On Feb. 27, Huntsville Mayor Tommy Battle held a press conference on the novel coronavirus. At the time, COVID-19 wasn’t a household term, so he spelled it for those who hadn’t heard of the disease. Alabama had no confirmed cases at that point; only 60 cases had been found in the United States.
Lined up behind Battle were doctors from the Alabama Department of Public Health, representatives from Huntsville’s two hospitals, the director of the local EMA, the Madison County Commission chairman and the mayor of nearby Madison.
“We have a whole group of health professionals which are behind me, and every one of them much more qualified than a mayor to talk about this situation,” Battle joked during the press conference, before inviting each to the podium to talk about how their organizations were prepping for the coronavirus.
Two days later, the U.S. officially recorded its first coronavirus death. A week later, Alabama Gov. Kay Ivey established a statewide Coronavirus Task Force. Two weeks after that, Mobile County’s health officer shut down restaurants, bars and other businesses and installed a curfew.
As the coronavirus became a worldwide pandemic, it took an uneven course through Alabama. Some hotspots emerged early on, only to be eclipsed by others a few weeks later.
Huntsville and Mobile, at opposite ends of the state, are the Alabama’s second and third biggest population centers. Their metro areas each contain more than 400,000 people.
But after nearly three months in shutdown, their coronavirus outcomes are wildly different: Madison has about 281 confirmed cases and four deaths, while similarly-sized Mobile has 1,773 confirmed cases and leads the state in deaths, at 104.
There are many factors, luck included, that play a role in how an epidemic unfolds. But a look at how each city handled the crisis reveals stark differences in early testing, public messaging and adherence to health orders.
In Mobile, businesses were shut down earlier than in Huntsville, but at least one early press conference led to tension among local leaders.
On March 18, one week after the NBA cancelled the season and the United States stopped most flights from Europe, Mobile County Health Officer Dr. Bernard Eichold II issued a health order shutting down dine-in restaurants, bars and senior centers. Mobile County has a health department that operates independently from the state, which allowed it to issue local health orders.
When Eichold took that step, Birmingham and Tuscaloosa had cases. Evidence of a cluster had appeared in Lee County. The virus had even cropped up in nearby Baldwin County, among the beach towns and fast-growing suburbs of Mobile.
But Mobile County hadn’t been touched.
“Even though we have not had a case here, we need to do this to stay ahead of the virus,” Eichold said.
Mayor Sandy Stimpson held a press conference one hour later where he openly questioned Eichold’s order. It was not a united front.
“Dr. Eichold has the authority to do what he did,” Stimpson said. “That is not what I would have done. And I will leave it at that.”
Huntsville relied on the state health orders, which came later, to close businesses. Both Huntsville and Mobile cancelled St. Patrick’s Day festivities earlier, and the public school systems closed schools March 16. Despite the warnings, many private groups went forward with celebrations on St. Patrick’s Day weekend in Mobile, contradicting messages from public officials. Madison County Commission Chairman Dale Strong closed the Madison County Courthouse the same day.
“There were people questioning the closing of the courthouse, but based on what we were watching in New York, I knew it was the right thing to do,” Strong said. Two courthouse employees later tested positive for COVID-19, he said. “Two people could have become 10, 25, 100. It could have created a petri dish of the spread and who knows where that could have led.”
Not enough tests
In the same public appearance where Stimpson questioned Eichold’s decision to close restaurants and bars, the Mobile mayor suggested that a lack of testing might pose a larger problem than open bars and restaurants.
University of South Alabama Health had begun testing of staff and patients the weekend before, but a shortage of supplies limited tests countywide. Hospitals around the region had to ration swabs and chemicals needed to detect the virus.
“The biggest challenge we face right now is the number of tests that we need,” Stimpson said on March 18. “We have so many citizens that want to be tested and the tests aren’t available. The city’s not responsible for those, for the procurement of those tests, but that is the biggest challenge if you listen to the heads of the hospitals. … We can’t do it without the testing equipment, and that comes back to the Mobile County Board of Health."
In Huntsville, testing efforts were led not by the county health department, but by Huntsville Hospital, the state’s second largest hospital and the region’s main trauma center. There are 11 hospitals in the not-for-profit Huntsville Hospital System, spread throughout North Alabama.
Tests were limited around the state, as hospitals scrambled to find supplies. The day of the Mobile press conference on March 18, Huntsville Hospital opened its Flu & Fever Clinic to test symptomatic patients for non-COVID illness and to administer COVID-19 tests when other options had been ruled out. The clinic saw 250 people the day it opened.
Two days later, Huntsville Hospital opened a drive-thru testing site at John Hunt Park near Joe Davis Stadium and tested 200-300 people daily over the next couple of weeks.
Strong believes those testing sites were responsible for keeping infection rates low.
