Dr. Lauzardo supports metric of single-digit COVID-19 cases and 1% positivity rate

BY JENNIFER CABRERA

During their April 15 meeting, the Gainesville City Commission discussed the possibility that the County might let the mask mandate expire. City Manager Lee Feldman said he wasn’t looking for the commission to take “definitive action. As your City Attorney pointed out last time, this actually is within my authority under the Emergency Order. So today I’m just looking for guidance.”

Mayor Lauren Poe noted that the County said they would reconsider the mask mandate on May 12, and the City Commission meets next on May 6, so “we’re able to stay ahead of this, I believe.” He said he was looking forward to hearing from Paul Myers, Alachua County Administrator for the Florida Department of Health, and Dr. Michael Lauzardo of the University of Florida about “what we need to continue to do to get to where we all want to be, which is, you know, being able to go where we want and do what we want without any fear of getting somebody sick, and they eventually dying or having, you know, lifelong complications from this really dangerous virus.”

Myers said, “I just want to remind everybody the reason why we flattened the curve. We flattened the curve to protect the healthcare system… hospitalizations have gone down significantly. We have vaccinated 82% of our most susceptible population, that’s the 65+, in Alachua County residents. We have vaccinated over 68% of those over the age of 50… The median age [of cases] continues to be those in those 20s and 30s… we can… definitively say that’s who’s mainly responsible right now for spreading COVID-19 in Alachua County. The good news is that segment of the population does not suffer the severe consequences of this disease… We certainly expect to see hospitalizations go down, but we’re not quite there yet.”

Arreola was concerned about UF’s announcement about full attendance at the stadium in the fall. “Obviously… I’ve been in full support of maintaining those mandates until we have sufficient evidence to show that spread of the COVID virus has been muted… It’s the fourth quarter, where you have to play your best, so let’s do it.”

Lauzardo said, “There’s still some heavy lifting to do. I share that optimism as far as us being able to start getting the upper hand here, getting back to normal as soon as early summer… As excited as I am about the first 40% of the population that we’ve vaccinated… the hard work begins now. Making sure we work through people who think they’re not at risk… making people understand why they get vaccinated and still need to wear masks afterwards… I guess we’re closing in on 100,000 residents. That’s, you know, above 40%… of the eligible 220,000 residents in the county that are 16 or older. But again, if we stop here, this drags out for a long time… 

“We have the control over when this ends, and it has to do with how we can communicate the importance of vaccination, how we can explain that the 20s, 30s, and 40s, those are the age groups that are transmitting this infection. And that is the age group that needs to be vaccinated just like the vulnerable need to, as well. Again, emphasizing the point that 75%, three quarters of the spread, is from people in their 20s, 30s, and 40s who may not think of themselves as vulnerable, but yet we cannot protect those 65 and older, even though we have high rates of vaccination, because there’s still a lot that have not been vaccinated, and there’s still vulnerable people … Part of protecting their community, protecting their loved ones, protecting their family members, would be them getting a vaccine as well. Not just for their own personal health.. 

“I think that masks are important… If we just press on with the masks, keep it going for now… in several weeks, probably two to three weeks, we’ll really start to see the benefits of vaccinating the people in the younger age groups… That’s gonna depend on our ability to communicate well.”

Hayes-Santos asked where we need to be on vaccination rate. Lauzardo replied that “instead of focusing on the number, we’ll know we’ll get there when the [case numbers] start to go down.”

Myers added, “I’m with Dr. Lauzardo in terms of not wanting to put a number out there. We know what our vaccination rates are. What we don’t know is how many people have been naturally infected. And so when you add the vaccination, that type of immunity, to the natural immunity that comes with infection, it may be much, much lower than the number that we all look at, in terms of 70% [vaccinated]… But I just want to remind everybody the reason why these mitigation strategies were implemented to begin with was to flatten the curve, and we’ve done that.”

Hayes-Santos asked about the specific positivity rate they’re looking for. Lauzardo replied, “I don’t want to put a number on it specifically, but I think that if we stay consistently down in single digit cases per day with similar levels of testing, and we get our positive rate below 1% consistently, those are going to be very good signs that we’re coming to sort of the end of the pandemic phase.”

