Florida, driven by the unvaccinated, is epicenter of the pandemic

Photo: Courtney Hale/Getty Images

Driven by the Delta variant and the unvaccinated, Florida has become the epicenter of the country's COVID-19 pandemic. 

Despite surging numbers, Florida Gov. Ron DeSantis has said he objects to vaccine mandates for hospital workers. DeSantis has not said he would ban the practice, according to Florida Trend.

However, the increasing number of COVID-19 cases nationwide from unvaccinated individuals has led to more federal agencies, states, health systems and hospitals mandating vaccines for healthcare workers.

In New York today, Governor Andrew Cuomo announced that staff at hospitals and long-term care facilities, including nursing homes, adult care and other congregate care settings, will be required to be vaccinated against COVID-19 by Monday, September 27. 

In Maine, Gov. Janet Mills said on Thursday she is requiring healthcare workers to be fully vaccinated by October 1.  Some workers are threatening to quit over the mandate, according to the Bangor Daily News.

America's Essential Hospitals, American Hospital Association, the Association of American Medical Colleges, Catholic Health Association of the United States and Children's Hospital Association have all said they support hospitals and health systems that implement mandatory vaccination policies, with the appropriate accommodations for medical or religious reasons.

WHY THIS MATTERS

Florida leads the nation in the number of daily COVID-19 hospitalizations, as surges there push numbers back to the early days of the pandemic, according to The Wall Street Journal.

Over the past five to six weeks there's been a definite increase in hospital inpatient rates due to COVID-19, according to Justin Senior, CEO of the Safety Net Hospital Alliance of Florida. The alliance has 14 hospital systems that include academic medical centers, public hospitals and children's hospitals. The three dozen hospitals are in areas ranging from Pensacola, along the Panhandle and down to Miami. 

"The state is at record level for COVID-19, but not every area," Senior said. Current hot spots are in Jacksonville, Orlando and around Hollywood. "We're seeing surges from people not vaccinated."

About 92% of inpatients are unvaccinated and 8% are vaccinated, according to Senior. Children ages 18 and under represent between 1% and 2% of inpatients. 

Two children's hospitals in the system, Johns Hopkins All Children's Hospital in St. Petersburg and Nicklaus Children's Hospital in Coral Terrace, had 39 children in care as of Friday, with 14 being in the Intensive Care Unit.

What the alliance is seeing, according to Senior, is that most of the inpatient beds are filled with adults who are able to get vaccinated.

There is hope that while hospitalization numbers are climbing, the rate of vaccination is also growing, according to Senior. The number of doses being given has gone up and is tilting towards that first dose, which shows vaccinations are winding up, not down, he said.

"We have seen it and it's gratifying," said Senior, who is urging more unvaccinated individuals to get vaccinated as the best way to control the pandemic. "It's very important that we see that the vaccines work and prevent hospitalization. It's a very stressful environment to work in. If there's something people can do, it's to go out and get the vaccine."

At a couple of facilities in the Safety Net Alliance system, healthcare personnel are mandated to get vaccinated. Some facilities are waiting to make it a requirement until later in the year, around November, when the COVID-19 vaccine will be given in conjunction with other vaccination drives, Senior said. 

Ascension is one, requiring all employees be vaccinated against COVID-19 by November 12.

ISSUES WITH THE MANDATE

There are issues with mandating vaccines during surges, according to Senior.

One is that, while an all-hands-on-deck mentality pervades, mandates means individuals who get vaccinated may be out sick for a day or two.

"One catch we're kind of in is, we're in the thick of it," Senior said. "Staff is at a premium. You don't want anyone offline."

The majority of nurses are vaccinated, he said, from 50% to 70%, but this is far lower than the 90% doctors who are vaccinated. 

One reason being given for not getting vaccinated is that COVID-19 vaccines have gotten emergency use authorization only and not full approval from the Food and Drug Administration. While vaccine approval generally takes five to 10 years, the COVID-19 vaccine was approved in a year.

Another somewhat under-the-radar argument from women of child-bearing age is that the vaccines reportedly result in changes to menstrual cycles, with accompanying fears of infertility, according to QZ. In some cases, the periods are earlier, heavier and more painful, while in others they are lighter and delayed, according to NPR. The reported changes typically affect one or two cycles.

The Food and Drug Administration, as well as drugmakers Pfizer, Moderna, and Johnson & Johnson, have said the reports don't represent evidence that the irregularities exist. The American College of Obstetricians and Gynecologists continues to strongly recommend getting the vaccine, irrespective of period cycles.

Dr. Deidre Gunn, assistant professor and fertility specialist in the University of Alabama at Birmingham's Division of Reproductive Endocrinology and Infertility, said "Based on the available data – in both humans and in animals – the vaccine does not affect fertility, but it does significantly lower the risk of COVID infection and the risk of severe complications from COVID." 

Gunn said that, although pregnant women were not included in the first vaccine trials, some women did become pregnant during the study period. In fact, people got pregnant after receiving the vaccine in similar numbers as those who got the placebo, suggesting that there was no adverse effect on fertility, according to the UAB report.

THE LARGER TREND

Hospitals are going through yet another surge of COVID-19, but there are differences this year compared to last that help healthcare providers, according to Senior.

For one, the vaccine exists. Clinicians who are vaccinated are no longer getting sick at the rate they once were. This means less burnout from the fear of getting infected or from not having enough staff members because so many are sick. Also, when there is not enough staff, a 1,600-bed hospital may be only able to staff 1,400 beds.

"That situation is significantly better this year than last year," Senior said.

There's more personal protection equipment and better testing. Most of the hospitals in the association are not relying on the state for supplies, he said. 

It's also easier to discharge patients. Many, now in their 40s and 50s, can be discharged to their homes. Last year, many of the patients were elderly who could not always be discharged to their assisted living or retirement community because of infection fears.

"The dilemma Florida had to solve last year, we'd reach a point where you've got a 78-year-old patient, but you can't free up the bed, because you can't discharge back to the facility," Senior said. 

The Safety Net Hospital Alliance of Florida represents: Ascension Florida & Sacred Heart, Broward Health, Halifax Health, Jackson Health System, Johns Hopkins All Children's Hospital, Lee Health, Memorial Healthcare System, Mount Sinai Medical Center, Nicklaus Children's Hospital, Orlando Health, Sarasota Memorial Health Care System, Tampa General, UF Health Jacksonville and UF Health Shands.
 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com