A Perfect Storm Setting the Stage for a COVID-19 Catastrophe

The last week in June always means the recent medical school graduates have just begun their first days as real physicians working in the halls of our nation’s hospitals. With youth comes energy, altruism, enthusiasm and inexperience.

The first year was once called an internship and is now called Post Graduate Year 1. Directors of training programs and their teaching colleagues work overtime to orient, teach and supervise closely so that inexperience does not interfere with excellent patient care. Excellent programs have layer after layer of patient care review to prevent the development of judgement and experience from adversely affecting outcomes in care.

We are in the middle of a health care crisis of previously unseen proportion by old timers like me and newly minted physicians. As the coronavirus surged in the state of NY, state officials accelerated the graduation of fourth year medical students and sent them into the fray to care for COVID-19 patients on the front lines. A general call for extra help went out to the medical community nationally to bring back retired physicians but to also reassign specialty doctors to COVID-19 care even though they had little recent experience in infectious disease and respiratory care.

Some news stories talked of dentists and podiatrists being drafted to provide medical care for ailing New Yorkers. The death toll in the NY hospitals was exceptionally high and some critics believe the use of inexperienced clinicians, with minimal supervision, contributed to these extremely high death and complication rates. I believe that while that may be a factor, the real issues were lack of familiarity with a new pathogen, lack of effective medication, lack of personal protective equipment as well as a lack of sleep and rest and mental health counseling all contributing to the inexperience but valiant efforts made by NY health care personnel.

With new medical school graduates on the wards here in Florida, we now face many of the same issues our colleagues in the NY Metropolitan area faced several months ago. What they did not face months ago was a population unwilling to follow the safety measures outlined by Public Health officials, infectious disease specialists and scientists.

The financial hub of the USA, perhaps the world, closed quickly to save lives and slow the spread of disease. Our south Florida hospitals have prepared extensively for the arrival of the new medical graduates. Our best faculty members are out teaching and supervising. Despite this, they are at a disadvantage because there is no governmental leadership by example at the county, state or Federal level.

The number of Florida residents who continue to treat wearing a mask as a civil liberties issue, rather than a deadly public health issue, is astounding. The number of Floridians who do not believe that keeping a safe social distance apart prevents disease spread and fail to observe the recommended guidelines as a protest about loss of freedom is mind boggling.

 Instead of Floridians demanding a comprehensive and organized program to stop COVID-19 while meeting the financial. food, educational, safety, housing, childcare and supply needs of the populace, we have politicians telling us that the increased rate of infectivity is safe in young people. Young people give it to middle aged and old people, and they have a greater chance of getting sicker, ending up hospitalized and dying.

The daily local hospital case load is increasing. The available beds are decreasing. We have not even factored in that we are now in hurricane season which might call for evacuations and mass movements of Floridians for storm related safety.

This is the perfect storm scenario. If you are happy with it then carry on. If you are not then please call, write, text and email your elected officials at all levels of government and tell them in no uncertain terms what your needs are.

Do Statins Increase the Risk of Eczema?

Like many senior citizens and patients of mine, if asked if I am healthy, I would probably answer “yes.” “Yes” ignores the fact that my blood pressure is well controlled with a blood pressure medicine, salt restriction and constant efforts to control my weight.

I exercise regularly and with great duration and modest intensity, so I think I am healthy. My allergies are controlled with a long acting non-sedating antihistamine. My normal pressure “glaucoma” requires nightly eye drops and thankfully the developing cataracts have not caused issues.

Then there is the cholesterol which is normally elevated despite eating according to expert advice and is controlled by a popular statin. Since I take the statin, I deplete my Coenzyme Q 10, so I take that as well. I guess the correct answer to the question of “are you healthy?” is I have multiple chronic medical conditions being well controlled with medication, diet and exercise.

I started the statin a few years back and was always amazed at the lack of muscle aches and pains I experienced yet so many of my friends and patients suffer greatly. What I did not expect was to see my skin slough and get irritated and itch with an atopic dermatitis called eczema. Several dermatologists prescribed soothing creams and ointments without making any attempt to determine the core cause of the problem. One suggested I go for allergy testing.

This is the background of me seeing an article in the Journal of the American Academy of Dermatology asking, “Do Statins Increase the Risk for Eczema?” The study performed in Iowa looked at patients taking statins for high cholesterol and heart disease and compared them with individuals not taking lipid lowering medications.

