South Florida Sun-Sentinel (Sunday)
Hospitals learn from more than 3K deaths
Respiratory therapist Joan Norell starts her day at Westside Regional Hospital in Plantation by checking the oxygen level of the patients in the coronavirus ward where she may tend to as many as 10 a day or more.
“Every day will be different,” Norell said. “If they need breathing treatments, I will have to deal with that. If someone is critical, I am there next to the doctor, assisting with ventilation.”
It’s so much better than it was three months ago. “Patient after patient would say ‘don’t let me die.’ ” As she battled to help them keep an open airway, some did die. Now, losing a patient to the virus happens less often. “We know so much more,” Norell said.
As Florida infections hit new highs in recent days and patients again flood into local hospitals, nurses like Norell bring three months’ experience to the fight. The lessons learned from more than 3,300 deaths now guide the health response to a mysterious virus that may still be in its infancy.
Respiratory therapist Joan Norrell is shown with a respirator at Westside Regional Hospital in Plantation on Tuesday.
Ventilators aren’t the only choice
Health experts once sounded the alarm that we’d run out of ventilators. They now realize that they used this invasive, last resort procedure far more often than they should have.
Florida doctors discovered early on that people on ventilators tend to stay on them for a long time and complications often arise. They learned that many coronavirus patients can survive at low oxygen levels without breathing assistance, and they no longer rush to intubate those patients.
Patients are also younger and healthier now. Norell said patients who came to Westside in Plantation in March often were so sick it was hard to ween them off the ventilator, and when she did, they often needed to go to rehabilitation. “Now I feel like they can get off ventilators quicker and we can keep them off.”
Data compiled by statisticians at Florida International University shows just how sharply the use of ventilators has declined. In April, about half of the patients hospitalized in South Florida were on ventilators. In mid-June only about 30% were on ventilators.
A far less painful solution
In the most severe cases, fluid continuously fills the lungs, which can’t get enough air. As people with Covid-19 filled hospitals in South Florida, doctors discovered that a simple technique used for years with respiratory patients could improve the breathing of coronavirus patients. It’s called proning — simply laying a patient on their stomach.
“We found early proning does make a difference,” said Dr. Wael Barsoum, former CEO of Cleveland Clinic Florida.
At Westside Regional Hospital in Plantation, patients are now turned on their stomachs as soon as they go into respiratory distress, said Dr. Giorgio Tarchini, infectious
disease specialist and chief medical officer. “That has become the standard of care,” he said. “While we can’t ascribe success to one single intervention, we have seen that it gives better oxygen to the lungs.”
Younger patients, better medications
Some of the first patients to flood South Florida hospitals were the most vulnerable: elderly persons from nursing homes, emergency responders with diabetes or hypertension, and staff and vacationers from cruise ships who arrived in advanced stages of the virus. Hospitals say patients are now younger, not as likely to need intensive care or ventilators.
Doctors have learned which treatments work, and which don’t.
“We still don’t know all the answers, but I think we’re in a better place in terms of offering options,” said Dr. Carla McWilliams, an infectious disease specialist with Cleveland Clinic Florida in Weston.
Antivirals such as remdesivir and steroids such as dexamethasone are being used in South Florida hospitals to reduce fatalities in the sickest patients. So are high dose Vitamin C and zinc treatments. Doctors say plasma collected from previously infected individuals has emerged as one of the most promising therapies.
“Every hospital uses a combination of everything, even though it might be a little different,” said Dr. Larry Bush, an infectious disease specialist in Wellington.
Length of stays shorter
Gino Santorio, CEO of Broward Health, said the North Broward Hospital System now tracks much more information about its covid-19 patients than at the start of the pandemic. He said average hospital stays are now half as long as they were in April — now 6 days compared to 10.5.
Santorio attributes the shorter stays to “early detection and early intervention.” He said the hospital system knows when and how to prevent the virus from worsening.
Dr. Tarchini at Westside Regional Hospital said the shorter stays are coupled with
fewer deaths. “Our patients are surviving more because of the additional knowledge we have and because they are coming to the hospital earlier once they develop respiratory distress. They are more aware they shouldn’t wait at home to get really sick.”
At press conferences this week, Gov. Ron DeSantis repeatedly said the younger people making up the majority who are testing positive will have “fewer clinical consequences” and “can handle the disease better.”
In the emergency room of Cleveland Clinic Florida, McWilliams said she sees young and old who are extremely sick. Underlying health issues, not age, drives hospital stays and treatments. “Age isn’t the primary factor that drives how we treat or screen,” she said.
Collaboration rather than competition
In South Florida, competition among hospitals had been fierce. But during the pandemic, local healthcare systems are talking weekly, sharing information on covid-19 treatments, hospital occupancy and best practices in staffing and supplies.
From Miami to Palm Beach, health system CEOs have shared data about how full their beds are, whether they can add more beds to ICUs and how they have handled patients from long-term care facilities.
“There is a lot of collaboration and learning from each other on ways what treatments work and ways to do things more effectively,’ said Crystal Stickle, president of the Florida Hospital Association.
The result is better outcomes for covid-19 patients, and a quicker reaction to a potential surge, leaders say.
“There is still a lot we don’t know about the virus, but I do think we have learned better how to manage patients, what to look for and treatments that might help the most,” said Dr. Margaret Gorensek, an infectious disease physician with Holy Cross Hospital in Fort Lauderdale.