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Younger, Less Sick Coronavirus Patients Surging Through Hospitals

Miami-Dade hospitals report far more beds available than beds filled with COVID patients. Still, hospital administrators and emergency room physicians say they’re concerned by the surge, and that they’ve resumed near daily meetings with state regulators

by Ben Conarck, Daniel Chang, and Douglas Hanks, Miami Herald / June 24, 2020
TNS
(TNS) - Record numbers of patients with COVID-19 are filling Miami-Dade hospitals, with one medical center in Homestead reaching ICU capacity on Tuesday after county officials identified the area as a hot spot of new cases.

Countywide, hospitals report far more beds available than beds filled with COVID patients. Still, hospital administrators and emergency room physicians say they’re concerned by the surge, and that they’ve resumed near daily meetings with state regulators.

But they point to a silver lining in the growing number of new cases and hospitalizations in Florida’s hardest-hit county: The patients are younger and not as severely ill as they were during the first wave in April, and doctors and nurses have gained valuable experience in the months-long pandemic — leading to shorter hospital stays and better outcomes.

Dr. Sergio Segarra, an emergency room physician at Baptist Hospital Miami, said the Baptist Health South Florida network of hospitals had more than 280 patients on Tuesday. But Segarra said he is seeing fewer elderly patients and residents of nursing homes than he did in April, and not as many are intensive-care admissions.

The change in patient demographic suggests that SARS-CoV-2, the virus that causes COVID-19, is spreading more widely in Miami-Dade as businesses reopen and people return to work.
“Community spread is the source of a lot of the patients that are coming in,” Segarra said.

Miami-Dade public health officials are also gaining new insights into the current wave of patients and the areas where cases are spiking. Many of the younger patients admitted in the past week to Miami-Dade’s public hospital, Jackson Health System, were obese, which suggests diabetes or other underlying health conditions.

Jackson Health CEO Carlos Migoya said the public hospital system, which reported 210 inpatients with COVID-19 on Tuesday, has also found that new infections have been highest in some of the county’s lower-income communities of Allapattah, Little Havana and Homestead.
“These are lower income people that, if they don’t work, they don’t eat,” he said. “Those people go out, they get infected, and then they bring it home and then they get the entire family infected.”

Plateau in May to increase in June

The number of admitted COVID patients at Miami-Dade hospitals had plateaued throughout much of May and began to tick down in early June, dropping to 546 on June 12 before increasing ever since.
Tuesday was the busiest day of the pandemic so far in Miami-Dade, with hospitals reporting 818 patients with COVID-19 — up from 776 on Monday, and the second consecutive day of record patient volume, according to county data. Fire rescue calls for COVID-19 also rose, topping 100 for the first time in June.

Segarra said Baptist Health has stepped up educational outreach, urging patients and their families to wear masks, wash hands often and maintain a safe distance from strangers. But there is concern about the rising number of patients. Migoya called it “frustrating” that no one knows how high the case numbers will rise or how long the surge will continue.

At Homestead Hospital, which is part of Baptist Health, the intensive care unit had filled to capacity on Tuesday, but a spokesperson said doctors managed capacity in part by transferring patients among the system’s 11 hospitals in Miami-Dade and Palm Beach counties. The hospital’s intensive care unit was at capacity due in part to COVID-19 but also due to the resumption of open heart surgeries and complex neurosurgeries, Segarra said.

Dennis Moss, a county commissioner representing the Homestead area, said the county can’t really tell what’s driving the higher hospitalization rates without more contact tracing of new cases — the process where state investigators try to contact people who interacted with newly discovered COVID cases and get them tested, too.

“We need a system in place that goes beyond speculation,” Moss said.
County officials had been trying to add more contact tracers to the roughly 200 employed by the state Department of Health, but those efforts have stalled in recent weeks.
Worsening COVID numbers, in and out of hospitals

HCA Healthcare, which owns three hospitals in Miami-Dade, said its facilities were also seeing a surge in younger patients who were not severely ill. HCA’s Miami-Dade hospitals include Kendall Regional Medical Center, Mercy Hospital and Aventura Hospital and Medical Center.

“Though we continue to see admissions from a variety of age groups, we are seeing younger individuals being admitted for COVID-19 treatment,” Peter Jude, a spokesman for Kendall Regional, said in a statement. “We are also experiencing a decrease in acuity with less COVID-19 patients requiring mechanical ventilation and ICU admission than during the region’s previous peak in March.”

Miami-Dade Mayor Carlos Gimenez and his top aides point to the county’s ample number of hospital beds as proof that the Miami area isn’t close to facing the kind of healthcare crisis that hit New York in the spring.

The county requires daily reports from hospitals, and the latest summary showed about 30% of Miami-Dade’s available 658 intensive-care beds were occupied by COVID patients, leaving another 461 to fill.

During an interview with NPR’s “Here and Now” program Tuesday, Gimenez noted hospitals have even more room for less-serious COVID admissions.
”In terms of hospitalizations and hospital beds that we have available, we have well over 2,700 hospital beds still available. So it’s not getting anywhere close to the capacity of the health system here,” he said.

Tests show breadth of spread

Because it can take weeks for COVID to cause serious symptoms, hospitalization figures are lagging indicators. Test results are the best day-to-day measure of viral spread, and they continue to set records and hit alarming levels in Miami-Dade.

The county set a goal of 10% for the portion of daily COVID test results that come back positive, and managed to stay below that threshold every day since Gimenez lifted closure orders on most businesses May 18. That declining trend reversed in early June, and crossed the 10% threshold for the first time.

It’s only getting worse. On Tuesday, the daily positive results hit 26%, a record.
Hospitalization numbers also are on the upswing, increasing nearly 25% in two weeks.

The Gimenez administration sees the worsening numbers as evidence of Miami-Dade’s younger residents interacting more frequently at restaurants and other businesses without following the countywide mandates to wear masks and not crowd others.

The county’s management office, which oversees daily COVID statistic reports, released a summary from the state’s Health Department showing one of out of every three new COVID cases in Miami-Dade last week fell between the ages of 18 and 34. That age group represents less than 22% of the population.

For Baptist’s Homestead hospital, more than half of the facility’s 66 COVID cases were adults younger than 50.

The Gimenez administration’s approach to the worsening COVID numbers is to demand more policing of existing rules, rather than imposing new restrictions or revive past closure orders for businesses. During a staff meeting Tuesday on COVID, two participants said Gimenez raised his voice when telling a police administrator the county needed to be tougher. “We’re done being nice,” he said. Gimenez confirmed the exchange.
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