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.

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]

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.

_________________________________

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:

___________________________________________

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

  1. Kent Casey

    I live in Florida and am in your supraspinatus study and believe that you have lost all credibility on this subject. Yes, Florida’s data is a mess and the state government wants to keep it that way. Beyond that, if you look at the positivity rate on the Johns Hopkins site which shows data for all of Covid history you will find:
    The current 7 day average positivity for Florida is 16.1%
    On or near June 1 it was 4.2%
    On or near April 1 when only symptomatic folks were tested it peaked at 11.7%
    The current situation is dramatically worse than early June with a steep positive slope since the 2nd week of June.
    To look only at current case positivity and proclaim no issue since the average age of the positive folks is dramatically lower that it was in March and April totally ignores the second and 3rd order effects of those folks passing the virus along to family, older friends neighbors and those they cross paths with in public. Until the younger cohort and the older people who proclaim personal liberty over public health start to act like adults the rest of us will be forced to self quarantine to avoid those 2nd and 3rd order effects. This alone may not be enough to sink the economy but will significantly add to the wounds and still probably will overwhelm the hospital resources in a month or so. Unless there is a nearly immediate change of mindset in the southeast and southwest, there is no way I will travel to Colorado, even if allowed to, for a 6 month followup.

    1. Chris Centeno, MD Post author

      Kent, all other sites and models including JH would get their data from the state of Florida. This is today’s report from the state (the blog from this am was on the current data as of 6/29): http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf Looks like the state changes the positives every day for any given day, likely as they get more data. As of this afternoon, the past 7 days trailing positives are: 16.58, 16.80, 15.71, 13.95, 14.34, 14.70, and 10.22%. I’m between patients so I don’t have time to calculate an average, but it’s not 16%. Hence the JH data is likely old. The data is at the top of page 2.

  2. Jenna

    As always… We greatly appreciate the clarity and perspective. Thanks so much from Naples, Florida!!

  3. MARC

    Chris, what you are neglecting to report is that Florida has been purposely manipulating the data to under report cases. That is why Rebekah Jones, the women who was fired from the department of health created her own portal on Covid cases. She is reporting different data and reported that they were forcing her to under-report cases in order to open up the state more quickly. DeSantis is a tool of Trump and you talk abut politicizing the pandemic they are the the major offenders trying to downplay the virus and get him re-elected. I wouldn’t trust the Florida Dept of Health at all. Also, hospitalizations and mortality greatly lag positive tests and more younger individuals are testing positive and will be bringing the disease home to the more vulnerable. I think you are doing a great disservice to your audience by continually to seemingly downplay the seriousness of this disease when there is so much that is really not known about it at this time. Your estimate on the mortality rate may turn out to be correct, but you neglect the long term impact of the disease on those who have contracted it. I have friends and patients who have had it and have serious residuals that no one can say when or if they will resolve. I have a high regard for your expertise in regenerative medicine, but I believe you are playing with fire when you are venturing into this field. And yes many of the studies out there are flawed as researchers throw the proverbial shit against the all to see what sticks, but there are thousands of experts in epidemiology and viral science looking at this with microscopic vision to get a better hold of this. No one knows where this is going and least of all myself or you. Just wait until over 20,000 college students converge on our town and the partying begins. We may be seeing a similar scenario as to what is occurring in other states in the country. Remember the virus doesn’t care what you or I think it will do as it pleases and until there is a drug that greatly reduces mortality, severity and duration of this disease it will continue to spread. A vaccination is a long way off and the with the numbers of individuals who won’t even agree to receive it, the effectiveness will be suspect. You have enough on your plate with the areas of expertise you shine in why stir the pot when we really don’t know what is cooking.

    1. Chris Centeno, MD Post author

      Marc, I follow the data and analyze it myself, which with 50+ peer-reviewed scientific publications, I’m trained to do. I then draw conclusions about what the data tells me. You’re following what’s being reported by others.
      On a conspiracy theory that the number of positive tests in the state of Florida was suppressed for political purposes, without lots of proof and criminal indictments, I’ll pass on that one.
      On ‘experts”, there is no expert without an agenda. Hence, the need to look at the data and make your own decisions.
      As I have said, the only sane response is to shut down hot spots to keep health systems from being overloaded, not to keep the country on long-term lockdown until a vaccine is found. If that’s your plan, how is that supposed to work? Your thesis is that we don’t know enough, so the default should be to destroy people’s lives by shutting down? Meaning, the American Academy of Family Physicians estimates we’ll lose 150K lives because of the shutdown and that’s just to alcoholism, suicide, drug abuse, domestic violence, and other illnesses of despair. That doesn’t count the hundreds of thousands who will die of treatable diseases because they’re too freaked out to get a colonoscopy or a routine scan.

