The reopening of Disney World in mid-July is one of several factors that worry experts in regards to Florida’s COVID-19 surge. Getty Images
  • Florida is one of the epicenters of the U.S. COVID-19 pandemic, leading all states in new cases per capita.
  • Experts say the reopening of businesses as well as a general reluctance to wear facial coverings and to adhere to physical distancing are the main factors.
  • Experts urge Florida to adopt some of the restrictions enacted by Arizona several weeks ago to help stem the rising tide of COVID-19 cases, hospitalizations, and deaths.

Florida is now the center of the sports world. 

Twenty-two NBA teams restart their season next week, sequestered in a “bubble” at Disney World in Orlando.

Twelve WNBA teams are doing the same on Saturday in their Tampa-area home base.

Major-league soccer is a couple weeks into a tournament in its own Orlando world.

The Tampa Bay Rays host the Toronto Blue Jays on Friday night in the teams’ Major League Baseball season opener. However, the Blue Jays won’t be able to return the favor.

The Canadian government deemed it too risky to allow teams to fly into Canada from the United States, where the COVID-19 outbreak has been surging again.

The Rays’ home state is likely a big reason for that.

That’s because Florida is also now one of the centers of the COVID-19 pandemic in the United States.

Experts blame the state’s lackluster response and a seemingly unique degree of resistance to physical distancing or wearing facial coverings such as face masks.

They add that things such as sport competitions or the reopening of Disney World don’t help either. 

The question they’re asking now is how much worse is it going to get.

For answers, they’re looking to models, trends, and the experience of Southwest states such as Arizona, where cases started surging again just a bit before they really took off in Florida.

Predicting the peak

On Thursday, Florida was leading all states in new cases per capita by most calculations.

It had more than 1,300 new cases in a day for the first time on June 10 and has continued to rise from there. There were 9,785 new cases Wednesday, down slightly from the record highs over the weekend.

The rate of tests coming back positive has also climbed, so the uptick likely isn’t just due to more testing. In Miami-Dade County, for instance, the positivity rate hasn’t been in single digits for more than a month.

According to the models, if things continue as they have been, that climb in daily new cases may continue.

Children’s Hospital of Philadelphia’s PolicyLab has been modeling the spread of COVID-19 at the county level across the country.

In their models, updated Wednesday, Miami-Dade County is projected to see daily new cases increase from around 3,000 currently to 4,700 by mid-August.

Several other counties are also projected to be on their way to setting new highs, including Broward (neighboring Miami-Dade), Duval (home to Jacksonville), Hillsborough (Tampa), Pinellas (St. Petersburg), Seminole (just north of Orlando), and Volusia (Daytona Beach).

The projections are less steep but still predict a gradual rise in all the other counties included in the model. Only one, Charlotte County (between Sarasota and Fort Myers), is projected to see a decline. 

“The question is what is (Florida’s) potential peak if they continue not to mount a serious response to this,” Dr. David Rubin, director of the Philadelphia PolicyLab, told Healthline. “And I think that’s everyone’s question right now.”

His models are based on the rate of spread in the county and other nearby areas as well as population demographics, local testing capacity, and weather factors.

They also include how much physical distancing is happening, based on cellphone GPS data about movement compared to movement before the pandemic started.

“The bottom line is we’re not seeing enough physical distancing in Florida at this point,” Rubin said.

He noted that “if there’s any sign of optimism” it’s that there is some improvement in physical distancing in the Tampa area. 

In hard-hit southern Florida, Zoran Bursac, PhD, chair of Florida International University’s Department of Biostatistics, is seeing a few other signs of hope in the numbers.

“What we’re seeing in South Florida — and the trends are similar to the rest of the state — is some of the measures and mandates that have been put in place are slowly taking some effect,” Bursac told Healthline. “Even though the number of cases is high, it may be kind of plateauing a bit, or teeter-tottering a bit, not significantly up or down.”

Bursac has been working with other area researchers to maintain the Miami-Dade County COVID-19 Trajectory, which tracks patterns in COVID-19 statistics in Florida’s most populous county. 

