Let’s explain: the basic task to assess the impact of Covid-19 should be simple, involving only two parameters: the number of deaths and the number of cases. But in Florida, these numbers – although presented with very brilliant usability – are hard to follow if you dig an inch below the surface.
As reported in the Washington Post, the governor’s office and the state’s medical examiner disagreed on the death toll. First, there was the governor’s well-known attempt not to name the affected nursing homes; after weeks of refusal, he gave in at the end of April. Next is an argument regarding the state’s definition of Covid-19 death, which public health experts say guarantees substantial undercoverage.
In Florida, citing Covid-19 as the official cause of death requires a positive diagnostic test for the virus. The U.S. Centers for Disease Control and Prevention uses a different standard, counting probable cases of people with clinical syndrome, whether or not a laboratory test confirms it. This is also how the CDC reports seasonal deaths from influenza and other respiratory illnesses during the less politically busy periods.
This distinction is very important – especially in a population of nursing homes where tests were not readily available at first.
A third group of cases is also included by a number of countries: the number of excessive deaths in a given period compared to the same period in previous years. In general, mortality rates vary only slightly from year to year, making the impact of a pandemic easy to discern. Counting cases in this way would include victims of Covid-19 who have never seen medical care, as well as people who have suffered heart attacks and strokes, have avoided hospitals for fear of infection and died without home treatment.
A recent CDC report showed the profound impact of the last two groups in New York. In two months, 13831 cases in New York were laboratory confirmed, an additional 5048 were probable (without laboratory confirmation) and 5293, out of a total of 24172, or 22%, died above the expected number on years of historical numbers.
In other words, the total number of New York City has increased by almost 40% when you include the types of cases that Florida does not report among its 2,096 deaths.
Understanding the direction of new diagnoses is also confusing. The Florida Department of Health dashboard shows a clear downward slope for new diagnoses, emergency room visits for people with complaints suggesting Covid-19 infection, and the overall rate of positive test results.
Here, Florida shares a major limitation with other states. It does not identify the populations it tests, which makes the results fundamentally uninterpretable. For example, only 0.7% of the nearly 6,000 Major League Baseball employees had the Covid-19 antibody, but in three other contexts that are predictably at the top of the New York Times “hot spots” and the most important epidemic lists – – meat packing plants, prisons and rest homes – 10% to 50% of people tested positive.
But the data for these three groups in Florida is incomplete. For example, JBS and Tyson both have meat packing plants in Florida and neither has reported outbreaks or test results.
Florida has a high incarceration rate, with around 100,000 prisoners at any given time. As of May 20, the Florida Department of Corrections had diagnosed active infections in 12% of the 9,690 people tested. If we exclude more than 1,181 people tested without results still available (a big problem during a pandemic), the positive rate is actually 14%. The number of cases among the thousands still untested will largely determine the severity of the Covid-19 epidemic in Florida.
It is important to note that the correctional service also detected 241 infections among staff members, although the number tested was not listed. Florida employs 24,000 people in its correctional facilities. Infected members of this group could quickly contribute to the spread of the virus in surrounding cities.
The quantity of Covid-19 in the 691 nursing homes in Florida, home to 71,000 residents, is not yet well known.
To date, more than 700 deaths (1% of all residents) have occurred in this population, accounting for more than half of all Covid-19 deaths in Florida, according to a recent Tampa Bay Times report. . However, the extent of the tests and the number of cases overall are not known. Likewise, there is very little information about the employees of these establishments who, like prison officers, live in the surrounding communities and can bring the infection home.
In addition, the premature and unwanted removal of Florida Department of Health team science chief data officer Rebekah Jones raised concerns that the figures may be inaccurate. Florida Governor Ron DeSantis called the situation “not problematic”.
For example, on May 12, about a week after his referral, 240 cases in nursing homes were removed from a department report, which reduced the number of cases from 1,907 to 1,667. more than a drop of 11%. The daily increase in cases since then has also been more modest, perhaps another worrying signal.
This apparent redesign of the data may have a simple explanation. The data oscillates and oscillates as more is learned and new definitions are applied. But given political tensions at the national level as well as the dismissal of a key member of the data team, for now, the Covid-19 reports in Florida will need to be treated with caution.