Surge in virus hospital visits
AdventHealth activates ‘Phase 2 emergency’ as staffing needs increase
The number of COVID-19 patients at AdventHealth hospitals has “grown significantly over the last week,” so the system is activating an emergency plan for more doctors to deal with the surge, it said in an email to staff obtained by the Orlando Sentinel.
“As we predicted in May, the Central Florida area is experiencing a surge in COVID-19 admissions,” said the email sent Tuesday night. “… We are identifying additional needs and potential sources for additional clinicians in the coming weeks.”
The number of patients hospitalized for COVID-19 has been steadily growing across Florida in the past several weeks, following the phased reopening of the state, and more hospitals are filling up their regular and ICU beds, although they say that’s partly because of their return to normal operations.
In Central Florida, only Seminole County has been reporting daily COVID-19 hospitalization via a public dashboard. On Wednesday, it reported 189 patients were hospitalized for COVID-19 in the county, an increase from 137 patients on Monday.
Orange County has been providing the numbers during press conferences or when reporters request them.
As of Wednesday, Orange County hospitals had 393 COVID-19 patients, with 74 in the ICU. That’s compared with Monday, when 357 people were hospitalized with 72 in intensive care. On June 28, 164 were hospitalized with with 35 in the ICU.
Lake and Osceola counties have not shared any information about
their COVID-19 hospitalizations.
Hospitals have emergency surge plans to respond to unforeseen situations, including the coronavirus pandemic.
Orlando Health said that it maintains a comprehensive surge plan “that identifies additional resources, including beds, that would be available if needed.”
At AdventHealth, a phase 2 emergency means doctors quickly get the appropriate credentials to work in other areas.
“In this case, an emergency room physician demonstrates skills every day that can be expanded to treat COVID-19 patients in other parts of the hospital as necessary, so this step allows us to position doctors to utilize their skills to best care for our patients,” an AdventHealth spokesman said in a statement to Orlando Sentinel.
In its email to staff, AdventHealth said it has increased nighttime staffing on multiple campuses and is also looking at elective medical procedures, which were stopped in March but then resumed at the beginning of May, per Gov. Ron DeSantis’ executive orders.
“Our team has been working over the last week to build an elective surgery plan for phases based on the COVID-19 census, staff availability, and clinical urgency of elective cases,” officials wrote.
Lack of personal protective equipment was one of the main reasons to stop elective procedures a few months ago, the email said, but this time, the issues are resources “such as staffing, intensivists and beds.”
Intensivists are doctors who only work in intensive care units.
Dr. Mary Jo Trepka, professor and chair of the department of epidemiology at Florida International University, expects the number of hospitalizations to grow in the coming weeks, since hospitalizations trail new cases by two weeks or more.
“The other thing I’ve noticed is that the median age of [new] cases is inching up,” said Trepka. “And that’s worrisome because the older you are, the more likely you are to be hospitalized, and of course, you’re also at a higher risk of dying.”
She said part of the reason for the increase in the median age could be because young adults who have been testing positive recently are starting to infect older individuals.
It’s difficult to know how quickly the numbers of patients currently hospitalized for COVID-19 are growing because the state does not report how many COVID-19 patients are currently hospitalized in each county. It had promised last week to start sharing that information but has not done so.
Local health systems also don’t share their numbers, except on rare occasions, such as public meetings with local officials.
The state’s hospital occupancy dashboard, which provides a snapshot in time and does not parse out COVID-19 patients, shows that ICU beds in some Central Florida hospitals are filling up, although countywide, there are still beds available.
Local health systems have raised issues with interpreting the decline in occupancy rates as a surge in COVID-19 patients. They’ve said that their hospitals are full because they’re going back to normal operations.
Orlando Health and AdventHeath, the two major health systems in Central Florida, have continued to say that they have enough capacity and can meet the needs of all patients.
On Wednesday, Orlando Health said that it has changed how its reporting bed capacity to the state to clarify any misconceptions about its capacity.
“Instead of reporting only the number of beds currently staffed, as had been our practice, we are now reporting our total existing bed capacity that can be staffed and filled,” a hospital spokeswoman said in a statement. “Staffing for these units will continue to be adjusted based on patient volumes.”
Orlando Health ORMC, which had shown 0% capacity for ICU beds on Monday and again on Wednesday morning, showed a 16% capacity on Wednesday afternoon, with 12 of its 64 beds available.
Hospitals that had full ICUs on Wednesday afternoon included AdventHealth East Orlando, AdventHealth Kissimmee, Orlando Health - Health Central Hospital, Orlando Health South Seminole Hospital and Poinciana Medical Center, all of which have 18 beds or less.
AdventHealth Orlando’s ICU, which has 148 beds, had 23% capacity.
Countywide, Orange County has 19% ICU capacity, Lake 14%, Osceola 8% and Seminole 7%.
In Miami, the surge in COVID-19 patients prompted Jackson Health System, MiamiDade’s public hospital network, to ask the state for 100 nurses this week. Some hospitals in South Florida have halted their elective procedures once again.
Meanwhile, projection models for Florida continue to show a growing number of coronavirus cases.
If all things remain as they are in Orange County, the area could see as many as 4,200 cases a day by Aug. 2, according to modeling by PolicyLab at Children’s Hospital of Philadelphia.
“Our projections show that without immediate actions to significantly reduce travel and social distancing nationwide, this virus will not only threaten our ability to reopen schools in the coming weeks, but our capacity to care for the sickest individuals,” said Dr. David Rubin, MSCE, director of PolicyLab, in a news release.