September 17, 2021
"The Population is Shrinking"
“The state population is shrinking, and we have never seen that happen before in the history of Alabama.” That’s what Dr. Scott Harris told reporters on Wednesday. In 2020, Alabama’s death rate exceeded its birth rate for the first time ever, and it is expected to do the same in 2021. Last December, an average of 52 Alabamians died of Covid-19 every single day and that number rose to 68 per day in January. Then, as vaccinations ramped up and cases dropped, deaths declined. By May, only 3 Covid deaths per day were reported in Alabama. Delta’s arrival this summer changed that.
During the last 4 days, 370 Alabamians reportedly died of Covid-19, including 192 today, and 13,048 people in our State have now died overall. Our per capita death rate in the last 7 days is up 110% from the prior week and we are virtually tied with Florida and Mississippi for the highest death rate in the nation. This should surprise no one. For weeks, our state hospitals have been forced to provide more intensive care than they have the space or staff to handle.
Rising hospitalizations lead to rising deaths - and, like Alabama, the rest of the Deep South is besieged with Covid hospitalizations. Those states with the most per capita Covid hospitalizations in the last 14 days are: Kentucky (58/100K); Georgia (56/100K); Alabama (55/100K); Florida (52/100K); West Va. (51/100K); S.C. (50/100K); Tennessee (48/100K); Texas (48/100K); and Mississippi (42/100K).
There is a stunning contrast between the South and the rest of the country in terms of Covid deaths. In a study of CDC data between 1999-2019, published by Fortune magazine, cancer deaths per 100K population varied by a factor of 1.5 from the highest of any state (Mississippi) to the lowest (Utah). Deaths by heart disease varied by a factor of 1.9 from the highest (Oklahoma) to the lowest (Hawaii). In the last 6 months, however, per capita Covid deaths in Florida (highest) have exceeded those in Vermont (lowest) by a factor of 8.4. That is a staggering difference. If Florida and Texas had Covid mortality rates equal to Vermont’s, they would have collectively saved 23,000 lives since March 1 alone.
Death, of course, is a lagging indicator and, like a wildfire, the Delta variant constantly needs new wood to burn. As more Alabamians get vaccinated, there are hopeful signs that the variant may be running out of wood. Since my last letter on Monday, we have seen 14,541 new cases - 3,944 on Tuesday, 3,651 on Wednesday, 3,972 on Thursday and 2,974 today - down from 16,630 cases for the same 4 days the prior week.
Our hospitalization rate has also improved this week - 2,223 patients in 105 hospitals, including 53 children (21.2 per hospital) - down nearly 15% compared to the prior week. UAB Hospital is currently treating 115 Covid patients, a drop from 126 patients two days ago. Yet, there remain over 725 Covid patients in intensive care units throughout the State, out of a total of 1,580 ICU patients overall. Alabama is tied with Kentucky, West Va. and Georgia for the highest per capita ICU occupancy rate in the nation.
Any examination of hospitalization and death in this pandemic must end with the observation that vaccination is the key to survival. Although breakthrough infections do occur, 88% of all hospitalized Covid patients in Alabama are unvaccinated and that percentage has remained constant. Moreover, a new nationwide study of hospital records, published in Research Square, found that, among those cases severe enough to require hospitalization, there is a significant qualitative difference if you’ve been vaccinated. Roughly 57% of the vaccinated patients in the study were considered “soft” hospitalizations, meaning they need only minimal treatment and leave the hospital relatively quickly. That's compared to only 45% of unvaccinated patients who fall in the “soft” category.
Today, an FDA panel voted to recommend against booster shots for younger adults, but supported boosters for seniors aged 65 and older. This vote is further confirmation that vaccines work as intended. Vaccines are not an impenetrable shield and their efficacy begins to wane over 6-8 months. But, they go a long way to prevent severe infection and, most of all, they keep you alive. The totals:
9/5 - 2,162
9/6 - 2,566
9/7 - 2,672
9/8 - 4,791
9/9 - 4,367
9/10 - 4,800
9/11 - 4,494
9/12 - 1,794
9/13 - 2,792
9/14 - 3,944
9/15 - 3,651
9/16 - 3,972
9/17 - 2,974