Half of Flagler’s Covid Case Load Driven by School Infections as Physicians Urge More Focus on Science and Safety

On a day when the Sheriff’s Office and the community laid to rest a sheriff’s corrections deputy who died last week of the disease, Covid deaths have reached 165 in the county, and totaled 2,345 across Florida this week alone, by far the largest weekly total of the pandemic. Last week’s statewide total was 1,727. Orlando’s Channel 9 earlier this week reported that federally funded portable morgue cooler units are being dispatched to Florida because local hospitals’ morgues are at capacity.

Florida is averaging 325 deaths a day and at 46,000, it is rapidly approaching New York State’s total of 54,000 (the daily rate in New York is 29). Dr. Michael Gayle, medical director of Wolfson’s Pediatric Intensive Care Unit at Wolfson Children’s Hospital in Jacksonville, said in a webinar this week that two children, including a newborn, were among the latest deaths from the disease.

The number of Covid in-patients at AdventHealth Palm Coast has declined to 67 as of today, according to Bob Snyder, director of the Flagler County Health Department, a state agency. The hospital is licensed for 99 beds, including its ICU beds, but has expansion capabilities to 150, according to Dr. Ron Jimenez, the hospital’s CEO. AdventHealth Palm Coast does not have a pediatric unit: children are transferred to Wolfson, Halifax, or AdventHealth Daytona Beach, among other hospitals.

The Flagler County school district ended this week with 341 student infections and 27 confirmed infections among teachers and staff, for a combined total this week alone of 368 infections. A FlaglerLive analysis of infection rates among school districts as of the beginning of this week found the Flagler district with the third-highest level of infections in the state, among the 39 counties that report figures. Cumulatively, the district has totaled 873 infections among students and staffers so far, including 143 at Flagler Palm Coast High School.

Aside from a failed attempt at the school board on Aug. 17 to enact a temporary mask mandate in schools, there’s been no movement toward changing covid-related safety measures in the schools beyond cleanings, suspending “non-essential” visits to schools and limiting indoor extra-curricular capacities. Other protocols have been minimal compared to last year. The district’s official line has been that federal and state guidelines don’t always match up, leaving the district to “navigate” guidelines on its own, David Bossardet, the district’s safety director until this week, said on an online webinar on Tuesday, even though Snyder and the medical director at the local health department have been urging the district to adopt universal masking. A judge earlier this week declared Gov. Ron DeSantis’s ban on mask mandates in schools illegal and enjoined its enforcement.

By Wednesday, Bossardet had been shifted from his safety specialist role to assistant principal at Flagler Palm Coast High School.

It’s never been clear how many Flagler County children, if any, have been hospitalized and with what degree of severity: neither the local or state health departments nor the school districts are providing that information. The state shut down its daily data reports and pediatrics report, which until June had included data from the counties. At the time, Flagler had accumulated 902 cases of covid among children, out of a total of 6,000 tests. It had had three cases of hospitalizations among children ages 0 to 14 and no deaths, and 12 cases of hospitalizations among people 15 to 24 (unlike most other states, Florida did not break down that demographic between those under 18 and those over, thus clouding the ability to track the pandemic among minors.)

The Associated Press, citing Centers for Disease Control figures, reported on Aug. 31 that 60 children per day were being admitted in Florida hospitals. It is statistically unlikely, if not impossible, that Flagler’s children are being spared, given the local incidence of infections among children.

On Aug. 31, during an online webinar co-hosted by Flagler County School Board member Colleen Conklin and Dr. Paul Mucciolo, parent of two children in the district and the chief of staff at AdventHealth Palm Coast, Mark Linde, the local Health Department’s director of nursing, provided some  current data: Lindy said that from July 2 to July 22, the county had just seven infections among children ages zero to 4. Since July 22, there’s been 120 in that small age group alone. For the next age group, from ages 5 to 14, there’s been 795 cases in August alone. But he had no hospitalization figures.

While children very rarely get seriously sick and even less rarely die of covid complications–through the number of those suffering from long-haul covid is growing–children remain potent carriers and transmitters of the disease. So they expose their parents or other adults, who then get sick and are statistically likelier to develop complications.

Snyder in the webinar–Conklin termed it “Uncomfortable Conversations”–addressed the decline in public information related to covid in startlingly candid comments that placed him at odds with the state Health Department’s approach: “On statewide calls that I participated in with other health officers,” Snyder said, “including the Surgeon General, Dr. Scott Rivkees I asked: Listen, the biggest lesson learned during the 1918 pandemic flu was the importance of knowledge, data, information so that we can squelch information that is disinformation and squelch the falsehoods. But when I said, please, we’re now on the fourth surge of this pandemic in all of our communities, data is more important now than ever. And all I heard was crickets. And I’ve got no response whatsoever. So I want our community to know that I as health officer, I’m not pleased about that. I’m actually disappointed about that. And when I talk to my colleagues in Tallahassee, again, there’s no answer. We get a weekly report at the end of each Friday that Mark and I get. And it’s basically number of people vaccinated to date, and number of cases to date, over the last seven days, and people vaccinated over the last seven days. So if someone does ask for information, we’ve got to dig, dig, dig, and Mark has to take his time, he and his staff, to dig into our epi system or Merlin, to find the information. And listen, I’m being totally transparent here, that that is very unfortunate.”