Almost ten thousand patient records were reviewed over a six-year period. It turns out that those taking stain medicine had a higher risk of developing eczema at almost 7% compared to the general population at less than 2%. The study by Dr. Cheung and associates called for further research to determine the exact mechanism of statins being associated with an increased risk of eczema.

In the meantime, I continue to take my rosuvastatin and CoQ10, watch my intake of forbidden foods, exercise and support the pharmaceutical industry by purchasing specials soaps , creams and ointments to mitigate the eczema and prevent me from scratching my skin until it bleeds.

What Happened to Honesty & Integrity?

A great deal of time and research was invested in developing a safe plan to resume seeing patients in our office. We prescreen everyone before scheduling an appointment. We screen again the night before the visit and, once again, at the front door. We ask extensively about their contacts and exposure. I expect the answers to be truthful. I have a professional responsibility to keep my patients safe and well cared for. I also have a responsibility to protect my staff and myself.

My first patient back had pushed his way into an expedited visit with a complaint of excessive weight loss. His request for one of the first visits after we reopened was supported by “telehealth” consults recently from two specialists – assigning the evaluation of this problem to me. Of course, they hadn’t bothered to weigh him.

When he arrived at the front door, we gave him a mask. He answered “no” to unmasked close encounters with others and to questions about behavior and visits which might raise his risk of catching COVID-19.

I treat all patients now as if they are contagious so I was masked, face shielded, wearing a gown and feeling safe. After a detailed history he told me he was flying on a commercial airline in two days to his northern home.

On Monday, his “back doctor“ was going to inject him for chronic low back pain. I asked him if his northern physician was aware that he was flying commercially and not maintaining a 14-day self- quarantine as advised. He said “no” and he had no intention of informing him. I told him that was wrong and that with diabetes, hypertension, heart disease and obesity I didn’t think flying on a crowded jet was a great idea.

His exam showed nothing of concern and when we weighed him his weight loss was minimal. He brought blood test results from his other physicians which we discussed. I wished him luck, suggested he quarantine after flying commercially and suggested he drive up instead. He chuckled, removed his facial covering and wished me a safe summer.

Two days later, as we closed up the office, my cell phone rang. The patient had flown up north and as he walked down the concourse he received a call from his friends who told him they were ill, were hospitalized and tested positive for COVID-19. He was calling to ask me what he should do.

He admitted that a few nights before his visit to my office this couple had been to his home for dinner. No masks were worn and no social distancing was practiced. I suggested he go home and self-quarantine for 14 days and seek medical attention if he felt ill.

The patient said he said he did not mention his encounter which occurred before his exam at my office because he wanted to be seen and did not wish to wait 14 days.  What happened to honesty and integrity?

Stay Safe & Stay Home – It’s Still the Best Decision

This past week the number of new Coronavirus cases in the state of Florida has dramatically increased. The percentage of patients having positive results and the number of patients showing up at the emergency rooms locally complaining of flu like symptoms has increased as well.

Due to a continued shortage of testing supplies, patients receive a nasopharyngeal swab and the test is sent out to the reference lab with results back in 48 to 72 hours. The number of hospital admissions with COVID-19 has increased dramatically in the last two weeks. The number of individuals requiring intensive care beds has increased while the availability of ICU beds has decreased. Some hospitals in Jacksonville and Sarasota have no current availability of critical care ICU beds.

Florida’s Governor says it is due to more people being tested so there are more positives. He initially blamed it on migrant farm workers of Hispanic descent but farmers and elected officials from farm districts pointed out they had left the state after harvesting crops weeks ago.

The increase is blamed on young people who will not require hospitalization or develop very many complications from COVID-19 say the elected officials. No need to order masks in public places in Palm Beach County according to the County Commissioners despite numerous studies saying facial coverings are an effective way to slow the spread of the disease. Epidemiologists and virologists from the University of Florida School of Medicine blame the surge on opening businesses too soon and lack of facial coverings as well as social distancing by those people going to restaurants, gyms, shopping and retail stores. The Director of Nursing at the University of Miami Jackson Memorial Program feels the same way as does an infectious disease expert at Florida International University in Miami.

Over the last three weeks I have read, re-read and studied numerous protocols and guidelines designed to safely reopen my small business establishment and internal medicine practice. We spent two weeks training the staff, rearranging traffic patterns, purchasing new equipment for protective purposes. We called our patients and started to bring them in slowly and in small numbers while reviewing and critiquing what we could be doing better to make sure our patients were well protected on the trip from their cars , up the front steps or ramp with a bannister, through a revolving door, into a common lobby and up an elevator to the second floor before reaching my office. It was going very well until the surge of new cases.

