As Dr. Don Williamson saw the coronavirus approach Alabama, he said he worried about three areas of potential shortages in the state.

First was the number of hospital beds, ventilators and other equipment that would be needed. Second was personal protection equipment for medical professionals to shield them, and then others, from the virus.

Third was the medical staff itself.

“I have real concerns about COVID-19 on health care workers,” Williamson, the executive director of the Alabama Hospital Association and former state public health officer, said.

Williamson points to Italy, hard-hit by the virus weeks earlier than the U.S., where about 10% of the infected are health care workers. That means they can’t serve, and the co-workers they came into contact with must be quarantined too.

“Now, you overlay that with the fact that we have, historically, major health care professional shortages around the state. I think one of the real critical issues we’re going to face is health care worker shortages,” Williamson told Alabama Daily News on Wednesday.

The United Health Foundation’s 2019 America’s Health Rankings put Alabama 42 in the nation for the number of primary care providers, with 122 per 100,000 people. Efforts to entice physicians and nurses to rural Alabama have been ongoing.

To keep medical care providers “in the game,” Williamson said proper personal protection equipment is critical.

And as the epidemic worsens, Alabama will look for ways to bring more health care workers into the system.

The state boards that license doctors and nurses have eased rules to make it easier for retired professionals or those whose licenses have lapsed to again get licensed.

“As other states have, we’ll be looking for retired physicians who can be brought back,” Williamson said.

There are about 104,000 nurses in Alabama, with the largest numbers in the state’s biggest cities and along I-65, said Honor Ingels, chief policy officer at the Alabama Board of Nursing.

“The more remote your area is, the less likely you are to be adequately staffed,”

“Longterm, there will definitely be a strain.”

Meanwhile, other states are facing the same crisis and potential staff shortages.

“This is very different from a tornado or hurricane, where people can come from other states,” Williamson said. “We’re all in the same basket.”

As of Thurday morning, 466 cases of COVID-19 had been confirmed in Alabama and one death in Jackson County had been reported.

The majority of people on contract the disease don’t need medical care at a hospital. But Alabama Health Officer Dr. Scott Harris earlier this week said 8% to 9% of Alabamians with COVID-19 were requiring hospitalization.

Williamson said two variables will impact the health care shortage: The virus’ attack rate — how many of those exposed to it actually get infected; estimates range from 10% to 60% — and how long the epidemic lasts.

Alabama officials on March 19 issued an emergency public health order meant to slow the spread of the coronavirus. Dining in restaurants is prohibited, beaches are closed and large gatherings outside of the workplace aren’t allowed.

But Williamson said those actions will have no effect on people being diagnosed now. They were already infected.

“We will not know if we’ve flattened the curve until somewhere out in three weeks,” he said Wednesday.

“I suspect our peak will be sometime will be into the end of April or early May.”

As people are forced to stay home, some unpaid, and businesses slow and stop completely, state and federal officials have said the economy can’t withstand weeks’ of coronavirus control attempts.

Williamson said he’s very aware that this is a major economic disruption. But it will be even worse if people stop socially distancing.

“The worst thing we can do is have half measures,” he said. “Half measures will still cause us to feel the pain of the health measure, without giving us the benefit of stopping the epedemic, and will give us even worse consequences when the epidemic breaks through because of the half measures.”