South Florida’s hospitals are bracing for novel coronavirus, but say they’re prepared
As the sun rose over downtown Miami’s health district on Wednesday morning, the city’s hospitals were visibly bracing for the potential impact of an emerging and highly contagious pathogen.
At the Miami Veterans Affairs Healthcare System, employees showing up for their 7:30 a.m. shifts were funneled through a single entrance to be screened for signs of respiratory symptoms. They had been notified one day earlier of the protective measures.
Down the street, the University of Miami Health System, or UHealth, had set up an isolated blue tent outside an emergency room entrance as part of its preparations, though the health system did not specify what it would be used for.
The measures come less than a week after Florida confirmed its first cases of COVID-19, the disease caused by the novel coronavirus that has since infected at least 26 people across the state, including one man in Miami-Dade.
Patients, too, are undergoing additional screening. At the Miami VA, healthcare providers wore protective masks. A sign posted outside gates roped off with yellow tape directed those experiencing flu-like symptoms or a fever to return home and call a veteran’s hotline: 1-877-741-3400.
UHealth is partnering with Jackson Health System to address the novel coronavirus, setting out joint guidelines to restrict visitors, screen patients and move anyone suspected of being infected to isolation rooms without exposing healthcare workers. The two health systems said they were closely monitoring guidance from the U.S. Centers for Disease Control and Prevention to inform their plans.
“It’s an evolving, very fluid protocol and process,” said Dr. Lilian Abbo, chief for infection control at Jackson Health System and a professor of infectious diseases at the University of Miami.
To manage the flow of information, Jackson has been having daily or twice-daily meetings to communicate the latest COVID-19 protocols to staff.
Jaime Caldwell, president of the South Florida Hospital and Healthcare Association, said that even though this coronavirus is a new and unique threat, the region’s hospitals are ready to manage highly infectious diseases. Previous outbreaks such as the avian bird flu, SARS, MERS and Ebola, he said, prepared health systems for COVID-19.
“The name of the game is to reduce the opportunity for patient-to-patient transmission by safely assessing patients in a setting where the potential for disease spread is minimized,” Caldwell said.
How do hospitals screen for patients suspected of having COVID-19?
With the potential for highly infectious people showing up to seek treatment for COVID-19, hospitals across South Florida have put up stop signs at entry points that have long been open for walk-ins.
Jackson and UHealth are screening patients and visitors at clinical entry points and over the phone regarding their travel history and any symptoms they may be experiencing. Those suspected of potentially having COVID-19 are then moved to isolation rooms by dedicated clinical staff who wear personal protective equipment. If the patient requires hospitalization, UHealth and Jackson have negative-pressure rooms, used to direct air flow and prevent cross-contamination, at all of their hospitals.
At Baptist Health South Florida hospitals, patients who have respiratory symptoms and think they may have been exposed to the novel coronavirus are given surgical masks and placed in isolated rooms. HCA Florida hospitals — which include Mercy Hospital, Kendall Regional Medical Center and Aventura Hospital and Medical Center — imposed visitor restrictions and began directing people to specific entrances for screening.
“We have positioned supplies at points of entry, so that any potential symptomatic patient who arrives can be properly masked and immediately isolated to protect our colleagues and other patients,” a spokesperson for HCA Florida said.
A spokesperson for the Miami VA did not comment on the the hospital’s screening process, but a memo to employees obtained by the Miami Herald laid out the hospital’s “enhanced screening protocols,” which included restricting access to certain areas and reserving other areas for more vulnerable patients.
To prevent people from needlessly coming to emergency rooms or urgent care centers, doctors at both Baptist Health and Nicklaus Children’s Hospital said they hope to make more use of their 24-hour Telehealth systems, which allow patients and their caregivers to consult with doctors from a mobile device or PC.
What happens if hospitals get a surge in demand for intensive care units?
Given the severity of respiratory symptoms caused by the most extreme cases of COVID-19, health experts have raised concerns about the potential demand for intensive care units.
Though none of the local hospitals specified their ICU bed capacity, they stressed their flexibility in adding intensive care units. Similar measures have been taken in countries such as Italy, which has still seen its hospitals overwhelmed with patients needing advanced care.
UHealth and Jackson said they have multiple intensive care units to “meet the needs of anyone who requires critical care.”
“If UHealth or Jackson had multiple COVID-19 patients, we have designated units at each of our campuses that would solely house this patient population and it would be staffed by medical teams who have undergone specialized training and who are dedicated exclusively to these patients,” the two health systems said in a joint statement.
Memorial Healthcare System in Broward County said it had developed contingency plans to expand it if needed.
“Our ICU has board-certified physicians, and we will work through our capacity,” Kerting Baldwin, the health system’s spokeswoman, said. “In the event of a surge, we have plans on how to manage a high volume of patients within our healthcare system.”
All the major hospital groups in South Florida interviewed by the Miami Herald said they had adequate protective gear and supplies of ventilators and other equipment that might be needed to treat respiratory infections.
“We always keep a reserve stock,” said Dr. Stanley Marks, chief medical officer for Memorial Healthcare System, which operates six hospitals in Broward County. Supplies are monitored daily, he said.
Simulating an influx of patients
Nicklaus Children’s Hospital ran drills last week with mock patients complaining of novel coronavirus symptoms at both its emergency room and its urgent care center in Midtown to make sure staff members are prepared.
“Leadership knew this was a drill, but the frontline staff had no idea this was occurring,” said Vernon Jones, director of emergency management at Nicklaus. “This really was a test of our protocols.”
While around 80 percent of COVID-19 patients will experience only mild to moderate flu-like symptoms, its mortality rates are drastically higher than the flu. Patients with underlying health problems such as hypertension, heart or kidney disease, lung problems, diabetes, or who are undergoing cancer treatment are at higher risk.
The two most important ways to prevent spread of the virus are frequent handwashing and staying home when sick, said Dr. Evan Boyar, chief of emergency medicine for Broward Health, the public health system for North Broward County.
“The best medicine is primary prevention,” he said.
People 18 years and younger account for less than 2.4 percent of the COVID-19 cases worldwide and “infants have done remarkably well,” said Dr. Aileen Marty, a professor of infectious diseases at Florida International University. “The seriousness goes up as we get older. We in South Florida have an aging community. We have to be particularly attuned to that reality.”
This story was originally published March 11, 2020 at 5:50 PM.
