The past three weeks have set consecutive records for the number of new coronavirus infections in Florida, stirring fears that the tsunami of cases that the state had previously avoided has finally arrived.
Gov. Ron DeSantis has said the spike can be explained by the recent increase in testing, especially among younger adults and high-risk populations. But a number of cases tied to bars and restaurants has led to questions about whether Floridians have let their guard down and whether the state’s reopening is partially responsible for the increase.
On Friday, after the state recorded 25,000 infections in five days, it announced it had suspended the consumption of alcohol at bars.
How worried should you be? The Tampa Bay Times examined the data tracking coronavirus’ spread and asked eight public health experts.
The analysis revealed key differences between infections being discovered now and those from a few months ago, including some positive changes that DeSantis has touted in press conferences. Even as cases have gone up, deaths so far have barely budged, increasing from an average of 35 deaths per day earlier this month to 38 per day in the past week.
There are other signals in the data that experts find alarming — indicators that they said leave little doubt that Florida’s outbreak is now growing extremely quickly.
Here’s what we found.
The spike in cases far exceeds the increase in testing.
Since June 1, the average number of tests per day has increased by less than 25 percent. During that same time, the average number of infections per day has nearly quadrupled — from fewer than 1,000 cases per day at the start of this month to more than 4,000 cases every day in the past week.
On Wednesday and Thursday, Florida added more than 5,000 cases. On Friday, the state added nearly 9,000 cases, and Saturday it added more than 9,500 cases — approaching some of the peak days in New York, the state with the worst outbreak.
“We’re finding more cases because there’s more testing, that’s true,” said Mary Jo Trepka, a professor of epidemiology at Florida International University. “But that’s not the only explanation because we’re also seeing that the portion of positive tests is increasing.”
Over the prior month, fewer than 5 percent of test results returned positive, on average. As of June 17, that number jumped to more than 10 percent.
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DeSantis has been slow to link the higher positive test rates to increased community transmission. Until this week, DeSantis has said that increased contact tracing explains the uptick.
In a June 16 press conference, DeSantis pointed to the state’s efforts to trace contacts among farmworkers and migrant workers, among whom the percentage of positive tests can be upward of 40 percent.
By tracing contacts from a single infection, testers found “90 positive cases, in one round of testing,” DeSantis said. “In our drive thru sites, it would take you several days to get 90 positive cases with all the people going through.”
But experts warn that it will take little for those infections to become a substantial risk to the surrounding population.
Even outbreaks inside prisons have spread to the community, said Gregg Gonsalves, a professor of epidemiology at the Yale School of Medicine.
“These are literally locked down facilities, but it’s no problem for COVID-19,” Gonsalves said. “So if you have a community of migrant workers in Florida somewhere, that potential of community spread is there.”
Social distancing has been on the decline for weeks.
Cell phone tracking data indicates that social distancing across Florida declined dramatically weeks before the current outbreak.
In May, an analysis by the Times found that Florida residents were staying home long before state officials ordered them to. By the time the statewide stay-at-home order came into effect, over half of the phones tracked by one firm, Descartes Labs, had not traveled more than a mile, a reduction of nearly 90 percent relative to movement earlier in the year.
Updated releases of that same data show that residents’ willingness to stay close to home did not last long.
The Times reviewed cell phone location data from three companies. Each company’s data showed the same thing: Within a week of the statewide shutdown order, people started venturing outside again.
By the time the first counties began the first phase of reopening on May 4, residents across the state had already resumed more than 40 percent of their normal movement, according to data collected by Descartes Labs. By June 16, that number exceeded 70 percent.
In 31 counties, including Leon and Alachua, residents have resumed more than 80 percent of normal movement, based on median distance traveled each day. Pinellas, Hillsborough and Pasco counties remain at 69 percent to 73 percent of normal.
Those changes have come quicker in Florida compared to states with larger outbreaks, data from Unacast and Descartes Labs shows.
When social distancing hit its peak in April, more than half the residents in New York and New Jersey traveled just 250 feet or less from home each day. Social mobility in these two states only returned to 40 percent of normal last week.
In contrast, social mobility in Florida rebounded much faster, returning to one-quarter of normal movement within three weeks of the statewide order. More than half of Florida’s residents traveled two miles or further during that time period.
Not only has mobility increased, said Ali Mokdad, a professor of health metric science at the University of Washington, but people have become more lax in their precautions. At first, people remained vigilant, Mokdad said. “They were wearing their masks and staying away from one another.”
Within a month, Mokdad said, the thinking shifted to: “I can be less careful and lose my mask and my safe distancing from others.”
“And now we’re paying for it.”
Protests may have contributed to the increase, but less than you’d think.
