In Miami-Dade, COVID hospitalizations fall while new cases surge. Here’s what we know.
As Florida reported a second record day of new COVID-19 cases Friday, with 1,902, COVID-19 hospitalizations in Miami-Dade — the hardest-hit county in the state — dropped to 546, the lowest number since April 7.
Government officials have offered some explanation for the worrying rise in cases. Florida Gov. Ron DeSantis said Friday that agricultural workers may be contributing to the increases, which have risen to an average of more than 1,350 a day. In the past, he’s also said that increased testing means finding more cases.
And Dr. Jay Butler at the Centers for Disease Control and Prevention, in a news conference Friday, said spikes in states like Arizona, Texas, North Carolina and Florida are likely due to a combination of factors including nursing homes, prisons and failure to social distance during Memorial Day events.
“There’s no one answer,” Butler said.
But how do experts make sense of conflicting information — in this case, rising positive cases but falling hospitalizations — to assess risk? And how can regular people figure out what’s going on when they look at the numbers? Over the past eight days, Miami-Dade has averaged about 260 new cases a day, according to the county’s “Moving to a New Normal” report — up from an average of 202 a day the prior week.
“It’s great that you have all that data but it is confusing,” said Eric Toner, a physician and pandemic preparedness expert with the Johns Hopkins Center for Health Security. “It’s hard to disentangle all the different sources of potential hospitalizations. ... That is not a direct indication of how much disease is transmitting in the community because of the large pool of people in nursing homes that are feeding hospitalizations.”
Toner advised against focusing too much on any single metric because no single data point tells the whole story. Trends are the thing to watch, he said.
“There is no magic number to follow,” he said. “You have to look at all the data.”
The drop in Miami-Dade hospitalizations — a number the county keeps track of — may mean that expanded testing is catching more mild or asymptomatic cases that don’t require hospitalization, as DeSantis has said.
Or it could be that those infections will lead to hospitalizations later — they just haven’t gotten that bad yet, said Robert A. Bednarczyk, assistant professor at Emory University’s Rollins School of Public Heath in Georgia.
“Just because we’re not seeing those more severe outcomes as of yet, as more people are getting infected and getting ill, it’s offering up a greater probability for that to start happening as the disease continues to progress,” Bednarczyk said.
For Floridians wondering if the coronavirus outlook has improved, there are reams of data available in daily reports from the state Department of Health — including deaths, hospital admissions and cases in nursing homes and prisons — but those offer no sense of what the statistics actually mean, said Thomas Tsai, a surgeon and health policy researcher at Harvard T.H. Chan School of Public Health.
“It’s an undue burden to the public to be responsible for determining number of new cases, positive rates, hospitalization rates ... that’s not the job of the public,” Tsai said. “That is the job of public health agencies.”
Though the state’s information can be incomplete and lack context, as the Herald has reported, the data is supposed to inform the public about the spread and scope of the novel coronavirus pandemic in Florida, where health officials have confirmed more than 69,000 cases since reporting the state’s first infection in March.
Still, Tsai explained that some of the most meaningful metrics aren’t being offered or explained by public officials: how many contacts of confirmed cases are successfully being traced and tested? How quickly are those test results coming back? How many new cases are the result of that contact tracing? And how many are asymptomatic?
“We need key performance indicators of the processes that have been stood up during Phase 1 before we move into Phase 2,” Tsai said, discussing the reopening of the state.
Tsai said rising COVID-19 cases would not be a warning sign if the rate of positive tests also declined as testing expanded. But in Florida, it hasn’t. The percentage of positive tests in the state has ranged from 4% to 8% over the past two weeks and was about 7% on June 11, according to the most recent number available from the Florida Department of Health.
Positivity rates — or the percentage of total tests that come back positive on a daily basis — are being frequently used as a way to measure the effects of COVID-19. The World Health Organization advises governments that, before reopening, positivity rates should be at 5% or lower for at least 14 days.
Tsai said Florida’s positivity rate appears roughly static to him even as Florida tests more people, indicating that the state has not yet gotten the disease under control.
“That’s the part I haven’t seen in Florida yet is the deceleration,” he said. “The positive rate has been constant and the goal is not to perpetually mitigate COVID-19. The goal is to suppress the disease.”
The sheer number of new cases — and whether the trend line is going up — is another way to figure out how bad things are. It’s the first piece of information that Toner, the Johns Hopkins expert, looks for. But he also checks at least two other indicators, especially as the disease spreads over a longer period of time. Is there a rise in testing to account for the new cases? Is there a rise in hospitalizations to point toward a worsening of the pandemic?
“If I see a rise in cases, then I look to see the number of tests that are being performed, and if the rise in cases is due to increase in testing, we should be seeing a proportional rise in testing, and if we’re not seeing that it’s an indicator to me that we’re probably seeing more transmission.
“And then I look a week or two down the road to see if I see an increase in hospitalizations. If I’m seeing that, that would confirm to me that these number of positive tests is in fact real new cases resulting in hospitalizations.”
Even then, Toner said, it’s important to remember that data is imperfect. Not everybody who has COVID-19 tests positive, he said, though there are likely many more people who have the disease than have tested positive for it. Not everybody who has COVID-19 gets admitted to a hospital, either, and not all hospital admissions from COVID-19 get recorded, he said.
“People have to take each of the numbers with a grain of salt,” Toner said, “but I think the trends are what’s important.”
There’s yet another metric that public health experts focus on: emergency room visits for COVID-like symptoms, such as cough, fever and shortness of breath.
“If I see that going up, it’s very worrisome,” said Mary Jo Trepka, an infectious disease epidemiologist with Florida International University’s Stempel College of Public Health.
So far, those numbers have fluctuated but remained at lower levels than seen during the pandemic’s peak in late March.
That’s not foolproof either, though, because many people are scared to go to an emergency room amid a pandemic.
Those who do go to the ER are “just the tip of the iceberg for COVID,” she said, “because most people are going to have mild symptoms or no symptoms at all.”
And Tsai, of the Harvard T.H. Chan School of Public Health, said the recent resurgence in COVID-19 infections can be contained with the same measures that health experts have been preaching for months: wearing face masks in public and practicing social distancing.
“One the hardest part for the public is to move from a very blunt instrument like staying at home, social distancing and shelter in place to now a portfolio of smaller tools,” he said. “Making sure you get tested. Making sure you wear masks universally. Making sure you practice good hand hygiene. Making sure you don’t give up on vigilance around the precautions. This remains incredibly important.”
This story was originally published June 13, 2020 at 7:00 AM.
