In the Villages, America’s biggest retirement oasis, the dangers of coronavirus stack up

The Villages built itself into America’s biggest and most famous retirement community by selling the ultimate Florida lifestyle: endless vacation in a warm-weather paradise where you never have to be alone.

But everything that defines the Villages now puts its residents at risk.

If the coronavirus rips through the community, experts say the Villages’ huge population of highly social seniors could crush the local health care system. Older adults are much more likely to be hospitalized or to die from the virus. If too many people need intensive care, the fear is there will not be the supplies and hospital space needed to save lives. This is already happening in some cities.

In the Villages, nearly 80 percent of residents are over 65.

The community has other factors lined up against it. Its main hospital has been given a rare one-star rating by the federal government and has been criticized by residents for long emergency-room wait times. It sits in a part of the state that Harvard University researchers found would be ill-equipped to handle a large influx of coronavirus patients, based on the number of available hospital beds.

And the Villages has drawn national attention in recent weeks as a place where social gatherings continued as parts of the country began to shut down.

Public health experts say limiting social contact is the best way to stop the virus. For seniors, they say, such restrictions can be the difference between life and death.

The Villages is far from the only place in Florida that has experts worried. The state has the highest percentage in America of people 70 years or older. But in many ways, the Villages exemplifies the challenges Florida could face. It wasn’t until Wednesday that Gov. Ron DeSantis ordered a statewide shutdown, and unlike many larger counties, local officials in the area didn’t issue their own — meaning residents were potentially exposed to the virus longer than other Floridians. DeSantis has referenced the Villages frequently at press conferences and took steps to make testing available there.

A representative of the Villages’ developer did not return multiple requests for comment. A spokesman for the community’s two main hospitals said they can handle an outbreak. He emphasized that hospitals in the area are not yet inundated.

“If we experience a surge, we will deal with it,” said Frank Faust, the spokesman for UF Health, which recently bought the two hospitals that primarily serve the Villages. “We are very comfortable at this time with our ability to scale up.”

Other cities have found the disease’s movement to be largely invisible until it is too late.

Experts say the toll can be mitigated only by separating people early, before it can spread too far.

That runs against the basic nature of life in the Villages: Afternoons at the pool. Line dancing in the square. The togetherness embodied by the motto: “Florida’s friendliest hometown.”

Lee Huntley, who from 2008 to 2011 was president and CEO of the company that ran the Villages Hospital and is now a hospital consultant in South Florida, warned: “If it catches in there, it would be a wildfire.”

The fire may be starting to catch. Over the last two weeks, the number of cases among residents of the Villages has gone from 7 to 47. As of 10 a.m. Saturday, five people had died in Sumter and Lake counties, which include most of the Villages.

Because of testing delays and the time it takes for symptoms to develop, experts say those numbers lag behind the virus’ spread by a week or more. Even a few positives means a community is extremely likely to be experiencing an outbreak, according to a report released this week by the University of Texas-Austin.

As the number of cases has grown, many Villagers say they were alarmed to see gatherings continue. Though far more subdued than regular life in the Villages, the scenes didn’t feel reflective of life in a pandemic, they complained.

One evening, a week and a half ago, dancing still appeared to be encouraged. The disaster had ended the happy-hour tradition of live bands at the town’s three squares, but the radio still played.

In one of the squares, as Copacabana pumped through the speakers, about a dozen people line-danced several feet from one another. Even more people showed up to watch, with ice cream cones, coolers and lawn chairs.

A DJ told them: “When things are normal we know that bands are performing at the three squares, but it is our honor to be able to do that with no band performing — to play our music with the speakers up.”

Before playing a Fox News update on the virus, he added, “Stay safe, though.”

For hours, large groups of friends — some bunched together far closer than the 6 feet doctors recommend — shared the evening air.

• • •

The Villages is one of the fastest growing places in America. It has a rosy lens and conservative bent.

The community of roughly 125,000 is a powerful base for Florida’s Republican party. In 2018, DeSantis won the three counties that contain the Villages by nearly 100,000 votes, in a statewide election decided by a total of 34,000.

