Did South Florida hospitals learn enough from the summer COVID surge to keep more patients alive this winter?

Have South Florida hospitals learned enough from last summer’s surge to keep more patients alive this winter?

Hospital leaders are counting on it with COVID admissions up 60% in the last month and uncertainty over whether a vaccine will arrive in time to slow down the inevitable spike.

“By now, everyone is experienced and trained,” said Conor Delaney, CEO of Cleveland Clinic Florida.

Eight months into the pandemic, the tents in hospital parking lots for coronavirus screenings have come down and the signs plastered all over the emergency departments listing symptoms are gone, too.

Instead, if you get sick enough from the virus this winter to go to a South Florida hospital, you will get swabbed before admission to learn immediately if you have the flu or COVID-19. If positive, you will be put on a dedicated COVID floor and prohibited from having visitors. Your options for treatments will be more expansive and chances for recovering higher than during the summer months when local hospitals last saw their admissions peak.

“Everything we have learned has prepared us to treat our patients and get them home,” Tony Gomez, CEO of Jackson North Medical Center, said during a panel discussion sponsored by the North Miami Chamber of Commerce.

Gomez and other CEOs watch as overwhelmed hospitals across the country struggle with staffing shortages and crowded intensive care units and recognize they could be next. They are stocking up on supplies and ordering drug treatments. They are preparing to convert regular floors into COVID wings or critical care units and move staff between individual hospitals within their systems. The last step would be to halt elective procedures to free up staff, beds and equipment.

Mary Mayhew, CEO of the Florida Hospital Association, said most Florida hospitals have created their own surge plans and know the patient thresholds that will trigger them.

“In a crisis, hospitals have to be able to respond quickly,” she said.

Here’s how your experience as a COVID patient will differ from earlier in the pandemic:

Treatments

If you arrive with shortness of breath, you won’t immediately be put on a ventilator, or isolated in a negative pressure room. “We can keep you safe without negative pressure,” said Delaney of Cleveland Clinic Florida.

Rather than a ventilator, doctors will put COVID patients on a high-flow oxygen therapy or a BiPAP machine for respiratory support. Depending on the severity of your illness, you might be given plasma from someone who recovered from the virus, the steroid dexamethasone or the antiviral Remdesivir — all have improved outcomes in some patients.

If you have only mild breathing concerns, you may get sent home with a small clip-on device to monitor your oxygen levels. Or you could be given an infusion of newly FDA-approved antibody treatments Regenoron or Eli Lily’s bamlanivamab, which have shown promise in keeping the virus in check early in the disease.

“We don’t have a remedy, but we do have treatments that shorten the length of stay, " said Aurelio Fernandez, CEO of Memorial Healthcare System.

Peter Powers, CEO of Memorial Regional Hospital in Hollywood, said not only should treatments help shorten your hospital stay, but your chance of recovering should also be greater than it was during the summer surge.

“I don’t expect mortality to go up, especially as we have more and more things at our use to fight the disease,” he said during the Chamber of Commerce panel discussion.

Staff

Medical staff are now seasoned, better supplied and know how to wear gear to protect themselves. They also know how to work the COVID floor, monitoring oxygen levels and choosing from various treatments. But will there be enough nurses and doctors if the virus continues to spread in Florida?

To handle surges, hospitals have trained staff from areas outside of critical care to treat COVID patients. If patient volume swells, your doctor or nurse could be someone who normally replaces hips or cares for patients having colonoscopies.

Some local hospitals, like Memorial, see admissions creeping up and already have hired temporary staffing, anticipating that if a surge hits hard as it has in other states, the pool of reinforcements could be dry.

National Nurses United, the country’s largest union for registered nurses, has been vocal about problems in hospitals including those in Florida. Marisa Lee, a longtime labor and delivery nurse at Osceola Regional Medical Center in Kissimmee said nurses are being exposed to the virus by patients waiting for test results.

Even with protective gear, nurses are getting sick. In Ohio, Cleveland Clinic has about 1,000 employees sick or in quarantine due to COVID-19.

Mayhew said hospital leaders know their biggest challenge is having the staffing level to treat the critically ill.

“Hospitals can convert regular rooms to ICU level of care. They can convert areas of the hospital, like meeting space, to patient care areas. But having the nurses and physicians ... that is going to be a challenge,” she said.

Vaccines should be arriving in South Florida within weeks — at Jackson Memorial in Miami and Memorial Healthcare in Hollywood — in time to keep more healthcare workers on the job. But as new infections increase daily, the race will be on to get a vaccine to protect hospital workers across the state before Florida’s healthcare systems become overwhelmed with COVID patients.

Beds and ventilators

If you are sick from COVID-19, getting a bed at a South Florida hospital should be doable. Health systems like Broward Health and Baptist Health have plans that include converting regular floors into critical care units, adding beds, and shifting patients between hospitals.

The issue will be whether you will have a nurse or doctor to give you medical attention as quickly as you need it.

Justin Senior, chief executive officer for the Safety Net Hospital Alliance of Florida, said most Florida hospitals still have plenty of open beds. However, hospital CEOs watch the daily coronavirus admissions continuously, he said. “We know that if a third wave hits, the beds can fill up quickly.”

Baptist Health South Florida had 850 coronavirus patients in beds during the summer peak. It has just over 200 now.

“We are seeing a gradual increase of patients, not a bell-shaped curve,” said Lincoln Mendez, CEO of Boca Regional Hospital, owned by Baptist Health. “It seems fewer patients are critically ill and ending up in ICU and fewer need ventilation. That’s a good sign. We are seeing that throughout our system.”

Baptist Health South Florida, with 10 hospitals in the area, shares resources to accommodate as many patients as possible.

“If there is not a bed open at one, the patient can be transferred to another facility,” Mendez said. “During the last wave, we took ventilators from Boca and sent them to Miami.”

Visitors

If there is something that hasn’t changed throughout the course of the pandemic, it’s the visitation policy at hospitals. When you are admitted for coronavirus, you will not be reunited with family again until you are discharged.

“If you have the virus and are hospitalized, you likely are infectious,” said Delaney, at Cleveland Clinic. “We are trying to keep everyone safe.”

The no-visitation policy has been especially tough on critical patients, some who don’t end up making it home. Hospital leaders say their ICU staff has become seasoned at helping patients use technology to talk to loved ones. But this gets more difficult when patient numbers rise.

With the new infections in Florida climbing above 9,000 most days this month, Senior at the Safety Net Hospital Alliance of Florida, said hospitals are “hoping for the best and preparing for the worst.”

Meanwhile, healthcare workers have banded together to create a public campaign, pleading for Floridians to wear masks and social distance. Their plea to the public: Even well-prepared hospitals cannot compensate for an unchecked pandemic.

Got a health-related tip? Health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com or Twitter @cindykgoodman

———

©2020 the Sun Sentinel (Fort Lauderdale, Fla.)

Visit the Sun Sentinel (Fort Lauderdale, Fla.) at www.sun-sentinel.com

Distributed by Tribune Content Agency, LLC.