Florida Governor Ron DeSantis July 21 Press Conference Transcript

Governor DeSantis: (00:00)
… association, Lindy Kennedy from the Safety Nets, and then we have two physicians with AdventHealth, Dr. David Moorhead and Dr. Scott Brady. Taken together, the two groups represent over 70% of the hospitals in the state of Florida, and I think can provide some good insight into what’s actually happening on the ground. We’ve worked from the very beginning with our hospital system. Our main pillars have always been protect the vulnerable, expand testing, social distancing and support our hospitals and health care workers. Yesterday, we had an event in Orlando, touting the need to donate with OneBlood, convalescent plasma. We’ve got a number of people who have recovered from COVID-19. A number of people have COVID antibodies. By providing those blood donations, these doctors are then using that to treat patients, and it’s had success. And a lot of the patients are doing a lot better in this time than they were in March or April, so we want to continue to do that.

So when we found out that there was increasing demand, that the supplies were running low, we sprung into action and put the message out. And as people go and test at the state test sites, drive-through sites for antibodies, they get the result right there. If they get it, then you go give blood and really help somebody. So we appreciate people stepping up to the plate to do that. We also have worked with the hospitals as they’ve needed additional therapeutics, such as the drug remdesivir. A couple of weeks ago, they came to me saying that the next shipment was not likely to be here in time for when they would have a gap. So I worked with the president and the vice president to get shipments expedited. We needed it expedited again, and so we just recently received 30,000, or the hospitals recently received 30,000 vials of remdesivir. And that’s something that is being used by physicians every day to treat people. And again, they’ve had a lot of good success with it.

You’ve heard different things about no ICU beds here or there. And I just think it’s important to kind of explain how some of this works. The big-picture item is this morning census is that statewide 24% of the hospital beds in the state of Florida are empty. That’s over 14,000 hospital beds. And about 20% of the ICU beds are empty, and that’s over a thousand ICU beds. When they say that there’s a hospital without, just understand, we have a lot of rural communities and hospitals that have zero ICU capacity. Under any circumstances, they just don’t have them. And if there is a need for that level of care, then the patients are sent to areas that are a little bit more populated that have that.

Also, we have a number of hospitals who are part of a larger system who may only have a few ICU beds in that particular hospital, but system-wide, there would be a lot of capacity. And Advent is one example of that, so they’re going to talk about how that is going on. In Miami-Dade, for example, which is obviously seeing the most hospital admissions in the state of Florida, they have almost 18% of all their beds are available, which is, I think about 1,500 beds as of this morning. And then they have 15% of the ICU beds available. ICUs, they typically want to run them at 88 to 90% full, because you have no need to staff something if you’re not going to use it. It’s a more expensive level of care. You do need the types of staff. So an ICU is not a fixed product. If there’s expanded need, then they can expand those types of services, and these hospitals throughout Florida have been able to do it.

And you also look at other parts of the state. Palm Beach, 30% of the beds available, 25% of the ICU beds available. Orange County, 26% of the beds available, 21% of the ICU beds available. So there is capacity, obviously, to deal with COVID, but it’s also important to note COVID-19 is just a fraction of what these hospitals are doing every day. They’re treating people for all types of ailments, and they’re doing a good job doing it. I think that the concern I have when I hear, see things and people somehow think that there’s not capacity throughout the state is, we don’t want people who have other conditions other than COVID in particular to be deterred from seeking medical care. We know that that happened in March and April, where a lot of people with heart and stroke were deterred from going to the emergency department. You saw significant declines across the country of people deferring care. Part of that was, I think, a fear of acquiring COVID while in the hospital, which is not a good fear because these folks are taking huge precautions to keep everyone safe. But then I think part of it was people just assume there was no capacity for people other than COVID, which is absolutely not true. What’s happened is those folks that have deferred care are now in hospitals. And again, this is not for COVID. These are other instances. And then they are now in worse condition than they would have been. So we don’t want to repeat that mistake.

Just want to let people know, they’re here to serve folks and they’re really doing a good job. And what you do and give in different situations … So for example, like a Jackson healthcare in Miami, obviously they’ve had the most significant epidemic. Their census overall has been relatively stable. They just have a higher percentage that are COVID. So they make changes to make sure that they have the capacity. And the one thing that we’ve had folks come to us with hospitals is, “I got beds. I got space, I got all this. I got equipment. I got PPE. I just want to make sure I have enough staff to be able to handle whatever comes down the pike.” Part of that is some of the staff have been worked very hard. I mean, it’s been a very stressful time and we understand that. We also appreciate what everybody’s done. But part of it too, is if staff get infected, some of them have to be isolated. You can be shorthanded there.

And then some of it is just, this is usually a low census time for many parts of Florida, so there’s a natural reduction in staff that typically occurs. Now that we have the COVID-19 that is peaking, there is the need for staff. So we’ve already deployed, with the Department of Emergency Management, hundreds of medical personnel. We’ll deploy up to 1,400 very soon for those who are requesting. And we’re going to continue to do that. What we didn’t do was do an edict from government saying, “You can’t do an elective surgery,” or, “You got to do this or that.” That was kind of the March/April view, and that’s what happened across the country.

But I think if we look back at that, it caused a lot of hospitals to have to shed staff. There were a lot of hospitals that were half full, who were not allowed to do elective procedures. And the fear was, I think, that there weren’t going to be enough beds. I don’t think that was probably evidence-based. But then there was the fear that they would run out of PPE. And so the elective procedures were put in to be able to do that. Well, they now have PPE. They know how to manage this. And so as you’re in areas where you start to see increase in COVID like they saw in Jackson and Miami, then they dial back some of the other things. If you’re in central Florida, they’ve been able to have a balance there, I think the physicians will talk about. We saw as the prevalence was increasing in late June and into July, you saw more admissions. Now, in pretty much all parts of central Florida you’re in a stability situation where the census has been very stable with COVID-19.

Obviously, they want to tend to the other needs as well. And so we want to give them the flexibility to be able to manage that. And I think that that’s been a much better approach this time around. We’re also supporting hospitals indirectly by establishing … We’re now at what, Mary? 25 COVID-only nursing facilities. One of the biggest problems that you’ve seen throughout the pandemic is if a COVID-positive patient would be put into a nursing home, it then spreads and it makes it very difficult. So we’ve prohibited that practice from the beginning. At the same time, you have situations where folks who were residents of long-term care facilities are positive, but do not necessarily require hospital level of care. They’re medically stable, which is a good thing. And so these COVID nursing homes are places where a hospital could discharge safely a long-term care resident who’s COVID positive.

