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Rivals in normal times, Tampa Bay hospitals battle the virus together

Can they fend off the kind of COVID-19 surge that has tested health care systems in other states?
Tampa General Hospital's clinical command center, opened in August, is being thrown into action to help the whole region prepare for a COVID-19 surge. The center takes data from other area hospitals to track patients and hospital resources.
Tampa General Hospital's clinical command center, opened in August, is being thrown into action to help the whole region prepare for a COVID-19 surge. The center takes data from other area hospitals to track patients and hospital resources. [ Times (2019) ]
Published Apr. 17, 2020
Updated Apr. 21, 2020

Dr. Ravi Chari recalls the early hours of Florida’s coronavirus crisis.

“It was Saturday morning, Feb. 29,” he said. “I texted Tommy and John, and that was sort of the start.”

A 60-year-old man had been hospitalized at Doctors Hospital in Manatee County, one of 15 facilities Chari oversees as CEO of HCA Healthcare’s West Florida division. The patient was one of the first two people in Florida to test positive for COVID-19, the disease caused by the virus.

Ravi Chari
Ravi Chari [ HCA Healthcare ]

On the group text were Tommy Inzina, head of BayCare Health System, and John Couris of Tampa General Hospital. Together, the three executives are responsible for 22 of the Tampa Bay area’s 34 major hospitals, including the region’s only Level 1 trauma center at Tampa General.

“I told them we need to get together and begin to understand how we can start pulling our resources,” Chari said.

Two days later, the three spoke again outside a health department lab in Tampa, where Gov. Ron DeSantis and state Surgeon General Scott Rivkees had publicly addressed the outbreak for the first time.

Thus began an extraordinary period of cooperation among rivals who, in normal times, compete vigorously in a health care market that is measured in tens of billions of dollars. In recent weeks, as most people focused on social distancing, shuttered businesses and mounting unemployment, these and other local leaders planned for a surge in virus cases that could yet test the limits of Tampa Bay’s health system or reveal its strengths.

“We began sharing every detail of what we were doing to prepare,” Chari said. “We talked about hospital beds and ventilators. We looked at visitor policies together and the supply chain."

Tommy Inzina [BayCare Health System]
Tommy Inzina [BayCare Health System]

Whether their unified approach pays off remains an open question, though recent numbers offer evidence that Tampa Bay could escape the shortages and other health care horrors reported in places like New York, Detroit and Seattle.

Even as Florida logs hundreds of new COVID-19 cases a day and dozens of deaths each week, the state’s daily counts have started to level off. In Tampa Bay, just over 40 percent of the region’s hospital beds — about 5,000 in all — remain available for new patients, according to a mid-week report by the business coalition Tampa Bay Partnership and other groups, including the University of South Florida’s Muma College of Business.

About 35 percent of the region’s Intensive Care Unit beds are currently available, the report said, although that number was starting to edge down. Similar numbers can be found in a real-time spreadsheet kept by the state that shows hospital capacity across Florida.

With the current load of cases, “clearly, we have not gone even close to busting the medical system here,” DeSantis ventured in his televised Wednesday briefing. But he and many others acknowledge that nothing is certain until more people can be tested and the virus runs its course.

Mike Schultz, CEO of AdventHealth's West Florida Division, walks toward the entrance of the Tampa Bay Buccaneers training center, which bears the health system's name. In early March he joined a group of local hospital executives working to plan for a COVID-19 surge. [Times (2019)]
Mike Schultz, CEO of AdventHealth's West Florida Division, walks toward the entrance of the Tampa Bay Buccaneers training center, which bears the health system's name. In early March he joined a group of local hospital executives working to plan for a COVID-19 surge. [Times (2019)]

In interviews, the leaders of Tampa Bay’s major health systems sounded optimistic that the region would be mostly spared from any big surge, given the latest trajectories. In addition to Chari, Inzina and Couris, the group includes Mike Schultz, CEO of AdventHealth’s West Florida Division, which operates seven hospitals in Hillsborough, Pinellas and Pasco counties.

