Florida’s Covid-19 tragedy

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Sean Rameswaram: COVID-19, am I right? A few months ago, the entire world watched bodies pile up in New York City. We read about doctors and nurses losing their lives. It was harrowing. And all the while, we saw images of people in Florida hanging out on beaches, partying. And now, New Yorkers are slowly returning to some semblance of normalcy. And Florida, man. Tonight, Florida finds itself in a harsh spotlight. The state was one of the first to reopen. Now, it's breaking records for new infections. Florida reported more than 15,000 new cases yesterday. That shatters the one-day record for any state. ICU bed capacity in Miami-Dade County, the epicenter of the nation's new epicenter, now at nearly 92% and rising. The volume of COVID patients coming to the hospital is five times higher than it was a month and a half ago.

Sean Rameswaram: We spoke to one of the leaders in the emergency department who said, listen, we have seven ICU beds available, but we're doing everything we can to ride that wave right now and not get overwhelmed by the patients who keep coming in day after day. Florida's got 500,000 cases and counting. Their daily case tolls have outnumbered continental Europe. Something like 8,000 people have died.

Sean Rameswaram: Veronica Saragovia, you've been covering this crisis for WLRN Public Radio in Miami. How did things get so bad there? Florida had the heads up. Right. For one thing, Florida was late to close down and reopened too soon. And in March, the governor had not yet ordered a shutdown of a lot of businesses. And so people had actually started staying at home on their own. And that helped Florida a bit for a while as New York got really bad. But once it reopened, I mean, we recently had Disney World do a partial reopening. The Mickey Mouse and Tinkerbell meet and greet are not happening right now, but you can find Mickey, Minnie, the whole Fab Five, Tinkerbell, and all the characters you want to see pretty much all around the park. It's like a special magical surprise.

Veronica Saragovia: And the Major League Soccer had a tournament in Orlando. MLS confirmed today that six players from FC Dallas have tested positive for the coronavirus. Florida has been reopening things where people are gathering when it doesn't have a control over the spread of this disease. Shopping malls are open and you'll see, you know, parking lots full of people. And the other problem, too, is that there's no statewide mask mandate. And so it's up to mayors to set these. And it's, I think, very confusing for people. And Florida is a state where people tend to live close to their families. And that's caused a lot of problems with younger people visiting parents and grandparents and spreading the virus or just people celebrating graduations or, you know, it's summertime and people want to be together with friends.

Veronica Saragovia: And so I guess that's a bunch of reasons. But the way this has been managed has just been very confusing and no strong leadership to get these numbers down. What's the governor doing now that you guys are setting records and that Florida has become like the global epicenter of the coronavirus?

Veronica Saragovia: The governor has been working on improving the testing because that's been a big problem that he's recognized that for a while people were waiting two, sometimes three, even four weeks to get the results back. And of course, during all of that time, people are going around spreading the virus until they know if they have it or not. And so this week, we now have some more rapid testing. It's a 15-minute test for people who are either 65 and older or for children or for people who have symptoms And there has been a slight improvement in money allocated for contact tracing That also been a really big problem The state just really has had a lot of problems getting its contact tracing going And so that effort, which has really helped in other states and other countries to get people to isolate at home, just really hasn't been present here in Florida to the extent that it should, given the population size.

Veronica Saragovia: And Florida's got a lot of retirees. Are elderly people being hit harder than others in Florida? Some of the hardest hit people have been those who live in nursing homes or assisted living facilities. And that's because a lot of the certified nursing assistants who work at these nursing facilities, they work more than one job for a lot of them. I've spoken to union representatives who tell me they earn about $12 an hour. And so they have exposure by working at more than one place. A lot of them don't have health insurance. And so it's been really a big problem in terms of the spread at nursing homes. And so at one point, more than 50% of the deaths in the state were at these facilities.

Veronica Saragovia: Governor Ron DeSantis has been talking a lot about this new effort underway. We have created over the period of the last few months, 23 COVID only nursing facilities that have over 1,500 beds. And these are facilities that can be used to transfer a COVID positive resident out of a nursing home to a place where they could be properly isolated. They could also be discharged from the hospital to a COVID only facility, even if they're still COVID positive, because the facility is set up to deal with that. And you don't run the risk of putting them in a regular nursing home and spreading it amongst the seniors.

