Published 4:48 PM EDT Apr 3, 2020
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There may still be time to avert a COVID-19 catastrophe in Florida, one model suggests, as long as the Space Coast and other Floridians do all the right stuff like getting hospitals ready and making sure people practice social distancing — at least six feet — and stay home.
The much talked about April “spike” in the number of cases and deaths that researchers and experts expect to hit the country in the next few weeks is a bit further out for Florida, according one model by University of Washington.
The model predicts that hospitals in Florida should get a few more weeks than most other states to stock medical supplies before the predicted peak surge in caseloads hits the state in early May.
While that sounds good, epidemiologists warn that if Florida hospitals don’t capitalize on that extra time, and the public fails to keep its distance, the dire die will be cast for Brevard and the rest of Florida, increasing the odds of worsening the human toll in the Sunshine State.
Complacency, and failure, epidemiologists say, is not an option for the county that went to the moon.
“We still have to be very careful,” said Asal Mohamadi Johnson, assistant professor of public health at Stetson University.
“This is not going to leave us, and it’s going to be with us awhile,” she added. “This may actually get a lot worse. We’re going to experience multiple waves.”
Local doctors urge us to stay the course.
“If everybody just keeps patience with social distancing, the numbers based on every model out there are going to get worse … over the next four weeks,” warned Dr. Tim Laird, Health First’s medical director. ” That doesn’t mean the social distancing is not working.”
Nor is it a reason to give up on the concept, Laird said.
So even though Floridians might grow discouraged as case numbers inevitably worsen, those numbers would be much worse without social distancing.
Johnson worries the Florida public will let down its guard too soon, once they perceive COVID-19 cases have passed a “peak.”
The recent model run by the University of Washington showed demand for health care resources in Florida peaking on May 3, two weeks later than the April 15 peak demand it forecasts for the nation at large. That buys Florida more time to prepare than most of the rest of America.
Even though the state isn’t yet seeing a large spike in COVID-19 cases, Florida hospitals need to do everything they can to save masks, gowns, gloves and other personal protective equipment, including stopping elective surgeries, which Gov. Ron DeSantis ordered postponed until the crisis passes.
According to UW’s model, Florida will need 16,963 hospital beds by May 3. There are 20,184 available, so the model doesn’t anticipate a shortage in total beds. But it also predicts the state will need 2,555 intensive care unit beds by that time, falling 860 beds short of demand.
Florida also will need 2,044 ventilators by May 3, the model says, but it does not address whether there will be enough.
Brevard hospitals have said they can handle the surge in demand for ventilators.
Health First, Brevard County’s largest medical system recently told public officials it’s four hospitals in the county are prepared. Health First has “469 positive pressure devices, which includes single-use resuscitation devices and over 200 ventilators that can be used if needed for patients with respiratory illnesses,” CEO Steve Johnson wrote in an April 1 COVID-19 update.
Health First ordered an additional 2,000 devices and expect delivery within the next few weeks, Johnson said.
“In addition, we have converted 66 regular hospital rooms to dedicated negative pressure rooms, which can be dedicated to treat those with respiratory illnesses, including COVID-19,” he said. “These additional resources allow Health First to have over 200 specialized beds to serve our community during this crisis.”
According for the state’s Agency for Health Care Administration, Brevard only has a total capacity of 154 adult ICU beds. As of April 2, 99 of those beds were taken and 55 available: 20 at Holmes Regional; nine at Cape Canaveral Hospital; five at Parrish Medical Center; and only two at Rockledge Regional Medical Center.
The AHCA published those numbers recently on a running dashboard of hospital bed availability in Florida.
“Right now they have capacity,” Maria Stahl said of hospital bed availability during a Facebook live update Monday with Rep. Randy Fine, R-Palm Bay. “They do have alternate plans for surge. If we ever do reach New York City (case levels), I’m sure we will have some issues, but we are doing contingency planning right now with emergency management and all of the hospitals.”
As a way to reduce any unnecessary hospital visits, Health First is promoting “virtual visits,” which allow patients to speak with their doctor via phone or video chat.
“I’m comfortable that we’re well positioned to respond to this need,” said Laird of Health First.
Florida Department of Health has legal authority to enforce a mandatory quarantine, Stahl said. “In Brevard County, we have not had to do that,” she said. “Citizens have been wonderful, but we do have that authority.”
In addition to hospital preparation, the other key to keep the demand for the those scare resources as low as possible is that people stay at home as much as possible. Experts now believe the number of people with the virus who don’t show any symptoms is greater than they first thought and the fewer contacts people have outside their home the less likely the disease will spread.
But whether enough citizens have been heeding expert advice not to travel or closely interact with other people is unclear. Video over the weekend posted on YouTube showed crowds of weekend boaters at some spoil islands, partying on the sand bars, which county officials subsequently shut down for this weekend.
Cellphone location data shows large numbers of Brevardians are certainly not staying put.
According to an analysis of cellphone location data by The New York Times, places like Seattle were successfully social distancing, with people moving, on average, just 61 feet from their homes. In Brevard, however, which stretches 72-miles long, that figure on Friday was 2.4 miles. That ranked the Space Coast the 13th worst in the nation at staying put, based on average distanced traveled in counties over 500,000 population.
Keeping apart will help everyone’s odds of staying healthy through the pandemic, Stahl says.
