UAB epidemiologist Dr. Rachael Lee today said that Alabamians will have to exercise personal responsibility to keep the state’s increasing COVID-19 infections from overwhelming the health care system.

Lee said that the increasing number of positive cases is “concerning,” particularly as the state increasingly relaxes restrictions and as the number of tests administered remains steady. Alabama is one of several states being watched because the number of confirmed positive cases of the potentially deadly viral infection are going up.

Lee held UAB’s weekly coronavirus press conference the day after the largest single day increase in coronavirus cases in the state. She addressed a wide range of questions during the more than 45-minute-long press conference, dealing largely with the spike in cases, hospitals’ nearing capacity in some areas, how the coronavirus differs from the flu, remdesivir, the feared second wave and the ongoing need for personal protective measures.

“We are seeing nearly 16,000 cases of COVID-19 here in Alabama with about 600 deaths. Our numbers continue to increase and over the past week they’ve continued to go up,” Lee said. “Part of that is with testing — we’ve opened up more testing — but part of that is likely due to having more people open and out and around. So it’s a little bit concerning to us as infectious disease experts as we see this continuing upward trend.”

Lee said that “the increased numbers that we’re seeing are from a variety of issues. Number one, a lot of those testing sites may have been closed for Memorial Day weekend. And so we may be seeing an increased number of cases just because they weren’t able to get to those sites. Second is increased … testing. But if you look over the past seven days in Alabama, we’ve had consistently about the same number of testing throughout the state. …

“So this increase that we’re seeing is concerning to me, and part of that may be due to relaxing some restrictions. Part of it may be not wearing masks in public or having larger events, which is what we would be concerned about for Memorial Day weekend.”

Memorial Day weekend, traditionally viewed as the unofficial start of the summer travel season, also usually brings on parties and other large gatherings. Even with the threat of COVID-19, large gatherings with little social distancing occurred in several places across the country, including in Alabama, during the holiday period.

“My concern after Memorial Day weekend, where we have removed restrictions, is we’ll continue to see a rise in cases and if we aren’t careful, that can overrun our health care system,” Lee said. “We talked a lot about flattening the curve before, and we’ve been really able to do that as a state — to be able to make sure that we have the ICU beds available to take care of these patients.”

She said that having the antiviral drug remdesivir is “helping the patients get out of the hospital faster.

“But if we’re not careful, our health care systems may not be able to care for these patients in the way that we want to. And I think some of the Montgomery hospitals have seen a large influx of patients and that’s required moving, transferring them to other facilities,” she said.

UAB had about 60 COVID-19 patients at the time of the press conference and had treated about 300, including 50 transfers.

“This is a little bit concerning to us right now because of the trend,” Lee said. “Our ICUs are fairly full right now with our COVID-cohorted patients, so we’re putting patients who are at the same infection on the same unit. And so we’ve had to open some of these beds up more, mainly to help care for these patients more. So if this continues, we’ll have to think about opening up more units as we can.”

Masks and Distancing

Wearing masks and maintaining social distancing are necessary to keep the number of patients manageable and to make sure that hospital workers continue to have enough personal protective equipment to safely do their jobs caring for coronavirus patients, Lee said.

“What I think needs to happen is continued diligence in wearing our masks everywhere,” she said. “So I wear my mask when I walk outside and potentially around people. I wear my mask when I go to a retail area … . We really need to take personal responsibility to care for others as much as we can.”

Why is it so hard for some people to take such warnings seriously, especially since they have been coming regularly for weeks from Lee and other health care officials and experts, as well as politicians and policy makers? Lee said that Americans “desperately care … about our personal freedom.”

But there’s more at stake than personal freedom, she said. COVID-19 is not like the flu or any of the diseases we’re used to, she said.

“We are dealing with a pathogen that we can’t see and it’s not like someone who has influenza where they feel terrible, they’re coughing and and they stay home for the vast majority of cases. We have a lot of patients and a lot of people that start off being very asymptomatic but then continue to spread that — and that’s a lot harder to really stop in its tracks, compared to, say, influenza or tuberculosis or measles, those sorts of things. Those are all the things where we have really defined timelines of when people get sick. And because this is a new pathogen, it’s much harder,” Lee said.

“What I would say (is) I completely understand having freedom to choose and I hope that people choose to wear a mask to protect you and to protect your loved ones, to protect your coworkers, anybody that’s out there. Because we just don’t know enough about this illness yet to give definitive answers.”

Too Many Cases

One concern is that Alabama’s health care system could become overtaxed by the number of coronavirus cases. Lee pointed to measures enacted to make sure that hospitals are not overwhelmed, noting that a system has been set up to track the status of hospital beds statewide.

