Cen­tral Florida COVID-19 hos­pi­tal­iza­tions are ris­ing

Orlando Sentinel - - Front Page - By Naseem S. Miller and Stephen Hu­dak

Hos­pi­tal­iza­tions from COVID-19 are spik­ing in Cen­tral Florida as the num­ber of pos­i­tive cases have reached record highs in re­cent days, less than a month after the state en­tered its sec­ond phase of re­open­ing.

As of Mon­day, 115 pa­tients with COVID-19 were be­ing treated at Orange County hos­pi­tals, ac­cord­ing to in­for­ma­tion shared by Orange County health depart­ment of­fi­cials.

That’s 51 more cases than the week be­fore and 85 more than the week of May 17.

Health sys­tems told the county “their num­bers were higher than ever be­fore,” said Dr. Raul Pino, health of­fi­cer at the Florida Depart­ment of Health in Orange County, in an email on Mon­day.

Semi­nole County is also see­ing more hos­pi­tal­ized coro­n­avirus pa­tients. There are cur­rently 46 pa­tients with COVID-19 in the county’s hos­pi­tals.

“Three weeks ago we had an av­er­age of 3-4 per day,” said Alan Har­ris, chief ad­min­is­tra­tor of Semi­nole County Of­fice of Emer­gency Man­age­ment in an email. “This is an in­crease for cer­tain.”

Har­ris said three COVID-19 pa­tients are cur­rently in the ICU; in Orange, there are 20 pa­tients in the ICU, a num­ber that has stayed rel­a­tively flat over the past month.

In a shift from the be­gin­ning of the pan­demic, when most of the hos­pi­tal­ized pa­tients were in their 70s and 80s, pa­tients now are in their 40s and 50s, Pino said.

As Florida on Mon­day passed 100,000 pos­i­tive coro­n­avirus cases, the num­ber of COVID-19 hos­pi­tal­iza­tions are im­por­tant be­cause they in­di­cate the spread and sever­ity of dis­ease and can sig­nal whether lo­cal hos­pi­tals are at risk of get­ting over­whelmed.

Lo­cal hos­pi­tals say that they still have enough ca­pac­ity, and they’ve learned how to bet­ter man­age COVID-19 pa­tients.

Un­like the early days, ven­ti­la­tors are not the first line of treat­ment for the ma­jor­ity of the pa­tients. As a re­sult, fewer pa­tients are be­ing ad­mit­ted to the ICU.

Also, over time, treat­ments like con­va­les­cent plasma ther­apy and an­tivi­ral drug remde­sivier have proven ef­fec­tive in fight­ing the dis­ease, re­sult­ing in bet­ter out­comes for pa­tients.

“We’ve learned a lot,” said Dr. Sean Benoit, chief med­i­cal of­fi­cer at Cen­tral Florida Re­gional Hospi­tal. “I think had these num­bers oc­curred in the very be­gin­ning, it would have been more alarm­ing. It still is alarm­ing. We are pay­ing at­ten­tion to our num­bers, our PPE and what we have.”

Benoit added that “the num­ber of cases we’ve seen in­creas­ing cer­tainly is real. It’s not just in­creased test­ing. It cer­tainly in­creased hos

pital­iza­tion of COVID pa­tients as well,” he said.

Ad­ven­tHealth and Or­lando Health, the two ma­jor health sys­tems in Cen­tral Florida, are keep­ing a close eye on their num­bers.

“We are watch­ing trends care­fully . ... While our in­pa­tient COVID num­bers are ris­ing, the sever­ity of the cases aren’t as sig­nif­i­cant as when we first be­gan treat­ing COVID-19 pa­tients,” Ad­ven­tHealth of­fi­cials said in an email.

Or­lando Health of­fi­cials said that they’ve seen a steady in­crease in COVID-19 hos­pi­tal­iza­tions, mir­ror­ing the in­creas­ing num­ber of cases in the com­mu­nity since mid-May.

“This sec­ond wave of pa­tients has not demon­strated the level of sever­ity and mor­tal­ity that we saw with the first wave — 8% are be­ing man­aged in an ICU, and only 5% are re­quir­ing a ven­ti­la­tor,” they said in an email. “Although pa­tient char­ac­ter­is­tics such as age and co­mor­bidi­ties may play a role, the dif­fer­ences in first and sec­ond wave out­comes are likely at­trib­ut­able to more ef­fec­tive clin­i­cal care, in­clud­ing res­pi­ra­tory man­age­ment and use of emerg­ing ther­a­pies such as Remde­sivir and con­va­les­cent plasma.”

It’s dif­fi­cult to know how many pa­tients are cur­rently hos­pi­tal­ized with COVID-19 in spe­cific hos­pi­tals for most coun­ties, be­cause the state does not re­port the data. The state also re­cently changed how the hos­pi­tals re­port ICU bed oc­cu­pancy.

Ac­cord­ing to the gov­er­nor’s of­fice, the change was made to more ac­cu­rately re­flect the rea­sons a pa­tient was moved to the ICU.

