Florida seemed headed for disaster: In the earliest days of the coronavirus epidemic in the U.S., throngs of rowdy spring breakers flocked to the state's beaches and bars. Disney World, which draws visitors from around the globe, seemed a uniquely dangerous breeding ground. And the state's demographics were worrying, given that Florida is chock-full of retirees in populous senior communities (Gov. Ron DeSantis has recently joked that Florida is " God's waiting room ").
DeSantis, for his part, spouted off false information about the virus as he resisted increasingly urgent calls from experts and local leaders to take action. He refused to close the spring break gathering spots, allowing officials in South Florida to make their own decisions about restaurant and beach closures. He waited until April 1-two weeks after other states began closing their businesses-to issue a "safer-at-home" order. As Florida reported the first deaths on the East Coast, it seemed inevitable that the country's third-largest state would join New York, Washington, and California as one of the pandemic's regional hubs.
The disaster didn't arrive, though. Florida hasn't exactly been spared, and as of Tuesday, it has had more than 47,000 cases and more than 2,000 deaths. But the predictions had been dire: 465,000 Floridians hospitalized under the worst-case scenario, if social distancing measures were not enacted. If you rank states by the number of cases per capita, Florida is 32nd-just worse than California. (It's 27th on the list of deaths per capita.) Despite many ominous signs about Florida's handling of the coronavirus, the state appears to be doing, surprisingly, OK.
This has led people to speculate. Were fears overblown and DeSantis' critics wrong? Could it be that Florida never needed to take the kinds of measures New York took? Is it just the weather?
According to one popular theory, that might be part of it: Floridians fared better because of the state's tropical climate. Since COVID-19 emerged, scientists have wondered if the virus will experience seasonal fluctuations, dipping in the summer because it spreads less under hot and humid conditions. Some of the optimism is based on the behavior of flu viruses, which have a familiar seasonality. Similarly, Dr. George Rutherford, the head of the infectious disease and global epidemiology division at the University of California in San Francisco, said that human alpha coronaviruses-the ones that can cause common colds-peak in winter months. But no experts have claimed that the summer will save us.
A number of working papers suggest that the coronavirus does do worse under hot and humid conditions. "SARS-CoV-2 probably does have some temperatures it likes better," said Dr. Larry Chang of Johns Hopkins Medicine. But, he added, "none of that is 100 percent, slam-dunk definitive." Lab experiments have shown that the virus spreads more and survives better in cold and dry settings. Even with the flu and common cold, we don't really understand the mechanisms that cause the viruses to stumble in the summer. But scientists have theories. SARS-CoV-2 is enveloped in a coat that may be broken down under heat or humidity, or under UV light from the sun, meaning it would no longer have the structure needed to be infectious. This degeneration also happens when it's exposed to soap or just exists on its own for long enough.
Humidity, some experts have proposed, may also help because the virus is transmitted through droplets when you cough, breathe, or talk. One theory holds that in humid air, the virus-laden particles fall more quickly to the ground. Another theory says that low humidity can affect the respiratory tract's cilia, microscopic structures that help clear them of dirt and mucus, therefore making us more susceptible to certain viral infections. Similarly, sunshine helps the body produce Vitamin D, which may be connected with good health and resilience.
There's another factor that generally helps summer slow the spread of disease: human behavior. People spend more time outdoors in the summer and less in enclosed spaces with other people. Children also get out of school in the summer, resolving one of the most reliably common methods the flu virus spreads. (The coronavirus may not follow this trend. We know children can become infected, but we don't know how much they transmit the virus, so we don't know how much a return to school will affect the numbers. "With influenza, elementary schools are massive factories," Rutherford said. "But we have no evidence of that with this virus.")
"The coronavirus is a very different virus, so we just don't know yet," said Dr. Dean Winslow, an infectious disease specialist at Stanford Health Care. He agreed that there was room for hope, but not too much, and he warned that we should be careful to make any assumptions about the virus. "I think a lot of us are reticent to make too broad of predictions because this virus has fooled us so many times," he added.
And lab tests are notoriously difficult to apply to real life. Rutherford noted that what seems more convincing, from a practical standpoint, is that Brazil had a major epidemic, and there was even an outbreak in a bath house in China. "So I think that if there's an effect, it's going to be quite modest," he said.
So if it's not climate, then what?
DeSantis has tried to claim some of the state's success for himself. He has repeatedly declared victory over his critics, noting the high rates in Democrat-controlled states, such as New York (a state DeSantis has been eager to both blame for the virus and compare himself against). In an interview with the National Review published Wednesday, the governor said the state's aggressive stance with regards to nursing homes allowed it to be more lax with the general population.
This has some truth to it. Florida ramped up testing at long-term care facilities and gave the workers at those facilities priority when it came to personal protective gear and other resources. DeSantis ordered the National Guard to conduct on-site tests at elder care homes, ordered all staff at senior care facilities to be screened for temperatures, and launched a mobile testing lab to travel to long-term care facilities. Significantly, in early May, he ordered hospitals to test patients for the coronavirus before transferring them to the care facilities. New York, by comparison, mandated that nursing homes accept recovering COVID patients in order to free up beds in the hospitals-a decision that has been heavily criticized.
