More Alabamians are in the hospital for COVID-19 now than they have been since early March. That’s according to the Alabama Hospital Association (AlaHA). AlaHA reports, as of Wednesday, August 23, 229 people were in the hospital, and 37 residents were in the ICU for the coronavirus.
“If we went back to right after the Fourth of July, we had about 60 people in the hospital and five to 10 people in the ICU,” said Dr. Don Williamson, president of AlaHA. “We’ve seen, especially over the last four weeks, a pretty regular and sustained increase in COVID cases.”
As of the publishing of this report, the Centers for Disease Control and Prevention (CDC) found that, through the week of Aug. 12, 216 Alabamians were hospitalized, accounting for 4.41 new COVID-19 hospital admissions per 100,000 residents. Choctaw and Sumter Counties had the highest number of new hospital admissions. The public health agency also reports that Alabama saw a 25.3% increase in coronavirus-related emergency department (ED) visits between the weeks of Aug. 12 and Aug. 19. The state’s overall percentage of COVID-19 ED visits is now considered moderate, at 3.4%. It was previously listed as low.
The Alabama Department of Public Health (ADPH), as of May 2023, no longer reports the total number of COVID-19 cases in the state. Despite this, Dr. Williamson said as hospitalizations and ICU visits pick up, residents can expect an increase in overall community transmission as well.
“I think everybody recognizes there is more COVID being spread in the community now than there had been in May, June and early July,” he said.
Dr. Williamson said a new COVID-19 variant could help explain the recent summer surge of COVID-19 hospitalizations in Alabama. The variant is called EG.5.
“It doesn’t appear to have symptoms any different than what we’ve seen with the XBB strain or most of the recent Omicron strains,” he said. “It is more capable of spread, as evidenced by it now accounting for about 21 to 25% of the infections in the United States. But it does not appear to cause more severe disease, and the emergence of EG.5 as the current, most prevalent strain helps to explain the increase in hospitalizations and disease in the community.”
While the new EG.5 variant does contribute to more disease, Dr. Williamson said it is not the only factor at work here; immunity and lingering summer heat also play a role.
“We are all now a fairly great distance removed from our last booster. Many of us had a booster six months ago or a year ago. Immunity has waned, and disease burden has, until recently, been very low. Even natural immunity has not enhanced,” he said. “The other thing that may be a little different from previous summers has been the heat. How does the fact that it’s 103 [degrees outside] contribute to increased COVID cases? Because it’s so hot, people are not outside as they have historically been in the summer. People are sheltering indoors in air conditioning. You have a better opportunity for transmission in indoor environments than you do outdoors.”
These three factors are not only affecting Alabama. According to the CDC, Alabama, Georgia, Florida, Mississippi, Tennessee, Kentucky, North Carolina and South Carolina collectively saw a 13.8% increase in positive COVID-19 tests between the weeks of Aug. 12 and Aug. 19. That’s 9,435 positive tests overall. Nationally, the number of positive COVID-19 tests was 13.4% as of Aug. 19. Dr. Williamson said the country is also seeing an increase in hospitalizations nationwide, with 12,613 hospital admissions during the second week of August alone.
Though the number of hospitalizations in Alabama has risen from double to triple digits over the past eight weeks, Dr. Williamson said the new EG.5 variant is not expected to cause as much of an impact as previous strains.
“We’re looking at dramatically lower numbers than what we’ve seen with previous outbreaks,” he said. “I don’t think anyone expects this [variant] to be like anything we’ve seen around the country with earlier outbreaks, where we had over 1,000 people in the hospital. In fact, our numbers are fairly stable now. Over the last several days, we’ve had about 215 people in the hospital. We’re not really seeing dramatic increases right now. It certainly does not appear to be more deadly than what Omicron has been. Over the last several days, we’ve not had any reported deaths due to COVID.”
Not only that, Dr. Williamson said Alabamians who are in the hospital for COVID-19 are doing OK overall.
“This is not the sort of thing we saw either with Omicron when it first came out or with Delta. We’re certainly not looking at hospitals being overrun and overwhelmed. This is simply an observation we’re seeing [that] more people with moderate to severe respiratory illness [are] being hospitalized due to COVID,” he said. “Fortunately, they’re generally doing very well when they get care. It’s not any different, frankly, from what we would expect to see with influenza or with respiratory syncytial virus (RSV).”
As with other COVID-19 variants, AlaHA and ADPH report Alabamians at most risk for contracting EG.5 are those aged 50 years or older as well as residents who are immunocomprised, suffer from underlying respiratory or cardiovascular diseases or are unvaccinated.
