The coronavirus’s omicron variant is far more infectious and less virulent than its predecessors, but it is not the common cold, Dr. Vincent Hsu, executive director of infection prevention at AdventHealth’s central Florida division said in a press conference, stressing the urgency of universal masking in school, boosters and other precautions and pointing to a rise in hospitalizations of children.
The Flagler Health Department is reporting covid outbreaks in all sectors–schools, day care centers, nursing homes, assisted living facilities and the Flagler County jail, and a significant increase in covid-attributed deaths in Flagler County since Christmas. (Main Street assisted living facility has the largest number of cases, with 13.) As of Dec. 24, 277 Flagler County residents had died of Covid-19. As of today, 285 have. Bob Snyder, who heads the Flagler Health Department, said he expects the week’s infection numbers in Flagler to exceed 1,000 when thee numbers are released Friday, a new record. The virus’s incidence has been shattering records across the country for weeks.
“Omicron, while it may be a little milder variant, is still a very serious virus to be reckoned with,” AdventHealth’s Dr. Hsu said. “It is not the common cold you don’t see people hospitalized on ventilators in the ICU for common colds. But with Omicron, even though it may not be as virulent or as severe as the Delta variant, can still cause significant disease, hospitalizations. No one wants to be hospitalized. So as a result, we want to make sure that we treat this virus very seriously.”
In Florida, Covid cases have risen by 948 percent in two weeks. Dr. Neil J. Finkler, AdventHealth’s chief clinical officer, reported in an internal email that Centra Care’s statewide seven-day rolling positivity rate is now 39.5 percent, “representing the high transmissibility of Omicron throughout the community.” In other words, four out of 10 people tested have covid.
As of Wednesday, there were 630 patients admitted on a primary diagnosis of covid at AdventHealth hospitals in Central Florida, including 19 in Palm Coast–less than half the total of the August peak, which reached 1,700 patients, though well before that August peak the hospitals had been forced to eliminate elective surgeries and restrict other services to manage the covid load. So far, that’s not the case. The hospitals remain on normal operations, and far fewer people are in intensive care units or on ventilators. But the ongoing surge is still on the upswing. The system has seen a greater number of staffers infected, requiring careful staff management to meet all obligations. [Local health officials are urging Flagler residents not to go to the emergency room to be tested: the ER must remain exclusively focused on treating all emergency medical cases, which do not include testing.]
AdventHealth hospitals are bracing for staff shortages as many workers test positive for covid-19. But the hospital is allowing workers to return to work on day five if those infected are either asymptomatic, if their symptoms have resolved in the previous 24 hours without medication, or if they have a pair of negative tests (one rapid, one PCR). “These changes are motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after,” Finkler wrote to AdventHealth staffers. The hospital system is scaling back testing to focus only on symptomatic people.
“Team members with an exposure, but no symptoms, may report to work with no restrictions,” Finkler told staff. “As a reminder, face masks and social distancing are required for all workforce members, patients and visitors, regardless of COVID-19 vaccination status, in both clinical and nonclinical settings.”
Hsu’s assessment was unvarnished–and cautioned against making too many comparisons with South Africa’s experience with omicron, especially the rapidity with which it ran through South Africa, apparently exhausting itself very quickly, and the dearth of hospitalizations it left in its wake. Hsu pointed to one major difference between South Africa and Florida: Florida’s population is much older. The median age in South Africa is 27.6. The median age in Florida is 42. In Flagler County, it is 51.
“What we’re seeing in the hospitals are again, many people are in there with primary Covid. They have shortness of breath, they have cough, they’ve got low oxygen saturations. That’s still what we’re seeing,” Hsu said. “We are not seeing as many proportionally in the ICU. And that’s good news.”
There is still a difference between the vaccinated and the unvaccinated, he said, though AdvantHealth has not released breakdowns the vaccinated and the unvaccinated. “We are seeing that the serious illnesses are largely still among those that are unvaccinated,” he said. “So getting vaccinated and getting that booster if you haven’t gotten that booster, critically important to reduce the risk of severe hospitalizations and and having to be on a ventilator.” But barely more than a third of Americans have received a booster so far, even though vaccines are in plentiful supply.
But Hsu later clarified that in fact, only a third of patients in Advent hospitals, on covid diagnoses, are unvaccinated, a sharp decline from the percentages during the delta surge. AdventHealth’s numbers track those at Flagler Hospital in St. Augustine. According to a report released by Flagler Health+’s Gina Mangus this morning, Flagler Hospital had 29 patients admitted with Covid-19, with just 38 percent of those patients unvaccinated (a day earlier, the proportion was 42 percent), a far lower number than had been the case during the summer surge. But only one of the patients was in Flagler Hospital’s intensive care unit, down from three a day earlier, and no patient was on a ventilator.
AdventHealth makes a distinction between patients admitted on a primary diagnosis of Covid and what the system calls “incidental Covid,” meaning patients who are in for other reasons, but happen to test positive for Covid. But, Hsu noted, Covid as an extremely inflammatory virus can also precipitate such emergencies as heart attacks and strokes
“We are seeing a greater number of children being hospitalized. It is approaching where we were with delta,” Hsu said, though there are no significant numbers of ICU or ventilation cases. “It’s probably because of this just the sheer number of infections that have occurred. So the patients that we have in the hospital, in the children’s hospital, are in for Covid-related illnesses. They may have chronic pre existing illnesses, lung disease for example. Covid adds that extra punch that lands them in the hospital. So again, we want kids to be very careful. My recommendation as an epidemiologist, as an infectious disease expert, is that we should keep mask on our children at all times while in school. I recognize that it’s not this landscape that we’re in right now. But we want to encourage every child to wear their masks.”
Flagler County schools have adopted the Gov. Ron DeSantis’s business-as-usual approach, leaving last semester’s already scant protocols unchanged. The state forbids mask mandates in schools, and the majority of students are going unmasked. Between Dec. 26 and Wednesday, Jan. 5, 31 students in the Flagler district tested positive, and 11 staff members did, a sharp increase from weeks before the Christmas break. Those individuals were quarantined. There were an additional 29 “contacts” resulting from the infections.
Hsu said monoclonal treatment for omicron is less effective, with two such treatments not showing effectiveness, and the one monoclonal treatment that does to some extent–Sitrovimab–being in very short supply across the country. “So in this case, it is really important to emphasize avoidance, vaccinations, social distancing, masking, especially if someone is at risk,” Hsu said. “We have to recognize that unless you are at home all the time you’re you’re going to have a risk, but you’re keeping it as low as possible. I would say continue doing what you can, wear your masks, keep social distancing as possible.” The type of mask matters greatly: KN95’s or cloth-plus-surgical mask adds protection.
The cautions and directives issued this week coincide with recommendations from members of President Biden’s former health advisory board to revamp Covid-19 strategy–abandoning any hopes of defeating the virus and learning instead to live with it, but avoiding “a perpetual state of emergency” divorced from benchmarks, such as hospitalization levels.
Nevertheless, the health experts said current hospitalizations and deaths remain unacceptably high when compared to peak periods of influenza epidemics. There were 52,000 deaths from flu in the 2017-18 epidemic, for example. “Today, the US is far from these thresholds,” three of the experts wrote in a Jama Network article published today. And they called for far more testing capacity and home-testing than is currently available–and free masks. (See the experts’ “National Strategy” recommendations here and here.)