Retirement havens dot the Atlantic and Gulf coasts and stretch across the heart of Florida. But none match the Villages in spectacle and size. The collection of subdivisions stretch across 32 square miles, featuring single-story homes, tidy yards and more than 50 golf courses.

The Villages prizes itself as a place that preserves youth through camaraderie and active lifestyle. But with age naturally comes a weakened immune system, which makes fighting off the coronavirus harder for older adults, medical experts say. Seniors are also more likely to have underlying health conditions that make the coronavirus more dangerous.

In interviews, three experts said they were concerned by the prospect of a large retirement community where people were still gathering weeks after the virus began to spread.

Joseph Eisenberg, who chairs the epidemiology department at the University of Michigan School of Public Health, said the elderly are a concern for one main reason: “That’s where we’re going to see the majority of all the deaths.”

In a preliminary federal report on U.S. coronavirus patients, the fatality rate among people aged 65 to 84 was between 3 and 11 percent. For people younger than 54, it was below 1 percent.

Still, residents say distancing in a community that so strongly promotes closeness has been hard.

In mid-March, the Villages announced that many community amenities, such as pools, would close, a move residents hotly debated on Facebook. Some suggested the changes were an overreaction; others called those people selfish.

“It’s bloody hot out there and going to the pool is the only exercise a lot of people can get in this weather,” one resident wrote in a letter published on Villages-News.com, an online publication that covers the community.

A commenter countered on Facebook: “Stay home and GROW UP!!!!”

An aghast resident’s YouTube video showed a packed estate sale. Others angrily posted photos on Facebook of people riding around in golf carts and eating takeout at picnic tables.

On March 27, an infectious disease doctor at UF Health Villages Hospital put a video on Facebook begging Villagers to stay home and noting a shortage of medical supplies across the country.

“We still see you here in big groups having fun on your golf carts, big gatherings, and at the same time we see you on our units gasping for air in the ICU, intubated,” said the doctor, Elias Maroun. “Please take this seriously.”

• • •

Recent research on the availability of hospital beds across America has shown that every part of Florida could be overwhelmed by a wave of coronavirus patients.

The analysis was performed by Harvard University in collaboration with the nonprofit news site ProPublica. It splits the country into regions that are supposed to mimic where people seek medical treatment.

The Villages is divided between two regions — one that contains Orlando and the other Ocala.

The Ocala region is more at risk of being overwhelmed by coronavirus patients than anywhere else in Florida, according to the data. If 40 percent of the region’s population was infected over the course of a year — the researchers’ moderate scenario — Ocala would need 4.75 times its current number of hospital beds.

That made it the 13th most at-risk area in America, according to the analysis. Even in the best scenario the researchers considered — a 20 percent infection rate over 18 months — the region didn’t have enough hospital beds.

The Orlando region covers huge portions of Central Florida, including the Villages Hospital. It includes more than 10,000 hospital beds, but even so, an influx of patients could overwhelm its facilities. In the moderate scenario, it would need 2.68 times as many beds.

Both communities would also not have enough ICU beds, the analysis found.

Looking at the Villages alone, the situation could be dire.

The analysis is based on estimates that 20 to 60 percent of the country could become infected. It assumes 29 percent of people over 65 may have to go to the hospital. Combining those estimates with census data, as few as 4,000 people in the Villages might need hospital beds, or as many as 12,000.

According to new state data, as of Friday, the Villages Hospital had 152 staffed beds, 32 of which were available. UF Health Leesburg Hospital, another nearby hospital Villagers use, had 205 beds, with 47 available.

Faust gave a higher number of staffed beds and said hospitals can increase their capacity if necessary. The UF hospitals already have lowered their patient volumes by a third, he said.

Even when the Harvard researchers assumed all the hospitals in the area would be able to cut their occupancy in half to care for more coronavirus patients, they still found both regions might need more beds if the outbreak unfolds quickly.

All three counties that surround the Villages have unusually few doctors, according to a community-needs assessment prepared by a local nonprofit. In Sumter County, where most of the Villages is located, the number of physicians per resident was 155 percent below the state average during the 2017-2018 fiscal year, the report said.