“I will always attribute that to lower death and infection rates,” he said. “We set up for testing outside of the hospital, rather than what we saw in New York, where anybody who had symptoms had to go to a hospital and potentially infect others.
“I tip my hat to (Huntsville Hospital CEO David) Spillers for setting that up,” Strong said. “That (decision) was questioned at the time but I promise you that nobody is questioning it now.”
Strong’s wife Laura, a nurse and administrator, was one of the clinicians administering tests John Hunt Park. She later joined a mobile unit from Huntsville Hospital and Thrive Alabama that administers COVID-19 tests in Huntsville’s homeless community.
Strong said he worried for her safety, and it brought home how serious the epidemic was. “While I was doing my job, my wife was right in the middle of it all.”
In Mobile, Eichold’s move beat the virus by a hair. One day after closing bars and restaurants, health authorities confirmed the city’s first case. It was, unexpectedly, a child. The virus typically hits harder in older patients and those with underlying health conditions. The patient, Eichold said, was recovering at home.
A day after its first case, Mobile workers set up barricades at Ladd-Peebles Memorial Stadium to prepare for drive-through testing. But the city still had no test kits. Mobile County Department of Health’s Rendi Murphree said not to expect many more for at least 10 days.
“Any delay in testing absolutely means a slower time identifying cases and less of an ability to isolate positive cases and track anyone they have come into contact with,” said epidemiologists Dr. Bertha Hidalgo and Dr. Suzanne Judd of the University of Alabama, in written response to questions from AL.com. “This enables continued spread of COVID-19 that goes undetected until you put testing, isolation and contact tracing into place.”
The coronavirus still seemed to pose little threat in Mobile. But in Tina Patterson’s home, the virus took root. Her husband, 66-year-old guitarist Wayman Henry, came home March 15 from a Saturday night gig in New Orleans. Henry felt tired and sore. Within a couple days, he spiked a fever and became so weak he couldn’t make it to the bathroom. She took him to the hospital on Thursday, March 19.
“By Saturday morning, they called me about 2 o’clock in the morning, they called me to say they had to put him on a vent because he was not able to breathe,” Patterson said. “That was the last time I even got to talk to him.”
A week after he entered the hospital, Henry went into organ failure. Patterson said the hospital didn’t offer much hope, and the next morning, he died.
Henry was the first person to die from coronavirus in Mobile, on March 26. Doctors never tested Patterson or her son for coronavirus.
"Faster and more effectively"
Dr. Allen Perkins, chair of family medicine at the University of South Alabama, was involved in early efforts to ramp up testing in Mobile.
“The lack of testing really hurt us,” Perkins said. “You had a number of people go out and get community infected, and they brought that back into the nursing homes.”
Mobile County Commissioner Merceria Ludgood said health officials struggled to obtain protective equipment and test materials, shortages that became more acute as time went on.
“It was not just a Mobile issue,” Ludgood said. “It was a national issue.”
Huntsville Hospital had to close its drive-thru testing site on March 28 due to a testing supply shortage. But the hospital continued to test at its Fever & Flu Clinic, and in-house, as other area clinics began offering limited testing in the following weeks.
Despite initial shortages, David Spillers, CEO of Huntsville Hospital, credits testing as the reason Madison County’s infection rates remained low.
“There’s no question Madison County implemented testing on a large-scale basis faster and more effectively than anywhere else in the state, which helped us identify patients and get them quarantined,” he said.
In late March, Stimpson announced that drive-through testing in Mobile would be delayed again. City officials entered an agreement with a local lab for 10,000 test kits, to be delivered by April 1. The lab owners could not get their hands on enough supplies to make it work.
Reaching the public
On April 2, Mobile had its largest one-day jump so far in confirmed cases, from 57 to 69. The city’s drive-through test site was still on hold, but Stimpson decided to take action on large crowds in big box stores, issuing an executive order that capped occupancy at 40 percent. A day later, Stimpson announced a curfew with fines for non-essential workers caught out at night.
Other cities announced fines as high as $500 – but Mobile opted for a lower penalty of $100.
Four days later, Mobile’s cases more than doubled. The drive-through test site finally opened at Ladd-Peebles Stadium on Monday, April 6 for patients with appointments after Mobile-based Synergy Laboratories came through with test kits for the county.
The week after wider testing began, Mobile’s coronavirus tally more than tripled. Stimpson proposed stricter limits on capacity at big box stores but backed away after objections from some city and county leaders.
Up in Huntsville, Madison County’s new daily cases remained, for the most part, in the single digits. Local leaders announced at press conferences that police would be dispatched to enforce distancing and occupancy rules at big box stores.
But unlike all of the other large cities in Alabama, Huntsville never adopted a curfew during lockdown.
On April 10, Stimpson, Eichold and Mobile County Commissioner Merceria Ludgood came together to create a Mobile Unified Command to make decisions for the regions. Up until that point, the county’s 11 cities had 11 different set of rules and regulations.
