BIRMINGHAM, Ala. (AP) – With its dozen intensive care beds already full, Cullman Regional Medical Center has started to desperately search for options as more COVID-19 patients show up.
Ten beds normally used for milder cases were turned into intensive care rooms, with additional IV machines. Video monitors were installed to allow staff to monitor patients whenever a nurse had to rush to attend to someone else.
The patch did the job – at least for now.
“We’re like a tub that fills with water and the drain is clogged,” Hospital Chief Medical Officer Dr William Smith said last week.
Alabama, long one of America’s most unhealthy and poorest states, has become one of the country’s most alarming coronavirus hotspots.
Its hospitals are in crisis as the virus spirals out of control in an area with high rates of obesity, high blood pressure and other conditions that can make COVID-19 even more dangerous, where access to health care was limited even before the outbreak, and where public resistance to masks and other precautions is stubborn.
The virus has killed more than 335,000 people across the United States, including more than 4,700 in Alabama. Places like California and Tennessee have also been particularly affected in recent weeks.
At Cullman Regional, a mid-sized hospital that serves an agricultural area 55 miles north of Birmingham, the intensive care unit last week was at 180% of capacity, the highest in the state. Other hospitals are also struggling to keep up with people being crushed by the virus.
While a typical patient may need intensive care treatment for two or three days, Smith said, COVID-19 patients often stay two or three weeks, leading to an increase in the number of cases.
Alabama ranked sixth on the list of states with the most new cases per capita over the past week, according to Johns Hopkins University. Alabama’s latest average positivity rate – the percentage of tests coming back positive for the virus – is nearly 40%, one of the highest numbers in the country. And the state averages 46 deaths per day, up from 30 on December 14.
While intensive care units nationwide were at 78 percent of capacity during the week of Dec. 18-24, those in Alabama were 91 percent full, according to the U.S. Department of Health and Human Services. As of last week, 15 hospitals in Alabama had intensive care units that were at or above capacity, and the intensive care units at six other hospitals were at least 96% full.
As of Monday, 2,800 people in Alabama hospitals were infected with COVID-19, the highest total since the start of the pandemic.
Experts fear the tension will only increase after the holidays due to new infections linked to travel and meeting family and friends.
“I think we are in bad shape. I really do, ”said Dr. Don Williamson, chief of the Alabama Hospital Association. “I’m afraid our Christmas wave is a lot worse than Thanksgiving.”
Alabama Governor Kay Ivey, breaking at the time with some of her Southern counterparts, imposed a statewide mask mandate that has been in place since July, but health officials struggled to get people to comply. The Republican governor also issued a stay-at-home order at the onset of the pandemic, but strongly opposed doing so again, saying, “You cannot live without a livelihood.”
California, on the other hand, has issued strict stay-at-home orders in recent weeks in areas where intensive care unit occupancy rates have reached 85%.
“We have, unfortunately, people who still get together in groups, travel for vacations, do things that aren’t safe,” said Dr. Scott Harris, Alabama public health official.
The Deep South state has some of the highest rates of certain chronic diseases that increase the risk of death or serious illness from the coronavirus. Alabama has the sixth highest rate of adult obesity in the United States and ranks third in the percentage of adults with diabetes.
Alabama is also one of twelve states that have not extended Medicaid under the Affordable Care Act and therefore has a large number of uninsured. About 15% of people aged 19 to 64 do not have coverage, the 13th highest percentage in the country, according to the Henry J. Kaiser Family Foundation.
The state has seen the closure of 17 hospitals, mostly small rural hospitals, over the past decade, a trend that has left regional facilities to take over.
At Decatur Morgan Hospital, deaths from COVID-19 have tripled since September and the intensive care unit is full, said Dr James Boyle. The pulmonologist struggled to keep his cool, stopping and pursing his lips, as he discussed the possibility of having to ration care in the New Year.
“I’ve been practicing in this county since 98. I’ve never had more than two or three people on a ventilator with the flu in the past 20 years,” he said. “We still have a lot of patients in care. intensive in winter. Having 16 patients on ventilators with a disease we usually don’t have is unprecedented.
UAB Hospital, which is affiliated with the University of Alabama at Birmingham, has drawn on retired nurses and dozens of teachers and students from its nursing school.
Alabama hospitals are getting calls from neighboring states such as Mississippi and Tennessee as doctors seek additional space for COVID-19 patients, but they are not able to help as often as they are did in the past. The same is true within the state, with hospitals that could help treat patients after a disaster like a tornado unable to help yet.
With thousands of people already vaccinated with the first of two doses needed to guard against COVID-19, the end of the pandemic is in sight. But the toll of medical workers is increasing in the meantime.
“We see death. It’s part of what we do; it’s part of our training, ”Boyle said. The difficulty this year is just the huge numbers. We cannot cry for one patient before we have to go and take care of another. ”
Associated Press writer Kim Chandler contributed to this story from Montgomery, Alabama.