Top EMS doc: Pinellas hospitals preparing for a surge in COVID-19 patients

Pinellas County hospitals are preparing to revisit their plans for a surge in COVID-19 patients as case counts continue to rise.

Dr. Angus Jameson, Pinellas County EMS medical director

“Every hospital in our community has extensive surge plans,” Dr. Angus Jameson, medical director of Pinellas County Emergency Medical Services, told the St. Pete Catalyst in a Zoom interview Monday morning. “We’ve spent the last few months developing, refining, getting ready for those and then as we did such a good job flatting the curve we said maybe we’re not going to need those. But I can tell you those plans are being pulled back out this week and I really hope that our community can come together and take some of these steps, like we were before so that we don’t get to that point.”

As of Monday morning, there were 3,854 total cases of the virus reported in Pinellas County since the state started releasing case counts by county. That’s an increase of 187 cases from Sunday. For the past week, the number of cases has increased an average of 209.3 per day. The rate of people who take a COVID-19 test and test positive was 7.2 percent for Sunday, a slight decline from the past few days, when the percentage of positive rates were in the double-digits.

In Pinellas, a total of 117 people have died as a result of COVID-19 and the number of people hospitalized with COVID-19 is on the rise, Jameson said. “I watch Pinellas County numbers most closely, but I also look at the Tampa Bay area in general. I can tell you in the last couple of days here we have seen the highest number of people hospitalized for COVID in Pinellas County ever, and we also have more people in the ICU than ever before right here in Pinellas County.”

St. Pete Catalyst: Do we have adequate hospital beds and capacity right now?

Jameson: “I think this very moment, today, we are doing OK. There is beginning to be some strain on the hospitals and I think the big concern is that if this pattern continues in a week or two from now we’ll be talking about how the hospitals are really struggling, and maybe we’ll have to start looking at surge and disaster plans.

“I did some of my training in NYC and I have friends and colleagues there. I’ve heard what they’ve gone through over the last couple of months. If there’s anything we can do to prevent us from getting in that situation here, it would be a good idea for us to do it.”

St. Pete Catalyst: Are hospitals at this point being forced to turn away COVID patients?

Jameson: “Taking care of a COVID patient is not easy. It takes a lot of resources. It takes a lot of work. When I get suited up to go in and take care of a COVID patient in their room, that takes a lot more work than it takes to see a regular patient in the emergency room. And there’s a lot of risk involved with it of course.

“COVID patients, or any patient who requires that kind of isolation, is extremely resource intensive. That’s the whole point about flattening the curve, is to protect our hospitals from being overwhelmed because of all that resource utilization. If our hospitals get to the point where they are overwhelmed and can’t continue to do proper PPE or have the resources, the time, the staff to care for heart attack or stroke patients, or others, that’s when we really start to see the impact of the virus grow exponentially in the community. Because it’s not just that you got sick from COVID, it’s that maybe it took you longer to get treatment for your stroke, because of what was going on in the hospitals.

“So I think our hospitals have done a fantastic job so far, but I am concerned that we are getting close to a point if we continue where we will start to see them get stressed.

“We at EMS work extremely closely with the hospitals and make sure that we try to match patients to resource availability as much as possible. We do actively work with the hospitals where they are getting to a point where it’s a struggle for them, then we try to steer folks to a hospital where there are more resources available at that time. That is happening.”

St. Pete Catalyst: Please tell me about your about your personal observations of the virus impact?

Jameson: “This is not the flu. This is a new disease and there’s just so much we still don’t know about it.

“What I do know so far though is this is an infection you do not want to get. The mortality rates are in flux but they are much higher than flu.

“I’ve personally cared for patients with this disease and doctors I have worked with have had it, and I can tell you even in the cases that don’t get hospitalized, it’s not fun. They are very uncomfortable and have a long period of not feeling well.

“There’s a very wide spectrum with this virus. Some folks can be asymptomatic and not even know they have it. Other folks can be critically ill in the ICU. But even the folks who stay home and just have the flu-like version of it, it’s not a fun flu.

“So knowing folks that have had it and taking care of patients with it, I can tell you it’s not a virus to take lightly.”

St. Pete Catalyst: We’ve heard about an increase of cases in younger people. Do symptoms differ by age?

Jameson: “It does seem younger folks who are generally healthy with less medical problems have less of a problem with the virus, but not entirely. There are certain folks that for reasons that we are beginning to understand, and some we still don’t understand, have worse problems than others.

“You may have seen just the other day there was the case of a 17-year-old who died from this.

“The thing about this virus is it really doesn’t care how old you are or who you are or anything like that. It is a new virus and we’re still learning how it works … we’re seeing lots of relatively mild disease but we’re also seeing lots of more severe disease.

“I wouldn’t say that just because you are a young person you can count on being OK.”

St. Pete Catalyst: Why are we seeing this increase in younger people?

Jameson: “The significant rise in cases, particularly in younger people, although all cases are rising, likely has to do with how people are living their lives.