Schultz said Chari called him in early March to get involved.

“We’ve noticed a plateauing of activity lately," Schultz said. "I believe we’re well-suited to take care of the surge that might happen in the Tampa Bay market.”

According to Chari, the hospital leaders told Mary Mayhew, secretary of the Florida Agency for Health Care Administration, that they are poised to “handle the current volumes.”

But Couris of Tampa General warned that this outlook has a caveat.

“We have adequate supplies, ventilators and beds right now. We feel good about that,” he said. “We’re prepared for the surge. The wild card, in my perspective, is if this virus gets into skilled nursing facilities. Then all bets are off.”

Those fears became real on Tuesday when 38 patients from a Pinellas County nursing facility were transferred to three local hospitals with COVID-19 or possible exposure to the disease. Twenty-one patients and six employees had tested positive for the virus at Seminole Nursing Pavilion, part of the sprawling Freedom Square retirement community in Seminole.

John Couris, President and CEO of Tampa General Hospital, photographed at TGH overlooking the Tampa skyline on Sept. 28, 2018.
John Couris, President and CEO of Tampa General Hospital, photographed at TGH overlooking the Tampa skyline on Sept. 28, 2018. [ DANIEL WALLACE | Tampa General Hospital ]

Florida elder care facilities have been operating under lockdown since March 15, but DeSantis announced plans Monday to deploy the Florida National Guard to 93 assisted living facilities across the state.

The Tampa Bay hospital executives now have a rolling weekly phone call, sometimes more often, but it’s unusual if they’re not emailing or texting on any given day, Chari said.

“Every day we’re sharing information about positive patients in the hospital, and we’re collaborating on surge and testing where it’s appropriate,” Couris said. “The idea is if one hospital is hit hard, we would collectively be there to support."

Each hospital has its own surge plan for disasters, and they share those details with emergency management officials. By the time Hillsborough County reached out to meet with local hospital operators about coronavirus plans, they were ahead of the curve, said Schultz.

“The county seemed pleased and surprised at how we were already handling this," he said.

The pandemic is unlike anything county government has had to face, said Hillsborough County Administrator Mike Merrill.

“Unlike a hurricane, a big part of this crisis is the public health aspect to it,” Merrill said. “The hospitals play a major role, and they’ve put aside whatever competitiveness they’d had.”

Hospitals have worked with the health department to plan for testing and a surge, he said. Emergency plans call for using the Yuengling Center at USF as a field hospital if necessary.

Hospital plans include details on how to share supplies and workload, in addition to plans for which facilities would step up if others become overwhelmed.

So far, none of those plans have had to be put into action, said Dr. Nishant Anand, chief medical officer at BayCare.

“We made sure we were prepared for every contingency,” Anand said. “Projections are only as good as the data you have, and it’s been too early to tell.”

They also pooled resources to get the drive-through COVID-19 testing site at Raymond James Stadium off the ground.

“We may not have always agreed, and it hasn’t always been easy, but they realized that time is of the essence,” Merrill said.

Tampa General has led efforts to create a region-wide data dashboard, which is pulling numbers from state and national data-tracking models and combining it with local information to provide a more complete picture of what could be coming for Tampa Bay.

HCA, BayCare and AdventHealth, along with 51 hospitals across seven health systems along the Gulf Coast, are reporting bed and supply numbers to Tampa General twice a day, said Dr. Peter Chang, who runs the hospital’s new data-driven command center.

“We came up with the idea after looking at what’s happening in other parts of the country," Chang said. “We determined we needed to understand if we had enough equipment and space, and enough medical staff.

While the hospital leaders described their collaboration as unusual, it isn’t the first time they’ve come together to solve a problem. Most were already teaming up on other community initiatives. For example, BayCare launched the West Central Florida Mental Wellness Coalition last year, which looped in hospitals and community groups to widen the region’s access to mental health care.

But this feels different, Chari said.

These, he said, are extraordinary times.

• • •

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