‘God’s waiting room’ finds a way to keep virus out
Florida hit the grim milestone of 100,000 confirmed coronavirus cases yesterday, following a series of record daily totals. But the headline figure is far from the full story. On that same day there were only 12 deaths, and 82 people admitted to hospital, in a state of 22million people, which has so many elderly retirees it is known as “God’s waiting room”. Florida’s fatality rate – the proportion of deaths per positive cases – has fallen to 3.4 per cent. That compares with 5.2 per cent for the United States, and the same globally. The UK’S rate is 14 per cent.
Most startling of all, the average age of people testing positive has plummeted from 65 in March to 35 now. In some Florida counties it is under 30. The figures reflect the Sunshine State’s strategy of protecting the elderly, while allowing the young and healthy to proceed with life as much as possible.
It is an approach not dissimilar to what was originally proposed in the UK and, with the addition of focusing on the elderly, what has played out in Sweden. It could provide a model for how the virus can be managed.
If anywhere was set for catastrophe when coronavirus emerged, it was Florida. The state has 691 nursing homes, with about 85,000 beds, and more than 3,000 assisted-living facilities, with 106,000 beds.
It is home to numerous resorts for the elderly, including The Villages, the largest in America, which has more than 130,000 senior citizens, with an average age of 70.
The approach of Ron Desantis, the
Republican governor of Florida, was simple: shield the elderly, and let others carry on because they were less likely to get seriously ill, and contributed more to the economy.
The result has been a lot of cases, but fewer deaths, and less pressure on the state’s health system. No special measures were introduced for the elderly. But repeated appeals were made for over-65s to stay home, and avoid crowds. It was each individual’s decision, but they listened. When the first case was confirmed in The Villages on March 19, public events there had already stopped and restaurants had switched to takeaway.
Churches immediately made services online or drive-through only.
Days later, Mr Desantis unveiled what he called the “most innovative testing site in the country” at The Villages. It was a drive-through centre that tested anyone, regardless of symptoms, and returned results within 72 hours. Testing went on for a month. Scientists hailed it as a global example. Despite predictions the virus would devastate The Villages, less than 100 cases have been detected there.
Florida is nearing completion of testing everyone in all its nursing homes. All nursing staff are being tested every two weeks. The governor ordered the National Guard to help. “The impression [from Mr Desantis] has been protect the vulnerable people [the elderly] while trying to maintain the economy in Florida,” Prof Cindy Prins, an epidemiologist at the University of Central Florida, told The Telegraph. “We have a lot of large retirement communities, but overall Florida didn’t get to the point the models predicted. Our older people took note of the need to protect themselves. The shift in cases is in part thanks to them continuing those practices, and younger folks not.”
Experts like Prof Prins are still worried by the recent spike. “The preference is to not have this many cases. This is not a desirable situation. When we look at younger cases, they’re not admitted to hospital as often, not as likely to die,” she said. “But the 25-year-old may still go visit grandma and grandpa.”
Mr Desantis was reluctant to issue a statewide stay-at-home order, eventually doing so in April, and reopening started in early May. Now, restaurants and bars are operating at 50 per cent capacity (100 per cent outdoors). He has not made masks mandatory. From Memorial Day (May 25), Floridians have flocked to beaches. Images of sun worshippers avoiding social distancing have given public health officials apoplexy. But the governor is pleased at how the average age for positive cases has “shifted in a radical direction younger”. He said: “A trend that’s very important is what is the median age of those people who are testing positive. Those under 40, in particular, who don’t have any underlying conditions are much, much less likely to be admitted to hospital or to suffer a fatality.”
The figures appear to back up the approach. Florida has the third highest population of any US state, including a very high proportion of vulnerable elderly people. Yet it has had the ninth most deaths – 3,173. That equates to 147 deaths per one million people. The US average is 368 per million. For the UK it is 641 deaths per million. New York’s figure is 1,602 per million. Florida is also testing aggressively. There were 41,028 tests on Saturday. On that day the percentage of positive tests was 14 per cent, compared with an average of less than 6 per cent previously. It reflects contact tracing efforts.
The falling age of patients has eased pressures. In Broward County, the length of hospital admission has fallen from an average of 10 days to six. At the start of the pandemic elderly patients required long stays. Now, the majority of younger patients are not admitted, and are sent home to recuperate.