“We are just seeing other countries reach or pass their peak, and I think there is still a lot to be learned about how this will play out,” the Decatur physician said. “I do think the end point will be far less clear.

“We will be dealing with this virus until a vaccine is made available, and that is probably at least 18 months away.”

McCormick, a radiation oncologist, has studied the data on COVID-19 closely, in part because many of her patients are at high risk of death if they contract the disease.

With no vaccine or cure available, she echoes state and federal health agencies in identifying the most important tool available in fighting the pandemic: social distancing.

The numbers demonstrate that even more rigorous social distancing is necessary, McCormick said. A downward trend in the growth rate of confirmed cases gave some hope in recent weeks. While the numbers kept increasing, they did so at a slower rate. On Wednesday, however, the number of confirmed cases in the state was 2,499. That was up 302 from the previous day, at that point the largest jump since testing began in Alabama. On Thursday, the previous record was broken again, with a 339 jump in cases bringing the total to 2,838.

“Hard to say if it’s just a blip in the data or if it will continue trending upward,” McCormick said Thursday evening. “But it shows us that our growth rate has the potential to escalate. Just because it has been trending downward, it doesn’t guarantee it will continue that direction. Continued social distancing is imperative.”

She explained the importance of social distancing early Wednesday, when there were 150 confirmed cases of COVID-19 in Madison County. That number reached 171 on Thursday.

McCormick begins by looking at the R0 — pronounced R-naught — of the novel coronavirus, which accumulated data suggests is between two and three.

“What that means is that every person that has the virus will (on average) spread it to two to three other people,” she explained.

Even assuming the R0 is at the low end of that range, the numbers add up quickly.

“The number of infected people increases very rapidly.”

This exponential growth is precisely what Gov. Kay Ivey and State Health Officer Scott Harris are trying to slow through emergency orders closing schools, bars and restaurant dining rooms, and generally prohibiting social gatherings of more than 10 people and gatherings in which people can’t stay at least 6 feet from one another.

“Through social distancing, we lower the ability of the virus to spread, effectively lowering the R0,” McCormick said. “So instead of one person with the virus spreading it to two to three people, ideally they aren’t spreading it to anyone, or maybe just one to two people.”

Examples of the consequences of failure to social distance are increasingly common.

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Tracing outbreak

Chambers County, with a population of about 33,000, had 161 confirmed COVID-19 cases Thursday evening and eight confirmed deaths, making it the hardest hit county in the state per capita. In tracking the cases, Harris told Alabama Daily News last week, ADPH investigators concluded the outbreak began at a church homecoming in the county in early March — well before the state implemented its April 4 stay-at-home order. That gathering led to COVID-19 cases among the attendees, and then health care workers.

While ADPH is accumulating an increasing amount of data on the spread of COVID-19 in the state, determining the extent to which the virus has spread relies on rough estimates. The ADPH reported 20,605 tests had been performed as of late Thursday. That’s about 0.4% of the population.

The actual number of tests performed is higher than that, Harris said Thursday, but not dramatically.

“Part of the issue we’ve had is tracking all these test sites that aren’t affiliated with us in any way,” Harris said in explaining the discrepancy between actual tests and reported tests. “Certain hospitals, depending on their supplies, stand up their own testing in their own community, and the specimens they collect they may send off to a private company like Quest or LabCorp.”

While positive results are reported to ADPH within four hours, there can be a significant lag time before negative test results are reported.

McCormick also emphasizes that the actual number of tests is underreported.

“With that said, without widespread testing, we really have no idea of the true prevalence of the disease in our area,” McCormick said.

“We need to do a better job with testing,” Harris agreed, noting that more widespread testing has resulted from the recent increase in availability of testing kits and specimen-collection kits.

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Patient precautions

Some estimates can be made based on data collected on the disease since its emergence in late 2019. About 25% of cases have no symptoms, 20% are severe and the rest have mild to moderate symptoms, McCormick said.

“I think we can safely say all the severe cases are being tested as well as some of the mild to moderate cases,” McCormick said of Alabama. “You can extrapolate from that the possible number of undiagnosed cases out there.”

The lack of testing is a significant problem, both because infected people with no symptoms can still transmit the disease and because a loosening of restrictions might be appropriate for those who have recovered from the disease.

“If we had more widespread testing, we could more easily figure out who has a mild or asymptomatic case so that they can quarantine themselves while their disease is contagious and know they will likely have immunity when they recover,” McCormick said.

In the meantime, however, we can’t know who is contagious. Those with shortness of breath, a cough and fever are exhibiting symptoms consistent with COVID-19, but those with no symptoms at all may be infecting others as well.

Consequently, McCormick asks her oncology patients to practice strict social distancing guidelines.

“We are asking them to stay home and not to take visitors. We are asking them to have other family members run errands and buy groceries if possible. We are asking them and their family members to wash their hands often. We are asking our patients and their family members to wear a mask and stay 6 feet from others if they must go out,” McCormick said.

Patients who must come in for treatment related to cancer are screened daily for symptoms of COVID-19 or exposure to it. McCormick has limited the number of people who are allowed in the clinic at any one time and is making sure they are spaced out when they are inside.

“Our staff is wearing PPE (personal protective equipment), not only to protect ourselves, but to protect our patients as well,” she said.

She believes these steps are necessary for her uniquely vulnerable oncology patients. But she points out that ADPH demographic data of COVID-19 deaths suggests many others who are especially vulnerable — such as those with high blood pressure, diabetes and heart disease — may not realize they are at risk.

Given that the vulnerable may not know they’re vulnerable and the infected may also be oblivious, the answer is obvious, she says. Practice social distancing.

“If we didn’t have social distancing guidelines in place,” she said, “the transmissibility of this virus is such that that the majority of our population would be infected.”