Alabama hospitals lost about $739 million in revenue from mid-March to the end of April because of the coronavirus outbreak, according to data collected by the Alabama Hospital Association.

The 93 acute care hospitals had $101 million in COVID-related expenses, including personal protection equipment, in the seven-week period.

“Obviously, that’s not sustainable,” Alabama Hospital Association President and CEO Dr. Don Williamson said of the revenue decline. He previously served as Alabama’s state health officer.

Williamson said the revenue losses were a “decline in business” attributable to canceled procedures and people delaying hospital care if possible.

A state health order in mid-March delayed elective medical procedures. They were allowed to resume earlier this month and will be key to increasing hospitals’ revenue, Williamson said.

“It’s easy to understand why hospitals were having to furlough staff and do some layoffs,” he said.

Not all hospitals are up to their pre-COVID-19 procedure abilities, Williamson said.

Some laid off or furloughed staff and are in the process of bringing them back.

Hospitals with fewer COVID-19 cases in the community, such as in Huntsville, can ramp up elective procedures more quickly, Williamson said. In Montgomery and Mobile, current COVID-19 hot spots, PPE and other resources are still being diverted from elective procedures and toward virus response.

Williamson last week said many hospitals can count their PPE supplies in days, not weeks. Wednesday, he said some hospitals are reserving operating rooms for COVID-19 patients. A COVID-19 outbreak at a local nursing home can quickly fill hospital beds, Williamson said.

The Montgomery Advertiser on Wednesday reported that hospitals in the capital city and Prattville had a total of one ICU bed remaining available and were sending acute care patients to Birmingham for treatment.

“Right now, if you’re from Montgomery and you need an ICU bed, you’re in trouble,” Montgomery Mayor Steven Reed said. “If you’re from central Alabama and you need an ICU bed, you may not be able to get one. … We don’t want to lose anyone — any life — because we don’t have the resources to treat them in this community.”

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‘This could go on a very long time’

As of Friday morning, there were 13,418 confirmed COVID-19 cases in Alabama, about one-third of them diagnosed in the last 14 days, according to the Alabama Department of Public Health.

Williamson said while increased testing is important to gauge COVID-19 in the state, so are the number of people in hospitals because of the disease.

“Hospitalizations are staying up,” he said. “... We’ve been consistently between 450 and 500 for the last two weeks. So, to me, the problem is, I’m not seeing evidence that disease requiring hospitalization is going away.

“I look at the situation in Montgomery, and as in most of the cases are not associated with a nursing home outbreak, they appear to be community spread. So, what I worry about is this could go on a very long time, because we are seeing community spread continue. And I think it makes the social distancing challenge even more important.”

Williamson said he understands people can’t and won’t be forced to stay home indefinitely, but as the state reopens, social distancing and the practices that people began in March — correct and frequents hand washing, using sanitizer, coughing into their arms — are still critical.

Williamson said he has worried about the Memorial Day weekend and the opportunity for the spread of the virus.

“We’ve got COVID-19 fatigue, I have COVID-19 fatigue,” he said. “But having said that, I think it’s now more important than ever (to be cautious). Because if we don’t, I worry that three weeks from now we’ll be back where we were a month ago.”

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‘The longer this goes on, the greater the threat’

Williamson said so far, the Alabama Hospital Association estimates a little more than $400 million in federal CARES Act money has come to Alabama hospitals.

“So, roughly half of the expenses and lost revenue has been made up by the CARES Act, but only half,” Williamson said. “So, you know, that’s why hospitals are in real difficulty, and why the longer this goes on the greater the threat to the health care system.”

Williamson said he is hopeful for more federal money and expects more money in the CARES Act.

Meanwhile, in the $1.8 billion allocated to the state in the CARES Act, Gov. Kay Ivey and lawmakers recently carved out $250 million for health care providers, though it’s not clear yet exactly how much of that will go to hospitals.

“All these things are going to help, but at the end of the day, it’s really going to be about the sooner we can get COVID-19 under control and return the health care system to something resembling normal, whatever that is, the better off we’re going to be and the longer it goes, the greater the financial strain.”

Prior to COVID-19, many Alabama hosptials were struggling. Eighty-eight percent of rural hospitals operate in the red, ADN reported last year. Seventeen hospitals have closed in the past decade, The Associated Press reported earlier this year.

“We have got to get (COVID-19) under control so the system can begin to function normally; otherwise, I have no doubt we will lose rural hospitals,” Williamson said. “We may lose some large hospital systems as well.”

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