While the Flagler Health Department and AdventHealth Palm Coast are overrun with Covid cases and in-patients, local governments have gone silent, indifferent to the worst wave of the pandemic yet, making a mockery of their claim of a “partnership” with the Health Department or the hospital and amplifying community apathy that multiplies infections.
This is the crisis hospitals and public health agencies have feared since the beginning of the pandemic. It did not overwhelm hospitals and health departments in the first three waves. It is overwhelming them now. And unlike previous waves when health workers were lionized and local governments championed their health departments, no one is doing so this time around. In Flagler especially, the Health Department and AdventHealth Palm Coast are fighting this one on their own.
The unvaccinated continue to refuse to be vaccinated: despite record-breaking numbers day after day, the vaccination numbers are barely budging, reflecting the gravest indication of indifference from the segment of the community that could be battling the fourth wave, and future waves, most effectively.
There is no big, ominous tent outside the emergency entrance at AdventHealth Palm Coast, as there was in the earliest days of the Covid pandemic, when hospitals feared being overrun with patients. But there are scores of chairs lined up outside the ER. Wednesday night, the ER inside and out was full, and 60 beds in a hospital licensed for 130 were filled with Covid-19 patients, almost twice the record set last January, and double the number from barely a week ago.
There are now 1,000 covid patients in AdventHealth’s 16 hospitals in the Central Florida region, a record. And on Wednesday alone, 139 covid infections were confirmed in Flagler County–a number that previously had been alarming enough when it reflected a weekly total. This week’s infections, when confirmed on Friday, are on pace to be in the 700 range, shattering last week’s record 400 infections.
“I went to the ER in Palm Coast, but when I saw the scene was like a hospital in Gaza, I turned around and came home,” Rick de Yampert, FlaglerLive’s culture writer, said of his experience Wednesday night, when he went to the ER at 9:45 p.m. He’d been battling a urinary tract infection. It had gotten worse. He needed to see a doctor.
He saw this instead: “There was a giant, a huge RV-looking vehicle, and right behind it was a Ford Explorer, one of those type trucks, and I could see in the street lights, each of them had a ‘Covid Response’ banner on them. I got out, I went to the entrance, a woman came up to me and said, ‘Can I help you?’ and I said it doesn’t look like you can, because it looks like you’re being overrun.” By then he’d seen inside the waiting room. “It was people everywhere I looked, it was socially distanced but I didn’t see an empty seat, and outside they had chairs, and eight or 10 people were sitting there. One of the security guards was trying to calm down an elderly man who didn’t want to sit in the chairs.”
Between the people inside and outside, de Yampert estimated 30 were waiting. “It was kind of unnerving, like, fuck, what if I had a more serious thing–what if people there had serious [issues],” he said. (He saw his doctor in Ormond Beach this morning.)
On Wednesday, there were 107 Covid patients in Advent’s Daytona Beach hospital, 162 in Orlando, 31 in New Smyrna Beach, and 112 at Altamont, among other Advent locations. A new phenomenon: multiple unvaccinated, pregnant women in intensive care, some on ventilators, according to AdventHealth spokesman Jeff Granger, with disturbing consequences for gestating babies’ development. Flagler County’s public health department, itself overrun, is scrambling to add case investigators and contact tracers while revamping its testing and vaccination operations to make them more efficient during the crisis.
Yet for all the sense of crisis within hospitals and public health departments, the community bat large has been mostly indifferent: vaccinations in Flagler County continue to lag to the point that the Health Department is closing its three church-based vaccination sites, which were drawing only three or four people willing to be vaccinated each of the days they were open. Local governments are proceeding as if this were just another summer. Palm Coast and county governments in earlier points of the pandemic were focused on safety messages and measures. The last few days, they’ve been issuing smiley-faced news releases about sewer plants, a “litter pick-up” event on Saturday, a feature on the county’s emergency helicopter or boasting about commissioners’ awards. The school district is preparing for a full opening of schools on Aug. 10 without mask requirements or learning options other than in-person (the usual virtual school option aside). Flagler’s Tiger Bay Club just announced its August wine tasting event, in-person of course (but outside, under a tent).
It’s two parallel worlds. A few businesses are restoring masking mandate (Disney did so in Orlando on Wednesday, for all visitors, whether vaccinated or not, at all times), but Gov. Ron DeSantis continues to fight all local covid-safety measures, including masking or vaccine checks.
In contrast with earlier covid waves, not a single local government has sent out public advisories urging safety or cautionary measures. Not a single local government has issued vaccine advisories. Not a single elected official, in the county, on municipal boards or on the school board, has used his or her seat to urge vaccination.
On the face of it, the governments continue to call themselves partners with the local Health Department. In fact, the Health Department is now battling the public health emergency alone, while the hospital is contending with it as if ghettoized from the rest of an indifferent community.
