Florida is the only state where more people are dying of COVID now than ever before. What went wrong?
A few months ago, Gov. Ron DeSantis, Republican of Florida, declared his hands-off approach to COVID-19 “a tremendous success.” Politico announced that he had “won the pandemic.”
But then came the hypercontagious Delta variant, which continues to hit Florida harder than anywhere else in the country.
The result? DeSantis just added another, less flattering distinction to his résumé. When COVID first surged across the Sun Belt last summer, the average number of Floridians dying of the disease every 24 hours peaked at 185, according to the New York Times’s state-by-state COVID database. The same was true over the winter.
A few days ago, however, Florida’s daily death rate cleared 200 for the first time, and today it stands at 228 — an all-time high.
This makes DeSantis the first (and so far only) governor in the U.S. whose state is now recording more COVID-19 deaths each day — long after free, safe and effective vaccines became widely available to all Americans age 12 or older — than during any previous wave of the virus.
So what went wrong? California thinks it has the answer.
Since last spring, Florida and California — two of America’s biggest and most influential states — have been locked in a pitched battle over which kind of pandemic response makes the most sense: less or more. At times, the Sunshine State seemed to have the upper hand — like when Florida avoided the worst of a nationwide winter surge that hit California particularly hard, all while refusing to require masks in public and keeping bars and restaurants fully open.
But Delta may have changed that.
“Vaccines are working to prevent deaths in many other countries that have seen post vaccine spike in cases, and most other states in the U.S. as well. Florida is different,” Dr. Vincent Rajkumar, a professor of medicine at the Mayo Clinic, recently explained on Twitter. “What’s different in Florida is that, relative to the vaccination rate (~50%), the relaxation of distancing and masking was disproportionately high. Leaders expressed disdain for masks and mask mandates. The total number of people unvaccinated is high. And hospitals got overwhelmed.”
To be sure, comparing COVID numbers from two different states is always a fraught proposition; there are many factors — the introduction of a new, more devious variant such as Delta; the weather; plain old bad luck — that people and policymakers have little control over. And any declaration of victory (or failure) during such an unpredictable pandemic is likely to be premature. In theory, California could suffer more this winter.
But by looking at how California and Florida are doing this summer, post-vaccination, versus how they did last summer, pre-vaccination — an approach that minimizes seasonal variables such as weather and indoor gathering — you can get a rough sense of what is or isn’t working.
The difference is stark.
Last summer, COVID surged in both Florida and California, just as it did across much of the rest of the Southern and Southwestern United States. California fared better. There, new daily cases peaked at 25 per every 100,000 residents; total hospitalizations peaked at 23 per every 100,000 residents; and new daily deaths peaked at 0.35 per every 100,000 residents.
In Florida, those numbers were more than twice as bad: 55 cases/100,000 residents, 56 hospitalizations/100,000 residents and 0.86 deaths/100,000 residents.
So something about Florida — tourism? humidity? fewer restrictions, even last year? — likely makes it more susceptible to summer spread.
The problem, though, is that while California is doing much better this summer than last, Florida, for some reason, is doing much worse.
In California, the current new daily rate case is somewhat higher (35 cases/100,000) than it was during its summer 2020 peak — in part because California is now conducting twice as many tests per day (about 250,000). Yet despite that, and despite the fact that Delta is twice as transmissible as the initial strain of SARS-CoV-2 that was circulating in 2020, current hospitalizations in California (21/100,000) are still lower than last summer’s peak — and deaths, the metric that matters most, remain twice as low (0.17/100,000).
That’s the kind of progress you’d expect after vaccination.
Florida is the opposite. There, new daily cases appear to have topped out at 138 per every 100,000 residents — more than two and a half times last summer’s peak. As a result, the state’s current hospitalization rate (80/100,000) is nearly one and a half times last summer’s peak; new daily deaths (1/100,000) are higher than ever. And they’re both still climbing.
In other words, Florida did roughly twice as badly as California last summer in terms of COVID cases, hospitalizations and deaths. This summer, however, Florida is doing roughly four times worse in terms of cases and hospitalizations — and nearly six times worse in terms of deaths.
Why has Florida moved in the wrong direction while California has gone the other way? Again, simple misfortune probably plays a part (as do other hard-to-quantify forces). But not every factor is beyond human control. Take vaccination. There are just five counties in California (of 58) where fewer than 35 percent of residents are fully inoculated. In Florida, that number is 23 (of 67). It’s easier for Delta to get a foothold and spread in places where the vast majority of people are unprotected.
