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The Florida Roundup

Infectious Disease Experts Criticize Florida's Containment Efforts

Miami Herald
Infectious disease experts who spoke with the Florida Roundup are critical of the lack of a statewide mask order and the lack of contact tracing in Florida.

Florida reported an additional 11,433 cases of COVID-19 Friday, bringing the total number of cases to 244,151 across the state. It’s the second time the state’s single-day tally exceeded 11,000. The health department reported 435 more hospitalizations on Friday, the largest single-day increase the state has seen thus far. 

The percent of people testing positive for the virus each day was 12.75 percent Thursday. It comes as some intensive care units in South Florida are nearing capacity. 

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Some infectious disease specialists are critical of the state’s efforts to contain the virus. Chad Nielsen, the infection prevention director at UF Health Jacksonville, and Tom Hladish, research scientist at the University of Florida, joined the Florida Roundup and talked about the state's handling of the coronavirus pandemic with hosts Tom Hudson and Melissa Ross.

Here’s an excerpt from the conversation. 

MELISSA ROSS: Florida has gotten a lot of criticism in the last few days about its testing and its contact tracing program to try to get a handle on spiking COVID cases around the state. What's your assessment of the state's contact tracing efforts? Let's begin there. 

TOM HLADISH: This is something that I've tried to understand, kind of from the outside. I have been working with the state, but not directly in conjunction with their contact tracing program. It seems to me that they're following the CDC’s guidelines for how to do contact tracing, which seems like a perfectly reasonable thing, but first of all, it's clearly not working.

We're seeing a dramatic increase in cases. And so it's not serving its primary function to limit the spread of the epidemic. And I think that there are also some pretty serious missed opportunities for data collection related to the contact tracing program. 

ROSS: What do you think the states should be doing to get a better database together so that we have a better understanding of who's infected and who's at risk of infection? 

HLADISH: The big issue right now is we don't really have a system in place for assessing the changing interventions that we're trying. As different types of businesses open up, as the rules for how many people can be inside of a restaurant, things like that. As those change, we really need information about what kind of impact that's having. 

And contact tracing is kind of ideal for that. You know, we're doing all of the hard work. We have thousands of people who are making many thousands of phone calls every day, asking people about their interactions. But we're not storing any of that information. So the contact tracers are learning about this. But there's no way for them to document it. And, of course, therefore, there's no way for us to actually see what effect changing interventions is having. 

ROSS: What do you think the governor, the health department, should do to better contain coronavirus in Florida? Should we have a statewide mask order? Do you think another shutdown? What else? 

HLADISH: The mask order is just it's so obvious to me. And the governor has said that the reason he doesn't want to make a mask order is because it can't really be enforced, like, you know, how are you going to police people? But, there are so many people that I've talked to that take their cues on what the government is telling them to do. 

I think from an epidemiological perspective, and we don't have to be worried about the small number of people who would say, "Well, you're not going to arrest me. So why should I bother?" We should instead be thinking about the many people who would say, and "I guess this is important because we're told it's something we need to do."  Most people, I believe, will try to be compliant.

In terms of a shutdown, I'm sympathetic to the governor's perspective there. It's a very disruptive thing to do. What I'm not sympathetic to is how we squandered the last opportunity. You know, that was really the time we needed to take to put together a good strategy for containment for once we reopened, and I don’t see any evidence of that.

ROSS: Chad Nielsen is director of accreditation and infection prevention at UF Health Jacksonville. We're seeing most large cities in the state have mask orders in effect. Do you think the governor needs to declare one for the entire state?  

CHAD NIELSEN: I certainly think that it's warranted. We've seen other states like California go through that and Texas. And I think it's hard to look at the numbers in Florida versus these other states and say that perhaps that's not needed for us. So I definitely think, you know, increased mandates for masking across the state could definitely move our numbers in a better direction than we’re currently headed.  

TOM HUDSON: Chad Nielsen, let me ask you, going forward, what needs to change in your estimation in order to contain this spike that Florida is experiencing now?  

NIELSEN: I'll tell you, there's a growing number of folks who are thinking "Can this be contained at this point?"

HUDSON: Are you among those?

NIELSEN: Well, I'm getting there, to be honest. There's a 33 percent positivity rate in Miami-Dade County. That means one out of every three people had it. Generally speaking, once you start approaching 20, 30 percent positivity, it's almost impossible to stop the spread without really dramatic action. 

You know, another shutdown, you know, increased testing. We're running out of reagents. We should have been able to do this on the front end, because now when you have, you know, several thousands of cases, new per day, contact tracing is virtually impossibleSo, you know, mishandling this with the lack of testing and a lack of coordinated response on the front end has really, really inhibited our ability to control what what's surging right now.