Florida is on the verge of a COVID-19 resurgence

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Workers assist people with COVID-19 testing at the Hard Rock Stadium drive-thru site on Tuesday Oct. 13, 2020 in Miami Gardens, FL. - Susan Stocker/South Florida Sun-Sentinel/TNS

FORT LAUDERDALE, Fla. — Florida’s rising number of COVID-19 cases could be the leading edge of a dangerous spike that could continue for months as the state remains wide open for business, tourism and education, public health experts warn.

A decline of cases since the summer surge is over, four weeks into the state’s Phase 3 reopening of bars and restaurants at full service, state and national data indicates.

With Gov. Ron DeSantis promising there’s no chance of a return to lockdowns, no matter the severity of another surge, we can expect more people will need hospital treatment and more will die, experts say.

“My worry for Florida is that the embers are out there and they’re starting to burn, and by the time we see it in the numbers that are reported officially, it’s too late, and you’re going to see it only in the rearview mirror and wish you’d been a little more aggressive,” said Dr. Thomas Giordano, chief of infectious diseases at Baylor College of Medicine in Houston.

As of Friday, the number of new COVID cases per day in Florida had increased 36.4% over the past week (3,335) compared to 14 days earlier (2,445.) That followed a 6.1% decrease in the state’s average daily cases in the two weeks from Sept. 25 to Oct. 9.

The White House Coronavirus Task Force as recently as Oct. 11 cited “early warning signs” of an uptick in Florida cases.

A report obtained Thursday by the Orlando Sentinel came with recommendations for more testing and “mask and physical distancing messages for all residents, both in public and private spaces.”

Florida, which had been withholding the report from the public, released it under pressure from the Sentinel’s lawyers.

“There’s a real effort to obfuscate the pandemic, for reasons beyond my comprehension, because sticking your head in the sand doesn’t make it go away,” said Dr. Aileen Marty, professor of infectious diseases at Florida International University in Miami.

Florida is not alone among Sunbelt states that were hit hard by outbreaks in the summer. Many improved considerably in September and are experiencing a new rise in cases.

In Texas, the seven-day average of cases increased by 20.5% between Oct. 8 and Thursday. Arizona’s cases were up 47.1% over the same stretch, based on information from the COVID Tracking Project.

In California, which has had limited reopenings — Disneyland still remains closed — average daily cases are up only 5.7% over the past two weeks.

California, the most-populous state in the nation, has seen a rate of 8.1 new cases for every 100,000 people in the last seven days, according to the Centers for Disease Control and Prevention. Florida is almost twice as high at 15.2 cases per 100,000 people — more than Arizona’s 12.3 cases but less than Texas’ 17.6 cases.

The situation is far worse in the country’s upper Midwest, which is in the throes of a major coronavirus surge, according to the CDC. North Dakota has recorded 101.9 cases for every 100,000 residents in the last seven days, followed by South Dakota at 81 and Wisconsin at 60.

Experts say Florida could be better off because more people can be outdoors, where the virus does not spread as easily, and the region has more experience with fighting the coronavirus. But the state could quickly find itself back in the fire.

“We’ve been at this relatively high level of, I’d call it a fragile stability … so we’re not necessarily in a good place, meaning that it wouldn’t take much for us to see another wave or spike in activity,” said Dr. Marissa J. Levine, director of the University of South Florida’s Center for Leadership in Public Health Practice.

Florida’s rise in cases comes just as the United States on Friday set a one-day record of 83,757 cases — topping the previous high in mid-July — showing the virus is anything but under control, according to John Hopkins University data.

DeSantis, in remarks to reporters on Thursday, contended that shutdowns don’t necessarily stop the spread.

“We look now at what’s happening in different parts of the country, different parts of the world, some of these areas that have had real harsh policies are still seeing big outbreaks,” he said. “You’re seeing it in Europe. You’re seeing it in parts of the Midwest here.”

The governor likely was referring to Wisconsin, which earlier this month imposed restrictions on restaurants and bars, and all indoor public gatherings, to 25% of capacity, in response to a major outbreak. Cases have continued to surge there despite the measure, which a state appeals court temporarily blocked Friday.

DeSantis in the past week also defended his latest decision to allow children back into nursing homes and schools by pointing to near-pandemic lows in statewide hospitalizations, a continuing rollout of 6.4 million rapid tests and less severe symptoms among infected children.

