More COVID patients are entering South Florida ICUs. More deaths are likely to follow
Even as news of highly effective vaccines nearing emergency federal approval offers new hope in the fight against the COVID-19 pandemic, intensive care units of South Florida’s largest hospital systems are seeing a familiar and grim pattern emerge.
Following weeks of rising COVID-19 cases and hospitalizations heading into fall, the ICUs at Miami-area hospitals say they now have increasing numbers of patients with severe disease and those needing to be intubated so they can breathe. Medical experts fear that, as in previous surges, the number of deaths from the pandemic will rise as well in coming weeks.
Across Miami-Dade County, the number of patients in ICUs rose sharply over the last several days, from 125 on Saturday to 158 as of Tuesday morning — about 25% of the 658 COVID-positive hospital patients in total as of that day.
Dr. David De La Zerda, a critical care physician and medical director of Jackson Memorial Hospital’s intensive care unit in Miami, said he had been expecting the increase in the number of critically ill patients after weeks of rising case numbers that have now reached an average of about 2,000 cases per day.
As he has done since the spring, De La Zerda pleaded with South Floridians to take the virus seriously. The lag between when cases spike and when hospitalizations start to surge, he said, can often lull the public into a false sense of security.
“You see all these positive cases and think maybe I can relax because the virus is changing,” he said, ”but it’s not changing.”
The latest wave of severely ill COVID patients at Jackson is coming on top of ICUs that are already filled with patients brought in for other reasons, such as delayed surgeries and other medical care postponed due to the pandemic, De La Zerda added. Though Florida’s fall resurgence of the virus has trailed behind other states with spiking cases, such as those in the Midwest, recent weeks have brought accelerated virus growth in Florida as well.
“Now everybody is here, so we have a full ICU of non-COVID and now we have a full ICUs of COVID,” De La Zerda said “And I think that’s different from the first time, when people just weren’t going to the hospital.”
Mary Jo Trepka, an epidemiologist and professor at Florida International University, said last week that she expected the number of patients in Miami’s intensive care units to rise soon. On Wednesday, when that expectation had materialized, Trepka said that Miami-Dade’s epidemic trajectory was “sadly very predictable” — rising cases are followed by rising hospitalizations, followed by rising levels of patients in intensive care and finally, tragically, by rising deaths.
The infectious disease expert wasn’t predicting that things would get better with the virus any time soon.
“It’s not that we’ve reached the peak — we’re still surging,” Trepka said. “I fear we’re going to be well over 2,000 [cases] a day in the coming weeks, and then the hospitals are really going to start to get full and get very stretched.”
More of the same at Miami hospitals
Dr. Yvonne Johnson, chief medical officer at South Miami Hospital, part of Baptist Health South Florida, said her goal for the past couple of weeks has been to brace herself for the next several months until vaccines arrive for the general public, perhaps as early as next spring.
“That is a bright light at the end of a dark tunnel,” Johnson said. “But we still have some of that tunnel to get through, so it really is incumbent upon all of us to do everything we can to get safely through that tunnel until the vaccine is widely available.”
Johnson said that the outcomes of those who end up in the intensive care units at Baptist Health hospitals haven’t shifted much since the summer surge, though physicians and nurses have gotten better at treating the disease.
“For some people, they’re there for weeks in intensive care and I’d say the majority of our patients walk back out the front door, but we have seen a significant amount of mortality over the course of this pandemic,” Johnson said.
Like Jackson’s De La Zerda, Johnson agreed that little has changed as far as how many people who are admitted with COVID-19 become severely ill and the known risk groups: those who are older and have other medical conditions, for example; and then there are others who are young and seemingly healthy before they contract the virus.
Physicians and nurses have learned how to manage respiratory care for people struggling to breathe, but there’s still no treatment specifically for COVID-19, and little known about the effectiveness of broad-range antivirals like remdesivir. Johnson called it a “steep learning curve.”
“We have absolutely gained a greater understanding of treating the disease, but I can’t say that we have any kind of miracle type treatment available to us right now,” she said. “The best therapy right now is prevention. It’s not getting it.”
This story was originally published November 25, 2020 at 3:31 PM.
