BIRMINGHAM, Ala. (AP) – With a dozen or so intensive care beds already full, the Cullman Regional Medical Center began desperately looking for options as more and more COVID-19 patients showed up.
Ten beds normally used for less severe cases were converted into intensive care rooms, with additional infusion equipment. Video monitors were set up to allow staff to monitor patients when a nurse had to rush to care for someone else.
The patch did its job – at least for now.
“We’re like a bathtub that fills up with water and the drain is blocked,” said the hospital’s chief physician, Dr. William Smith, last week.
Long one of the unhealthiest and most impoverished states in America, Alabama has become one of the country’s most alarming hotspots for coronavirus.
The hospitals are in crisis as the virus is out of control in a region with high rates of obesity, high blood pressure and other conditions that can make COVID-19 even more dangerous, where access to health care was limited even before the outbreak, and where the public resistance to masks and other precautions is persistent.
Another sign of how easily the virus can spread is the first reported US case of the COVID-19 variant seen in the UK, in Colorado.
The variant was found in a man in his 20s who is isolated southeast of Denver with no travel history, health officials said Tuesday. Scientists in the UK believe the new variant is more contagious than previously identified species.
In total, the coronavirus has killed more than 335,000 people in the US, including more than 4,700 in Alabama. Places like California and Tennessee have also been hit particularly hard in recent weeks.
At Cullman Regional, a medium-sized hospital serving an agricultural area 55 miles north of Birmingham, the intensive care unit had 180% capacity since last week, the highest in the state. Other hospitals are also struggling to keep up with the crushing of people who have become ill from the virus.
While a typical patient may need ICU treatment for two or three days, Smith said, COVID-19 patients often stay for two or three weeks, increasing caseload.
According to Johns Hopkins University, Alabama ranks sixth on the list of states with the most new cases per capita in the past week. Alabama’s latest mean positivity rate – the percentage of tests that return positive for the virus – is nearly 40%, one of the highest in the country. And the state sees an average of 46 deaths a day, up from Dec. 30 on December 14.
While ICUs nationally had 78% capacity during the week of Dec. 18-24, those in Alabama were 91% full, according to the U.S. Health and Human Services Department. As of last week, 15 hospitals in Alabama had intensive care units with capacity at or above capacity, and six other hospitals’ ICUs were at least 96% full.
On Tuesday, 2,804 people in Alabama hospitals were with COVID-19, the highest number since the start of the pandemic.
Experts fear that the burden will only increase after the holidays because of new infections related to travel and gatherings of family and friends.
‘I think we’re in bad shape. Really, ”said Dr. Don Williamson, Chief of the Alabama Hospital Association. “I fear our Christmas wave will be much worse than the Thanksgiving surge.”
Alabama Governor Kay Ivey, who broke with some of her Southern counterparts at the time, imposed a statewide mask mandate that has been in effect since July, but health officials are struggling to get people to comply. The Republican governor also issued an order to stay home at the start of the pandemic, but he has again strongly resisted this, saying, “You can’t live a life without an income.”
California, on the other hand, has issued strict stay-at-home orders in recent weeks in areas where ICU occupancy has reached 85%.
“Unfortunately, we still have people who get together in groups, go on vacation and do things that are unsafe,” says Dr. Scott Harris, Alabama health officer.
The state of Deep South has some of the highest rates of certain chronic health conditions that increase the risk of death or serious illness from the coronavirus. Alabama has the sixth highest adult obesity rate in the US and is ranked third in the percentage of adults with diabetes.
Alabama is also one of dozens of states that have not expanded Medicaid under the Affordable Care Act and thus has large numbers of uninsured people. According to the Henry J. Kaiser Family Foundation, about 15% of people ages 19 to 64 have no coverage, the 13th highest percentage in the country.
The state has seen the closure of 17 hospitals, mostly small rural hospitals, in the last decade, a trend that has left regional facilities behind.
At Decatur Morgan Hospital, COVID-19 deaths have tripled since September and intensive care units are full, said Dr. James Boyle. Struggling to keep his cool, the pulmonologist paused and pursed his lips as he discussed the possibility of rationing care in the new year.
‘I’ve been practicing in this province since ’98. I have never had more than two or three people on flu ventilator in the past 20 years, ”he said. “We always have many patients in the ICU in winter. Having 16 patients on respirators with a disease we don’t normally have is unprecedented. “
The UAB Hospital, which is affiliated with the University of Alabama at Birmingham, has attracted retired nurses and dozens of nursing school teachers and students to assist.
Alabama hospitals are getting calls from neighboring states such as Mississippi and Tennessee as doctors seek additional space for COVID-19 patients, but they cannot help as often as in the past. The same is true within the state, with hospitals that can help care for patients after a disaster, such as a tornado currently unable to help.
With thousands of people already vaccinated with the first of the two doses needed to protect themselves against COVID-19, the end of the pandemic is in sight. But meanwhile, the toll on medical personnel is increasing.
‘We see death. That’s part of what we do; it’s part of our training, ”Boyle said. “The difficulty this year is simply the sheer number. We cannot mourn one patient before we have to care for another. “
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Chandler contributed to this story from Montgomery, Alabama.