Florida COVID Emergency or Is the COVID Hospital Bed “Crisis” Self-created?

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What’s up with the media’s reports of Florigeddon? How does that intersect with Texageddon? When I blogged on the Texas hospital bed crisis I noted an interesting discrepancy between the number of hospital beds listed on COVID models and the number that the Texas DSHS website had listed. Now after hearing quotes from a Texas hospital administrator, it’s clear to me that the hospital bed crisis in these states is a self-created mess. Meaning the shortage of beds is mostly fictional and created by hospitals trying to stay financially afloat. So let’s dig into Florida today and revisit Texas to illustrate the issues.

The Fool’s Errand of Following Positive Cases

The media loves to report daily positive cases because that scaremongering sells eyeballs to advertisers. However, that’s medically foolish. Why? Because when you run more tests, which many states are doing now every week, you find more positive cases. Hence, the only metric we should be following is the positive testing percentage. Meaning, when you run 100 tests, how many people are positive or what percentage is positive? That actually measures the amount of COVID in a community.

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Florigeddon?

Florida has been in the news lately with all sorts of headlines reporting hospital bed shortages and imminent disaster. Hence, I checked the University of Washington IHME COVID-19 model for Florida hospital beds (1). Despite the panic in the media, this is what is listed for June 30th:

Meaning Florida has more than enough hospital and ICU beds right now and through the summer.

Florida’s Test Data Is a Mess

The other thing we keep hearing in the media is that Florida’s cases are “surging”. Hence I went to the Florida Department of Health website. This is the percent positives for Florida COVID-19 tests for the second half of June (2) [data accurate as of 6/29]:

First, this data is all over the map. The range here is from a low of 7.7% to a high of 15.7%! That’s while running between 22,000 and 66,000 tests a day! Think about that, there are days when about 20K test results are reported and then days with 3X that number. That’s pretty strange.

What all of this tells me is that Florida has a test reporting consistency problem. Some days some testing sites are dumping massive amounts of data for the week and other days fewer sites report. What this also means is that claims about Florida’s positive test rate going dramatically up this past week are way too early. For example, if you looked at June 21st, the positive test rate was only 7.7%, which is below most states. Then two days later it’s double that at 15.7%! Then the next day on June 24th it’s down again at 8.9%. Hence, we likely need at least another week’s worth of data to see what the Florida trend is or isn’t.

Florida Conclusions

Looking at the IMHE data on hospital beds and the percentage of new cases, there doesn’t appear to be an issue with the number of available hospital beds in Florida. In fact, looking at the model, Florida wouldn’t run out of ICU beds until late September, but any model followed out that far is VERY inaccurate. There is also no clear trend up yet in the percentage of positive versus negative COVID-19 tests. [See 7/1/20 update below at bottom of page]

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The Texas Hospital Bed Conundrum

When I blogged on the reported Texas COVID hospital bed shortage I noticed a discrepancy between national and state-reported available beds. This morning I was traveling into work listening to NPR and I heard this back and forth between a Methodist Houston hospital rep and a reporter that explains that disconnect (3):

“So if you look within the hospital what it looks and feels like here right now is that every day I am clearing out another unit and I am putting in COVID patients…” The NPR correspondent then discusses that she hears the Methodist rep saying that they do have enough beds. Then the Methodist rep responds with, “So when we were at the point where the volumes of COVID were down we were able to open up many of our other services and what we found when we opened up a lot of our services was that many people had waited for a very long time to seek medical care and were very sick. So we were able to treat many patients both in clinics and in the hospital and in all of our services.

So let’s unpack what’s being said here because it confirms my suspicions about the dramatic difference between available Texas hospital beds listed on the IHME model and those listed on the Texas Department of State Health Services website. Remember that these were way off, with IHME listing more than 4X the number of beds. Why the huge discrepancy? I posited that the IHME listed the total hospital bed capacity while the Texas website listed only beds that hospitals had declared eligible for COVID.

If you read between the lines of the Methodist rep above, she just confirmed my suspicions. They have many open beds (Methodist hospital alone has 907 beds making it one of the largest US hospitals), but they are loath to use them for COVID. Why?

There are really two things going on here:

  1. There is a legitimate public health concern when you use hospital beds for COVID patients that could go to other sick people. She brings this up.
  2. There is a substantial net loss of revenue when you take insured patients in a private hospital and fill those beds instead with COVID patients.

Hence, there is a huge incentive for these hospitals to only list a percentage of their actual available beds as eligible for COVID-19. Hence, this “bed shortage” is really fictional. The beds are there, the hospitals just don’t want to use them for COVID patients.

What Is our COVID Endgame?

Again, as I relayed in a prior blog, the only rationale for reversing the “opening up” procedures in a state is if the hospital capacity is legitimately threatened. Meaning nobody wins if our hospital capacity is overwhelmed. However, it makes no sense nor is it financially sustainable to stay shut down until a vaccine is found. That’s societal suicide. Hence, the media needs to focus on the hospital bed situation, making sure that they are actually reporting on real and not fictional hospital shortages. The NPR reporter did a reasonable job of finding some of that out, but never dove deeper to ask why.

The upshot? Texas and Florida don’t have a hospital bed problem. They may have a “hospital willingness to use all of the beds for COVID” problem. On the one hand, that’s understandable, but serious reporting would delve into that issue rather than just stoking panic about overloaded hospitals.

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7/2/20 Update:

As I said above, the Florida COVID-19 test data needed more time to percolate before there was a clear trend. Here is the latest data on Florida first time positive cases accessed today at 12:41 p.m. MST:

Hence, there is an increase in positive cases over the past two weeks.

7/3/20 Update:

This is the updated Florida testing data. Again, a clear positive trend:

7/4/20 Update:

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References:

(1) The University of Washington-Institute for Health Metrics and Evaluation. COVID-19 Projections. https://covid19.healthdata.org/united-states-of-america/florida Accessed 6/30/20.

(2) Florida Department of Health. COVID-19: summary for Florida-Data through Jun 29, 2020 verified as of Jun 30, 2020 at 09:25 AM. http://ww11.doh.state.fl.us/comm/_partners/action/report_archive/county/county_reports_latest.pdf Accessed 6/30/20.

(3) National Public Radio. Houston Methodist Hospital Sees No Leveling In Coronavirus Cases. https://www.npr.org/2020/06/30/885157514/houston-methodist-hospital-sees-no-leveling-in-coronavirus-cases Accessed 6/30/20.

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