Still, vaccination doesn’t explain everything: Statewide, Florida’s full vaccination rate (52 percent) is the same as the national number and just 3 percentage points lower than California’s (55 percent). And Florida has fully vaccinated more of its seniors (82 percent) than California (79 percent).
So as Rajkumar explained, precautions are probably playing a big part as well — and here too the difference between California and Florida couldn’t be more pronounced.
When Delta took off, Los Angeles became the first county in the country to reinstate its public indoor mask mandate. The San Francisco Bay Area followed suit soon after, and nearly every large county in California that doesn’t require masks indoors at least strongly recommends them. No lockdowns, no business closures, no official curbs on indoor drinking or dining — just indoor mask requirements and recommendations.
In contrast, DeSantis doubled down on his opposition to mask mandates, prohibiting local governments and even local school districts from implementing such policies. “Did we see areas like Los Angeles, with heavy masking, having reduced cases to a trickle?” DeSantis once asked, mockingly. Such wisecracks were all part of the governor’s larger message: Now that vaccines are widely available, he argued, requiring additional precautions is not just unscientific and unnecessary — it’s an infringement on your personal freedom.
At this point in the pandemic, it’s impossible to determine whether mask mandates actually trigger more caution or simply reflect existing attitudes in a particular community. “Because the pandemic has become so politicized, people have already sorted themselves into their different camps,” Vox’s Dylan Scott wrote in June. “By now, you are already either a mask-wearer or you’re not. A government mandate probably isn’t going to affect someone’s behavior in June 2021 as much as it would have a year ago, especially after enforcement has been nonexistent.”
But either way, the behavior associated with mask mandates — that is, universal indoor masking — has been proved to work. In fact, according to a research summary by the Centers for Disease Control and Prevention, “at least ten studies have confirmed the benefit of universal masking in community level analyses: in a unified hospital system, a German city, two U.S. states, a panel of 15 U.S. states and Washington, D.C., as well as both Canada and the U.S. nationally.”
“Each analysis demonstrated that, following directives from organizational and political leadership for universal masking, new infections fell significantly,” the summary continues, adding that “two of these studies and an additional analysis of data from 200 countries that included the U.S. also demonstrated reductions in mortality.”
Meanwhile, another 10-site study showed “reductions in hospitalization growth rates following mask mandate implementation,” and a separate series of cross-sectional surveys in the U.S. “suggested that a 10 percent increase in self-reported mask wearing tripled the likelihood of stopping community transmission.”
This isn’t to say that if DeSantis had pulled a 180 and issued a statewide mask mandate, Florida would have dodged Delta (though it might not have hurt). Mostly, the damage is done. Behavior — and thus vulnerability to new variants like Delta, which can transmit via vaccinated people — is already baked in.
In mid-July, for instance, both vaccinated and unvaccinated Americans reported regularly wearing masks at exactly the same rate (43 percent), according to the Yahoo News/YouGov poll. But since then, mask wearing by the vaccinated has increased by 22 points (to 65 percent) while mask wearing by the unvaccinated has actually fallen (to 39 percent).
In short, the people who need the most protection from catching and spreading the virus are, paradoxically, masking up even less often now than they were before Delta took off. Instead, it’s the least vulnerable Americans — those who are vaccinated — who have been responsible for all of the recent uptick in regular masking.
A recent survey by the University of Southern California also found that unvaccinated Americans are more likely than their vaccinated peers to go to a bar or a friend’s house and less likely to avoid large gatherings.
“Lack of mask measures, lack of worry about it, lack of vaccination are all kind of the syndrome,” Kevin Malotte, an emeritus professor of epidemiology at California State University, Long Beach, recently told the New York Times. “And I think that’s what we’re seeing correlate with the high rates.”
And yet this divide wasn’t preordained. Fate did not decree that Floridians would be more inclined than Californians to view wearing masks indoors for a few more weeks — or gathering outdoors more often, or waiting a little longer to drink at the bar — as violations of their personal liberty. Leaders have some power to encourage or discourage such attitudes, and some responsibility for the behaviors they help to normalize (or not).
The good news is that cases finally appear to be peaking in Florida; the state’s seven-day average has fallen by nearly 30 percent over the last week (though testing is down too).
But new cases may be leveling off in California as well, and at a much lower level. Both Los Angeles and San Francisco have registered promising declines over the last 14 days.
In the meantime, 228 people are dying of COVID in Florida each day — more than three times the number dying each day in California, a state that’s almost twice as populous.
And this time, nearly every one of their deaths was preventable.
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