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How the CDC’s COVID warning system fails Tampa Bay and Florida

Federal guidelines show Hillsborough, Pasco and Pinellas counties are at “high” risk of COVID-19. So why won’t federal officials sound the warning?
Meredith Mechanik, right, of Tampa, wears her mask as she browses through books at Tombolo Books, a bookstore at downtown St. Petersburg, on June 11, 2021. Residents in Hillsborough, Pasco and Pinellas counties should once again wear masks indoors due to rising levels of COVID-19, under federal guidelines.
Meredith Mechanik, right, of Tampa, wears her mask as she browses through books at Tombolo Books, a bookstore at downtown St. Petersburg, on June 11, 2021. Residents in Hillsborough, Pasco and Pinellas counties should once again wear masks indoors due to rising levels of COVID-19, under federal guidelines. [ MENGSHIN LIN | Times ]
Published May 24|Updated May 24

Tampa Bay residents should once again be masking indoors, according to federal COVID-19 guidelines.

But public health experts say that guidance should have come sooner.

Hillsborough, Pasco and Pinellas counties are at “high” risk of COVID-19, according to a Tampa Bay Times analysis. That is based on the Centers for Disease Control and Prevention’s latest community risk guidelines.

Once cases and hospitalizations reach a certain threshold in a county — more than 200 infections and 10 hospital admissions per 100,000 residents — federal health officials recommend that everyone, regardless of health status, should wear a mask in public indoor spaces.

However, the CDC’s own website still labels Tampa Bay and South Florida counties at “medium” risk of COVID-19 as of 3 p.m. Tuesday. The agency was aware as early as May 19 that some counties were mistakenly mislabeled, but the errors have not been corrected.

That means in Florida, the CDC has failed to sound its own COVID-19 warning system.

Related: Tampa Bay has ‘high’ COVID levels, masks recommended indoors

CDC spokesperson Jasmine Reed said in an email to the Times that the agency’s “medium” risk classification “is correct for the three counties, Hillsborough, Pinellas and Pasco.” However, the email cites CDC data showing zero infections detected in those counties from May 13-19.

That is not the correct 7-day case rate per 100,000 residents. It’s actually 246.4 infections in Pinellas, 224.9 in Pasco and 224.4 in Hillsborough, according to state and federal data released May 20 — well above the 200 case rate threshold to trigger “high” risk.

The CDC says it relies on weekly updates to determine risk levels and Florida’s should be updated when new data is counted Thursday.

A public health tool isn’t useful if it can be undone by a single data issue, said University of South Florida virologist Michael Teng. It’s even more confusing that most of the state’s community COVID-19 levels are considered “low” when cases are clearly going up.

“There’s been a lot of times when the CDC has come up with a mixed message,” Teng said. “And this is a case study in how not to communicate protocol measures.”

The delay in updating Tampa Bay’s status to “high” risk only compounds what experts say is a larger problem with the new guidelines, released in February: They’re slow to react to viral spread.

“We have lost what, in my opinion, is precious time in which to take collective action to try and curb the spread of the virus,” said University of South Florida epidemiologist Jason Salemi.

A lagging indicator

COVID-19 cases have been rising in Florida for nine straight weeks. Last week average daily infections jumped by 53%. Florida health officials recorded more than 8,600 new infections per day. The state’s positivity rate has reached 16.9%.

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The swell in infections was “pretty inevitable (since) we’re not taking community action to curb transmission of the virus,” Salemi said. State leaders have banned compulsory masking and cast doubt on the effectiveness of masks and vaccines.

Salemi thinks Floridians could have taken steps to slow viral transmission if they had been warned sooner. But the CDC only recommends that everyone wear a mask indoors once cases and hospitalizations hit a certain threshold.

Related: Florida COVID cases jump 53%. Tampa Bay transmission levels rise.

That’s a problem, he said, because hospitalizations are a lagging indicator. It can take days or weeks for an infected person to get sick enough to require hospitalization, which means transmission levels were already high well before hospital admissions reveal it.

Everyone should have returned to wearing a well-fitting mask indoors by now, Salemi said, “but we’re waiting too long until community spread gets too high and we’re waiting for the hospitalization number to trigger (universal masking recommendation).”

No perfect indicator

There is a statistical advantage to relying on the number of hospital patients admitted for COVID-19: Unlike case data, hospitalizations are a reliable and consistent measure of the pandemic.