This is a very transmissible virus with newly contagious and minimally symptomatic individuals felt to infect 5.7 patients before they discover they are ill. As the surge reached day five on record new cases we met as an office, two experienced physicians, one experienced nurse manager, two medical assistants and one receptionist and decided it would be safest for our patients who were doing well to just stay home and delay a routine visit until the number of new cases and hospital cases declines again.

We phoned and used email as well to contact our patients and try to reschedule them. The negative blow back was both disheartening and surprising. “We need our blood work and are overdue for checking our cholesterol and sugars.” No, you are not. We were accused of being afraid of catching COVID-19.

With the protective gear we have and training and experience I believe seeing a patient in my office is far safer for me than entering and exiting my office building or walking my dog at dinner time. The concern is for my patients’ safety and health in an environment where many have been led by our elected public officials to believe the pandemic is over and scientists, doctors, epidemiologists are blowing COVID-19 out of proportion with the help of the media.

On a personal level these comments are hurtful and simply inappropriate. If younger asymptomatic people have the disease and are roaming the community without face coverings your trip to the supermarket, retail store, hospital emergency room is far more dangerous now then it was a month ago when potential COVID-19 patients were easy to spot and separate from those with other problems.

My hair cutting shop opened up two weeks ago when the Governor gave Palm Beach County an early opening even though the county had not met any of the minimal guidelines set by the Federal agencies including President Trump’s Coronavirus task force. When a client called in sick with COVID-19 two days after a haircut; the owner closed the shop, sanitized the facility and re-examined his protocols to protect his employees and customers. That shop is still closed with no imminent plans for opening

We still have no medical treatment for COVID-19. A vaccine is months away. There is promising news about blocking monoclonal antibodies. Self-distancing, hand washing, and facial coverings is all we have.

A recent article in a peer reviewed journal pointed out that people recovered from COVID-19 only had protective IgG antibodies for sixty to 90 days calling into question whether we ever can achieve “herd immunity” by keeping everything open and allowing the young less vulnerable to get sick, recover and develop antibodies.

How many more people must die in the name of economic well-being? How many people will get so ill that even if they recover the rehabilitation process will be so long and so partial that the price is too steep to pay?

I cannot say it enough – stay home, keep your distance and wear a facial covering in public. That is not an imposition on your civil rights. It’s being caring and compassionate for others.

Testing in Pharmacies, Another “Duh” Moment for Florida’s Governor DeSantis

At his coronavirus pandemic news conference, the Governor of Florida, who last week defined professional wrestling as an essential business, announced that testing for COVID-19 will be expanded by using pharmacies as test sites. He indicated the details still need to be worked out.

In the absence of a Federal plan for testing, states like Florida, which are desperately trying to reopen for tourism and business, are attempting to figure it out themselves. I just raise these simple questions:

1. Who will be performing the testing? Will it be the same pharmacy techs that take 30 minutes to give a vaccination that can be administered in five minutes or less elsewhere? Will they hire nurses? Medical assistants? Moonlighting EMS personnel?
2. Which test for COVID-19 will they be using? If it requires a nasopharyngeal swab will the personnel have adequate personal protective gear? Will it be sent to a lab? Will it be a quick on site test? If 100 people with COVID-19 took the test how many would test positive? If 100 people not infected with COVID-19 took the test, how many would falsely test positive?
3. Who will train the pharmacy personnel on how to correctly take a deep nasal sample?
4. Who will train the pharmacy personnel on how to dress in the personal protective gear and sanitize between test subjects so that they do not expose the non-infected, or next test subject in line, to COVID-19 or expose themselves?
5. Where in the pharmacy will this be done? Will it be a drive thru in the parking lot? If it is in the pharmacy how will you protect healthy shoppers from potentially sick patients? How often will each store need to be disinfected and how will they do it?
6. Who will pay for the cost of testing?
7. For those who test positive, who will be responsible for reporting it to Public Health? Who will be available and responsible for tracking down contacts of infected patients?
8. Will the testing only be done by appointment at specified times?
9. Will the pharmacies have the same limited test supplies that has prevented appropriate recipients from being vaccinated for shingles with the Shingrix vaccine?

The State of Florida, through decimation of its Public Health system due to inadequate funding under former Governor, now Senator Rick Scott, is reeling from an inability to respond, test and treat the poor and underinsured of Florida. They once again turn to an inexperienced and untrained private sector to assume their responsibility.

