That once-empty office suite is now Alabama’s COVID-19 Unified Command, a collection of resources from the Alabama National Guard, the Alabama Emergency Management Agency and the Alabama Forestry Commission to support the Alabama Department of Public Health in handling the information and logistical challenges in fighting the virus.
“It's been extremely important for us in [the Alabama Department of] Public Health because we simply don't have the capacity to handle a problem this size,” Alabama State Health Officer Dr. Scott Harris said during a media tour of the facility. “To have an event that we're responding to in every county of the state, all at the same time, that's evolving this way when there's so many unknowns, we simply cannot do this without our partners.”
The ADPH’s main offices are located on different floors in the same building, including a conference room command center where twice daily briefings are held with the leadership of each organization.
About 140 people now work at unified command every day, providing the state its constantly updated data on the virus, organizing the distribution of personal protective equipment across the state and cleaning and disinfecting nursing homes and other facilities that have had outbreaks.
Retired Col. Jim Hawkins of the Alabama National Guard came back from the private sector to coordinate the unified command structure and make sure those agencies work together effectively. About half of the people working there are in the Guard, but Hawkins said the state health department is running the show.
“Public health personnel are embedded across all areas,” Hawkins said. “Anything we do should look like a normal public health solution.”
Inside the unified command, it might look like a typical, if sparsely decorated, office suite with an unusual dress code. Each division has taken over conference rooms on the perimeter of the suite, with other work stations set up in a field of cubicles.
In addition to the printed signs listing the occupants of each conference room or cubicle, there are a handful of motivational posters and signs to keep up morale.
A printed sign on the doorway of the medical operations division reminds those called there to stay on mission.
“I am still falling but since the parachute slowed my fall that means it’s okay to take it off now?” the signs asks, over a cartoon Wile E. Coyote and clipart of three parachuters gliding down to safety. “You are making a difference!! Stay the course!!!”
Another sign says “Keep calm what we do is hard,” in the style of the British campaign to carry on during World War II.
Inside the conference rooms, the walls are plastered with maps of the state of Alabama, organizational charts with contact information for the leaders of various divisions and status updates written on butcher paper.
In the data division, masked Guardsmen collect information from hospitals, and other care facilities about how many beds, ventilators and intensive care unit spaces are available, providing as close to real-time information as possible to the Department of Public Health and the state.
“There's a lot of different data streams, so one of the challenges is, how do you take all that disparate data and put it together in a package that enables sound discussions on policy and policy decisions?” Hawkins said. “We're not making policy in the unified command. We're arming the administration with the facts.”
The logistics division takes requests from medical facilities and first responders around the state for more protective equipment like masks and gloves and uses National Guard or Alabama Forestry Commission to distribute material from the state’s stockpile to places where it’s most needed.
Procurement officer Bethany Elliott, who works for the Forestry Commission, said tracking down that PPE is getting somewhat easier, but is still a challenge.
“Our normal supply chains were almost non-existent, they just didn't have product enough to support everyone and so we needed to go outside of the normal supply chains,” Elliott said. “There were a lot of vendors who jumped into this business, you know, Johnny-come-lately type thing and it took a lot of effort to source good, reputable vendors that we can get product from.”
Elliott said medical gowns are now among the most needed items in addition to masks and gloves.
“Right now we need isolation gowns so if you can make isolation gowns, give us a call because there is still a shortage,” Elliott said. “Those are lightweight gowns that you typically see in a lab setting that we could use a lot of those. If you've got an empty factory somewhere and you want to start making gowns that'd be perfect.”
Not everything is in short supply, however. A chart on a dry-erase board in the conference room says the state received 10 more kiddie pools than it requested for the National Guard’s nursing home decontamination operations.
The medical operations unit assesses and tries to project the needs for hospitals and care facilities across the state, as well as sending National Guard units to decontaminate nursing homes and other facilities that have seen outbreaks and training for staff of those facilities on minimizing contamination.
“Right now the National Guard teams are being able to provide those [decontamination] services free of charge, which they're pretty expensive,” said Col. Lisa Pierce, who leads that division. “If you try to hire a company, it might cost about $10,000 to do that, so that's a free service provided by the Guard.”
The unified command structure was implemented in late March, as the response to the disease was already well underway. Hawkins said the arrangement was like “building an airplane in the air.”
“But it flies,” he said.
Harris said that plane will need to keep flying for a long time.
“I think we all agree that this is going to go on for some time,” Harris said. “And it may be that we'll have periods where the number of people here in the building for example may go up or may go down, depending on what's happening in the state, but I think we all feel like that we're going to need to continue to work together for many months to come.
“There are going to be times when we see outbreaks that are going to require bigger responses and then there may be times when we're not having so many people all at one time working together, but this is going to be going on for a while.”
Harris said that pulling in the strengths of each participating agency will be important in the response going forward.
“The most important part of this, honestly, is the relationships we've built, with each other and with the other agencies,” he said. “We know each other, we understand what capacities people have. At the outset, I would say, those of us in public health didn't even know what was available from other state agencies necessarily.
“People bring so many different skill sets and so much expertise, things that we don’t have internally, and so we’re fortunate to have all that in Alabama and have all that on the same team working together.”
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