By 
April 24, 2020
Our knowledge of COVID-19 is rapidly evolving, but one thing is abundantly clear.
As officials finalize plans to reopen the economy, life as we knew it before coronavirus will not be the same.
What does that mean for nearly 5 million Alabamians currently under a stay-at-home order from the state? Until scientists learn more about the disease and a vaccine is available, things won’t go back to “normal” anytime soon.
“We’ve got people itching to go back to work and go back to life as usual,” said Huntsville Hospital CEO David Spillers. “Until this plays out a little bit longer, I’m not sure we’re going to be able to do that.”
The new normal
Don’t be surprised if you return to work in a few weeks and your employer takes your temperature. Or if you dine in at a restaurant and your server wears a face covering and gloves.
These measures and more may be part of the “new normal” when Alabama’s stay-at-home order expires and businesses begin to open up again.
Face coverings, hand washing and physical distancing will be critical to help slow and eventually stop the spread of coronavirus in our communities.
We still have COVID in our population, and it’s going to pop up when it finds a vulnerable individual.”
“Social distancing is going to go with us right into the new normal,” said Dr. Pam Hudson, CEO of Crestwood Medical Center. “We have to be protective of ourselves, paying attention to the fact that people don’t come into our 6-foot space.”
Many believe the virus will dissipate in warmer weather. Unfortunately, the evidence doesn’t back this up.
The World Health Organization (WHO) said COVID-19 is transmittable in all areas, including those with hot and humid climates. So residents should continue to be vigilant as summer approaches.
“We still have COVID in our population, and it’s going to pop up when it finds a vulnerable individual,” Dr. Hudson said.
Protecting others
COVID-19 is primarily spread by respiratory droplets via coughing and sneezing. The virus, which typically appears 2-14 days after exposure, can range from mild, cold-like symptoms to severe illness and death.
In some cases, those with COVID-19 show no symptoms at all. It’s for this reason that all residents should assume they’re contagious, even if they don’t feel sick.
The novel virus can affect anyone, but is especially dangerous for senior citizens and those with chronic health conditions. Moving forward, State Health Officer Dr. Scott Harris said we must do everything possible to protect those high-risk groups.
This includes staying home when you feel sick to prevent others from becoming ill.
“What we can expect to see once the curve flattens out is we’ll still be at risk to having outbreaks in a nursing home or a particular workplace that, at least temporarily, will be a real crisis for those facilities,” he said.
Dr. Harris said Madison County is among the healthiest in the state, but is not immune to the effects of COVID-19.
While Huntsville has a relatively small number of COVID-19 cases compared to other areas, Dr. Harris said the situation could worsen if people don’t take health advice seriously.
“This disease is particularly a problem with our seniors and for people with certain health conditions,” he said. “Alabama being a relatively unhealthy state anyway at its baseline means a lot of our workforce is high risk for problems.”
Increased testing
One of the reasons Madison County’s numbers have been fairly low is because officials were able to identify sick patients early and get them into quarantine.
In the coming months, COVID-19 testing should become routinely available, the same way a physician would test for flu, diabetes or strep throat.
“The patient would know right then if they need to go home and quarantine,” Spillers said.
Dr. Neil Lamb, vice president of educational outreach at HudsonAlpha Institute for Biotechnology, said we also need to increase access to molecular tests that detect the early stages of infection as well as newer serological tests that provide insight into who has been infected.
We’ve definitely increased the number of tests available, but we need to continue that trajectory – especially if the data suggest we should be providing wide-scale testing of the population.”
“We’ve definitely increased the number of tests available, but we need to continue that trajectory – especially if the data suggest we should be providing wide-scale testing of the population,” he said. “The quality of the tests are also improving as we gain more information and experience. We need to be using the most accurate testing available.”
On April 20, the U.S. Food and Drug Administration (FDA) authorized the first at-home COVID-19 test by LabCorp. Dr. Karen Landers, Northern district medical officer for the Alabama Department of Public Health (ADPH), said the test is promising, but she hopes results are reported accurately.
“My one concern about that is I want to be sure the health department gets those results because obviously we want to make sure we have every positive in our database,” she said.
Other efforts
ADPH is also ramping up its contact tracing efforts, which include supporting COVID-19 patients and warning contacts of exposure to help stop the virus from spreading.
“When we find someone who is infected, we need to be able to find out who they live with, who they work with and who they’ve been around and reach those people to screen them for illness,” Dr. Harris said. “We need to make sure that they know they’ve been exposed and should take precautions.”
The state normally has less than 10 people doing contact tracing work, but now has 50-60 people in those roles to meet demand. They’re also reaching out to medical students in Huntsville and other parts of the state to increase capacity.
There’s been much discussion about the use of serological or antibody tests to help combat COVID-19. The FDA said these tests can “play a critical role in the fight against COVID-19 by helping healthcare professionals identify individuals who may have been exposed to SARS-CoV-2 virus and may have developed an immune response.”
“In the future, this may potentially be used to help determine, together with other clinical data, whether these individuals are less susceptible to infection,” the agency said.
But because we’re still learning about the virus, area leaders say it’s unclear whether antibody tests are an effective tool.
“We don’t know enough about the disease to know if that antibody will last 30 days, 90 days or a year,” Spillers said. “You only know the point in time you are tested. … Without retesting on a regular basis, you don’t know if you still have the antibody and you don’t know if you’ve got enough of the antibody to keep you from getting it again.”
Next steps
Although workplaces will begin to reopen in the coming weeks, Dr. Lamb said we aren’t going back to pre-COVID-19 behaviors and guidelines anytime soon.
“Yes, we will get out of our homes and interact with friends, family and colleagues,” he said. “But this process will be gradual, not instantaneous. We are still living with a deadly virus in our midst. We can’t ignore that or wish it away.”
But there’s good news: it is in our power to slow the spread, by accepting a slightly different way of living for the short-term.
“We can’t fully predict where we’ll be in three weeks, much less in three months or next year,” Dr. Lamb said. “That’s not something we like to hear, but it is the truth. We have to be flexible, look out for others and embrace a different set of behaviors as we continue to co-exist with SARS-CoV-2.”
But this process will be gradual, not instantaneous. We are still living with a deadly virus in our midst. We can’t ignore that or wish it away.”
Dr. Hudson said Crestwood is anxious to reactivate certain operations within the hospital.
“We have patients who need surgeries, who need care, and they have been postponing it perhaps to their detriment,” she said. “We want to be ready to go the instant we are permitted to and do it in a very safe manner.”
Just because life begins to resume some normalcy doesn’t mean we can let our guard down, Dr. Landers said. If we become complacent, we risk seeing a significant increase in COVID-19 cases and death in Alabama and across the U.S.
“We can’t relax our standards and we always have to be mindful of this virus until we have better information on treatment and the vaccine, which is at least a year away,” Dr. Landers said.
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