ComebackTown is published by David Sher for a more prosperous metropolitan area of Birmingham and Alabama
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Today’s guest columnist is Frank McPhillips.
When a deadly pandemic collides with exponential growth, the result is frightening. We have reached this point in Alabama and we must accelerate the distribution of vaccines.
In October, some 30,000 Alabamians contracted COVID-19. In November, the number rose to 42,500 in one month. In December, the number of cases more than doubled to 111,000. And January cases are increasing even faster than those in December.
As of this writing (January 12), more than 400,000 Alabamians have contracted the virus since the first official case on March 12, and the death toll is 5,347. It is not easy to understand the magnitude of 400,000 cases. This is virtually equivalent to all men, women and children who live in Mobile County, our second most populous county. No other state with our population has witnessed so many cases.
More cases inevitably result in more hospitalizations, and more hospitalizations lead to more deaths, especially when all ICUs are full. On January 11, Alabama recorded 3,088 hospitalizations, the highest level ever, and double the number of patients in Alabama hospitals in July, when the state battled its worst outbreak so far.
Intensive care units in Alabama now average 94% occupancy, according to official data released by the Department of Health and Human Services. In the Birmingham area, ICU occupancy rates in Medical West, Brookwood, UAB Hospital and St. Vincent’s are at or above 94%, while those in all hospitals serving Mobile, Huntsville and Montgomery reach 96%.
Meanwhile, in the midst of a big fuss, Alabama received its first shipment of the Pfizer vaccine on December 15, the same day that we exceeded the 300,000 case limit. In the intervening 28 days, the state saw 108,000 new infections, but only 87,000 inoculations, according to the State Department of Health’s vaccine panel.
It is clear that the state’s vaccine distribution program so far is terrible. We administer 1,775 doses per 100,000 inhabitants, the lowest per capita rate in the country. West Virginia administered Alabama doses 3.5 times per capita. After four weeks, it should be unacceptable that only 1.7% of Alabama’s population has been vaccinated. At this rate, it would take more than three years to achieve 80% of the herd’s immunity.
Why is the vaccine application so slow? One reason may be a strict adherence to the CDC-recommended layered distribution plan. At the first level are 300,000 frontline medical professionals and nursing home residents, followed by seniors over 75 and specified essential workers, then elderly people aged 65-74 and additional essential workers and, finally, the population generally.
The layered system may be more equitable, but what happens when, as in the case of Clay County Hospital, 90 of the 200 high-risk doctors choose not to get the vaccine (despite the hospital being full of COVID patients, oxygen running out, and beds being added to the ICU)? How long should we wait for those at the first level before moving on to the next level and so on?
To speed things up, the State Department of Health announced last week that the state will open vaccination for those over 75, while continuing to vaccinate eligible first-level recipients. Within hours of establishing a hotline for consultations across the state, the Department of Health closed it because 1.1 million calls flooded the line. Hospitals across the state were packed with calls from residents desperate to get the vaccine.
There are about 300,000 health professionals in the state and 350,000 people aged 75 and over who qualify for the vaccine. At the current rate of vaccination, an essential worker (such as a teacher) or a 65-74 year old with pre-existing illnesses would not be eligible for vaccination until at least September. Just this morning, HHS Secretary Alex Azar reversed his earlier recommendation, urging states to open vaccination for seniors aged 65 and over.
A second reason for the slow implantation is that employees have withheld sufficient doses to guarantee a second booster injection for those who received the first dose. That policy may also be changing, as Secretary Azar, under pressure from the new Biden administration, urged states to release all doses currently stored in warehouses due to growing confidence that second doses can be provided by ongoing production. It also helps that new vaccines (Johnson & Johnson and AstraZeneca) are on the horizon.
Alabama is not the only state facing distribution problems, but it is among the worst. According to data released by the CDC, our state is the last in the country in terms of the percentage of vaccines received by the state injected into the arms of people (only 23.4%). The State Department of Health, whose panel was updated last night to show a 32% distribution rate, would question that classification, but even ADPH would admit that Alabama is in the bottom quartile.
People are justifiably angry because our civil servants are so ill-equipped to deliver vaccines after months of preparation. I don’t intend to have all the answers, but let’s be clear: there are only two ways to immunize the population – by infection or vaccination. With an average of 1 death for every 75 cases in our state (400,000 cases and 5,334 deaths), unless the state recognizes the urgency and dramatically increases the rate of vaccination, tens of thousands of Alabamians are likely to die.
Frank McPhillips is a recently retired lawyer, husband dedicated to Louise and father of three adult children. Frank graduated with honors from Harvard College and the University of Virginia Law School, and practiced law for more than 35 years at Maynard, Cooper & Gale. He currently serves on the board of several nonprofit organizations, including Advent Episcopal School, Impact America and National Multiple Sclerosis Society. To receive Frank’s free Alabama COVID daily newsletter, sign up at frankmcphillips.substack.com.
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David Sher is the founder and editor of ComebackTown. He was president of the Birmingham Regional Chamber of Commerce (BBA), Operation New Birmingham (REV Birmingham) and City Action Partnership (CAP).