Restaurants, state parks and stores will open in most of Florida on Monday for the first time in weeks. Businesses once deemed “nonessential” will welcome back workers. Hospitals will perform surgeries put on hold since March.
It’s the first step in restarting an economy intentionally halted to slow the spread of the coronavirus. It is also a real-life experiment: Never in the lifetimes of Floridians have leaders attempted to reopen in the middle of a pandemic of this scale.
Gov. Ron DeSantis asserts his plan can get business flowing while keeping people safe. Is he right?
The Tampa Bay Times and Miami Herald asked seven public health experts to review DeSantis’ plan. Combined, their backgrounds reflect more than 150 years of experience working in medicine for universities, governments and hospitals.
Opinions varied. Dr. Gregg Gonsalves, an epidemiologist at the Yale School of Public Health, said the state’s blueprint wasn’t a public health plan but a “political document." James Howell, the former Florida secretary of health under Democratic Gov. Lawton Chiles, said DeSantis was taking a “wise road.”
Despite that disparity, two reoccurring — and seemingly contradictory — views emerged. First: DeSantis’ plan is a reasonable, balanced road map to cautiously get people back to work. On this, six of the seven agreed.
Second: Even if it’s a good approach, it’s still too soon to deploy, five of the seven concurred. Growth of the spread has slowed, but without a vaccine, it takes just one asymptomatic person to reignite an outbreak, they said, and the systems aren’t in place to catch and contain it.
Dr. Les Beitsch, the state’s Deputy Secretary of Health in 2018, said there’s one chance to get this right, so why rush?
“Once you reopen, it’s difficult to have a time out. It creates a serious concern about people’s trust in their leadership,” Beitsch said. “And if you’re incorrect, the consequences could be catastrophic.”
Experts are empathetic to the difficult decision DeSantis and other governors face. The impulse to get people back to work is understandable, said Dr. Marissa Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida.
“Purely from a public health point of view, it would be good to continue what we’re doing for longer,” Levine said. “But we can’t indefinitely keep people apart. There’s a larger health and well-being to consider.”
In its latest model, the Institute for Health Metrics and Evaluation at the University of Washington advised that relaxing social distancing in Florida may be possible after June 22. That date is predicated on strong containment strategies, such as testing and contact tracing to limit spread of disease. The model has guided Florida’s response and was cited by the White House as one of the metrics informing the nation’s response efforts.
Beitsch and others don’t believe Florida is close to reaching the needed testing levels for COVID-19. Less than 2 percent of the population has been tested, a Times/Herald analysis found, and until recently, Florida was mostly testing people who were hospitalized or experiencing symptoms. Testing is still unavailable at workplaces or in many rural communities.
In response to these concerns, DeSantis promised that soon the state will see an expansion of testing with rapid results. Florida’s Department of Health is opening testing sites, particularly in South Florida, where most new cases are concentrated, but also in remote communities like Immokalee. The state converted an RV into a roaming lab that returns results in 45 minutes, DeSantis said.
He expects the state will have the capacity to conduct 30,000 to 40,000 tests a day by this week. That’s three times the number of tests the state conducted per day during the last week in April.
“That would make us the most aggressive testing state in the union,” said Dr. Charles Lockwood, the dean of the University of South Florida’s College of Medicine, who was generally complimentary of DeSantis’ plan.
Gonsalves, the Yale epidemiologist, took issue with the outsize role business leaders played on the task force that shaped the state’s strategy to reopen.
Gonsalves also criticized the report for failing to account for the strong possibility of a second wave of the coronavirus, as projected by Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention.
“If this were based on the science,” Gonsalves said, DeSantis “would realize that the chances of recurrence, even if we do all the right things, is very likely to happen once, or more than once, over the next year or two until we have a vaccine."
Still, most commended DeSantis for choosing a far less aggressive first step than other governors across the southern United States.
During phase one, Florida retail shops, museums and libraries can open at 25 percent capacity. Restaurants can do the same indoors, or seat customers outside 6 feet apart. On Friday, DeSantis added state parks, as long as visitors aren’t in groups of 10 or more.
The hardest-hit region, South Florida, will remain under stay-at-home orders for the foreseeable future. Howell, the former secretary of health, said this made sense in such a diverse state; others cautioned that viruses don’t respect county boundaries.
Barber shops, hair salons, gyms and movie theaters must remain closed statewide. DeSantis said he will keep an eye on how these businesses operate in other states before allowing them to reopen here.
DeSantis also chose to disregard the advice of his task force, which wanted restaurants opened at 50 percent capacity and sporting events at 25 percent capacity.
“In general, he chose to err on the side of caution and safer practices,” Lockwood said.
DeSantis, though, did not require employees returning to work to wear face masks, but he encouraged the practice. Customers don’t have to wear them, either.
In Ohio, Republican Gov. Mike DeWine has instituted a “No mask, no work, no service, no exception” policy. DeWine also rolled out exhaustive rules that businesses must follow or risk closure.
DeSantis, a member of the libertarian Federalist Society, has been careful to avoid orders that could be perceived as an infringement of civil liberties. The executive orders he has issued are far less detailed than those in other states. His initial stay-at-home order did not officially require any businesses to close, and he is often critical of governors who enacted what he called “draconian orders."
“People have rights,” DeSantis said. “The government needs to protect health, but we should not go beyond what is necessary to do that.”
Beitsch expects public sentiment will play a key role in preventing another wave of outbreaks.
“The one wildcard that cuts in favor of the governor is people are concerned about opening up too soon,” Beitsch said, “and they want to maintain social distancing, so people may police themselves beyond whatever lifting of government restraints.”
What the experts say
Marissa Levine, director of the Center for Leadership in Public Health Practice at University of South Florida.
“Purely from a public health point of view it would be good to continue what we’re doing longer but we can’t indefinitely keep people apart and there’s a larger health and well being to consider.”
Leslie Beitsch, chair of behavioral sciences and social medicine at Florida State University and former deputy secretary of Florida Department of Health
“He’s trying to thread the eye of a needle; it’s really a challenging thing. If I was in his shoes, I think I’d want more testing to be in place first.”
Charles Lockwood, dean of the University of South Florida’s Morsani College of Medicine
“His plan is more prudent than the White House Task Force recommendations which are also quite reasonable, and I believe appropriate for Florida given our higher percentage of more vulnerable older folks.”
Crystal Watson, senior associate at the Johns Hopkins Center for Health Security
“One thing that’s missing is really building a capacity for contact tracing and case identification for public health. If you don’t and we open more fully and we have increased transmission, which is likely, it puts us back in a position of why we needed home orders in the first place.”
Gregg Gonsalves, epidemiologist at the Yale School of Public Health
“They’re dressing it up and trying to make it look like something it’s not. It’s not a public health plan. It’s not a medically based plan. … It’s largely a political document.”
Roderick King, CEO of the Florida Institute for Health Innovation
“Are we testing enough and are we testing everyone to be able to … isolate and then treat if necessary? That’s the part of the report that I think is not that strong, and that has actually been our Achilles’ heel throughout this pandemic.”
James Howell, physician and the former Florida secretary of health under Gov. Lawton Chiles
“I think he’s taking a wise road. He’s listened very well to the professionals in the area. He’s listened to our mayors and all. It’s a very challenging decision to make. But he’s doing it incrementally.”
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