BREVARD COUNTY, Fla. –Texas and Arizona were among the first states to take a leap of faith in May by reopening their economies from lockdown orders meant to slow the spread of the novel coronavirus.
But in the weeks that followed, new COVID-19 cases began to gradually climb in both states. Then, after bars, gyms, hair and nail salons and other places not conducive to social distancing reopened, new cases skyrocketed.
Now both states are seeing a growing number of COVID-19-related deaths as hospitals reach capacity to handle new patients. The governors of those states have reversed parts of their reopenings. Thursday, Texas Gov. Greg Abbott mandated face coverings for most of the state — something he'd opposed earlier.
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Florida's reopening schedule trailed the two Western states by about two weeks, and like them, Florida has seen a stunning rise in coronavirus cases, with a record 10,109 new infections reported Thursday and 11,458 on Saturday.
But, for now, deaths and hospitalization numbers are not as dire in the Sunshine State as in Texas or Arizona.
It may be only a matter of time, though, public health experts warn. And whether Gov. Ron DeSantis's phased reopening was prudent enough to avoid overwhelming medical systems will be apparent in the coming weeks.
“We've gotten hit. And now we have to wait and see whether or not those folks who are testing positive are passing it on to those who will be more susceptible to illness and death, but we won't know that for a couple more weeks," said Jay Wolfson, the vice dean of the University of South Florida's medical school.
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Amid the spiking cases in Florida, DeSantis on June 26 essentially closed the bars by banning the consumption of alcohol on premises, but he has not signaled a desire to reverse course further. At a press conference Tuesday, DeSantis said "We're not going back, closing things."
DeSantis also has resisted calls to mandate mask-wearing statewide, leaving the decision up to local governments.
Is Florida on the same course as AZ and TX?
Florida differs substantially from Arizona and Texas because of the tourism the state sees and has seen in the past several weeks, meaning instead of centralized hotspots like Houston or Phoenix, Florida may see several epicenters spread across the state.
“We are different ... folks don't routinely go to Texas," Wolfson explained, "and people come to Florida to have a good time, people will travel from different parts of Florida to the beaches in Florida to enjoy it.”
But what is also clear now is that new cases per day over the month of June rose substantially in Florida, and in Texas and Arizona that trend appeared to start in late May.
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Texas, Arizona and Florida all began reopening in early May, Arizona was the first to reopen bars on May 16, followed by Texas on May 22 and then Florida on June 5. Florida and Texas closed their bars on June 26 and Arizona followed suite on June 29. Maricopa County, home to Phoenix, has eclipsed New York City as the nation’s worst epicenter of the virus. In Houston, hospital systems are reaching capacity for the first time.
Arizona, with a population of 7.2 million — about a third of Florida's — squandered early opportunities to contain the virus.
Similar to DeSantis, Arizona's Gov. Doug Ducey downplayed the risks and took a non-aggressive approach, his critics say.
Months later, the state is among the world's worst coronavirus hotspots.
And the victims are getting younger. The average age of people who die from the virus in Arizona dropped nine years, from age 78 in late April to 69 years old by mid June, according to that state's health stats.
Many point to the mid-May reopening of bars, gyms, hair salons as the cause of the current spike in Arizona.
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By mid-June, some cities in the state refused to wait for the governor to act and enacted their own mask-wearing mandates.
Monday, Ducey announced that bars, gyms, theaters and water parks would again close down, and he limited swimming pool crowds to 10 people and other public crowds to 50 people. Churches or political gatherings remain exempt.
Like Arizona, Texas began reopening its economy earlier than many states.
In Texas, Gov. Greg Abbott began re-opening the state on May 1. Like Florida, Texas took a phased approach, with different businesses reopening at different levels of capacity staggered throughout May and June. Bars in Texas reopened on May 22 as a part of the state's 'Phase II.'
Now Harris County, which includes the city of Houston, is a major epicenter of the disease in the state and Texas hospital systems are reaching ICU capacity for the first time.
Since Memorial Day, the number of patients hospitalized with COVID-19 has quadrupled in the state, according to the Texas Tribune.
The state's reopening, the Houston Chronicle proclaimed in an editorial, has been "a disaster."
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Some health experts fear a similar disaster for Florida.
Florida reopened bars on June 5, when the state was recording a little more than 1,000 new cases per day. By June 12 the state began recording nearly twice as many daily new cases. By June 26, when DeSantis barred alcohol consumption at bars the state recorded 9,580 new cases.
DeSantis initially attributed the rising numbers of infections to increased testing. But while the number of people being tested in Florida has increased dramatically, so has the percentage of tests coming back positive.
The state's goal is to keep the rate of people testing positive 10% or lower. But in the past few weeks, that rate has climbed to the 12% to 15% range on some days.
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Medical experts say people congregating in enclosed places like bars and stores has likely contributed to the growing number of cases.