Dr. Williamson said the best way Alabamians can prevent getting COVID-19 is by receiving a vaccine or their next booster shot. Alabamians looking for a vaccine that is specifically targeted towards the XBB lineage of the Omicron variant, including EG.5, may have that option in the coming weeks.
“The most important thing is, if you’ve not had a booster recently, and by that I mean in the last six months, get vaccinated. Vaccinations across the country have, unfortunately, sort of fallen off, as concern about COVID has fallen off.” he said. “The good news is there will be a new booster that’s a monovalent booster specifically targeted toward XBB and its relatives, of which EG.5 is one. It will come out and be available, hopefully, in September. I think that will certainly help.”
Pfizer and BioNTech first submitted regulatory applications to the Food and Drug Administration (FDA) for the new Omicron XBB Monovalent vaccine in June following recommendations from the FDA’s Vaccines and Related Biological Products Advisory Committee. The vaccine will be available to everyone aged 6 months and older.
Dr. Williamson said some residents may be better off receiving a vaccine now rather than waiting on the latest booster until next month.
“For people aged 65 and older, especially those who have underlying immune disorders and other things that put them at risk, they may want to go ahead and get vaccinated now with the [current] bivalent vaccine and not even wait on the new, monovalent booster to come out,” he said.
Other medical experts advised that residents should consider waiting for the newest monovalent vaccine. Pfizer also published a press release discussing the advantages of this upcoming booster earlier this summer.
“Although [earlier] Omicron-adapted bivalent COVID-19 vaccines provide some protection against a range of outcomes from XBB-related COVID-19, evidence suggests that vaccines better matched to currently circulating sublineages can help further improve protection against symptomatic disease and severe COVID-19,” Pfizer said in an online statement. “[Pfizer and BioNTech] have manufactured Omicron XBB.1.5-adapted monovalent COVID-19 vaccines to ensure readiness ahead of the fall and winter season. Pending regulatory review and approval, the companies expect to be ready to ship Omicron XBB.1.5-adapted monovalent COVID-19 vaccines immediately.”
Ultimately, Dr. Williamson said it is best for Alabamians to speak with their physician to determine which vaccine is best for them. In addition to vaccines and boosters, Dr. Williamson said residents should continue practicing daily safety measures as they did with previous COVID-19 variants.
“Obviously, if you’re ill, don’t go out in public. Cough into your arm. Cover your sneezes. Wash your hands. Some people we’re seeing wear masks again. If you’re at risk of a bad outcome [like hospitalization] and you’re going into a large group gathering, there is nothing wrong with a well-fitted, N95 mask. That will reduce your risk,” he said. “For individuals who do have COVID, stay at home for at least five days [until] you’re free of disease. Residents should talk with their doctor. They may be a candidate for Paxlovid, depending upon their circumstances. It’s the things we’ve talked about all along, [but] the most important one going forward is going to be the vaccination with the booster.”
Looking ahead, Dr. Williamson said future COVID-19 surges are possible, and the same factors that contributed to Alabama’s summer surge will likely contribute to a future winter surge.
“I think it’s highly likely that we’re going to see a winter [surge]. I would not expect the current upsurge to last all the way into January. I expect it to go back down, and I expect another winter increase [in transmission],” he said. “[Though] we’re talking about EG.5 today, I assure you, there are other variants already out there that people are monitoring. There will be other variants. People who get vaccinated in September, their immunity is going to be less come January. And If we have a winter where it actually gets cold, you’re going to have people indoors more, which will facilitate transmission. We expect to see RSV, influenza and COVID all show a winter increase.”
However, Dr. Williamson said this will likely become a norm for the state and the country.
“I think we’re headed toward episodic boosters against COVID just as we do against influenza. Now that we have an RSV vaccine, we will be able to do it against respiratory syncytial virus too,” he said. “I do think there is a difference with the rapidity in which COVID mutates. Its mutations allow it to do a remarkable job at evading previous immune exposures, I think, to a greater degree than influenza. I think we’re going to be dealing with this as just another winter, viral illness that we get vaccinated against to try to reduce both our risk of disease but equally, more importantly, our risk of hospitalization and death.”
Readers can stay up to date on vaccine information and advisories by visiting the CDC’s website. More information on COVID-19 hospitalizations can also be found on the CDC’s website or by contacting the Alabama Hospital Association at 334-272-8781.
