Gov. Ron DeSantis didn’t anticipate how devastating Florida’s summer COVID-19 surge would be.
The warning signs were there. The highly contagious delta variant of the coronavirus had produced an explosion of sickness and death in India, a country that had fared surprisingly well during the pandemic.
The Centers for Disease Control and Prevention declared delta to be a “variant of concern” on June 15. DeSantis suggested the threat was exaggerated when asked about delta on that same day, saying, “There has been a lot of talk about variants leading up to this. I think it gets put out there in ways designed to frighten people.”
He advised people to get vaccinated if they hadn’t but predicted Florida’s summer wave wouldn’t be as bad as the previous summer surge.
Flash forward to September, and Florida is logging a record number of COVID-19 deaths, the highest per capita rate in the nation. Central Florida hospitals ordered portable morgues to accommodate overflow bodies. Funeral homes are struggling to keep up. A record number of COVID-19 patients strained the state’s health care system, forcing the postponement of elective procedures.
As fall approaches, Florida is closing in on a grim milestone of 50,000 COVID-19 deaths, higher than the number of Americans killed in combat during the Vietnam War.
Several factors contributed to Florida’s summer surge, some of which were outside the governor’s control. Delta’s contagiousness served as the primary driver, allowing the virus to move more swiftly than it did in the past. Florida’s sweltering heat drove people indoors, where the virus spreads even more efficiently. Social media misinformation festered distrust of the vaccine, prompting some people to skip getting shots.
But as Floridians faced the delta onslaught, they heard little warning or alarm from the governor. DeSantis allowed the state’s COVID-19 emergency declaration to expire on June 26. With daily cases low, DeSantis stopped holding events promoting the vaccines, focusing instead on other issues such as securing the U.S.-Mexico border.
DeSantis predicted a summer increase in cases, but he said the vaccination rate among the state’s elderly population and natural immunity from past infections would mean fewer hospitalizations and deaths than during previous waves.
That turned out to be wrong. August has emerged as the deadliest month of Florida’s pandemic with more than 7,000 deaths reported so far, and final numbers are still being compiled.
Florida has reported more COVID-19 deaths after the vaccines became available than before they were introduced. When the first vaccines were given on Dec. 14, the state’s death toll stood at 21,410. As of Wednesday, Florida had recorded 48,273 deaths.
Dr. Howard Forman, a Yale University professor of public health who tracks COVID globally, estimated as many as 18,000 people could die as a result of Florida’s summer surge, despite the widespread availability of highly effective vaccines.
Christina Pushaw, DeSantis’ press secretary, defended the governor’s approach, saying he pushed hard to immunize Floridians and then offered monoclonal antibody treatment when hospitalizations surged. In a statement, Pushaw said neither mask mandates nor an emergency declaration would be effective measures in battling the pandemic. She also blasted vaccine passports — immunization documents showing a person had gotten the COVID-19 shot — that DeSantis has pushed to ban.
“No government intervention has been proven to stop the spread of COVID-19,” she said, adding, “Setting aside the ethical issues with forcing everyone to get a COVID-19 vaccine and show their papers to participate in everyday life, there’s no evidence that such draconian encroachments on civil liberties would even be effective in stopping COVID-19.”
A better message needed
Public health experts, though, say stronger messaging on the dangers of delta from political leaders, mask-wearing and better vaccination rates could have blunted Florida’s deadly summer wave. As America’s vacation playground, Florida welcomed tourists to a state where mask-wearing and other COVID-19 measures were few and far between.
The explosion of COVID-19 in parts of the United States is happening because of “relatively clear reasons,” said Dr. Theo Vos, a professor of health metrics at the University of Washington.
“Low vaccination,” he said. “Mixed messages sent from leaders. Poor compliance with control measures.”
Even though 83% of Floridians 65 and older are fully vaccinated, about 800,000 seniors are unvaccinated or only have partial protection. Those pockets of vulnerable people allowed COVID-19 to spread with devastating consequences. Florida has one of the lowest vaccination rates in the country for people living in nursing homes at about 74%.
“To have several hundred deaths a day in Florida, that is pretty bad relative to the population size,” Vos said. “A highly contagious variant like the delta variant can quickly sweep through a very large susceptible population and create a lot of very sick people who require hospitalization with a good number dying on a daily basis.”
When DeSantis allowed his COVID-19 state of emergency to expire on June 26, about 45% of the state’s population had been fully vaccinated. DeSantis stopped holding daily events at vaccination sites in April after adults of all ages became eligible for the vaccines, a change from his enthusiastic promotion of the shots for the elderly over the winter.
Even as cases rose, DeSantis didn’t shift his messaging to emphasize that Floridians were facing a more contagious virus, and he held firm in his approach to COVID-19.
“If you look at the seasonal wave we’re experiencing in Florida, that’s being driven a lot by a lot of younger people,” DeSantis said during a July 30 event in Cape Coral. “They’re not getting really sick from it or anything, but they are getting it and they will develop immunity as a result of those infections.”
About the same time, DeSantis’ campaign website offered drink koozies for sale that asked, “How the hell am I going to be able to drink a beer with a mask on?” Another read, “Don’t Fauci My Florida,” referring to the White House’s COVID-19 adviser Dr. Anthony Fauci.
Pushaw disputed criticism that DeSantis downplayed the threat posed by COVID-19.
