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Only 2 percent of Florida residents have been tested. It’s much lower in rural areas.

Gov. Ron DeSantis’ easing of restrictions concern researchers who worry that the risk to rural areas and much of Florida could be large and unseen because of low levels of testing.

TALLAHASSEE — As major swaths of the state reopen for business Monday, about 1.8% of Florida’s population has been tested for COVID-19, according to a Times/Herald analysis, with percentages much lower in rural areas, including counties where nursing homes and prisons have become hot spots for the virus’ silent spread.

In Gadsden County, just over 1% of residents have been tested but those who have tested have the highest positive rate in the state: 19%.

It’s almost the same rate in Suwannee County, where 108 residents and employees at a nursing home have tested positive as of Thursday but only 1.6% of Suwannee’s 45,000 residents have been tested.

“Our numbers may look bad but it’s all confined to one place,’’ said Sam St. John, Suwannee County sheriff who heads the county’s emergency operations center, referring to infections at the nursing home, the Suwannee Health and Rehabilitation Center. “It’s not spread county wide.”

To date, the state has tested less than 2% of the population — far short of the amount many experts suggest is necessary to determine the true levels of infection. The recommended numbers vary, but the dean of the University of South Florida’s College of Medicine told Gov. Ron DeSantis last week that Florida needs to test at least 150 people for every 100,000 residents every day — that’s about 33,000 people every day, more than double the current rate.

Experts say the massive numbers of tests are needed not only to properly screen a community to determine the scope of the virus but because anyone who tests positive must be tested more than once to confirm if they have recovered.

After a month of expanding testing in Florida, the state’s rate of positive tests, at roughly 9%, falls under the World Health Organization’s target of 10% or less, which suggests that enough tests are being given to document the extent to which the virus has spread, not just the most extreme cases.

“If you test more, you’re gonna find more,’’DeSantis said at a news conference Wednesday when he announced he was ending his stay-home order starting Monday for all counties except Miami-Dade, Broward and Palm Beach. “We know there’s a lot of asymptomatic people out there, so as Florida tests more and more, we will find more. That’s not necessarily a bad thing.”

Testing is essential

Public health experts say that testing remains essential to containing the spread of the novel coronavirus because many people who show no symptoms silently spread it.

DeSantis’ easing of restrictions excluded Miami-Dade, Broward and Palm Beach counties, which have been the hardest hit by the novel coronavirus, but researchers worry that the risk to rural areas could be large and unseen.

The Florida Department of Health testing data shows that at least 12 counties have had high rates of people testing positive for COVID-19 but will be allowed to open restaurants and many businesses. Eight of them — Gadsden, Suwannee, Jefferson, Hendry, Madison, Hardee, Glades and Sumter — are rural counties.

“I have concerns about rural areas,” said Harvard epidemiology professor William Hanage. “You’re now beginning to see it in some of these smaller towns. Once the virus gets in there, it can transmit rapidly. A pandemic is so-called because it has the capacity to affect everywhere, not just the urban areas.”

A national report released Thursday by the Kaiser Family Foundation, a non-profit health research organization, found “while metro counties still have significantly higher cases and deaths per capita, non-metro counties are experiencing faster growth rates, potentially signaling challenges ahead.”

The report noted that in most rural counties throughout the U.S., the population tends to be older, younger people are more likely to have high-risk health conditions, and there are fewer intensive-care beds compared to metropolitan counties.

In Gadsden County, where the privately-run women’s prison has tested 20 inmates and staff whose results were positive, the county is just starting to catch up to demand for tests and get a handle on the spread of the virus, said Shawn Wood, the public information officer for the sheriff’s office, which oversees emergency management.

“We’re working hard with the state, because we do want more testing,” he said. “They’re in the process of providing more testing than what we’ve been getting.”

Wood, who lives in Gadsden County on the Florida-Georgia line, referred to the example of Albany, Georgia, which was ravaged by coronavirus that spread in March after a well-attended funeral. Wood said he fears that the county’s medical resources wouldn’t be able to handle a surge in cases.

“We’re not built for this,” he said.

In Sumter County, where 59 of the 176 of the positive cases are from the state prison and another 8 are at an elder care facility, 1.4% of the county’s 128,000 residents have been tested and one of every 10 has been positive.

What’s the testing protocol to reopen?

As DeSantis and his communications team declared success in containing the spread of COVID-19 Wednesday, he said he hoped to expand testing in the coming weeks but offered no guidance on whether restaurant workers and daycare providers should be tested.

Unlike other governors who have loosened stay-home restrictions, DeSantis provided no protocol for outpatient surgery centers which, unlike hospitals, don’t have access to rapid testing machines or in-house labs, except to refer to the Centers for Disease Control and Prevention guidelines.

