MIAMI – In a letter sent to Jackson Health System employees, Carlos Migoya, the chief executive officer of Miami-Dade County’s public hospital, painted a grim picture. “This will almost certainly get worse before it gets better,” Migoya wrote, echoing U.S. As the deadly respiratory illness spreads, Jackson Health System and other hospitals “could be at great financial risk,” Migoya warned. In the letter, Migoya asked employees in non-clinical roles “to voluntarily use personal leave over the next few weeks” in an attempt to avoid layoffs. Despite the $830 million bond that passed in 2013 allowing Jackson to invest in much-needed upgrades, the response to the pandemic’s impact is testing the system.