Elderly patients are no longer the majority of those being diagnosed and treated at Lakeland Regional Health Medical Center, said Dr. Hal Escowitz, Chief Quality Officer and Chief Medical Informatics Officer.
"We have seen basically a switch in the demographic or the type of patient that we're seeing here at the hospital has completely changed over the last few weeks," Escowitz said. "So initially, during the early course of COVID, the vast majority of the people that we were seeing were the nursing home population that we were aware of were coming in tens at a time. And they have slowed down to maybe one a day, if that."
Instead, the hospital's emergency departments are seeing mostly younger adults and some children, Escowitz said Monday.
That suggests a new phase in the COVID-19 pandemic locally. From March through May, Polk County's cases were driven largely by infections of the elderly, including outbreaks at long-term care facilities.
Over the past two weeks or so, however, cases have surged in younger age groups. The Florida Department of Health announced a record daily total of 185 new cases reported Sunday for Polk County, and 112 of them involved residents age 40 or younger.
Escowitz described his level of concern as high and continuing to rise.
The county's median age for cumulative COVID-19 cases has shifted from 53 to 45 over the past week. The daily median age has been under 40 for 10 of the past 12 days, according to FDOH reports.
Recent daily reports have included some cases of patients listed as age 0.
All of that indicates that Polk County is experiencing what epidemiologists call "community spread," transmission of a disease absent contact with someone known to be infected.
"I think the numbers pretty much speak for themselves in that there does seem to be a lot more community spread," said Dr. Mark Vaaler, chief medical officer for Bartow Regional Medical Center and other BayCare Health System hospitals. "We've gone through a wave where we had community spread, then we went through a wave where we had a lot of positive cases in our extended care facilities, our nursing homes and assisted-living facilities. And now what we're seeing in this next segment is much more community spread in all our different facilities that we're testing."
As of Tuesday, the Department of Health reported 2,269 cumulative cases of COVID-19 among Polk County residents. Those yielded 419 hospitalizations and 78 deaths.
"The patients we're predominantly seeing now in the emergency department and admitting to the hospital are the younger population from the community," Escowitz said. "So we're seeing people out in the workforce, who have been out and about and have sick family members who are now coming into the hospital for the first time. I guess a lot of it could be attributed to the lockdown and social distancing and things being slowly relaxed, but that is what we're clearly seeing in the hospital."
Escowitz said some patients in their twenties have been admitted to intensive care after contracting COVID-19.
Vaaler said a certain spike in COVID-19 cases was expected as Gov. Ron DeSantis and local authorities began lifting restrictions and Floridians began venturing back to restaurants, bars and fitness centers. But he said the recent surge has been alarming.
"We are seeing the highest number of hospitalizations that we've had within the whole outbreak through our BayCare facilities," he said. "The percentage in ICU (intensive-care unit) is not as great, but certainly the numbers in ICU are about as high as they've been. So we are seeing a significant acuity of illness in our ICUs."
Even as total COVID-19 cases have soared recently in Florida, DeSantis said the numbers are being driven upward largely by younger people without symptoms. DeSantis has cited that factor in dismissing suggestions that he might reinstitute statewide restrictions on social gatherings or mandate that all residents wear face coverings in public.
Though younger people are generally less vulnerable to serious complications from COVID-19 than elders, Escowitz said the demographic shift is not a reason for complacency.
"I don't know if I would think that's a good thing or a bad thing," he said. "Certainly many of these people have the ability to spread it to the more vulnerable population, and even in the young it's not benign. We see people out of the workforce for several weeks; we see younger people who need to be hospitalized, and again they can spread it to their parents. They can spread it to their grandparents. More is more. To me, at least, it doesn't bode as something we should be celebrating."
Vaaler made a similar point.
"That's the danger is the 18- to 34-year-olds may not get as sick, but they are certainly at risk of spreading it to their parents, to their aunts, their uncles, their co-workers," he said. "So I'm very, very concerned that that spread will go to the older population again as this age group continues to interact with them. And as you know, it's well documented that asymptomatic patients can still spread the virus."
The overall intensive-care capacity at Lakeland Regional is about the same as it was at the peak of the pandemic, Escowitz said.
"We are slowly building a population of community-based COVID cases," he said. "So I wouldn't say we haven't had an explosion; the hospital's not being overwhelmed by COVID, by any means. But we've had this continuous, steady rate of admission and rate of increase. It's just the type of patient that we're seeing and where they're coming from is entirely different."
Gary White can be reached at gary.white@theledger.com or 863-802-7518. Follow on Twitter @garywhite13.
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