Hayes-Santos said they should put this item on the agenda for their May 6 meeting “so we can be kind of ahead of the curve.” Poe instructed the clerk to put it on the agenda and label it “COVID-19 update.”

Commission Gigi Simmons asked what percentage of the minority community has been vaccinated. Myers said it was uncertain because many people don’t put their race on the consent form. But “60% of the vaccines are going into females… I guess [the males are] just not as smart as the females, because they’re not getting the uptake that the females are. We really need to have the women in this county, you know, encourage their male counterparts to get vaccinated. You know, we’re all in this together.”

During public comment on the item, Kali Blount spoke in favor of continuing the mask mandate and complained about non-compliance on city buses.

Nathan Skop had some questions for the presenters: “Mr. Myers has stated that he does not support a mask mandate; I want to make sure that I heard that correctly… He stated hospitalizations were going down but we’re not there yet. It appears the hospitals currently have 39 COVID patients, so what is the target number to be ‘there’?.. I’d like to know… what the false positive rates are and whether it’s reasonable to get a consistent 1% positivity rate with false positives. And then, finally [directed at Mayor Poe],… if wearing a mask didn’t keep you from catching a cold or flu or whatever you had last Thursday… could we get the doctor or Mr. Myers to explain that paradox?”

Josh asked, “What metric are we looking for to drop the mask mandate?… Masks should be voluntary and not mandated.”

Poe responded, “For the target, we heard Dr. Lauzardo say it and Mr. Myers reinforced it, we would like to see single digit cases daily and a single positivity rate, and it all depends on the direction of the numbers and what we’re learning. It’s not just Alachua County. It’s statewide and nationally we’re going to see vaccination rates in correlation to drop in community spread. So that was answered.” 

Myers then responded, “I’ve been very consistent… CDC guidelines are recommendations, they are not mandates… Regarding false positives, I’ll defer to Dr. Lauzardo about these tests… I’d like to see our hospitalizations at zero, I don’t know if we’ll ever get there.” Myers deferred to Lauzardo on false positive rates.

Lauzardo talked about the false positive rate: “I think what really matter is the negative and positive predictive value. So if you get a positive test, does that mean you truly have the infection, and that depends on what’s going on at the same time. The general public may have trouble grasping this. If we were doing the same PCR test in July of 2019, let’s say that test existed and there was zero COVID around in the world. We do that test and every test that you get back that’s positive, you know it’s a false positive because the disease doesn’t exist, the incidence is really low. 

“Likewise, hopefully in a few months, when you get positives among asymptomatics, if there’s not a lot of community transmission, you don’t have a lot of people in the hospital, if you get a positive, they’re likely to be false positives. It goes way down as the incidence in the population goes down. 

“When you have a lot of disease in the community, it’s not going to zero. You’re looking at the big picture, not just one or two cases, so the environment, so the population. When that’s the case, the false positive rate or the positive predictive value goes up, the false positive rate goes way down, so you have to look at the context, and it’s not a static thing. It’s not like, oh, the false positive rate is x. No, it depends on what’s going on in the community.

“In terms of the effectiveness of masks, I do struggle to think that we’re still having these conversations about the effectiveness of masks because our own personal data at UF, our own personal data in Florida, our own experience is that yeah, masks are not a hundred percent effective, but they’re really effective in dropping the infection rate… We don’t want to be wearing the masks, but it would be foolish for us to deny the effectiveness and the role that they play as we get to the finish line and get this done with already.”

Poe added, “I’ll just say as I started noticing I had symptoms, I isolated myself in my house away from my family, I wore a mask everywhere in the house, and the rest of my family did not get the same illness that I did. While I was unlucky and I was rolling my eyes at myself because I’ve been practicing impeccable hygiene for the last 18, 20 months but nonetheless, my behavior, you know, likely kept the rest of my family healthy, and that to me is more valuable than whether I got it or not.”