The increase in Covid cases in Flagler are affecting “all age groups, with the largest increases in the younger age groups,” Bob Snyder, the Flagler County Health Department chief, said. “So this is now requiring a shift in our strategy. We’re just going to have to reprioritize ourselves to focus on the most vulnerable in our community. That would include of course our seniors immunocompromised, and especially our kids now that school is going to be returning on August 10. Individuals under the age of 12 are not vaccinated, so we consider our children’s school aged children to be among the most vulnerable. ”
The testing and vaccination will take place at Health Department headquarters at at 301 Dr. Carter Boulevard in Bunnell and at the department’s annex, especially since the school district has agreed to cooperate with the department in the rapid-covid-testing system for teachers and students. That rapid testing will reduce the number of staffers and students who need to quarantine, as long as they test negative after exposure to other confirmed cases.
But the department is trying to cope with a surge it has not previously experienced. “It’s overwhelming,” Snyder said. “We’ve added staff. We have staff that were maybe not working a full 40 plus hour week, were OPS staff, they now are again.” (OPS is a human resources acronym that stands for Other Personnel Services.) So thank God we have a little stable of individuals at the ready to commit to longer hours, plus we have put in through a special manpower request for five additional case investigators and contact tracers.”
At this morning’s briefing on Covid, AdventHealth’s physicians tried to put in words the unprecedented in an 18-month pandemic that’s mutated the unpredictable.
“We’ve seen waves occurring, of course, since the beginning of the pandemic, with the most recent large wave being in January,” said Dr. Vincent Hsu, executive director of infection prevention and epidemiologist at AdventHealth. “Our current wave that we are seeing is actually exceeding and past the numbers that we had seen in January, and what’s extraordinary is the speed at which we are currently seeing new cases. And unfortunately right now, the slope is pretty steep, and we haven’t seen the end of it.” He added: “It is going to get better, clearly it’s going to get better. I don’t have a crystal ball as to when. I think we have to recognize that the delta variant behaves in ways that were unlike the other variants and so this is a significant issue that we’re going to have to deal with.”
The hospital system has again narrowed the visitor policy to one visitor per patient, whether Covid or not, except for children, who may have two visitors at a time. Earlier this week, the Centers for Disease Control changed its mask recommendation, again pushing masking indoors even for those who have been vaccinated. This applies in areas of high transmission. “That really includes the entire state of Florida, Hsu said. “That’s what we’ve been doing at AdventHealth in our facilities, and it is something that we should follow–we should follow the advice of the CDC until we get more data on this. But I also want to emphasize: mask wearing is something that we would recommend even if you are vaccinated, but for those that are unvaccinated, really consider getting vaccinated. This is really one of the reasons why we have had spread is we’ve had so have a large number of unvaccinated. That is the single best way that you can do to protect yourself and prevent spread.”
Masks, he said, can only help. Disinformation aside, they do not hurt.
With “Gaza”-like scenes at emergency rooms such as the one described above, AdventHealth officials are urging patients who are not requiring oxygen or are significantly short of breath, “the way to be tested is in the outpatient world,” says Dr. Michael Cacciatore, chief medical officer of the AdventHealth Medical Group. “Our primary cares in our group have testing, rapid testing done available in their offices. We can get tested at CentraCare, there are government places that you can be tested as well. And we even have some drive thru for our AdventHealth medical group patients that we can know where you’ve been seen by telehealth, that don’t want to go into an office but want to stop and get tested. So there are a lot of options out there and [emergency rooms] should be the last choice.”
Significant illness is described as inability to catch one’s breath or taking a few steps without feeling exceptionally short of breath. With those signs, a visit to the ER is recommended. Some patients can now be given monoclonal antibodies, which block the development of the illness as long as the injection–essentially, a 30-minute IV drop with monoclonal antibodies–is provided within the first 10 days of infection. Those patients show remarkable success fighting the infection and keeping it from becoming grave.
There is no question, however, that “breakthrough” infections–infections of people who have been vaccinated–are happening. But wearing a mask and distancing is another way to prevent breakthrough infections, which nevertheless are very unlikely to degrade into hospitalizations and intensive care requirements.
Florida meanwhile has become the nation’s epicenter of the epidemic–again. There are no equivalent measures of epicenters of misinformation. But local officials are battling that, too–and the complete vacuum of solid, public health information from local governments, which disinformation finds easier to fill.
“It is just very, very frustrating. There’s so much misinformation out there,” Snyder said. “And all we can do as public health officials and as scientists and researchers and the medical community, physicians, all of us, we just need to continue to just share the truth, share the data, and just provide our common sense, public health recommendations that have been identified as evidence-based and just validated by the medical community in general. We just need to keep communicating and identifying the reasons why folks need to get vaccinated and hope that minds get turned. And again, be available to have open discourse and answer questions. You know, this thing has been politicized. And so that definitely is an obstacle. but I don’t think it’s one that us public health officials can overcome.”