Mobile deals with being Alabama's new COVID-19 hotspot

May 4, 2020

An Alabama Public Radio news feature, which is part of APR effort to address the "news desert" along the state's Gulf coast. APR recruited and trained veteran print journalists in Mobile and Baldwin counties to join our news team to do radio stories from along the Gulf coast.

Mobile County is now Alabama’s COVID-19 hotspot. It’s the first county in the state to top 1,000 cases of the coronavirus. The county also leads in coronavirus deaths with 49 as of April 29.

Epidemics have been part of Mobile’s history for more than 300 years. Back in 1853, yellow fever killed more 10 percent of the population. In the current outbreak of coronavirus, Mobile County now leads Alabama in cases of COVID-19. One reason could be the coastal city’s proximity to other areas being hit hard by the virus.

“There was personal contact,” Mobile mayor Sandy Stimpson said. “You pass this disease by personal contact, so it was individuals that were in New Orleans that were attending functions or were dining out or at entertainment venues where they came into contact with someone that had the virus, contracted it and brought it back to Mobile."

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There’s already been speculation in the press that New Orleans’ Mardi Gras celebration this year may have been a factor in spreading COVID-19 in the Big Easy. Huge crowds packed in tight spaces may have helped spread the virus.

"Early on, there were some questions that were being asked of the people that were sick,” Stimpson said. “There was a connection to New Orleans because of the proximity that we have to New Orleans, because of the relationships our citizens have...And I’m not saying that to blame it on New Orleans, it’s a point that needs to be made about the infectious nature of the disease that just through a social interaction in New Orleans or it could have been somewhere else, but in this particular case, because we know New Orleans was hotbed, I think that did impact the city maybe more so than it did other cities in the state.”

Mobile officials are still working to trace the origin of the outbreak, but with more than, 1,000 cases, the priority now is to track the spread of the disease in the area. Dr. Rendi Murphree is an epidemiologist with the Mobile County Health Department.

“In the early part of the outbreak we were focusing on travel because that was where we were getting,” Murphree SAID. “Our very early cases were most likely exposed in areas where community transmission was occurring, but as soon as we started seeing community in Mobile, then that question really became less relevant.”

Mobile County residents are among Alabamians being asked to maintain social distance of 6 feet away. Murphree says one thing they’re trying to trace now are what they call the 6-15ers. In other words, people who stood within 6 feet of an infected person for more than 15 minutes.

“We still ask those questions, but with community transmission and as much asymptomatic COVID-19 as we have around the county, it now is even more difficult to try to determine where people got exposed,” she said. “So we really have shifted our focus to now that we have widespread community transmission and we know that we have asymptomatic COVID positive who are potentially exposing people without even knowing it, we really have to focus on contract tracing and trying to identify as many household contacts, close contacts, what we call the 6-15ers, the contacts that have been around an infected person for 15 minutes or more within that 6-foot distance, that’s the 6-15er, so 6 foot and 15 minutes and then we try to notify all those contacts that they need to be quarantined for 15 days.”

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Murphree said one reason for Mobile’s statistical jump was an increase in testing in April. Test results can be tricky when you’re trying to determine the actual spread of a virus where a patient may not show symptoms for days while still being contagious.

"I as an epidemiologist prefer to look at things like illness onset date to look at how transmission is occurring in the community, but we have a large number of asymptomatic covid-positive patients and that makes it challenging to try to look at transmission patterns because we don’t really know when they may have been infected because they’re not symptomatic,” Murphree said. “We know that if people develop symptoms, they are generally symptomatic within two to five days of exposure. Could be as long as 14, but for asymptomatic people, it makes it very, very challenging to sort of understand the transmission patterns."

The virus is supposed to peak in Mobile around the end of April. Gulf Coast residents, however, know that predictions aren’t always exact.

“I try to remind folks we have been through many a hurricane where the best and brightest scientists have predicted that the path of the hurricane would be anywhere between New Orleans and Tampa and we know that we use that information to make some decisions but there’s a lot of variability in these models and we just have to sort of wait and see what happens,” Murphree said.

One thing that researchers have found is that cases in Mobile are showing up in clusters. Dr. Bernard Eichold is Mobile County health officer.

“In some places,” Eichold said, “where have a rapid spread of a disease among a small population who are at high risk, we unfortunately end up with higher numbers in that population.”

Some of those populations have been in nursing homes. The Crowne Health Care has had almost 100 residents and employees test positive for COVID-19. Twelve of them have died. Frances Coleman is a spokeswoman for Crowne Health.

“It’s a stressful time in this kind of business where you care for elderly people, most of whom have what they say in healthcare jargon, co-morbidity,” Coleman said, “which is just a jargon way of saying they’ve also got diabetes, or they have COPD or some heart problems.”

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Healthcare providers point out that patients with other ailments, or who are elderly, or have less access to a doctor appear at greater risk of dying from COVID-19.

“At Crowne, we have since the very beginning, been taking all the precautions that the Centers for Disease Control recommends,” Coleman said. “We’ve screened people as they’ve come in and as they go out, limited, or restricted really, visitation from folks sanitizing equipment and surfaces and all the other things that you would do.”

Even if case numbers drop in Mobile and other areas, the outbreak may not be done. Murphree has been looking at previous epidemics, such as the 1918 Spanish Flu.

“What they learned from that event is there were actually three waves of influenza stretched over two years and we are looking at that trying to learn from what happened during that pandemic to try to apply those lessons to what we’re experiencing now,” Murphree said.

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Murphree’s office is in a building where patients were treated during that 1918 Spanish Flu pandemic and Mobile’s yellow fever outbreak of the 1800’s. Mobile got through those events and will get through this one.

“I think that it speaks to our resiliency as a community,” Murphree said. “We are a strong community and as long as we are working together to protect our neighbors and our families, we’ll be able to survive this just like we have survived devastating epidemics in the past and devastating natural disasters like hurricanes and tornadoes and oil spills and all of those things.”