  4. Marc

    Chris:
    I never said anything about shutting down again. All I was remarking about was that while much is unknown about this disease it is not wise to downplay the severity of it. I totally agree with shutting down hotspots and allowing others to proceed. I also clearly recognize the devastation putting off necessary health care interventions has on the public and for that matter on medical practices across the country. I just feel by being the contrarian you are potentially encouraging a much more cavalier attitude by individuals who do not review the science and make sound decisions on how to behave in this environment. Those people do not need any more excuses than they already have. Time will tell how this plays out and in the meantime I will stay as safe as I possibly can and encourage others to do this as well.

    1. Chris Centeno, MD Post author

      Marc, I am reporting the data. On severity, the latest study out of Stanford pegs the infection fatality rate at 1 in 2,000. Why would reporting the actual data be bad? Just a 10% drop in the number of people seeking care for treatable but otherwise fatal diseases will kill far more per year than this disease ever will. The talking heads in the media are not generally discussing that balance, just their narrow focus on the virus.

  5. Marc

    I am not sure which study you are referring to, but are you referring to the study by Dr. Ioannadis? His data has been attacked as being fraught with bias, for instance including deaths in healthy blood donors, but not a recent Spanish seroprevalance study showing a much higher rate. A lot of the studies he looked at were contradicted by evidence from other areas of the world. Granted the actual death rate is way lower than original projections, but in any case this virus is clearly way more contagious and deadly than the flu. Upwards of 130,000 US dead in about 1/2 year when 30-60,000 die from the flu in a severe year. We may see over 200,000 before too long, but who knows? By the way my opinions are not just based on listening to the media. My daughter has been living with us for 6 months. She is an excellent source of info as she spends a vast majority of her day looking at the research on Covid. She has completed course work on a Masters of Science in the control of infectious disease from the London School of Hygiene and Tropical Medicine. She has studied with the people who have written texts on pandemics both from an epidemiological and science based viral perspective. She is currently working on a research paper looking into the effects of Covid-19 in the Hispanic community. She will be entering an ID residency and we discuss this information regularly. Again I don’t doubt your expertise. You are a great physician and I respect your opinions and have been reading your blog semi regularly when time permits. There is just too much unknown about this virus and until we have either a vaccine or a treatment as mentioned earlier I don’t see it letting up unless it miraculously disappears as our President thinks.

    1. Chris Centeno, MD Post author

      Marc, let me get this straight. The state of Florida is manipulating PCR test data. A Stanford professor who doesn’t agree with your point of view is biased and also manipulating data.
      Please study your history. The 1957 Asian flu pandemic, scaled to today’s US population would have killed 250K people.
      So let’s take the low-end IFR of 1 in 2,000 and the highest reported to date in NYC of 1 in 200 and split the difference. Let’s even weight it toward your side and say the IFR is 1 in 500. What would the average American say to that given that we just tanked the economy and spent more money in a few months than they did in all of World War II (today’s dollars)? This is why we should NEVER let academics control something like this issue. What they report is important information that needs to be weighed against all other factors. For example, the great recession saw a drop in GDP of 1%. The Atlanta Fed predicts that second-quarter GDP will come in at an astounding and terrifying -35%. Given that the great depression saw a GDP drop of -15%, that’s far scarier than COVID.

  6. Frank Romeo

    What a reasoned , logical approach. Hooray for you Dr. Centeno. MSM is our problem and under serving other diseases is a tragedy. Death by other disease is tragic if a hospital bed is reserved for Covid 19 only. Shout this from the roof tops.

  7. Marc

    Come on Chris you are attacking the messenger not the message. Everyone has a point of view including you. It is not my point of view to criticize Dr. Ioannadis. He has been criticized by his peers. The Florida data has also been criticized by many people. We can all choose to believe whatever we want. I said back in early March that the economic impact was going to be way worse than the infection, but you know what, the virus doesn’t care. My whole point in initiating my response to your blog was that I thought you were downplaying the seriousness of this disease which would give many people the opportunity to engage in behaviors that spread it. Neither you nor I know how this is going to play out in the long run and I hope you are more right than I am, but again time will tell. In the meantime we are both spending too much time on this and I have charts to do and patients to see. I will keep reading and listening and I know you will as well and time will tell the rest of the story. Stay safe and healthy.

    1. Chris Centeno, MD Post author

      Stay safe Marc!

  8. Peter Salvatori

    I question your linear regression line through the data and the 20% increase conclusion. When I look at your graph I see a lot more area below the line than I do above the line. I input the data into Excel and fit a linear regression line with different results. The straight line passes through ~10.1% on 6/18 and ~14.6% on 7/1. That is a greater than 40% increase. Looking back an additional week or two, I think a case can be made that the percent positive has more than doubled in June. (Based on clicking on the “Florida Testing” tab and looking at the weekly “Percent Positive for Laboratory Testing” graph.)

