Regional Medical Center saw an unexpected increase in hospitalizations for COVID-19 over the weekend, forcing the hospital to reopen its second coronavirus unit.
“It’s like the floodgate opened,” said Dr. Raul Magadia, who runs the coronavirus ward at RMC.
Health officials say it is a sign of how fast the situation can change as the pandemic spreads. And they can’t rule out the arrival of a long-predicted second wave of the virus as the weather cools.
On paper, Calhoun County and the rest of Alabama look like they are marching slowly toward victory over the virus. While 3,922 people in the county have had the virus since March, the number of new infections discovered daily has declined through most of October.
Magadia and his RMC colleagues were seeing success, too. On Oct. 5, they closed down one of two COVID-19 units they were operating at the hospital. Magadia said the hospital at the time was taking in only two or three new COVID-19 patients per day. By the middle of last week, there were only 18 COVID patients at RMC.
On Friday, new patients started showing up in the emergency room, positive for COVID and needing a hospital bed.
“In the last week, we’ve basically gone from 18 to running in the upper 20s, and we hit 31 one day,” said Louis Bass, CEO of RMC. The hospital sent three patients to other hospitals for care, and on Sunday reopened its second COVID wing.
Health officials don’t know why hospitalizations are up when the number of new infections is down. Bass said it is possible infections are up among people who simply haven’t been tested.
“You don’t see as many of the mass-testing sites as you used to,” he said.
Early in the pandemic, local officials offered free drive-through testing around the county, but in recent weeks they’ve switched to drive-through flu shot clinics.
On Friday, state health officials raised their coronavirus warning level for Calhoun County from “low” to “moderate,” largely because of an increase in the rate of positive results among people who have been tested.
Calhoun County Emergency Management director Michael Barton said officials typically set up drive-through testing sites when there are signs of high demand for tests from doctors and hospitals. In recent weeks, he said, there haven’t been signs of high demand.
Barton and other officials have been closely watching projections from the Institute of Health Metrics and Evaluation at the University of Washington, the nation’s top forecaster for COVID-19. The institute’s charts show the virus surging in November, reaching and possibly surpassing summertime highs in December.
It’s possible the uptick here, as well as a smaller climb in hospitalizations across the state, are signs of that predicted second wave, Barton said.
“Hopefully this is not the beginning of a steep incline,” he said.
For much of the fall, the new normal of coronavirus seemed to be working in Calhoun County. Schools reopened with emptier hallways, and football teams played in front of reduced crowds, without raising the rate of new infections, at least according to the state’s count.
“It only takes one person to infect you, not 5,000 people in a stadium,” Magadia said.
Magadia said doctors typically look to a large public event to explain a surge in new cases or hospitalizations. Now they’re looking to smaller gatherings, Magadia said: the college student who brings the virus home to his grandparents, the church service in which people take off their masks, the workplace bringing employees back from at-home work, the in-law who doesn’t take precautions but who visits more careful relatives.
It’s also possible, Magadia said, that the number of infected people truly hasn’t risen, and that the virus is for some reason causing more severe illness.
“Is it a mutating virus and it’s getting you sicker? I cannot tell,” Magadia said. Looking for mutations isn’t something RMC is equipped to do, he said.
Magadia is quick to point out more benign possibilities. The weekend surge could just be bad luck. He said some of his recent patients were “happy hypoxics,” suffering from low oxygen levels that would normally put them in the hospital, but unaware of the problem because they were confined to a bed or couch and weren’t exerting themselves.
“They start doing regular household chores and they recognize that something’s wrong,” he said.
Health officials have increasingly warned of the onset of flu season, an annual epidemic that puts its own strain on hospital resources. Magadia said he has seen patients recently with both flu and COVID, and even patients with flu, COVID and strep infection.
None of the flu-and-COVID patients — fewer than 10 so far, Magadia said — have died. Still, the doctor is reluctant to make predictions about how the two illnesses interact.
As Alabama enters its eighth month of dealing with the virus, frustration is clear everywhere. Many people still don’t wear masks despite public health orders that mandate it. Public health officials still have the same advice — use a mask, keep social distance and wash hands — because the fundamentals of the disease haven’t changed.
“We need to give the people of Alabama a goal to work toward,” said Barton, the EMA director. He said the state health department should set targets of some sort to help encourage compliance. “They go on from month to month with ‘masks are working,’” he said.
Barton and other officials agree that masks do work, no matter the difficulty of making the message stick.
“I don’t get tired of preaching that, if it can save one or two lives,” Magadia said.