem.
Particularly worrisome are communities like Montgomery, Tuscaloosa and Dothan, which have less than 10% of ICU beds remaining.
On Monday afternoon, UAB Hospital reported its highest-ever number of COVID patients, at 124. The hospital has converted its general waiting room into a 10-bed COVID acute care area, and had previously converted other hospital units into COVID units.
Birmingham overall has about 500 total ICU beds and sits right at 90% capacity, said Williamson.
The Huntsville/Madison County area in North Alabama has seen stable and manageable hospital volumes in recent days, said Crestwood Hospital CEO Dr. Pam Hudson. On Monday, Madison County had 121 COVID hospital patients, 40 of whom are in the ICU.
But, she said, theres been a sharp uptick in ICU patients needing ventilators.
Instead of it being 30-40% of patients in the ICU needing a ventilator, its closer to 60%, she said.
Huntsville Hospital Health System, which operates several hospitals across North Alabama, had 208 COVID patients on Monday, down slightly from its highest level a few days earlier.
On Monday, East Alabama Medical Center in Opelika had 45 hospitalized COVID patients, with 26 of its 30 critical care beds in use. The hospital has created alternate care sites to centralize patients with COVID and used other employees to help care for patients. EAMC, Lee County, is the closest hospital to Auburn University, which plans to welcome students back to campus in the coming weeks.
We do have concerns, but we also know that schools and parents have difficult decisions to make and there is no right answer to every situation, said John Atkinson, spokesperson for EAMC. He said the concern over hospitalizations lies mostly with students parents, grandparents, teachers and staff.
If students and staff are both wearing masks, the level of transmission at school should be limited, he said.
In some instances, some smaller Alabama hospitals near state lines have transported a few critical care patients out of their hospitals and into hospitals in other states, said Williamson. That happens usually because the Alabama hospital to which they normally transfer patients is full.
This week, the National Guard is assessing potential sites for adding more COVID-19 beds if hospitals become full.
There are no immediate plans to pull any triggers, said Williamson. When you start moving patients off-site, you compound the challenges of taking care of them by pulling staff away from the main hospital, and not having them closer to basic infrastructure.
And beds arent typically the biggest problem for hospitals; its having enough nurses and staff.
Some Alabama hospitals have even looked at potentially bringing in nurses from other countries because the nursing shortage is nationwide.
Taking care of a COVID patient is more labor-intensive than for some other patients, he said. You may be able to assign one nurse to six patients on a general medicine ward. But for COVID you may need one nurse for four patients.
And Alabama had a nursing shortage prior to COVID.
Williamson said he worries about staff growing exhausted, working extra shifts to handle the surge in patients, even as some staff are out sick with COVID themselves. He also worries about the emotional toll.
They know now how difficult and challenging COVID patients can be, and now theyre getting hit with the second wave, he said. Many are stressed, already knowing what the future will look like.