Key West The Newspaper

Monroe County Emergency Management Director Shannon Weiner held a COVID-19 countywide coordinating meeting this morning. There was much concern regarding hospital capacity. The number of cases of COVID-19 has risen from 109 to 380 since the reopening on June 1st, just a little over a month ago. There are currently 7 COVID-19 patients in Florida Keys hospitals; of those 3 are currently in ICU. COVID-19 patients are being transferred to hospitals outside the Keys however hospitals in Miami are already stressed with COVID patients and have taken measures such as halting elective procedures to maintain capacity. Florida Keys Baptist hospitals representatives said that ventilators are currently a problem for some of their sister facilities in Miami. In the event of a surge Monroe County hospitals expressed having an issue with staffing. Lower Keys Medical Center reported that at this time with their current staffing they only have the ability to receive 11 more patients at the hospital on College Road. (See more details below in the partial transcription or watch the video above.)

Roman Gastesi, Monroe County Administrator: “This is – obviously it’s clear from the rising number of cases that we are headed in the wrong direction. This is very unsettling times. We are getting many calls, texts, emails inquiring about reestablishing the checkpoints. In my estimation we are far from putting up the checkpoints again. From the beginning of this and still today we use the hospitalizations and medical capabilities throughout the Keys as our central parameter in our decision-making matrix. Therefore, Shannon, in this call I’d like to hear from the hospital representatives what the Keys’ medical capacity is. Hence, the number of beds, the number of ICU units, and the ventilators and I think more importantly we continue to hear about personnel. Do they have the personnel to handle a COVID surge? So, if you don’t mind, maybe we could do that. When the representatives get up they could give us those matrix – as far as what the numbers are and lastly I’d like to say, folks, this is difficult stuff. This is really difficult stuff. This is not rocket science. This is more difficult than rocket science. We’re in very unsettling, very interesting times.”

Heather Carruthers, Mayor of Monroe County: ” I think Roman’s laid it out pretty well. I do think – and I’m sure Bob Eadie will fill us in on this – I think that we’re probably seeing now the results of a couple of weeks without mandating masks and without sort of the significant vigilance that we’ve been trying to put in place. And what we did last week – the effects of that will really show up in another two or three weeks. But still, you know, it’s out there now and the more it’s spread the more it spreads. So that’s a big concern. I would also like to ask – because I know on yesterday’s report it looked like – in terms hospitalizations we have three in the Lower Keys and three elsewhere but this morning I think I saw a report that said we had actually four at Lower Keys – one of them at ICU. So, I want to make sure along with Roman that we are getting accurate counts on our hospitalizations and utilizations and our capacity. We are going to have to have some tough conversations about what kinds of additional procedures we could perhaps put in place – certainly in terms of increased enforcement of regulations we have right now. Roman’s right – it’s harder than rocket science because we also dealing with human beings which are unpredictable and sometimes unmanageable.”

Bob Eadie, Administrator Monroe County Department of Health: “Most everything has been said. We are moving in the wrong direction with the number of cases. The cases are younger. We are seeing a lot of service workers now of the ones that are becoming positive and that’s impacting – will impact our restaurants. But, I mean, that’s where they are. We are going to close in on 400 positive cases but of those 400 positive cases at least half of them are no longer of concern in the sense that their fourteen days have passed so you can say they have recovered but still we are going up with cases. Our hospitalizations are up one – from what I understand this morning – the report is that we have one in ICU at Lower Keys and three others in non-ICU and three in the Fishermens/Mariners system… We’re having I guess – well let me put this out in case nobody’s heard this – we have begun setting up testing sites in Key West, Big Pine and Islamorada and those are being announced as to when we are going to have those. This is not for testing for the public: But I have a nurse now that I’ll be able to station in Roth building at Tavernier who can do testing and contact tracing but her testing is going to be for those that have – as our contact tracing reveals that their positive – that she can do that to follow up with rather than at a testing site. We are exploring having an additional testing site in Key Largo as well.”

John Johnson, Fire/Rescue Chief City of Marathon: “Do you have any numbers on the facilities off-island – have any numbers on their hospitals? How they are rating in beds and availability?”

Eadie: “I don’t have them at my fingertips right now. I don’t remember them but they’re not as good – I don’t have right here. Maybe somebody else does – it’s on that state report. They’re starting to fill up. But their numbers are horrendous too – as far as the new cases. And – you know – that effected us as much as anything else – is having those cases – asymptomatic people coming into the Keys.”

Carruthers: “Chief Johnson, you know, Jackson Memorial cancelled elective surgeries so they’re starting to have some kind of strain.”