“There are lots of folks like my parents who are still very concerned about this and taking every precaution they were taking two months ago — staying away from folks, limiting any kind of interactions outside of their own small group in the house, certainly not going out and going to concerts or bars or restaurants or going to big groups.

“I think it’s not surprising seeing how our community has come back together over the last few weeks that we’re beginning to see a big increase in cases.”

St. Pete Catalyst: When a person tests positive, what should they do? And, do you believe everyone is following that advice?

Jameson: “The first thing of course if you have a positive test is that I hope you have a healthcare provider who can walk you through what you need to do and make sure that you are being looked after while you are going through having that infection.

“The most important thing we can all do, though, is almost act as if we’re all infected at any given time. We should all be trying to do whatever social distancing we can. We should all be wearing a mask when we can. This is a disease spread primarily through the respiratory route, and so that means it travels through the air, between you and somebody else. If you can stay apart from somebody else, that helps. If you can wear a mask, that helps.

“All of us should be doing that all the time, even if we don’t have a positive test, because we do know there’s so much asymptomatic transmission of this virus.

“For the individual who is actually diagnosed with this, it’s very important that you monitor yourself closely. If you’re feeling short of breath, if you are feeling worse, you do need to go to the hospital and get evaluated. It’s very important not to let that just linger for a few days as you get worse and worse. You definitely want to make sure that you are taking care of yourself, staying hydrated.

“It’s also very important with this virus not to just sit on the couch for two weeks. When that happens, not only do your lungs not work as well — and you need to keep those lungs working to prevent worse infection — but we also know that this virus in many people is causing the blood to easily clot. So people are having blood clots in their legs or even their lungs or other places from this virus and that’s causing a lot of problems for people.

“It’s very important not to just lay down on the couch for the two weeks or so that you can expect to be sick. It’s important to make sure you are moving around, exercising your lungs, keeping things moving to give yourself the best chance of avoiding some of the more severe consequences.”

St. Pete Catalyst: That sounds like it would be hard to do because as you initially said, you may feel very uncomfortable.

Jameson: “Absolutely. And if you get to the point where you are having a lot of shortness of breath or unable to do that kind of stuff, I would say you definitely need to see your healthcare provider or go to the hospital at that point.”

St. Pete Catalyst: What should be next steps for the state or the county?

Jameson: “I was happy to see the state reissue guidance over the weekend, in terms of the actions we all should take and where we are in this. I think some people forgot or felt like this was over. I know it’s tiresome and we’ve been doing this for a long time, but I think some folks have let their guard down over the last few weeks.

“This virus attacks our very human nature. This virus takes advantage of our social nature as people. We want to be together, we want to be with each other, and be supportive of each other and have fun, shared experiences. That’s the exact human trait that this virus plays upon.

“So it’s difficult to maintain all those things people talk about — whether it’s staying apart, staying home, not going to places where there’s big crowds.

“Nothing has really changed in the way we can control this virus. It’s the same thing that we’ve been talking about for months. But I think the real change is that it’s hard to keep that up for so long and people have gotten to a point where it’s difficult to continue that.

“We did such a good job, we flattened the curve so well, that people lost the urgency for that. I can tell you the curve is not flat anymore. The curve is the opposite of flat right now. And I’m worried in the next couple of weeks, if we continue on this pathway, that we will see our healthcare system begin to be very stressed and we will see more and more people get sick.

“Another important thing to remember is even though you might be young and healthy and do OK with this, you are part of the community. You might live with somebody who has more risk factors. You might work in a place where there are people with more risk factors.

“Wearing a mask out in the community isn’t so much about protecting you. It’s about protecting other people. There’s a level of responsibility and a level of coming together as a community where we can all do that and all make a difference, and not thinking about it as I’m doing something for me, but think about it as I’m doing something for others.”

St. Pete Catalyst: Would you like to see Pinellas County adopt a mandatory mask requirement?

Jameson: “I would like to see as many people as possible wearing masks, and however that comes to be is fine with me.

“This is primarily a respiratory virus. The primary way of protecting yourself and others is not to be up close with other folks, not to be breathing out virus and then somebody else breathes in the virus. Distancing, No. 1; masks No. 2; and hand hygiene No. 3.

“An analogy I like is driving your car. Your car has three things that make it safe. One is you as the driver, the second is your seat belt, and the third is your air bag.

“You have to drive defensively first to be safe. Just because you have a seat belt or an air bag doesn’t mean you can just drive like crazy. So first things first: be defensive, stay away from crowds, know what your risks are. If you are a high risk person, take precautions as you go about your life.

“And then, No. 2 wear your seat belt, or wear your mask. There’s always the possibility that somebody is going to going to sideswipe you so wear your seat belt. So wear your mask as well.

“And then, also have your air bag. Wash your hands, do good hygiene stuff.

“No one of those things on its own is going to solve the problem, but all of those together give us the best chance.”