Managing Spread of COVID-19 is a Balancing Act Between Health and the Economy

Gov. Kay Ivey spoke to a socially distanced media corps about relaxed COVID-19 rules Friday, May 8, 2020. (Source: Alabama Governor’s Office, Hal Yeager)

Acknowledging the balancing act between protecting the health of citizens and the health of the economy, Jefferson County Health Officer Dr. Mark Wilson on Friday expressed concern about the state’s relaxing of restrictions put in place to combat the spread of COVID-19.

Wilson did not issue a new emergency order for the county, but he issued a strong recommendation that people in Jefferson County refrain from having public gatheri­­ngs of greater than 10 people, including worship services, for at least another two weeks after this weekend. He said he wants to see the effect of the governor’s new order.

The new Proceeding With Caution order, which Gov. Kay Ivey announced Friday morning, allows restaurants, bars, athletic facilities and close-contact service providers such as nail salons and barber shops to reopen starting Monday. It also lifts the 10-person cap on non-work gatherings, but it stresses that people must maintain six feet between themselves and others from different households while in public. The new order expires May 22.

“We’re going to be opening a lot of things,” he said. “I’m very concerned that we could start to see an increase in disease.”

He wasn’t the only voice calling for caution as the state starts to reopen amid the COVID-19 pandemic. Other health care officials and government leaders expressed concern, most of them saying they also understand the need to get people back to work.

“It’s a tough decision to make and I’m very sensitive to the economic issues,” Wilson said in an afternoon video press conference. “I’ve said many times that people have to have a job, people have to have income (and) when people don’t have income, they don’t get the other things they need. That’s actually a threat to health as well.”

But he said the virus is still in the community and it doesn’t care ­that government officials have said it’s OK to loosen restrictions on gatherings and allow businesses to reopen.

Dr. Mark E. Wilson, chief medical officer of Jefferson County, in a COVID-19 press conference 3-16-20. (Source: Solomon Crenshaw Jr.)

Wilson admitted Ivy’s new steps toward reopening the state’s economy “make me nervous.” But there’s no way to avoid some anxiety, he said.

“We have to eventually open this back up,” he said. “If it were three months from now, I’d still be nervous about it. That’s why we’re really urging everybody to be very, very careful as we go. We’re here to help everybody succeed, we need everybody on our team.”

Dr. Jeanne Marrazzo, director of the Division of Infectious Diseases at UAB, acknowledged the painful sacrifices that have been made during the pandemic. She said health care workers and researchers are among those who have been laid off because of the downturn in the economy.

“That said, getting our activities back to normal really has to be done with excessive caution,” she said. “Jefferson County, under the leadership of Dr. Wilson and Mayor (Randall) Woodfin, acted very early to implement some of these social distancing measures and were well ahead of many other parts of the state. I firmly believe that the only reason that we’ve been able to (manage the disease) has been by and large by the incredibly responsible attention and guidance that mayor and Dr. Wilson so courageously carry on.”

The Business Council of Alabama applauded Ivey’s action.

“As we all navigate this unprecedented time, today’s order adds much-needed clarity and reassurance,” the BCA statement read. “Our state’s businesses, workers and families will benefit as a result.”

In a statement from his office, Woodfin said he’s reviewing Ivey’s new order.

“As we have done from day one, we will be engaging with the Birmingham City Council, community leaders, health officials, business owners and other important members of our community to continue a plan that has two priorities: take steps to protect the health of our citizens and work with our leaders to get our economy back open as quickly and safely as possible,” he said in the statement.

Social Distancing Concerns

In a video news conference that followed Ivey’s announcement, U.S. Sen. Doug Jones said he did not agree with Ivey’s comments that Alabamians have been practicing the prudence necessary to curb the spread of COVID-19.

U.S. Sen. Doug Jones. Source: WBHM

Jones referred to the University of Maryland COVID-19 Impact Analysis Platform, which lists Alabama among the states with the least social distancing. The platform uses a social distancing index based on a variety of information, including location trackers on cars and phones.

