With eight new COVID-19 deaths reported Tuesday, infected Lawrence County residents are dying of the disease at a rate more than three times that of Morgan and Limestone counties and more than twice the statewide rate.

In one week, from Sept. 8 to Tuesday, the Alabama Department of Public Health’s reported COVID-19 death toll for Lawrence County residents increased from five to 20. With more than three times Lawrence County’s population, Morgan County has 25 deaths. Limestone County, with more than twice the population of Lawrence, has 19 confirmed COVID-19 deaths — one fewer than Lawrence County.

“I think everyone here knows someone who died of it,” said Lawrence County Commissioner Bobby Burch, who said he personally knew a half dozen who succumbed to the disease.

There are signs things will get worse for the county before they get better. The cumulative number of COVID-19 cases has doubled since July 25, reaching 568 Tuesday. Among those tested in the last two weeks, 22.13% — more than 1 in 5 — Lawrence County residents have tested positive. That’s more than double the statewide positivity rate over the last two weeks. Twelve new cases were reported Tuesday, about double the seven-day average.

Dean Griffin, CEO of Lawrence Medical Center, said he’s been following the spike in fatalities, although none of them have been patients at his hospital. He said the hospital has had eight to 10 COVID-19 patients total, but many with the disease go to other hospitals in the region. ADPH records fatalities not at the county where individuals died, but where they resided.

“I was surprised when it jumped to 12 (on Saturday), and obviously with eight more to 20 is extremely concerning,” he said Tuesday.

One factor, he said, may be that Lawrence residents are not seeking treatment as quickly as they should. 

“Some patients are scared to go to the hospital or to their doctor until they’re very sick,” he said, increasing the likelihood of a bad outcome.

Poverty

Demographics could in part explain the unusually high death rate among infected individuals, and also their reluctance to obtain costly medical care.

Statewide, according to ADPH, 77.1% of those who die of COVID-19 are 65 or older. About 19% of Lawrence County’s population is 65 or older, according to census data, which is about 1 percentage point more than Morgan and 4 percentage points more than Limestone.

Almost all statewide deaths have involved people with preexisting conditions, with the most common being heart disease, diabetes, kidney disease, lung disease or a combination of several such conditions.

About 14% of Lawrence County residents under the age of 65 have no health insurance, higher than either Morgan or Limestone counties. Lawrence County’s 19.3% poverty rate is 6 percentage points higher than Morgan and 8 percentage points higher than Limestone. Median annual household income in Lawrence County is $44,515, more than $5,000 below Morgan and $12,000 below Limestone.

Assistant State Health Officer Dr. Karen Landers said these demographics make a difference when it comes to COVID-19 death rates, because it correlates directly with the preexisting conditions — also called co-morbidities — that make people more vulnerable to COVID-19.

“You will see that poverty is an issue,” she said.

Even if they get prompt medical attention for COVID-19, years of inadequate treatment for other medical conditions leave them at high risk when exposed to the coronavirus.

“We do know that with those who are uninsured, underinsured or in poverty, or all three, you see more of the co-morbid conditions in your population. You’re not accessing medical care. You’re not able to maybe purchase your medication or stay on your medication on a regular basis, or receive the follow-up care that you need,” Landers said.

“Certainly, underlying health problems are more prevalent in people who have less access to medical care. For example, when you see people who have poverty, you will also see more underlying problems such as diabetes, hypertension, heart disease — people who are underinsured or uninsured not seeking medical care.”

Landers said the fact that eight new Lawrence County deaths were reported Tuesday does not mean eight people died Monday. ADPH reviews each death reported to it as a COVID-19 death before determining whether that was the actual cause. A person infected with the coronavirus can die from other causes, and ADPH does not record those deaths as resulting from COVID-19.

She said delays in receiving medical records, death certificates and other information can delay ADPH’s reporting of COVID-19 deaths.

“If you have a number of deaths reported in a county in one day, that doesn’t mean that all those deaths occurred overnight, but rather over a period of time,” she said.