“For ex­am­ple, a preg­nant woman who tests pos­i­tive upon ar­rival to the hospi­tal but is with­out symp­toms could be moved to an ICU bed to iso­late her from other ma­ter­nity ward pa­tients, not be­cause she needed ICU lev­els of care,” said a spokes­woman for Gov. Ron De­San­tis’ of­fice on Mon­day in an email. “While she would still be tak­ing up a bed — the key met­ric when it comes to ICU ca­pac­ity — she could be moved else­where if needed for a pa­tient who needs to go the ICU.”

Some coun­ties, like Mi­ami-Dade have man­dated their hos­pi­tals to re­port their daily COVID-19 hos­pi­tal­iza­tions and dis­charges to the mayor.

In Mon­day’s press con­fer­ence, Orange County Mayor Jerry Dem­ings said the county will “en­deavor” to make the hos­pi­tal­iza­tion num­bers pub­lic.

De­San­tis has re­it­er­ated, as re­cently as a Satur­day press con­fer­ence, that more young peo­ple, many of whom have no symp­toms, are test­ing pos­i­tive and their ill­nesses don’t have “huge clin­i­cal con­se­quences.”

“We’re see­ing it spread in 20- and 30-year-olds faster than we would like to see, so we re­ally want to send a mes­sage of dou­bling down on what we’ve been preach­ing since the start ... in terms of so­cial dis­tanc­ing” and other pub­lic-health guide­lines, De­San­tis said.

The me­dian age of COVID-19 cases in Orange County is 34, com­pared with the state’s av­er­age of 43. In Semi­nole County, the me­dian age is 33. Osce­ola and Lake coun­ties’ me­dian age is 44.

State data shows that younger peo­ple are less likely to be hos­pi­tal­ized than older adults, but some still land in the hospi­tal be­cause of COVID-19 in­fec­tion.

Florida’s stay-at-home or­der be­gan on April 3 and ex­pired on May 4 — ex­cept for sev­eral South Florida coun­ties. The state en­tered the first phase of re­open­ing by al­low­ing lim­ited open­ing of stores and restau­rants and re­sump­tion of elective pro­ce­dures at hos­pi­tals. The sec­ond phase took ef­fect on June 5, al­low­ing bars and movie the­aters to open with 50% in­door ca­pac­ity, and gyms at full ca­pac­ity.

Pino also said that vis­its to hospi­tal emer­gency rooms for COVID-19 or flu-like ill­nesses have been in­creas­ing no­tice­ably in Orange County, go­ing up from about 100 cases two weeks ago to about 300 cases last week.

Lo­cal hos­pi­tals have main­tained their tem­per­a­ture screen­ings at the en­trance, one-vis­i­tor poli­cies, re­liance on vir­tual vis­its, and in some cases they have strength­ened some of their ex­ist­ing poli­cies.

Last week, Or­lando Health made it manda­tory for all em­ploy­ees to wear masks after sev­eral staff mem­bers were ex­posed to COVID-19 in sit­u­a­tions that could have been avoided had they been wear­ing a mask.

“De­spite nu­mer­ous, fre­quent com­mu­ni­ca­tions re­mind­ing team mem­bers of our PPE poli­cies through­out all our fa­cil­i­ties, we learned of a re­cent lapse in mask wear­ing in a non-clin­i­cal area that re­sulted in sev­eral team mem­bers be­ing placed in self-iso­la­tion,” an Or­lando Health spokes­woman said in a state­ment. “As a re­sult, we have strength­ened the pol­icy to man­date that team mem­bers wear masks at all times when they are in the pres­ence of oth­ers.”

Ad­ven­tHealth, Ne­mours Chil­dren’s Hospi­tal and HCA hos­pi­tals, in­clud­ing Cen­tral Florida Re­gional Med­i­cal Cen­ter, have had the manda­tory mask­ing pol­icy for staff in place al­ready, they told the Or­lando Sen­tinel.

“Wear­ing masks may be the No. 1 thing you can do, and when I go out into the com­mu­nity I see not as many peo­ple wear­ing masks as need to,” said Dr. Scott Brady, se­nior vice-pres­i­dent of am­bu­la­tory ser­vices at Ad­ven­tHealth, in an emailed state­ment. “Masks help re­duce the trans­mis­sion of any kind of droplets and it’s the best thing you can do to keep your­self safe — it’s the most lov­ing thing you can do for your com­mu­nity to keep them safe.”

The health sys­tems have also im­ple­mented pro­ce­dures, in­clud­ing pa­tient test­ing, to iden­tify and sep­a­rate COVID-19 pa­tients from oth­ers. They say that many pa­tients have de­layed their care be­cause of fear of catch­ing COVID-19 at the hos­pi­tals and are now show­ing up in the ER with more se­vere ill­ness.

“My mes­sage to the com­mu­nity is to ab­so­lutely be care­ful. The cases are in­creas­ing. This is not a time to re­lax and not prac­tice so­cial dis­tanc­ing. You should still be wear­ing masks,” said Benoit of Cen­tral Florida Re­gional. “We also want them not to ig­nore their health. We want them to know that the hos­pi­tals have taken a lot of steps for their safety and se­cu­rity.”


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