Even as new cases of COVID-19 have been trending down statewide, a sharp increase in cases in Morgan and Limestone counties over the past 10 days has hospital officials preparing for an expected influx of patients.

Both counties were elevated by the Alabama Department of Public Health to “very high risk” for coronavirus transmission Friday, two of only six counties in the state in the highest risk category.

On Friday, ADPH reported 49 new cases in Morgan County, the highest daily count since Aug. 26. Limestone County had 43 new cases reported Friday, the most in one day since July 9.

One-day counts are sometimes misleading due to reporting issues, so ADPH often focuses on seven-day averages. Doing so in Morgan and Limestone counties, however, shows the same rapid increase in new cases.

The seven-day average of new cases per day for both counties has been rising steeply since about Sept. 30, approximately doubling in nine days. On Sept. 30, the seven-day average in both Morgan and Limestone counties was about 16 new cases per day. As of Friday, the seven-day average of new cases per day in Limestone was 34, and in Morgan was 30.

Statewide, the seven-day average of new cases has declined slightly since Sept. 30.

The percentage of COVID-19 tests that come back positive also is increasing in both counties, even as it has declined slightly statewide.

Judy Smith, public health administrator for the Alabama Department of Public Health Northern District, said school-related activities, church activities and generalized community transmission seem to be driving the increase in cases.

“The scary thing is we’ve also had an uptick in hospitalizations,” Smith said. “While other hospitals across the state have seen downward trends, Morgan and Limestone … have seen an uptick in hospitalizations. And now people are planning for Halloween.

"Things that bring people together where they don’t distance and they don’t wear a mask is a tragedy waiting to happen, an outbreak waiting to happen.”

Decatur Morgan Hospital

Decatur Morgan Hospital reached a peak of COVID-19 hospitalizations a few weeks after the July 4 weekend, trended down after that, but now is seeing a steady increase. As of Friday, the hospital had 30 confirmed or suspected COVID-19 patients, including seven in intensive care and five on ventilators. Athens-Limestone Hospital is also seeing the number of COVID-19 patients rise, reaching 16 on Friday with three in intensive care and one on a ventilator.

Kelli Powers, CEO of Decatur Morgan Hospital, on Friday said the hospital is scrambling to open a COVID unit at its Parkway campus as soon as possible, hopefully by Nov. 1. She said she expects the recent uptick in the county’s new COVID-19 cases to translate into more hospitalizations in coming weeks.

“We’re planning for that,” she said of the expected increase in patients. “That’s the reason we’re going to open the COVID unit at Parkway. That’s our No. 1 priority right now. We’re trying to hire as many staff as we can. As soon as we can get in and oriented, and our physicians on board, we want to get that opened. Staffing is the biggest issue.”

She said the COVID unit at Parkway will have 15 beds but have the capacity to expand to 36 beds.

It will not include intensive care units, but Powers said she is working on obtaining funding from the Federal Emergency Management Agency to build another ICU at the main campus that would have 12 beds. She said if the funding is approved, it would take six to seven months to build the unit.

“We need it desperately, COVID or not,” she said.

Due to an increased need for ventilators — including for patients with illnesses other than COVID-19 — Powers said the hospital just opened a few extra ICU rooms in the back of the emergency room and was bringing in additional staff for the rooms over the weekend.

Powers said hospital employees are weary.

“They’re all tired,” she said. “We’re not just seeing COVID patients, but COVID has put a burden on the entire system. Even our housekeepers, everybody has been affected by it. They’ve done a great job, and we’re trying to think of things we can do to make their lives better.”

As of Friday, Powers said, eight hospital staff were off work after testing positive for COVID-19, and 11 were isolating themselves after being exposed to the virus.

Like Powers, Smith is concerned the expected increase in hospitalizations resulting from the recent increase in cases will overlap with more flu hospitalizations. COVID-19 hospitalizations typically increase about three weeks after new cases increase, she said.

“We are beginning to get reports of flu cases,” Smith said. “We don’t need to have COVID added on to flu. We don’t need to have hospitals inundated.”

Smith said increases in capacity like those being undertaken by Decatur Morgan Hospital will help, but hospital staffing could be the critical issue.

“Medical staff, hospital ancillary staff, physicians as a whole have been going at this now for six to seven months,” she said. “Most of them are tired. Most of them know their big hit of the season is coming. One of the tragedies in this is we’re actually seeing people get out of the medical profession. It has been such a draining situation.”

Smith said churches and schools have been the focal point of many cases locally. Church activities, especially those indoors or without social distancing and masks, have resulted in several recent cases, she said. She said school transmission typically begins with exposure outside of the classroom.

“The bottom line is it’s less what the schools are doing than what people are doing outside of schools, but then they bring it back into the schools where they expose numerous people,” she said.

Decatur City Schools

Dwight Satterfield, deputy superintendent of operations at Decatur City Schools, said that as of Friday 411 students — 4.67% of the student population — were in quarantine. He said 28 students had recently tested positive. Decatur High had the most infected students, with nine, plus that school had another five students with major symptoms who were awaiting test results. He said four staff members in four different schools had recently tested positive and 39 were in quarantine.

Satterfield said students and parents are frustrated by the high quarantine numbers, but DCS is carefully following ADPH guidelines. He said a relaxation of quarantine recommendations for schools, announced last week by ADPH, will have almost no effect on the number of people that need to be quarantined when a DCS student or staff member tests positive for COVID-19.

Satterfield said the revised guidelines, which no longer require placing a student in quarantine based solely on a newly developed cough or difficulty breathing, will make little difference in DCS quarantine levels.

“We’re not generally seeing a new cough or breathing difficulties as something that’s triggering quarantines for our students,” Satterfield said. “What we mostly see, of the major symptoms before we get a test, is loss of taste or smell, along with fatigue, some fever, feeling bad, stomachache and things like that.”

He said the change in the guidelines to no longer require quarantine for those with a new cough or difficulty breathing “will probably affect less than 1% of the quarantines we’ve had all year. That’s just not what we experience.”

The system takes no pleasure in quarantining students, he said, because it impacts educational opportunities, causes frustration for parents and students, and generates lots of paperwork.

“Believe me, we’re not overdoing quarantines,” he said.

Satterfield said outdoor athletic events like football do not appear to be a significant source of transmission for students, but indoor events like volleyball are causing problems.

“Our football numbers and band numbers have remained relatively low in terms of quarantines,” he said. “Volleyball has been an issue. I know I’ve heard from multiple folks about recent volleyball tournaments having a lack of masks and a lack of social distancing.”

Decatur High Principal Leslie Russell tested positive for the virus last week, and Satterfield said she suspects she contracted it at an away volleyball game.

With the volleyball season nearing its end, Satterfield said DCS has no plans to end games in the sport, but the experience is leading the district to take more aggressive steps for the upcoming basketball season.

“We’re going to play all games this year in our arena. We’re going to severely limit, probably more so than a lot of the neighboring systems, the folks that come in,” he said.

The tentative plan is to allow a maximum of about 650 attendees in gyms that have seating capacity of 1,500 to 1,600. He said the Austin-Decatur games will be played over two nights. DCS also plans to host Decatur Youth Basketball games at its larger gyms but will limit attendance and have gaps between games to better facilitate social distancing.

Satterfield said the elevation of Morgan County to "very high risk" does not automatically change precautions taken by DCS, but he added it was fortuitous that students will not have in-person classes this week. Fall break is Monday and Tuesday, and the district had already planned to be fully virtual for the remaining three days of the week.

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eric@decaturdaily.com or 256-340-2435. Twitter @DD_Fleischauer.

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