Miami’s diverse community challenges effort to fight COVID-19

The novel coronavirus came to Miami by land, air and sea. 
As a major U.S. docking point for cruise ships, PortMiami in March and April took in passengers and crew members from ships stranded at sea after they were denied port throughout South America and the Caribbean over COVID-19 concerns. 

As the world shut down, Miami opened its doors. 

“While we are all committed to preserving resources for our own residents, an international community like Miami would never turn our backs on people aboard ships at our shores,” Tania Leets, a spokeswoman for Jackson Health System, said at the time in a local news report. Miami-Dade County Mayor Carlos Gimenez, for his part, said accepting cruise ships like the Coral Princess, which didn’t dock until April 4, was necessary to save lives. 

Miami’s identity as an international city with a diverse population has steered its response to the pandemic, health officials say. Miami is not only home to immigrants and those from various cultures, but it’s also where many migrant workers and those who are homeless live. Add to that the area’s ranks of retirees and tourists, and it has created an environment in which hospitals need to reflect the community in order to provide good care. 

“We have such a diverse population, it makes it a little difficult for us,” said June Ellis, associate chief nursing officer at Jackson Memorial Hospital, the flagship hospital of the county-run Jackson Health System.

Indeed, that openness to the world may have pushed Miami-Dade higher on the county ranking of COVID-19 infections than its size would dictate. Johns Hopkins University & Medicine’s Coronavirus Resource Center lists Miami-Dade as having the second-highest number of COVID-19 cases in the country after Los Angeles County, and as one of the top 10 counties for COVID-19 deaths. 

As of Sept. 23, Miami-Dade had 166,784 confirmed cases of COVID-19 and 3,127 deaths, according to Florida Health Department data. 

Hospitals take in passengers
Ship passengers or crew members who required medical attention were sent to Miami-area hospitals, such as those run by Jackson Health, Baptist Health and the University of Miami Health System, for treatment. “Some of our first patients we received were from outside Miami,” Ellis said. 

Passengers were stuck at sea for weeks, and many had been quarantined in their rooms for as long. “It was frankly a bit heartbreaking to see these people,” said Dr. Sergio Segarra, chief medical officer for Baptist Hospital and an emergency physician who helped care for those from the cruise ships. “They had no idea even where they were.”

Natives and seniors were hit hardest, though. Early on, Miami’s COVID-19 cases were largely among its older population, as in many places. To date, virus-related deaths remain largely isolated to those who are over 65, according to Florida Health Department data. 

As home to many retirees, Florida has the second-greatest proportion (21%) of those 65 and older in the country, according to the U.S. Census.And in Miami-Dade, the population of older adults is expected to double from 2015 to 2040, according to the Shimberg Center for Housing Studies at the University of Florida. 

Aside from the cruise-ship passengers, infections are concentrated among the county’s diverse residential population. As a tourist destination, Florida also breaks out nonresidents in the daily COVID-19 statistics issued by the state health department. As of Sept. 17, there were 1,093 confirmed cases of COVID-19 in nonresidents in Miami-Dade, which represents less than 1% of the county’s total cases. 

Although Miami beaches reopened for Labor Day after being closed for other major spring and summer holidays, nonresidents aren’t visiting, Segarra said. “We’re not seeing that influx of tourism that we had seen earlier,” he said. 

To reach different communities, the Florida Health Department in Miami-Dade County worked with county and municipal governments and community partners, including hospitals and nursing homes. “This is a very strong community with many resources, and when we all come together, beautiful and important things can happen,” said Yesenia Villalta, administrator and health officer for the Florida Health Department in Miami-Dade County. 

Focusing on immigrants
Caring for immigrants was a focus. In June, the American Friends Service Committee’s Miami Immigrant Rights Program, a Quaker organization promoting immigrant rights, worked with the Florida Health Department to bring mobile testing to migrant farmworkers and their families in Homestead, an agricultural community south of Miami.

They also distributed masks, food and information. 

Migrant workers often live in tents or crowded housing units, which makes preventing the transmission of COVID-19 more difficult, Baptist Health’s Ellis said. Long working hours and a lack of transportation that prevents testing access add another layer of complexity. 

“We see them typically when they’re very sick,” Ellis said. “They shy away from healthcare because some of them are undocumented.”

Florida Gov. Ron DeSantis in early June said agricultural communities represented the state’s No. 1 outbreak, a sentiment that was met with criticism by aid groups, which said the state failed to help those communities in the early months of the pandemic. 

In one instance, a farm worker who had been working in Miami-Dade County infected at least 76 other workers when he relocated to a watermelon farm in Alachua County in the northern part of the state. 
The Florida Health Department in Miami-Dade County also works with the Miami-Dade County Homeless Trust, which coordinates the homeless response in the county. 

Together, the organizations created a team early in the pandemic to coordinate testing and contact tracing among the homeless population. Before that, the Homeless Trust also started distributing hand sanitizer, masks and face coverings and trilingual informational materials to homeless people. “Because we’re so warm, we have a population at all ends of the spectrum,” Ellis said. 

In September, the Homeless Trust started offering free flu shots through Walgreens to homeless people on the streets, at quarantine and isolation sites, and in emergency shelters. The trust serves an estimated 8,000 people experiencing homelessness. 

The state health department, as well as the hospitals, disseminate information in the area’s three predominant languages: English, Spanish and Creole. 

At Baptist Hospital, the staff mirrors the community, making it easier to care for patients who speak multiple languages and have various cultural backgrounds. “Our employees are as diverse as the community we live in,” said Segarra, who fluently speaks English and Spanish. “I do not speak Creole, yet there’s always a nurse or someone who does.”