Other indicators have faded as the pandemic reaches 27 months. Public test sites have dwindled across the state. The number of tests reported from Florida’s clinics, hospitals and testing facilities are at the lowest level since the start of the pandemic. At-home tests are popular, but are not reported to health officials, so they cannot be used to help track COVID-19 infections in a community.

Wastewater tracking, a promising new technology for measuring viral spread, is of no help to most Floridans. The Department of Health received more than $1.2 million in federal funds last summer to build a statewide tracking system, but no such system exists. A patchwork of local utilities test residents’ wastewater for COVID-19 levels, but the national initiative shut down April 15 while a new federal contractor takes over the program.

Related: Tracking COVID in wastewater is the future — but not in Florida

COVID-19 admissions, on the other hand, are reported daily from hospitals across the country. That makes it a good choice for tracking where healthcare infrastructure is straining, Teng said. But admissions rise long after COVID-19 has permeated a community, which makes it a flawed metric for deciding when to recommend immediate safety measures such as masking.

“It’s like reporting a car crash a couple hours after it happens,” Teng said. “Once people have already gone off to the hospital, it’s kind of too late to prevent it.”

There is no perfect indicator for tracking the pandemic, but useful preventative measures should be forward-looking, Teng said. The CDC could look for pockets where vaccination levels are low or immunity is waning.

Once the virus starts spreading again, it’s those areas that should mask up first.

‘Too individualistic’

Hospitalizations have started to climb as well in recent weeks, albeit at a slower pace than infections. Florida hospitals had nearly 1,700 confirmed COVID-19 patients at the end of last week, a 21% jump from the week before.

Hospitalizations are still low, relative to previous periods of the pandemic. That’s a good sign that immunity from vaccination or prior infection is still preventing serious illness for most people, Salemi said.

But an infection could still be life-threatening for many immunocompromised or elderly Floridians. Unvaccinated adults are also at risk and are five times as likely to be hospitalized for COVID-19 compared to those who are vaccinated and boosted, according to CDC data.

“Floridians are free to make their own decisions about risk,” said state health spokesperson Jeremy Redfern in an email to the Times.

Related: Most Americans — and 75% of children — have gotten COVID, says CDC

When a county reaches a “medium” community level of COVID-19, federal guidelines only recommend that those high-risk individuals wear a mask indoors. Salemi worries that the guidelines put too much of the safety burden on vulnerable populations.

“It’s too individualistic,” Salemi said. “It’s relying too much on people to protect themselves.”

It isn’t until cases and hospitalization reach a critical level that the general population is asked to wear a mask indoors, by which point the virus has had days or weeks to spread through the community, he said.

“And the virus has shown us repeatedly that when spread gets this pronounced, it is very good at finding those vulnerable individuals.”

• • •

How to get tested

Tampa Bay: The Times can help you find the free, public COVID-19 testing sites in the bay area.

Florida: The Department of Health has a website that lists testing sites in the state. Some information may be out of date.

The U.S.: The Department of Health and Human Services has a website that can help you find a testing site.

• • •

How to get vaccinated

The COVID-19 vaccine for ages 5 and up and booster shots for eligible recipients are being administered at doctors’ offices, clinics, pharmacies, grocery stores and public vaccination sites. Many allow appointments to be booked online. Here’s how to find a site near you:

Find a site: Visit vaccines.gov to find vaccination sites in your ZIP code.

More help: Call the National COVID-19 Vaccination Assistance Hotline.

Phone: 800-232-0233. Help is available in English, Spanish and other languages.

TTY: 888-720-7489

Disability Information and Access Line: Call 888-677-1199 or email DIAL@n4a.org.

• • •

More coronavirus coverage

OMICRON VARIANT: Omicron changed what we know about COVID. Here’s the latest on how the infectious COVID-19 variant affects masks, vaccines, boosters and quarantining.

KIDS AND VACCINES: Got questions about vaccinating your kid? Here are some answers.

BOOSTER SHOTS: Confused about which COVID booster to get? This guide will help.

BOOSTER QUESTIONS: Are there side effects? Why do I need it? Here’s the answers to your questions.

PROTECTING SENIORS: Here’s how seniors can stay safe from the virus.

GET THE DAYSTARTER MORNING UPDATE: Sign up to receive the most up-to-date information.

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