‘The cost of happy talk’: Medical experts warn of death toll if shutdowns don’t happen now

A statistical model, cited in the decision to issue a countywide shelter-in-place order in Dallas, shows that Florida may have only one week to contain the virus before hospitals are overwhelmed.
Chicago's Lake Shore Drive is barren of its usual vehicle traffic, Monday, March 23, 2020. The coronavirus pandemic could test a generation in ways they have never faced. One expert likens the impact to that of the Great Depression. As they're being asked to study at home and distance socially to help their more vulnerable elders, how will they cope?
Chicago's Lake Shore Drive is barren of its usual vehicle traffic, Monday, March 23, 2020. The coronavirus pandemic could test a generation in ways they have never faced. One expert likens the impact to that of the Great Depression. As they're being asked to study at home and distance socially to help their more vulnerable elders, how will they cope? [ CHARLES REX ARBOGAST | AP ]
Published March 24, 2020|Updated March 24, 2020

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TALLAHASSEE — Gov. Ron DeSantis took to the airwaves Monday to vigorously defend his decision not to order people to stay home.

“You simply cannot lock down our society with no end in sight,’’ he said at a teleconference from the governor’s office with only television reporters in attendance.

He said he is more inclined to work with selective communities across Florida to impose restrictions but “those measures need to be sustainable for the long term.”

“Floridians are willing to do what it takes” he said, but added, “I don’t think it’s going to be stay in your house for nine months. That’s just not going to work.”

The governor’s position is contrary to a mounting number of public health experts and local and legislative officials who want him to issue a temporary, short-term, stay-home order to prevent the spread of the novel coronavirus before the number of seriously ill Floridians overwhelms the healthcare system.

“It is past time to intervene to slow transmission [in Florida],” said Marc Lipsitch, professor of epidemiology at Harvard T.H. Chan School of Public Health in a call with reporters on Monday.

He and other public health experts warn that it will take three weeks of self-imposed limits on public movement before relief is felt on hospitals and emergency rooms but, without it, more people will die.

They point to a statistical model, cited in the decision to issue a countywide shelter-in-place order in Dallas, that shows that Florida may have only one week to contain the virus before hospitals may be overwhelmed.

COVID Act Now is a tool created by a team of data scientists, epidemiologists, public health officials and political leaders that models the impact of the virus in certain regions of the country. It takes into account government interventions and the number of hospital beds in each state to estimate the number of hospital beds needed and the number of deaths expected.

In Florida, the model predicts 465,699 people will be hospitalized because of COVID-19, the illness caused by complications from the virus, by April 24 but there will only be 36,384 hospital beds available by that date.

The model’s curve, however, flattens with three months of social distancing. It flattens more with three months of shelter in place and it is almost completely flat with what the model calls “Wuhan-style lockdown.”

The model updates every four days, which is roughly equivalent to one disease doubling period. It also gives the date of the “point of no-return” for state intervention to prevent hospital overload.

For Florida, that date is March 30, one week away.

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The model has been used elsewhere to project the impact the virus will have on hospitals. In Texas, Dallas County Judge Clay Jenkins, who oversees the four elected county commissioners, issued a stay-home order for the city Sunday, citing data from the model.

Joe Nation, a professor of public policy and biology at Stanford University, said he endorsed the statistical model because it “gives a sense of order of magnitude and impacts” of the disease but acknowledged the conclusions are imprecise.

On Tuesday, leading U.S. medical and health organizations called on the American people to stay home to help reduce the spread of COVID-19.

Related: Read the letter here

As DeSantis rejected calls to impose a stay-home order or close non-essential businesses, governors in California, New York, Washington and 10 other states have moved ahead with temporary restrictions.

DeSantis pointed to crowded beaches in California and the stream of travelers from New York to Florida as evidence that those orders aren’t working.

“And the fact of the matter is, a governor is not going to start imprisoning people just because they leave their house,’’ he said. “So you’re going to have a lot of non-compliance.”

DeSantis announced that while the state won’t halt the number of people who are fleeing to Florida from other states, he will require “anybody traveling from those regions in New York or New Jersey to the state of Florida is going to have to do a mandatory 14-day self isolation.”

The governor said earlier Monday in a press conference at The Villages that he wants “good data” on the coronavirus to drive his decisions about whether to shut down the state. He implied that it isn’t yet a major concern in many parts of Florida.

“We’ve still got 20 counties with zero infections and I think about 26 that have 2, 3, 5, 7 type of infections,” he said.

But the data he’s relying on may be inadequate and out of date. As of midday Monday, Florida had conducted just over 13,000 tests in a state of more than 21 million people. Because a person may get multiple tests, the number of people who have been tested is less than 13,000.

Public health experts estimate that because half of the transmissions may be coming from people who show no symptoms, they are fighting an invisible foe. That has people showing symptoms in alarming numbers without tests to confirm it is the virus.

“There are a lot of messages, which makes it complicated, but the summary of those messages is, if we want to slow transmission, and especially slow transmission to the most vulnerable, you should be minimizing contacts,’’ Lipsitch said.

