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Alabama governor has no plans for a statewide shelter in place order

                                A man had his nose swabbed by staff during a screening at Waddell Family Medicine as Athens-Limestone Hospital opened a flu and fever clinic on Thursday.


    A man had his nose swabbed by staff during a screening at Waddell Family Medicine as Athens-Limestone Hospital opened a flu and fever clinic on Thursday.

MONTGOMERY, Ala. >> Alabama Gov. Kay Ivey said today that she has no plans to issue a statewide “shelter in place” order to combat the coronavirus, although the state’s largest city has directed city residents to stay at home.

Citing economic concerns, Ivey signaled a reluctance to join states including New York, California, Illinois and Louisiana that have ordered residents to stay home unless going out for food, medicine and essential services.

“We have no current plans to do so. We have seen other states doing that … but we are not California. We are not New York. We are not even Louisiana,” Ivey told reporters in a conference call. “My priority is to keep the Alabama economy going as much as possible while we take extraordinary measures to keep everyone healthy and safe.”

However, the Birmingham City Council the same day approved a “shelter in place” directive through April 3 that would direct citizens to only go out for food, medicine and essential services and work. Health officials in Jefferson County, where Birmingham is located, had already ordered the closure of nonessential businesses, including hair salons and many retail stores, in a bid to stem the outbreak.

Alabama today had at least 242 confirmed coronavirus cases, with 91 of those cases in Jefferson County. State Health Officer Scott Harris said the ages of people testing positive, raged from 1 to 97. He said the median age was 41.

No virus-related deaths have been reported so far in Alabama.

“We don’t have the luxury to wait, and this is a moment that we all need to look in the mirror and know that this is the right thing to do,” Birmingham Mayor Randall Woodfin told council members. Birmingham has 211,000 residents.

The ordinance has several exemptions for medical facilities, gas stations, grocery stores, restaurants offering take-out, hardware stores, financial institutions, nonprofits and certain businesses. People could also go out to get exercise or to take care of family members or pets. City officials said that it does not increase the number of businesses that the county health department ordered closed.

Woodfin said the temporary ordinance, which is considered a 24-hour “public safety curfew” could be enforced similarly to the city’s existing nighttime curfew for juveniles, but added that he doesn’t “believe we will actually have to enforce or arrest anyone.”

Dr. Sarah Nafziger, the co-chair of the University of Alabama at Birmingham’s Emergency Management Committee, said the hospital has isolated 45 COVID-19 patients and is awaiting test results for another 81.

“We have experienced an exponential increase in the number of patients in the last few days,” Nafziger said. “This is a dangerous situation that our community needs to take seriously.”

The virus causes only minor flu-like symptoms in most people, who recover in a matter of weeks. But it is highly contagious and young people who show no symptoms can infect others. Older people and those with underlying health problems can develop severe illnesses that test the health care system’s capacity to respond.

The state has closed all K-12 schools through April 5, and prohibited on-site restaurant dining and non-work gatherings of more than 25 people where people can’t stay 6-feet (2-meters) apart. Ivy also closed beaches and delayed the March 31 Senate primary runoff until July 14.

Health officials nationwide are trying to slow the spread of the disease and avoid overwhelming hospitals. Dr. Don Williamson, president of the Alabama Hospital Association, said Alabama has 1,344 ventilators in the state. About 550 of those are in use on an average day, leaving a “surge capacity”of about 800, he said.

The Alabama Department of Public Health said today that a 10-year-old state document that circulated about how to triage ventilators in a catastrophic event is merely guidance and not a directive for the state. It described the possible shift of ventilators away from individuals suffering conditions such as end-stage organ failure, including neurological failure, in favor of other patients.

“Decisions for care remain those of the medical professional, as the treating provider, in discussion with the patient and the patient’s family. Sometimes clinicians at the bedside will be faced with very difficult decisions, and in a true catastrophe, clinicians will be tasked with making the best possible decisions,” the department said in a statement.

Williamson, who was the state health officer at the time that document was prepared, said it was done around the time of the H1N1 flu pandemic to give guidelines that medical providers might consider if they had to make those difficult decisions. Williamson said the document was based on thinking from 10 years ago, and that different decisions might be made today.

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