Covid-19: Florida v. New York

The Nursing Home Issue

According to the New York Times as of 7/23/2020 there were 414,405 cases of Covid-19 reported in New York State and 32,270 deaths.*  According to the Florida Board of Health there have been a total of 389,868 coronavirus cases and 5,632 deaths.  Though the populations of New York and Florida are similar (Florida has about 2 million more residents) and the number of overall cases reported by each state thus far are similar, there is close to a 6 fold difference in mortality.  Hopefully Florida will not catch up to New York in regard to the death toll, but why we have this difference is not yet completely clear.  It may never be completely understood, but there are some logical reasons as to why Florida has had so many fewer deaths than New York so far in spite of the fact that Florida has the larger population and a greater percentage of elderly patients.  One likely reason for this is that Governor Desantis took a more aggressive approach in protecting this vulnerable, elderly population.  For example, unlike in New York elderly Covid-19 patients were not sent into nursing homes where they could easily infect other residents and staff.  In early March, Governor DeSantis put out a strong preventive message to his elder population, advising them to stay at home in order to avoid potential exposure.  He made sure that nursing home personnel had the protective personal equipment (PPE) that they needed to help prevent acquisition and spread of the virus.  He deployed the National Guard to help institute testing in the state’s nursing homes where older COVID-19 patients were not sent.   These actions and others helped to give Florida a much better survival rate for patients in long term care facilities compared to New York.  On the other hand in New York, Governor Cuomo had patients with Covid -19 go back to nursing homes that were not prepared to care for them.  In spite of the fact that there were other alternatives such as the hospital set up at the Javits Center, the Hospital Ship Comfort that was sent to New York Harbor by President Trump and the Samaritan’s Purse field hospital that was set up in Central Park.  There was inadequate protective personal equipment (PPE) for the staff in these nursing home facilities in New York and inadequate isolation procedures which led to promulgation of the virus and increased death tolls among staff and patients.  In late April, the New York State Health department finally clarified that nursing homes should not take any new residents if they are unable to meet their needs.  In May Governor Cuomo finally reversed his directive, and tried to shift the blame for the nursing home fiasco on to President Trump though President Trump had no role in determining Governor Cuomo’s  response to the pandemic on a statewide basis.  Governor Cuomo also said that nursing homes could have refused to comply, but he did not specify how they could do so without incurring any penalties.

Some Other Reasons Why New York Infections Skyrocketed

Another probable reason as to why New York became an epicenter of this virus is that early on in the pandemic, New York’s Governor Cuomo and the New York City’s Mayor de Blasio, tended to downplay the significance of the virus telling people to continue their normal activities including socializing.  This lead New York City with its great population density to become an epicentre of the pandemic in the U.S. in such a rapid fashion that New York’s hospital system was overwhelmed. Their response as political leaders was marked by missed warning signs and health care policies that many health-care workers say put residents at greater risk and led to unnecessary deaths.  For example, in the first few days of March, Governor Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mayor de Blasio tweeted that people should “go see a movie”. Only after the disease was running rampant in the New York City’s low-income neighborhoods later in March did Governor Cuomo and Mayor de Blasio mobilize public and private hospitals to create more beds and intensive-care units.

Some Good News

The good news is that the death rate from the virus seems to be decreasing nationwide even though the incidence of infection may be surging in some areas like Florida and Texas right now.  The reasons for this decrease in death rate are again not completely clear, but some of this may be due to the fact that we have learned how to better manage this infection.  We know more about the sequelae of the infection and how to treat them. We have better contact tracing and management.  We have some therapeutic modalities that seem to be helpful.  Whatever the means, driving down Covid-19 deaths is becoming a major breakthrough.  If treatments for Covid 19 eventually result in a mortality rate of only 0.1% similar to influenza than the Covid-19 would no longer be a major health problem even though it might persist in the population for  long time to come.

More Testing Means More Numbers But Accuracy and Interpretation of Data Are Key

It should also be remembered that it may also be possible that the virus itself is changing and mutating to a less virulent and less infectious form.  As far as the incidence of new cases is concerned some of these numbers have to be interpreted in light of the fact that more and more people are being tested.  Moreover, as we get further and further away from this pandemic as time goes on, we may find that there have been irregularities in the data reporting and problems with the various screening tests that have been brought to market in terms of their reliability and accuracy.  For example, the number of false positives and false negatives will need to be better scrutinized especially since there are a number of companies marketing tests that may not have been fully validated.  So the total numbers of patients who have been exposed to coronavirus may be greater or lesser than what we now appreciate.  Mortality issues will also need to be reevaluated. Many patients who have been cited as having died from coronavirus may actually have died from other illnesses, but they were listed as Covid-19 deaths because they were found to be positive for the virus when they were tested in the hospital.  It’s well know that many patients who have the virus are asymptomatic or relatively asymptomatic so having a positive test in someone who ultimately died of something unrelated to Covid-19, but reported as a Covid-19 death, would obviously skew the data regarding total Covid-19 deaths.

Importance of “Herd Immunity” Cannot Be Overemphasized

Given the increased numbers of individuals who have been exposed to and presumably have antibodies against the virus should lead to greater “herd immunity”  as time goes on.  Overall, even though we are seeing some peaks of infection nationwide, the pandemic seems to be decreasing. “Flattening the curve” does not necessarily mean eliminating the virus all at once. What is really means is that the incidence of infection is flattening so that we are not overwhelmed by large number of cases. Things should only get better as time goes on and we get vaccines along with better therapeutics in the months to come.  Also, as time goes on “herd immunity” will become greater and greater.  Ultimately the virus that causes Covid-19 virus should, if not disappear completely, become much more manageable much like our conventional influenza virus.  We may need annual vaccines like we do for influenza, and we may need to rely on different antiviral agents to treat sick patients.  However, Covid-19 will likely become much much more manageable as time goes on similar to influenza.  There is also the possibility that this coronavirus (Sars-Cov-2) will mutate to a less infectious and aggressive form as these viruses sometimes do although the alternative is also possible.

*This was data collated by the New York Times from several sources.

The Devil is in the Details