On Tuesday, Sunrise Mayor Mike Ryan sent a. e-mail to local political leaders and healthcare professionals regarding a growing number of COVID-19 patients in Broward hospitals. Ryan, a lawyer, challenged medical information provided by Broward Health CEO Gino Santorio. In an earlier email, Santorio told leaders that reports from Broward Health frontline medical personnel indicated recent COVID-19 cases were “less virulent” than the more serious cases from during the March/April outbreak.

Santorio stated improved diagnostic techniques and treatments meant Broward Health hospitals were not facing a similar crisis that occurred in March/April.

For some reason, Mike Ryan believed his law degree, his position of power in Sunrise government and hours of watching MSNBC qualified him to debate the CEO of the North Broward Hospital district.

Ryan challenged Santorio’s information and use of scientific terms.

In his panicked screed, Ryan called for limitations on indoor dining, mandatory quarantine for those testing positive and even a Federal bailout of restaurants. Wonder how restaurant and bar owners in Sunrise feel about Ryan’s plan. Did Mayor Ryan think about how a shutdown would affect Sawgrass Mills Mall and other Sunrise businesses?

Somewhere, John Lomelo is laughing.

Here is Mayor Mike Ryan’s email response:

Colleagues, 

We are presented with a moment in time to prevent a catastrophic surge that we see all across the country.  This is an opportunity I cannot let pass silently. 

I know you all understand COVID-19 is NOT a different virus depending on where you live.  The only difference is the effectiveness of mitigation strategies.   So, we see the storm clouds around the country and need to batten down the hatches. 

Let me again point out (and confirmed by Dr. Thaqi) – Gino was scientifically and medically incorrect in even suggesting that COVID-19 is less virulent!  In fact, we now know that intermittent exposures accumulating over 24 hours can provide sufficient viral load to be infected and get sick from COVID-19.   If anything, we understand a bit better that the ability of COVID-19 to infect a host (virulence) and there is nothing re-assuring about what we now know.  This is the second time I have had to correct his medical statements.  Words matter and if we are looking to health systems for guidance they should be accurate in the words chosen.  Gino may have been unartfully suggesting hospitals have been improving how they are treating COVID patients and that we hope those changes in interventions will reduce mortality – but make no mistake, COVID is no less lethal for some as we see around the country.

Local positivity rate remains well above 7% and the threshold we were told necessary to re-open.  As Mayor Ross pointed out, we were told that if we were not below 5% positivity, we would not re-open and yet we are wide open. 

Now, we are about to welcome home college students from all over the country.  People are wanting to come to South Florida to leave bad weather and hot spots.  Thanksgiving recommendations and requests for voluntary compliance will only be followed so far.   Flu season will be superimposed.  Then, December holiday and new years … 

The fact that the current surge in hospitalizations is real but gradual is NOT a moment to declare “mission accomplished”.  Instead, it is the canary in the mine that our time to act is now!  Another real surge will wreck our economy and strain our health systems — with real human consequences.

Moreover, as confirmed on the call yesterday, there is growing body of literature and reporting that residual long-term consequences of COVID-19 include possible neurological, mental health and physical impacts – these may be permanent even in young people.

Exclusive reliance on personal responsibility as a public health strategy is the absolute last tool we should rely upon  – and I would say such reliance is proven as ineffective at best and absolutely dangerous at worst. 

If we do not act boldly, we will look back and regret that we had this very moment in time to act.  Said by another, if we act and it feels uncomfortable, then we acted timely; if we act and it feels comfortable, we are too late.  None of this is political to me — this is based upon the science and data presented and so many of us said we would follow the science and data no matter where that took us. 

We should implement 

• Indoor capacity restrictions matched with increase in outdoor capacity and mandatory distancing for bars and restaurants; 
• Meaningful enforcement mechanism as we did earlier, including closure of business who violate;
• Quarantine mandates for those who test positive, who have been exposed and who have traveled from outside our community;
• Enforceable and reasonable restrictions on gatherings. 

Additionally, we must  

• Demand State and Federal Governments implement immediately a Hospitality Industry Relief Fund for those displaced and asked to sacrifice in our restaurants and bars;
• Advocate the Governor to permit virtual quorum opportunities be reinstituted. 

