Here we go again (again), again (again)

Florida COVID-19 Update: Trouble Brewing in 2022

If you’ve been following the coronavirus situation in Florida and around the world, you’re probably aware of the rise in cases nearly everywhere – most likely the result of the highly contagious Omicron variant.

Florida’s rapid rise in cases has been especially dramatic, going from one of the least infected states (per the state’s own data, which is problematic, but you already know that) just weeks ago to currently among the worst in the USA with little sign of slowing.

The most recent 7-day average is nearly 4 times greater than just a week before – going from 5,320 cases/day on December 17 to 21,125 on December 25. Since recording an average of about 2000 cases/day on December 11, the 7-day average has increased more than 10 times in two weeks.

Now these numbers may seem frightening on their own – and they are for many reasons – but the immediate concern is managing hospital resources. How has the most recent surge effected hospitals so far?

Admissions, hospital census, and hospital deaths within hospitals are all increasing, but not nearly in proportion to earlier waves of infection.

In previous waves, cases and hospital admissions moved closely in tandem (along with hospital census and deaths within hospitals). Within the past few weeks, however, there is a distinct divergence between cases and hospital numbers.

This could be due to widespread recently acquired immunity during Florida’s deadly Delta wave in Summer 2021 or possibly lower severity of the Omicron variant. It may be in part due to the outbreak being thus far concentrated in the most vaccinated areas of Florida – Miami-Dade, Broward, and Palm Beach counties (more on this later) – or in younger age group. It could also be in part due to the extremely rapid spread, where hospital admissions need more time to “catch up” to the explosion of cases.

At this point, just a few weeks into the Omicron wave, it is more difficult to determine the new relationship between cases and hospital metrics. It is likely that the risk of hospitalization (per case) is lower in this wave than the previous Delta wave due to more milder cases in those who are vaccinated. During the Summer 2021 wave, daily hospital admissions were about 10-15% of the total cases (7-day average). Now, this number is trending much lower, with daily admissions only about 2% of total cases.

That is the good news. The bad news is that hospitalization numbers are projected to rise along with admissions – much more rapidly than the previous two weeks. Using today’s admissions, we can get a fairly accurate prediction of the hospital census a week or so out (see the graph above where the blue ‘Admissions’ line is nearly identical to the black ‘Census’ line, shifted several days back).

Between December 12 and December 26, the 7-day average hospital census increased from 1,408 to 2,108, or a 50% increase. However, by the new year (just six days between December 26 and January 1), the hospital census is expected to increase by nearly 80%, going from 2,108 to almost 3,800.

With cases and admissions still increasing, this estimate for January 1 is already almost a quarter of the worst of Summer 2021 that resulted in over 17,000 active hospitalizations and 400 deaths/day at its peak. Although the risk of hospitalization appears lower for this wave, the death rate of those hospitalized is unknown currently.

Making matters worse is the location of the current outbreak: relatively highly vaccinated South Florida (although it is difficult to know the true level of vaccination in this area due to the large number of vaccines given to non-residents that is not tracked by Florida DOH, and Florida’s previous over-counting of vaccinations).

Current hospitalization predictions may be optimistic in that the cases are disproportionately from counties with presumably high vaccination rates. Once spread continues into regions with less immunity, the ratio of hospitalization to case rates will likely increase. Combined with Florida’s below average boosting rates, there will be tough times ahead in 2022.  

Hospital data can be found here:

https://beta.healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh

Hospital admissions are calculated using the sum of “previous_day_admission_adult_covid_confirmed” and “previous_day_admission_pediatric_covid_confirmed.” Hospital census is “inpatient_beds_used_covid.”

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