DeSantis justified reopening, in part, because COVID-19 hospitalization rates and death rates were dropping and hospitals had ample beds, ventilators and other capacity to handle a surge in patients throughout May and June.
"The increasing number of people testing positive should not be viewed in a vacuum,” DeSantis's spokeswoman Helen Aguirre Ferré, said in a June 12 email to FLORIDA TODAY, part of the USA TODAY Network.
“This could mean that individuals who are testing positive for COVID do not have underlying health issues, and/or we are getting better at treating this disease,” Ferré added.
But that reality evaporated last week, when across the state hospitals began to see a marked uptick in COVID-19 admissions and ICU usage.
On Wednesday, four of Southwest Florida's nine acute-care hospitals reported having no available intensive-care unit (ICU) beds for adults partly because of the surge in COVID patients, the Naples Daily News reported.
Since the last week of June, Wolfson said, there's also been an increasing number of COVID-19 patients requiring ventilators.
For the next three weeks, Wolfson added: “what we really have to look at carefully is not only the hospital admissions, but the hospital admissions for COVID, and then those that go into ICU.”
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Through the reopening in May and June, Wolfson said increased hospital use was due only to the backlog of elective and non-essential procedures being caught up. But for the past week he says there’s a new added burden of COVID-19 cases that wasn’t there before.
“If we experienced the same follow through, from high levels of new positive cases that Arizona and Texas did, then we run the risk of having the super spreaders having created a community spread, and those folks are going to potentially overwhelm our hospitals,” he said.
Already, Wolfson said the surge in testing is leading to a lack of kits available for testing hospital staff. In the past few days, state health officials closed testing centers in Pinellas and Hillsborough County, Wolfson said, due to strain on the test supply.
Floridians flout warnings
Public health experts see several parallels among Arizona, Texas and Florida, especially with the behavior of younger people.
The health experts had urged people to forgo attending church services or other events with large crowds packed into small, confined spaces. But descriptive notes in the Florida Medical Examiners Commission's COVID-19 database shows some — and not only youngsters — did not heed those warnings, with fatal consequences.
One of the youngest persons to die in Florida to date, a 17-year old Miami-Dade County woman, died on June 23, from complications of the virus. She had days before, on June 10, attended a church function with 100 other children and no masks, the medical examiner noted.
The medical examiner's notes indicated several risk factors for the woman including a preexisting rare nerve condition, asthma and morbid obesity.
Health officials also warn against unnecessary risky trips, but on June 24, an 82-year-old Orange County woman with dementia died after being admitted to the hospital on June 15 with a cough and shortness of breath. She had recently taken a “shopping vacation in Miami,” the medical examiner noted, and the family admitted "no one wore masks or practiced social distancing."
DeSantis, at a Thursday press conference in Tampa flanked by Vice President Mike Pence and Dr. Deborah Birx of the White House coronavirus task force, appealed to Floridians to wear masks and avoid congregating in enclosed, air-conditioned spaces. He said "various factors" are driving new infections, but attributed it primarily to the young and said that in hospitals the average age of patients is already dropping.
Too early to reopen Florida in the first place?
Throughout the reopening process, DeSantis cited Florida’s most-positive health metrics such as decreasing death rates and ample hospital space to handle a surge.
But dozens of counties in the state appear to never have met Florida's own reopening benchmarks that the state laid out before the phase one reopening began.
Speaking to reporters in May before the present spike in cases, USF's Wolfson said the benchmarks not being hard-and-fast rules, so much as guiding indicators ultimately meant DeSantis's decision was going to be in part based on data, and in part based on feeling.
"DeSantis and others are making a very tough decision to try to balance the economy's needs with public health needs and in this case he made a 'leap of faith' that reopening is the best choice even though the data showed that there are some counties that might not be ready," he said.
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Whether there ever was sufficient data to support the reopening has been at the heart of allegations that Florida health officials tried to "cook the books" on COVID-19 data.
When officials looked at the numbers county-by-county, they didn’t like what they saw, according to Rebekah Jones, former manager of the state's COVID-19 data dashboard, who says she was fired for refusing to manually alter data, in particular the testing positivity rate in specific rural counties.
Some counties had positive results for more than 10% of the tests, another standard Jones said the Florida Department of Health considered in reopenings. During an April 26 meeting, Jones said she was asked by Deputy Secretary of Health Shamarial Roberson to simply change the numbers so that counties were below 10%.
Roberson and the Department of Health have denied the claims. But they've also left questions unanswered about how the positivity metric is calculated. What's more, no researchers at any Florida university yet have access to the DOH's raw data to verify or analyze the state's numbers. A data-use agreement is currently being negotiated by the Council of Florida Medical School Deans.
The White House guidelines and Florida's benchmarks are nonbinding. State officials could ignore them altogether if they chose.
Reporter Bailey Gallion and the Arizona Republic contributed to this report. Follow Jim Waymer on Twitter: @JWayEnviro