It also is a place where if there’s infections inside a long-term care facility, a long-term care facility can send to the COVID-only facility. So it’s a step up from there, a step down from the hospital. As of right now, we’re up to almost 1,400 beds that are … Many are in use, but the capacity is 1,400. So that’s a really, really important tool, not only to help limit outbreaks in long-term care facilities, but also provide the flexibility, that if you do have someone that’s stable, they’ve got a safe place to be discharged to because we cannot allow a contagious patient to be sent back in to a long-term care facility that doesn’t have the capability of appropriately isolating them. And so this is, I think, helpful for long-term care residents, but it’s also helpful for hospitals to be able to manage their resources appropriately.

Mary started doing this in April, had a lot of facilities come online since then. That’s an important tool that we didn’t have in March. We also are now, after having gone through the nursing homes and tested the residents and tested the staff, we’re now doing mass testing of all the long-term care staff. So we have a great system in place and it’s a self-swab and we’ve got a good company that’s dedicated to this. So we’ve gone through and tested over 200,000 staffers in the last two weeks. We’re going to be doing that every two weeks. We have had, obviously, people test positive. It’s been a lot lower than the positivity rate from the general community. It’s been about 3%. but nevertheless, when you’re doing 200,000, I mean, that’s a significant number of people. They obviously get isolated. You can then do an investigation to see what the prevalence is inside the long-term care facilities.

At the beginning of the pandemic, we had the Florida Department of Health send incident management teams to every long-term care facility to check on their infection control practices, screening procedures, sanitation, wearing of PPE. They’re out in the field, again, doing the same thing, particularly at the facilities that have active infections. And we think that that’s going to continue to be important. When we did kind of the March/April, had a little run up and then started to settle down as we got into the middle of April. But then you kind of saw a tail where you had some long-term care outbreaks. And really, throughout most of May and the beginning of June, we had very low prevalence with the community, very low positivity rate, and it was pretty much looking at the long-term care facilities. So it’s definitely something that we’re going to continue to be concerned about.

So I think that this is going to be important just to give Floridians some reassurance that we’ve got a health system that’s working. We’ve got folks who are in this fight, people that have thought very, I think, cogently about how do you appropriately manage these resources. And I think that they’re doing a very good job of it. And I’d also say we’re going to get through this. If you look at the date, I know people focus on the cases, and that’s something that is an issue, but you look at the COVID-like illness, ED visits, we had 2,500 on July 7th. The last two days, we’ve had about a thousand statewide. And so that’s a very significant indicator about who’s actually going to the EDs. And then we’ve seen, obviously, the hospital census is a really stabilized in most parts of the state. Some of them have even declined, which is a good sign as well.

So I think that we’re going to get through it. I think we are on the right course. I think we will continue to see improvements. We just got to continue to keep doing, particularly the Floridians who are just doing the basic things that really make a difference. We appreciate what you’re doing. So I’m going to turn it over to Mary Mayhew for her to be able to make some comments about what she’s seeing, what they’re doing. And then we’ll hear from all of our guests. And then we’ll just have a discussion.

Mary Mayhew: (12:50)
Thank you, Governor. It’s very difficult to add to what you just laid out. It is incredibly comprehensive, and it is true. From the very beginning, you have had a laser beam focus on protecting our most vulnerable, our elderly individuals with underlying medical conditions, and evaluating daily the capacity of the health system to respond. I want to express my appreciation for the hundreds of thousands of healthcare professionals, frontline staff that have been working throughout this pandemic, the nurses, the CNAs, the dietary staff, the people who are cleaning the rooms, the emergency physicians. They tirelessly have been on the front lines, supporting this effort. I think it’s important to underscore that rarely does a one-size-fit-all approach work, which is why, as the governor described, we have coordinated to support these regional responses. I am on the phone daily with hospital staff and CEOs and chief medical officers to hear what they need and how the state can be responsive to their ability to meet the demand.

And as the governor described, they’re not only there providing high-quality care to COVID patients. Mothers are still having babies. Cancer has not been cured. Individuals are still suffering from heart attacks. And I need and we need our hospitals to be there, effectively providing that care. Let’s not confuse calm with a lack of concern or commitment. Because every single day, we have been working with and monitoring and responding. Yes, this has been a crisis. But thoughtful decision making, the isolation centers, the federal government has referred to what we’ve done as an absolute model that we’ve been able to appropriately provide the right level of care so that hospitals could provide that warm handoff, that discharge, to these isolation centers, to have over 20 around the state.

And again, we look at the areas of need to support the establishment of those facilities. I know people are scared around the state. But they should have confidence in the health care and in the regional resources, and frankly, in the regional collaboration that I have to believe is unprecedented, the coalitions that have formed among the county health officers, the chief medical officers, the hospital CEOs, the EMS personnel. And they are talking regularly. I have been on more Zoom calls with county administrators and county health officers and CEOs, and together they are sharing data and they are coming up with plans that respond to the needs of their region. And then we are here to support those efforts.

The governor’s prioritization of staffing has been absolutely critical. He said to me, “I want those isolation facilities to get the nurses they need to make sure that those beds are available.” Over a thousand beds that have been provided to support our elderly receiving the highest quality of care while they’re recovering from COVID. So we have looked across the continuum to meet these needs. And let me also say this, there isn’t a day that goes by that my heart doesn’t break over the restrictions on visitation. But it was and remains the right thing to do.

I have shared before, I had my 87-year-old mother and my 25-year- old son living under the same roof for many, many months. And I saw the fear for my 87-year-old mother and the compassion from my 25-year-old, and lots of hard decisions. And what the governor has said and what we keep repeating, we know that for the most part, the biggest risk is among our elderly individuals with diabetes, cardiovascular disease, respiratory illnesses. And we need our 20-year-olds to constantly think about their 80-year-old neighbor, their grandmother, their grandfather.

You think about their 80 year old neighbor, their grandmother, their grandfather, their aunt, and their uncle and take the right steps, the right precautions to protect those vulnerable relatives and friends and family and neighbors.

But I am so grateful for the leadership the governor has provided for the team effort that exists at the state level and for the engagement locally that has supported our response and continues to inform it every single day. Thank you, governor.

