DeSantis questions the effectiveness of shelter-in-place policies

BY JENNIFER CABRERA

In a call with Florida Chamber of Commerce members today, Governor Ron DeSantis said his priorities are better/faster testing and re-opening the economy.

Virus was probably in Florida before the Super Bowl

DeSantis said he “would be shocked” if the COVID-19 virus wasn’t already in South Florida during the Super Bowl. He said the southeast Florida area is the state’s number one “hot spot,” and he did press conferences today in Miami Gardens and in Palm Beach to implement stay-at-home orders for Broward, Miami-Dade, Palm Beach, and Monroe counties.

One of his priorities is to expand testing. He said we’re seeing a lot of positive tests, but there’s also a huge increase in the amount of testing that’s been done. The number of cases will continue to climb as we increase testing.

He said one problem with shelter-in-place orders is that the number one way COVID-19 is transferred is inside the home, amongst family members. “The virus is going to prefer enclosed environments, relatively moderate temperature, and repeated close contact.”

“The same number of people are going to get infected either way”

He reiterated the idea that “flattening the curve” does not mean that fewer people get infected; you’re trying to spread out the infections, so they don’t occur all at once and overwhelm the medical system. “The theory is the same number of people are going to get infected either way, but this way you’re doing it in a way that the hospital system can cope with it.”

He said there are currently “large vacancies” in the hospital system statewide–almost a third of the beds in Florida are available. Miami-Dade, for example, has 40% of its beds available. Despite having 1600 cases, their hospitalization rate is only 6-7%, possibly because the infected population is relatively young. “You would rather have more infections with a much lower hospitalization rate than fewer overall infections and a higher hospitalization rate.”

“No precedent” for the number of unemployment claims

DeSantis said there’s “simply no precedent” for the number of unemployment claims being filed, both in Florida and across the country, “way, way, way more significant than during the Great Recession, and I think as long as this goes, I think the more those losses are going to compound… My concern with this is if you have small businesses, they may be able to go 2 weeks or even 4, well, that’s tough, but once you get beyond that, it becomes really, really difficult, and just sending stimulus is not enough… they may just never exist any more… When I take action, it’s because I’ve determined there’s a factual basis… I’m not just doing it because some other governor does it or because the media says you need to do it… We’re trying to have an approach that’s tailored to the different regions of our state.”

CDC doesn’t recommend “stay-in-place”

He said the CDC doesn’t recommend “stay-in-place… they stopped short of doing that. They basically say close the bars, restaurants, gyms, things like that… they actually don’t say do the total lock-down. I don’t think they oppose that… but the… federal guidelines did not anticipate or demand that you do that.”

“But I do worry about some of the long-term effects of some of these mitigation measures… we’ve never attempted this in the United States in modern American history… The pandemics of ’57 and ’68, they basically didn’t do any mitigation; they knew there was something going around, and they basically just told you to protect yourself…”

“So this is a much different model. It’s not necessarily a model that has any basis in terms of experience… a lot of it is theoretical…” He said he tries to figure out all the consequences of taking an action, and when you do that, “it’s not as much about epidemiology as it’s about human nature, how people respond to incentives.”

He gave the universities as an example. First, they suspended classes for 2 weeks, then the students came back to campus and were hanging out at the bars, so they closed the bars. Then they were drinking at fraternity houses, so they sent the students home. “Well, you know, looking back… they were kind of in their own self-contained community. Once they go home, now they’re all back in the homes with their families, I wonder what was better in terms of containing the virus.”

He said “as soon as there’s a window to get back to as close to normal as possible, we snap into action because I think the longer we wait, it’s going to be harder to put the pieces back together.”

He said that instant tests will help people know if they are infected and antibody tests will help determine how many people have already had it.

Many contradictions in current policies

He said businesses should think about how they could thrive in an era of social-distancing, which may continue, off and on, for quite a while. He said that, as one example, people could start eating in restaurants again if they were spread out and surfaces were disinfected frequently. “People will wrestle with 200 people in Costco for toilet paper, and that’s considered acceptable social distancing… in New York City, subways are packed… it’s just odd how this is shaking out because I think there’s some things that are being done that are viewed as ok, but you’re probably very risky, and then there’s probably some things that people say don’t do that you definitely could do safely if you just had the proper parameters in place.”

He reiterated a point he makes often, which is that economic health factors into public health, and indicators like drug abuse, suicide, domestic violence, and child abuse become inflamed when there is high unemployment.

The literature is mixed on “shut-down”

Responding to a question about the wisdom of implementing stay-at-home orders, he said it had been done in southeast Florida and in metro areas of central Florida, but “I think that would be problematic in other parts of our state. You know, you’re basically tossing people out of a job, you’re going to cause a lot of problems. And I question whether the contacts that you would be shifting them to would be less problematic from a public health perspective.” He mentioned New York Governor Andrew Cuomo’s recent statement that closing the schools may have been a mistake from a public health perspective. “You channel people into contacts where they’re more likely to transmit or acquire the virus. I think there’s more negative than positive, and… the literature on doing the ‘shut-down’ is very, very mixed, and there’s a lot of people in public health who think that’s a bad thing to do.” Statewide, they’ve only recommended that people 65 and up and who have underlying health conditions stay home.

“Quarantining the general population… may be counterproductive”

“If you look at our adverse outcomes (hospitalization and death)… 98-99% are people who are elderly or have underlying medical conditions… Quarantining the general population, I don’t think you’re getting the bang for the buck in public health. In fact, I think it may be counterproductive in public health, and then of course, you could be doing a lot of damage on the other side.”

He said that after California Governor Gavin Newsome issued a “stay-at-home” order, “once one governor does something, people kind of feel like they have to follow suit… I felt a more tailored approach made more sense.”

Businesses will need a new culture to bounce back

He also wondered what people would do if this extends more than a couple more weeks. “There’s just a lot of stress right now… but I think it would be great to think about how different areas that have closed down… how could they come back in a way that is honoring the age of social distancing, assuming that this is going to be with us for the foreseeable future…”

“I think there’s a belief… among the public health people… that people can never be trusted to do the right thing, but I think if the business community is developing a culture of safety and looking out for this, that would give the people confidence that there’s certain things we could do that are not going to put people’s health in jeopardy… “