CIW to Collier County Government, FL Department of Health: “Failure to prepare invites catastrophe”…

A bus picks up dozens of farmworkers outside of La Fiesta #3 in Immokalee on Friday, April 3, 2020. (Photo and caption: Alex Driehaus/Naples Daily News/USA TODAY – FLORIDA NETWORK)

Collier County Government, FL Department of Health to local CBS affiliate, WINK NEWS: “A field hospital concept has been evaluated and determined unnecessary at this time due to apparent capacity at local hospitals.”

CIW response: “Given concerns of population density, underlying population risk factors and lack of existing medical infrastructure and capacity, proactive development of a field hospital [in Immokalee] would be best practice and consistent with precedents in other parts of FL and the US.  Failure to prepare invites catastrophe.”

Late yesterday, we received an email from a correspondent with the local CBS affiliate, Lauren Sweeney with WINK News. WINK had done an excellent report on the petition to Governor DeSantis to help meet farmworkers’ needs for emergency medical care in the face of the coronavirus pandemic including, among other things, a field hospital or alternative care site in Immokalee.  Here below is that original story:

The email we received was to ask for our response to a reply to that story from the Collier County government and the Florida Department of Health.  The reply included this passage:

The Florida Department of Health continues to provide their services and COVID-19 testing in Immokalee. The Healthcare Network of Southwest Florida continues to provide medical care and COVID-19 testing in Immokalee. A field hospital concept has been evaluated and determined unnecessary at this time due to apparent capacity at local hospitals.

We have written about the unique nature of the farmworker community in Immokalee and the resultant urgent need for intervention by public health authorities to provide critical health resources and services before it is too late on multiple occasions (here, here, and here, to link a few).  So we will not cover that ground again now. 

Instead, we will simply share the response we sent to WINK News this morning with you here, today.  It follows below the break.  Most important is the list of ten reasons why we remain unsatisfied by the Department of Health’s determination that a field hospital is not necessary for Immokalee.  That list appears at the bottom of the email.  When you have finished reading it, please consider signing the petition calling on Governor DeSantis to clear the way for a field hospital and other urgent medical interventions in Immokalee if you haven’t done so already.  Lives depend on it.  Thank you. 


Dear Lauren,

Thank you for sharing the DOH’s response regarding the farmworker community’s call for a field hospital in Immokalee.  To avoid any confusion, when we say “field hospital” we are using the popular term for a facility also called an “alternative care site,” with both beds for those with minor symptoms of COVID-19 but no means to self-isolate at home, and advanced lifesaving medical resources for those suffering the worst symptoms of this terrible virus.  

As you might expect, we — including our medical advisory team, which counts advisors from the Nobel-Prize winning Doctors Without Borders, physicians expert in rural public health care with decades of experience in the Northeast U.S., Central America, and Africa, (including one currently volunteering in a frontline ICU in Brooklyn) and experts in community health economics and epidemiology who work internationally on pandemic planning and response in Canada, Africa and Europe, including a focus on agricultural guest workers, among its number — do not agree with the DOH’s conclusion that a “field hospital concept (is) unnecessary at this time due to apparent capacity at local hospitals.”

On the contrary, we feel that this is exactly the time to be working on preparations for an alternative care site in Immokalee, given that current projections predict the surge of cases to hit SW Florida in the next week and half to two weeks, and the process of getting an alternative care site up and running can take at least two weeks, according to experts in the field.  The math is as clear as it is alarming: We have, quite simply, no more time to waste. 

Indeed, in today’s Ft. Myers News-Press it was reported that in Lee county — with far fewer farmworkers than Collier, and nothing remotely approaching a population center with the numbers and density of Immokalee’s 25,000 residents — health officials have already “reached out to Lee County’s school district and Florida SouthWestern State College” in preparation for the overflow of patients to come, saying:

“We currently have available capacity inner hospitals, but as part of preparing for a worst-case scenario, we are researching alternative sites of care.”