Thank you and you know, we very much are cognizant of the mental anguish that that happens when you have things like restricting visitations to longterm care facilities and that was something that we did very early, cause we didn’t know who would be bringing in the virus. I mean, it’s hard enough even when you’re screening staff. It’s the asymptomatic staff still bring it in and that’s hard enough. But it’s been a big, big burden and the minute that we think that we’re able to move in different direction, we want to do it.

There was a story of a woman in Jacksonville, whose husband was in a facility, a memory care facility, and she was obviously frustrated understandably. So she got a job working at the facility and now is able to see him. So those are the types of things that, we focus so much on kind of what the virus is doing and understandably it’s important, but these other human stories I think are very, very significant and so we want to figure out how we can bring that human connection back when the circumstances warrant it. So we will work to do that as soon as we can.

Crystal Stickle, Interim President for the Florida Hospital Association. Talk a little bit about your hospital members and what’s going on.

Crystal Stickle: (19:53)
Thank you, governor. Good afternoon. So FHA, the Florida Hospital Association has a unique vantage point being able to serve as part of the state’s emergency response team. We’ve been working out of the emergency operations center since day one of activation and it has been, it has certainly been a challenge but our members have been able to rise to that challenge because of the support we have had from this administration.

So early in March and April looking out at what our needs were, they were certainly focused on personal protection equipment. PPE was in high demand and now as we move into July and August, our main concerns have been around staffing, ensuring access to some of the treatments that are available now, which were not available in March and April, such as Remdesivir and some of the other things that have come out.

So one thing has been constant. There has not been a resource that we have communicated to the state that has not been met. PPE was being delivered on a daily basis in March and April and now here we are in July and with staff being one of the main challenges and we have significant staffing support coming from the state.

So the support having PPE and the staff that we’ve been able to have from the state, have enabled us to maintain capacity and to open up beds. So when you talk about hospital capacity and I know it’s not something that most people study on a daily basis, but it’s important to understand that the number of beds that one has licensed versus the number of beds one staffs is very different. So when we look at that capacity and want to open up and expand, we have the room, we have the bed space to do that. What we lack at this point is the staff to help do that.

So when you look and see that there is, again, one ICU bed, much like the governor mentioned, it’s also important to look in context and say, that’s part of a system. So our systems work on a daily basis, communicating with each other, to ensure that they’re the patients that need to be in ICU, have ICU beds available.

I would say throughout the entire pandemic, one thing that has been sort of an advantage for Florida is we did have a lot of time in March and April to learn, to be able to reconfigure our plans. Hospitals routinely prepare in emergency preparedness and response. Pandemic as part of it. Certainly you all are more familiar with hurricanes and what we do from that perspective but pandemic planning is part of our emergency response planning and those plans sit on our shelves and March and April, when we all started to really learn what this was going to look like, gave us the opportunity to reconfigure those surge plans, to be able to provide the adequate capacity and space for patients as they come through into our hospitals.

I think one thing that is important that we talked about, we did early on bring down elective procedures. When people talk about elective, they tend to think maybe plastic surgery or a knee. Elective can be a scheduled heart bypass, if you catch that someone is in trouble before they have a heart attack and you would schedule that procedure.

So when you’re talking about elective procedures, it’s important to understand the impact that that can have on the health of the community. So I think right now we’re in a really good place where we are certainly monitoring COVID and the hospitalizations resulting from COVID in our communities but we’re also able to have the flexibility, continue to care for the community in the way that we need to be caring for the community and addressing some of these things that really shouldn’t be delayed in our elective, if you’re the one being told that it’s notable to be done now for quite some time.

So I think that’s a simultaneous need to be treating COVID positive patients, in addition to ensuring that access, regular access to appropriate care, is going on is very important and something that we again appreciate the governor recognizing the importance of that.

Great. No. Appreciate it. Thanks. Your members have worked really hard to care for a lot of our folks, which we really appreciate. Done a great job.

Lindy Kennedy with the Safety Nets and so do you want to offer some comments?

Lindy Kennedy: (24:10)
Well, I certainly do. Thank you, governor, and I had four points that I wanted to discuss this morning and they’ve all been covered.

So let me just suffice to say that I’ve been blessed to be here in Florida, born and raised and spent over 30 years in public policy. I’ve worked under governors in both administrations, worked in other previous major health emergencies, national disasters, et cetera, and never before have I seen such collaboration, such dedication.

I asked my CEOs and medical directors of our hospitals, which by the way, were only about my hospital association. Majority of our hospitals do fall under the Florida Hospital Association umbrella, but our members are your large academic centers, your large teaching hospitals, such as Shands, UFL Shands. Tampa General, Jackson Memorial, your large nationally recognized public hospitals systems such as Memorial Healthcare, Halifax, Sarasota Memorial, Lee Memorial. Many of you’ve been reading about all of the work that these hospitals have been doing in their communities.

These hospitals don’t have to call the governor and tell him what he needs… What they need. The governor is calling them. What do you need? Do you need staff? Yes. Days, few days later, we have more staff. We need Remdesivir. Saturday deliveries of Remdesivir. We are truly blessed in Florida to have some of the most highest rank medical facilities in the nation and it’s large part due to the commitment of this administration and the commitment to continue to support what they need.

So while we’ve covered many of the key issues that I know you’re inquiring about today, bed capacity, et cetera, suffice it to say that we have sufficient beds, at all Safety Net hospitals. We have staff. We have the equipment. We are undergoing clinical trials, advancing the medicine. This medicine is evolving as the weeks go by and we find ourselves reducing the death, the fatality rate. We have significantly reduced the COVID positives in our elderly and our vulnerable population.

So what the governor and Secretary Mayhew set out to do when this pandemic began, they are making successful gains and we just can’t thank you enough, governor.

Well, thank you. Appreciate it. We have Doctor David Moorhead, Chief Medical Officer for Florida Hospital, in central Florida. So Doctor Moorhead, you want to take it away?

Doctor David Moorhead: (26:59)
Sure. Thank you, governor and thank you for inviting us. As the chief physician for a large hospital system, this has been a learning experience that old surgeons like me have never experienced before.

The concept of a pandemic like this one, the medicine involved has forced us to constantly learn, but I’m pleased to tell you that back in March when we really started down this journey, since March, we have learned a great deal. We prepared and today, what we’re seeing across all Florida and I look at the data for AdventHealth across Florida, is that we’ve reached a plateau.

