TALLAHASSEE — Patients ignored chest pain for days only to arrive at the hospital in cardiac arrest. Other patients ignored seizures until their situation became more severe. And a study by the Cleveland Clinic found a 38 percent decrease in patients presenting to the hospital with stroke and heart attack symptoms since onset of the pandemic.
As fear of being exposed to the novel coronavirus consumed the public, it also kept people away from seeking critical medical attention, several doctors told Gov. Ron DeSantis this weekend during a two visits to hospitals.
“It’s time for the community to understand — and the numbers support this — it’s time to come back and get your healthcare,’’ said George Ralls, chief quality officer for Orlando Health during a press conference with DeSantis on Sunday. “There are many cases that we have seen come into the emergency departments that were much, much worse than they would have been had they come in a few days before.”
DeSantis signaled this weekend he will be announcing an end to the ban elective on procedures at hospitals and outpatient clinics, noting that the fear that hospitals would be overwhelmed by patients with COVID-19 had subsided.
“These elective procedures really do affect patient’s health,’’ DeSantis said at a news conference at the Cleveland Clinic in Weston on Saturday. But because hospitals have the capacity now, he said, “we do need to move in that direction so we’ll be announcing it pretty shortly.”
Canceling ‘elective’ surgery
DeSantis signed an executive order March 20 delaying all elective surgeries in hospitals, ambulatory surgical centers, office surgery centers, dental offices and other healthcare providers until May 8.
The goal, modeled after a recommendation by the Centers for Disease Control and Prevention, was to preserve hospital space for what epidemiologists were projecting was going to be a surge in hospitalizations and demand for critical care beds for patients struggling with the deadly respiratory disease caused by the coronavirus.
At the time of the executive order, the governor had not issued a statewide stay-home order, Florida’s beaches were still open and the number of positive COVID-19 cases was doubling every three days.
“The reason why we stopped the elective procedures was wanted to make sure there was enough hospital beds in case of a surge of COVID patients,’’ DeSantis said Sunday at Orlando Regional Medical Center.
The two-day tour of hospitals came after some members of the governor’s re-opening task force last week said they needed the advice of medical professionals to inform their work.
“What this group needs to do ... is to listen to the medical professionals and have a clear understanding: This is the amount of feet that human beings need to be apart,’’ said House Speaker José Oliva at a Wednesday meeting of the task force. “This is the type of protective gear that human beings need to wear within this kind of space. If you meet those requirements, you’re open for business. If you don’t meet those requirements, you’re not allowed to open for business.”
Visiting key hospitals
So DeSantis hit the road Saturday and Sunday and held press conferences with panels of doctors in white lab coats to get feedback from officials at two hospitals — and get some to agree with his assessment that the number of positive COVID-19 cases had plateaued.
“So is the curve flat in Central Florida?” DeSantis asked David Strong, president of Orlando Health.
“Right now, the the curve’s still going down,’’ Strong answered.
DeSantis also used the events to spread the word that hospitals were safe places for non-COVID-19 patients to enter.
“As the coronavirus has become the all-encompassing issue, you’re not seeing as many people come to the hospital with stroke symptoms or heart symptoms,’’ DeSantis said at the Weston event. “Now, maybe magically, people just aren’t having heart attacks or anymore strokes, but I think part of that is people don’t feel comfortable coming in.”
Wael Barsoum, CEO of Cleveland Clinic Florida, said “every hospital has taken incredible efforts to ensure that our hospitals are as safe as possible.”
He and the doctors meeting with DeSantis said they had enough equipment, beds and staff to open hospitals to all patients while also treating current and new COVID-19 patients.
“I am 100 percent confident that we can handle patients that we’ve put off and, I’ll use the term loosely, ‘elective’ surgeries,” said Sunil Desai, a senior vice president of Orlando Health.
He said that while doctors call it “elective surgery,’’ the only thing elective about it is “when you set up the time,’’ he said. “To that patient or that family, it is not elective. It was something that was prepared for.”
Ralls warned, however, that hospitals could see “a surge of unmet medical needs.”
“We’re very, very concerned about patients that have other conditions not coming in to seek care and the potential downstream consequences of that,” said Carla McWilliams, an infectious disease specialist at Cleveland Clinic in Weston.
There’s plenty of room
Mark Jones, president of Orlando Regional Medical Center, said only about 1,300 of the hospital’s 2,400 beds were filled on Sunday, and the hospital was treating only 13 COVID-19 patients, including six on ventilators. He said the highest number of COVID-19 cases they had was on April 8 with 54 patients, including 26 on ventilators.
“So, certainly the peak, we believe, has passed,’’ he said. “We’re ready for volumes 20 times more than what we’ve actually received.”
Desai said patients should expect protocols to be different at hospitals because of the infection-control procedures in place now for COVID-19.
Orlando Health, like most hospitals, screens all patients for COVID-19, imposes limitations on visitors, and separates patients “so patients who don’t have COVID or are in the hospital for something else, aren’t exposed to those patients and their team members.”
“We’re here and we’re open. And we are safe. So please, please take that message to heart,’’ Ralls said.
Meanwhile, hospital and physician organizations had prepared letters to DeSantis last week urging him to end the restrictions on elective procedures.
Hospitals officials told the governor’s task force that they have lost an estimated $400 million to $500 million in revenue as they ended elective procedures in order to set aside beds for COVID-19 cases that haven’t materialized. Each COVID-19 patient costs hospitals an estimated $6,000 to $8,000, according to the Agency for Health Care Administration.
The task force submitted written recommendations to the governor’s deputy chief of staff, Chris Spencer, over the weekend and is expected to review the draft a proposals early this week. The proposals are expected to mirror the phased-in approach offered by President Donald Trump’s task force by recommending how business sectors and regions of the state will be allowed to re-open for business.
At the Orlando event, DeSantis acknowledged that a central challenge to restarting the economy is going to be instilling confidence in the public that the state is following a methodical and safe process to reopening.
“Even if you could flip the switch, if people don’t have confidence, then the economy’s not going to just take off,’’ he said. “It’s just not the way it works.”
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