And if the Villages does become a hot-zone for coronavirus cases, the community will be counting on a hospital that some residents have said can’t be relied upon for emergency care under normal circumstances.

The Villages Hospital is only one of 228 in the country that the federal Centers for Medicare & Medicaid Services has given a one-star quality rating, on a scale of one star to five. Faust said the hospital is decorated for its care in some specialties and noted the rating system is controversial.

The hospital has been criticized for years over long emergency room wait times, with residents complaining on social media and in letters to Villages-News.com.

Faust said those problems don’t exist today. A 2019 assessment report didn’t give specific numbers but said the median wait time from “door to evaluation” had improved by more than 82 percent over three years, far more than the hospital’s goal.

UF Health, which bought both hospitals in December, would not provide any specifics on its reserve of ventilators or personal protective equipment. Faust described the hospital as well equipped with supplies and staff. Asked about masks, which have been running out across the country, he initially said the hospital had enough so none were being reused.

Days later, that changed.

The hospital posted written guidelines in the intensive care unit telling nurses to wear the same mask for two shifts, noting the hospital is also “trialing” mask cleaning.

After reporters obtained the guidelines, Faust said the hospital changed its approach upon learning of protocols to sterilize masks with ultraviolet light, to be “judicious” in a time of national shortage. He said the hospital still had enough supplies, which continue to roll in, and declined to provide the hospital’s coronavirus protocols.

• • •

DeSantis has mentioned the community repeatedly in the press briefings he’s held throughout the crisis.

Early on, he announced that the Ocala area is one of five places in the state that could get a 250-bed field hospital. (In the worst-case scenario, the Harvard analysis suggested the region could need as many as 4,122 beds.)

On March 23, DeSantis visited the Villages to announce that he had called on the University of Florida to jumpstart an effort to provide coronavirus testing in the community to anyone who wanted it — a striking departure from most places in the country, where low-running test supplies have been in high demand.

DeSantis said the testing — part of a larger study by the university to learn about those who have the disease but present no symptoms — would be open to Villagers or anyone else.

Since then, at least 2,300 people have arrived, many by golf cart, at the Villages’ polo fields to have their noses swabbed. Asymptomatic people were given special tests the university developed for research.

The vast majority of the asymptomatic people who were tested came back negative, said Dr. Michael Lauzardo, the clinical director for the UF Health study. But he added that researchers believe the epidemic is just starting to make its way through the Villages.

The number of positive tests increased as the week of testing went on, he added.

As reporters from across the country have descended on the community, some in the Villages have blistered at the attention.

Becky Carr, 28, who is staying with her snowbird parents in the Villages, said she sees many people being careful. She feels the community is often misunderstood and disrespected by outsiders. She said the Villages is filled with people who have experience with tragedy and hardship, including veterans who survived war zones and people forced to carry on after the death of a spouse.

“The rest of the country kind of looks at the Villages like, ‘If they don't do something now, they're all going to die,’ ” she said. “The Villagers themselves are kind of like, ‘Hey we are okay. We are going to make it.’ ”

Phyllis Walters, 71, has been stunned to see packs of neighbors watching the sun set in Sumter Landing, one of the squares.

“It just didn’t seem like anybody really cared,” she said. “I think it is insane.”

In an interview last week, Villages District Manager Richard Baier said radio music wasn’t playing in the squares. When told that reporters heard the music and saw Villagers dancing, he insisted otherwise. Then he said it wasn’t his job to turn the music off.

Wednesday, the Villages fenced off Sumter Landing. The district’s website blamed a new construction project. Hours later, the governor announced the state would shut down at midnight and explicitly ordered senior citizens to stay home.

At 5 p.m., before the order went into effect, but with Sumter Landing closed, Villagers showed up at one of the other squares. They lined up several feet apart. They started to dance.

Data reporter Connie Humburg contributed to this report. This story is part of a collaboration with FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.

Correction: An earlier version of this story misstated the square miles of the Villages.