Eadie: “I’ll find out that number for you, Chief, and get it for you after the call.”

Baptist/Fishermens/Mariners representative: “We have two ICU patients and one regular bed patient in-house at Mariners, zero at Fishermens. Speaking to the question about staffing: We’re green on staffing at this point. We’re continuing to monitor supplies and we’re green on emergency preparedness. The numbers that I have relevant to us – closest to us – Homestead Hospital 58 positives in-house, South Miami 61 positives in-house, Baptist Hospital Main 122 positives in-house. For us we have no capacity issue here. It is causing a challenge for high-acuity transfers out. At this point we have not stopped elective surgeries but the rest of the Baptist system has.”

Gastesi: “The specific number of beds available? I know that not all beds are COVID beds – just kind of a general sense of how many beds and if you could break it down to Fishermens and Mariners, please? Three questions: The number of beds, number of ICU units, the number of ventilators.”

Baptist/Fishermens/Mariners representative: “So we have 25 flex that would be considered either high-acuity or medium-acuity that’s available between the two facilities.”

Second Baptist rep: “No, at Mariners we have 25 beds that we can flex up for surge if we need to. At Fishermens we have 4 that we can flex up if we need to. We’re hoping not because staffing then becomes an issue and that’s where we are at this time.”

Gastesi: “Venilators?”

Baptist rep: “We have 3 here, 1 at Fishermens.”

Gastesi: “Three here? Which here?”

Baptist rep: “3 at Mariners.”

Baptist rep: “Ventilators are a problem for some of our sister facilities in Miami right now.”

Baptist rep: “Correct… Mr. Gastesi the only other thing I can add in terms of regional concerns is: I know Homestead is putting up an alternate collection point on their campus. We’re working with them on needed supplies and logistics. That means they’ll have a negative pressure holding area on their facility – close – meaning on their campus – they’re having issues with regular walk-up patients and also screening. That’s the only thing that’s relevant for our region.”

Baptist rep: “Homestead’s looking at if they can transfer some of their non-COVID [night surge?] patients to Mariners but a lot of the insurances – Mariners and Fishermens are not part of the plan – so we are looking to see what we can do to help decompress their ER of non-COVID patients.”

Carruthers: “Do we know if any Keys residents have been transferred out of County?”

Baptist: “Yes.”

Carruthers: “COVID patients have been transferred out of County?”

Baptist: “Yeah and some others have for other reasons. Those that required a higher care have been transferred to our bigger hospitals and some have gone out of our organization.”

Carruthers: “Do we have numbers for that?”

Baptist: “We can get it. Mayor I’ll get back to you. We can get if for you.”

Carruthers: “OK. Thank you.”

Gastesi: “When this first started I know the Convention Center in Miami Beach was converted or part of it was converted to a hospital and it wasn’t utilized initially. Do you know if that’s still up and do you know it it’s being utilized and still available – the status of that?”

Shannon Weiner, Monroe County Emergency Management Director: “The Convention Center hospital – my understanding is that it’s not currently being used – it is on standby at this time.”

Baptist: “They did offer another hospital for patients who are longterm care who have not been cleared yet to go back to their longterm care so that they’re taking a few patients over to Pan American so that helps decompress a little bit for the people that are not really acutely ill but still haven’t gotten negative results to go back to their longterm care facilities.”

Lower Keys Medical Center representative: “We do have 4 total COVID patients in-house. One still in ICU, three in our COVID unit. We have 5 ICU beds available and we do have 5 patients pending discharge to [?]acute facilities that will help decompress our surge beds but we are getting pretty close to full capacity of med surge beds until we decompress. We do have surge plans in place in case that is not able to happen. And other than that we are green on supplies and staffing for our current patient load.”

Gastesi: “Number of beds and number of ventilators? And I think I heard 5 ICU beds?”

LKMC: “5 ICU beds available, 11 beds available in total. Currently we only have 2 patients in-house on ventilators at this time.”

Gastesi: “How many ventilators do you have?”

LKMC: “We have 7 total ventilators, 5 available. We also have a surplus of supply of disposable ventilators that can be hooked to H-tanks if needed, for surge.

Gastesi: “I’m sorry if I’m not being clear but what I need is the number of beds in the hospital. I keep hearing 11. Is that the number available? Or is that the number of beds that you have at the hospital. I thought the number of beds was 120 beds or something like that?”

LKMC: “We do. We currently have 11 available beds in the hospital.”

Carruthers: “You mean ICU only – or total beds?”

LKMC: “Total beds right now are 11 available; 5 of those are ICU.”