Now, obviously no one could predict the future, but for over the last week, we’ve had a very significant plateau, which has been incredibly welcomed. If you look at our ICUs, we have had some decrease in ICU volume and overall, what this has allowed us to do with our preparation is to do what we normally do and that is to give hopefully, the very best care that is available and to have our staff be able to devote the time and energy necessary to take care of the patients in the normal way that we do it.

Our staff is really busy. They’re tired. They worked really hard but they’re hanging in there and I’d like to echo what Secretary Mayhew said about, these are the real heroes of this whole experience. Every day they’re coming, leaving their families and going in and just doing an amazing job and we can’t thank them enough. I think a lot of the great results that the state of Florida has had because of the incredible dedication and contribution of the people on the ground. A statistic that you may be interested in and that AdventHealth in Florida has about 450 events and we’re using about 183 of them.

So what, in summary, what we’re seeing is a really significant issue that we’ve all banded together. We’ve seen a plateau that we’re incredibly grateful for. We’re incredibly grateful for the fact that we’ve received some help with staff, with Remdesivir and just the concept that we’re able to as a global medical community in the state of Florida, communicate and work together to try to give our citizens the best care we can give and we’re appreciative for the opportunity to be here and to make sure that our citizens know that your healthcare companies, groups, hospitals, are working really hard and that as of today, we continue to do a really good job and to really try hard to serve our communities.

Well, thanks Doctor Moorhead. We also have Doctor Scott Brady, Senior Vice President, Ambulatory Services for the AdventHealthcare, AdventHealth Central Florida Division.

Doctor Brady.

Doctor Scott Brady: (30:06)
Thank you, governor. As Doctor Moorhead, our Chief Clinical Officer was saying that AdventHealth started preparing for a pandemic even before the pandemic occurred. But in March, we formed a pandemic response team and in March, we were able to even know that the volumes didn’t get nearly as high as they have recently, we were able to look at our system and say, we need more vents and we’ve got more vents. We need more PPE and we were able to get more PPE. We also looked at our rooms and our capacity and said, this is how many rooms we have. Can we convert other rooms into ICU beds? And we began that process in case we needed it. Thankfully we haven’t needed it but we’re prepared to do that.

So today we have capacity and we have other beds that can be converted into ICU and PCU beds should we need more and so we’re ready and we’re thankful that they we’ve seen the flattening in the last week. Each of our counties that we look after an AdventHealth has either seen a flattening or a little bit of decrease in the past six or seven days. Outside the hospital, we have hundreds of physician offices and urgent care centers that are seeing patients every day. We’re trying to do more testing in the community. Our urgent care centers started out with the antigen test about a month ago and we were doing 3,000 tests a week. Now we’ve ordered as much as 40,000 tests a week. Our physician offices are doing those tests as well.

We also have the ability to help folks that are coming to the emergency room and don’t need to come into the hospital. They go home and we’re able to monitor them to make sure that they don’t need to be hospitalized at all.

So this is a dynamic situation. We’re so thankful for flattening numbers but this is going to be an ongoing situation where we have to be ready and we believe that we are ready with enough supplies, enough people, although we need more, if should the numbers go up, enough vents to prepare for this.

Governor, if I could just add an echo, a comment there. As challenging as this pandemic has been, the lives lost that we mourn over, the silver linings of the innovation, the telehealth and the expansion of telehealth and tele-monitoring obviously to support individuals with COVID. We have many, many individuals with mental illness, individuals with compromised health conditions that we have tried to support in their homes and our hospitals and our physicians and our behavioral health providers have risen to a level of commitment in the resources that they’ve been providing to support.

When you think about we’ve got four and a half million people in the state of Florida over the of 65. We have 154,000 living in nursing homes and assisted living facilities. So we have many more vulnerable elderly who are living in their homes and we have supported policies and resources to provide and meet their needs in their homes and the hospitals have really provided a level of leadership and innovation to care for those individuals so that they are in the right level of care and they’ve reduced their risk of exposure in the community.

Absolutely. It’s it is definitely true. It’s been alluded to about the collaboration and the communication. A lot of times these health systems don’t talk to one another and so just the fact that they’re working and then a lot of times they get no love really from the government or from the state. So the fact that Mary’s there working with them, really day in, day out, always taking their calls and then obviously I’m in contact with many of the CEOs on a regular basis.

It really has been really good collaboration. I think it’s made it so that we were able to get in front of issues as they came down the pike. I mean, when the Remdesivir was going to be an issue, we were able to spring an action on that. A couple times when we’ve had a… we just heard about the convalescent plasma, so we immediately went out and put out the call for folks to come up and do that.

When we have had the issues with the longterm care residents, we worked in April with this model of these COVID dedicated facilities in Dolphin Pointe in Jacksonville, worked really well, and so now we’ve been able to really expand that concept and we’re going to continue to do it. I mean, I think just in the last 10 days, there’s been what, like 300 beds out and just in Miami-Dade probably, which is a really, really important thing.

So there’s just been a lot of collaboration and I think that it’s because of that, I think folks have handled it well and when you’re working together, when you’re communicating, when we’re getting things done we need to get done, everyone does their job. It’s not easy. I know that there’s difficult circumstances, but we’re able to do it in a way without unnecessary panic or hair on fire. Just do your job. Do it. It’s a very confident way I think that they’ve approached this and it really does make a difference and I think ultimately it makes a difference for the patients.

Doctor Moorhead, can you explain about the whole, the ICU capacity issue cause when folks will say that there’s a certain number of hospitals with none, no capacity, some of those are Advent hospitals, but you’re part of a big system where you do have a considerable ICU capacity. So if like one hospital is showing no ICU, how should folks interpret that?

Sure. When you look at a system like AdventHealth in Central Florida, we have multiple ICUs and so we use the concept level loading and then downtown facility in Orlando is our quaternary hub. So every day, as Scott said, we have a spreadsheet and understand where patients are and we move them around. So you may see a particular hospital above 95%, but…

… a particular hospital above 95%, but we may at the large hospital have capacity of over 25%. So we have not reached our ICU capacity at some of the local ICUs you may see. All right?

That’s fine.

We’re okay?

Yep.

You may see some high numbers. In central Florida, AdventHealth has adequate ICU capacity.

Are ICUs fixed beds? You have licensed beds, but if there’s a need to have more ICU in a given region, you can then convert some of the existing space into ICU. It’s more of a level of care than what the type of bed is, right?

