Dr. Margaret Crossman
As we draw near the close of our eighth month in this pandemic, we recognize that COVID-19 will continue to impact our community and health care system for the foreseeable future. While the learning curve has been steep, prospects for infected patients have improved. As with many other viruses, a myriad of factors contribute to development of symptoms, and their severity. In general, increased age and certain pre-existing conditions, especially morbid obesity and uncontrolled diabetes, predispose an individual to more severe disease, with increased rates of hospitalization and death.
Let’s look at the estimated numbers:
80% of known infected people have either no symptoms or are mild to moderately symptomatic with predominantly upper respiratory or GI symptoms.
15% of infected people develop severe respiratory disease that requires oxygen support.
5% have critical disease, with complications such as respiratory failure, sepsis, abnormal clotting and/ or multiorgan failure, including acute kidney or cardiac injury. Depending on age and baseline health status, 50- 75% of those with organ failure recover.
After recovery, regardless of disease severity, some will have lingering symptoms that may last for months, perhaps longer.
Supportive treatment remains the most critical aspect of caring for patients with COVID-19. For hospitalized patients, this includes continuous monitoring of vital signs, nutrition and hydration, along with surveillance for organ dysfunction or failure. Other treatments such as antiviral medications or immunotherapy can be helpful, especially if initiated early in the course of hospitalization. In some cases, the best window of opportunity for a given treatment may be pre-hospitalization, and more research is being done in this regard. Use of interventions and medications to prevent abnormal blood clotting is also indicated in more severe cases.
At Halifax Health, most of our critical COVID-19 care has occurred in our Special Isolation Unit, designed by hospital engineer, Jacob Nagib. This unit was designed with ventilation, safety, efficiency and serviceability in mind. Served by 100% fresh air, with a dozen or more air exchanges per hour, each bed is fully equipped and capable of mechanical ventilation for up to 30 patients. This is in addition to our baseline 90 critical care beds. Dr. Kent Harman, Director of Halifax Health Critical Care Services, admitted our first patient with COVID-19 in March. His leadership from the bedside continues to this day. He is joined by other dedicated intensivists, hospitalists, nurses, respiratory therapists, and ancillary service Team Members who help ensure continuous high quality care for our patients.
In keeping with our theme of transparency, Halifax Health has admitted approximately 400 patients with COVID-19, with 64 deaths, including one team member. With earlier treatment, better supportive care, and expanded testing to younger and less symptomatic populations, death rates continue to trend down. Since entering Florida Governor DeSantis’ Phase 3 plan, our three hospitals’ capacities remain ample and stable, with no significant increase in hospitalizations since our peak of 42 patients in mid to late July. The average age of hospitalized patients with COVID-19 has trended down, although we continue to care for many elderly patients. The average length of stay is around one week, unless a patient requires mechanical ventilation, in which case they will likely be on a ventilator several weeks, and hospitalized closer to a month. This is longer than typically seen for patients with complicated influenza who require mechanical ventilation. We currently average 15-20 COVID-19 patients on any given day, with 3-6 on mechanical ventilators.
While Volusia County recorded one case of multisystem inflammatory syndrome in children (MIS-C) earlier this summer, the majority of children rarely get ill from COVID-19. In addition, consistent with experience across the globe, we have learned children are not efficient spreaders of this virus. A recent Yale study of over 50,000 daycare workers across the country concluded there was no evidence of significant COVID-19 illness or spread to adults in the daycare setting, provided core health and safety mitigation practices are followed.
For children under the age of 15, the US has recorded 72 COVID-19 related deaths. While every death is a tragedy, this compares annually with more than 600 pediatric deaths due to motor vehicle accidents, and over 125 US pediatric deaths due to influenza for the 2019 flu season. Most recently, the CDC reported that for patients under the age of 20 with COVID-19, survival rate is 99.997%. This is good news for the young, and especially so for our daycare centers and elementary schools.
From here we press on. We have enhanced affiliations with local public health officials, emergency operations center officials, and state counterparts that will continue to benefit this community. As we watch Europe grapple with renewed surges in cases, we are vigilant in maintaining a state of readiness. We do not take lightly the fact that a second wave could be more deadly than the first, as occurred with the 1918 Spanish flu. But we are forewarned and prepared, encouraged by promising treatments, and hopeful in the development of safe and effective vaccines.
We are grateful for letters of support, meals, and other forms of encouragement that have cheered us on during this pandemic. As the holiday season approaches, we urge everyone to continue targeted mitigation strategies, and to get a flu shot. For those with medical conditions that may increase risk of more severe disease, now is the time to optimize your own health and nutritional status. This virus is a reminder we never know what a day may bring; but whatever it may bring, we are here to face it with you.