Meanwhile, access to testing remains significantly different for people living in rural areas. While state-run drive-up testing centers have removed barriers to testing, allowing anyone who wants a test to get a test, healthcare providers in rural communities continue to limit who gets access to tests.

Rural counties rely on public health units and private healthcare practitioners to provide the tests, said Kerry Waldron, director of public health for Suwannee and Lafayette counties in North Florida.

At county public health centers, testing is limited to people the Department of Health has determined are “priority cases” — those who have symptoms, have been exposed to someone who has tested positive or who works at a nursing home, healthcare facility or is a first responder.

“We’re awaiting guidance from the Department of Health to expand testing,’’ Waldron said.

Some testing priorities still in place

In the more populous counties with similarly small percentages of the population tested, not everyone who can get a test wants to be tested.

“The number of the cars that we’re seeing are not the number we were expecting to see,” said Andrew Fossa, Pasco County director of emergency management. Pasco County has had just 1% percent of its population tested with a positive rate of 5%.

County officials have increased their promotion of the testing sites and relaxed restrictions on who could qualify for a test so that anyone who wants a test can get a test.

“Now if you drive up and want a test, we’ll test you,” Fossa said.

In making his argument that Florida has effectively contained the spread of coronavirus, DeSantis compared the rate of positive cases in Florida to those in other states, such as New York and New Jersey.

“We were never really that bad,’’ DeSantis said Wednesday. “You know, we had some of those days where we were 15%, we kind of were settled into the 10 to 12 to 13% and a lot of that was driven by Miami-Dade in those early days.”

But of the 16 counties where positive cases exceed 9%, nine are rural counties where testing per capita is to date also below the statewide average, the Times/Herald analysis found. With some small counties having administered as few as 51 total tests to date, epidemiologists say its hard to draw conclusions about the prevalence of coronavirus in those communities.

“I wouldn’t feel comfortable assuming that transmission is low with so few tests,” Natalie Dean, a biostatistics professor at the University of Florida, said in an e-mail. “We would need to be testing more deeply and regularly.”

Jefferson County, which saw just over 17% of its 162 tests showing positive, has tested roughly 1 percent of the population for coronavirus. Those numbers have largely been driven by one nursing home in the county, Cross Landings Health and Rehabilitation Center, where 13 residents and 7 staff members tested positive.

Paula Carroll the director of emergency management in Jefferson County, said the county has not had any problem getting access to tests.

“We’ve been doing it as the community has requested it,” she said. “If someone has needed to be tested, they’ve been tested.”

But she expressed hesitance in the governor’s decision to allow limited reopening of businesses.

“I feel like it’s a little soon,’’ she said ahead of the governor’s announcement Wednesday. “But of course he’s in charge.”

Glades County has natural distancing

In tiny Glades County directly west of Lake Okeechobee, with a population of just over 13,000, there have been 61 people who have been tested and 6 positives, but the infection rate is not increasing, said Brenda Barnes, public information officer for the health department in Glades and Hendry counties.

“I can’t say that it’s been contained, but with our rural population, and people living miles apart, people are not in close contact,’’ she said.

Hendry County, which is adjacent to Palm Beach County, has had 526 people tested with a positive rate of just over 15% and a case count of 80, including 26 in the county’s two nursing homes.

The testing data also shows how the state has focused attention on hot spots as they emerged at nursing homes and prisons with high positive case loads.

Miami-Dade County has had the highest per capita number of people who have been tested for COVID-19, 2.8%, but the next highest is tiny Bradford County where 2.6% of the population in the county of 28,000 has been tested. Of the 46 positive cases as of April 28, 34 were in elder-care facilities.

DeSantis said Wednesday that the state expanded testing in the last two weeks of April and, despite that, new cases have not risen at the rate they had been rising earlier in the month, and the rate of positives has declined.

He said the state will continue to direct testing facilities to under-served areas, including the rural areas that are home to farm workers and Escambia County in Florida’s Panhandle, where the most significant outbreak has been at a nursing home.

But the bulk of the testing attention will remain in the urban areas, with the state supporting 15 drive-through and walk-up testing sites that can each do 750 tests a day, DeSantis said. Some cities have started their own testing sites to supplement what the state is doing.

The state has also obtained an RV with a rapid testing machine that will drive to nursing homes and healthcare facilities and do 3,500 tests a week starting next week.

“As you expand testing — more people have access — you get a better sense of how it’s moving throughout the community,’’ DeSantis said. “If you have symptoms, go.”

Mary Ellen Klas can be reached at meklas@miamiherald.com and @MaryEllenKlas

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