But how much underlying COVID-19 risk is already baked into Brevard’s socioeconomic and health-indicator cake?
The Centers for Disease Control lists among the highest risk groups people 65 or older; those living in a nursing homes; people with lung disease, moderate to severe asthma, diabetes, and the immune compromised.
Taking the pulse of these underlying conditions in Brevard, one at a time, shows a county poised for a deluge of potential COVID-19 complications, Florida Department of Health data suggests.
Aged and special needs residents
Take the oldest among us. A key challenge for Brevard — as during hurricanes, wildfires and other natural disasters — is the thousands of senior citizens and/or residents designated as “special needs.”
Of Florida’s 101 deaths attributed to COVID-19 so far (as of April 2), 39 of deaths were age 80 or older, and 69 deaths were age 70 or older (68%).
Brevard has 21 nursing homes, 127 assisted living facilities and 2,400 “special needs” residents — although that number changes daily — said Kimberly Prosser, Brevard’s director of emergency management.
They include basically anyone who needs assistance during evacuations and sheltering because of “physical, mental, cognitive impairment, or sensory disabilities,” according to state law.
Brevard is older than the rest of Florida, with more than 144,000 (24%) age 65 or older, compared with 20.5% in that group statewide.
Although those under 50 are much less likely to succumb to COVID-19, being younger has not spared suffering from the disease. The median age of cases in Florida is 50, but with cases clustering in the 20s and 30s as well. While no information is available regarding whether they had underlying health conditions, five of the deaths in Florida have been people under age 50, the youngest a 28-year-old Sarasota man.
When it comes to health insurance, Brevard is in a little bit better shape, with almost 91% insured, compared with 87% statewide, according to state health department.
Air quality here is good, state air monitors show, with sea breezes helping send pollution elsewhere, sparse industry, and the virus’ scourge limiting travel and therefore pollution from tailpipes. But dry conditions threaten the onset of an above-normal fire season, state forestry officials say, with flames that could loft fine particulates that lodge deep into lungs, potentially increasing risk for COVID-19 complications among those with moderate to severe asthma and other lung conditions.
Bad air pollution and older males who smoke made outcomes worse in China, studies show.
Smoking, lung disease and asthma
Lifetime smokers should take coronvirus seriously, health experts warn. In Brevard 18.3% of adults smoke, compared with 15.5% statewide, according to state health data.
Vaping and electronic cigarettes also puts young people at higher risk of worsening COVID-19 symptoms, evidence shows. CDC estimates more than 3 million students — 1 in 5 — vape nationwide.
School officials have called vaping an epidemic in Brevard County Schools.
Another higher risk for Brevard: Almost 10% of adults here have asthma, compared with 6.7 percent statewide, according to state health department data.
Brevard also is a few percentage points higher for chronic obstructive pulmonary disease (COPD): 9.2%, compared with 7.1% statewide (2016).
The immune compromised
CDC says the immune compromised also are at higher risk from COVID-19. That includes people undergoing cancer treatment, bone marrow or organ transplants, or who have poorly controlled HIV or AIDS, or who have prolonged use of corticosteroids and other immune weakening medications.
Brevard had 68 HIV cases in 2018, and averages about 60 cases per year, state health data shows.
For specific cancer types, state health department statistics show that Brevard had higher age-adjusted cancer rates than the rest of Florida 12 of 12 years for kidney cancer and lung cancer; 11 of 12 years for bladder, skin, oral and brain cancer and other central nervous system cancers; 8 of 12 years for leukemia; 7 of 12 years for breast cancer, according to a FLORIDA TODAY analysis of state cancer data.
But Florida health officials downplay those statistics, noting that cancer can occur due to many risk factors simultaneously, including age, gender, race, smoking, and other lifestyle factors.
Another coronavirus wild card for Brevard and Florida: hurricanes. Forecasters expect an above average hurricane this year.
“What if it lasts into fall” Johnson, of Stetson University, wonders, “and before we deal with this, we have to deal with hurricane issues. This is going to overwhelm our public health system.”
Meanwhile, as Brevardians try to stay away from each other, New Yorkers and others just can’t seem to stay away from Florida, feeding contagion from their home states to come here. At least four of Brevard’s 51 cases (as of April 3) are from New York, and several others had traveled there.
“There is a tight relationship between Florida and New York, and that’s a big warning sign,” Johnson said. “It is incredibly difficult to track this movement.”
Stahl hopes for as few movements as possible.
“We need to stay apart,” Stahl said. “We need to stay home as much as we can possibly stay home.”
What is COVID-19?
COVID-19 stands for coronavirus disease 2019, caused by a virus named SARS-CoV-2. SARS is short for severe acute respiratory syndrome. The disease was first detected in December 2019 in Wuhan, Hubei Province, China.
Globally, the case count nears 1 million, with more than 50,000 deaths (as of April 2).
Symptoms of COVID-19 include fever, cough and breathing trouble. Most people suffer mild symptoms. But some, usually those with other underlying medical complications, develop more severe symptoms, such as pneumonia, which can be fatal.
Experts warn that because so many people appear to be asymptomatic and therefore not included in the infection counts, the death rate is likely lower than reported. But so much still remains unknown.
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Jim Waymer is environment reporter at FLORIDA TODAY.
Contact Waymer at 321-242-3663
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