'This is a serious situation we’re in. We are making some progress, but there’s no reason for relaxing our vigil,' Florida Department of Health-Flagler Medical Director Dr. Stephen Bickel said.
In a city of Palm Coast Virtual Town Hall meeting streamed live over the internet July 29, Flagler County's emergency and public health officials reiterated the usefulness of masks in reducing COVID-19's spread, and noted that "COVID minimizers" who downplay the seriousness of the virus have a track record of being wrong.
Dr. Stephen Bickel, the medical director for the Florida Department of Health-Flagler, said there seem to be two groups of people who are resistant to masks.
"The better we do controlling this, the more we’re able to resume opening up."
— DR. STEPHEN BICKEL, medical director, Florida Department of Health-Flagler
"One is the people who think it’s an imposition on their freedom, but the other group is kind of this group I call COVID-minimizers, people who think it’s not so bad, and they kind of use every piece of data to support that," Bickel said. "And one of the pieces was the death rate wasn’t going to be so bad this surge, because it was going to be younger people infected, so even though the case number’s going up the death rate wasn’t going to go up. Well, that turned out to be wrong.
"And yesterday, I think, we set an all-time record in Florida. All the experts predicted this. So for those of you who think this isn’t a serious infection, keep in mind our local hospital is as full with COVID patients as it’s ever been, our level’s about 10 times what they were a couple months ago, and the death rate in Florida is as high as it’s ever been. So this is a serious situation we’re in. We are making some progress, but there’s no reason for relaxing our vigil."
FDOH-Flagler Administrator Bob Snyder noted that many businesses are now mandating masks.
"More and more folks are being added to the rolls of mask wearers as time goes on," Snyder said. "We truly believe that facial coverings is probably the number one measure that really has an impact."
Snyder said the health department has hired and trained 18 new staff members and is conducting testing at six sites around the county (see locations in the sidebar below).
As of the morning of July 29, Snyder said, Flagler County had 850 positive cases, up from 302 four weeks prior. Of the 850 cases, 601 were in Palm Coast zip codes. The positivity rate in Flagler County over the past 14 days averaged 7.1%, up from 1% a few weeks ago.
"The public health strategy is focused on testing, tracing, isolating and monitoring for hot spots," Snyder said. "Community testing has expanded over the past month; 12.2% of our county’s residents have been tested."
Rate of spread
Two indicators, at least, have been trending in the right direction: ER visits for COVID-19 related symptoms started trending downward on July 12, and the "R0 value," pronounced "R-naught," has dropped below 1 and is now 0.93, Bickel said.
The R value, Bickel said, indicates the the average number of people that one COVID-19 patient will infect: The higher the number, the more rapidly the disease spreads. An R value of one would mean that the growth rate goes down to zero because each person infects only one other person.
A value of about one, he said, is "a sign that we’re not losing the battle, in the sense of things aren’t getting worse, but it’s also a sign we’re not winning it."
Just about a month ago, there were 10 new cases a week in Flagler County, he said, then within about six weeks of opening up, the county went from 10 new cases a week to about 150 new cases a week.
At its peak, Bickel said, the R value in Florida was 1.47. At that rate, you can go from 1 to 1000 new cases in one month, and then to a million in another month.
"We need to get this R significantly below one," Bickel said. "... If we get the R down through less intrusive measures, it means we can lessen up on the other restrictions and get our economy back. ... The better we do controlling this, the more we’re able to resume opening up."
Because the percentage of positive cases is high in Flagler County, Snyder said, community spread is still an issue. "We’re just not catching it quickly enough."
Part of the issue is slow turnaround on testing — up to 10 days. To address that, Snyder said, the state Department of Health is contracting with two new labs that have committed to turnaround times of two to three days.
At AdventHealth Palm Coast, said Chief Operating Officer Wally De Aquino, staff are not seeing any increase in COVID-related hospitalizations, but they're not seeing a decrease, either.
They're also seeing people show up "a little too late" with non-COVID-related concerns, he said. "I invite all of our community not to wait, even if it takes a phone call with your primary care or urgent care," he said.
The hospital is protecting staff and patients by requiring all people who enter to wear masks — "the proper mask," not just a bandana, De Aquino said — and is screening people with temperature checks and a questionnaire. People who screen positive are not allowed inside.
The system works, DeAquino said: A patient who arrived for a non-COVID-related reason but later turned out to be asymptomatic for COVID 19 did not infect anyone else at the hospital.
Preparing for school reopenings
With Flagler Schools preparing to reopen to students on Aug. 24, Snyder said, the Department of Health has worked with the school district on strategies to minimize the spread of COVID-19 in the school population and respond to any outbreaks.
The school district's reopening plan gives parents three options for their children's education — two online options, and one on campus.
That way, Snyder said, parents who must send their children to a brick-and-mortar campus can do so, while those who are able to keep their children home have that option as well — which will help reduce the number of people on campuses and therefore make social distancing more feasible.
The schools will also require mask wearing on campus in situations in which social distancing isn't possible.
If a student or staff member tests positive, Snyder said, the health department would start a contact-tracing investigation.
"A plan is in place, and we do know what to do," he said.
Meanwhile, the city of Palm Coast has stared testing wastewater for COVID-19 in an attempt to identify any clusters early on. The data will be arranged in heat maps that also indicate the locations of schools and the schools' district boundaries.
The city has collected its first wastewater samples for testing, City Manager Matt Morton said, and the results are expected soon.
The wastewater tasing, Bickel said, could be used to target cluster areas for large-scale testing initiatives.
"If we can find these spots and then test extensively, we can interrupt the transmission earlier than we’re doing now," he said. "So much spread happens before people are asymptomatic, which is also why masks are such a big part of this equation."
"Embracing concepts like facial coverings, mask wearing, especially when indoors, it is going to make a difference," Bickel continued. "The science, the research, and the studies that have been peer reviewed have shown this. That is the number one tool that we have in our toolbox, so thank you all for complying."