August was Florida's worst month for COVID, so far

Although T.S. Eliot’s poem proclaims “April is the cruelest month,” for Florida this year, that title belongs to August. It’s been Florida’s worst month for COVID-19 since the pandemic began.
 
August 2021 has seen twice as many Floridians being hospitalized or dying from the virus than at any time since the scourge began in early 2020.

A New York Times database reported an average of 247 deaths per day during the week ending August 29, a COVID-19 state record. The CDC further reports Florida had an average of 693 new cases per 100,000 residents for the week ending August 29, making the state’s rate second-highest in the nation after Mississippi.
 
To better understand these numbers, the Hillsborough County Medical Association (HCMA) held its 7th COVID-19 update on Monday evening, Aug. 30, with a panel of medical experts including:
  • Dr. Charles Lockwood, Senior VP for USF Health;
  • Dr. Doug Holt, Director of the Florida Department of Health in Hillsborough County;
  • Dr. Margarita Cabrera-Cancio, Affiliate Professor at the University of South Florida Morsani College of Medicine, Department of Internal Medicine;
  • Dr. John Sinnott, Chair, USF College of Medicine Internal Medicine.
The group was moderated by Dr. Joel Silverfield, President of the HCMA (Hillsborough County Medical Association).

Here are the some of the questions posed to these experts:

Why have hospitalizations rates in Florida spiked?

Allowing for Florida having an older population, Dr. Holt noted that hospitalizations have tracked new cases -- with 99% of new cases and 85% of deaths in Hillsborough County (including Tampa) among the unvaccinated.

Why the hesitancy about vaccinations? 

In Hillsborough, only 55% of residents are fully vaccinated. However, “there are specific populations that have been a challenge,” Dr. Lockwood noted, including young people under 40, African-Americans, Latinxs, and rural and working-class whites. Each of those demographic segments of the population lags in vaccination rates for a variety of reasons.
 
“There is a lot of genuine fear and anxiety,” he noted, saying that the message is in the numbers.
 
“The risk of significant side effects of the vaccination is in the range of 2 to 5 per million,” he emphasized in contrasting that to the risks posed by getting COVID. As an example, he noted, the risk of dying from COVID at age 40 is about .1%. For a 65-year-old, it is about 1%. That’s a 2,000 times greater risk for having the virus versus having the vaccine.
 
Dr. Lockwood pointed out that long-term COVID risks, including depression and brain fog, also are significant, especially for those over 60. As an Ob-Gyn specialist, he added that in pregnancy, COVID-19 dramatically increases the risk of prematurity, by up to 40%, and increases hospitalization rates as well.
 
Moderator and HCMA President Dr. Silverfield recalled a patient telling him that she thought of vaccinations like seatbelts: “They won’t prevent an accident but you are more likely to survive if you wear one.”

How reliable are home tests?
 
Dr. Holt indicated that COVID cases diagnosed with home tests are not routinely reported to the state database. Home tests are most useful, Holt advised, when someone is symptomatic or has an exposure, but are not as reliable as screening tests.

How much contact tracing is being done? 

Given the 1,600 new cases per day in Hillsborough County, widespread contact tracing, explained Dr. Holt, “must be targeted and focused on long-term care and nursing facilities given the resources that are available.”
 
Schools are devoting a great deal of time to contact tracing, he said, but by the time the process is complete, the identified student is often already past the quarantine period.

Are masks dangerous for kids? 

They are not, the panel agreed. While children, especially those under 12, are at a lower risk for getting the virus, those who get it can become virus spreaders. A major reason for masking kids is to protect parents and other adults, like grandparents, who may be at greater risk. The Delta variant now poses a greater risk to kids too.

Is it time for boosters?
 
Confusion about when and whether to get boosters reflects a lack of data and a lack of agreement at present among professionals, both with respect to what to get and how much time should pass between doses. (The CDC is recommending a booster for seniors after 8 months. Israel, which has been a global leader in distributing COVID vaccines, now recommends everyone over 30 who has been vaccinated get a booster shot 6 months later.) Pharmaceutical companies are collecting data and working on versions of boosters; some supply more of the same ingredients for a “third jab” while others are slightly altered and pending FDA approval. For now, there appears to be more questions than answers.

Will we get to “herd immunity”? 

Herd immunity refers to the resistance to the spread of an infection once a high percentage of a population has been vaccinated or previously infected. The panel was unanimous that the magic number or percentage for herd immunity is going up due both to insufficient vaccinations and to the spread of the more easily transmissible Delta variant.
 
“We need between 90 and 95% now to reach herd immunity,” Dr. Holt said. Whether it is attainable is unclear at the moment.
 
On the bright side, Dr. Lockwood noted that those having been infected -- and contributing to herd immunity -- are drastically undercounted because of minimal or no symptoms in many individuals. So, optimistically speaking, American society may be closer to herd immunity than the numbers reflect.

What should be done in case of exposure to COVID-19?
 
Dr. Cancio addressed the question of dealing with exposure to someone with known COVID-19. Exposure has been defined as being within six feet of someone with COViD-19 for 15 minutes, even intermittently. The general recommendation in such situations would be to be tested in three to five days whether you are vaccinated or not. Then, if your test is positive, you should isolate for 10 days, she noted.

The CDC also recommends wearing a mask in public for 14 days after an exposure or until your test is negative. It’s more complicated for people who are immunocompromised, she emphasized, referring to a range of clinical situations from taking medications that may have a slight effect on the immune response to having had a transplant or an immunosuppressive condition like HIV/AIDS where immunosuppression is more likely.
 
Where an immunocompromised condition is an issue, the use of monoclonal antibodies may be considered, but the treatment must be given within 96 hours of exposure to be effective. 

What do we know about the “Delta variant”?
 

Dr. Sinnott pointed out that we are close to exceeding the U.S. deaths from the Great Influenza of 1918, which claimed 675,000 American lives.
 
As of this writing, 648,000 U.S. deaths have occurred from COVID-19.
 
But unlike the Great Influenza, which was contagious only after symptoms appeared, you may be contagious with COVID-19 for a full 48 hours before symptoms develop.

The Delta variant, unlike the 2020 version of COVID-19, is more transmissible and more deadly, according to Dr. Sinnott. “It may carry with it a high risk of ‘long’ COVID,” he added, meaning long-lasting or even permanent effects.

One thing the panel agreed upon was succinctly put by Dr. Cancio: “We have a method of prevention of COVID-and it is called vaccination and masks.”
 

Read more articles by Dr. Bruce Shephard.

Dr. Bruce D. Shephard, a retired Obstetrician-Gynecologist and Affiliate Associate Professor, Department of Obstetrics and Gynecology, USF Morsani College of Medicine, is best known locally for delivering more than 7,350 babies. He now occasionally teaches and always practices good health, dabbles in writing, and raises monarch butterflies. He and his wife, Coleen, live in Tampa.
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