By Eric Fleischauer

For the Enquirer

At its current trajectory, Alabama could have 8,000 COVID-19 hospitalizations within two weeks – a number that eclipses the previous peak and that local and state health experts said would overwhelm the health care system.

“The hospitals in Alabama are not prepared for that,” said Dr. Sarah Nafziger, vice president of UAB Hospital Clinical Services. “Our hospitals have a breaking point.”

It’s an ugly forecast, but Decatur-Morgan Hospital officials are taking it seriously.

“We have our COVID response and surge plan in place, and we’ll use that to respond to a surge; however, it would greatly overwhelm Decatur Morgan Hospital in its current state,” said Bryan Vest, service line director of inpatient nursing and support services. “We are above our normal (patient) census for this time of year, even without COVID. Adding all the (projected) COVID to that will definitely overwhelm our hospital.

“We’re prepared for it; we have everything in place to respond to it; but it would tax us greatly.”

Vest said a surge, even at the levels experienced in January and February, would force the hospital to limit the influx of non-COVID patients, to convert regular rooms into ICU rooms, to use emergency room space for inpatient care and to convert non-patient rooms into rooms that could serve patients.

Vest said the average age of COVID patients at Decatur Morgan is markedly lower than in previous waves of the virus, with an average age of 52 this week. He attributes this to low vaccination rates among the young.

“A majority of our patients are in their 30s and 40s,” he said. “It stands to reason that the unvaccinated are the ones that are suffering with this variant.”

Vest said Decatur Morgan Hospital’s percentage of unvaccinated COVID hospitalizations is about the same as Huntsville Hospital System’s, which includes Decatur Morgan. Systemwide, 86 percent of non-ICU COVID patients were unvaccinated as of Wednesday, and 89 percent of ICU patients were unvaccinated.

Morgan County has averaged 40 new infections per day over the past week. Limestone has averaged 44, and Lawrence County has averaged nine.

Decatur Morgan Hospital had 26 COVID patients Thursday – well below its peak of 100 in January but double the number from a week ago. Athens-Limestone Hospital had 12, a number that also had doubled in one week.

Thursday, 2,441 Alabamians were hospitalized with COVID, a 10-fold increase since early July. State Health Officer Dr. Scott Harris on Thursday predicted that within three to four days, COVID hospitalizations would exceed the previous peak of 3,100 reached in January.

The UAB projection of 8,000 statewide COVID hospitalizations is based on the experience of south Alabama, which began seeing a dramatic rise in infections and hospitalizations in late July. The concern is that the Delta variant took hold in Florida, began its rapid spread in south Alabama in late July and ultimately will have the same impact in the rest of Alabama.

Under that model, 1 in 4 Alabamians could be sick or quarantined with the virus and unable to work by the end of the month, according to Suzanne Judd, professor and epidemiologist in the UAB School of Public Health.

“We’re going to accumulate a lot of cases this time because (the Delta variant) spreads so rapidly. This is very different from what we experienced last year,” Judd said.

She said risk factors that make the projections more likely are not just that a high percentage of Alabamians are unvaccinated, but that even vaccinated people can become infected by the Delta variant. While their symptoms are generally mild or nonexistent, they can spread the virus to others.

Judd said particularly concerning is that the accelerating infections and hospitalizations have, for the most part, not yet been affected by the return to schools and other indoor group activities.

‘TIDAL WAVE’

Nafziger said the hospitalization rates already are causing serious problems, and a surge would be debilitating.

“We are in a dire circumstance right now,” Nafziger said. “We’re seeing an absolute tidal wave of patients coming to see us who are infected with COVID, who have terrible symptoms of COVID and who are requiring treatment and hospital admission for COVID.”

As dire as the situation is now, she said all indications are that it will get much worse.

“The healthcare system is not unbreakable,” Nafziger said. “We’re rapidly getting into a position where care for services we take for granted is not going to be available if we don’t turn this thing around.”

Judd, Nafziger and Harris have all said immediate vaccinations and masking are the options available to slow the transmission of the Delta variant.

“This has turned into a very political debate,” Nafziger said. “The vaccine is not a member of a political party. COVID is not a respecter of your politics. It will infect anyone.”

She said the vaccines are remarkably effective at preventing hospitalizations and death.

“We’re trying to prevent people from dying, y’all,” she said. “I don’t want people to panic, but I also don’t want people to die … We wouldn’t be sitting here telling you we need you to wear a mask, and we need you to take your vaccine, if we didn’t have the research and data to show it really does make a difference.

“These vaccines that are available are the miracle we prayed for when this pandemic began, and we got that miracle,” Nafziger said. “It’s here. It’s been in the freezer since December.

“What we’re seeing is people who are vaccinated who later catch COVID – their case is very mild. They have a cold. It takes this killer disease and turns it into a cold.”

The susceptibility of children to the Delta variant is of particular concern to health officials, especially because those younger than 12 cannot receive a vaccine and because most schools don’t have mask mandates.

Children’s of Alabama in Birmingham had 22 COVID patients Thursday, five of whom were on ventilators. At its previous peak during the height of the January surge, Children’s had 13 COVID patients.

Judd said two events in Cullman – a Rock the South concert this past weekend and a rally by former President Donald Trump this coming weekend – are likely to accelerate infections in north Alabama, despite being outdoors.

“Those type of events are definitely going to lead to transmission,” she said. “It would be very possible for transmission to spike after one of those events.”

“We’re definitely worried these could turn into super-spreader events,” Nafziger added.

Judd said if the projection based on south Alabama’s case rates holds true for the state, she expects 13,000 new cases per day.

“That means one in four Alabamians will be sick on a given day. I don’t mean just a little sick; these are the people who are actually sick and need to be home, can’t go to work, having a difficult time breathing. That’s a lot of folks not to be able to do their job,” Judd said.

“I don’t mean to be doom and gloom right now, but it’s where we are. It’s the path we’re on.”