Boca Raton Regional Hospital is “the busiest we’ve ever been” with COVID-19 patients.
That’s according to Chief Medical Officer Sam Fahmy. We spoke Tuesday as the virus surge continued in South Florida and statewide.
An internist by training, Fahmy took over in February, during the early stages of the pandemic. His job is to “assure the highest level of quality of care.” He supervises 650 members of the medical staff and 200 physician assistants and nurse practitioners.
As associate clinical dean for academic affairs at Florida Atlantic University, he also supervises 125 residents from FAU’s medical school. About 85 percent of his work these days related to the pandemic, not just treating those with the virus but reassuring non-virus patients that the hospital is safe.
Boca Regional admitted its first COVID-19 patient on March 11. At the time, when Boca Regional had stopped elective surgery to maximize space, Fahmy said the hospital was “between four and five” on a scale of one to 10 for readiness to treat COVID-19 patients. “Few hospitals,” he said, “were prepared.”
These days, Fahmy told me, “We’re close to an eight or a nine.” The hospital has adequate personal protection equipment for the staff. Doctors and nurses know about therapies such as remdesivir and dexamethasone. They know that, contrary to practices at the start of the pandemic, delaying intubation with a ventilator can save lives.
Still, shortages persist. Fahmy said Boca Regional was nearly out of remdesivir until a shipment arrived Monday. The hospital expects another next week. It’s also taking much longer to get convalescent plasma, donated by those who have been infected. It has helped some patients, though studies continue.
Test kits are another issue. Supply varies “from day to day and week to week.” Though the hospital can get some results back quickly, many people must wait for seven or eight days. At one point, that delay forced Boca Regional to “needlessly isolate” patients who showed COVID-19 systems but didn’t have the virus. All COVID-19 patients are in a separate unit.
Slow results also make it harder to contain the spread. County Health Director Alina Alonso told the county commission last week that those delays make any contact tracing program “useless.” Fahmy agrees.
So despite that progress within the hospital, Fahmy is “disheartened” and “discouraged” by what’s happening outside and sending him more patients. The surge has made Florida the world’s – not just the nation’s – COVID-19 epicenter. “The last two weeks,” Fahmy said, “have been the most challenging” for the hospital.
Gov. DeSantis has claimed that the soaring case numbers – two weeks ago, Florida set a national one-day record – don’t represent a serious public health threat because most new infections are among younger people. They are less likely to require hospitalization.
Fahmy, however, dismissed the notion that “disease prevalence” among younger South Floridians doesn’t threaten older people who still make up the great majority of Boca Regional’s COVID-19 patients. “Young people are more likely to spread it faster.” Infection rates also are rising at senior centers and nursing homes.
Like so many physicians and public health experts, Fahmy is frustrated because the science shows that widespread wearing of masks and avoidance of large gatherings could stop the surge. “We have solutions that we have seen work.”
Yet not until late June did Palm Beach County require people to wear masks in public places. Not until this week did Publix require masks in all stores. “We are trying to get results like New York City,” Fahmy complained, without doing what New York City did.
What about reopening public school classrooms? Fahmy paused. “I would like to see a dramatic, steady decline in new cases” before that happens.
With this first wave not over, Fahmy says the question of whether we see a new surge in the fall – accompanying the start of flu season – “depends on the intervention.” He calls Miami’s new 8 p.m. curfew “a step in the right direction. We need strong measures.” Without that, “It will be difficult to climb out” of the current hole. And Boca Regional will stay busy.
Boca City Council mulls restrictions
The Boca Raton City Council meets Monday and Tuesday for the first time in July. The council won’t meet again until the end of August.
Given the COVID-19 surge, should the city impose stricter restrictions or tougher enforcement measures?
Stand-alone bars remain closed. Under the governor’s Phase 1 reopening, restaurants must limit indoor dining to 50 percent of capacity. Many restaurants have focused on seating more people outside, with social distancing.
This month, to crackdown on after-hours gatherings, the county banned restaurants from serving dine-in customers after 11 p.m. Some, though, continue to push the limits. A city spokeswoman said Boca Raton code enforcement officers issued a written warning to the downtown sports bar Hijinks for “bartenders not wearing masks and not social distancing inside at the bar.”
