Florida is fast becoming the last Covid-19 epicenter in the United States. The rise in sunshine has been linked in part to younger Americans, but that doesn’t mean there is no cause for concern.
Like many Covid-19 stories, it started with a dry cough.
Fever, loss of taste, and chest pain followed Sanjay Bharath’s diagnosis in early March.
Bharath, who is a hospital nurse in South Florida, says she contracted the virus from a patient when the Covid-19 admissions screening process was less stringent. They told him to quarantine two days later.
At 34, Bharath does not belong to an age group vulnerable to viruses. But 14 days after that first contact, he had coughed up blood and checked into the hospital.
Two days later, on March 26, he was intubated.
“I didn’t think it was that bad,” he says, describing his first hours in the emergency room. “I honestly thought they were not going to admit me to the hospital, they just sent me home with some kind of medication.”
As his symptoms worsened, Bharath says he would wake up sweating with a fever every six hours, feeling chills and lightheaded and unable to catch his breath.
“I couldn’t breathe deeply without coughing and choking,” he says. “It’s like you’re constantly running a marathon just sitting down.”
Bharath would remain on a respirator for eight days.
Florida has been averaging almost 10,000 new cases per day for the past week. On July 12, the state broke the national record by reporting 15,300 cases in a single day. A Reuters analysis on July 12 found that if Florida were a country, it would be the fourth in the world for most new cases in one day.
As of July 13, more than 4,200 Floridians have died from the virus, and the state’s weekly average has risen to 73 people each day according to local counts.
Florida saw the biggest daily jump in hospital admissions on July 9, with more than 400 patients needing treatment. The state’s highest number of daily deaths was recorded the same day, with 120 residents, including an 11-year-old girl, dying from the virus.
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Critics say the number of deaths is likely higher, since Florida does not like other states to report deaths suspected of being caused by Covid-19. The state also has to report daily hospital admission rates, though authorities have promised to do so.
Along with Texas and Arizona, the Sunshine State has quickly become one of the regions with the largest waves in the country.
The positive test rate, which indicates how much the virus is spreading even with test increases, is close to 20%, the highest since the beginning of March, when the pandemic hit the US. That’s also four. times the reopening standard set by the World Health Organization, and doubles the recommendation of the Centers for Disease Control.
Florida only reached the 100,000 case mark on June 22, according to data from Johns Hopkins University. Just 13 days later, that number had doubled.
Now, there are more than 278,000 cases.
“There is a lot of misinformation across the web about the severity of this outbreak,” says Dr. Aileen Marty, an infectious disease expert at Florida International University who has been working with state officials in responding to the pandemic. She says this is in part why Florida is now among the worst affected regions.
“Since we don’t have a consistent message in our state, let alone in our country, there is even more confusion.”
In May and June, Governor Ron DeSantis said the reopening was feasible as cases had declined. He promised not to back down.
When cases began to escalate, DeSantis in June reversed its decision to allow bars to reopen. But he has refused to require masks statewide, although local leaders in major cities like Miami have done so, and has joined President Donald Trump in emphasizing the importance of keeping the economy open.
“The way we have acted after our initial blocks has perpetuated the problem,” says Dr. Marty. “It was a failure because they didn’t do it right the first time.”
Dr. Marty, who also serves as an adviser to the World Health Organization, says that establishing a contact tracking and isolation system while the state was closed was a key step that never happened.
The lack of early evidence of asymptomatic individuals plus weeks of civil unrest, between protesters against the blockade and marches against racial inequality, have also worsened the situation.
But even as Florida numbers continue to rise, DeSantis said last week that he felt the state’s numbers had stabilized, saying to residents, “There is no need to be afraid.”
The Republican governor has also downplayed the severity of the Florida outbreak by pointing to increased testing and infection for younger Floridians, particularly those ages 25 to 34, as well as a lower death rate.
“Overall, deaths are still about two weeks late when we receive the positive results,” explains Dr. Marty. She rejects the idea that the United States is doing well with deaths from this virus, and says that even looking at raw data alone shows that the national rate, at about 5.6%, is worrisome.