Snyder added moments later: “I’m not blaming my colleagues in Tallahassee. I will tell you though that more is in play here at higher levels and I’ll stop right there.”

The void of information leaves a remnant of basic pandemic data that is more suggestive than analytically detailed, and either giving cover to local school officials to say they have no real data to act on or preventing officials from enacting safety precautions calibrated to the evidence.

Data relating to adults is slightly more visible. Of the 77 people hospitalized as of Wednesday at AdventHealth Palm Coast, 13 were so-called “breakthrough” cases–people who were either vaccinated or have had Covid in the past, and thought they were immune, according to Snyder. “So the percentage of breakthrough cases are significant,” Snyder said. The rest were unvaccinated. Snyder put little stock in national statistics putting the percentage of breakthrough cases at only 1 percent. And the ages of the patients were still not available.

After declining to fewer than 400 a week in June, vaccinations in Flagler briefly rose when the fourth covid wave–the delta wave–began immediately after July 4, peaking around 1,300 for the week of Aug. 6. But vaccinations have been declining every week since, and for the past two weeks, have been lower than the incidence of covid.

Dr. Anthony Tucker, a Palm Coast physician who was a member of Conklin’s panel Tuesday, described his near-death bout with Covid last year–he was in intensive care for 62 days and on an ECMO by-pass machine, used in life-support situations, for 43–and warned against a recurring misconception: having had Covid is no protection against another bout. “That’s something that I’m really hoping people understand is, because you’ve had Covid doesn’t mean anything. You can still get sick from Covid,” he said. “I can still get sick from Covid. I can still get exposed to Covid and get it and get sick again.” That’s why the importance of vaccines.

“Some of my own friends are saying, well, see, what’s the point of getting the vaccine? You’re going to get Covid anyway,” Conklin asked Tucker. The answer, Tucker said, is that it significantly lowers the chance of severe disease and death.

An internal advisory from AdventHealth this week stated that “AdventHealth will not accommodate patient requests to know team members’ vaccination status and to be treated only by vaccinated staff.” But the system is urging its employees to document their vaccination status with AdventHealth.

In a sign of the slight easing of the fourth wave, the Central Florida AdventHealth network this week lowered its status from black to red, resuming some surgical procedures that had been suspended. But capacity issues remain–among them the “misconception,” Tucker said, that just because a hospital is said to be at 85 percent capacity in normal times, it couldn’t be that stressed if it were at higher capacity now. “Hospitals are always like this: that is an untruth. That’s very inaccurate,” he said. “I have never in my career seen–and that’s including in military times and military hospitals–seen hospitals functioning at capacity this way. And that’s incredibly dangerous for someone that’s going to have a heart attack, or like the military veteran that passed away recently in Mississippi [from] a gallstone.”

Much of the webinar discussion was focused on debunking myths and outlining current, local protocols and how to navigate them. But Tucker’s description of his illness, however well known across the community by now, was among its most arresting segments. Tucker got sick before the vaccine was available. He was eventually discharged on Dec. 18, and got his first vaccine dose three days later. He’d never expected it, considering himself out of the demographic most likely to be severely affected.

“So you can get incredibly sick. And one of the biggest misperceptions out there is, you have to have already had some kind of comorbidity,” Tucker said. “And that’s not true. I was actually very healthy and actually just gotten a full bill of health from my primary care physician, because I’m used to going on a yearly visit just from being in the Navy. So it’s something I had done about six months before I got very ill. I took no normal medications, other than a Motrin occasionally if I played too much golf. I got exposed to the virus and within eight days I was in an intensive care unit. You can get very sick, very quickly.”

He described himself as a “healthy middle-aged guy maybe a couple of pounds overweight” with no indications that he’d get so severely sick. At first he thought his illness was allergies. It got worse. He used oxygen from his office. His wife then “ made me go to the emergency room, and within an hour of being in the emergency room I was in an intensive care unit. So it went very quickly.”

As he’d been doing before his illness and since on his Facebook page, Tucker urged a reliance on factual information and vaccines. Both are available in Flagler in copious supply. A significant segment of the population, reflected in the county’s infection and death rates, remains defiantly uninterested in either. One of the signs brandished at the last school board meeting, when the bulk of public comments opposed a new masking requirement, read: “Pandemic is a hoax.”