As Alabama continues marching toward a fuller reopening, the number of confirmed cases of coronavirus in the state continues marching upward.

But officials say it’s too early to determine whether the numbers are increasing because testing is increasing or more people are becoming infected.

A day after State Health Officer Scott Harris described infection numbers as “not as good as we could hope for” – which was also the same day the state had its worst COVID report card  yet, posting 615 new cases and 19 deaths in a 25-hour period – a UAB doctor said Wednesday that people still need to take precautions.

“As we all know, Alabama has opened up and currently we are seeing an increase in our cases, particularly in hotspots such as Montgomery,” said epidemiologist Dr. Rachael Lee. “I believe Jefferson County had their highest number of cases yesterday that they’ve had this whole period of time and some of that may be reflective of testing. But it’s hard to tell at this stage.”

Lee’s comments during a Wednesday morning conference call echoed those made May 18 by her colleague, infectious disease specialist Dr. Jeanne Marrazzo, who also is a member of the task force advising Gov. Kay Ivey on the state response to the pandemic.

“We have had on average the last week above 300 cases,” Marrazzo said. “For a while we were feeling a little bit better – we had 200. We had 400 cases reported on Friday (May 15). There is this question again: ‘Is it because you’re testing more?’ I do think that testing is contributing to it.

“On the Alabama Department of Public Health website, it looks like right now about 7% of all the tests that they’re doing in the state are positive. It was 9% when we first started testing, but we were testing more people with symptoms early on. So I think the concern I have is that we are not seeing a decline in cases,” she said. And then she repeated the statement. “We are not seeing a decline in cases.”

“We are still facing taking care of very sick people in the hospital,” she said. “We have almost 70 people here at UAB right now who are infected and a number of those are on ventilators. So I think that it is really premature to declare victory, to say the least.”

Lee said that the climbing numbers mean that the same individual precautions are in order even with the state reopening.

“I think now is the time to continue to focus on everything that we’ve been talking about: social distancing as much as we possibly can, really maintaining six feet of distance. Wearing your mask in public is one of the biggest things. As I’ve gone out to some of these retail stores, I’ve noticed people are not wearing masks,” she said. “And it’s really hard. We get fatigued from wearing the mask and having to continue to do it. But it’s now our time to be vigilant and to be careful and really to maintain space as much as we can. So if you’re going to a restaurant, it may be better to sit outside rather than inside where everybody is enclosed in a small space. The more open space you can have the better.”

Even as more churches resume in-person services, Lee noted that people need to take a realistic view. “We all want to go back to church, but churches, really, can contain the virus because of ventilation systems and we all are hugging and loving on one another and so we have to be careful there,” she said.

Although she’s convinced that UAB has the capacity to treat the number of COVID-19 patients coming its way, Lee also said the count needs to be going in the other direction. “I’m actually concerned about the numbers as we have been watching them over the past couple of weeks, those numbers have either been at the same level or they’re slowly going up and not going down like we would like them to,” she said.

“If you look at UAB’s numbers, we are continuing to see a consistent number of patients being admitted with COVID-19. So, we talked a lot about flattening the curve and it looks like we’ve flattened it, but it’s just not gone down. And that’s what I would really love to see.” That uptick in numbers allows the disease to spread even more, she said.

Lee said that understanding the actual state of coronavirus infection in the community is important. “I think the other piece to connecting to testing and having an increased number of positive tests is also how many hospitalizations are we having and how are hospitals handling a potential surge of more patients,” she said. “And I think that should be included in whether or not we’re seeing this from community-acquired, or whether or not it could be a long-term care facility that may have had an outbreak.

“You just don’t know based on these numbers yet. And I think as the health departments are looking into these numbers, they can provide more information for us … . It is very very hard at this point to determine what is the cause and make sure that we are doing what’s right for Alabama.”

What should happen if the numbers go up past the point that can be attributed to increased testing? Lee deferred to the governor’s task force.

“I would believe that they would have guardrails in terms of at what point should we pull back some of the recommendations we have for opening up Alabama, such as maybe having to close restaurants down again or saying that we need to have only 10 people in a particular area,” she said. She believes that “those kind of smaller things, maybe modifying it without having to go completely back to what we did in April, would be something that I would consider doing,” she said. “As an epidemiologist, we are all concerned about a second surge, either now or later on.”

With Memorial Day weekend approaching, UAB doctors urged that people remember what’s at stake as they make plans.

“For Memorial Day weekend, I think that people just need to try to continue to exercise some cautions with social distancing and masks,” Marrazzo said. “I know that everybody wants to get out there and be with their friends and family. There’s no reason you can’t do that. But really pay attention to that group of 10. Try to hang out with people you’ve been hanging out with. And really try hard to remember you can prevent transmission of this virus by good hand hygiene, good personal distance and masks.”