A couple of months ago, the media, almost as one, decided that Gov. Ron DeSantis was a public menace who was going to get Floridians killed with his lax response to the coronavirus crisis.
In an interview with National Review, DeSantis says he was surprised at “how knee-jerk” the hostile coverage was, but he “also knew that none of these people knew anything about Florida at all, so I didn’t care what they were saying.”
The conventional wisdom has begun to change about Florida, as the disaster so widely predicted hasn’t materialized. It’s worth delving into the state’s response because it is the opposite of the media narrative of a Trump-friendly governor disregarding the facts to pursue a reckless agenda. DeSantis and his team have followed the science closely from the beginning, which is why they forged a nuanced approach, but one that focused like a laser on the most vulnerable population, those in nursing homes.
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An irony of the national coverage of the coronavirus crisis is that at the same time DeSantis was being made into a villain, New York Gov. Cuomo was being elevated as a hero, even though the DeSantis approach to nursing homes was obviously superior to that of Cuomo. Florida went out of its way to get COVID-19-positive people out of nursing homes, while New York went out of its way to get them in, a policy now widely acknowledged to have been a debacle.
The media didn’t exactly have their eyes on the ball. “The day that the media had their first big freakout about Florida was March 15th,” DeSantis recalls. “There were people on Clearwater Beach, and it was this big deal. That same day is when we signed the executive order to, one, ban visitation in the nursing homes, and two, ban the reintroduction of a COVID-positive patient back into a nursing home.”
DeSantis is bemused by the obsession with Florida’s beaches. When they opened in Jacksonville, it was a big national story, usually relayed with a dire tone. “Jacksonville has almost no COVID activity outside of a nursing-home context,” he says. “Their hospitalizations are down, ICU down since the beaches opened a month ago. And yet, nobody talks about it. It’s just like, ‘OK, we just move on to the next target.’
So how did DeSantis go about responding to the epidemic? It began with the data …
Learn from the Evidence
At the outset, DeSantis looked at South Korea’s experience, which he says “had no fatalities under 30, and then 80 percent of them were 70 and above or something like that. It was really, really dramatic.”
Then there was Italy: “I think the median age of fatality was something like 82 in some of those areas in Northern Italy … That really helped inform the strategy to focus most of our efforts on the at-risk groups.”
The DeSantis team also didn’t put much stock in dire projections. Instead, “we started really focusing on just what we saw.”
Florida was better able to do that than many states because of its routine experience dealing with natural disasters. “Many states simply did not have the data infrastructure that Florida has,” says Mary Mayhew, secretary of Florida’s Agency for Healthcare Administration. “We have an emergency status system that gets stood up in the case of a hurricane. Hospitals and nursing homes and other long-term-care providers are required to submit data on a daily basis, twice-daily basis, regarding their bed availability.”
The Florida Department of Health produces a report that DeSantis sees every morning: new cases, number of tests, positivity rates, etc. He also gets a rundown of the people who have gone into hospitals and of ICU usage. He can follow the key indicators down to the county level. He cites the example of rural Hamilton County. It had 67 cases the other day. DeSantis was able to call the surgeon general of the state to find out what was going on and learn it was an outbreak in a prison rather than a wider community spread.
His focus has been on “clinically significant cases” and that pointed to the nursing homes.
First, Protect the Nursing Homes
Florida has roughly 350,000 residents and staff at more than 4,000 long-term-care facilities, and the state took precautions with its seniors generally.
“We advised, before there was even mitigation,” DeSantis points out, “if you’re 65 and older, stay home as much as possible and avoid crowds.”
Inspectors and assessment teams also visited nursing homes. Florida, DeSantis notes, “required all staff and any worker that entered to be screened for COVID illness, temperature checks. Anybody that’s symptomatic would just simply not be allowed to go in.” And it required staff to wear PPE. “We put our money where our mouth is,” he continues. “We ended up sending a total of 10 million masks just to our long-term-care facilities, a million gloves, half a million face shields.”
Florida fortified the hospitals with PPE, too, but DeSantis realized that it wouldn’t do the hospitals any good if infection in the nursing homes ran out of control: “If I can send PPE to the nursing homes, and they can prevent an outbreak there, that’s going to do more to lower the burden on hospitals than me just sending them another 500,000 N95 masks.”
When the state was seeing infections at nursing homes presumably caused by staff, DeSantis deployed what he calls “an expeditionary testing force” — 50 National Guard teams of four guardsmen together with Department of Health personnel that tested staff and residents.
Most facilities haven’t had confirmed cases. “But the ones that have,” he says, “the majority of them have had between one and five infections. So the infections are identified, but then, you’re isolating either the individual or the small cluster before you have an outbreak.”
The state has just deployed a mobile testing lab in an RV that has a rapid test with results in an hour or two. It has also started a sentinel surveillance program for long-term-care facilities, routinely taking representative samples to monitor for flare-ups.
Finally, it has established several COVID-19-only nursing homes, with a couple more in the pipeline. The idea, again, is to get COVID-19-positive residents out of the regular nursing homes to the maximum extent possible.
Diverse State, Diverse Approaches
At the same time, Florida was giving its counties latitude in how they reacted to the crisis.
“I said from the beginning,” DeSantis explains, “we’re a big, diverse state. Even at this point, 60 percent of our cases have come from just three counties.”
DeSantis issued his own statewide order, but he argues that it was more flexible and less prescriptive than those of other states. “We basically had businesses operating. We had the day cares open, we had recreation open, and my order never actually closed any businesses. We allowed them to operate within the context of just limiting contact between people outside the household.”
He was relaxed from the beginning about outdoor activities, even as critics sounded the alarm about the beaches: “I always believed that respiratory viruses were less likely to be transmitted in a hot outdoor environment, and then you started to see the studies come in, in March, saying that that’s what it was.”
He thinks that the relatively short, relatively capacious shutdown order has allowed Florida to be ahead of the curve of reopening of the more restrictive states. DeSantis maintains that “what we did in March and April is the equivalent of what New York will be or California, when they go to phase three.”
Looking ahead, he says, “being measured and being thoughtful and just following data is important.” But “outside of southeast Florida, we’re not seeing a huge amount of community transmission, which is a good sign.” Of course, testing will continue to be a priority, as it has been all along.
Perhaps things will still go wrong in Florida, but no one can say that the state hasn’t taken a thoughtful approach to the crisis. Or, no one can reasonably say that — which, of course, hasn’t stopped many journalists.
“I view it more as a badge of honor that I was doing a good job,” DeSantis says, “and that they viewed me as a target, because if I wasn’t, they probably would just ignore me.”
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