Judy Smith, administrator of the ADPH Northern District, also said her understanding was the eight deaths reported Tuesday had been spread out over a period of time, but she said the number of deaths in such a small county is of concern.

“A death is a tragedy no matter when it occurs, and it’s certainly a tragedy for that family,” she said. “I did confirm with our state physicians that they did not have a report of an immediate cluster, which is good in terms of turning down the alarm button. On the flip-side of that, one of the most critical pieces of this data is that this is not over. The potential for high-risk individuals to be sick, and really sick, is truly there.

“Even if we’re turning the curve in terms of total (statewide) numbers, it’s not time to turn loose of the steering wheel. In fact, it’s time to hold that steering wheel tighter.”

Lawrence County Coroner Scott Norwood said he has tested some deceased individuals but has not listed COVID-19 as a cause of death on any. He said he only examines unattended deaths, so his evaluations would not include those who die in hospitals or nursing homes.

Some of Lawrence County’s 20 COVID-19 deaths likely involved residents of NHC nursing home in Moulton, but it is impossible to know how many.

Thirteen NHC-Moulton residents who tested positive for the coronavirus had died as of Tuesday, said NHC corporate spokeswoman Casey Reese, but not all died of COVID-19. “Those are patients who have died with COVID. It includes any of our patients who may have been in hospice or had Stage 4 cancer. They may have been asymptomatic (for COVID-19) but had a test that was positive,” Reese said.

Thus, some of those 13 may not be reflected in the ADPH count of coronavirus-caused deaths.

Also, many people receiving care at NHC are not Lawrence County residents, and their deaths would be reported by ADPH according to their county of residence.

Community spread

Reese said the national chain has seen the same scenario play out in other facilities. Despite ending in-person visitation by family members at the Moulton facility since March, spread of the virus in Lawrence County inevitably meant some employees would be exposed.

“That county has really spiked in its community cases, and as the community cases increase, eventually we anticipated we would have some cases in the center,” Reese said. “Since this outbreak that we’ve had — that started last month — we’ve been doing weekly testing. The weekly testing confirmed a couple of positive employees. They were automatically sent home to recover and then return to work. Through that weekly testing we identified more of our patients and employees.”

She said employees are now being tested twice a week due to the increase in Lawrence County cases.

The facility has 10 residents with active cases of COVID-19 and 49 residents who have recovered. Forty-four NHC employees have tested positive, and all but one have since quarantined, tested negative and returned to work.

Reese said NHC has a designated COVID-19 unit for those residents who have tested positive, and there are no contacts between those residents or the staff assigned to the unit and residents who do not have the disease.

“It looks like the set of (the movie) E.T., or like an ICU unit,” she said. “It’s got all these enclosures and zippers, and people are wearing exactly what you see in the hospital."

She said in addition to screening employees daily and testing them twice a week, other steps are taken to protect residents from the virus, including requiring staff to wear masks and gowns and following all infection prevention protocols.

“But it is a pandemic. There are things that everybody is facing that are new. I wish I could say there was a crystal ball that would tell everybody how to keep the virus out, but unfortunately as the community cases increase, we just continue to follow CDC and health department guidance on how to face the challenge,” she said.

The lack of visitation and other changes have taken a dramatic toll on residents, but employees also are bearing the burden.

“Not only are they caring for our patients, but they’re helping families stay connected with virtual visits, making sure everybody is social distancing, wearing that PPE all day long,” Reese said. “They’re doing their best to keep spirits up.

“I tell you, I don’t like 2020. I saw something about the time change coming up and I thought, ‘I don’t want another hour of 2020.’”

She said at the Moulton facility and others throughout the nation, NHC can only keep COVID-19 out if the infection rate falls in the surrounding community.

“If the community can get it under control — everybody wear their masks and wash their hands and social distance — then our hope is we can reunite our patients with their families,” Reese said. “That’s what we want.”

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

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