Facing shortages of beds and remdesivir, South Florida hospitals halt elective surgeries

As South Florida hospitals canceled non-emergency surgeries on Wednesday to make room for a growing wave of patients with COVID-19, the health department told hospital pharmacies that the state has temporarily exhausted all supplies of remdesivir, one of the few drugs shown to be effective at treating the disease.

Florida’s case count began to rise two weeks after Memorial Day and has not declined since, with an additional 6,563 COVID-19 infections confirmed on Wednesday — raising the statewide total to 158,997 people since the pandemic began, with more than 30% or nearly 50,000 new cases reported in the past seven days.

The surge threatens once again to overwhelm hospitals in the regions where the virus has struck hardest, including Miami-Dade and Broward counties.

In Miami-Dade, which has had a total of 37,961 confirmed cases so far, more than any county in the state, Jackson Health System said it would cancel all non-emergency surgeries starting on July 6 in order to preserve hospital beds and nurses who care for patients. The number of patients with COVID-19 across Jackson Health’s hospitals in North Miami Beach, Miami and South Miami-Dade have doubled to 296 in the past 14 days, including 80 patients who were in intensive care units.

“Our hospital’s capacity is being pushed to the limit right now,” Jackson nurse Helga Segura told Miami-Dade commissioners during an emergency meeting of the board to discuss the county’s COVID response. “Where do we go from here? Once hospitals meet capacity, do we have a plan for that?”

Jackson Health CEO Carlos Migoya told commissioners reducing surgeries and other elective procedures would get Jackson ready for what he predicted would be a “hot” month for COVID admissions in July. He said the hospital is already seeing signs of strain, including an increase in the portion of Jackson workers testing positive and a growing backlog in lab results.

“Are we having a challenge with staffing? Absolutely,” he said. Migoya said Jackson has been hiring new nurses, and is ready to convert some operating-room staff into intensive-care positions as the hospital system receives more COVID cases. “All of South Florida is going through a similar kind of situation.”

Baptist Health South Florida, the largest non-profit hospital system in the region, said its administrators also were considering new measures to handle the spike in patient volumes at its 11 hospitals from Monroe to Palm Beach counties.

In Broward, where the state has confirmed 16,155 COVID-19 cases, the second most of any county in the state, Memorial Healthcare System said it would also postpone all non-emergency surgeries as of Wednesday but would continue to provide outpatient procedures that do not require an overnight stay.

A new hospital for COVID patients

To help hospitals prepare for a potential surge, the state’s Agency for Health Care Administration opened a 120-bed hospital in Miami-Dade on Wednesday intended to serve patients who are still testing positive for COVID-19 but are well enough that they no longer require the intense level of care provided at hospitals.

The reopening of the former Miami Medical Center, which had been shuttered since October 2017, will also help hospitals find a place for nursing home residents who have recovered from COVID-19 but are still testing positive and cannot return to their long-term care facilities.

The facility is one of a handful across the state designed to help prevent a shortage of hospital beds due to COVID-19. The hospital in Miami is owned by Nicklaus Children’s Hospital but will be staffed by an independent contractor so as not to siphon healthcare workers from local hospitals. Migoya told commissioners the facility will accept about 90 patients this week, including 30 patients who are now at Jackson Health facilities.

Tamara Konetzka, a public health researcher at University of Chicago, said other cities like New York and Chicago have tried similar approaches and found some success at increasing their local hospitals’ ability to care for COVID-19 patients.

“That’s been a very common and mostly effective solution,” she said.

Remdesivir supply runs low

As South Florida hospitals prepare for a steady rise in COVID-19 patients, Florida’s health department told hospital pharmacies this week that the state had exhausted its supply of remdesivir, an antiviral drug that has shortened recovery time and led to better outcomes for patients in a randomized trial of 1,063 patients funded by the National Institute of Allergy and Infectious Diseases.

Florida’s health department allocates the drug to hospitals, and on Tuesday the agency’s Bureau of Preparedness and Response informed hospital pharmacies that the agency had temporarily exhausted all remdesivir in stock. The health department suspended all orders on Tuesday but said that more supplies were on the way and that deliveries to hospitals would resume beginning on Thursday morning.

Dr. Lilian Abbo, an infectious disease specialist at Jackson Health, confirmed on Wednesday that supplies of remdesivir were running low at the public hospital but said that they still had enough to complete the course of treatment for patients who had started it.

“If we get to a point where cases continue to double, as we’re seeing now, then we need to make sure we have enough of the drug to be allocated,” Abbo said. “We don’t want to get to the point where we don’t have the drug. This is extremely dangerous. … If we run out of treatment it could be fatal for people.”

The breakthrough treatment, the first to be proven effective in treating severe cases of COVID-19, is manufactured by U.S.-based Gilead Sciences. The company came under fire earlier this week when it released its pricing on the drug, which will cost $3,120 for a five-day course if purchased through a private insurance company.

The United States has secured the next three months’ worth of supply of remdesivir, effectively blocking other countries from placing orders, according to media reports. Federal health officials allocate the drug to state health departments based on their COVID-19 hospital volumes, and state health departments distribute the drug to hospitals.

The Florida Department of Health did not respond to questions about the state’s supply of remdesivir or the agency’s plans for redistributing the drug to hospitals. But Abbo at Jackson Health said she expected distribution of the drug to resume by Thursday or Friday.

County hospitals brace for surge

Miami-Dade Mayor Carlos Gimenez said he was convening a meeting of hospital CEOs across the county on Tuesday to ask them to take similar steps on elective procedures in order to create more space for COVID patients.

Even with daily testing counts up significantly, the portion of results coming back positive for COVID remains nearly double the 10% threshold Miami-Dade established as safe when Gimenez lifted business closure orders in May. Gimenez told commissioners that rising positive rates are “corresponding with an increase in the number of people going into the hospital.

His administration also is reviewing “surge” plans for hospitals to deal with overflow should beds get full. A Florida contractor last month dismantled a field hospital built at the county’s Tamiami Park in late March, but continues to maintain an empty 450-bed facility at the Miami Beach Convention Center.

At testing sites across Miami-Dade, demand has skyrocketed. While the county was recording about 1,000 tests a day in early June, the latest tally put that figure at 4,000. Migoya said while testing is far more available than when it was at the start of the coronavirus crisis in March, results are lagging and Jackson can’t get the materials it needs to test quickly on its own.

“All these labs that the tests are going to are getting pressure by the entire country. Now there’s a delay between three and five days,” Migoya said. “We’re doing our own testing. The problem we’re [having is] our reagents for own labs are being limited. We’re getting slowness in our own labs as well.”

Miami Herald staff writers Douglas Hanks and Mary Ellen Klas contributed to this report.