‘An Absolute Tidal Wave’: As COVID Delta Variant Marches Across Alabama, Hospitals Struggle to Keep Up

The vice president for clinical resources at UAB Hospital summed up the crisis that faces her facility and many others across Alabama in four words: “We’re in dire circumstances.”

Dr. Sarah Nafziger’s comment came during one of two online conferences held by top health officials on Thursday, as they struggled to grasp the magnitude of the current surge in COVID cases fueled by the spread of the mutation known as the Delta variant.

Hospitals are facing a huge influx of patients, roughly 90% of whom have not been vaccinated for the virus. That is stretching capacities to their limits and threatens to surpass the numbers from the winter surge. All that comes on top of the existing higher-than-normal caseloads from those who had previously put off procedures for treating cancer, strokes, physical injuries and the like, many of which had been delayed for months because of COVID patient needs in the winter.

Add to all of that a major shortage of nurses and other health care personnel, and administrators are digging deep to convey, without panicking, to the public the message of what they are facing.

Dr. Sarah Nafziger. Source: UAB

Thursday’s count by the Alabama Hospital Association and the Alabama Department of Public Health showed 2,441 beds occupied by COVID inpatients across the state. That total is quickly climbing near the all-time high of 3,084 beds on Jan. 11, at the height of the winter surge, and contrasts with the low of 166 set on June 20, just seven weeks ago.

Nafziger said that emergency departments, which are designed to treat those with the most immediate medical issues and then move those patients on to conventional units elsewhere in the hospital, are instead having to house patients for extended periods.

“Our emergency departments are extraordinarily crowded. Most mornings we have around 40 people waiting for a hospital bed,” she said.

The traffic jam is causing administrators to look for alternate sites for beds — “conference rooms, hallways, wherever we can find,” Nafziger said. “That’s the reality of the circumstance we’re in. … That is the path we’re on, and it’s very alarming.”

Nafziger’s dilemma is similar to that of hospitals in Mobile, which is in the heart of a belt across the Gulf Coast that is seeing the worst of the outbreak. But hospitals in Huntsville, Montgomery, Dothan and Tuscaloosa also are on the brink.

Alabama Hospitals in ‘Crisis Mode’

Dr. Don Williamson, president of the Alabama Hospital Association, said many his members are in crisis mode.

Dr. Don Williamson, president and CEO of the Alabama Hospital Association and former state health officer. (Source: AHA)

“Our hospitals are in the midst of the most rapid expansion of COVID since the pandemic began. We’re not seeing anything that’s going to slow this down,” Williamson said. “On the path we’re on right now, by the middle to end of next week we will exceed the 3,000 we had in January.

“Statewide, we have only 5% of our (intensive care unit) beds open, and in some places there are no ICU beds. There are none in Montgomery, none in Baldwin County, none in Dothan. Theoretically, there were 10 in Mobile, but there were hospitals holding more patients that needed acute medical care than there were ICU beds.

“Basically, throughout the state, were in situations where we’re seeing patients who show up in the ER needing to be admitted, and spending in sone cases days in the ER getting ICU-level care in the ER because there’s no place for them to go upstairs.”

Mobile Infirmary’s chief medical officer, Dr. Bill Admire, said his facility had 202 COVID inpatients on Thursday, with a full ER and ICU beds expanded into a hallway. Thomas Hospital in nearby Fairhope, which has only 170 total beds, had 100 COVID patients. North Baldwin Infirmary in Bay Minette also had more than half of its beds occupied by COVID cases.

That overflow in emergency COVID patients has follow-on effects for the rest of the community.

“Unfortunately, we’re still having strokes, heart attacks, motor vehicle accidents, (and) kids are still falling out of trees. In many places in Alabama today, we cannot guarantee you that if there is a mass disaster in that community, that we can find beds to take care of all of those patients,” Williamson said.

Younger People Affected by This Surge

Unlike the one last winter, the latest surge is affecting a younger demographic because older patients have been much more willing to be vaccinated.

Most people over age 60 took the vaccine when it was first available early in the year, a much greater percentage than middle-aged adults and younger. And for the first time, a larger number of pediatric patients have COVID — 43 statewide as of Thursday, with Children’s of Alabama treating 22 of them, compared to its previous high of 13 in January.

The situation is more dangerous for children aged 12 and younger, as there still is no vaccine approved for them, plus the uptrend comes just as children return to school to start the new academic year.

Hospital staffs are not immune to the effects of the virus, either. Nafziger said that as of Thursday, around 140 to 150 UAB staff members had active COVID infections. Similar situations exist at other hospitals across the state, further exacerbating the shortage of medical personnel available to handle the increase in patient loads.

COVID Spike Falling into Line with Worst-Case Scenario

The spike in overall cases and hospitalizations is falling into line with the worst-case scenario outlined by UAB’s Dr. Suzanne Judd.

Dr. Suzanne Judd. Source: Zoom news conference.

About two weeks ago, she released findings of computer models she compiled of the trend of COVID’s recent spread. Using data taken from the United Kingdom, India and South Alabama, the models predicted that new case totals across the entire state could reach 13,000 a day by the end of August, with hospitalizations around than 7,800 in early September. Both numbers are more than double the January peaks.

Now, with additional data to compare, Judd said the South Alabama model — the worst of the three — is coming to pass, though not quite as high as feared. Still, the trends are disturbing.

“This Delta peak is different. It doesn’t matter whether we’re on the India path, southern Alabama path or the UK path. We’re going to accumulate a lot of cases this time because this spreads so rapidly. This is very different from what we experienced last year,” Judd said, adding that Delta can also be spread by vaccinated people, even though they may have few or no symptoms.

“If we really wind up at that peak of 13,000 cases per day, that means one in four Alabamians will be sick with COVID on a given day,” Judd said. “That’s a lot of folks not able to do their job. On top of that, there will be about five people for every one of them who were exposed. … Absenteeism will be something live we’ve never experienced before. It’s the thing we all feared at first when we all ran out and got toilet paper, because we thought the supply chain would be interrupted. This time you’ll see interruptions in the supply chain.”

‘We Can End This Thing’

Judd urged diligence in social behavior, particularly in situations with large gatherings of people. Aside from the coming football season and the return to in-person instruction in colleges and public schools, two other big events are scheduled soon: this week’s Rock the South music festival and a rally the following weekend featuring former President Donald Trump, both in Cullman County.

All of the health professionals continue to implore people, as they have done for months, to get their vaccine shots. Their effort is working to some extent, as State Health Officer Dr. Scott Harris said vaccinations numbers are “ticking up” across the state.

Nafziger continues to press the case for vaccination.

“These vaccines that are available are the miracle that we prayed for when the pandemic began, and we got that miracle. It’s here. It’s been in the freezers since December,” Nafziger said. “All you have to do is get your vaccine. If we do those things — if we mask up, if we get our vaccine, if we socially distance and wash our hands … then we can end this thing.”