WASHINGTON — New research published earlier this month in the American Journal of Public Health argues that Florida is undercounting the number of people who died from COVID-19 by thousands of cases, casting new doubt on claims that Gov. Ron DeSantis navigated the coronavirus pandemic successfully.
Conservatives have celebrated DeSantis for his handling of the pandemic, which has killed more than 30,000 residents of the state. Critics of the combative governor, meanwhile, say that many of those deaths would have been prevented if he had listened more diligently to health experts. DeSantis resisted lockdowns, downplayed masks and has made it increasingly difficult for localities to institute public health measures of their own.
And the state could be on the cusp of a new coronavirus surge.
The impact of the pandemic in Florida “is significantly greater than the official COVID-19 data suggest,” the researchers wrote. They came to that conclusion by comparing the number of estimated deaths for a six-month period in 2020, from March to September, to the actual number of deaths that occurred, a figure known as “excess deaths” because they exceed the estimate.
There were 400,000 excess deaths across the United States in 2020, a spike closely correlated to the coronavirus pandemic.
The lack of testing early in the pandemic may also have undercounted COVID-19 deaths, explains Daniel Weinberger, an epidemiologist at the Yale School of Public Health who has also studied the coronavirus and excess deaths.
The issue was further complicated because each state has its own death-counting methodology. “Some states classify a death as due to COVID if a positive molecular test was obtained, while other states allow the death to be classified as due to COVID if there is a suspicion that it was caused by COVID (even without a molecular test),” Weinberger wrote in an email to Yahoo News.
Polymerase chain reaction tests — another name for the molecular tests Weinberger referenced — are the most reliable way to tell if a person, dead or living, has been infected with the coronavirus.
In the case of Florida, the researchers say, 4,924 excess deaths should have been counted as resulting from COVID-19 but for the most part were ruled as having been caused by something else, thus lowering Florida’s coronavirus fatality count. That’s possible because people who die from COVID-19 often have comorbidities, such as diabetes and asthma. That leaves some discretion for medical examiners, who have sometimes struggled with conflicting science and been subject to political pressures during the pandemic.
In Florida, the state’s 25 district medical examiners are directly appointed by the governor. Last spring, the DeSantis administration was accused of trying to keep those medical examiners from releasing complete coronavirus data. (In August, the state said coronavirus deaths no longer required certification from a medical examiner.)
“I am sure that COVID-19 is responsible for most of these excess deaths,” says Moosa Tatar, a public health economist at the University of Utah who led the research team looking at Florida’s excess deaths. He said he chose to focus on Florida because of how quickly the governor lifted restrictions there. That move was widely criticized as reckless, though some believe that he has been vindicated by the fact that states where lockdowns persisted in the spring and fall did not necessarily have better outcomes than Florida.
The DeSantis administration did not respond to a request for comment.
Florida already has the fourth-highest total number of deaths in the country from COVID-19, but it is also the country’s second most populous state. It has the second-oldest population in the United States, a significant factor in a pandemic that tends to affect the elderly more severely than young people.
The debate over the state’s pandemic response is, to a large degree, a proxy for the broader debate over how effective restrictions have been in stopping the disease.
Donald Trump, who railed against restrictions even as his own government implemented them, is now a resident of Florida; DeSantis is a political disciple of Trump with presidential ambitions of his own. He recently lashed out at President Biden as a “lockdowner.” The president has not tried to “lock down” Florida, but his administration has expressed concern in recent days about spring break crowds partying without masks, which appears to be driving a spate of new infections in the state.
Tatar’s findings have not been universally accepted. Lauren Rossen, a statistician at the National Center for Health Statistics at the Centers for Disease Control and Prevention who has analyzed excess deaths, told Yahoo News that she saw nothing exceptionally suspicious in the state’s excess death numbers.
“Florida doesn’t stand out to me,” she said.
Other critics of Tatar’s findings described Florida as neither a glowing success nor an unmitigated disaster but rather a state that has handled the pandemic with some successes and some failures, with the excess death data reflecting that mixed record.
Jason Salemi, an associate professor of epidemiology at the University of South Florida, told Yahoo News that it was wrong to assume that every excess death during the period in question should be attributed directly to those who contracted the coronavirus, especially since people who were never infected may still have been fearful of seeking care for other conditions while the pandemic surged and hospitals filled with COVID-19 patients.
“You could’ve never gotten the coronavirus, delayed needed health care, and died from diabetes-related complications. That’s still indirectly tied to the pandemic,” Salemi told Yahoo News, describing Florida’s statistics regarding all-cause excess deaths and the coronavirus as “kind of middle-of-the-pack.”
Excess deaths were at 21 percent nationwide for 2020, according to the CDC; Florida saw a 15.5 percent rate of excess deaths for the period that Tatar studied. California’s excess death rate was also 15 percent, despite that state’s governor, Gavin Newsom, having enacted much more stringent restrictions than did DeSantis in Florida.
Salemi runs a Florida-focused coronavirus dashboard and frequently talks to state epidemiologists. “I don’t think there’s anything egregious going on with the data,” he told Yahoo News. “I would know. I am just constantly in these data.”
Weinberger, the Yale epidemiologist, also said that his analysis indicated that Florida’s “gap” between COVID-19 and excess deaths was about average.
The question isn’t whether deaths occurred, but how states counted them. Research conducted by Andrew Stokes of Boston University has shown that in pro-Trump sections of the country where elected officials tended to take the pandemic less seriously, excess deaths were less likely to be attributed to the coronavirus.
Stokes told Yahoo News that what was true for the U.S. was also true for Florida, with heavily Democratic counties like Miami-Dade, Osceola and Hillsborough tending to report all or nearly all excess deaths as COVID-19 deaths. By contrast, most of the counties where COVID-19 death underreporting was especially high — Franklin, Wakulla, Taylor and Sumter — are Republican strongholds.
“There’s a lot of regional variation within Florida,” Stokes said in an interview, describing what he said were “patterns of underreporting.” That contradicts what Rossen, the CDC statistician, told Yahoo News.
Those underlying patterns could explain why the state’s average numbers elicit such strikingly different reactions. While the state as a whole looks, as Salemi said, average, more finely grained data suggests discrepancies at play.
In other words, it appears that diligent coronavirus reporting in Democratic sections of the state may have been compensated for by underreporting from Republican regions.
DeSantis has personally taken pains to favorably contrast himself to New York Gov. Andrew Cuomo, who is accused of concealing the number of deaths in nursing homes. But he has also attracted criticism of his own by feuding with a data scientist who was fired after accusing him of manipulating data. Political opponents have branded him “DeathSantis” for what they have charged has been a reckless inattention to a state full of elderly and otherwise vulnerable people.
The political debate over how governors including Cuomo and DeSantis have handled the coronavirus may reflect nothing more than the fact that every state, whether red or blue, suddenly found itself dealing with a pathogen that challenged American society at every level.
And the uncertainty involved in confronting the new disease was compounded by changing guidance from Washington on how to handle the pandemic. Public health experts believe that clearer and more decisive leadership by the Trump administration could have prevented hundreds of thousands of needless deaths.
“Overall, COVID-19 was the third most common cause of death in the U.S. during 2020,” says Johns Hopkins epidemiologist Justin Lessler. The pandemic was topped only by heart disease and cancer. “Given it did not exist at the beginning of the year, this should be troubling to everyone.”
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