Alabama is making a late-summer push to tamp down its surging COVID-19 cases before schools reopen.
Alabama Gov. Kay Ivey announced a statewide mask order Tuesday that expires on July 31, just over two weeks from the time it went into effect, in the hopes of decreasing the state’s runaway escalation of coronavirus cases.
“I’m trusting the people of Alabama to do the right thing and wear a mask,” Ivey said. “With everyone’s cooperation, we can slow the spread of this virus.”
But can the numbers slow down fast enough for school systems and parents to feel comfortable reopening for the fall? And will the results of this two-week push be seen in time for parents to make difficult decisions?
Dr. Rachael Lee, an infectious disease physician at the University of Alabama at Birmingham, said it takes time for measures like closing businesses and requiring face masks to start showing decreases in case numbers and the mask order may have to be extended at the end of the month.
“If you look back at our stay at home orders, it took about a month and even longer to see some of those numbers come down,” Lee said. “I suspect that they’re going to continue to look at these numbers in two-week increments and then make a further determination as to whether or not we should continue to require masking.”
Dr. Don Williamson, president of the Alabama Hospital Association and former state health officer, said just before Ivey’s mask order was announced that even short-term “surge” measures can make a noticeable impact.
“This is one of those rare diseases where we control our future,” Williamson said during a press conference with U.S. Sen. Doug Jones. “If we -- over the next 10 days to two weeks -- will put on masks, will avoid large group gatherings, will maintain six feet of social distancing, will wash our hands and do all the things that we’ve talked about now, it seems like forever, we will make a meaningful difference in the transmission of this virus.”
A few school systems, such as Mobile and Selma, announced plans to move all lessons online to start the year. But most are planning to reopen the school buildings next month, while also offering a virtual option.
Yet, before the results of the mask requirement are seen, many schools are asking parents to lock in a decision and stick with it. Will they send their kids back to classrooms? Or will they stick with online learning?
Williamson said he wants schools to be able to open to students in the fall, but the current very high rates of COVID might make reopening unsafe for students themselves and especially for the parents, grandparents, teachers and other school employees who may catch the virus from students and suffer worse outcomes because they are at a higher risk.
He said schools in Europe have been able to reopen in some scenarios without seeing large spikes in cases, but Williamson said those locations had rebounded from their worst outbreaks, while Alabama’s curve is still going up. Alabama already saw more new coronavirus cases in July than any other month, and now hospitalizations and deaths are also hitting new highs.
“They brought them back into classrooms with enormous amounts of social distancing, and they’re bringing them back into classrooms from a community where viral transmission is dramatically reduced because of actions they’ve already taken,” Williamson said. “So my concern is if we find ourselves in a situation where we still have significant ongoing viral transmission, and we aren’t able to maintain six feet of social distance in the classroom, are we going to have those same sorts of results? I don’t know the answer to that.”
The hope is that a major increase in mask-wearing by the general public, especially during high-risk interactions, where people may remain closer than six feet for 15 minutes or more, can slow the rapid rise of new cases in Alabama before hospitals fill and stricter measures closing schools or businesses are required.
Even in Alabama, there are indications that mask requirements can have an impact. Montgomery Mayor Steven Reed said this week that the city’s number of new daily cases had been cut in half a month after implementing a mask order, though those numbers fluctuate a lot.
At UAB, Lee said that the number of infected healthcare workers in the hospital dropped significantly after implementing a universal masking policy.
But it could take much longer than two weeks.
Dr. Robert Redfield, director of the U.S. Centers for Disease Control, said this week that the country could bring the epidemic under control if everyone wore a mask for up to eight weeks. He also warned that “fall and the winter of 2020 and 2021 are going to be probably one of the most difficult times that we’ve experienced in American public health.”
Alabama State Health Officer Dr. Scott Harris, when announcing the statewide order with Ivey, said masks are one of the few tools that the state has to limit spread of the virus.
“Everyone asks ‘Does the economy need to be shut down?’ and the answer is ‘No, not if people will cooperate with the orders that we have in place,’” Harris said. “Face coverings or masks will prevent disease transmission.”
“We don’t have an effective vaccine, we don’t have highly effective treatment, we don’t have really many other options at all, but we do have the ability to try to keep person-to-person spread from occurring.”
If Alabama’s mask attempt doesn’t work, and cases continue to escalate as schools open, Williamson said the state could be facing system-wide shortages in hospital beds, personnel and personal protective equipment that are already in short supply.
“There’s nothing inherent in the virus that means it’s going to stop circulating,” Williamson said. “If we find ourselves then in August, in September, with rapid transmission of the virus, well, we have flu season that has started as early as October in Alabama.
“And the combination of influenza, which fills our hospitals, coupled with COVID-19 filling our hospitals, that’s the scenario where I become extremely concerned about system-wide capacity. So I think it’s imperative that we get this under control before we also have to deal with flu season.”
Williamson said that the way to keep businesses and schools open and hospitals from being overrun is to get people to wear masks as much as possible.
“The mask really is the gateway to more normal business,” Williamson said. “If people want their businesses open and not to have to worry about being shut down, it really is about wearing masks.”
And it's not just about reopening schools. All sorts of decisions need to be made right now about what will happen this fall in Alabama.
“If there is any hope of anything looking like a normal SEC football season,” said Williamson, “it’s doing something now and wearing masks.”
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