Distancing, N95 Masks and Eye Covering Protect Against Respiratory Illness

To wear a facial covering or mask, or not, has been turned into a political affiliation and machismo issue in the United States instead of a scientific, medical and public health issue. A publication in the British medical journal Lancet clearly brought the issue into a medical public health category.  The “cliff notes” summary of the study is that for each meter (2.2 meters = one foot) you distance from a contagious individual, the less likelihood you have of becoming infected with that illness.  Facial coverings diminish your risk of catching the disease by about 15% and N95 or KN95 respirator masks work better than surgical masks, bandanas or cloth masks.

The study was a systemic review and meta-analysis of 172 observational studies involving SARS, MERS and COVID-19 spanning six continents with almost 26,000 participants.  Daniel Chu, MD, PhD made it clear, “The risk for infection is highly dependent on the distance to the individual infected and the type of face mask and eye protections worn. Six feet or more away is the optimal distance to maintain. While N95 masks scored best in terms of protection for health care workers, facial coverings of any type reduced the chance of infections from 17.4% to 3.1%. Eye protection reduced the risk of infection from 16% to 5.5%.”

Due to a shortage of personal protective equipment (PPE), the CDC downgraded its requirements for health care workers treating sick infected individuals  to surgical masks, cloth masks or bandanas.  Professor Raina MacIntyre, MBBS, PhD at the Kirby Institute University of New South Wales in Sydney went on to say that recommending anything less than an N95 mask for health care workers is like sending troops into battle “ unarmed or with bows and arrows against a fully armed enemy.”

Many wonder what the difference is between an N95 respirator mask and a KN95 respirator mask. They both are supposed to prevent 95% of the particles of a certain size from penetrating. If the masks are reviewed and approved and certified by USA agencies such as OSHA or the CDC, they are labeled N95.  If they are reviewed by similar agencies in China, they are labeled KN95. In most cases the product is made outside the USA even if the company is an American firm.

Key points to remember are:

• Distancing works with over six feet best for preventing person to person transmission of respiratory illnesses like Covid-19.
• Facial coverings reduce the risk of infection.
• N95 and KN95 are the gold standard for health care workers.
• Eye covering reduces infections even further. 

This is not a macho or political issue. It’s an infectious disease public health issue.  Be smart and considerate of others. Cover your mouth, cover your eyes and keep six feet or more apart.

There is Still a Pandemic in Florida Folks!

I opened the local newspaper to headlines that the Palm Beach County Commission has opened county facilities but is not requiring visitors to wear masks, facial coverings or observe social distancing rules.  A county commissioner was quoted as believing that it was not within their authority to require facial coverings.  Strange opinion when they have closed businesses , facilities and services due to COVID-19 and then reopened them independent of Public Health, CDC or even White House guiding rules and regulations and published the conditions under which these facilities will open and operate.  I imagine, or hope, the County civil servants have union representation that will address the issue of their employees being called back to work with their health and safety being taken for granted.

Recently, I spoke to a patient who believes COVID-19 is overblown. They are closer to 80 years old than 70, continues to smoke tobacco regularly despite having documented coronary artery disease and is incensed that the free flow of patients has not restarted in our medical practice.

I keep coming back to the same question.  Despite our Governor opening the state up again, what has changed medically or scientifically?

1. We still do not have an onsite quick accurate test to determine if a patient has COVID-19 and is a contagious asymptomatic carrier. Yes, testing sites have increased but most test results come from a lab with a 48-hour wait delay.  Our local medical center, Boca Raton Regional Hospital Baptist Health system has on the physician website a request to only perform quick in-house COVID-19 testing one time on admitted patients only because they do not have enough supplies on hand.  Patient’s presenting to the Emergency Department still receive a nasal swab which is sent to an outside reference lab and results take 48 hours.
2. We don’t have enough personal protective equipment for hospital staff to change masks, capes, face shields and gloves according to their own guidelines for treating an infectious patient and preventing transmission of the pathogen to others, including you! In view of the shortage of equipment, the CDC and hospital infectious disease departments have relaxed their own guidelines several times to ensure their guidelines agree with the way equipment is being used.
3. We still do not have a treatment other than supportive care. Yes, there is some evidence that remdesevir early in the course helps and that a triple drug regimen in more severe cases helps.
4. We are still months away from having a vaccine.

