In the past few days, events have overwhelmed me, and have made this particular post both more important and harder to write. A couple of weeks ago, a friend sent me a long, glowing National Review article on Governor Ron DeSantis’s Coronavirus strategy in Florida. For those who don’t know, the National Review is a conservative journal, so naturally the way some of this article is worded is obviously partisan—even the title is a challenge rather than just a presentation of information. But the information is interesting, and somewhat at odds with the claim that drove the lockdown, which said that everything had to be shut down to avoid the virus increasing. But it’s not at odds with it in a way that ignored the threat. From the article, it sounds like a reasonably well thought out response, at a time when none of us knew what the best course of action was. So is the article accurate?
First, I wanted to look at some of the other “hysterical” articles to which DeSantis refers. On March 18, as New York was already reeling from the disease, the New York Times published this article, with some of the information about the availability and robustness of testing directly at odds with DeSantis’s claims. It’s worth noting, though, that on March 18, tests were not widely available anywhere, so it seems likely that between March 18 and May 20, testing levels improved. The Villages, a retirement community in central Florida with over 50,000 residents, is mentioned in the Times article as having had only 33 Coronavirus tests, while by the time the National Review article came out, DeSantis claimed they had had 1,200 tests of asymptomatic residents, with no positive results. But much of the information in the Times article corroborates DeSantis’s account, although the way each article presents the information is 180 degrees apart.
Of course, everything associated with COVID-19 has been politicized. On May 20, The Guardian, a left-leaning UK newspaper, reported a story that Rebekah Jones, the woman responsible for Florida’s online COVID-19 dashboard, was fired and claimed that the reason was because she refused to falsify data. (The example used in The Guardian had more to do with lags in reporting than with actually falsifying total numbers, but it would call into question how well the “granular” approach was actually working.) The governor’s office denies that this was the reason for her firing, but plenty of questions remain. (The right-wing Daily Mail, in a bizarre response to the charges, dug up 2-year-old charges against Jones that alleged she stalked a 21-year-old student. They did not directly dispute her account of her firing.)
So with all the noise, what do we actually know? On May 11, the New York Times ran an article on the number and percentage of nursing home cases and deaths in each state. The data in this article came from the Times’s own database rather than relying on the sort of dashboard that might be under question in Florida. According to the Times, Florida has, at 615, the most nursing home facilities, with Pennsylvania the runner-up at 539. But Florida appears tenth on the list in terms of the number of nursing home and long-term care facility deaths, with 714, which represent a whopping 42% of the state’s total. The number of cases is 5,576, approximately equal to New York’s 5,637, but given that New York had 5,403 deaths, it would appear that the “cases” in New York are understated because of the enormity of the problem. (It would be unlikely, in other words, that only 1/6 of cases in Florida care homes resulted in death, but almost 100% of the cases in New York did.) The number of facilities with at least 50 cases is also illuminating. Florida had 22 facilities on that list, while New Jersey, with almost 100 fewer facilities than Florida overall, had an extraordinary 148 of those facilities with more than 50 cases. This, too, could be the result of more diligent reporting of cases in New Jersey, but with 4,855 care-home COVID deaths in New Jersey, or about seven times the Florida deaths, it seems unlikely that the problem is low reporting of cases in Florida. Indeed, since, as I said above, if we assume that the percentage of cases that end in death would be fairly consistent throughout this population, Florida’s 12.8% death percentage indicates that more of its cases were identified than in New Jersey, which had an 18.5% death percentage. I’m not, of course, saying categorically that Florida identified more cases. I’m just saying the numbers look reasonable.
The next step is to see what DeSantis’s focus on care homes (and allowing beaches to stay open, spring break to take place, and a number of businesses to reopen earlier than in other states) did for the overall statistics. We can go back to the New York Times, which generally didn’t think the approach was a good idea, for those statistics as well. On June 3, they produced their most recent state-by-state breakdown. Florida’s numbers look pretty decent here, as well. Their numbers are flat, meaning the number of new cases is not decreasing, as it is in New York, but it is staying the same. Given that New York has 1,942 cases per 100,000 and 153 deaths per 100,000, compared to Florida, with 267 cases per 100,000 and 12 deaths per 100,000, it seems that New York, like London, is showing a decrease because the rate was so high before. Florida doesn’t have as far to drop.
What does this all mean, since we’ve already done what we’ve done as far as the lockdown is concerned? I think it means a great deal about reopening. We need to put aside our preconceived notions, based on politics, about what works and what doesn’t. As the British press and politicians keep saying, this situation is unprecedented. If the numbers are correct, we need to understand why. It seems that a good portion of the credit has to go to the tight controls on nursing homes. There have been articles that suggest that the Florida weather may be playing a part, too, so it might not all be down to better controls. But that’s part of what DeSantis was suggesting—that places with different conditions should not all be treated the same. Unless we want to be stuck in lockdown forever, we need to figure out what the smart moves are for getting out. The optics of a crowded beach, be it in Bournemouth or Clearwater, are easy to wag our fingers at, but with everything we know so far, maybe the crowded beach doesn’t matter so much, as long as the people likely to be affected are kept safe—and keep themselves safe. I know someone who has two underlying conditions and is in that borderline age group (he’s 63) who is just dying to get out and be in crowded casinos and restaurants again. Right now, there’s no clear message from above that what is rational and fairly low-risk for a 25-year-old carries a great deal more risk for someone in his condition. As I’ve said previously, and as many other people have written on at length, the lockdown itself is a health risk. People are suffering from isolation and depression, they have been scared into ignoring other health problems that might be fatal if not attended to, and the economic hit they are likely to take probably has the longest impact on their health, especially in the United States. As we stumble forward, it seems foolish to discount one state’s experience because we don’t like the governor or the president who champions him. We shouldn’t blindly accept it, but just like hydroxychloroquine, we need to look at it without assuming it won’t work because Donald Trump endorses it.