A 68-year-old woman was confirmed to have died of Covid-19 on Friday, and another 68-year-old woman was confirmed to have died of the disease today, according to the latest Florida Department of Health data, bringing Flagler County’s total number of deaths attributed to the coronavirus to four.
Previously, a 77-year-old man died on March 26, and a 72-year-old woman died on March 22. While both the earlier patients had had contact with others who’d been exposed to the virus, the department could not confirm any such contact with the two latest victims, underscoring the extent of so-called community transmission–meaning that the virus had been propagating in the community.
The deaths add to a statewide tally approaching 1,500 as the Institute for Health Metrics and Evaluation, one of the models most closely watched by state and federal officials, revised significantly upward its estimate of deaths for Florida, to nearly 4,000, by August 4, with a curve descending at a much slower rate than previously calculated.
“The social distancing and restricting public gatherings is one of the many injects into that model,” Flagler County Emergency Management Chief Jonathan Lord, who monitors the model, said. “So when you start phasing out social distancing anywhere in the country, you can now see that there’s an impact with the reopening of America.”
The institute’s projections echo a somewhat more dire report by the Centers for Disease Control that forecasts 200,000 new Covid-19 cases a day by the end of May, up from 30,000 new cases at the moment, and 3,000 deaths per day by June 1, nationwide.
But the CDC reports sees different areas affected very differently. It sees Flagler County for example, in the category of “sustained decline” of new cases. That decline is illustrated by the last two week’s testing numbers, which show a smaller proportion of positive cases relative to the number of tests: 6 percent last week, barely 1 percent in three days of reported testing numbers so far this week. But Lord and Dr. Stephen Bickel, the medical director for the health department in Flagler and Volusia, caution that one of the reason the ratio is lower is because testing criteria is much broader. Previously, only people with a list of Covid-like symptoms were being tested, which increased the possibility of positive results. Now, the testing at the drive-up site, on the campus of Daytona State College, is open to anyone with any single flu-like symptom. That’s lowered the incidence of positive results.
Still, the downward trend, for now, is clear, if not nearly as pronounced as officials would like it to be. It’s a slow decline, and it’s rife with caveats, among them, Lord says, the fact that any single week’s numbers can be deceptive. It’s the accumulation of weeks that matters.
Raising slight alarms, too, are indications in the latest Department of Health figures of an uptick in local emergency room visits of people with influenza-like illnesses, and with Covid-like illnesses. Specifically, those reporting Covid-like illnesses had numbered 50 the week ending March 22. The numbers dropped steadily to 20 each of the weeks ending April 12 and 19, but have then risen back to nearly 40 the week ending April 26. Again, a single week’s upswing or downswing does not make a trend. And AdventHealth Palm Coast’s bed count has plenty of capacity, according to numbers released by the state Agency for Health Care Administration.
All those indicators are playing in Flagler’s favor, and are reflected in many other counties across the state. Notably, the CDC report also sees sustained decline of Covid-19 cases in South Florida, the areas most severely struck by Covid-19 in Florida in spring. But counties along the I-4 corridor and the Tampa Bay region would experience either an “elevated incidence plateau” or actual elevated growth in new cases–as would most counties in Georgia, which has taken more aggressive steps to reopen.
“There remains a large number of counties whose burden continues to grow or are in elevated incidence plateau,” the CDC report states, “including the Great Lakes region, parts of the Southeast, Northeast, and around southern California.”
Lord cautions that the models are calculated with a constant new flow of data, and that Florida’s projections are likely to reflect the fact that while a reopening is taking place, Gov. Ron DeSantis is applying it in much more cautious steps than Georgia, “basically opened the floodgates.” If Florida’s governor stays the course, Lord said, the models should reflect the change. “I would love to see that the predictions don’t come true,” he said, but along those lines, it has to do with residents’ and businesses’ behaviors and staying within the boundaries the governor sets.
Dr. Stephen Bickel, the medical director at the Flagler and Volusia health departments, who analyzes reams of Covid-19 monographs, articles and data, sets out five criteria for a community to reopen confidently, and grades each when applying it to Flagler. First, the data must show a clear trend in the county’;s favor, in terms of declining positive cases and percent of positive cases versus testing overall. He gives that criteria only half a point. Second, there must be adequate testing. With Flagler ramping up testing somewhat, but not massively–the number of tests reached 379 last week, the highest single-week total since the coronavirus emergency began–he gives that half a point as well.
Third, there must be a surge of a public health contingent to carry out all the contact tracing, containment and monitoring necessary. He gives that no points, because while there are some 30 people fulfilling that role locally, it’s not where it must be The fourth and fifth criteria are ensuring that health care workers have enough personal protective equipment, and ensuring that there are enough hospital resources to handle a surge. He gives each a full point. Totaling it up, “I give it three points out of five,” Bickel said. “It’s not enough.”
Bickel said the local health department, within its means, is trying to do what should be done statewide and nationally: push for as much testing as possible and contact-trace and monitor on a systematic basis. But the resources are still lacking, a victim of national and state policies that have not been in sync, allowing for a patchwork approach that defies the unified front required in the face of a pandemic that respects no borders, and that will affect every community in time. “It’s all this disjointed approach that’s just kind of like asking for trouble,” Bickel said.
He recognizes the debate about reopening the nation economically, and balancing that with the risk of more deaths. But he sees that as a false and dangerous dichotomy: it’s not either or. It doesn’t have to be the economy or the fatalities. “There is a third way,” he said. That third way is to invest in an army of public health workers and technology to monitor the flares or extent of any Covid-19 incidence in every community, the way Taiwan, Hong Kong and South Korea have, thus enabling public health departments to immediately know who is infected and where the clusters are. With armies of contact tracers, infections can be detected, infected persons isolated, and society allowed to go on about its business, as has been the case in Southeast Asia. It would take billions, possibly hundreds of billions of dollars to get to that point, Bickel acknowledges–but it would still be far less expensive to American society than the trillions being spent on relief to businesses and individuals, while the nation hobbles toward a depression.
“I think the state could pull it off even if nationally they did not,” Bickel said. But from the start, the national approach has been flawed, scuttling efforts down the line. “We dropped the ball on the testing big time, we never came up with a strategy to rectify that, and we should have known it would have been a challenge to open up. Anybody who doesn’t think it’s going to be a challenge doesn’t understand what’s going on right now.”