“What it allowed us to do was rather than having a patchwork of responses, we could have a countywide response,” Ludgood said.
The group began holding regular press conferences.
Meanwhile, Huntsville had been holding a unified, daily press conference since March 16.
Leaders were also meeting by phone each day at 11 a.m., in a call organized by the Madison County Emergency Management Agency that included local leaders, representatives from both hospitals, emergency services and first responders.
“We modeled it (based) on our history of tornadoes and other natural disasters, where EMA coordinates the meeting and everybody who would respond in a disaster is on the call,” said Spillers.
Each day at noon, local media gathered for the daily Madison County COVID-19 briefing, while thousands watched on Facebook Live and local news stations. Some days, video views on the city’s Facebook livestream alone topped 10,000.
Each press conference included remarks from a leader in healthcare community, usually Spillers from Huntsville Hospital, Crestwood Medical Center CEO Dr. Pam Hudson or Dr. Karen Landers from the Alabama Department of Public Health. Each would speak about local infection and hospitalization numbers, and the importance of safety measures like social distancing and sanitizing.
Spillers was among the first in Alabama to press the importance of wearing masks in public. Huntsville and Crestwood hospitals on April 2 became the first in the state to announce all visitors must wear masks before entering the building.
A local leader – typically Strong, Battle or Madison Mayor Paul Finley – would discuss community responses.
After each daily briefing, the speakers took questions from local media.
“We’re a region full of engineers and people who like data,” said Spillers. “We had reams of data, and the feedback we got from our press conferences is that people like that data. People in general don’t like to be kept in the dark, so our goal was to tell them what we know.”
Hildalgo and Judd, the UAB epidemiologists, said public messaging during a pandemic is “supremely important.”
“A community that is informed with evidence-based, scientific information should be better equipped to make informed choices,” they said in a statement. “The dissemination of information about how COVID-19 spreads, how to get tested, where to get tested, who is at risk; all information pertinent to preventing further spread of disease is very useful.”
Madison County Emergency Management Director Jeff Birdwell closed each briefing with the same message: “Stay safe, stay separate and remember to sanitize.”
Strong said he initially focused on Madison County during the press conferences, but soon began getting emails from surrounding counties that were in the viewing area of TV stations airing the briefings.
“I started thinking that this was a better opportunity to let them know how to protect themselves and reduce transmission,” he said. “I later found out north of 125,000 a day were watching that press conference.”
Battle said the partnership between the hospitals, local leaders and public health officials was “the most important thing” when it came to Madison County’s response.
“It’s been a team sport,” he said, “and that’s what’s helped us get through.”
Haircuts become flashpoint
Ivey issued a stay at home order on April 3, shuttering entertainment venues, athletic facilities, salons, schools and gatherings. The number of cases statewide surged toward 2,000, with 50 deaths.
But by April 15, Huntsville’s leaders were cautiously optimistic, as the number of new cases dropped to roughly three per day. Hudson with Crestwood Hospital said on April 15 that Huntsville was “on solid track to claim success at flattening the curve.” Spillers said the hospital had only eight COVID-19 patients, with another 10 in affiliated hospitals throughout North Alabama.
That week, Spillers cited the nearly 9,000 tests administered by Huntsville Hospital and its affiliated hospitals: “Early testing and a lot of testing allowed us to isolate people early in the process to keep it from spreading.”
Quarantine fatigue boiled to the surface further south. Mobile led the state on citations for curfew violations even as its cases began to skyrocket. On April 21, barber Joel Edwards opened his Mobile barbershop in violation of the state health order. He and law enforcement officials soon agreed to close the business, but local leaders expressed sympathy for the plight of small business owners unable to earn money during the shutdown. A support of the barber handed him $500 to pay his fine.
Stimpson joined several other mayors to lobby Gov. Kay Ivey to allow the reopening of barbershops, which she had declined to do in April.
Also on April 21, the city council debated whether to reopen golf courses, tennis courts and basketball courts. Mobile City Council President Levon Manzie cautioned leaders to move slowly.
“I think all talk of that nature is premature until we see appreciative evidence that we are trending downward,” said Manzie. “I am the first advocate for opening up everything. But I want to do it when it’s safe for our citizens.”
By April 30, the day Ivey relaxed some restrictions, but not on barbershops, Battle asked publicly when Huntsville would be rewarded for its success in keeping infection rates low. He wanted to see a reopening of businesses.
“One size does not fit all in this case,” he said, adding that he’d have preferred the state reopen by regions. But he appeared to go back and forth that day, as he also said he was fine with the way the state handled it.
By early May, as Alabama started to slowly reopen, the average number of new cases in Mobile held steady at about 40 a day. After the late start, its testing capacity caught up to other cities. By mid-May, 4 percent of the population had been tested. Still, Mobile County, far smaller than Jefferson County around Birmingham, led the state in number of confirmed cases and deaths.