“That is considering the fact that we are better now than before,” he adds. “We will get people to bed earlier, we will move people to ICUs sooner.”
The tests, despite delays in obtaining results, have also helped mitigation. The medication is helping, although Florida has run out of the antiviral drug Remdesivir and is awaiting further shipments.
“I just don’t understand the people who say our death rate is excellent,” says Dr. Marty.
Younger Americans have been accused of sudden increases across the country, and particularly in Florida, where the majority of new cases are of people under the age of 30 who follow summer weather and national holidays.
The average age of infections in Miami-Dade County, the state’s most populous region, is 40. In Tallahassee, the median recently hit a 25-year low.
But the fact that younger people are less likely to die than the elderly of this disease does not make this increase less worrying. Health experts warn that there are still serious risks and too many unknowns about what long-term Covid-19 procurement means.
Recent studies have found that some asymptomatic survivors lost some of their sense of smell, even if they didn’t notice a change. On scans, people who feel well show signs of lung damage.
“There is a risk of [young people] now that he is small, and an unknown risk to his future, “says Dr. Marty.
At the hospital, Dr. Marty has seen Covid patients develop clots that lead to strokes. Some clots lead to loss of limbs. Others develop inflammation of the heart. All this in addition to the damage to the lungs, the scars that will feel the effects for the rest of their lives.
Only in the last week has he seen patients between 30 and 80 years old.
“It is not one and it is already done,” he emphasizes.
There are also questions when it comes to herd immunity, with no proof yet that it works with this virus. Data from the other six coronaviruses that have caused human infections suggest that none of them produces immunity that lasts more than a year.
Bharath was one of the first staff members at his hospital to catch Covid-19 in March.
After being removed from the ventilator, the 34-year-old man was transferred from the ICU to recover for four days in an exclusive Covid-19 unit, the same unit where he now works. No visitors, not even family, were allowed.
“Recovery was a little difficult at first,” says Bharath. “I was still out of breath, I still had pneumonia. I was still having trouble breathing and moving.”
In the two weeks in the hospital for Covid-19, Bharath lost 20 pounds (9 kg). Standing still in a hospital bed exacerbated a previous nerve problem in his feet: he lost some sensitivity in his toes while other tendons tightened painfully. He was out of work for another six weeks.
Now, four months after his hospital stay, Bharath is still recovering. “I still get a little out of breath here and there,” he says.
When he returned to work in early June, he says he “hesitated a little.”
“But I felt like I owed it to the staff and the employees, and there is still a job to do, so I had to go back.”
Endless work is beginning to affect health workers across the state. The staff is exhausted, frustrated, scared.
As of July 13, there are just over 13,700 hospital beds, about 22% of the total, still available in the state, according to data from the Agency for Health Care Administration. Almost half of all ICUs in the state report that they are at least 90% full, leaving less than 1,200 beds available. More than 40 hospitals are already in capacity.
“There are a limited number of trained and prepared professionals,” says Dr. Marty. “We are talking about doctors, we are talking about nurses, we are talking about assistants of all kinds, who know how to use even the type of equipment we need to use. A brain surgeon has no idea how to use a ventilator.”
Florida will import more than 100 nurses in the coming days, and it seems likely that the state will also need to import doctors. Essential to keep staff safe and contain the spread of the virus in care settings, personal protective equipment is also being depleted again.
“We are stressed,” says Dr. Marty. “The nurses come to me because they are told to wear surgical masks instead of N95 because we don’t have N95.”
Evidence continues to be America’s ever-present problem. Without it, keeping Covid-19 contained is a shot in the dark.
The United States had begun increasing testing capacity, but the lawsuits are now threatening to overwhelm laboratories in Florida and across the country. Machines cannot keep up with increasing testing, resulting in delays that in turn feed the community, as people don’t know if they are positive for days.
Bharath says it’s frustrating to see people continue to refuse to wear masks, and denies that Florida’s recent surge is due to its drive to reopen.
“They are putting many people at risk,” he says, adding that there is always a fear that he may catch him again or take home more vulnerable family members.
“The strange thing about this virus is that it affects many people differently,” says Bharath.
“Why take the risk if you can?”