On May 1, according to the platform, Alabama’s social distancing index was 20 on a scale of 1-100, and only a handful of states, Mississippi among them, had a lower number.

“I appreciate the fact that the governor is doing all she can to walk a fine line between trying to get our economy open, trying to get folks out and going while at the same time following the advice of health care professionals,” Jones said. “It’s a difficult balance that I think she is trying to thread here. But the key is really not the governor. The key is really each of us.”

“It’s fine if you want to get out,” Jones said as his own face mask hung from his neck. “But you still got to social distance, you’ve still got to wear the mask … . It is one of those precautions for folks to do, and the problem that we’re seeing is that … so many people are not listening.”

Jones said one model has projected that Alabama’s COVID-19 deaths could jump seven-fold to about 2,300. “It’s a model, it’s just a prediction,” he said, “but I think it recognizes that Alabamians may be taking too many things for granted, may be letting their guard down a little bit and we just can’t afford to do that.”

More People Advised to Be Tested

Both Jones, a Democrat, and Alabama’s senior U.S. senator, Republican Richard Shelby, said much more COVID-19 testing is needed.

“We ought to step it up,” Shelby told CNN. “We ought to make the test as quickly as we can, accelerate it and do it. I think it’s key to getting people back to give them confidence and also ascertaining who is carrying the virus.”

“The administration has not done a good job with testing and distribution of testing at all,” Jones said, adding that testing has been sorely lacking in places such as the Alabama Black Belt.

“As tests ramp up, and (they) will ramp up, we have got to do a better job of getting those tests to folks that need it in those communities,” Jones said “And when a vaccine is developed, there needs to be a plan put in place, and that plan needs to be put in place now. They don’t need to wait until we get the vaccine, and I haven’t seen anything (from) the administration yet about a plan for distribution of (a) vaccine.”

Wilson agreed that tests are essential. He said the reasons to get a test have been broadened, and anyone who has reason to think they have COVID-19 should schedule a test.

In addition to people who are coughing or have difficulty breathing, Wilson said those showing other symptoms such as a loss of taste or smell, diarrhea or body aches also should be tested. He also advised tests for people living in communal settings such as nursing homes, homeless shelters and jails.

Additionally, people who think they have been exposed to the virus, especially those who have underlying medical conditions, should be tested, Wilson said.

Protect Yourself

Marazzo, also speaking during that news conference, said many cities “have managed to keep their levels of infection low” through social distancing.

“In Jefferson County, we actually have been doing a pretty good job, and we have been able to maintain a relatively stable rate of cases as well as admissions to the hospital,” Marrazzo said. “So, I don’t think there’s any question that the social distancing or physical distancing measures that we have been talking about work very well.”

But she warned that the state could quickly backslide and risk losing the gains made so far. One big event, such as a picnic or funeral, is all it would take to ramp up community spread of the disease to much higher levels, she said.

Marrazzo in a later press conference said the need for social distancing will be with us for a while.

I think we’re going to have to do some variation of this until we have a vaccine,” she said.

Given that, she urged people to be cautious as they spend more time in public, saying aggressive hand hygiene, masks and distance are key to containing the virus.

“I would think strongly and twice before going to any establishment where I could not control who was touching the things that I was going to be touching … or where I was going to be placed in close proximity to another customer,” she said.

Bars, which can reopen as of Monday under the current order, are a particular concern because they aren’t built for social distancing, she said.

“In fact, they’re built for the exact opposite, maybe more intimate distance,” she said, saying that bars have the potential to be hotspots.

Discussing the possibility of a second wave of the virus, Marrazzo said “the biggest thing to consider … is going to be how quickly we take away the measures … that have been so successful in containing this virus. If everybody just starts acting like it’s a normal summer, then I suspect that we will see a very bad fall ahead, especially as we face the respiratory virus season that we have all the time.”

Read Ivey’s full proclamation