The spike in infections comes just weeks after the first protests over the killing of George Floyd drew crowds across Florida. The correlation between the two has not gone unnoticed, but experts say it’s unlikely that the protests had much effect.
“We think about person-hours: the number of people and the amount of time that they’ve been interacting,” said Thomas Hladish, an infectious disease researcher at the University of Florida.
By this measure, Hladish said, the recently reopened bars and restaurants “really probably will dwarf the contribution to transmission due to the protests.”
By mid-June, visits to non-essential businesses had doubled across the state, compared to when the stay-at-home order took effect, according to cell phone data from Unacast.
Across the country, the data that’s currently available shows protests have not been correlated with spikes. A June 22 working paper studying more than 300 cities found that, following protests, social distancing usually increased and the number of infections stayed the same. The study has not been peer reviewed, and author Andrew Friedson warned that detailed data is not available. But he said it likely meant that when protesters took to the streets, other people stayed home to avoid the disruption.
What makes Florida different, said Derek Cummings, an infectious disease epidemiologist at the University of Florida, is that the protests here coincided with policy changes that allowed for more person-to-person contact.
“The clearest evidence that the protests don’t explain this,” Cummings said, “is the fact that there are places that had much bigger protests that are not experiencing the increases in cases that Florida is.”
Fewer of the people getting infected are getting seriously sick.
Even as the number of infections has increased, however, the number of hospitalizations has slowed. At the start of the month, the state announced one hospitalization for every 10 infections. That number has since fallen to one in 20.
That’s probably because the people getting infected are younger. The median age of new cases dropped from a high of 65 in early March to 35 as of Thursday. It has continued to drop in recent days, as more cases have been discovered.
The increase in widespread testing has also identified more cases with mild symptoms or no symptoms, especially among younger adults, DeSantis said.
DeSantis has assured the public that the increase in cases among younger adults should not be cause for concern.
Data from the Centers for Disease Control shows that the coronavirus does not affect younger people the way it does the elderly or other vulnerable populations. During the initial wave of cases in March and April, when the majority of identified infections were among older adults, hospitalizations increased in step with new cases.
The lack of growth in hospitalizations could be due to a number of factors, said Robyn Gershon from New York University, but one stands out: “The young people who are out there spreading it, they are getting infected but they’re not getting really sick.”
But it could still be a problem.
Nonetheless, eight public health researchers from across the country interviewed by the Times all agreed that the uptick in infection, combined with the decrease in social distancing, is troubling.
Younger adults may not be as susceptible, but they are not immune to the virus, experts say. CDC data shows that those with pre-existing conditions are the most at-risk for serious complications, regardless of age. In the past week, two 17-year-olds have died of COVID-19, the state’s youngest deaths to date.
“Young people are not getting hospitalized by huge numbers,” said José Szapocznik, a professor of public health at the University of Miami. Still, he said, “there are more younger people being hospitalized because more younger people are getting the virus because they’re not used to wearing masks.”
Even if those contracting the coronavirus are less susceptible to the worst symptoms, the widening outbreak makes it harder to protect those who are vulnerable. Older adults continue to shelter in place and avoid risky behavior, but experts say, their risk of exposure increases as the virus spreads.
“You’re playing with fire a little bit, because it just takes somebody who works in a long-term care facility or nursing home to bring it,” said Jeffrey Shaman, a professor of health sciences at Columbia University. “You can then have a real problem.”
The data indicates that might already be happening. Even as the number of infections among the young has skyrocketed, cases among those 65 and older has also been going up.
At the beginning of the month, on average, about 150 cases among seniors were identified every day. Two weeks ago, roughly 250 infected seniors were being identified daily. Over the last week, the average jumped to 400.
On June 23, Pinellas County hit a new peak of 13 deaths, all between the age of 67 and 93.
“Unfortunately, it stands to reason that with more cases, even if the preponderance is among the young, there will be more opportunities to infect the elderly,” Shaman said. “The concern is that cases among the elderly will grow and that deaths will follow.”
As the virus spreads, social distancing will be more important than ever, Szapocznik said.
“We are more isolated than we were on March 1 when all this started,” he said. “Yet, the number of cases is much greater because there are more people to spread. So even less mobility than we have before is causing a much greater number of cases.”
While there is a way to reopen safely, “we are not taking this as seriously as it is,” Szapocznik continued. “Even with a few people who are moving around, you’ll get more transmission. That’s seriously scary.”
CORRECTION: Florida’s reopening began on May 4, at which point the state’s residents had resumed more than 40 percent of normal movement. An earlier version of this story incorrectly stated the reopening began May 18, when movement had reached 50 percent.
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