Hospitals are expected to report the number of beds they have available and how many patients they have with COVID-19. “Sixty-three hospitals as of yesterday (Tuesday) submitted that data, and that is helping us kind of keep abreast of how many ICU beds do we have and where should we be concerned,” she said. “They’ve even broken it down based on hotspots and so I think ADPH and AlaHA are working closely with all these other health care systems to make sure that no one individual hospital is overrun with cases.”

A related concern is availability of masks and gloves in hospitals, she said, “making sure that we have enough for our health care workers and if we are continuing to see these cases, then we may not have enough personal protective equipment available.”

Remdesivir Trial

People continue to be enrolled in a clinical trial for the antiviral drug remdesivir, Lee said. Patients are selected by a “multidisciplinary treatment community” — including pharmacists, clinical care physicians, infectious disease doctors, ethicists and rheumatologists — who determine the best candidates for remdesivir. UAB has a limited supply of the drug.

She also said that UAB is getting some of the drug to use in emergency cases. Lee cited a preliminary study that shows that the drug reduces intensive care stays by about 4 days. “That’s incredible if you think about it because the longer that you’re in the hospital, the more at risk you are for weakness and other infections,” she said.

She noted that the drug does have limits; it can’t be used on patients with kidney or lung problems, which includes patients so sick they’ve been on a ventilator. Overall, though, Lee said, the drug shows promise. “I think we still are waiting to tease out some of these side effects from the medicine, but overall it appears to be fairly tolerated.”

The Vaccine

Lee said she was hopeful about developments on the vaccine front.

“It’s been incredible to see globally how many people have really, are doing their best to find an answer, of a good vaccine target,” she said. But it won’t happen as quickly as many hope,” she said.

“It will be very difficult … in terms of getting everybody in the world vaccinated in a particular time frame and also to manufacture those vaccines,” she said. “So, I think that we as Americans need to be prepared that we may see another wave of infections in the fall and potentially be prepared that we may have to shelter in place again if that’s necessary. I think if we prepare ourselves now, then hopefully we won’t need to do that.”

Second Wave

Lee said that Alabamians need to get ready for a second wave of infections, based on what has happened in previous epidemics. “What we have is from pandemics past, and the biggest one that comes to mind is the influenza pandemic of 1918,” she said. “And based on those numbers, there was an initial kind of surge and then there was a second bigger surge and then … a few months later, there was that third surge.

“I’m not exactly sure where we are currently in Alabama’s standpoint. You know, initially, we were coming down and now we’re coming back up and so is that the same wave as before? Or is that that second wave that came kind of very close to the first one?”

Lee took issue with speculation that summer will bring significant relief from the pandemic because ultraviolet rays can kill coronaviruses. While UV will kill the virus, it is not clear if it will stop it, she said. “I don’t think that we can say that, based on the recent study that saw from a geographical standpoint, even places that have higher temperatures, they were still having cases of COVID-19. And I think that has a lot to do with our immunity or lack of immunity … . So we need to be prepared.”

She noted that people want to get back to normal, send the kids to school, go back to the workplace, etc., but need to think about a new normal going forward. “I think that’s where we need to think outside of the box. … How does safe at work — what does that entail? Does that mean masks? Yes. Does that mean continuing social distancing? Yes. And so all of those things have to be part of our planning for the future.”

COVID-19 Versus the Flu

A persistent bone of contention in some quarters of American society is the notion that COVID-19 is no worse than the flu, which officials say kills a large number of people every year. But they’re hardly the same thing. Cases aren’t even counted the same way, Lee said.

Lee said that flu cases every year are based on CDC estimates. The estimates include flu-like illnesses and cases that are not reported, versus the COVID-19 cases, which are confirmed by tests.

“If you compare that to the number of confirmed flu cases, the number of COVID-19 cases over this past fall and winter and early spring have just skyrocketed in comparison and the same thing with the deaths associated with that,” she said.

Ironically, the pandemic may have actually helped disrupt the flu season, she said. “Typically we see influenza from October through April and then through the summer we may see a couple of cases … every week or so in our health care system,” she said. “With increased hand hygiene and distancing and masks, those numbers have gone down … . We really truncated our influenza cases because of these other efforts,” she said. That could carry over into schools if students are socially distancing, potentially wearing masks in school, and similar measures, she added.

Lee said it is important to appreciate that this disease has to be taken seriously.

“We can get very numb to the numbers,” she said. “But as a reminder, if you have a loved one who has died from COVID-19 or been in the hospital from COVID-19, it is very much real. And that’s what we want to protect people from….

“That’s why we will continue to come up here and we will continue to recommend masks and we will continue to recommend distancing until we can get that vaccine or the wonder drug that we really need.”