Day after day, hospitals’ staffs are sounding the alarm: in Palm Coast and elsewhere, the fourth wave of the coronavirus pandemic is not getting better. Hospitals and emergency rooms continue to be at crisis levels. The number of hospitalized children in AdventHealth’s Central Florida region alone is at an all-time high, at 12. And infections continue to pile up: 118 in Flagler on Wednesday, 111 the day before, 89 the day before that.
In the past 11 days alone, the county has confirmed 1,117 cases, an average of just over 100 cases per day.
Those are the infections confirmed through the Flagler Department of Health. They are undercounts, because unlike in the previous three waves of the pandemic, home tests are now available for Covid, and those who test at home do not necessarily report their infection to the department. Previously, every person testing positive, whether at a walk-in clinic, at a hospital or at the Health Department, was recorded through the Health Department, thus ensuring that contact tracing could be carried out to limit the spread. That’s no longer happening with an undetermined swath of the population that’s self-testing.
On Thursday evening, the Flagler County school district’s update reflected 15 new infections district-wide–12 among students, three among employees, with four students at Matanzas High School reported to be infected. In total since school resumed Tuesday, 41 students have tested positive, and 17 employees have tested positive (employees returned to school last week). Volusia County schools enacted a mask mandate for all adults inside district buildings for at least 30 days. No mandate of any sort has been issued in Flagler County schools.
As of Wednesday the Central Florida division of AdventHealth had 1,555 in-patients on a primary diagnosis of covid-19 between its 16 hospitals, according to an internal bulletin, including 82 in Palm Coast (the hospital is licensed for 132 beds), 161 in Daytona Beach, 256 in Orlando and 64 in DeLand. Covid patients now now fill at least 43 percent of Florida’s adult intensive-care beds, according to the AdventHealth bulletin.
The numbers at Flagler Health+’s St. Augustine hospital are equally sobering: according to this morning’s update from the hospital, there were 133 patients admitted with Covid-19, up 11 from the previous day, including 13 admissions in the past 24 hours against just three discharges. Thirty patients were in the ICU and 17 were on ventilators. Flagler Health+ is not associated with AdventHealth.
“The beat goes on, and it’s the beat of a war drum,” said Dr. Michael Keating, Chief Medical Officer for AventHealth for children in the hospital system’s weekly briefing this morning. He was speaking to AdventHealth’s Tom Johnson. “When you and I met here a few weeks ago on July 15 There were 430 patients in our system. We’ve tripled that, and it doesn’t look like it’s slowing down. So the surge continues and we’ve got to blunt that surge, and we’re in a war, if you look at it. I read somewhere recently we’ve lost more people to Covid than soldiers were lost in the Civil War. The civil war affected every family in our country, and there’s little doubt that there’s not a family in this country that’s not currently been affected by Covid. So, we’ve got some work to do.” (While the figure of 618,000 Civil War casualties had prevailed for more than a century, scholars updated that figure in 2012, based on more reliable data, to 750,000, a number the nation may yet match with covid deaths absent a vaccine surge.)
Bob Snyder, director of Flagler County’s Health Department, said that as of Thursday, three of AdventHealth Palm Coast’s patients are in their 30s.
Deaths have been reported internally, but not confirmed. Snyder attributed the delay to a “lag” between deaths and confirmations. But the state Health Department, which several months ago stopped issuing detailed, daily reports on the covid pandemic’s effects in Florida, has also stopped issuing county-by-county death reports. It is now restricting information to a single, weekly report with few details other than general numbers about infections and vaccinations, and one line totaling the number of deaths since the pandemic began.
But Friday’s report indicated a total death count of 39,695. The previous week, the count had been 39,079. In sum, 616 Floridians have died of Covid-19 in the past week, one of the highest totals of the pandemic, though the department continues to mask the victims’ county of origin. The previous week, 175 people had died of the disease in the state.
Hospitals are seeing a distinct increase in cases among children: nearly 94,000 cases were added nationally between July 29 and Aug. 5 alone, according to the AdventHealth bulletin, representing 15 percent of the weekly reported cases in the U.S. The AdventHealth system’s census of hospitalized children–12–is at an all-time high, most of them with Covid pneumonia, needing supplemental oxygen and steroids.
While it is accurate that, in previous waves, only 1 percent of children were hospitalized, and only 0.01 percent die, many children can become “long haulers”–people who experience prolonged, recurring symptoms, like covid “fog,” problems with memory, fatigue and other symptoms. Children infected can go on to develop “long Covid,” according to NIH director Dr. Francis Collins said at a House Energy and Commerce subcommittee hearing last spring. Proportions vary depending on the study.
There is also multi system inflammatory syndrome in children. There’s been “probably well over 60” such cases in the Central Florida division. It does not present at the same time as when the infection develops. “It usually occurs about three to four weeks after an infection and for some reason, children and adults will have almost a hyper immune response to the infection,” Keating said, “and as a consequence, many different organ systems in the body can be affected, such as the brain, the heart, the lungs, the liver, you can go down the list. We know how to treat it, but it can be quite a serious illness.”
The data emphasize the need to reach herd immunity, the AdventHealth bulletin states. “It is imperative that adults & children who are age-eligible be vaccinated. Until vaccines for younger children become available, masking, handwashing & social distancing are the keys to keeping them safe.”
Unquestionably, vaccination is the difference between hospitalization and non-hospitalization. “What we’ve seen so far is that only the minority of the patients that come to the hospital, ill, are vaccinated, most of them are unvaccinated, so getting vaccinated is the thing that they could really do the most to help us out at the front lines to be able to continue to care for patients.” He elaborated: “What we’re seeing right now is more than 90 percent of the patients that come to the ICU that are really sick, that require mechanical ventilation or almost about to require mechanical ventilation or the breathing tube to be able to help them breathe–they are unvaccinated. The minority that’s vaccinated that comes to the ICU, they usually have some underlying problem, or illness or immunosuppression where they are unable to mount a certain number of antibodies to fight the infection. So definitely there is significant protection if you get vaccinated. Maybe, maybe, you may get hospitalized, but overwhelmingly in most cases you will never reach the ICU, which is the most dramatic location as far as care and as far as how ill, our patients are.”
Second to vaccination is the necessity of masking. Keating said last year, 80 percent of children in Florida were in school by the time the school year ended, and mask mandates in schools were prevalent–as they were in Flagler County schools. “We had blunted the surge of one of the Covid waves, and we did the right things–we masked, we socially distanced when we could, we washed our hands. Nothing’s changed,” Keating said. ” In fact, if anything, this Covid is more significant, and more potentially dangerous to our children. And kids have adapted. I can’t understand why they aren’t adapting again to this year. So when kids come into my office, I say look, this is your daily hygiene, you brush your teeth, you comb your hair, you put on your mask. And they get it. I don’t get any pushback. I would strongly encourage everybody to at least mask children and give them that lesson.”
True, most children develop only mild symptoms, if any at all. Why the measures? “Why take the chance?” Keating said. “If I have a one in so many thousand chances of getting really sick, that may not be a chance I want to take. And in addition, if a child goes to school and comes back symptom free and infects the parent who’s not been vaccinated or grandparent who has a pre-existing condition, you’ve got yourself a lot of trouble that could have been avoided. I think that’s the tragedy. A lot of this could have been avoided by better vaccination and will be blunted by better masking and vaccinating when age able.”