By Ramsey Archibald

The state added nearly 6,000 new COVID cases to its database on Wednesday alone –
one of the worst single days since the virus first emerged here in March of 2020.

Alabama hospitals and ICUs, while still short of the huge numbers seen during the late summer delta surge, are already being stretched thin by omicron. And some areas are getting hit harder than others.

Dr. Donald Williamson, CEO of the Alabama Hospital Association, said hospitals in the Montgomery-Opelika region are essentially out of ICU beds – 12 more people there are in need of critical care than there are staffed beds, he said on Thursday.

Just behind was the Birmingham area, where only 28 of the region’s 514 ICU beds were available.

“Those are the two areas that are in greatest jeopardy right now,” Williamson said.

He said omicron is putting a new burden on ICUs that were already operating with just 15-16% of ICU beds available before this surge, a number that, before the start of the pandemic, would typically be around 20%. Williamson said many areas in the state are getting dangerously close to the levels seen last summer, when there were a net negative number of available ICU beds in the state.

“What’s happening is, it’s everything else plus omicron,” he said. “It’s a combination of already being filled with the usual stuff, and now with the explosion of COVID, we’re going to find ourselves from day to day in some parts of the state in a similar situation as we were [back during delta].”

On Thursday, in the midst of a rise in hospitalizations, just 9% of ICU beds in the state were available.

Statewide, Williamson said there were 268 people with COVID in the ICU, and 106 on ventilators. He said both numbers have been consistently going up. Alabama is approaching 1,500 total COVID hospitalizations – a rapid increase since Christmas, but significantly lower than highs from previous surges.

[Can’t see the chart? Click here.]

But that number includes 48 pediatric patients with COVID, and another 34 pregnant women. Williamson said the number of pediatric COVID patients peaked at around 60 during the delta surge. He said that just before omicron there were just four pediatric patients and only one pregnant woman in the hospital with COVID.

There are a number of ways in which this omicron surge looks different than all previous surges.

One is the sheer number of new cases – the state added more than 12,600 new cases on Thursday, the most ever in a day, breaking the high set just one day prior.

But considering the sheer number of cases, especially compared to previous surges, the situation in Alabama’s hospitals doesn’t seem like it would be as bad. But that’s not the case, Williamson said.

“It’s actually harder,” he said of the situation on the ground inside the state’s hospitals.

Why? One reason: Staffing.

“The real challenge is staffing,” he said. “We’ve got hospitals with over 500 staff out with COVID… And it’s not just nurses, it’s not just people in nutrition, it’s not just people who admit people, it’s all of them.”

He said some medical departments have had talks about using telemedicine to treat patients in the hospital, and that many hospitals around the state said they were as bad off now, or worse, than they were back in August and September.

The main reason staffing has been so affected this time around is because of omicron’s ability to get around vaccine protection, Williamson said. But there are other rdifferences.

One of the biggest differences this time around is there are more people in the hospital for other things – gun shot wounds, heart attacks or other issues – who test positive for the virus while they’re there. Williamson referred to the difference as people who are in the hospital “with” COVID, vs. those in the hospital “because of” COVID.

“My initial thought was, it doesn’t change the workload of the staff because they still have to doff and don PPE… but it’s actually worse now,” he said. He said that’s because COVID patients are now spread throughout the hospital, rather than confined to COVID-specific wings where the staff are well trained in the proper use of personal protective equipment.

“Mild” can still be dangerous

One big problem with omicron, Williamson said, is the perception that it’s a milder version of the virus. Statistically, that seems to be true – early data suggests a lower percentage of people who catch this strain are going to the hospital or dying than from previous strains. But that doesn’t mean people shouldn’t take it seriously, he said.

“The thing that bothers me the most at this point is a misperception that people are saying ‘it’s milder,’ and they translate that to mean there’s going to be no problem, when in reality it means it may cut your chance of dying in half, or your chance of going to the hospital by two thirds,” he said. “It doesn’t mean you, as an individual, are not going to have to be hospitalized.”

He reiterated that this is not ‘just the cold.’

“Some people are going to think this is just the cold, and they are going to end up in the hospital, on a ventilator, and die.”

With omicron, it’s a numbers game, he said. He compared the delta surge, when daily cases hovered around 3,000 cases per day, and around 10% of those ended up hospitalized. Over the last two days, we’ve averaged around 12,000 new cases, and just 3% of those have been hospitalized so far.

“3% of 12,000 cases is more than 10% of 3,000 cases,” he said. To back that up, he said new hospital COVID admissions now are nearly identical to back in September, when there were nearly 3,000 COVID patients in Alabama hospitals.

“Still getting a substantial number of people admitted to the hospital.”

And while it’s true that there are many COVID patients in Alabama hospitals who aren’t in the hospital because of the virus, Williamson said around 80% of COVID patients in state hospitals are there because of the virus, rather than for some other reason. And that extends to pediatric cases and pregnant women, too.

“We have both pediatric cases and pregnant women in the ICU, and both pediatric cases and pregnant women on ventilators,” he said.