Absolutely. ICU is a level of care and really the bottom line is that it is staff and the equipment necessary to take care of that degree of acuity that a patient may have. So we can move that around, we can open up additional beds. And Scott did a lot of work when we planned in the search for if we were to be confronted with a very large number, that we can find additional spaces to do critical care.

And so throughout our system, we have looked at all the beds in AdventHealth and said, okay, we can convert this many of our progressive care to ICU, from med surge to PCU. And so we have the ability. If you look at a static numbers as zero ICU beds, that doesn’t mean there’s zero ICU beds, it means is they’re looking to get the license number. And so, we have the ability to expand. And also as Dave just said, level load. And so if this hospital needs to have a few people go to another hospital nearby, we can do that as well.

And the standard way hospitals operate would be you want ICUs to run at 90% plus capacity, correct?

That’s not uncommon if you look at most typical influenza seasons for our system, it’s 95% to 105% capacity. So those numbers are not scary to us. We work with those numbers all the time.

And this could be for either of you or both of you want to weigh in. I had mentioned and a lot of physicians have told me as well, and the statistics bear it out about the deferral of care in March and April for folks with heart stroke and some of the other really significant issues that really are prevalent throughout the population. Now, we see some of those same folks in hospitals that have conditions that are materially worse than perhaps they would have been if they’d gotten care. Are you guys seeing that at Advent? And if so, what’s kind of your message for people now who are thinking about whether they need to go in, given all that’s going on with coronavirus.

It was really amazing in March and April, we saw a decrease in heart attacks and strokes significantly, and the question, what’s going on? And then as folks started to come in, they were coming in, in a more serious state. Having to stay longer and their condition has been worse. Part of that was just fear. What happens if I go into the hospital? It’s important for folks to know that our COVID patients are cohorted together in a place. You’re not going to go into a room where you’re sharing it with a COVID patient or a nurse with a COVID patient. And so, we want people that have those serious conditions, strokes, heart attacks, chest pains, any of those to go to the hospital. That’s the right place to do, do not delay your care. And Dave, you’ve seen that as well.

I just was talking to [inaudible 00:03:25], who’s our chief of critical care. And this morning he wanted me to make a very different point. Our ICUs have a significant increase in non-COVID patients. And as he looked at them, this is heart disease, stroke, and severe diabetic issues of people who put off coming in. And so, the concept that during a COVID pandemic, that all these other medical conditions that have a certain incidence, then there’s a certain volume of this disease that’s occurring is going to go away if you shut down the hospital for other purposes is not wise, it doesn’t make sense. And so, our job right now is to incredibly value a COVID life, but to incredibly value a life of somebody else who has another problem. And what we’re trying to do is to do both of them very well.

And I think that just goes to, for the message for folks, if you are experiencing some of those other symptoms, they’re here to help. You have noticed it, I think it’s almost every place in the state. And I’ve talked to folks, you see more people in ICU for non-COVID reasons because of linked to this deferral of care in March and in April in particular. And so, obviously people started to become more comfortable going back in May because the prevalence was low in Florida at the beginning of June. Now as this has increased, obviously there’s a lot of angst and anxiety out there. And the message is don’t sit on those symptoms because you could end up a couple months down the road in a more serious state, and that’s not good for anybody.

So they are absolutely the majority of what they do by far is non-COVID related. And in fact, in most parts of the state, COVID is just a small fraction of what a lot of the hospitals are doing. So we want to continue to stress that message and just make sure people know it’s safe to go in and get the care that you need. And that anxiety over going in is not our friend. And we want people to be able to get the care that they need. So for the hospital perspective, I know we’ve worked with you guys on the Remdesivir, on the staff support. Of course, the Nursing Home COVID Only is an important tool. What else are you seeing as maybe needs, or is it really just boiled down, really just making sure you have a rested staff and make sure you have enough people?

I think you’re exactly right. It’s rested stuff. We have staff that are very tired and having the additional staff brought into the state, just even allowing our staff to take a day to convalesce and come back to work fresh has met a big difference.

Yeah. I would absolutely agree with the fact that staffing seems to be something that is very significant. Again, our workforce has been on the front since March dealing with this. So that has been key. But I would also say in the collaboration that has been discussed in working with the administration and you, Secretary Mayhew, is not only been the things, resources, Remdesivir, staff, but it’s also been the responsiveness and willingness to modify policies that might be in our way or blocking the ability to quickly move patients or do some of the things that are necessary in these unprecedented times.

There’s been a lot of emergency rules that have been put out. And as those have had their effect and needed to be dialed back, we dial those back. If they need to be ramped back up, I will say prior authorizations, being able to do some timely discharges. I’m working on some of those things, but not just adequate resources, physical things like personal protection equipment or staff or drugs, but certainly some of the policy changes that we have been able to work with the administration to really make our jobs easier.

How many of your members had to lay off staff in March and April because of the lack of business?

Sure. So it was definitely regional, which is what we see all across the State of Florida. So when electives were not going on in March and April, that certainly had a significant financial impact on many of our facilities, many of which did one of two things. So furloughed staff, some eliminated. Of course, no frontline workers were laid off, other positions within the hospital. And then if those that did not furlough or actually lay off staff permanently, many of them also did across the board reductions in compensation. So people were being financially impacted pretty significantly throughout the state. Again, some of those other pockets of the state that weren’t really experiencing high volume of COVID patients that had to bring down those elective procedures. That certainly had a really negative effect on them.

And then this would be typically the low season for our census normally. And I would imagine there’s probably some variation in staffing that naturally occurs there. So that adds to the need to make sure that we have a number of folks. Can you talk about, Mary, just the scope of all these facilities, where we stand now, where throughout the state we have a lot of beds and how those beds are being utilized?

Yeah. And one of the points that I’d like to make too, governor, is a couple of things. One, when asked why we’ve been able to be successful, to have some of the efforts around the state, it isn’t as complicated as one might want to make. The relationships that have been established, the ability to call day or night, Saturday, Sunday, throughout the week. And to hear, here’s how that policy could improve the situation and our ability with your leadership to swiftly act, that’s been critical and obviously informed by the data. I look at, you look at the rate of inpatient admissions every single day. I calculate over that period of time, are we seeing an overall increase, decrease? What’s the ICU rate of increase?