    1. Chris Centeno, MD Post author

      Peter, I just made a chart in excel (I’ll post it above) that includes yesterday’s data and added a trend line. That trend line shows about a 30% increase since 6/19 to 7/2. So the positives are definitely going up and Florida updates it’s positives every day. However, as I have said before, the focus is on protecting the healthcare system from being overloaded and not staying shutdown until a vaccine is developed.

    2. Chris Centeno, MD Post author

      I also just did a Google search of your name, which I periodically do on commenters. I can’t confirm that your name matches that email address. So if you’re using a pseudonym, that’s not permitted on this site. I’ll let it slide for now.

  9. Russ

    I would like to state up front that I am not afraid to point out conspiracies if I suspect one exists. I think this whole Covid-19 crisis has an odor of dis-ingenuousness. I would be curious to know if there were tests in previous outbreaks going back as far as is reasonable, what would the positive test case numbers be compared to the actual deaths that arose from those cases. Have we ever engaged in such massive testing. I suspect some day if the truth is ever exposed we will see with the benefit of 20/20 hindsight that the practice of testing as currently employed with Covid-19 has serious flaws. It seems this whole issue of testing has a lot of potential problems if we are to derive wisdom from giving them, analyzing them, reporting them, and then creating policy based on them. Wow! That’s a lot of ifs. I haven’t even got to the conspiracy yet. I hope that will be revealed in time.

  10. Peter Salvatori

    Thanks for responding to my comment regarding the Florida percent positivity data. I can assure you I am not using a pseudonym. Funny thing is we actually met by chance in the Marriot Cayman Islands in 2017 when I was there for my first Regenexx procedure. I get your point about protecting the healthcare system and not shutting down until a vaccine is developed (and mostly agree).

    1. Chris Centeno, MD Post author

      Great, thanks for the ID!

  11. Daniel Green

    Look at the Johns Hopkins graph at https://coronavirus.jhu.edu/testing/individual-states/florida and you will see that the 7-day moving average (blue line) clearly shows that the positivity rate is in a definitive uptrend. The moving average smooths out the daily fluctuations so you can identify trends. The situation in Florida getting worse by the day and will soon spiral out of control if people there don’t change their behavior.

    1. Chris Centeno, MD Post author

      Dan, regrettably, it looks like JH is tracking all positive tests and not new cases. The actual data through 7/3 is here: http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/state_reports_latest.pdf page 2. The graph is “Percent positivity for new cases”. That excludes people who have previously tested positive. I’ll add the graph above to the bottom of the post, as that includes data through 7/3.

  12. Joe LaValle

    What a difference 3 days makes. Florida now reports only 1,246 ICU beds available, as of early a.m. on 7/5/20 – which leaves a spare ICU bed capacity of only 20.5%. So in 3 days, Floridians swallowed up 450 ICU beds? The data on available ICU beds is from Florida’s Agency for Health Care Administration, 1,246 beds available out of 4,831 total adult ICU beds. At this rate, they’ll be out of adult ICU beds before the middle of July. Yes, Florida hospitals can add “surge” ICU beds – but where will they find the staff to support these beds, with ICU docs and nurses already working 12 hour shifts? Arizona is even in worse shape relative to available ICU beds….

    1. Chris Centeno, MD Post author

      Joe, Florida is playing the same game as Texas. The beds available are what the hospitals report. They are allocating a certain percentage of beds for COVID. Hence, you’re not seeing the total beds available. For that, see https://covid19.healthdata.org/united-states-of-america/florida . Florida doesn’t run out of all ICU beds until the end of Sept using the existing model. They may run out of the beds they want to use for COVID much sooner. However, it’s very rational to shutdown again if there is a health system overload. So if the powers that be in Florida believe they’re getting there, then that would be a good reason to reverse course.

  13. Joe LaValle

    What a difference a week makes — Floridians have consumed 43% of the available ICU beds noted in your 6/30 blog and now have under 10% of statewide ICU beds available, with nearly 50 hospitals and several Florida counties completely full. At this rate Florida will be completely out of ICU beds by the 3rd week in July. Of course, they can and will add surge capacity – but the issue will be finding the additional medical personnel to staff the extra beds, with many critical car docs and nurses already pulling 12 hour shifts.

    1. Chris Centeno, MD Post author

      Please see https://covid19.healthdata.org/united-states-of-america/florida. Scroll down to hospital resource use and then move your cursor over to July 8. The numbers you have quoted aren’t accurate. Floridians may have used 43% of what hospitals are willing to allocate to COVID, but there are still plenty of ICU beds. The current model still predicts that Floridians won’t run out of ICU beds until September. Again, swamping hospital resources is a valid reason to shut down again. Having said that, if Florida won’t run out of beds until September, then there are no issues.

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