Still, the city council voted down a mask requirement May 5, opting instead for a recommendation.
When Ivey announced on May 8 that restaurants and salons could resume service, Stimpson appeared eager to move forward.
“It’s time to go back to work now,” Stimpson said May 8. “But please don’t drop your guard. The virus is still out there.”
At the Mobile Unified Command press conference on May 13, Stimpson announced that he’d had a haircut and a meal in a local restaurant. A day later, 64 new cases of coronavirus were confirmed in the city, the third-highest number since tracking started in March.
Ludgood said many people still aren’t following the mask recommendation in Mobile County. She worries that messages about coronavirus have not been consistent, from national leaders and the community.
“I guess what I’m seeing at play is kind of resistance from the community to being told what they can and can’t do,” Ludgood said.
Perkins has concerns as people head back out of the house and into churches. Young people who may carry the virus could mix with older people more vulnerable to serious complications.
“My sense from talking to people is that there are a fair number of people who take it very seriously,” Perkins said. “But there is a small minority of people who believe that this is a test of their faith.”
Data shows that Madison County residents were more likely to remain home during the stay-at-home and safer-at-home orders. Madison County residents spent up to 90 percent of their time at home, according to a Washington Post analysis of cellphone location data in April. It was among the highest levels in the state. Mobile County spent about 85 percent of its time at home.
“We’re a very well-educated and compliant community,” said Spillers. “When we asked people not to go out, they didn’t go out. When we asked people not to congregate, they didn’t.”
It may have been easier in Madison County to stay home. The County’s biggest employer is Redstone Arsenal, which tightened access by mid-March, and where thousands of white-collar workers were given the option to telecommute. Mobile, on the other hand, has particularly robust restaurant, hospitality and tourism industries, as well as thousands of manufacturing jobs.
And there’s a difference in the racial makeup of the two counties. Mobile County is about 36% percent black, compared to Madison’s 25%.
“African Americans comprise approximately 36% of the (Mobile) population but account for 45% of known cases,” said Hidalgo and Judd, “and among known cases, 50.5% of COVID-19 related deaths.”
Mobile County has made the racial makeup of its cases and deaths publicly available. Madison County is overseen by the state health department, which has only released racial data on a statewide basis.
“It’s hard to speculate why the number of known cases might be so different, considering both counties have similar age distributions,” said Hidalgo and Judd. “There are economic and racial/ethnic differences that may or may not be statistically significantly different.”
By late May, Madison County has maintained a low number of COVID-19 cases even as case numbers spike elsewhere. Mobile continues to lead the state in number of cases and deaths.
As is the case across the state and nation, most of those deaths in Mobile have been among the elderly. The Mobile County Health Department announced nursing home outbreaks in six facilities. More than 100 cases have been confirmed at Crowne Health Care, and several staff members and residents have died.
More than 60 people also tested positive at the Mobile County Jail and one staff member died.
Huntsville has so far avoided that fate, but Spillers is cautious. Madison County crossed 200 cases by mid-April but has yet to cross 300 as growth has stalled over the last month. Madison County has reported just 4 deaths, a number that hasn't moved in a month.
Mobile and Madison looked about the same in early April. But while Madison stalled halfway through April, Mobile County watched the virus accelerate. The county has now seen 107 deaths and more than 1,800 cases.
“I’ve said before,” said Spillers, “we’re one long-term care facility or one church away from looking like a lot of these other communities, where multiple people get infected and all of a sudden you get 200 or 300 people who are sick.”
After all, doctors and officials in Montgomery, Alabama's fourth largest metro, recently announced that Montgomery is only now reaching its peak, as the city also saw limited spread early in the lockdown but watched the virus pick up in May.
In Madison County, community spread of the virus still appears minimal. On May 18, Spillers said the Huntsville Hospital system had been testing hundreds of people for COVID-19 prior to elective procedures in the past couple of weeks and found only one positive.
“Contrary to the belief that there are a lot of asymptomatic patients running around in our community that weren’t diagnosed, data is not proving that to be true,” he said. Even he sounded surprised, saying that he expected more.
In Mobile, the rise in new cases appears to have slowed in recent days, as the stay-at-home orders lifted and beaches, restaurants and retailers reopen.
Yet for some, it’s still hard to feel safe. Several weeks after her husband fell ill, Tina Patterson ventured out of her Mobile home.
“It took me almost six weeks to get out the door,” Patterson said. “And when I went out the door, I went out shivering and shaking because I was nervous. Because you can’t see this virus. You don’t know who has this virus. I wish Mobile would have taken this virus a bit more seriously.”
AL.com staff writers John Sharp, Lawrence Specker, Paul Gattis and Ramsey Archibald contributed to this report.
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