“Stating that COVID-19 is a seasonal virus is not the same as downplaying the threat of the virus, and I am not sure where this perception originated. COVID-19 cases fluctuate in a regional and seasonal pattern. ... That doesn’t mean COVID-19 isn’t a serious and potentially deadly infection,” she said.
Throughout the summer surge, the Republican Party of Florida has praised DeSantis’ handling of COVID and has repeatedly fundraised off of his promotion of the Regeneron monoclonal antibody treatment.
“Crisscrossing the state to raise awareness of these effective drug treatments, the Governor is also energetically backed by leading medical professionals in Florida,” the party wrote in an Aug. 20 email newsletter.
DeSantis has relied on advice from Dr. Jay Bhattacharya, a Stanford University professor of medicine, and Martin Kulldorff, a Harvard Medical School professor, in crafting his strategy. Both signed the Great Barrington Declaration, which called for letting the virus spread in the lower-risk population with the goal of herd immunity.
President Joe Biden’s administration underestimated the potential for a more contagious variant, too, celebrating “independence from the virus” on the Fourth of July. In May, the federal Centers for Disease Control and Prevention advised that vaccinated people could go without masks but then reversed course in July when studies showed vaccinated people could still spread the virus, even though the vaccine was highly effective in preventing serious illness.
In an attempt to boost vaccination rates, Biden is rolling out a sweeping mandate that will require employees in workplaces with more than 100 people to get vaccinated or undergo weekly testing.
‘People needlessly died’
Local leaders across the state sounded the alarm as cases skyrocketed over the summer. Orange County Mayor Jerry Demings pleaded with people to wear masks and warned in late July that Central Florida had entered “crisis mode” because of the surge.
But Demings said his efforts to contain the virus were frustrated by DeSantis’ orders blocking local governments from enforcing mask mandates.
“I believe that people needlessly died,” he said. “People needlessly contracted the virus because of that short-sightedness.”
Health care workers on the pandemic’s front lines watched their intensive care units fill up with a different group of patients than previous waves, said Mary Mayhew, president and CEO of the Florida Hospital Association.
“What we experienced was so fundamentally different — not just the rapid escalation of hospitalizations but the age of those getting hospitalized who for the most part did not have other underlying medical conditions,” Mayhew said. “Younger, healthier individuals were getting hospitalized for COVID, many of them acutely ill requiring intensive care.”
About 80% of COVID-19 deaths in previous waves were 65 and older, but that figure has dropped to about 60% with the delta wave, said Jason Salemi, a public health researcher at the University of South Florida, referencing an analysis of state data.
As hospitals filled up, DeSantis launched a campaign to promote a monoclonal antibody treatment, opening 23 clinics across the state and providing treatment to about 70,000 Floridians, Pushaw said.
The treatment is effective, and the campaign likely kept people out of the hospital, said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University.
But antibody treatment alone isn’t enough, and a robust campaign to encourage vaccination, mask-wearing and social distancing also is needed, he said.
“You can’t treat yourself out of a pandemic,” Schaffner said. “You’ve got to prevent yourself out of a pandemic.”
DeSantis did aggressively promote the vaccine when it first became available, hosting dozens of events across the state. But he’s banned businesses from requiring customers to show proof of vaccination. Colleges and universities are also barred from requiring students to get vaccinated. He’s tried to ban school boards from requiring students to wear masks in class.
DeSantis has framed the vaccine as a personal choice and refrained from criticizing people who don’t get vaccinated. DeSantis quietly received the Johnson & Johnson vaccine in April, and the Governor’s Office did not release a photo of the state’s leader getting vaccinated.
About 64% of eligible Floridians are fully vaccinated, which is in line with the national average and higher than every Southeastern state except Virginia, according to the CDC.
DeSantis has maintained that Northern states, many with more stringent COVID-19 measures than Florida, could see surges in the winter. Florida’s winter wave was not as severe as other states, which could have also been a factor in Florida’s big summer spike.
Jared Moskowitz, the state’s former emergency manager who led vaccination efforts, said people breathed a sigh of relief when infections were low in the spring, allowing the delta variant to catch them off guard.
“Quite frankly, we let our guard down in ways that may have been nobody’s fault, because again, we’re dealing with the novel coronavirus,” said Moskowitz, a South Florida Democrat who DeSantis appointed to lead the Florida Division of Emergency Management. “But, you know, we have 300% more cases now than we did at the same time last year.’'
Rick Kriseman, the Democratic mayor of St. Petersburg, was harsh in his assessment of DeSantis’ handling of the delta wave.
“Everything was underestimated,” he said. “But not only underestimated. I don’t know that he cares. I mean, honestly, when you look at everything that he has said during this delta variant, [it] says to me, ‘I don’t really care what the numbers are, I’m going to do what I’m going to do. I’m not listening to any serious, legitimate medical experts.’
“And the numbers be damned, and the people who die be damned. … It only seems that he cares if he benefits in some form or fashion, whether political or however else.”
Florida’s summer could have been different if more people had gotten vaccinated and adhered to mask-wearing recommendations, said Salemi, the public health researcher.
“What we experienced was not inevitable,” he said. “This was not going to happen no matter what. It could have been a very different wave.”
South Florida Sun Sentinel staff writer Cindy Krischer Goodman contributed to this report. firstname.lastname@example.org