With its dozen intensive care beds already full, the Cullman Regional Medical Center began desperately looking for options as more and more patients with COVID-19 appeared.
Ten beds normally used for less severe cases were transformed into intensive care rooms, with extra intravenous devices brought in. Video monitors were installed to allow staff to monitor patients whenever a nurse needed to run out to care for someone else.
The patch did the job – for now, at least.
“We are like a bathtub that is filling with water and the drain is blocked,” said the hospital’s medical director, Dr. William Smith, last week.
Alabama, long since one of the most unhealthy and impoverished states in the United States, has emerged as one of the most alarming outbreaks of coronavirus in the country.
Its hospitals are in crisis because the virus is getting out of control in a region with high rates of obesity, hypertension and other conditions that can make COVID-19 even more dangerous, where access to healthcare was limited even before the outbreak, and where public resistance to masks and other precautions is stubborn.
The virus killed more than 335,000 people in the United States, including more than 4,700 in Alabama. Places like California and Tennessee have also been hit particularly hard in recent weeks.
At Cullman Regional, a medium-sized hospital serving an agricultural area 55 miles north of Birmingham, the intensive care unit last week was at 180% capacity, the largest in the state. Other hospitals are also struggling to keep up with the flow of people infected with the virus.
Although a typical patient may need treatment in the ICU for two or three days, said Smith, patients with COVID-19 tend to stay two or three weeks, causing the number of cases to increase.
Alabama ranked sixth on the list of states with the most new cases per capita last week, according to Johns Hopkins University. Alabama’s latest average positive rate – the percentage of tests positive for the virus – is almost 40%, one of the highest in the country. And the state is seeing an average of 46 deaths per day, up from 30 on December 14
While ICUs across the country were at 78% capacity during the week of December 18-24, those in Alabama were 91% occupied, according to the U.S. Department of Health and Human Services. Last week, 15 Alabama hospitals had intensive care units of equal or greater capacity, and the ICUs of six more hospitals were at least 96% full.
As of Monday, there were 2,800 people in Alabama hospitals with COVID-19, the highest total since the pandemic began.
Experts fear that the tension will only increase after the holidays because of new infections related to travel and meetings of family and friends.
“I think we are in a terrible situation. I really do, ”said Dr. Don Williamson, head of the Alabama Hospital Association. “I’m afraid that our Christmas wave is much worse than the Thanksgiving wave.”
Alabama Governor Kay Ivey broke up with some of her southern colleagues at the time, imposed a statewide mask mandate that has been in place since July, but health officials have been struggling to get people to obey. The Republican governor also issued an order to remain at home at the start of the pandemic, but he vehemently opposed doing so again, saying, “You cannot have a life without a breadwinner.”
California, by contrast, has issued strict home stay orders in recent weeks in areas where ICU occupancy has reached 85%.
“Unfortunately, we have people who are still gathering in groups, traveling on vacation, doing things that are not safe,” said Dr. Scott Harris, Alabama health officer.
Deep South state has some of the highest rates of certain chronic health conditions that increase the risk of death or serious illnesses caused by 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 several states that have not expanded Medicaid under the Affordable Care Act and, therefore, has a large number of people without insurance. About 15% of people aged 19 to 64 are not covered, 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 ones, in the past decade, a trend that has left regional units to compensate.
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 maintain his composure, pausing and pursing his lips as he talked about the possibility of having to ration care in the new year.
“I have been practicing in this county since ’98. I have never had more than two or three people with influenza breathers in the past 20 years, ”he said. “We always have a lot of patients in the ICU in the winter. Having 16 patients on ventilators with a disease we don’t normally have is unprecedented. “
UAB Hospital, affiliated with the University of Alabama at Birmingham, brought in retired nurses and dozens of teachers and students from its school of nursing to help.
Hospitals in Alabama are receiving calls from neighboring states like Mississippi and Tennessee as doctors seek extra space for COVID-19 patients, but they are not able to help with the frequency they used to in the past. The same is true within the state, with hospitals that can help care for patients after a disaster like a tornado unable to help now.
With thousands of people already vaccinated with the first of the two doses needed to protect themselves against COVID-19, the end of the pandemic is near. But in the meantime, the number of medical workers is increasing.
“We see death. This is part of what we do; it’s part of our training, ”said Boyle. “This year’s difficulty is precisely the tremendous number. We cannot mourn a patient before having to look after another. “