For months, Gov. Rick Scott and state agencies have reported almost daily on the public health crisis posed by the spread of Zika.
From the first three travel-related cases identified in January, to the emergence of local Zika infections in Miami's Wynwood neighborhood in July, followed by the discovery of mosquitoes infected with the virus in Miami Beach in September, the governor and state officials have vowed to keep Floridians informed so they can prepare.
"We're going to put out accurate and timely information," Scott told a group of reporters after a Zika roundtable with civic leaders in Miami Beach in August. "We want everybody to be prepared. We all have to take this seriously."
But the information issued by the governor and state agencies has not been timely or accurate — cases announced as "new" are often several weeks old, because of a time lag in diagnosis — and excludes details that public health experts say would allow people to make informed decisions and provide a complete picture of Zika's foothold in Florida.
"I don't think the message has been strong enough, in terms of, 'We have a problem,' " said Arthur Caplan, director of medical ethics for New York University Langone Medical Center. "It makes no sense — unless you see it through the eyes of the impact on tourism. I think that's money driving reporting rather than public health."
Over the past month, as local Zika infections have spread beyond Miami-Dade, with cases cropping up in Pinellas, Broward and Palm Beach counties, Florida officials have:
• Stopped providing detailed information on epidemiological investigations into local Zika infections.
• Refused to identify all the locations where Zika-positive mosquitoes were trapped in Miami Beach.
• Underreported the number of local Zika infections in Florida by excluding anyone who is not a state resident.
Not reporting local Zika infections to tourists is particularly egregious to Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"That's just wrong," he said. "To get a true picture of what's going on in Florida, you want to know, among anyone who was in Florida, who acquired it there. . . . That's how it should be counted. If they're not, then that sounds to me like they're trying to minimize their number of cases."
The Florida Department of Health has been criticized before for its disease reporting methods, most notably for taking hundreds of HIV cases off the books in February as then-state Surgeon General John Armstrong was under fire for a spike in infection rates. The agency later explained that some cases had been shifted to the year of diagnosis or to the state where the individual resides to avoid double counting.
State Surgeon General Celeste Philip has said that, similar to HIV reporting, Florida's method for documenting local Zika infections adheres to standards set by the federal Centers for Disease Control and Prevention. CDC guidelines state that Zika cases are counted in the state where the person lives — regardless of where exposure might have occurred.
"There has been a lot of interest in how we count HIV cases, and it has to do with place of residence," Philip said after an August news conference on Zika. "So the governor announced that we had three (Zika) cases associated with tourists (in Miami Beach), and we were very transparent about where they came from. But in terms of the technical count for the state, CDC will count them in their (state) of residence."
But Florida chooses how to report local Zika infections to the public, Osterholm said.
On Sept. 7, the state Health Department, in response to questions from the Miami Herald, said eight out-of-state residents have contracted Zika in Florida but are not included in the total count.
Mara Gambineri, a spokeswoman, said the Health Department tracks those cases "as they are still important for us to be aware of, but the cases are not reported in our case counts. The department reports cases of Florida residents."
That means there have been at least 64 local Zika infections in Florida this year, not the 56 cases reported so far.
The vast majority of infections in Florida have been imported by residents who caught the virus while traveling abroad. Statewide, health officials have confirmed 700 travel-related cases, including 80 pregnant women, as of Friday. The Health Department has refused to say how many local infections involve pregnant women.