It was March 1 when Florida announced its first two cases of the novel coronavirus, a 29-year-old Hillsborough County woman who had traveled to Italy and a 63-year-old Manatee County man. But buried in data recently published by the Florida health department is an intriguing revelation: The spread of COVID-19 in Florida likely began in January, if not earlier.
State health officials have documented at least 170 COVID-19 patients reporting symptoms between Dec. 31, 2019, and February 29, according to a Miami Herald analysis of state health data. Of them, 40 percent had no apparent contact with someone else with the virus. The majority had not traveled.
At least 26 people who contracted COVID-19 started showing symptoms in late December or January — and at least eight of them both had not traveled and did not have contact with another person infected by the virus. The trend continued into February.
“That’s community spread,” said Eric Toner of the Johns Hopkins Center for Health Security. “It’s invisible, it’s invisible, it’s invisible, until it’s suddenly obvious.”
Though the vast majority of the state’s cases have swamped South Florida, the data show the virus spread silently through Central and even North Florida during January, a time when testing for the contagion didn’t exist in the U.S. and many healthcare practitioners might have mistaken it for the flu. The earliest cases identified by the Herald include both Florida residents and visitors ranging in age from 4 to 91 years old. Ten of the people died.
As late as March 11, Gov. Ron DeSantis denied that community spread was taking place in Florida, a claim challenged by experts and in direct opposition to statements made the day before by Dr. Anthony Fauci, widely considered the federal government’s top expert on infectious disease. DeSantis did not issue a statewide stay-at-home order until April 1, when there were nearly 8,000 confirmed cases and 101 deaths.
In the background, the state was collecting data that suggests much earlier community transmission — when the virus spreads with no known origin. DeSantis’ denials came more than two months after Florida residents with no travel history began to come down with COVID-19.
This week, one day after the Herald asked DOH about the early cases, the state stopped publishing the date of symptom onset for confirmed COVID-19 patients. The existence of the cases was first reported by the Palm Beach Post on Tuesday.
Scientists and public health officials say community spread is an important indicator for governments to factor in when considering whether to shut down commerce and movement in areas where COVID-19 is active. Understanding when and how the disease started spreading — and who it killed — is essential for developing an appropriate response now and in the future, they say.
The governor’s office did not immediately respond to a request for comment Tuesday.
Testing in Florida wasn’t available until late February, meaning state officials did not know about the early cases in real time.
China did not confirm human-to-human spread of the coronavirus until January 19, and Florida was shipping specimens up to the U.S. Centers for Disease Control and Prevention lab in Atlanta until late February rather than testing in-state. Even then, testing was largely restricted to people who had travel history or known contacts with the virus.
“Many of us have long suspected that there were undetected cases in the U.S. long before we had our first confirmed case,” Toner said. The new data “helps to explain what appeared to be a sort of explosive outbreak out of nowhere.”
Alberto Moscoso, a spokesman for DOH, said that many confirmed COVID-19 patients “reported symptoms that started weeks before their confirmatory tests.”
“It cannot be determined definitively if these early symptoms were a result of COVID-19 or other causes,” Moscoso said.
He also said that “most early cases of COVID-19 were associated with international travel or exposure to international travelers,” although DOH’s data shows that 61% of the early cases are marked as not travel related.
Altovise Porter died at a friend’s home in Fort Lauderdale on April 8 after contracting COVID-19, according to the Broward County Medical Examiner’s Office. Porter, 40, had not left South Florida for several years, her family told the Herald.
The details of her case line up with a 40-year-old Broward woman who died after getting sick on Feb. 1, according to DOH’s data on the early cases. Names of patients are redacted in DOH’s data but not in records provided by the medical examiner. The DOH case is listed as non-travel related.
Porter suffered from chronic bronchitis and had been feeling ill before she sought treatment, her younger brother Melvin Porter said.
“She had two weeks of being very weak, loss of appetite,” he said. “She was so weak she could barely talk on the phone. ... My older sister dropped her off some soup and that was Sunday. The following Wednesday she was dead.”
