After an exhausting July, COVID admissions slow at Miami-Dade’s hard-hit hospitals
Patient admissions to hospitals for COVID-19 have been ticking down in Florida and Miami-Dade County over the past week, leading doctors and hospital administrators to offer cautious optimism that the state and region may have turned a corner on the pandemic even as the statewide death toll continues to rise.
Florida’s record 257 deaths reported on Friday are part of what public health experts call a lagging indicator of COVID-19, reflecting the worst outcomes among the sickest patients to be hospitalized as the disease surged back in June, said Michael Lauzardo, a pulmonary disease specialist with the University of Florida Health System in Gainesville.
“Deaths will continue to increase, to catch up as a reflection of the people who are critically ill and in the hospital today,” Lauzardo said.
As COVID hospitalizations also tick down statewide — dipping from more than 9,000 a week ago to about 8,200 on Friday, according to the Florida Agency for Health Care Administration’s online tracker — Lauzardo said he suspects more Floridians may be heeding the advice of public health officials by staying home or avoiding crowds and indoor spaces where the virus spreads. But the numbers are still very high, he noted.
“The overall tone to me is that this is good news,” he said. “People are changing their behavior. They’re listening. There’s still a long way to go.”
At Jackson Health System in Miami-Dade, the chief medical officer, Peter Paige, is looking forward to the end of a difficult July and the beginning of what he hopes will be a sustained drop that would allow for a few weeks respite — if not longer — for doctors, nurses and other healthcare workers who have been at it for five months.
“I’m cautiously optimistic. It’s a term that’s kind of en vogue now,” said Paige, an emergency physician and administrator. “I don’t want to count our chickens yet, just because it’s been so unpredictable over the last five months.”
Jackson Health — Miami-Dade’s public hospital system — had 409 COVID-positive patients in its three Miami-Dade hospitals on Friday, with about 113 of those patients in the intensive care unit. That’s fewer than the 465 or so COVID-positive patients a day that Jackson Health reported last week, but Paige said there’s a slightly higher percentage of critically ill patients with the disease in intensive care.
A total of 368 patients have died of COVID at Jackson Health hospitals, Paige said, including 172 deaths in July and 52 in June. The high number of deaths in July followed the disease’s resurgence in Florida, which began about mid-June.
“You can see July was a really rough month for us,” Paige said. Though the majority of COVID-related deaths at Jackson Health in June occurred among patients who are 65 and older, Paige said he saw about a 10% increase in deaths among patients ages 50 to 64 in July.
He added that most COVID-related deaths are occurring among patients who have underlying medical conditions, such as obesity, heart disease, kidney disease, suppressed immune systems and other illnesses.
“Those definitely are dominating our death profile,” he said.
Baptist Health South Florida, which has 11 hospitals in Miami-Dade, Monroe and Palm Beach counties, also has seen a dip in patients over the past week, said Sergio Segarra, chief medical officer for the system’s flagship hospital in Miami.
“Things are getting better in terms of that the numbers of admissions are slowing down, the numbers of COVID-related visits to the emergency department are slowing down, that we’re able to discharge on a daily basis more people than we admit,” Segarra said.
Hospital administrators and physicians are grateful for the slowdown, Segarra said. But he added that many patients continue to be seriously ill.
“That really has not changed,” he said.
Baptist Health hospitals, including six in Miami-Dade, had 619 patients on Friday who have tested positive or are suspected of having COVID. That’s down from 746 patients on Tuesday. “That is giving me some optimism,” Segarra said.
That optimism, however, comes in the context of a June and July that saw four to five times as many patients at Baptist Health compared to the spring, Segarra said, though he added that treatment has led to better survival rates in the hospital system.
Segarra said doctors and nurses are exhausted from months of caring for COVID patients. He said everyone has pitched in, with anesthesiologists volunteering to work shifts caring for critically ill patients. Baptist has also hired more doctors and contractors.
“Just so we can give our people a break,” Segarra said.
Baptist Health also has created “quiet spaces,” introduced relaxation techniques and next week will offer massage therapy for its healthcare workers, he said.
“We’re very cognizant that this is a marathon and it would be no different than if you were on mile 16 of your marathon and all of a sudden you were asked to sprint,” Segarra said. “And that’s basically what’s happening. We’re asking everybody to sprint.”
At Jackson Health, a group of new nurses are helping to relieve healthcare workers at the county’s public hospital system.
Paige said the additional nurses funded by the state are a big boost.
He described them as “very bright, very excited to be here, very excited to help. … People are very, very happy thus far with the nurses, the techs that are coming in that are brought in from outside. I think some of it is because it’s starting to relieve some of the pressure from staff.”
Still, Paige said, five months of COVID care, which involves lots of protective gear and other precautions, has been exhausting.
“What we’re seeing is a lot of fatigue and a lot of wear, especially in the critical care units, where it tends to have the greatest intensity,” he said. ”Having patients stay in critical care units for five or six weeks and die is also very emotionally challenging for our physicians.”
This story was originally published July 31, 2020 at 5:58 PM.
