Hospitals filling up, encountering a new kind of virus patient

FORT LAUDERDALE, Fla. — With new cases skyrocketing and hospitalizations increasing, Florida hospitals are confronting a scary new trend: people entering hospitals without the symptoms of coronavirus they were showing a few months ago.

The fever check, a basic tool for screening for coronavirus, likely is not much value anymore, as the number of asymptomatic people rises by the day.

Now that elective services are back on and people have ventured out from lockdown, hospitals are filled with all kinds of patients, challenging the staff to figure out who is sick, what they have, and where to put them.

"Some people are coming in really sick but others aren't that sick at all," said Patricia Diaz, a nurse at University Hospital in Tamarac. "Some come in for abdominal pain or something else and through assessments, they come up positive."

When the novel coronavirus first surfaced in South Florida hospitals in March, patients were the elderly or those with medical conditions that made them vulnerable. Symptoms were obvious: cough, fever, shortness of breath. But now the virus has infected a younger demographic and taken on a more stealth nature in Florida while continuing to remain highly transmissible.

"We had two patients this week with appendicitis and they turned out to be positive," said Dr. Margaret Gorensek, an infectious disease specialist at Holy Cross Hospital in Fort Lauderdale. "We took the appropriate precaution and after surgery, they went to the COVID floor."

The virus is spreading most quickly among younger people in Florida, "those under 40, in particular, who don't have any significant underlying conditions, and are much, much less likely to be hospitalized or to suffer fatality," Gov. Ron DeSantis said during a news briefing on Friday.

People who arrive at hospitals for emergencies don't always show symptoms of the novel coronavirus. They may or may not be tested or admitted to the hospital. And, they could lie in a bed in a holding area waiting for hours or day to find out where in the hospital they will be taken based on their test result.

"If you come into the ER, we're only going to test you if there is something suspicious," said Diaz from University Hospital. "We do not test every person who comes in. It's a little scary because of the unknown."

At most South Florida hospitals, someone who arrives for a broken arm or a deep cut will be treated and sent home, without a test.

And even typical coronavirus symptoms like fever and cough, and a positive test result, may not be enough to get someone admitted anymore. "It's a changing picture," said Gorensek at Holy Cross. "Patients are not as sick as they originally were. If their symptoms are mild, they are sent home to follow up with their primary care doctor or our physicians that follow positive cases."

When patients are admitted, hospitals have discretion on how to maintain the isolation COVID patients require from the rest of the hospital population. Some might have entire floors or wings, others might only have negative pressure rooms in which the air is rerouted, away from other patients and hospital staff.

Crystal Stickle, interim president of the Florida Hospital Association, said some Florida hospitals are better equipped than others to keep their positive patients in one area. "All hospitals handle it differently. As long as they have dedicated staff and keep the door closed and properly identify a room with a coronavirus patient, I would not consider that an alarming practice" she said.

Holy Cross has an entire floor for patients with COVID-19 with an adjacent dedicated ICU. "We are trying to keep patients as safe as possible," Gorensek said. A patient may need to wait in isolation within the emergency room until a test result returns before getting X-rays or scans. In an emergency, a nurse will whisk them from the ER to surgery and return them to the COVID-designated floor.

"We have had patients come in with a heart attack or stroke in the mildly early stages, and we have picked up the virus and have been able to avoid exposure," she said.

With the presence of the virus more difficult to detect, South Florida hospitals have become more wary of incoming patients. In mid-May, Gov. Ron DeSantis allowed hospitals to reopen for elective services after prohibiting them for eight weeks during the peak of the coronavirus crisis. Now that patients are returning for hip replacements and colonoscopies, hospitals tout their efforts to keep a separation between the well and the sick.

At the five Tenet Health hospitals in Palm Beach County, anyone who comes in for elective surgery must be tested in advance, said Maggie Gill, CEO of Tenet's Palm Beach Health Network. A positive result means the hospital will postpone the procedure for 14 days, and test again.

Of course, emergency procedures can't wait. "We have patients in the hospital who are symptomatic, some who are asymptomatic, and some awaiting discharge. It's a mix," Gill said during a news briefing with DeSantis Friday. "We have the capacity, PPE (personal protective equipment), trained staff, and we are smarter in terms of how we manage patients today than we were in March."

Dr. Larry Bush, an infectious disease specialist at Wellington Medical Center, said he, too, has learned how to better treat and identify the virus. "We are testing everyone admitted, putting them in one area, and observing anyone who comes in for something else but develops respiratory issues," he said, adding that the screening has paid off. "We found three people with COVID who were not admitted for that."