The governor, who for months has championed a complete reopening of society while eschewing a statewide mandate for masks, said shutdowns are worse for health reasons.

“Yes, we need to mitigate the effects of this disease,” DeSantis said. “But this virus is not the end of all health issues. Health is about peoples’ physical, mental, emotional, social well-being. So mitigating one virus needs to be done, but it shouldn’t be done to the exclusion of anything else involving peoples’ well-being. … You’ve gotta look at the whole enchilada in terms of health.”

DeSantis’ administration this past week also took aim at perhaps the biggest black mark on the state — the number of COVID-19 fatalities. It’s been rising by about 1,000 newly reported deaths every 10 days, marring the state’s promotion of an improving pandemic picture.

The Department of Health said it is reviewing all deaths that have been linked to the disease so far, a number that stood at 16,544 and counting on Friday. That’s the fourth-highest total in the nation, behind New York, Texas and California.

Florida’s COVID-19 death rate since the pandemic began is ninth among states, tied with Illinois, at 76 deaths per 100,000 people, according to the CDC. That’s higher than Texas (60) and California (43). A rate for New York State including New York City is unavailable.

Over the past three months, Florida’s death rate per 100,000 people has tripled, CDC data show. It was 25.9 on July 25. California then had 20.3 deaths per 100,000 and Texas 15.8 deaths.

Florida health officials said the “integrity” of their death tally is in question because they’ve observed a lag of two or three months between the time some people tested positive and their deaths.

The implication is that the victims died from underlying health issues, even if they had COVID-19. House Democrats say the DeSantis administration is just trying to downplay the death toll, so the crisis appears less dire.

Some experts who run computer-based projections are signaling concern for Florida, and others are predicting a downward trend, according to a collection of forecasts assembled by the CDC.

One of the favorable models, from UCLA, shows the average daily case count for Florida will drop to 1,055 cases a case by Nov. 24 and fall further to 764 cases a day by Dec. 24.

Another forecaster, not cited by the CDC, the PolicyLab at Children’s Hospital of Philadelphia, said Wednesday that its forecasts for Florida still “remain stable comparatively to other areas of the country.”

But Dr. Brian Fisher, who works on the center’s modeling of COVID-19 trends across the nation, highlighted Miami-Dade and Broward counties as places “at risk for significant case count increases in the coming weeks.”

“That said, these regions should not throw up their hands and accept this projected fate,” Fisher wrote. “As we have seen in other areas of the country, rising incidence rates can be stymied with a collective community commitment to safety protocols.”

In other words, Florida could still avoid a COVID resurgence.

Wearing masks and social distancing efforts are especially key because of the arrival of influenza season, said Levine of USF.

“It’s really critical that we don’t let our guard down,” she said. “If we do, we could have a double hit with COVID and flu. … If this takes off, we won’t be able to stop it for a while.”

Marty, the COVID-19 expert from FIU, agreed the state is in a dangerous spot.

“This is a highly contagious virus that includes a significant subset of people who don’t know that they’re spreading it,” the professor said. “And you have these large gatherings of people not physically distancing and not wearing marks, of course our cases are going to go up.”

Marty said the public needs to understand that “maybe it’s not such a good idea to hang around without masks and start giving people hugs again.”

“We must keep it from getting from person to person long enough so we can develop a safe and effective vaccine,” she said, adding that it’s not easy to predict how many new cases are coming.

Cindy Prins, associate professor of epidemiology at the University of Florida, says there’s a definite connection between the state’s move to Phase 3 and the recent rise in cases. She sees it as “a potential red flag.”

“We’re not at a big spike in cases at this point, but it is a concern and a trend to keep an eye on,” Prins said. “As we know these things can start slowly, but as we saw in June … as you get more and more cases in the community you get increased spread and then things really start to take off. We’re at that point right now where we need to be watching this.”

Dr. Mary Jo Trepka, epidemiology department chairwoman at FIU, said the warnings are especially important for South Florida. The region has 29% of the state’s population but 40.6% of Florida’s 771,780 cases.

“Everybody still should act as if we definitely have COVID transmission going on in the community, because we do,” Trepka said. “If we don’t continue to be careful, it could mushroom again like it did this summer.”

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Data journalist Alonso Alcocer contributed to this report.

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©2020 Sun Sentinel (Fort Lauderdale, Fla.)