I asked council members if Boca Raton needs to do more. Mayor Scott Singer issued the most non-committal reply:
“As we have since March, we continue to monitor and evaluate the situation to determine appropriate next steps. We continue to communicate and coordinate with our neighboring cities and counties in the region, as well as stressing the importance of following public health guidelines.”
Council member Andrea O’Rourke said, “I believe if people did and would follow the mandates already put in place we would be better off. Same old stuff! But everyone has to do it!”
But should the council act? “If we don’t see improvement it might be necessary. However, it is difficult to realistically enforce.” Doing so would create “a tremendous burden” on the code enforcement and police departments, which O’Rourke said are short-staffed.
Andy Thomson said there would “probably be some discussion during Monday’s workshop meeting. “It’s something we need to look at.”
If there were new restrictions, Thomson would prefer that they be “regional,” as when all South Florida counties closed beaches over the Fourth of July weekend. Similarly, any enforcement changes should be “a partnership.”
Monica Mayotte is the most concerned. Though she would not close the city’s beach parks, she sees a potential problem in lack of business compliance.
“I believe the situation here in Florida, and especially Palm Beach County, is dire,” Mayotte said. “What needs to be determined is whether businesses are adhering” to rules restricting capacity.
“I recently returned from Colorado, where retailers we strictly enforcing their reduced capacity requirements. There were employees standing at the entrances with counting devices and lines were forming to allow people into the store as customers left. I even had to wait in line to get into a grocery store. Is this happening here?”
Mayotte favors “stricter enforcement” and “real monetary penalties for not following the rules. Individual businesses need to be empowered to enforce the rules. If they don’t, there is the possibility that everything will be shut down again. No one wants to have to do that.
“My sympathies go out to all the businesses that have been affected by the pandemic. But if the rules aren’t followed, it hurts all of us.”
From bad to worse
I spoke too soon last week.
I wrote that Covid Act Now had rated Palm Beach County’s risk for an outbreak “only” as High, which was better than Broward’s rating of Critical.
Since then, however, Covid Act Now has raised this county to Critical, which means “active or imminent outbreak.” Covid Act Now, a collaboration that includes the medical schools at Stanford and Georgetown, compiles the rankings based on five factors: the per capita rate of new cases, the infection rate, the rate of positive tests, intensive care space and contact tracing capability.
Florida is one of 11 states rated Critical.
Vaccine trial in Palm Beach County
Palm Beach County will be the site of a COVID-19 vaccine trial.
The Phase 3 trial – one step before Food and Drug Administration approval – will take place at JEM Research Institute in Atlantis. Supervising will be Larry Bush, the epidemiologist who diagnosed the anthrax case in Boca Raton after the 9/11 attacks.
Here’s the link for those wanting to volunteer: https://www.jemri.net/patients/join-a-clinical-trial/
Gretsas emails update
I wrote Tuesday about my review of emails related to the June 24 suspension of Delray Beach City Manager George Gretsas. In that post, I reported that Gretsas had offered to join “team-building session” after complaints that he yelled at City Hall staffers, especially women.
I wrote that only City Commissioner Ryan Boylston had commented on the proposal. In fact, Commissioner Shirley Johnson also had responded. Johnson said she was not interested. Johnson then voted with Mayor Shelly Petrolia and Commissioner Julie Casale to suspend Gretsas with the intent of firing him.
Delray property tax to stay put
The city commission voted Tuesday night to cap Delray Beach’s property tax rate for next year at the current level – $6.66 per $1,000 of assessed value.
Collectively, though, the commission asked staff to try for a budget that would allow a lower rate. Adam Frankel proposed instituting the lower rollback rate, which would raise the same amount of revenue as this year. Tax bills would not change, even after values rose.
Gretsas is on his own
For now, the Delray Beach City Commission won’t indemnify Gretsas in his dispute with a Miami-Dade company that claims Gretsas slandered it during conversations with city staffers.
City Attorney Lynn Gelin noted that the company’s letter to Gretsas only threatens a lawsuit against the suspended manager. If the company actually sued, Gelin said, the commission could revisit the issue.