This past month Florida hit record highs in COVID-19 case numbers, hospitalizations and deaths. As recently reported by the Tampa Bay Times, the death rate in Florida over the past six months is by far the highest among the six largest states, and looking across the course of the entire pandemic (based on data from the New York Times), Florida now has the fourth-highest rate of infection among all U.S. states and territories. How did we get into this situation?
These recent high case numbers were predicted in advance by our group here at the University of Florida, based on mathematical models — models which also predicted the rapid decline in cases that we are currently seeing.
We know that mask mandates reduce the risk of infection, based on solid, scientific data from multiple sources (including published data from the Florida Department of Health).
However, masks are only one part of an overall prevention package, which includes isolation of infected persons, contact tracing, quarantine of persons exposed to the virus, social distancing, good ventilation, and avoidance of high-risk settings (crowded, poorly ventilated small rooms with people singing and shouting).
The other critical component of this package is vaccination: Vaccination works, it’s safe, and it is a superb tool to save lives and prevent hospitalizations. When parts of this prevention package are removed, the effectiveness of the overall strategy drops. Vaccination is by far the most powerful component, but in the middle of a major epidemic these other interventions, as a package, play a crucial role in reducing transmission of the virus and decreasing the number of infections, hospitalizations, and deaths.
So, what happened in Florida? The governor has walked away from most parts of this prevention package, with only lukewarm support for vaccination and a rule that blocked vaccine mandates. At the same time, we had entry of a new virus strain, the delta variant of the coronavirus, that was far more infectious and more virulent than previous coronavirus strains, with an increased ability to cause severe illness in younger age groups.
As predicted by our models, under these conditions cases skyrocketed to record levels, hospitals were overwhelmed with very sick patients, and death rates soared. Put another way, without prevention strategies in place we were not able to “bend the curve,” and we saw the rapid spike in cases expected in an unmitigated epidemic.
Fortunately, a fair percentage of the population was vaccinated, so things were not as bad as they could have been. But there were unnecessary hospitalizations and deaths, which didn’t need to have happened if basic, well-established approaches to control of infectious diseases had been taken. These preventable infections have also set up a lot of people for “long COVID,” with persistence of symptoms for months (or longer) after illness.
We have now burned through most of the highly susceptible people left in the population, and as our models predict case numbers are coming back down, although it may be January before we are back to levels seen this past summer. However, we know that immunity to coronavirus wanes over time, and further surges driven by unvaccinated people are likely to occur. As we and others have shown, coronaviruses are constantly evolving, and, while impossible to predict, there also remains the concern that a strain nastier than delta is starting to spread somewhere in the world.
So where do we go from here? The governor has selected a new surgeon general who has expressed hesitation about vaccination, masking and other key elements of the CDC-recommended COVID-19 prevention package. On Sept. 22 he put out an emergency rule that tells schools that they cannot require children to wear masks if parents elect to “opt out” of mask usage and allows children’s parents to ignore standard public health quarantine procedures after their child has been exposed to an infected person.
These approaches follow the basic themes of what has been termed the Great Barrington Declaration (which both the governor and the surgeon general have espoused) that focuses on protecting the “vulnerable” while allowing as many other people as possible to become infected in an effort to increase herd immunity. When originally written, serious questions about this approach were raised by the public health community. It was also written before highly effective vaccines were available and before the delta variant took the world by storm — while it has become a major political talking point, it’s outdated and ignores the best current science.
We have outstanding universities here in Florida, with public health experts who work closely with the best scientists nationally and internationally. Unfortunately, minimal effort has been made to take advantage of this wealth of scientific expertise to implement targeted, science-based prevention programs at the state level.
As a starting point, public health data (appropriately de-identified) from the pandemic needs to be made widely available, and we need to encourage analysis of outcomes and risk factors by scientific groups outside of the Florida Department of Health.
Ideally, there would also be a state-wide public health advisory group, tasked to work with the surgeon general and the Florida Department of Health to apply the best possible science to prevention activities. The striking spike in cases this past month has demonstrated what happens when science is ignored and proven prevention packages scrapped. Let’s come together, Florida, and not let this happen again. It’s literally a matter of life or death.
Dr. Glenn Morris is a physician epidemiologist specializing in infectious diseases and an expert in emerging pathogens. Dr. Longini is a biostatistician and mathematical modeler specializing in quantitative infectious diseases modeling.