Search officials said crews have now combed through at least 680 acres around the medical facility.
The U.S. Marshals Service agreed to add $10,000 to the reward for information leading to Alston's capture. The reward now sits at $35,000. A new phone number has been set up to help streamline tips to investigators focusing on this case. That number is 919-324-1082.
Tips and clues uncovered during the search so far suggest Alston headed north of the medical facility. Officials plan to double back over the path K-9 officers lead them through in order to take a closer look for clues.
"So any signs that Mr. Alston may have been there -- any footprints, any discarded remains, handcuffs, attire, anything that we can find that would confirm a direction of travel and how he may have evaded capture," Orange County Emergency Services Director Kirby Saunders said.
Orange County Sheriff Charles Blackwood said his investigators have received a few unconfirmed sightings of Alston in Durham. He said the team is following up on those leads but stressed that none of those sightings have been confirmed.
He said his deputies have talked to some members of Alston's family. He described their cooperation as "varied."
"No concrete leads at this time," Blackwood said. "Somebody knows out there that this was planned, and they know who's involved in it."
As for Alston's appearance, Blackwood said Alston did have dreadlocks that were pulled back at the time of his escape. However, it's entirely possible that he has since cut his hair or done something else to style it differently. That's one reason why investigators have released several different pictures of Alston.
Two more permanent features of Alston's appearance include a tattoo of the word "flame" done in dots across his chest with a star in the middle of the word, and the word "niece" tattooed on his right arm.
Blackwood went on to say that he went to school with Alston's father and has known Alston his whole life.
"I've known Ramone since he was born. He was a troubled child, and he's been involved in criminal activity since he was a juvenile. He's extremely cagey; he's extremely dangerous, and he has nothing to lose."
The escape
The sheriff's office said Alston managed to free himself from leg restraints while inside a North Carolina Department of Adult Correction (DAC) vehicle in the parking lot of the clinic. The vehicle was a Chevrolet Traverse.
"As they (the officers) pulled up to the back entrance of the hospital and as they were removing Mr. Alston from the vehicle, he broke away from the officers in the parking lot and ran to the woods," DAC Communications Director Keith Acree said. The two officers were in charge of getting Alston out of the vehicle and into the hospital for treatment.
Alston was at the medical facility for a procedure. The specifics of that procedure and why Alston was transferred from lockup in Bertie County all the way to Hillsborough have not been released, but Blackwood said Tuesday he though it had to do with a continuation of care (in other words Alston was seeing a doctor for a condition that doctor had previously treated).
Blackwood said he had seen surveillance video showing Alston's escape from the medical facility's parking lot. However, he described the video as inadequate and not particularly helpful in determining all of the details about how Alston escaped.
"The door opens, his foot hits the ground, and then he is out of the frame, so he was moving quickly -- more quickly than the camera could capture," Blackwood said.
Alston is no stranger to the area because it's where he grew up and not far from the scene of the crime he's serving a life sentence for.
Who is Ramone Alston?
Alston was convicted of shooting and killing 1-year-old Maleah Williams on Christmas Day in 2015. The shooting happened in Chapel Hill. Maleah's mother told ABC North Carolina affiliate WTVD then that the children were outside playing with their Christmas toys and she was holding her daughter when someone started firing shots in the area. She was running from the area when she realized a bullet had struck Maleah.
"We don't have any added feelings about Mr. Alston, we're just displeased with the (Department of Public Safety) and their efforts to keep him in custody, or lack thereof. We wish Mr. Alston and his family nothing but peace, blessings, and prosperity," Maleah's father Shaquille Williams said in a statement Tuesday.
Williams added that the thing that bothered him was that "somehow, he got out of his leg shackles."
Alston and another man, Pierre Je Bron Moore took a plea deal in 2019. Alston received a life sentence for the child's murder and Moore received 28 to 34 years.
WTVD uncovered that Alston recently tried to get his sentence lightened. Records show Alston filed a motion for appropriate relief in October 2023.
The 20-page document goes through the evidence and facts of his case. In the document, Alston claims the state used misleading evidence in its case. The motion was denied in May, with a judge saying Alston had a fair, full hearing and the claims in the motion for appropriate relief lacked merit.