That is the kind of advanced planning and reasonable concern that we hoped, and expected, to hear from our friends and partners at DOH.  Instead, the spokesperson’s curt reply to the farmworker community’s legitimate concerns left us disappointed and, quite frankly, fearful about what the coming weeks hold for Immokalee.

The clock is ticking, if we are to believe our experts’ predictions.  Now is the time to be putting the pieces in place for an alternative care site, before the virus hits our region’s most vulnerable population with its full force.  And we should not – we cannot – commit the fatal error of allowing concerns about possibly “over-preparing” drive our decision making at this crucial moment.  To quote Dr. Fauci, our nation’s leading authority on the proper preparation for pandemics, “I like it when people are thinking I’m overreacting, because that means we’re doing it just right.” 

We may not have Dr. Fauci’s experience with pandemics, but we do know hurricanes, and we have worked shoulder-to-shoulder with Emergency Management and county officials during both Wilma and Irma, helping inform and mobilize Immokalee residents to take shelter before it was too late.  And we all know from hard-earned experience that you simply cannot afford to wait until the eye wall is on top of you to start preparations for a hurricane shelter.  Even for hurricanes, whose path and fury are far less predictable than this virus, you plan for the worst and hope for the best, and you start preparations, and public mobilization, with as much lead time as possible.  If Emergency Management personnel and administrators wait to be sure that the hurricane will hit before organizing a shelter, the cost of their hesitation will be high, and it will be paid in human lives. The same is true with the coronavirus, only far, far more so. 

For the purposes of informing and mobilizing the public, here below are the ten reasons why we are not satisfied with DOH’s current position, and why we expect that position to change in the days ahead. These draw not only from our direct experience regarding what’s needed in our community, but also from consultations with our medical advisory team over the course of the past several weeks.  Please feel free to share these with your viewers, as we believe an informed public is the single most important defense against a public health disaster like that looming in our community:

(1)  Immokalee’s overcrowding makes the community uniquely vulnerable to the rapid spread of the virus (specifically, farmworkers are unable to physically distance or self-isolate due to living conditions, lack the CDC recommended masks for personal use, and have limited access to sanitizers and hand-washing).

(2)  Planning for a field hospital takes time – officials must not only consider structure and materials, but also beds, equipment, staffing, medications.  Any alternative care site needs to be in place and ready to deploy before Naples hospitals are at capacity or risk significant mortality.

(3)  Due to what public health officials call farmworkers’ “congregate setting” — extremely overcrowded living and working conditions —  DOH should expect a significantly steeper curve of contagion and spread in Immokalee than in the rest of Collier County.  That means the lead time for preparations is even shorter in Immokalee, and delays in effective isolation and treatment during this period will exacerbate the number of people infected and result in increased mortality.

(4)  Immokalee already lacks medical infrastructure which would typically be expected in a community of this size.  Lack of medical resources will exacerbate the pandemic impact if no emergency measures are in place.

(5)  If resources to care for this population are not available in Immokalee, people will continue to seek care in Naples regardless of whether or not Naples is at capacity.  This will certainly disrupt an overtaxed health system in Naples.

(6)  Co-morbid conditions which are known to increase mortality in COVID are highly prevalent in the farmworker population (poorly controlled hypertension, diabetes, etc).  Health officials should anticipate significant morbidity and mortality as a result.

(7)  Population density is a significant driver of risk and preparation.  Immokalee FL has a population of 25,284 with a population density of 1,113 people per square mile, this is 172% higher than FL average and 11x higher than national average.  This is very similar to South Beach FL which is referenced in the above article as problematic for social distancing and therefore was considered critical that access be expanded in anticipation of need.

(8)  Farmworkers are not only a vulnerable population but also a population of “essential” workers.  Significant morbidity and mortality of these workers would result in food chain disruption which would impact a much larger population.

(9) There is significant precedent for anticipating the need for makeshift hospitals in Florida:

(10) Given above concerns of population density, underlying population risk factors and lack of existing medical infrastructure and capacity, proactive development of a field hospital would be best practice and consistent with precedents in other parts of FL and the US.  Failure to prepare invites catastrophe.