Florida shattered the nation's record for new daily coronavirus cases this week, logging 15,000 new COVID-19 infections in a single day. The record easily surpassed New York, which on its worst day in April recorded 12,000 new COVID cases.
More than 282,400 people in Florida have been infected with the coronavirus as of July 13 and at least 4,277 people have died, according to the latest figures from the state health department.
While 4,277 deaths may seem low compared to the more than 32,000 deaths in New York State since the beginning of the outbreak, experts say that death is a lagging indicator. Deaths in Florida can, and likely will, rise, experts say.
Another indicator of a worsening outbreak is a rising rate of positive COVID-19 tests. While Florida's positivity rate of testing dipped below 3.6% in early May, it's since soared to 11.2%, according to state health department data, higher than the 10% positivity threshold experts say states should aim to keep well below.
A high positivity rate can be a sign that a state is only testing its sickest patients and failing to cast a net wide enough to accurately capture community transmission, according to Johns Hopkins University, a category Florida is considered to fall into.
By comparison, South Korea, considered a global leader for its COVID-19 response, never had a positivity rate above 1% or 2%. In New Zealand, which has all but eradicated the virus, the nationwide positivity rate averaged 0.3% from January through July.
New York City's positivity rate currently stands at 2%.
What Florida did, and didn't do, to fight COVID-19
When the Centers for Disease Control and Prevention announced their reopening guidelines in April, relatively few states adhered to the agency's suggestions.
"Those are very sound public health principles that were offered to all states," said Dr. Howard Koh, a professor at Harvard T.H. Chan School of public health, who worked in the Department of Health and Human Services during the Obama administration.
Instead, many states pushed to reopen their economies early. In Florida, Gov. Ron DeSantis's stay-at-home order expired May 4 and by early June, the state was reopening bars and entertainment ventures, despite rising cases.
"They reopened too early in hindsight," Koh said, contrasting Florida to states in the Northeast, which had bigger outbreaks early on and tended to follow the CDC's guidelines more closely.
Florida was also behind on recommending that the general public wear masks to stop the spread of coronavirus. While New York Gov. Andrew Cuomo issued an executive order in April, requiring all people to wear face coverings in public, Florida's surgeon general finally made a similar announcement about face coverings on June 22.
"A universal mask policy is long overdue, not just for the state, but for the nation at large," Koh said. "We don’t have a vaccine yet," he added. "Until the FDA approves one, masks are the best vaccine that we have."
In at least one Florida county, local officials are taking matters into their own hands.
Palm Beach County Mayor Dave Kerner told ABC News he is taking the rise in COVID case seriously in his district. Last month, he issued a mandate, directing the public to wear face coverings while outdoors. Later this week, the mayor's office will mail four masks and public health literature to every household in the county.
“For $5 a household we can use our buying power, and in conjunction with the mandate, saturate our community with [information about] the most effective way to combat COVID,” he said. In Kerner's estimation, most local leaders are on the same page when it comes to public health strategies to stem Florida's outbreak, like mask wearing and strict limits on crowds.
Being on the same page, "takes the burden off a particular person or city to be the ‘bad person," he added.
The governor has since rolled back many of Florida's reopening initiatives, including effectively shuttering bars on June 26.
"Governor DeSantis has taken extraordinary steps to combat COVID-19 in Florida," a spokesperson with the governor's office told ABC News in a statement, citing changes to rules at nursing homes, increased testing and the surgeon general's mask recommendation.
"Governor DeSantis’ mission will remain the same, which is to protect the vulnerable, expand testing, encourage the practice of social distancing the use of masks, and support hospitals and health care workers, amongst others."
The confluence of factors working against Florida
Florida health care workers and officials, as well as the general public, have had the advantage of learning from hotspots like New York, which battled outbreaks early in the pandemic. Armed with that medical knowledge, they may do better at saving the lives of the sickest COVID-19 patients.
But there's also a confluence of factors working against Florida, according to Koh.
Although the profile of a typical person getting infected with coronavirus now skews younger than it did earlier in pandemic, one in five Floridians is older than 65, meaning a sizable portion of the state's population is at risk for severe COVID-19 complications and death. Like New York City, Florida is diverse. Forty-five percent of residents are Black or Latino, demographics which are show to have been disproportionately likely to become infected with and die from COVID-19.
Another key factor in Florida is insurance coverage. Florida's uninsured rate of 13% outpaced both the national average of 9%, as well as New York's 5% uninsurance rate, according to 2018 Kaiser Family Foundation data.
"If you are an older person in Florida, a person of color and you don’t have insurance, there are a lot of barriers for you to get lifesaving care right now," Koh said.
Notably, Florida is one of 14 states that did not expand Medicaid as part of the Affordable Care Act, a choice that could hurt the state's coronavirus response, according to a paper published in the New England Journal of Medicine last month.
"Covering more people in Medicaid is a rapid way to bring needed resources into the health care system and infuse federal dollars into state economies on the verge of a major downturn," Jonathan Gruber, an economist at Massachusetts Institute of Technology, wrote. As the United States outbreak continues, "both federal and state policymakers are looking to Medicaid as a central tool in their response to this national emergency," Gruber added.
As Florida, as well as Arizona, Texas, California and others, continues to grapple with their respective outbreaks, Koh pointed to the power of basic public health prevention strategies like mask wearing, hand washing and social distancing.
"The only tools we have right now as a society are maximizing the power of prevention in public health," he said. "States that have done that have seen dramatic progress."
But while prevention sounds easy in theory, by now most Americans know that it's more difficult in practice, especially over long periods of time.
"Everyone has to appreciate how fragile the gift of health is," Koh said. "At a time like this, that gift needs to be protected ferociously."
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