Now what I know in talking to the hospitals throughout the state, and I know you have heard this as well, governor, what I consistently hear is we want the ability to surge within our walls. That’s important. That’s not a hospital saying, I can’t handle any more. In fact, what they’re saying is we want to work with the state to maximize our physical plant space to accommodate future demand. So that pertains to all of the discussions around the field hospitals, the convention centers. What the hospitals routinely say is I will be competing for staff with those facilities.

It doesn’t mean that they may not, in the worst case scenario, be necessary. What the hospitals are saying is not only do I have the capacity today to meet the existing demand within my inpatient space, I want to have the flexibility to convert other space should we need it. As I’m on calls every other day with Miami, Dave, [inaudible 00:10:51], and Palm Beach, they are closely monitoring together and sharing data. I will also say for some fairly fierce competitors, I’ve heard them say to one another, you know what? If you need to transfer patients over to my system, I’m here to help.

That’s great. Dr. Morehead, Dr. Brady, maybe you guys can both weigh in just about the treatment of COVID patients and how that may have evolved since March and the type of success that you guys are having in Central Florida in treating them.

Again, as I said before, we’ve just learned so much. When I was in med school, back with Hippocrates, we didn’t learn much about COVID, but what we’ve learned is that there’s a few things that make a huge difference. And again, talking to my critical care friends, the number one thing is that we’ve had the ability and the staff and the time to do it right in the normal way. We haven’t been in an Armageddon chaotic situation where we haven’t been able to staff and we’ve been able to have the normal cadence that leads to high quality care.

Another real breakthrough in understanding has been the concept of proning. If you have somebody who lies on their back for days at a time, that portions of the lung will not be as effective. So we flip them over and put them on their belly, proning. And what that’s done has had dramatic improvement in the ability to oxygenate. Remdesivir has been a drug of a lot of hope. The final papers haven’t been written on its efficacy, but there’s really good evidence that it has helped. Also, dexamethazone has been of significant help. So there’s a lot that we’ve learned. We trache earlier than later now, but I believe our intensivists have been able to apply their training, not only as physicians, but as scientists and learn how to better care for this disease. And I think we do a lot better job today than we did back in March.

You had mentioned before we came out about the patients on mechanical ventilation, what the mortality rate is for you.

Yeah. We looked at it just recently and we believe that our mechanical ventilation mortality is about 25%. And in the Northeast, during the chaotic period, they were reporting very high numbers. We think that a lot of these things that I just enumerated have led to that mortality rate, which is I think a very, very, very good national rate.

Yep. Dr. Brady, do you want to weigh in on any of the standard of care, any of the treatments we’re seeing?

Yes. Another one we were seeing is as the plasma treatment. And so as you were at the blood center yesterday, absolutely. If you’ve had COVID, you have an opportunity to help other folks when you recover. And so the plasma has been also excellent, as we see the papers coming out. That’s been one of our key strategies. We’re also involved in several studies at AdventHealth, new medications, new drugs, and we anticipate learning more in the months to come.

Is the plasma… Do you use that in conjunction with Remdesivir? Is it either or, and then the same thing with the steroid, do you use all three of them in the same patient?

Sometimes you can. Not every time.

Right.

We looked up the numbers this morning. We’ve had over 270 patients in Central Florida received convalescent plasma.

Right. And when did that really start in earnest? Was that in April?

March, April.

Oh, so you were doing it in March, initially.

March, April. Yeah.

Okay. Well, that’s good. Well, we appreciate what you guys are doing. I know that this is a very challenging set of circumstances, but I think you’ve really risen to the occasion and we have a strong hospital system. We do have a lot of availability. As I mentioned, 24% of all the beds in Florida are available, including a significant chunk of the ICU beds. COVID is very important, but COVID is just one aspect of the overall healthcare system and the health needs of Floridians. And we want to assure people that if they do have other health needs, that these systems are open and we’ll take care of them. It’s really, really important that as we work to do as much as we can with the coronavirus, that we’re not neglecting other very real and important health needs. And so, I want to thank everybody for coming and thank you all for working hard day in and day out. I know it’s been a long slog, but you guys have done really, really well. So thanks for working with us. And we’re happy to take a few questions.

Speaker 1: (51:41)
[inaudible 00:51:41] some of the assisted living facilities [inaudible 00:51:54] testing residents and staff on the end of September. Is that a concern they should be worried about?

It’s new news to me. As I’ve mentioned before, when we went into this, we obviously had a lot of mitigation about not having visitors, having PPE. We sent PPE. The state has sent a massive amount of PPE to all the longterm care facilities, to be able to minimize the spread inside the facilities from staff to residents. We had national guard strike teams go into nursing homes, testing the residents, testing staff throughout April May and into June. And then since then, we now have this system where we’re doing every staff member every two weeks. And that’s going to keep on going. We’ve not put any limitation on that and want to continue to support as best we can.

Obviously, when the prevalence is high, then all these things are all the more important. The visitation becomes very difficult. As we get over this hump and get into lower prevalence, we can look at some of these other policies, such as the limit on visitation. And we’ll see how we’re doing with the testing. Now, the federal government is sending point of care tests to a number of longterm care facilities throughout the country. We’re not sure exactly how many are going, how many are necessarily going to be… Obviously, Florida we’ll get some, but I think the goal is, is to provide an easy way to be able to periodically test folks in longterm care facilities.

We have a relationship with the lab who turns it around relatively quickly for us with the staff, but it’s not an instant test. They swab, they mail it, and then we usually get the results back in about 36 hours, but that’s worked really well for us. And so, we want to continue to be able to offer support. As Mary mentioned, there’s 150 some thousand residents. They represent almost half of the COVID related fatalities, just out of that one group. And so, we want to be able to help as best we can. It’s a very, very important part of the response.

Speaker 2: (53:58)
[crosstalk 00:53:58] I know your message here is [inaudible 00:54:01] the hospitals [inaudible 00:54:02] are prepared in the United States-

Speaker 2: (54:02)
You were mentioned here [inaudible 00:54:01] the hospitals are prepared and they have the space. So I’m wondering the extraordinary step of 1400 people being [inaudible 00:00:08], health care people, and transferred around the state. Can you speak a little bit about how this has happened and where [inaudible 00:54:16]?

