COVID-19 Dispatch: University of Florida Health, Jacksonville

Low Vaccine Uptake Fuels Florida’s Pandemic Surge

At University of Florida Health in Jacksonville, the hope that the COVID-19 pandemic was winding down has given way to frustrated exhaustion as cases mount among the unvaccinated.

Bernadette Belgado, director of pharmacy, said the area is facing its third COVID-19 surge, with cases exceeding the previous peak from January. She said the health system’s leadership describes the local COVID-19 infection trajectory as “meteoric.”

“This is true of our hospital and many of the hospitals in the Jacksonville area. What we’re hearing is, we’re just seeing the start of it,” she said. “And our numbers are just continuing to rise.”

Earlier COVID-19 waves mostly filled hospital beds with elderly victims of SARS-CoV-2. But Belgado said this surge is affecting patients in their twenties, thirties, and forties.

“Patients are presenting sicker, and they’re presenting younger. And that is concerning,” she said. She confirmed that more than 90% of hospitalized COVID-19 patients are unvaccinated, and nearly all COVID-19 deaths in June and July were among the unvaccinated.

The Centers for Disease Control and Prevention (CDC) has described the ongoing surge as a pandemic of the unvaccinated. The surge is fueled by growing circulation of the highly infectious SARS-CoV-2 delta variant.

Belgado said the most upsetting aspect of this surge is that it was largely preventable, thanks to the widespread availability of effective vaccines. And the elation than many felt about vaccination curbing the pandemic has given way to the new reality of low vaccination rates and escalating cases.

“We really felt like we were turning the corner, and then it happened,” she said of the current surge. “It’s really sad. ... People are truly dying from this.”

Belgado said a mass vaccination clinic that the health system opened in December essentially closed its doors in June for lack of interest.

She said that although it’s frustrating to face this surge, hospital staff still cultivate and express empathy for the patients under their care.

“That’s one of the things that we do as healthcare providers,” she said. “Our pharmacists are completely dedicated to what they’re doing. ... We have a strong clinical effort within the hospital to make sure that we provide the best treatment for our patients.”

Belgado is involved in an initiative to vaccinate patients before they leave the hospital. That program uses the one-dose Johnson & Johnson–Janssen COVID-19 vaccine instead of the Pfizer–BioNTech or Moderna mRNA vaccines, which would require a return visit for second dose.

Although their hospital experience is fresh in the patients’ minds, some waver after agreeing to get vaccinated.

“There is some vaccine hesitancy, because folks will consent, and then we’ll get to the bedside and they’ll change their mind,” Belgado explained. Patients who agree to get vaccinated but express a strong preference for an mRNA vaccine are directed to local sites where those vaccines are available.

One of the pharmacy department’s biggest clinical challenges is the management of outpatient monoclonal antibody therapy for COVID-19. Belgado said demand for the therapy was strong when it first became available but had slowed to a trickle before the new surge.

“Now we don’t have enough appointments to accommodate everyone,” she said. Part of the problem, she said, is the number of infusion clinic staff who are under quarantine after exposure to the SARS-CoV-2 virus.

“It’s true in our nursing units as well,” Belgado said. “We’re running short on nurses and therapists and all of the other ancillary services. And ... it really puts a strain on the staff.”

Vaccinated and unvaccinated staff may be forced to quarantine after exposure. Belgado said the health system’s quarantine policy is based on guidance from CDC and the Occupational Safety and Health Administration.

Belgado said the new surge is prompting some staff members to overcome their reluctance to get vaccinated. The renewed demand prompted the employee health department to place its first order for COVID-19 vaccines in weeks.

“We’re excited about that,” Belgado said. She noted that up to 76% of the organization’s pharmacy team has been vaccinated, which is among the highest departmental rates in the health system.

“We have some holdouts, but we’re talking to them and hopefully when all is said and done, we’ll have 100% fully vaccinated,” she said.

Many people have fallen prey to misinformation about COVID-19 vaccines. Belgado said the health system has tried to counter that by holding town halls, producing educational videos, and going into the community to provide education and promote vaccination.

She also emphasized that COVID-19 vaccines are widely available locally in community centers, churches, pharmacies, and other locations — even on the beach. She attributed the lack of vaccine uptake to hesitancy in the community.

“I don’t think it’s because of lack of access,” she said.

She also said the pharmacy team is weary after coping with the pandemic for more than a year.

“We do our best to keep up morale,” she said, adding that celebrations are mostly low-key because of the pandemic. “We just had an ice cream day ... to let them know that we’re thinking about them, and we know that you’re working hard, and we thank you for all of the work that you’re doing.”

For access to ASHP' free tools regarding the pandemic, including our COVID-19 Vaccine Confidence Toolkit, visit the COVID-19 Resource Center and the COVID-19 Community at ASHP Connect.

[This news story will appear in an upcoming issue of AJHP.]