Thursday, March 19, 2020

A Deadly Coronavirus Mix in Florida: An Aging Population and Lots of Young Visitors. (NY Times)

A Deadly Coronavirus Mix in Florida: An Aging Population and Lots of Young Visitors

In Florida, where a quarter of the population is older than 60, Gov. Ron DeSantis has started to control public gatherings. But testing has been slow.

Credit...Saul Martinez for The New York Times

MIAMI — At the Florida community of The Villages, the retirement capital of America and the place with the nation’s highest concentration of older people, only 33 people have been tested for the coronavirus.
In the Florida Keys, swamped with young spring breakers and travelers from around the world, just 16 people had been tested by Monday night. Ten of Florida’s 67 counties have tested no one at all.
A disease that is deadly to the elderly and easily spread by the young has left Florida especially vulnerable. Yet faced with the prospect of dealing a shattering blow to an $86 billion tourism industry, Gov. Ron DeSantis has moved more slowly than some other states to contain a pandemic that is spreading with alarming speed. Whole swaths of the state have yet to begin robust testing, according to State Department of Health data. And even as some of the beaches still swarmed with college revelers, the state refused to close them.
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In many cases, even people who have a known exposure or are exhibiting symptoms have not been offered testing, according to interviews with doctors, patients and family members across the state.
While testing is falling well short of demand across the country, public health officials say the unique risk in Florida, where 27 percent of the population is over the age of 60, and eight people have already died, creates a serious need for better testing.
Epidemiologists raced on Tuesday to quarantine and evaluate the remaining 218 residents of an assisted living facility in Fort Lauderdale after a 77-year-old man who had been hospitalized since March 6 died of the coronavirus.
Debra Lounders, 63, was ordered to self-isolate after traveling through the Fort Lauderdale airport where a T.S.A. agent tested positive. Ms. Lounders, who has a low-grade fever, a cough and feels sluggish, works at one of the designated testing sites in Key West, but even she has been unable to determine whether she has the virus.
“I work at one of the federal testing sites, and even they don’t have the tests,” she said. “The physician assistant at my job told me, ‘I wish I could help you, but I can’t.’”
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A nonprofit health center that opened a drive-through testing site in Palm Beach County was so overwhelmed that it had to stop taking new appointments. Memorial Healthcare System in Broward County said it could drastically increase the 100 tests it conducted daily if it had the proper materials, but its vendor is only supplying certain facilities.

Credit...Scott McIntyre for The New York Times
Even a patient hospitalized in critical condition with telltale coronavirus symptoms struggled to get a test. Vickie Schafer, 61, did not get tested until Tuesday, when she was put on a ventilator and in a medically induced coma, said Crystal Lucas, her daughter-in-law.
Ms. Schafer went to the emergency room at Palms West Hospital in Loxahatchee, in western Palm Beach County, on Friday. It was not until two days later that doctors placed her in intensive care and brought in an infectious disease specialist, Ms. Lucas said. She was told that they swabbed Ms. Schafer for a coronavirus test, but the test was not actually done until two days later.