So at the beginning of this, we had contracts in place because we were preparing for all the exigencies that may happen. And so that’s been there, now we didn’t really need to, we actually… Actually, I take that back. We’ve used a lot of the contract medical personnel for our test sites. And so a lot of those, we have National Guard, we have contracts, some of them, we have hospital folks, Memorial Healthcare has folks, but we’ve really relied on that for that. So it’s been helpful. As we started to get into the middle end of June, we started to see prevalence rise, we started to see ED visits rise, we saw admissions. The hospitals are like, the feds built the Miami Beach Convention Center. And you talked to those folks so far they’re like, ” We just want to do inside our hospitals,” but you have a situation where the staff has fatigued.

Some of the hospitals are more seasonal and so they have fewer staff in the summertime. And then you have the situation where as the prevalence in the community is higher. You have more members of the staff who may test positive. I remember going to Tampa General at the end of April. And they said they had had a handful of staff that had tested positive and they believe everyone got it, New York or somewhere outside of Tampa. Well, obviously now this is just a function of the community. So if you’re in an area now, fortunately places in central Florida, they’re trending in single digit positivity. And so that will be reflected, but, in Dade where you have 20% positivity, that, so you end up having some staff that ended up having to be isolated. So to be able to fulfill that, and we’ve also used them for the longterm care COVID only, and also for longterm care. There was an outbreak in Jackson County where they had 50 staff members, all, I think they were all asymptomatic test positive.

So we sent 25 nurses there to be able to care for the residents. Then you also have the situation where people that get hospitalized for other things are all being tested for COVID now. And so if you get in a car accident in Miami, Jackson is going to swab you. And a lot of these, not a lot, but it’s a reflection of the community. So last time I talked to Carlos Migoya, he said between 30 and 40% of their COVID positive patients are actually hospitalized for something else, not for COVID, but just the fact that they have COVID means all those procedures, isolation need to be followed, and that takes more manpower to be able to do. And so, and then also, I’m sensitive of the fact that stopping the elective procedures was something that has caused some of the staffs around the state to atrophie because we had a situation… We got to the middle of April and we had almost half of our hospitals were, they were half empty the hospitals and they weren’t doing the procedures, they were having problems.

And so that reflected their ability to maintain some of the staff. And so I thought given that, it makes sense to do it. So it’s just planning, trying to meet exigencies, but they’re really being used for a whole host of things to support some of the hospital operations, support testing centers, to support longterm care, COVID only longterm care. And I think doing it in a way that’s been very, very helpful and that really, the [inaudible 00:57:28], some of these other things have been important. But I think that’s the one thing that as they look at, what’s going… And look, this is good news when you hear about the flattening of the Census, because that, and that’s, and I think, look, these things have, if you look the life cycle of this, how it’s worked in other areas, you see a similar life cycle.

I think we’re seeing that here, but that’s something that is good because they know they’re going to be able to meet the capacity and meet the demand. And then if you have other areas where you have different, but I do think that it’s, that was the prudent thing to do to prepare. I’m not sure how much ultimately some will be used in different markets because I think you have seen a plateau in places like central Florida, which is a good thing, and I’d rather be prepared and not need it than not have mobilized these people because you can never be sure what’s going to end up happening.

Speaker 2: (58:19)
[crosstalk 00:58:20]. Or are these all state [inaudible 00:00:58:25]?

Well, I think there’s a mix, the systems are actually are bringing in people to they’re doing that as well, but it’s not as easy as just doing it because there’s just, people have been worked very hard over the last few months, so they are getting some their own, you want to, they’re going to get some their own, then they are doing that. And then we’re also supplementing with our folks. So it is coming from a multiple directions.

Speaker 3: (58:55)
Governor, do you want Congress to extend $600 a week of [inaudible 00:58:56]?

I haven’t been following what they’re doing. I think that we want to get people back to work, fortunately, our unemployment 10.7 was probably lower than most people forecast it would have been. We’re going to keep society functioning. We want people to get back to work. I’ve heard of maybe offering kind of a reemployment bonus for people that are going back, that may be something that would be positive and could potentially make a difference. But it’s been tough for a lot of folks to see the economy change the way it is. I think we’ve added more employment than any people thought we could, but we’ve got a long way to go. And this is going to take some time.

And I think people should understand that it’s not necessarily just a question of whether you want to work or not, it’s a question of whether all the jobs are going to be there. And I think what you’re going to see is the way some of these businesses operate, how they’ve changed operations during the pandemic, some of those operations are going to change going forward. And some of the folks who were laid off, they may not have the ability to go back to some of these jobs. And we think there’s a lot of jobs that will just be filled, but I don’t think it’s going to be 100%. And that’s something that we’re going to have to reckon with.

Speaker 4: (01:00:08)
[inaudible 01:00:09].

Governor DeSantis: (01:00:08)
Yes, sir.

Speaker 4: (01:00:10)
It’s been a while since we’ve seen Surgeon General Rivkees and [inaudible 01:00:15] he’s been up to? And if you have him [inaudible 01:00:17] press conference.

No, he’s working really hard. We’ve got a lot of irons in the fire, as you know, there’s a lot of stuff going on with the Department of Health. And so I know he reiterated some guidance recently with some stuff about our vulnerable populations, about our advisories on face mask, about our advisories on some of the close contact and in large groups. And I think that that’s been very, very important. I think one of the reasons, if you look, I think we’re going in a good direction. I think obviously the ED visits, the plateauing, the hospitals suggest that, but you really could see as this became something that was “hot” again, in terms of something that people were really concerned about. And look, we had a very quiet may and early June, that’s just, we were fortune to that. If you look at those COVID like illness visits, they were very low for a state of our size consistently. And then as this, you started to see more of a wave here, I think people really did heed the guidelines. And I think that’s been a big part of why I think we’re turning this thing back in a good direction and why I think we’re going to continue to see some improvements.

Speaker 5: (01:01:29)
[crosstalk 00:07:29].

Yes sir.

Speaker 5: (01:01:31)
[inaudible 01:01:31] their Medicaid school pay program that they’re increasing premium, monthly premiums by about $30 a month starting in September. [inaudible 01:01:42] your radar? [inaudible 01:01:48].

Obviously I wanted to be as cheap as possible for people, for sure. So, we’ll definitely take a look at that.

Speaker 6: (01:01:54)
Governor, you had to shut down the [inaudible 01:01:56] Center [inaudible 01:01:57] weekend because [inaudible 00:07: 59]. Is the state going to be able the pandemic and a major hurricane?