Veronica Saragovia: So to be clear here, they're taking people who have COVID out of hospitals and sending them to like COVID only nursing homes? Exactly. And they actually this was done in New York state and other states as well. In New York, at first it had been mandated on nursing homes to take patients. In Florida, the nursing homes agree to it because they're going to get more reimbursement money from the state for taking these patients. So somebody who's an older person who lives, let's say, in a nursing home, they cannot, by state rules, they cannot go back to that permanent nursing home until they test negative twice. So what they do is they go to another nursing home that pledges it can take more people and keep them separate from the permanent population.

Veronica Saragovia: I've heard outrage from family members. There's one in particular that let the residents know a week before the new patients were allowed to come in. And that's not enough time for a family member to transport someone who I know of someone who's 98. It's not that easy to take someone out of a nursing home at that state and find a place for them to live safely. It sounds super dangerous. What have you heard from people who have family in these nursing homes?

Veronica Saragovia: I've spoken to a few and one of them is Barbara Fleming and she used to visit her mother pretty much on a daily basis. One of the head nurses came in and told me that visiting would have to stop until things calmed down with COVID. So, you know, it was really difficult. My mom and I both cried as we held each other and didn't know how long it would be until we were able to see each other again. And her mother fell ill and died at a hospital. My heart felt like it had broken into two. I would never see my mom again. I was hurt. I was angry because someone at the rehab had infected my mom. And all I could think of is how could this have happened to my mom, who was healthy and happy and loved life so much.

Veronica Saragovia: Then they called me from the rehab and told me that I had a week to pick up my mom's stuff, that they would box it up and that I had one week, which I'm afraid to go do because the place is covered in COVID. Everybody's got it now. And so she just said she's just going to keep what she had of her mother and those belongings are just, she'll never get them. This just feels sort of inexplicably irresponsible, like all of this could have been avoided. And Governor DeSantis isn't really changing his game plan on anything? Well, the one change that I see is that he's really focused on improving the testing situation. And unfortunately, for the last few days, testing was shut down at the state-funded sites. because of the tropical storm Isaias. But he is implementing these fast lanes at those sites where people who have symptoms or who are 65 and older and also children can get tested quicker and they can get results in 15 minutes.

Veronica Saragovia: But Governor Ron DeSantis has, he won't put a statewide mask mandate in place. And he also wanted schools to open by a certain date in August And so what I see is not really the level of urgency that this pandemic requires.

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Sean Rameswaram: Dylan Scott, your report on healthcare here at Vox. We just heard from Veronica about how bad things have gotten in Florida. How's the rest of the country doing? Also bad? Yeah, not great. We've still got states like Arizona and California and Texas, which have had a really high level of cases through most of the summer. They've been driving most of this summer wave and their cases are still high, even if they appear to maybe have peaked and are starting to plateau or even dip a little bit.

Dylan Scott: You know, we shouldn't take too much comfort in that news because the level of infections in those states are still really high. And even more troubling is we're starting to see some new hotspots start to emerge in states like Alabama and Mississippi. some of the metrics that public health experts watch to get a sense of how a state's outbreak is progressing don't look particularly good in those other southern states. And so I think what we'll be watching here over the next few weeks is that even if infections start to subside in those big four, Arizona, Florida, California, and Texas, there are going to be some other places where the virus is starting to flare up.

Dylan Scott: And this was pretty much the case the last time we had you on the show. we were talking about big new spikes in states like California, Texas, Arizona. Of course, you're saying it's now moving to Alabama, Mississippi. But what else is changing about how this pandemic is spreading throughout the country right now? I know I told you that we could expect deaths to start to pick up after a few weeks because there's just this long lag between when somebody gets infected with COVID-19, when they might develop symptoms that are severe enough for them to end up in the hospital. And then the time that it might take them to actually die, you know, that process can take a month or longer.

Dylan Scott: And so yes, a month ago, everybody was talking about how cases were rising, but deaths were still falling. And then pretty quickly, the death toll started to increase again. And now we are averaging over a thousand deaths a day for the first time since May. And because deaths are a lagging indicator, even though nationally cases seem to be plateauing again, I think we can expect the death counts to remain high for a while now because deaths tend to reflect the state of a pandemic four, five, six weeks ago.

