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Comparison shows risk of Florida’s gradual coronavirus response

Santa Clara County, for example, imposed social-distancing restrictions starting on Feb. 10. A shelter-in-place order was implemented on March 17. By contrast Miami-Dade County waited until March 12 before it issued a state of emergency.
Santa Clara County Public Health Department Director Dr. Sara Cody speaks during a news conference in San Jose, Calif., on Friday, Feb. 28, 2020. Santa Clara County health officials confirmed a second case of unknown origin of the novel coronavirus.
Santa Clara County Public Health Department Director Dr. Sara Cody speaks during a news conference in San Jose, Calif., on Friday, Feb. 28, 2020. Santa Clara County health officials confirmed a second case of unknown origin of the novel coronavirus. [ ANDA CHU | AP ]
Published Apr. 1, 2020

TALLAHASSEE — Social distancing is working, but timing and discipline is everything.

Those are the takeaways of new research emerging into the effectiveness of mitigation measures aimed at the spreading novel coronavirus that demonstrate communities that acted more quickly and aggressively had better results than those that implemented partial, or gradual measures.

Compare, for example, Santa Clara County in California, home to Silicon Valley, and Miami-Dade County in Florida.

Data from smart thermometer company Kinsa Health found that as social-distancing measures are enacted across the country, there has been “a significant drop in illness levels” as measured by the company’s Internet-connected thermometers. The number of people who got sick in a community depended on how early mitigation efforts were implemented.

Santa Clara County, for example, imposed social-distancing restrictions starting on Feb. 10. A shelter-in-place order was implemented on March 17. By contrast Miami-Dade County waited until March 12 before it issued a state of emergency — 32 days after Santa Clara announced its. The result was that while both communities saw cases drop, Miami-Dade had more people get sick first.

“The early and aggressive social distancing orders for Santa Clara were able to slow the spread of the disease and reduce illness throughout the county,’’ the Kinsa researchers conclude in a report on their website. The slower pace of Miami-Dade may have allowed the virus to saturate more of the community.

The research came at a time when public health experts and dozens of city and county officials across Florida were urging Gov. Ron DeSantis to issue a statewide stay-at-home order to contain the spread of the virus as cases double nearly every three days. He finally did that on Wednesday afternoon.

On Tuesday, President Trump’s top public health experts, Anthony Fauci and Deborah Birx, said they were confident that social-distancing measures are working. They predicted that if Americans continue to implement “full mitigation” measures for another 30 days it will reduce the projected number of U.S. deaths from COVID-19 to 100,000 to 240,000.

In public health, “full mitigation” means people strictly follow the Centers for Disease Control and Prevention guidelines to practice social distancing, work and school from home, avoiding discretionary travel, staying away from nursing homes and limiting social gatherings to 10 people.

“If you wait til you see it, it’s too late,’’ said Birx, the coordinator of the White House’s coronavirus task force.

Distancing matters

She noted that in states like California and Washington, where extreme social-distancing measures were put in place to curb the spread of COVID-19 early, the rise in cases was kept “low and steady.” But she pointed to New York which, like Florida, imposed partial measures at first and, unlike Florida, gradually ramped up to the strictest levels.

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One of the epidemiologists behind a coronavirus model cited by the White House told the Times/Herald that the White House’s optimistic projections assumed DeSantis would implement stay-at-home measures within a week.

“We’re assuming next Monday this will be in place,” said Ali Mokdad, a professor at the University of Washington’s Institute for Health Metrics and Evaluation. “If they don’t, these numbers will go up.”

Mokdad, a former epidemiologist for the CDC, said he told Florida’s top health official Monday night that the governor should issue a blanket stay-at-home order mandating the closure of non-essential businesses and social isolation in order to control the spread of the virus.

However, at a press conference Tuesday, DeSantis repeated his opposition to a stay-home order for the entire state, saying “everything’s pretty much closed,” and “it’s not like there’s anything to do.” But he added that he hadn’t been told to do so by the White House task force.

If the task force recommends it, “we’re going to consider it,’’ he said. “But nobody has said that to me thus far.”

DeSantis changed his tune on Wednesday.

As reporters asked the president on Tuesday about Florida’s response, Trump responded that the governor “knows exactly what he’s doing.” Vice President Mike Pence, however, stepped up and emphasized the need for “full mitigation.”

“The White House Coronavirus Task Force will continue to take the posture that we will defer to state and local health authorities on any measures that they deem appropriate,’’ Pence said. “But for the next 30 days, this is what we believe every American and every state should be doing at a minimum to slow the spread.”

Nita Nehru, spokeswoman for Kinsa Health, said the thermometer data the company has shows “that Florida is actually two times as severe in illness” as the number of cases being recorded by the state and the CDC. The company has been attempting to sound the alarm in the state for two weeks, she said, alerting public officials and the media.

“Something is happening in Florida,’’ she said. “We are concerned about the situation based on the data we’re seeing and we have talked about it for two weeks.”

Gathering fever data

The San Francisco-based company has sold or given away thousands of smart thermometers to households in Florida. The devices track in real-time people’s fevers as soon as they test for them and has proven to be an early warning of illness.

As the novel coronavirus has spread, Kinsa Health tracked a “strong correlation” between confirmed COVID-19 cases and illness that cannot be explained or attributed to seasonal flu across Florida, potentially indicating the spread of the virus is faster than the CDC was reporting it, said Patrick Phillips, head of data science for Kinsa Health.

Nehru noted that the confirmed cases in the state are doubling every three days. The data shows that “social distancing will break the chain of infection and reduce transmission events.”

DeSantis has relied on a voluntary response to curb the spread of the virus, gradually tightening social distrancing restrictions but leaving the more aggressive measures to city and county officials in Miami-Dade, Broward and Palm Beach, which have the majority of the state’s positive cases.

Part of the Florida governor’s approach is to frame the pandemic as unprecedented.

“This really has never been done in America before,” DeSantis said last week, speaking at a warehouse in Orlando in front of boxes of medical supplies to be shipped across the state. “It’s kind of like a real-life experiment.”

But public health experts and academics like Vicki Bier, director for Center for Human Performance and Risk Analysis at the University of Wisconsin, who has studied pandemics, say the nation has faced a comparable pandemic — the Spanish flu, from 1918-20 caused 39 million deaths, equivalent to 2% of the world’s population — and the lessons are instructive.

As troops were returning from World War I, and the virus was already spreading, several cities took very different approaches.

Philadelphia staged a huge parade with more than 200,000 people lining the streets “and a week later, they were just hammered,’’ Bier said. Every bed in Philadelphia’s 31 hospitals was filled with sick patients and within a week more than 4,500 people had died.

By contrast, St. Louis greeted its returning veterans without a public celebration. Within a few days of having its first case diagnosed, the city closed schools, banned public gatherings and the total number of deaths over time were much much lower.

The examples demonstrate how Florida’s partial and gradual approach could spell trouble for the Sunshine State, and potentially lengthen the time it takes for the state to recover, both from the virus and the economic hit, Bier said.

“Moving quickly makes a big difference,’’ she said. “And it’s really difficult to get enough compliance voluntarily to prevent spread.”

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