Well, fortunately this is something that they plan for. And so they do, everyone who was working from home, they have the capacity to do that. And so that’s built into the operational plan that if you do have something like that, that you’re going to be able to do it remotely. So it’s obviously not necessarily something that we want to see happen, but there are preparations that are in place and then they executed accordingly and they will continue to do it. And so we understand that in hurricane season, you got to be ready. Now, obviously, I would like another respite last year, we had a close call, but you got to be prepared. And you got to assume that that’s something that we’re going to have to face.

Speaker 7: (01:02:41)
Governor, do you think this is moving in a good direction? As you said, this it the first day that we haven’t had over 10,000 [inaudible 01:02:47]-

Yeah. But you got to understand, those were infections that probably happened 10 to 14 days ago. You look at the [syndromatic 01:02:57] surveillance info, you talk to hospitals that are seeing plateau in patients, that is much better to have ED visits going down than to have them going up. It’s much better to have the census plateaued. And there are some areas where it is declining for COVID patients. That is much better than seeing the escalation that we had seen. And so, yeah, I think it’s much better today than it was two weeks ago. And I think it will continue to improve. If you look at central Florida, for example, we have counties like Bravard and Orange and Lake and Seminole, who’ve now been in the single digits in terms of their percent positive.

You look at like a Pinellas County they’ve been consistently now single digits, that was not the case two weeks ago. And so these things take time. But I think the trend is much better today than the trend was two weeks ago. So I’m confident we’re going to get through this. I’m confident that the folks here in our hospital system are going to continue to do a great job. They’ll be able to meet the demand. And I think that Floridians, I think there’s a lot of anxiety and fear out there. And I think that folks just, it’s going to be, we’re going to be able to get through it. We got a lot of stuff going on in the state, we’re going to continue to have things that we’re going to need to do as a state.

So we’re going to get through it, we’re not there yet, but I think that I’d much rather have 1,000 visits than 2,500 like we were seeing two weeks ago, and I’m much rather have a hospital saying that they’ve had a week of stable census rather than saying, “This thing is spinning, it’s increasing, it’s increasing. We don’t know when it’s going to stop.” So that’s just the vantage point. And, but, but, but I think people are doing a lot of good stuff around the state and I really appreciate it. Look, we… I think looking back, March, April, the Northeast had their big spike. And I think it was just assumed that the whole US would have the same curve. And in Florida looking back, we had South Florida that had most of the outbreak.

And I think that was largely transplanted from the Northeast. The rest of the state had a relatively modest outbreak then. And I think now what we’re seeing through the Sunbelt is the true seasonal pattern for this thing, for whatever reason. And so it’s been, you’re kind of on edge about it in March, April having to do it granted end of April, may and early June was relatively quiet, but then the ramp up people are back at it. So particularly for the healthcare workers they’ve been at it for a long time.

And just because the census was lower six weeks ago for COVID doesn’t mean they still didn’t have to do the same procedures, didn’t mean that they still had to worry about infections, do all these other things that they’ve been doing. And so it’s been a lot of really, really hard work from an awful lot of people. And I really appreciate it, but I do think we’re going to be in good shape. And also just with the testing, we had an increase in prevalence starting in mid June and early July. Since then, it’s been pretty consistent based on the level of testing. So if we do 50,000 tests, we’re going to get a certain amount of positives. We do 75, we’ll get a certain amount. And I think that that’s been pretty consistent for the last seven or eight days. We’re doing more tests on a daily basis than anyone thought we’d be able to do.

Today was only, I think, 75,000, but we had 144,000 tests in one day that were done. We have had 100,000 or more multiple days. So when you do that, you are going to be able to detect particularly a lot of asymptomatic cases. And we looked at one of our big Miami sites and we ask questions and did survey, as people were coming through the line, “Why are you here? Do you have symptoms?” And only 20% had symptoms. Some were going because their employer wanted them to get tested. Some are going because they didn’t have symptoms, they thought they may have been exposed. And then others were, we had 25% of the test takers who were just curious and going, and that’s fine, it’s there, but that’s much different than what was happening in March and April, where you had to be symptomatic. And in a lot of times you had to be a certain age even to get tested. So we’re really testing a lot. We obviously saw the prevalence increase the end of June into July, but I do think with some of the changes you’re seeing in some of the positivity, I think some of the stabilization you’re seeing in places like central Florida, I think that those are good signs and we just need to continue going forward. So-

Speaker 8: (01:07:40)
In regards to the Emergency Operation Center, this is the place that was testing everybody twice a week, taking temperatures every day when you walk in, what does that say about the strength of this virus and the danger to just no matter what you do, you may still end up getting it?

Well, there was, I think Florida Atlantic or someone put something out today about how they think that this is the Sunbelt, what we’re seeing the Sunbelt, that this is acting in a much more contagious fashion than what we saw in March or April. I don’t know if that is true or not, but I will say, there’s no doubt that even the best laid plans, you follow all the screening and you still see sometimes it gets… Just think of areas like prisons that have seen outbreaks. They’re all locked in there and you see prison outbreaks. So, or nursing homes, they go through screening every day for all the staff and yet you still have folks who are asymptomatic. And so I think it’s a very difficult thing. Fortunately though, as we’ve seen more cases develop, you’ve seen a lower case fatality rate, much lower than what you saw in March or April.

And again, I don’t know whether that’s purely just a matter changes in testing or whether we’re seeing something a little bit different than what we saw in March and April. I’ve heard different people offer different judgments on it, but it’s definitely something that is very contagious. Fortunately for most people it’s mild or even totally asymptomatic. And that’s why we have these antibody tests going on. We opened it up to the general public a few weeks ago in our drive-through sites. You actually have people going through and they’re testing at between 10 and 15% positive for antibodies. That’s a lot higher than where we were about a month ago. And really, that’s probably a reflection of infections that occurred four to six weeks ago, probably six weeks ago. So I’d imagine the prevalence would be even higher, but a lot of those folks didn’t necessarily have significant symptoms.

Some of them didn’t even know that they would have been infected. They’re just curious and they’re going to get it. And so that’s the, I think the one thing about it is particularly if you’re under a certain age and you don’t have significant comorbidities, the mortality rate on this has been incredibly, incredibly low in those areas. And particularly for young children, which is something that I know a lot of parents including me are concerned about. So, okay, well, we’ll be back tomorrow doing something. So we’ll see you guys.

Speaker 9: (01:10:08)
Thank you.

Speaker 10: (01:10:08)
You guys want to come up here?

Florida Governor Ron DeSantis July 21 Press Conference Transcript

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