In Palm Beach County, civic leaders admit they bowed to the pressure of struggling businesses, distressed parents out of work, and home with school age children, and political pressure from Washington and Tallahassee in deciding to open the economy back up.  With Palm Beach County opening May 11^th and Dade and Broward County on May 18^th, we should begin to see an increased infection rate over the next two weeks based on the incubation period of COVID-19 and its complication rate developing around Day 8 or 9.  

I sincerely hope I am wrong about this, but my infectious disease colleagues, critical care colleagues and Emergency Department colleagues have shared this professional opinion with me.  This disease infects and kills youngsters, young adults, teenagers as well as senior citizens.  Asymptomatic carriers of the COVID-19 bug infect 5.7 individuals before they discover they are sick. 

Despite this, we ask county employees and restaurant servers to spend time up close with no requirement to wear a facial covering.  Tell me, what has changed other than the level of patience of our elected officials and their overwhelming desire to gain public favor and get re-elected regardless of the health care costs and carnage from COVID-19?

I’m Dealing With the Silent Fear of Infection

I saw a patient yesterday with a cough and intermittent fevers. I believe based on her history she is a low risk for COVID-19 disease. One must treat all patients as if they have COVID-19 until proven otherwise so I wore a double mask including a N95 respirator mask, a face shield and gloves.  The face shield limits your peripheral vision and fogs up easily as do your glasses. I could feel and hear my heart pounding and racing as I got close to the patient for an exam and the sweat pouring down my forehead into my eyes stinging and burning did not help.

The visit was uneventful.  I maintained my sanitary protective field, removed my protective gear afterward, as per protocol, and washed up extensively. The weather outside was stormy with torrential rain, thunder, lightening, high winds, flooding and some hail – adding to the apocalyptic climate that now exists in the patient care arena.

Yes, I began to relax some as the visit progressed but there was always this uneasiness wondering if I careful enough?   It reminded me of 1979 before we knew what the HIV virus was and what AIDS was. I was seeing a brand-new patient in the intensive care unit of Boca Raton Community Hospital. He was the editor of an internationally known tabloid published just north of Boca Raton.

Married to a French national, he had left New York to come oversee this paper and had taken ill.   I had seen many cases of this immune system destroying disease during my residency in Miami at Jackson Memorial Hospital. This obese gentleman struggling to breath had none of the risk factors for this new disease. He denied drug use or intravenous drug use. He denied being in relations with other men.  How could he possibly have this horrible new disease with none of the risk factors. His wife was testy when I questioned her alone about private and personal areas of their relationship all necessary to determine her husband’s risk of having this immune destroying disease. She was vigorous in her defense of his very ordinary, very traditional behavior.

In those days we rarely wore gloves to draw blood. It was unheard of. We rarely put on gloves to start an IV line. With this disease things were different.  I was in a paper gown, gloves, face mask, goggles and face shield as was the young pulmonary expert I was working with.  The confinement of the personal protective gear and the warmth and fogginess of your vision led to a rapid pounding heartbeat and the same sweating I was experiencing 40 years later. It calmed down some as we got into the procedure.  I was wearing scrubs then which never left the hospital locker room. I am wearing scrubs now which never leave my office. I come to work in pants, shirt and tie and change into special scrubs plus sneakers that are kept here. At the end of the day the scrubs go into a laundry bin. 

As a physician who cares for patients, I need to take this risk. As a human being over 60 years of age I realize I am high risk for developing complications and death if I catch the COVID-19 virus. I am most afraid of transmitting it to my wife, my children, my grandchildren unknowingly. I hope they have the courage to put up with my risk taking.

Absence of Leadership Is Why COVID-19 Is Destroying The USA

Two articles arrived at my desk discussing the ongoing tragedy of COVID-19. One is written in the New England Journal of Medicine by Dr. Eric Schneider. Dr Schneider sees the ability to test someone quickly and reliably as the only way out of the pandemic and back to some degree of normal life without there being mass casualties and deaths. He is appalled that foreign nations with far less developed scientific communities have developed testing and contact tracing so that they can limit the spread of the disease while safely opening those societies again. 

He cites the failure of the Trump administration to heed warnings, prepare for the arrival of the virus and more importantly to produce, distribute and test the public while collecting and organizing the data as the only reason we are now left with “non pharmacological interventions (NPIs)”   Shutting down society and staying at home is our only successful  NPI option to date.  He goes on to criticize the administration for looking for that magic cure with a medication or a quick vaccine which the scientists working on them insist will take longer than the President claims it will.  While Dr. Schneider believes that NPI’s have been successful, they carry their own price of economic ruin, social isolation and a restless population now demonstrating loudly to resume commerce and normal activities even though the infection rate and death rate will be so much higher. 