She remains in isolation while awaiting the results.
“If she’s dying, she’s doing it completely alone,” Ms. Lucas said through sobs. “People are going to be dying alone because they are suspected coronavirus cases, and we don’t even know.”
The census announced a two-week suspension of training and outreach.
Dr. Bruce L. Boros, who owns three urgent care facilities in the Florida Keys, said the medical community has had to scramble to handle the urgent requests for testing. “I got a million calls,” he said. “I made a million calls.”
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His three centers, spread over 100 miles from Key Largo to Key West, serve some 3,000 people a month — about 20 percent of them tourists. The centers were initially allocated a total of 15 tests and just got another 10.
Mr. DeSantis, a Republican, was at first reluctant to mandate mass cancellations of public events or restrictions on movement. But on Tuesday, after photos on social media showed crowds of tanned young people sunning shoulder-to-shoulder on the beaches, the governor shut down bars and nightclubs for a month and ordered restaurants to cut their seating capacity by half. He refused to close beaches, though groups will have to be no larger than 10.
The crowds of young people on the beaches have been one of the biggest sources of concern.
“These kids are asymptomatic,” Dr. Boros said. “They are not going to cancel spring break. They are going to come down here, drink beer and have fun. We have pretty much done ourselves in.”
The governor’s latest restrictions came two days after Puerto Rico’s governor ordered a nighttime curfew and daytime shutdown.
Some localities in Florida went further, especially in densely populated South Florida. Miami-Dade County and Fort Lauderdale closed entertainment venues and all restaurants except for carryout service. The county also shut down all retail deemed nonessential.
When the governor made his announcement, spring break was in full swing in Key West, where people filled the busy tourist drag, Duval Street, wearing green St. Patrick’s Day shirts, beers in hand.
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On Thursday, though, all hotels in the Florida Keys were ordered to close.
“We are essentially asking visitors to leave the Keys, much as we do during a hurricane evacuation,” said Mayor Heather Carruthers of Monroe County, which encompasses the entire Florida Keys.
The City of Key West ordered the closure of any businesses that “support social gatherings” of 10 or more people, including gymnasiums, movie theaters, museums and sightseeing vehicles.
There have been no coronavirus cases in Monroe County, but the Miami and Fort Lauderdale areas have nearly 200, and the movement of the virus was seen as inevitable, county officials said.
The more than 13,000 hotel rooms in Monroe County are normally booked at this time of year. Hotels were directed to take no further reservations, and current visitors were ordered to leave by Sunday at 6 p.m. The order is in effect for 14 days.
“This is a virus that is affecting the whole state but I think it affects different communities differently,” Mr. DeSantis said in making his announcement earlier. “The response may not always be the same on every little thing. We have counties that have not had a single case.”
The former governor, Rick Scott, now Florida’s junior senator, had a different view.
“The more we test, the more we can keep people informed and keep Americans and their families safe,” Mr. Scott, a Republican who is himself in isolation as a precaution, said on Twitter on Wednesday. “Every county in the US should have a mobile testing center up and running by Friday. No excuses.”
Haircuts are mostly gone, but this barber is fighting to keep his business going amid the coronavirus outbreak.
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In response to inquiries from The New York Times, the Florida Department of Health said it is following Centers for Disease Control and Prevention testing guidelines, which allow for the testing of symptomatic older people, people with underlying medical conditions and people hospitalized with Covid-19 symptoms. It said health care providers were free to test their patients who do not meet the criteria.
But interviews with a wide range of people around Florida suggest that even people who meet these criteria are often not being tested because there are still not enough test kits. Some said they were asked to meet stricter standards than the state’s published criteria.
“I am very, very angry about how things are being handled,” said Alexa Lane, 45, whose husband and two children were exposed at their synagogue in Palm Beach County but have not been able to get tested. “I feel like it’s not being taken seriously enough. If we don’t have the tests, we don’t have the numbers, we don’t have the correct precautions in place.”
As of Wednesday, a total of 2,493 tests had been conducted in a state of more than 21 million people. Twenty-four Florida counties listed test totals in the single digits.
By Thursday, 432 people had tested positive, many of them in South Florida.
“I think we need to do way more tests than that,” Mr. DeSantis acknowledged on Wednesday. Testing capacity has grown over the past week, he said, but there have been shortages of swabs and chemicals, and drive-through sites have taken longer than expected to open. The governor said that getting more testing material was his “number one priority.”
There have been suspected or confirmed coronavirus cases in at least 19 elder-care facilities across the state.
Mary Mayhew, who heads the state agency that oversees nursing homes, has asked hospitals to identify empty wings and buildings that the state could use if needed for patients who become gravely ill from the virus. Jared Moskowitz, Florida’s emergency management director, said the state planned to deploy a 100-bed field hospital near The Villages and two 250-bed field hospitals in Broward County and Orlando.

Credit...Eve Edelheit for The New York Times
The state has asked the federal government for supplies, including two million masks, 50,000 small bottles of hand sanitizer and 5,000 ventilators. And Mr. Moskowitz has asked if Navy hospital ships might dock at the state’s ports.
“This is the largest logistics operation the state of Florida has ever run,” he said.
Unlike a hurricane, the coronavirus affects every county.
In The Villages, a sanctum of sunshine, golf and afternoon happy hours, the first nearby case was reported on Tuesday in Lake County, though most of the retirement community is in neighboring Sumter County.
Catherine Hardy, 64, a Villages resident, said her weekly card game was canceled, though her husband was still golfing. Her friend Cindy Comer, 64, who returned home from Cincinnati last week, placed herself in isolation to protect her 87-year-old parents who live down the street.
In Boca Raton, Fran Greenberg, 63, said she was worried about her 88-year-old mother who lives in an independent senior living facility.
“I am freaking out,” she said. “They absolutely did not take this seriously soon enough. Just yesterday, the beaches and Disney were still packed. What is the risk to Florida? In two months, somebody I know could be sick. Somebody I know could be dead.” (Disney World closed on Monday.)
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Carlos Migoya, president and chief executive of the Jackson Health System in Miami, said his staff would be able to significantly ramp up testing by Monday. The hospitals have acquired lab equipment to run hundreds of tests a day with results back in a few hours. Previously, samples had to be sent out and returned in two days to a week, Mr. Migoya said.
“We have been known to take care of epidemics from Zika to Ebola,” he said. “We are prepared for this.”
Patricia Mazzei reported from Miami; Frances Robles from Key West, Fla.; and Audra D.S. Burch from Hollywood, Fla. Alain Delaquérière and Sheelagh McNeill contributed research.

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