We cannot do this city by city – we proved the patchwork of public health mitigation strategies are not only ineffective, they are counterproductive.  Yes, the Governor’s E.O. 244 is an apparent limitation on what we can do — but if we act and a Court tells us we were wrong, then history will judge us with at least having tried.  We need to act boldly and then join arms in defense of the attacks on our collective judgment and efforts.  If we prevail, then we have worked to preserve lives, the quality of life for those who could have been infected and took the steps demanded of courageous leaders.  

Below is a summary of what Philadelphia was forced to implement yesterday.  If we continue to proceed with the current local mitigation strategy, which is far from optimal, it is foreseeable that we could be there again. Soon. 

Best, 

Mike

Here is Santorio’s response:

Mayor Ryan,  

 

The ability to infect a host as you stated, is not the definition of virulence. 

 

“ 1. 

the severity or harmfulness of a disease or poison”

 

My suggestion that what we are seeing for COVID-19 is less virulent is a direct observation of the fact that our admitted patients over the course of a month now comprise 10% in the ICU, vs. near 30% during the first wave. I apologize if you feel that I’m misleading, that is certainly not the intent. I participate in these calls to provide an update of what we (our hospital system) is seeing. The only medical advice I have ever given was to follow CDC guidance and listen to the local clinical experts.

 

I specifically recall saying yesterday that we need to be  very observant of social distancing and infection prevention protocols. 

 

Further, below is a link to a peer reviewed article which concludes observations similar to my statement. Note, it discusses observed virulence related to the reports reviewed. When I report, I report for the benefit of what’s observed in our system not the virus globally. If that is confusing, I am happy to simply provide our numbers in an e-mailed report as my intent is not to confuse a complex situation further.

 

Conclusion 

“This case reports on a seemingly less virulent COVID-19 pneumonia, with a more benign course compared to the COVID-19 pneumonias we saw several months ago. This may be due to characteristic associated with the virus itself including mutation, or may have to do with patient factors. It is important to recognize various patterns in this evolving pandemic.” 

 

https://www.cureus.com/articles/37594-a-less-virulent-covid-19-pneumonia

 

 

 

 

 

Gino R. Santorio, MPA, FACHE

President & CEO

And here is Ryan’s rebuttal:

Gino, 

 

I am happy to debate these medical and scientific issues — virulent refers to the ability of a virus to cause damage to the host.  (Per National Cancer Institute: “Refers to the ability of a virus or a bacterium to cause damage to its host.“; I will not provide a supporting string cite to the use in this context). There is no consensus medical evidence that the ability of COVID-19 to cause damage has been reduced. 

 

Yes, as I indicated, there are medical interventions that seem to have improved outcomes and those are thought to lower mortality — note, there is very little published on the long-term impacts (i.e. damage other than death to the host).  So, maybe the medical interventions are improving mortality, but are you cannot conclude the virus has mutated or changed to cause less damage to people.  

 

Moreover, without further epidemiological analysis and scientific/medical/analytical controls, concluding the virus is less virulent while citing a case presentation involving a single patient is premature at best, particularly where such a statement is unqualified and suggests a mutation.  In fact, the Case Report you site to states that that the seemingly benign course of that single patient (there are 55.2 million cases as of this morning) may actually be due to the patient’s factors.   (“ Some reported risk factors through to contribute to COVID-19 morbidity include obesity, smoking, alcoholism, and poor overall health. Our patient had a normal BMI, did not smoke cigarettes or drink alcohol, and had no medical history. Thus, despite his age of 51 years, he was overall healthy and presumably able to combat the virus well.”).   And, there was no long term follow up of this patient — the followed up 2 days later and “continued to feel better at home.”.  There is certainly discussion in the medical literature regarding viral loads and better outcomes. That continues to evolve. 

 

I stand by my caution of any such conclusion that COVID-19 is less virulent at this stage.  There is no medical evidence COVID has mutated such that is it less damaging to people.  Again, I refute that your observations at Broward General or a case report of a single 51 year old patient in July without further analytical controls is sufficient to tell policy makers they should believe this is less virulent.  We have seen such claims or conclusions justifying a lack of vigilance in mitigation strategies.  Words matter.   

 

If you would like to exchange additional medical and scientific literature, I am prepared to evaluate those as well.

 

For now, what we should be messaging is this is a deadly virus, some otherwise healthy people die, those with risk factors are particularly susceptible to bad outcomes, the long-term impacts even on healthy individuals are not fully understood but could be debilitating and permanent so …. do everything to avoid COVID — stay home, avoid crowded places, close contact settings, and confined spaces.  

 

Mike