Leaders contemplate end to stay-at-home order

By its terms, the stay-at-home order issued by Harris on April 3 expires April 30 at 5 p.m. Prior to its expiration, according to the order, “a determination shall be made whether to extend this order — or, if circumstances permit, to relax this order.”

Ivey gave no indication that she planned to lift restrictions before April 30, although she did not rule it out. Her focus seemed to be on a gradual relaxation of the order, but she did not commit to that relaxation beginning April 30 or at any other specified date.

“Keep in mind, though, that these recommendations will have to be carefully integrated into the advice we’re receiving from Dr. Harris and our medical team of experts from throughout the state. On or before April 28, Dr. Harris and I will review these recommendations so that we can provide an updated plan of action before the current stay-at-home order expires on April 30,” Ivey said.

On Thursday, in an interview with The Decatur Daily, Harris outlined some benchmarks he would consider in determining whether relaxation of the stay-at-home order is appropriate.

“There are a few factors,” he said. “One is just seeing what’s going on nationally and for those states that have been in this maybe a full month longer than we have. We’d like to see how things play out there to give us some sense of what’s a good idea on when to scale back (on the order) or not.

“So far we don’t have anybody who has been able to show us that.”

He said he has some concerns that even in countries where near-total lockdowns took place, relaxation of social-distancing rules created problems.

“We’ve seen that kind of four-month lockdown in Hubei Province (in China), which is just not something that seems like it could work in the U.S. Even there, now they’re worried about reintroducing disease because the area’s opened back up to travelers,” he said.

In evaluating when easing restrictions makes sense, Harris is primarily focused on the state’s capabilities in dealing with the disease.

“The factors we’re all wanting to see: One would be that our cases are going down in some significant way and for a sustained period, not just a dip for a few days. You want to see a sustained reduction,” Harris said.

The news on this issue is mixed. While the daily number of newly confirmed COVID-19 cases in the state is growing, not dropping, it has recently been growing at a slower rate.

“Then you want to be sure you’re testing everybody that needs to be tested and that you’re able to do contact tracing and isolation on all the people that you find to be positive,” Harris said last week. “We’re working on expanding testing capacity. We’re ramping up our epidemiology capacity, but we’re still not where we want to be on either of those.”

Adequate testing has been a problem nationwide since the pandemic began. Harris explained that the stay-at-home order is in part a response to inadequate testing. Because people without symptoms can infect others, the only sure way to slow the spread of the virus is to maintain social distancing. More extensive testing would alert health officials to clusters of infected people, allowing for less expansive social distancing requirements.

Tracing contacts

Robust contact tracing should ideally be in place prior to any easing of social distancing restrictions, Harris said last week. This means identifying people infected with the virus, and then identifying all those who may have been exposed to the virus through contact with the infected person.

Harris on Tuesday reiterated the importance of this factor.

“We also want to be sure we can do contact tracing on all the people who do test positive, that we can reach those close contacts and that we can isolate people who need to be isolated,” Harris said. “In (the Alabama Department of) Public Health we are working very hard to add to our capacity to do this. We’re shifting employees from other parts of the agency into roles where they can do contact tracing.”

Another factor that Harris views as essential before social distancing rules are relaxed involves hospital capability.

“You want to make sure your hospitals are able to handle the load that they’re seeing, so they should be able to get back to normal functioning where they’re able to do their normal things and are able to handle it without the fear that there’s going to be a huge surge that’s going to swamp them,” Harris said last week.

As of Tuesday morning, Harris said, there were about 400 confirmed COVID-19 patients hospitalized in the state and another 600 hospitalized who were awaiting test results. He said he expects the peak surge in hospitalizations to be sometime in the next six to eight days. That’s consistent with the latest Alabama COVID-19 projection by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which projects the peak use of hospital resources in the state to come Tuesday.

“It looks at this time that we feel fairly confident that whatever surge we may see in the next week or so can be handled within the four walls of our hospitals, which is exactly what we would like to see,” Harris said Tuesday. “At the moment the numbers look as good as we have seen them. I’m very encouraged by that.”

Both he and Ivey stressed that they attribute those numbers to widespread compliance with the stay-at-home order.

Virus crosses borders

Harris last week also pointed to another factor that he believes should be weighed as the state contemplates relaxing the stay-at-home order.

“It matters also what’s happening in the states around us, of course. If the numbers are still going up in Tennessee and Georgia and Mississippi, that obviously has some impact on our decision-making here.”

According to the IHME, Georgia won’t reach its hospitalization peak until May 1. Tennessee’s projected peak is Thursday. Mississippi is expected to hit its peak Monday. Another border state, Florida, is not expected to peak until May 3.

“There are just a lot of unknowns right now,” Harris said.

While not specifying a definite timeline, Ivey on Tuesday indicated the stay-at-home order would not end abruptly.

“It’s got to be a reasoned process, so it will be over time and segment by segment or region by region, because one size does not fit all,” she said. “… What restaurants and bars need to do is different from what manufacturing or a retail store needs to do, so it will be phased in. We want to get folks back to work as soon as we can, but we want to do it as smart as we can.”

Harris said last week there is an ongoing balancing act as state leaders seek to protect the public from rampant infection while preserving the economy as much as possible. In the background is the realization that while Alabama has so far fared better than many states, worse outcomes are still possible.

“The worst-case scenario: Something like 10% of the state gets infected and you have 1-2% mortality,” he said.

With a population of 4.91 million, that worst-case scenario would equate to 4,910 to 9,820 deaths in the state.

“That’s really a worst-case scenario,” Harris reiterated. “New York City may have 10% or more people infected, and clearly we don’t have that kind of population density, and that seems to have a lot to do with transmission. We hope we’re nothing like that in terms of infection rates. With mortality, we just don’t know. We do have Alabamians who are really at risk based on average disease and chronic disease prevalence.”

On Tuesday, Ivey also stressed that while she wants to see the economy reopen, she wants to avoid sacrificing lives to do it.

“As governor, I have the responsibility to look out for both the health of our people as well as our economic health,” she said. “… We want to be sure we’re working as soon as we can but as smart as we can to reopen the economy, because we could have a resurgence of this virus even this fall. We’ve got to be prepared and be nimble enough to meet that crisis should it present itself.”