From the Sun Sentinel
Confirmed cases of the new coronavirus in Florida leaped sixfold in a week. By many projections, the pandemic will last at least two months. And if Broward County alone follows the current pattern of spread, the area may see 800 new cases in the next two weeks.
What more can Florida expect?
While no emergency or disaster model specifically outlines how this — or any — pandemic will play out in Florida, worried leaders are drawing conclusions based on past epidemics, current epidemiological research and guidance from the Centers for Disease Prevention and Control.
The news isn’t good over the short term: It’s only the beginning.
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“When you see what has been trending around the world, that’s what we are going to be seeing here,” said Lilian Abbo, chief of infection prevention at Jackson Memorial Hospital in Miami. “The cases will continue to go up. There will be people who will get very sick. What we want to minimize is severe cases.”
Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, put it very succinctly in testimony to Congress last week. “Bottom line, it’s going to get worse.”
How quickly will it spread?
How the new coronavirus advances in Florida rests largely on critical decisions made by Gov. Ron DeSantis and his teams at the Departments of Health and Emergency Management as the first infections were confirmed in the state over the past week.
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Their massive efforts to curtail public events and access to facilities that care for the senior population are based on the rate of infection so far across the world.
In just one week, Florida leaped from zero cases of the new coronavirus to more than 100 on Sunday. Some modeling suggests that a third of Americans will be infected. That’s 7 million people in Florida, a state of more than 21.3 million.
According to estimates shared by the American Hospital Association, the time frame in which the number of COVID-19 cases doubles is 7 to 10 days. But in Florida from Tuesday to Friday, the rate proved faster, more than doubling in those four days.
The numbers are large, but even more of a threat is that many of those cases likely will be among the elderly given Florida’s disproportionately large senior population and the risks that the new coronavirus has for them. Of the people already infected in the state, more than half are older than 60.
By studying China and South Korea, Dr. Glenn Morris, director of the Emerging Pathogens Institute at University of Florida, anticipates the intensity of new cases in Florida could last about two to three months before a drop-off, or a mishandled response could cause the spread to last longer, through the summer. He does not rule out a slowdown in the warmer months and a second wave of the coronavirus in the fall.
Will we be able to get care?
With only 67,000 hospital beds in Florida, a state with more than 21.3 million people, quick and decisive action from government leaders could make a difference in how fast and far the virus spreads.
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But if the number of cases rises rapidly, as it is starting to do, Florida needs to face a harsh reality: those who may need significant care — possibly at the same time — may easily overwhelm the state’s capacity to provide it. Florida hospitals run on tight budgets and have only enough equipment and beds to be cost-effective but still care for people in emergencies.
The new coronavirus is unprecedented in its demands for ventilators and intensive care treatment for people with significant respiratory illnesses.
Florida recently began tracking its intensive care unit beds through a statewide Emergency Status System. Of the state’s 210 hospitals and 21 long-term care facilities that have reported so far, and factoring in the 12 hospitals that have not reported, there are roughly 6,000 to 7,000 ICU beds for adult patients. That works out to one ICU bed for every 3,000 people in Florida.
Contrast that with the 4 million seniors in the state who are at risk for the highly contagious virus, the population most often admitted to the ICU and requiring ventilator support.
Florida hospitals are revising their pandemic preparedness plans, preparing for the crush of cases. Most hospitals, including the VA in West Palm Beach, have triage tents set up outside emergency rooms. The worst-case scenario could force Florida’s emergency room doctors to make difficult choices about who receives access to a limited number of respirators, Morris said, based on what he’s seeing happen in Italy.
Evan Boyar, director of emergency management for Broward Health System, recognizes that the trickle of people entering Broward Health with respiratory illness could flood his facility quickly, which is why about 10% of the beds are slotted for isolation. “When the virus first comes it tends to grow exponentially, but we anticipate that and have a strategic plan to accommodate a surge.”
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“Our goal in the community now is to make the curve as flat as possible, to bring this down to a slow trickle rather than a spike,” said Peter Antevy, an EMS physician and medical director who oversees emergency response for Davie, Coral Springs, Parkland and Palm Beach County.
Test results a mixed blessing
Testing is still ramping up and the number of confirmed cases will continue to rise, according to the Florida Department of Health. Florida had tested only about 700 people as of Saturday.
Jared Moskowitz, director of the Florida Division of Emergency Management, said on Thursday the state was testing 100 people per day but had the capacity to test 300 people per day. He said the state also has the capability to tap into commercial testing contracts to test up to 2,500 per day. Testing in Florida still is being limited to people who meet specific criteria, but that could be expanded.
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The state has purchased COVID test kits that can be used for up to 625,000 people, as the governor announced Thursday. Moskowitz said this, in combination with expanding to more testing sites, will give the state the ability to test anywhere from 5,000 to 40,000 people per day by the end of next week.
And that may result in a massive jump in the number of people confirmed to have the new coronavirus. People with mild or no symptoms may have been allowed to remain under the radar, possibly infecting others, because testing has not been widely available.
“We can’t fight a virus in the state if we don’t know where it is,” said Martha Baker, a registered nurse and the president of the union representing nurses and doctors at Jackson.
For every confirmed case of the new coronavirus in Florida, another two to three people are infected, according to an estimate UF’s Morris provided based on epidemiological models.
“We are missing a high number of cases so it is hard to know exactly what is happening in Florida,” Morris said. If doctors knew where clusters are — particularly people with milder cases — the state could take extra measures to stop more of a spread, he said.
How sick will we get?
About 80% of the people confirmed to have the new coronavirus will have mild symptoms, similar to the common cold or flu. Those people can be treated at home with over-the-counter medicines and usually make full recoveries, a large study by the Chinese Center for Disease Control and Prevention found.
About 14% of COVID-19 patients were considered severe, with symptoms that don’t go away on their own, and they often develop a lung infection.
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Just under 5% were considered critical, mostly the elderly or people with medical conditions who have respiratory complications from the virus and require hospitalization to help with breathing.
The death rate
In one model presented to the American Hospital Association, Professor James Lawler of the University of Nebraska Medical Center forecast the death toll in the United States from the new coronavirus at more than 480,000 deaths if the country’s social distancing and other efforts to mitigate the epidemic fail.
Other national models are similarly dire. The CDC says a fatality rate of 2.3% has been reported among confirmed cases of COVID-19 in China. If even just 1% of the Florida’s 4 million seniors get infected, that could be as many as 40,000 people, resulting in more than 900 potential deaths.
Florida Surgeon General Scott Rivkees has repeatedly pointed out at news briefings that the World Health Organization found the highest mortality among people over 80 years of age and those with underlying health conditions.
Florida, with more than 4 million seniors in the state, has reported three coronavirus deaths as of Saturday, all people who were 68 or older.
At this point with the new coronavirus, it remains more deadly than the flu. About 20,000 to 50,000 people have died from the flu this season, according to the CDC. The World Health Organization has said the flu kills less than 0.1% of people each year, and the current fatality rate for the new coronavirus appears to be about 2-3%.
There is no vaccine or treatment yet for COVID-19, although the symptoms can be treated.
POZitive Attitudes 
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