What went wrong in Florida’s COVID-19 response? Timing, testing, tourism and mixed signals
TALLAHASSEE, Fla. – Two months after Gov. Ron DeSantis boasted about proving the experts wrong by flattening the curve and getting COVID-19 under control, Florida has become the state that other states don’t want to become.
Even with an emergency order reversing the reopening of bars and nightclubs, Florida has witnessed unprecedented, record-breaking growth in the daily number of cases and deaths reported for the last two weeks.
With new cases averaging over 11,000 a day and a positivity rate hovering around 16%, Florida has become the new epicenter for the coronavirus pandemic not just in the US but globally, according to a Washington Post article.
“We don’t want to become Florida,” Pennsylvania Gov. Tom Wolf said Wednesday as he announced new bar and restaurant closures to slow down a surge of COVID-19.
For a month, from April to May, Florida saw relatively stable data for infection and death rates. Hospital capacity was good and ventilators were kept in storage.
The curve had been flattened.
Numbers remained stable through May as the state’s restaurants reopened during Phase 1.
But cases started spiraling upward as more businesses were allowed to reopen June 5. By June 26, the numbers had grown so exponentially that Florida Department of Business and Professional Regulation Secretary Halsey Beshears issued an emergency order shutting the bars back down.
But the numbers kept growing, breaking several records for new cases and deaths, surpassing the 300,000 benchmark and posting higher daily case numbers than any other state.
According to a leaked White House document obtained by the Center for Public Integrity, Florida is one of several states in a COVID-19 “red zone” with recommendations for stronger social distancing measures.
Hospitals that once had plenty of beds are approaching capacity and running out of ICU beds. Florida is second behind Texas in number of current COVID-19 hospitalizations.
So, what went wrong? How did Florida go from being a model of containment praised by the White House to having a positivity rate regularly higher than New York ever posted?
The USA TODAY NETWORK – Florida reached out to several public health and tourism experts to identify the main reasons Florida got off the rails – and how to fix it.
‘Not enough time’
Florida opened too soon, too fast.
“Ideally you want to give it time to see if the numbers change,” said Jennifer Nuzzo, an epidemiologist and professor at Johns Hopkins Bloomberg School of Public Health in Maryland.
“Start with the lowest risk activities. Give sufficient time to let data adjust to make sure you’re not heading in the wrong direction,” Nuzzo said.
And if there is a resurgence, you want to take action to slow things down, Nuzzo said. From May to June, Florida had several phased openings for different businesses in different parts of the state.
“Openings were clustered within two weeks of each other. That is not enough time,” she said.
Cindy Prins, a clinical professor in epidemiology and Master of Public Health Program Director at University of Florida, agreed.
“I guess we thought that Florida had done such a good job of staying at home and maintaining social distancing early on, and controlling the virus that way, that we just didn’t realize some people wouldn’t maintain that after reopening,” Prins said.
Too many businesses opened too soon where people like to congregate and interact, said Julie Swann, the department head and the A. Doug Allison Distinguished Professor of the Fitts Department of Industrial and Systems Engineering at North Carolina State.
“Florida is allowing gyms open at full capacity, allows gatherings of up to 50 people, has bars open, and has no state mandate for face coverings,” Swann said.
However, she noted that what Florida did to flatten the curve in the early phases of the pandemic was crucial to allow time for medical professionals to prepare for a potential surge and keep a relatively low daily death toll until recently.
“However, vigilance must continue, as likely 90% of the population of Florida is still susceptible to COVID-19,” she said.
The travel bug
After being on virtual lockdown for four months, Floridians were itching to get out of the house, said Peter Ricci, director of the Hospitality and Tourism Management program at Florida Atlantic University in Boca Raton.
“I equate Florida to a cruise ship,” Ricci said. “It’s very social and it’s very group friendly, whether you’re flocking to the beach with 10 friends or you’re all around the table having lunch.”
The state’s fortunes depend on tourism, Ricci said, but the state’s longtime reputation as a safe and family-friendly vacation destination could be permanently damaged if the virus does not get under control.
“We need to shut down back to where we were and deal with the financial consequences so we don’t have long term consequences for the state,” he said. “We’re doing a strong disservice to the tourism industry if we don’t take hold of this enemy.”
People might be quick to blame tourism, said Scott Smith, a hospitality professor and director of graduate studies at the University of South Carolina in Columbia.
During a crisis, Swann said, it is also important to consistently communicate the risk to the public and what can be done to mitigate it.
“Behaviors are driving the outbreak, and deaths can be reduced if everyone adapts their actions based on known risks and known solutions,” she said.
Not enough testing or contact tracing
With millions of people moving around there should be a bigger emphasis on testing, contact tracing and quarantining, said Dr. Leo Nissola, a clinical scientist, immunology specialist and investigator at National COVID-19 Convalescent Plasma Project.
Masks aren’t enough, he said.
“We need to trace every single case and be able to identify where the outbreaks are and how they are emerging,” Nissola said.
The positivity rate in Florida began increasing around June 9, which may reflect increased activity from Memorial Day forward, and now that rate is over 15%, Swann said.
“The rate in Florida suggests there is a significant amount of the virus spreading in communities,” she said.
The positivity rate is the early warning system that there is a high transmission rate in the community and many more infected who are not being identified, Nuzzo said.
“It’s higher than it’s ever been. It means we’re missing infected people and stopping them from infecting others,” she said.
Death is a lagging indicator, she said, “the last statistic to change.”
The pace of reopening is problematic if the public health capacity isn’t there.
“Can you test enough, can you do enough contact tracing?” Nuzzo asked. “If you have the capacity to respond, that can alter your trajectory.”
Young adults ‘don’t exist in a bubble’
The downward trend of the median age of people who have tested positive points to community interactions as a likely source of transmission rather than clusters in locations like nursing homes, Swann added.
“Younger people have a mistaken notion that their immune system is superior so they won’t get sick and they won’t spread the virus,” said Dr. John Lednicky, a virologist at the University of Florida who has studied different coronaviruses for decades.
People still don’t know how the virus is spread from person to person, he said. Many people dismiss the notion that the virus can be spread by airborne transmission, because the emphasis from the Centers for Disease Control and World Health Organization has been on close contact and droplets spread by coughing and sneezing.
In confined spaces, like a restaurant or bar or gym, these plumes can stay adrift and infect passers-by, he said. And many bars, gyms and restaurants don’t necessarily follow social-distancing and mask-wearing guidelines, he said, especially among people under 40 “who believe the message that COVID-19 is just a nuisance.”
Those young people are infecting older and more vulnerable populations, Nuzzo said.
“It is harder for vulnerable people to protect themselves against the infected,” she said. “They don’t exist in a bubble.”
‘Not much hope’
It’s one thing for state leaders to reopen and warn people that COVID-19 is a real and present danger, and folks should be diligent about wearing masks and social distancing around crowded indoor spaces, she said.
It’s quite another thing to say “We’re back to business as usual” and not going to reissue shutdowns, she said. “That says, ‘Nothing to see here. No issues. Not a problem.’”
It’s also sending a mixed message when you say everything is under control but shut bars back down, she said.
“Nobody wants to see states shutting down again, but without testing, there is not much hope,” Nuzzo said. “Saying ‘No’ or ‘Stay home’ is not a sustainable strategy.”
Contributing: Alexandra Clough, Palm Beach Post. Follow Jeff Schweers on Twitter: @jeffschweers.