An editorial in the revered British Journal The Lancet today discusses the need to revive the CDC. The editorial highlights the history of the Center for Disease Control and its role as a world leader in public health and safety.  It then goes on to illustrate how the Ronald Reagan and George W. Bush administrations, and now the Trump administration, have destroyed its funding and marginalized its role.

The Lancet editorial board first criticizes those administrations for reducing funding when the CDC was leading the fight against HIV disease worldwide. The current administration has eliminated funding and support even further.

The CDC always kept pandemic surveillance personnel in China since Asia has always been a birthplace of new serious viral illnesses such as SARS, Bird Flu and MERS. Funding elimination resulted in the last CDC surveillance officer leaving China in July of 2019.

When the current CDC Director Nancy Meissonier, MD warned the world about the COVID-19 pandemic on February 25, 2020; she was removed from White House briefings and public appearances because of her prophetic statement. “The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today’s complicated effor. Americans must put a president in the White House come January 2021, who will understand that public health should not be guided by partisan politics.”

Easing the COVID-19 Restrictions

I read an article written by an infectious disease physician in the state of Georgia. She was quite critical of her Governor Kemp opening the society prior to the state of Georgia meeting the very minimal guidelines for reopening the economy set down by the Trump Administration.  She believes it is a mistake and will be followed in 14-21 days by an increased rate of infection and death.  I next read an article on the CNN website about the reopening of Wuhan, China for business.  Wuhan is a big industrial manufacturing and commerce center of 11 million people who were ground zero for this pandemic.  Businesses are staying closed. Restaurants that could open for takeout are closing because consumers are still afraid and staying home. They fear a second wave of infection and death.

I say this as an introduction to my trip south down to Palmetto Bay, Florida south of Miami in Dade County.  It is a residential community of single-family homes in a reasonably well-to-do and well -educated diverse community.

My daughter and son-in-law moved into that community this past summer. We have not seen them face to face in over six weeks of our self-isolation and stay at home sequestering and miss our 2-year-old grandson desperately.  We had a ton of supplies at our home for them that just never made it south due to the disruption of the pandemic.

My daughter is pregnant and isolated because she too is considered “high risk.”   The trip reminded me of the sci-fi apocalypse series Mad Max Road Warrior. Traffic was light on the Florida Turnpike as I creeped along doing 75 miles per hour in the right-hand lane with SUVs roaring past me at 120+ mph. At certain times, I would see an auto in the left lane doing 80+ mph with the middle and right lanes empty and a faster driver would pull up behind them and tailgate them for miles. It was unclear why they just did not change lanes and safely whiz on by.

When I exited the turnpike for the Palmetto Expressway west the amount of traffic was incredible.  We dodged speeders and creepers and made it to the end on US-1.  The streets south were jammed. As we turned off onto 152^nd Avenue, we noticed the young homeowners of Palmetto Bay were all out in their driveways and streets with their children, no masks on and weren’t the social distancing guidelines recommended by Public Health Officials.

Three homes north of my daughter’s home a pool party was in progress with multiple vehicles in the driveway and people of all ages attending.   We dropped off the supplies in my daughter’s driveway, talked for 20 minutes through their impact windows and then headed home.

When I turned into my community and passed our children’s playground, still closed per executive order of the County and Governor, a high school graduation party was in progress.  Multiple vehicles from outside our non-gated community were parked at the park entrance and a large crowd of diverse ages was congregating and celebrating at distances far less than the suggested six feet.

While I am not a registered fortune teller, I do not need a crystal ball or Tarot cards to predict that 14-21 days from now there will be an increase in COVID-19 cases and deaths in Dade, Broward and Palm Beach Counties due to the reopening of the society.  No one seems to care about how highly transmittable this pathogen is and its devastating effects on the older population.

We are approaching off season in Florida. Traditionally the snowbirds or seasonal visitors go home, and the economy is supported by year-round residents most of whom are older Americans. Each newly infected Coronavirus victim, with or without symptoms, will transmit the disease to an average of 5.7 individuals before they know they are ill.

With the rush to open the economy in Florida championed by the Governor, following the President’s lead, if the over 60 crowd is sick or dead, who will financially support the economy this coming off season?