Medical professionals and public health experts say that delays in testing and the shortage of swabs and reagents have led to long waits for test results for thousands, making the emphasis on testing too little too late.

They say there is a surge in emergency room visits and hospitalizations from patients who, when tested, do not test positive for the flu, but may have COVID-19 if they could be tested.

Dr. Antony Friedman, an emergency department physician with Baptist Health South Florida, said doctors have seen a wave of “seriously ill” patients with fever, cough and respiratory symptoms and a “dramatic increase in younger, healthier people, from 20-50 age groups.”

“It’s definitely abnormal,’’ he said.

He and more than 75 emergency room doctors, nurses and physicians’ assistants wrote an open letter Monday to the people of Miami-Dade County pleading with them to stay home.

“Since many carriers have no symptoms at all, we must avoid all unnecessary contact with EVERYONE that we are not currently living with,” they wrote. “We are going to have to sacrifice a great deal temporarily for a better future for ourselves and the most vulnerable among us.”

Lipsitch said he has heard the same plea from physicians across the country.

In an commentary in the Washington Post, Lipsitch blasted “a feckless federal response” for creating such delays in testing that most of the positive cases in the U.S. are not being confirmed.

“We don’t know even approximately how many people are infected,’’ he wrote, “but it’s certainly more than the current count of more than 35,000 confirmed cases.”

He warned that if Florida doesn’t employ some of the same restrictions that states like New York, California and others with spiraling numbers of positive COVID-19 cases, the state’s healthcare system could be overwhelmed like Italy’s and Spain’s systems.

The reason for acting now is it takes around three weeks of reducing the number of people who are infected before you see it reduce the strain on the healthcare system, he said.

“People who get infected today will take three weeks before they need intensive care,’’ he said, adding that while most people won’t get that sick.

Dr. Mary Jo Trepka, a domestic infectious disease epidemiologist at Florida International University, agreed that the earlier measures are implemented, the more effective they are.

She said young, health people are not getting the message that COVID-19 is severe and should be doing their part to protect others in lieu of strict statewide measures.

She said there are Floridians who are not getting this message, and that the “state is struggling with the problem” of communicating with healthy people statewide.

Unlike some other states, Florida has not employed a massive public information campaign to explain what social distancing means. The governor has closed bars and restaurants and fitness centers across the state, closed state parks and shut down beaches in Broward and Palm Beach counties. But while he tells people to practice social distancing to stop people from getting sick, his focus has been on making sure the state is ready for when they do.

Nation, the Stanford University professor, said that the COVID Act Now model projects that because California has imposed an aggressive stay-home order, the projection of potential deaths is likely to drop from 500,000 — if it had imposed no restrictions — to 18,000 predicted now.

“I know it’s not easy to give people bad news,’’ he said. “But the cost of this happy talk is going to be a couple million lives in the U.S.”

Another model, prepared by The Laboratory for the Modeling of Biological and Socio-technical Systems at Northeastern University, provided TIME with access to 100 of the different coronavirus scenarios it generated for the Centers for Disease Control and Prevention.

The Northeastern model shows that even with a very high degree of infection surveillance and government intervention, South Florida remains a hotspot for cases in the country. With a moderate or low degree, Florida still glows orange on the nationwide map.

In addition to coronavirus test results, DeSantis said the state is also monitoring emergency room admissions for people with symptoms of the virus, which include fever, coughing and shortness of breath.

It’s not clear whether the state is looking at yet another source of data, which is showing that Florida is experiencing a dramatic spike in fevers, one of the earliest symptoms of COVID-19.

Kinsa Health, which makes Internet-connected thermometers, said its real-time data indicates that the problem might be much worse in Florida than the test results indicate.

“Related to other states, Florida is a class of its own,’’ the company’s data scientist told the Times/Herald last week.

When asked directly on Saturday whether state officials had seen [Gov. Ron DeSantis said d]Kinsa’s data, DeSantis and state Surgeon General Scott Rivkees did not answer the question. They instead touted the state’s testing and hospital numbers.

”The most important data we’re looking at is the testing,” Rivkees said Saturday.

Hospital data, which the state released for the first time Sunday, showed 181 people have been admitted to the hospital because of complications from COVID-19 in every major metropolitan area of the state.

Lipsitch and others say that because it usually takes about two weeks for someone with an infection to be hospitalized, the numbers signal that there is growing transmission in those communities. “Expect it to be double in a week or so and then worse in another week,” Lipsitch said.

If DeSantis fails to impose a stay-home order, local officials say they are prepared to act on their own.

On Monday, Miami Mayor Francis Suarez called for an emergency meeting for Wednesday to discuss what’s needed for a mandatory “shelter-in-place” order and a curfew.

St. Petersburg Mayor Rick Kriseman urged DeSantis to “mitigate inconsistencies and confusion by ordering Floridians to ‘stay at home’ as soon as possible.” But, he said, if the governor refuses, “St. Petersburg and municipalities across the state are likely to move forward on their own.”

Miami Herald staff writer Ben Conarck contributed to this report.

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