Gastesi: “Well, If I’m understanding then I should be really concerned. The hospital has 120 beds – it that –?

LKMC: “The hospital has availability for 120 beds at this time but we have a number in-house..”

Gastesi: “So you have 109 spaces right now? In hospital beds?”

LKMC: “Right. No sir. I guess the question – the confusion there is the number of beds we have and the number of beds that are available to be staffed at this time is probably the confusion. 

Carruthers: “Ah — yeah. So you have 120 actual beds but you can only staff 11 of them?”

LKMC: “We also have the DePoo Campus that includes our bed count. Behavioral health – not acute care.”

Gastesi: “Alright let me ask the question a different way: If 12 patients need hospital care in Key West today you can only take 11 of them? Is that what I’m hearing?”

LKMC: “Based on our current staffing. As far as the actual bed count that is not correct. We could take a larger number with our actual bed count  but our current staffing will be able to handle 11 additional patients for our current staffing.”

Gastesi: “So for that 12th patient would you be able to bring in additional – you said something about surge – would you be able to bring in additional personnel to handle that 12th patient?”

LKMC: “We would have to make a call to all hands on deck and we would have to move our surge planning into our yellow at that time.”

Gastesi: “Assuming the surge planning continues and go  into yellow or red or whatever colors there are could you staff up to the full 120 – support the full 120 beds?”

LKMC: “Not without reaching out to the Medical Reserve Corp additional sources in our community for staffing.”

Gastesi: “Shannon [Weiner] …”

Weiner: “And the additional contracts that you have for staffing as well –“

LKMC: “As far as contracts for staff is that the question?”

Weiner: “Yes.”

LKMC: “It would take us additional time to get additional contracted staff in. That is not something that we would immediately have. But we do have contacts in place to get contract staff in. That is just something we’d have to request.”

Weiner: “And that is part of your surge plan as well, correct?”

LKMC: “It is, but just to let you know, that then the housing becomes the bigger issue there. We have to start searching for housing to house all the contract staff.”

Weiner: “Right and that’s something that we can help you with.”

LKMC: “OK. Great. We’ll stay in close contact then with you as we monitor the situation.”

Gastesi: “Yeah. I would say this is very important Shannon. Let’s stay on this.”

Weiner: “Yes. Sir. And again if you want to look at those hospital status numbers they are on Web EOC. We do update them daily according to the report we receive from AHCA which is the state regulatory agency. It is plainly the hospital status board. You can drop down and see number of occupied, number of available, ICU capacity and then number of occupied ICU and then the number of beds. We track those every day from the numbers we receive from the hospitals and verify it from the state.”

[…]

Eadie: “I think we got our wires crossed a little with regard to hospitals – especially with the Lower Keys. I just got off the phone with David Clay and Jimmy’s giving you figures – but for the COVID patients in the Lower Keys Medical Center they’re four. One in ICU. There are three in the COVID isolation room that is not ICU that’s available at the hospital. No COVID patient is on a ventilator. There are two patients at the Lower Keys Medical Center that are on ventilators but are for unrelated to COVID. The hospital is currently staffed for 80 rooms in the whole hospital. It is licensed for 120 rooms at Lower Keys Medical facility. It can go up to – I think – I just lost the number in my head – but there’s at least another 50 beds that are licensed at DePoo that could be activated but primarily DePoo is used for behavioral health right now. There are additional rooms there. The issue is the staffing. And David Clay just said that they are O.K. right now. They watch their patient numbers very very closely and they are ready to move, if they need to, with getting additional staff. But let me repeat there are right now no COVID patients on a ventilator. One in ICU, three in the COVID isolation ward and they have 11 ventilators total which are being used for non-COVID patients. So, I just wanted to – it’s not as dire as it’s sounding – because I was beginning to sweat myself right there – but we’re ok here and the pressure that we all know is that we have to watch Miami so closely. That’s what has effected us in so many different ways in the Upper Keys. You heard from the Director of Nursing – they’re managing in the Upper Keys too. So, we’re not in as dire a situation as we are but we are not moving in the right direction and all of us need to be very concerned and very diligent as to what’s going on, all the way around. That’s the only thing we have is the social distancing, the masks, etc. that’s been told and unfortunately we may be at the point at where we’re going to have to start living with the virus in some ways and minimizing the effects that we have [?]. If Miami continues to surge, Florida continues to surge, there’s not much this county can do to hold off that surge. I’m thinking we’re beginning to see community spread.”

Weiner: “We have received several inquiries to see if we are out of test kits. We are not receiving any reports from any entities in town currently that we have a shortage of test kits but we will stay on top of that.”