The coronavirus continues to surge in Florida. On Wednesday, the state shattered its single-day record with 5,508 new cases. On Thursday, it reported another 5,004 cases. This marked a grim benchmark: The state has now had more COVID-19 cases in June than in the previous months combined. Florida has reported more than 114,000 cases and 3,327 deaths.
While the pandemic has been described as a matter of waves, Florida never saw an end to its first; it has only experienced a growth in cases since March. The scenario health experts warned of appears to have finally caught up with the state, including a significant spike in mid-June, a week or so after it began its second phase of reopening.
Slate spoke with Dr. Minal Ahson, a University of South Florida Health Med-Peds hospitalist in Tampa, about what this surge in cases looks like on the ground and how it hits differently four months into the pandemic. This interview has been condensed and edited for clarity.
Slate: What’s your job like right now?
Minal Ahson: On the day shift, every other week I’m on the COVID team for adult patients. If I’m working the night shift, at least every other night, we’re taking turns rotating through admitting COVID patients. We are seeing rising numbers, to the point that we have had to expand the amount of doctors who are seeing COVID patients. Before, we were admitting maybe one a night, and maybe two or three in the daytime. Yesterday, we admitted 20 patients within 24 hours.
When did you start to notice things were getting worse?
About two weeks ago, we started noticing the numbers rising, and they have been steadily increasing. We’re just starting that exponential growth rate, which is more unpredictable. Current estimates show a doubling time of a few weeks in the Tampa Bay area. We started planning back in March for these kinds of numbers—we were just thinking that we would get this much earlier than we did.
Were you and your colleagues prepared for this spike?
We were prepared that with the reopening of the state there would be a surge. I don’t think that any of us really knew what the surge exactly would be, so to see it rising at such an exponential rate is a little surprising. We will likely face staffing and hospital bed and ventilator shortages. But [it is] not completely out of the realm of what we pictured.
How do you think this later wave might hit differently than in an early phase of the pandemic?
When the state opened back up a few weeks ago, we were met with a surge in patient volume. Surgical cases were rescheduled, and patients returned to clinics and hospitals. Our hospitalist group was seeing very high volumes of non-COVID-19 patients. [So] we now face the possibility of going into the surge of COVID-19 with physicians who are carrying workloads in other areas. When the surge hit in New York and other states, most of them were on lockdown and had a more available work pool to pull from. [So even though] we have had a few months to prepare and come up with plans, those plans must now be modified.
[But] I think that two or three months of preparing has definitely put us in a better position. And knowing kind of what treatments are working gives us a slight advantage.
How have hospitals adjusted for this?
My colleagues and I have stopped wearing normal clothes to work. We all wear scrubs so that we have less of a chance of bringing COVID-19 back to our homes. We come in shoes that we don’t wear anywhere else. Every day, our temperatures are screened. The elevators are limited, our dining areas have moved their configuration so that we can’t sit together. And those colleagues that are working on the COVID team are isolated for that week.
The COVID units are in a separate part of the hospital. Our hospitalist group has already planned for expansion into different wards. We have been working with other groups to redistribute patients to allow more room for COVID-19 patients. We have a dedicated COVID-confirmed clinic [for] patients with home oxygen monitoring or who need close follow-up. The only issue is that since the numbers have been rising so quickly, over 2,000 patients are being followed in that clinic. There is no more funding for this clinic starting in July, so attending physicians and students are volunteering their time next month to keep the clinic running [as they look for] alternative funding.
What kinds of patients are you seeing now?
I think we initially were seeing a lot of travelers from different places, people on cruises. Then we transitioned to people in skilled nursing facilities. There were a few outbreaks in local facilities there. But now it’s seeming like we’re seeing a lot of people just in the community. Initially, when we saw the travelers, the median age was in the 50s. The skilled nursing facility residents were probably in a median age of 70s. And now that we’re at a community transmission point, we’re seeing people ranging from their 20s to their 80s and 90s.
Have the new wave of patients generally presented different symptoms or needed different treatment?
Symptom-wise, it looks very similar. Patients are coming in complaining of shortness of breath, cough, and fever.
Over the course of the last few months, we’re learning more and more about COVID. Initially, we were using hydroxychloroquine on basically all of our COVID patients. Now data has shown that that can actually be harmful. So we’ve stopped using that, and we’ve transitioned toward using dexamethasone, because early studies have shown that that may be useful in COVID-19 patients. Things are constantly changing. And we are improving our outcomes as we learn more, which is exciting. But it’s also scary for patients, knowing we don’t really have treatment that is proven to be effective in all different kinds of patients.
What is morale like among doctors there?
I think because we prepared early, we had time to mentally and physically be ready for this surge. We are not experiencing shock at the same level that our colleagues in New York and other hard-hit places did. But once you start putting these plans into action, it is a bit trying. Everyone’s been pushed to their limits, and we’re trying to take care of the patients while not overextending our staff so that they burn out, especially knowing that there likely will be much further to go. Personally, I felt ready for this two months ago. So to be able to utilize my skill set and my time to care for the patients now is fulfilling. But it’s also scary knowing what is to come. We don’t know how many more ventilators we will need, or how many more ICU beds or how many more deaths there will be.
Have you felt supported by the community?
In the initial pandemic, because everything was so fresh, we got a lot of donations and sidewalk shrines and signs everywhere. The support is still there: Whenever someone sees that I am a physician, they thank me and are very gracious. But it’s not as visible as it was initially, because some of the excitement has worn down.
With the state opening up, people tend to think that COVID is less of a problem, but in actuality, it’s the opposite. People have more of a responsibility to wear their masks and distance. People see the beaches are open and the restaurants are open, the bars are open. They think, “I don’t have to be as careful.” But we’re still in the middle of this. This is a marathon, not a sprint. We’re just getting into the part where it gets difficult, and it’s important to really sustain that. To keep wearing masks, social distancing, and hand-washing—that’s what’s going to get us through to the finish.