Dylan Scott: I guess one of the few things the country might have going for it is experience. We've been battling this pandemic for six, seven months now. Have we learned anything? Are we getting any better at fighting it, at testing it, at tracing it? Or are we just doomed, Dylan? We're not doomed. We have learned a lot. I think there's a few different ways to think about this question. There are therapies like remdesivir, like dexamethasone, that have been shown to improve outcomes for people who have already developed severe symptoms that are in the hospital and might have ended up on a ventilator

Dylan Scott: We know that if we give them those medications their outcomes are better We can get them out of the hospital quicker. That should mean that we hopefully will never see the level of fatalities that we saw back in the spring in New York City when nobody really knew how widespread the virus was and nobody really knew how to treat it. We've come a long way in developing those standards of care. And I think there's good reason to be optimistic that even as deaths are rising, they're not going to rise back to the same levels that we saw during the worst of it in New York.

Dylan Scott: It's just hopefully through some of these interventions that we've discovered, we'll be able to keep deaths at least as low as they can be. How have the politics of this changed in the meanwhile? I mean, President Trump recently reinstated his afternoon press briefings. Was that an admission that this is still a very serious issue that needs the nation's attention? I think so. I mean, for a while, it seemed like the Trump administration's strategy was to pretend that COVID-19 was under control. I think it's under control. I'll tell you what. How? A thousand Americans are dying a day. They are dying. That's true. And it is what it is. But that doesn't mean we aren't doing everything we can. It's under control as much as you can control it. You know, they wanted to simultaneously declare victory, but also wash their hands of responsibility for any new developments in the pandemic.

Dylan Scott: And I think that that has become untenable just because the chorus of experts and even Republican elected officials who have said that the U.S. response has been inadequate is just impossible to ignore. Just a few weeks ago, Mick Mulvaney, the former chief of staff to President Trump, said that the amount of testing being done in the United States was unacceptable. Maryland Governor Larry Hogan, who is a Republican, wrote a brutal op-ed in the Washington Post lambasting the Trump administration for its pandemic response. And the polling has been pretty clear that people don't trust what Trump says about the pandemic. They don't approve of the way he's handled the coronavirus response.

Dylan Scott: And so I think all of those things combined just made it unpalatable for the Trump administration to continue pretending as if COVID was under control or it wasn't their responsibility to try to control it. When you are not able to socially distance, wear a mask, get a mask, whether you like the mask or not. And so, you know, the best thing that they could think to do was to put the president back in front of the cameras again to try to present some kind of counter narrative to all the negative headlines that people were seeing about, you know, this rise in cases and now the rise in deaths here in the last few weeks.

Dylan Scott: Have the politics around this changed outside of the White House? I mean, is the country, as this spreads, taking it more seriously? Are governors, as they're having to deal with this in a more tangible way, starting to take this seriously? Are we learning from our mistakes, Dylan? Slowly and fitfully, we do seem to be learning from our mistakes. So we saw in Texas, as cases and hospitalizations started to increase, Governor Greg Abbott finally instituted a statewide mask mandate. He closed some bars and other businesses again. Mississippi, Governor Tate Reeves, who has also been, like many Republican governors, very resistant to the idea of a statewide mask mandate, finally issued such an order.

Dylan Scott: So, you know, once circumstances force these politicians' hands, they are reacting. I know that the public health experts would tell you that preemptive action is a lot more important. It's sort of this just almost this paradox where we do do what's necessary, but not until it's already too late. The U.S. just seems kind of constitutionally unwilling, starting right at the top in the White House with doing the work that is necessary to contain it.

Sean Rameswaram: Well, thank you for your work. Appreciate your reporting as always. Thank you. Dylan Scott, he's a health care reporter for Vox. You can find his work at Vox.com.

Sean Rameswaram: Our team is currently working on a story about dating during COVID-19. Rumor has it it's kind of hard to do, at least if you're trying to be responsible about it. We want to know what dating from a distance is like, especially if you're in an entirely online-only relationship. If you've fallen in love over FaceTime or Zoom, if you're just writing letters to someone with your favorite pen, Are you waiting with bated breath until the day you can finally see your person in person? Email todayexplained at vox.com or tweet at today underscore explained if you want to talk about love in the time of COVID.

Sean Rameswaram: I'm Sean Rameswaram for him. It's Today Explained. Thank you.