Still, it's not as if DeSantis acted quickly. The Miami Herald reported Wednesday that the state concealed its knowledge of the looming threat early on, and as new probable cases began piling up, the health department refused to release information about testing even to local hospitals and state senators. If nursing homes were spared some worse fate, it would also have something to do with those facilities' own decisions. Earlier in May, some nursing home administrators told the Herald and Tampa Bay Times that they had adopted protective measures more than a month before DeSantis ordered them. The state testing efforts, they said, were "great but way too late," and the lack of available tests early on had made it impossible to stop outbreaks.
DeSantis has touted other policy decisions that are trickier to examine. He has claimed, for example, that his decision not to close beaches statewide was vindicated. While beaches are generally considered safe places for responsible recreation, Peter Rebeiro, a professor at Vanderbilt University School of Medicine, noted that it's difficult to say what their effect would be if you factor in more crowded and party-oriented places, such as South Beach. Plus, southeastern counties made their own decisions to close their beaches.
And that gets at another significant factor. DeSantis has boasted about allowing different restrictions for different counties. "I said from the beginning, we're a big, diverse state," he told the National Review. "The epidemic is not going to affect this state uniformly, and what's appropriate in Miami and Broward may not be appropriate for Jacksonville or the Panhandle." But many public health experts agree that prompt action in the earliest days of the pandemic in the U.S.-even in rural areas-would have saved thousands of lives, and Rebeiro said most public health experts would agree that an earlier statewide order in a state as large as Florida would have spared a significant number of deaths.
Thankfully, Floridians started taking the pandemic seriously before they were told to do so. As state officials dithered, the residents of the hardest-hit counties began staying home in mid-March. The Tampa Bay Times, which also credited a car culture and urban sprawl that kept residents away from packed public transportation, analyzed statewide cell phone data to track residents' movement:
Miami-Dade has had the largest outbreak in Florida. But in the five days preceding the county's March 26 stay-at-home order, more than half the phones tracked by one of the firms never traveled more than a mile. That represented a drop of more than 80 percent...from mid-February to early March. Residents of the biggest counties were quickest to put social distancing guidelines in place. But the trend was consistent. ...By April 3, when DeSantis' shutdown order took effect, nearly half of the state's counties had seen 50 percent drops in median movement for at least two weeks.
The timing matters here-the pandemic hit the Northeast first. So it's not just that Floridians started staying home early compared to their official order; it's that they started staying home at an earlier stage of the epidemic. Anyone who doubted that the state's residents would be responsible underestimated Floridians.
But it may be that we need to question the idea that Florida has actually done as well as is being said. There's no question that the apocalyptic worst-case scenario numbers didn't arrive, but those numbers were meant to indicate the dangers of inaction. Florida looks good if you examine it by per capita numbers, but "statewide summaries are tricky in states where there's a balance between densely populated areas and rural sparsely populated areas," Rebeiro said. "Florida is very populous, but also very large. So there's room for there to be very different data."
Florida's most populous counties-Miami-Dade, Broward, and Palm Beach-were its hardest hit. Miami-Dade, with 16,300 cases and 578 deaths, looks significantly worse than the similarly sized Dallas County in Texas, which has had 8,000 cases and 196 deaths. Comparing hard-hit dense counties isn't a very fair way of looking at a state's success, but it's worth remembering that the state's stats will have been bolstered by its stretches of rural areas.
There's also reason to question the integrity of the data. Several Florida publications sued the state over its initial refusal to hand over data about nursing homes. And, the Miami Herald noted, the state tallies up numbers in inconsistent ways. An enormous disparity between state-reported testing numbers and CDC numbers was discovered Tuesday. It's not clear where that gap comes from, but it heightened concerns already raised last week, when the Florida Department of Health fired the data manager behind Florida's online coronavirus data site because of "a repeated course of insubordination." The woman, Rebekah Jones, said in an email to CBS12 News in Tallahassee that she had been fired because she objected to orders to "manually change data to drum up support for the plan to reopen." Internal emails indicated that Jones was fired after resisting orders from her bosses to cut off data so that users could no longer download it and to remove records of symptoms and positive tests posted before they were officially announced. The Tampa Bay Times also reported that after media requests about data, she had been asked to remove fields indicating when patients had begun experiencing symptoms. The news caused many critics to worry about the state's dedication to transparency.
It does seem, regardless, that newly reported cases were declining through April. But at the end of the month, that rate started to flatten, and in recent days, it's begun moving up again. A new model from PolicyLab at Children's Hospital of Philadelphia also warns that Southeast Florida in particular should brace for a second wave of cases in the next four weeks, following its early decision to reopen businesses.
So we should be careful when talking about Florida's success. When we're talking about DeSantis' "victory lap," we're talking about a triumph over dire projections.
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