Alabama COVID hospitalizations rise, fueled by BA.4 and BA.5 variants

COVID is making a comeback in Alabama. For the first time since the first omicron wave receded, Alabama’s hospitals reported more than 500 COVID-19 inpatients this week.

That number, while still well short of some previous spikes, has steadily increased over the last two months, as the new, more contagious versions of the virus – the BA.4 and BA.5 variants of the omicron strain – have spread rapidly, even among vaccinated and previously infected people.

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There’s not much state-level data showing the prevalence of BA.4 and BA.5 in Alabama yet, but data from the Centers for Disease Control and Prevention show those two strains – especially BA.5 – made up the majority of new reported viruses cases in the Southeast as of July 2.

And the steady increase in hospitalizations seems poised to continue, at least as long as the state’s positivity rate keeps going up, according to Dr. Donald Williamson, head of the Alabama Hospital Association.

“What I’m really focused on now is the increased positivity rate, and how long we’re going to deal with this,” Williamson said in an interview with AL.com Friday. “If we stay on this trend where BA.4 and BA.5 are the most common variants, and it doesn’t mutate to make it more deadly, we’re going to continue to see steady increase in hospitalizations.”

Alabama’s positivity rate – the percentage of COVID tests performed in the state that come back positive – has also steadily increased over the last two months. That number surpassed 29% as of Thursday, the most recent day for which data was available.

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The positivity rate ticked up even faster in the days following the Fourth of July holiday, a sign that hospitalizations could continue to rise in the coming days and weeks, Williamson said.

“I think the increasing positivity rate is predicting increases in hospitalizations.”

Alabama has also seen a rise in cases over the last two months, with the 7-day average for new cases crossing 2,000 on Friday for the first time since Feb. 15, according to data from the Alabama Department of Public Health.

In terms of metrics for measuring the pandemic, cases and positivity rate aren’t as reliable as they once were. The widespread availability of at-home COVID tests means that a large number of negative – and many positive – COVID tests go unreported, according to Williamson.

“There are two reasons, if I tested positive, that I would feel the need for my number to get into the system,” he said. “One was if I was so sick, I needed to go to the hospital. And the other was if I went to get another test so I could get Paxlovid. ”

Paxlovid is a pill used to treat COVID-19 before the onset of severe illness.

But while the overall positivity rate and case rate numbers are less important than they used to be, the trends are still vital to watch – and almost everything in Alabama is trending up, from cases to positivity rate to hospitalizations.

But for the time being, Williamson said, the current strains aren’t causing as much severe illness as the state saw during waves like the delta surge a year ago. He said there were currently 80 people with COVID in the state’s ICUs, and 22 on ventilators. Both of those numbers were up in recent weeks, but not drastically so, he said.

“Yes that’s increasing, but it’s not exploding,” he said. “We’re seeing slow increases in hospitalizations, we’re likewise seeing slow increases in the numbers of people with severe illness. We’re not seeing the explosion of severe disease like we did with delta or certainly not with the original variant. In terms of severity, it’s not anything like it was before. ”

Less severe disease is a good thing, and is reflected in the only COVID metric that isn’t showing signs of increase in recent months – deaths. Williamson said the state’s hospitals aren’t seeing a big increase in deaths in the last few weeks.

“We’re in a much better place than we were during even the decline of delta,” he said.

Boosters, masks back on the menu

The BA.4 and BA.5 variants are highly contagious, to the point where infection with previous strains of COVID and even vaccination offers only limited protection. But boosters still seem effective, Williamson said.

In terms of vaccination status, he said there’s not much difference among the Alabamians hospitalized with COVID – until you look at boosters.

Of the 350-plus hospital patients the Hospital Association had data on this week, roughly 53% were vaccinated. That’s about in line with the percentage of Alabama’s population that’s fully vaccinated. But only 16% of those hospitalized with COVID had gotten a booster shot, or around 30% of vaccinated hospital patients.

“If in the next couple weeks we can get the people who are already vaccinated boosted, we might be able to limit the impact on hospitals,” Williamson said.

Williamson also said it may be time to once again don the mask – especially in crowded, indoor spaces.

“I do think we’re back in a place where it is increasingly rational for people to think about mask wearing in a real sense in indoor spaces,” he said. “BA.5 does seem to be the most infectious variant – and masks, while not perfect, will at least protect you while you’re wearing the mask.”

Do you have an idea for a data story about Alabama? Email Ramsey Archibald at rarchibald@al.comand follow him on Twitter @RamseyArchibald. Read more Alabama data stories here.

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