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He said he was not sure how his sister would have contracted the virus. In fact, Melvin Porter said Altovise tested negative twice after visiting the Broward General emergency room on March 18. He said he was never told that Altovise tested positive, although the medical examiner lists her cause of death as COVID-19 in records provided to the Herald.
South Florida residents account for 34 percent of the early cases, with 32 in Broward and 24 in Miami-Dade County.
“This is the first I’m hearing of it. It’s another data point,” Broward County Commissioner Michael Udine said of the early cases. “We’re trying to do the best we can with the information we’ve been given. We’re relying on other people for other information.”
Early community spread
The earliest confirmation of a COVID-19 case in the United States came Jan. 21 — a Washington state man who traveled to China.
An additional 13 cases were diagnosed in six states through Feb. 23, with 11 of those people having visited China, according to the CDC. Medical examiners across the country are now investigating possible COVID-19 deaths in the United States from as far back as November, the Wall Street Journal reported.
None of the early cases in Florida are linked to travel to China, according to DOH’s data. Eight are linked to New York.
DeSantis has recently said that he believes the virus may have started spreading in Miami-Dade as early as the Feb. 2 Super Bowl, thanks to the wave of tourists who descended on South Florida.
However, 31 of the early cases involved people who felt symptoms before the Super Bowl.
Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine, said health investigators must probe the origins and early transmission of the novel coronavirus.
“We need to learn what we can do better going forward, as well as try to develop interventions in an ongoing outbreak such as we currently have,” Schaffner said. “If we understand transmission dynamics better, we’ll be better prepared for future outbreaks. There’s still a lot to know about this virus and how it gets around.”
For this story, the Herald analyzed three data sets published by DOH on April 27 and May 1.
Reporters discovered an anomaly: Six early cases that had appeared on April 27 did not appear in the May 1 data, including the two cases where symptoms dated back to Dec. 31, 2019. In the May 1 data, the earliest symptom onset date, or “event date,” was listed as Jan 1, 2020.
Those missing cases were not explained in detail by DOH.
It is possible that state investigators determined a different symptom onset date for the original cases and updated the data to reflect new findings.
“Event date will be updated as more information is gathered about the case,” Moscoso, the DOH spokesman, said. “For instance, we would not know the person’s onset date when we received the lab result. The county interviews the individual and determines their onset date, so the ‘event date’ would change.”
The Herald included those six cases in its analysis after DOH did not provide specific details.
‘I know that I infected people’
Many people who contracted the virus may not show up in state data because they were never tested.
When Thais Tepper of Chokoloskee came down with a fever, cough and shortness of breath in late January, she said the illness was unlike anything she had experienced before. Tepper, 67, said she blacked out once and felt “fizzing” in her lungs when she took breaths.
Once she began to feel better, Tepper said she went to an urgent care clinic in Naples on Feb. 3, where she was tested for influenza and strep throat.
“Both were negative,” Tepper said. She said the doctor at the urgent care clinic diagnosed her with acute bronchitis.
The disease spread to Tepper’s adult son, who is autistic and lives with her at their home. It also spread to one of her neighbors, who was helping the family, she said.
After her illness, Tepper said she began to suspect she may have had COVID-19. But testing for the novel coronavirus did not become available in Collier County until March 11, she said, and by then the active virus was no longer in her body.
In April, though, Tepper signed up for an antibody test at Interlab, a clinical research and pathology laboratory in Doral that provides blood testing for the novel coronavirus.
The results came back positive for the long-term antibody. Tepper provided the Herald a copy of her antibody test results dated April 13.
Tepper believes she contracted the coronavirus in Kendall in mid-January, when she and her son stopped to eat at a fast food restaurant after spending the day at a preserve park where, “we made no contact with other humans,” she said.
“I don’t think I got it here,” she said. “I think I got it there, in Miami.”
Tepper can’t prove her theory, and she said the health department has not yet followed up with her after she reached out to the agency’s office in Collier County.
“I know that I infected people in February,” she said.