He said daily new cases have been averaging a bit lower over the past 7 to 10 days, whereas it had looked possible that they could have instead “gone significantly up.” 

“We’re hopefully somewhere near the peak,” Bursac said.

The positivity rate appears it may be going down at least a little bit in Miami-Dade as well, albeit in fits and starts. Since a peak of 26 percent on July 8, it has fluctuated between 16 and 22 percent in the 2 weeks since, according to the tracker.

But, the tracker website cautions, “it is recommended that this proportion (of positive cases) not exceed 5 percent,” a threshold the county hasn’t been below since June 6.

As for the key metric of hospitalizations, Bursac says upticks in that category could lag behind new cases.

“Not sure if it will get worse but will probably stay at this level,” he said.

That level could be just on the edge of danger. The most recent data in the tracker, from Tuesday, shows a record number of 2,299 people were hospitalized with COVID-19 in the Miami-Dade area. A record number of them were also in the ICU (527) and on ventilators (312).

“We talk to hospitals all the time, and they say, ‘We can kind of manage it, but we need to reduce it… It can’t continue to grow,’” Bursac said. “Hopefully it will reverse in next few weeks.”

Looking to Arizona

To make that happen, Florida may need a U-turn in public opinion and public policy similar to what has been seen in Arizona.

While deaths continue to rise in Arizona, new daily cases have been on the decline since early July. That’s after they had jumped from under 200 new cases a day at the beginning of June to more than 4,700 by early July.

Far from a success story, but it now looks likely cases in Arizona peaked 3 weeks ago. There could be lessons for Florida here.

Chief among them, experts say: Limit indoor activities and wear face masks.

“We are all being very cautious about the data because the number of tests being reported has gone down dramatically from July 1st in Arizona,” said Purnima Madhivanan, PhD, an infectious disease epidemiologist at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.

She notes the system appears to overwhelmed and has been backfilling data from previous periods, making the actual number of tests and cases uncertain.

“That being said, Arizona did institute a face mask order on June 17th, and on June 29th it closed bars, gyms and theaters,” Madhivanan told Healthline. “Given that there is a 2- to 3-week lag in between instituting a public health measure and the actual results of that measure, I suspect that the closure of bars, gyms, and theaters is probably having a salutary effect on our case rate.”

Relying on people to make the right choice is less likely to work, she said. That’s why closures are necessary despite the costs

“What Florida can learn from us is that systemic structural interventions are more effective than those that depend on individual choice,” she said. “The challenge with the crisis like COVID-19 is that one or two people who don’t do the right thing can infect an entire group, even though most of the other people are making the right choices.”

She said that Florida should prohibit indoor dining.

“At this point, all the other solutions like contact tracing are impractical given the high case rates,” she said. “Currently anything that disrupts gatherings, particularly those in closed settings are probably the best measures that can be taken.”

While Florida Gov. Ron DeSantis re-closed bars in late June, retail stores as well as indoor venues such as bowling alleys and restaurant dining have been allowed to stay open in most counties.

In Orlando, Disney World re-opened on July 11 with new rules and safety measures, including requiring face masks and limited capacity.

Despite the safety measures, Bursac said, “if you have a lot of people in one area, I don’t see how it helps.”

A third of Florida’s counties have issued face mask mandates. But unlike in Arizona, DeSantis has refused to issue a statewide face mask mandate. 

“Florida continues to be in a lot of trouble compared to the Southwest,” said Rubin. “The Southwest looks like it’s buckling down, social distancing more… Don’t see the same evidence in Florida, not sure if the public messaging hasn’t been there or people are just letting it burn, resigned to the fate of what’s happening there.”

A sign of hope is that national retailers such as Costco, Walmart and CVS are requiring masks, notes Madhivanan.

But there’s a looming complication. Early on, there was hope the summer weather would lead to a decline in the spread of the virus. Now, it might have the opposite effect.

For one thing, many testing centers are outside, Madhivanan notes, which could be a problem as temperatures rise in Sun Belt states. And then there’s just the desire to be out of the heat in general.

“In the past, the high temperatures might have improved the situation, but in today’s environment, people are congregating more in air-conditioned settings, leading to more risk for community transmission of the virus,” she said.

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