With COVID-19 patients already filling beds at a record pace, hospitals across Alabama are bracing for an influx of people infected at Fourth of July gatherings.

Statewide hospitalizations Wednesday were 1,110, the highest number yet, Dr. Don Williamson, president and CEO of the Alabama Hospital Association said Thursday.

The state also had 163 admissions, the highest one-day number of new patients due to COVID-19. The state was down to 206 intensive care unit beds available, which is 12% of capacity, the lowest rate yet during the pandemic.

“The concern is that all the numbers we are using to monitor the outbreak moved in the wrong direction,” Williamson said.

“We saw Birmingham, Mobile and Huntsville all hit new highs in terms of patients in the hospital,” he added, with more than 250 COVID patients in Birmingham, 163 in Mobile and 104 in Huntsville.

The state is seeing more than 1,000 new cases diagnosed a day, with a record 2,164 on Thursday, and more than 1,000 hospitalizations per day. This includes spikes in the largest cities, which already had experienced previous spikes, Williamson said.

“Let me make it clear,” he said. “These cases are unrelated to the Fourth of July. Because the exposure is about eight days from around the Fourth, and we have an incubation period of 14 days, this is not the Fourth of July surge. That is yet to come.”

Hospitals Feeling the Pinch

Williamson said he thought last week the state might have 1,200 COVID-19 hospitalizations because of the holiday. Now, he said, he won’t be surprised if 1,500 people are in the hospital on one or more days.

“I’m worried about our ICU capacity,” he added, because it is already down to 12%.

State Health Officer Dr. Scott Harris said as many as 30% of coronavirus patients may require ICU care at some point during their hospitalization.

“Thus, the concern is that there needs to be adequate ICU care for COVID-19 patients, as well as for others with non-COVID conditions, who require intensive medical management,” he said.

While hospitals have surge and referral plans to expand capacity, staffing can become an issue during an increase of patients, Harris said.

“At this time, hospitals are handling the demand, but systems are becoming strained,” he said.

UAB Medical Center had 91 COVID-19 patients Wednesday and 87 Thursday.

Dr. Jodie Dionne-Odom, UAB assistant professor of infectious diseases, said the UAB Hospital can create more capacity as needed.

“We have units we can open and close to take care of patients with COVID,” she said.

But she points out that every bed or ICU space used for a COVID patient could have been used for someone with a stroke or other issue unrelated to the coronavirus.

“It has an indirect effect on how we care for other patients,” she said.

UAB serves as a primary transfer hospital for severe cases or patients from areas of the state that don’t have adequate facilities. Eight counties in Alabama have no hospitals, according to the Alabama Department of Public Health.

Dionne-Odom said the state continues to see an increase in cases since a stay-at-home order ended.

“We are worried about the trends we are seeing … these sharp increases in hospitalizations and cases,” she said.

While the virus has hit older people harder, with 77 percent of deaths in people over 65, it has struck children also.

Patients with the coronavirus currently occupy five of the 24 pediatric intensive care beds at Children’s Hospital in Birmingham, according to Delphene Noland, manager of Infection Prevention and Control. So far this year, the hospital has treated 56 patients who tested positive for COVID-19.

“Many of the patients do not have the classic symptoms, and many are not presenting with fever,” she added.

Noland said the hospital doesn’t expect a surge in young patients because of the July 4^th holiday, but it has the staff and space for more patients.

COVID-19 patients currently fill 41 of the 402 beds at Grandview Medical Center in Birmingham, according to Leisha Harris, marketing and communications director. This includes ICU beds.

“Grandview Medical Center does have the capacity to hospitalize additional patients,” she said. “As a reminder, care for any individuals with suspected or confirmed COVID-19 is delivered in a restricted, separate area from other patients.”

Williamson said Montgomery hospitals had only three of 106 ICU beds available earlier this week, according to the Montgomery Advertiser.

“That sounds very short,” he said. “It is, but I know they can expand that capacity. But what does it tell me in a situation with rising case loads, rising hospitalizations? It tells me that COVID is now putting a serious strain on the health care infrastructure. What it also tells me is this situation could get substantively worse by the end of August.”

Huntsville Hospital has stopped elective surgeries and converted three surgical floors to COVID-19 care, according to al.com.

The hospital had 72 coronavirus patients earlier this week, with 63 of those at the main hospital and nine in the Madison facility. Of those patients, 27 were in ICU and 13 were on ventilators.

Dionne-Odom said one problem is that people are trying not to go to the hospital, so they wait too long to seek treatment. Often, they hope the symptoms will go away, and sometimes they do.

“Our recommendation to those people, or anyone at home who is not breathing well, is to speak to your physician early and not wait,” she said.

She said new treatments at UAB and other hospitals are making a difference as the health care industry learns more about the virus.

It’s Time to Double Down, not Back Off

Health officials are growing frustrated with the number of people who aren’t protecting themselves and others, and they blame some of the carelessness on what Dr. Scott Harris calls “COVID caution fatigue.”

“Perhaps you have a false sense of security if you have not been directly impacted by COVID, if neither you nor anyone with whom you are closely associated has contracted the virus,” he said in a written statement.

“Too many people are failing to take precautions and follow the simple steps that have been proven to prevent transmission of the virus,” he added. “As Alabama is experiencing increased numbers of cases and, regrettably, more deaths, now is not the time to let your guard down.”

Harris said young people are thought to drive some of the rise in cases, perhaps because most cases are mild.

“Many millennials rely on social media and other sources that are not necessarily qualified to guide health decisions,” he said. “Other adults mistakenly view practices such as wearing face coverings as political statements. The virus is highly contagious and threatening to everyone.”

Williamson said he, too, is concerned about people becoming complacent because of the recent declining death rate. He said the lag time between infection, hospitalization and death can be three weeks or more.

“I expect over the next week, the number of people dying, our rate of death, is going to go back up,” he said.

The state recorded 23 deaths Tuesday and 25 Thursday.

To gauge the impact of July 4^th gatherings, Williamson pointed back to Memorial Day. Before Memorial Day, the state was averaging 500 coronavirus hospitalizations per day. Two weeks after the holiday, the number jumped to 600. By last week, the number increased to 798. Now, it’s more than 1,000.

He expects the impact of the Fourth of July to hit later in July and early August.