Why Are COVID Cases Rising in Florida?

At first, it seemed Florida had somehow skirted catastrophe. The state defied dire predictions from experts who pointed out the obvious: Florida wasn’t taking the dramatic measures public health experts called for, which was particularly worrisome given its large number of vulnerable retirees. But disaster never hit. By May, it had one-tenth the number of cases that had been predicted under worst-case scenarios. Gov. Ron DeSantis gloated of his state’s superiority over liberal states like New York, and reopening started in May.

Now, it seems that some of that gloating may have been premature. On Wednesday, Florida had its 15^th straight day of more than 1,000 new cases. Tuesday set a new single-day record for new infections, with 2,783, a number almost matched on Wednesday. Florida has joined a handful of states where the growth in cases is rapidly increasing, and unlike rural states with relatively small baselines, such as Oklahoma, the numbers in populous Florida are significant and concerning. The state now has over 80,000 cases and has reported more than 3,000 deaths. And yet, even in the face of these numbers, the state health department has insisted that the growth has more to do with increased testing than it does with actual increased cases. What is really going on in Florida?

According to experts, there’s almost no way testing can fully account for this spike. Cindy Prins, an associate professor of epidemiology at the University of Florida, said that if testing was responsible, there would be a fairly neat correlation between tests and cases. But while there has been a continued growth in cases since around June 2, testing has been more erratic. Florida has undoubtedly expanded its testing, at twice its rate in May, for a current total of more than 1.4 million Floridians. But there has been day-to-day variation in the rollout—and there hasn’t been much variation in the case numbers.

Another worrying indicator: Test positivity rates, meaning the percentage of tests coming back positive, have increased slightly in recent days. Some people have pointed out that, looking at the big picture, the rates have remained lower in Florida than they were in the worst weeks of the pandemic. But Prins said that that was inevitable. “From the beginning of us looking at cases and starting to test, you had high positivity rates because testing was limited,” she said. “So you expect a decrease in positivity rates no matter what.” Low rates, then, do not mean the state isn’t experiencing a spike. And other metrics support the case for a true second wave: Florida has also seen a rise in new hospitalizations in recent weeks. That can’t be attributed to simply having more testing.

Public health experts are familiar with the phenomenon of caution fatigue.

It’s hard to pinpoint how much this wave is a response to businesses reopening and how much it’s due to other factors. Prins noted that, anecdotally, a lot of Floridians appear to have given up on wearing masks. “I don’t think, in Florida, most people are using preventative measures to control the spread,” said Ambuj Kumar, a biostatistician and associate professor of internal medicine at the University of South Florida. “I don’t see people wearing masks.” Prins said she had noticed the same trend. “I’m a little concerned now as I see us open up, there’s less concern for that personal risk,” she said. “People took it as a message that you don’t have to worry about it anymore.”

Public health experts are familiar with the phenomenon she is describing: caution fatigue. One of the main reasons experts think Florida avoided a catastrophic epidemic in the first place is because its public began staying home before it was ordered to do so. But now, mentally exhausted after three months of stress, even residents in the hardest-hit parts of the country have grown complacent. That temptation might be worse for the people who haven’t directly experienced the pandemic’s toll—especially those in middle-class or wealthy white communities. It’s also hard to keep being cautious as visibly normal activity resumes around them, even as public health experts warn that the disease is still running rampant.

DeSantis has assured Floridians that there was no need to reverse any of the reopenings. He blamed increases on clusters, citing prison outbreaks, for example, and a watermelon farm where 90 out of 100 workers tested positive. And Florida’s large population of migrant farmworkers may in fact be a contributing factor: According to the South Florida Sun-Sentinel, many agricultural communities in Florida have seen a recent spike in cases, and one town in southern Florida, known for its tomato farms, has reported more than 1,000 cases out of a population of just 25,000. Farmworkers are often transported to work together in crowded buses, and immigrants often live together in overcrowded housing or in intergenerational families, exacerbating the spread. Counties with significant immigrant populations also run into issues with testing because of language barriers or because undocumented immigrants fear the presence of law enforcement at testing centers. Some people have no access to cars, cutting them off from drive-thru testing sites. Some critics have complained that the state failed these rural communities by not providing testing quickly enough. But as tragic as these outbreaks are, these communities aren’t large. They represent only a small number of the growing list of cases.

Protests against police brutality may be behind some of the recent growth too, though experts still don’t know how the protests, which took place outside, compare with gatherings in places such as restaurants and bars—early evidence from New York suggests it might not be a big factor. There also may be some spread rooted in tourism, but as an industry, it remains fairly limited. “There are so many unknown factors,” Kumar said. He pointed out that even when accounting for more obvious causes, there are still random occurrences and unexpected trends that raise questions. The only thing he could say for certain was that the general relaxation over social distancing measures played a part. “What we are doing wrong is we are letting our guard down,” he said.

Kumar did emphasize that it remains notable that the spread has been as limited as it has been, given the state’s elderly population. And Florida is now seeing a demographic shift: The people testing positive are now younger. A Florida Department of Health report found that Floridians under the age 18 are testing positive at almost twice the rate of residents of the state as a whole. This demographic change helps to explain another trend as well—declining numbers of deaths. The state’s health department does not publicize statewide hospitalization data, but self-reporting from some hospitals indicates that they’re admitting fewer COVID-19 patients. Young people who develop COVID usually avoid serious illness and hospitalization: Over 80 percent of deaths from the virus are among those 65 or older. It’s also possible there is a lag and that this wave of new cases might soon be followed by a wave of hospitalizations.

Given the commitment to keeping businesses fully open, it doesn’t seem like these trends will reverse soon. DeSantis has vocally encouraged sports to return, and he attended a NASCAR race on Sunday. The Republican National Committee announced Thursday that President Donald Trump would give his acceptance speech for the Republican nomination in Jacksonville, at an event that’s expected to draw thousands. Some theme parks have already opened for business, and Walt Disney World plans to reopen in early July. “You have to have society function,” DeSantis said Tuesday. “We’re not rolling back.”