How many people have recovered from coronavirus in Florida? It’s complicated
Florida has confirmed more than 80,000 cases of COVID-19 since the pandemic began. But how many of those people are still sick? How many have recovered?
It’s complicated.
Recovery data is not the most accurate or the most important measure for charting the course of an outbreak, according to health experts at the University of South Florida’s College of Public Health and at Johns Hopkins University in Baltimore.
Not everyone who falls ill with COVID-19 seeks medical attention, and those who are asymptomatic might not have known they were sick. Health officials also don’t know enough about COVID-19 yet to have a one-size-fits-all checklist to determine if someone has “officially” recovered from the disease.
Another caveat: Some states provide recovery data, others don’t. And the states that do provide estimates might not use the same definition for recovery, which makes it more difficult to give an accurate representation of recovery data during the COVID-19 crisis.
But, recoveries give people hope.
“It’s part of the whole picture and ... it really helps people understand what this disease is and what it isn’t,” said Dr. Marissa Levine, professor and director at the Center for Leadership in Public Health Practice at the University of South Florida’s College of Public Health. “ I think people take comfort in knowing that you can get COVID and fully recover, and if we can’t, we need to know that, too, and to an extent to some degree who might be at risk.”
More than half of Florida’s confirmed COVID-19 cases were recorded in Miami-Dade, Broward, Palm Beach and Monroe counties. It’s unknown how many of those confirmed with the disease are still considered contagious and are being tracked by the health department.
Florida’s Department of Health did not respond to multiple requests for comment this month on whether the state is collecting “recovery” data. In April, when the Miami Herald first inquired about COVID-19 recovery data, the state’s health department sent the following emailed statement:
“The state is developing new efforts daily as we respond to COVID-19 to keep Floridians and visitors safe and informed about the status of the virus ... Some states and countries measure a case as recovered when a person has had COVID-19 for more than 14 days, while others upon hospital discharge data — neither of which completely capture recovery of the full COVID-19 positive population. The Florida Department of Health will continue to provide information on hospitalizations and deaths to keep the public informed about the threat of the virus.”
Miami-Dade County’s Department of Health and Palm Beach County’s Department of Health both emailed the same statement to the Miami Herald last week. Palm Beach County’s Department of Health later said this week that it is tracking the status of every case and is investigating every positive case through contact tracing. Broward County did not respond to the Miami Herald’s inquiry.
Is Florida tracking recovered COVID-19 cases?
In the Florida Keys, where there are more than 130 confirmed cases with four deaths since the crisis began, the health department is not tracking recoveries, said Monroe Department of Health Administrator Bob Eadie.
The reason, he said: The state can’t settle on a definition for “recovered.”
“For me, that would be anyone that tested positive and is still alive,” Eadie said. “The problem is so many people don’t even show any symptoms at all or they have mild symptoms. You range from very sick all the way down to you didn’t even know you had the disease.”
Florida is one of 12 states that is not providing a “recovery” count in its novel coronavirus data, according to The COVID Tracking Project, a journalist-led volunteer organization launched by The Atlantic. The project collects daily data from all 50 states, five territories, and the District of Columbia.
The COVID Tracking Project uses 16 separate factors (broken into five categories) to evaluate how well each state has published and formatted their COVID-19 data, and then assigns the state a letter grade in a report card.
Florida has an “A” for meeting all but four of the criteria: how many people have recovered, how many patients are being treated in ICUs, how many patients are on ventilators and a pre-existing condition breakdown.
States that are providing recovery data do not have a consensus as to what “recovered” means.
Some states count hospital discharges in its recovery count. Others consider people recovered if they’ve had the disease for more than 14 days and are no longer considered to be contagious.
The Centers for Disease Control and Prevention told the Miami Herald in an email this week that it is not “systematically collecting data on people who recover from COVID-19” but that it is an “important subject that will help us learn more about the characteristics of this new virus.”
But even the CDC is not entirely clear as to what should be considered a “recovered” case. The term “clinically recovered,” “recovered” and “since recovery” aren’t defined in the CDC’s FAQ about COVID-19 or its interim guidance documents for healthcare providers and public health officials.
Instead, the documents provide recommended “strategies” to determine if someone no longer needs to be in isolation “since recovery,” depending on whether there were symptoms or hospitalization was needed.
By the CDC’s recommendation, people who have had symptoms can stop self-isolating if they meet the following requirements:
▪ They have been fever-free (without fever-reducing medications) for at least three consecutive days
▪ They have shown “improvement” in respiratory symptoms, such as coughing and shortness of breath.
▪ It has been at least 10 days since symptoms appeared.
▪ The CDC says someone can also stop self-isolating if they meet the first two conditions and have also received two negative COVID-19 test results taken at least 24 hours apart.
People who have “clinically recovered” can also still test positive for COVID-19 but are likely no longer infectious, though it is still unknown, the CDC says. The center also says each recovered person should be treated on a case-by-case basis when deciding if they can leave quarantine.
“We know people are recovering from the disease. We know that the disease is still out there ... we don’t know when we’ll have a vaccine or even an effective treatment so we need to create a new normal and figure out how to live with COVID now, so we can move on and do the things we need to do to continue to maintain a viable economy but do so in a way that protects us at the highest level possible,” Levine said. “We are watching numbers go up now and if we don’t act ... we may have a much more serious problem that will be even harder to dig ourselves out from.”
Why is it so hard to confirm someone has recovered from COVID-19?
One of the other problems with recovery data, experts say, is that the CDC has not given a clear explanation of what the role of recovery data should be during the pandemic nor a clear definition of what “recovery” means, at least publicly.
“It has been put on a lower-level of priority, if you will, because of the interest in getting the case numbers, the testing and the contact tracing that’s needed to respond and get the desired results,” Levine said.
The CDC did not respond to questions about what it considers a “recovered” case to be, what role recovery data should play during the pandemic and whether it recommends if states should track recovery data. Instead, it sent a written statement reminding the public that it’s still unknown if COVID-19 antibodies provide immunity to the disease and that CDC scientists are “currently conducting studies to answer these questions.”
The United States has more than two million confirmed cases of the novel coronavirus — 116,963 people have died in the U.S. and 583,503 have recovered as of Wednesday morning, according to Johns Hopkins University’s COVID-19 dashboard, which relies on the COVID Tracking Project for its recovery data.
But with each state having the option to track and define recovery cases, this “lack of clarity” makes the metric “useless,” said Dr. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security and an associate professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.
For Nuzzo, hospitalizations, daily new cases, testing and the positive test rate are more important than recovery counts. So are “active” cases — how many people are confirmed to be ill with the disease and are believed to be contagious — and how many contacts of confirmed cases are being monitored and have been successfully traced and isolated.
Florida does not provide the number of people currently sick with COVID-19 or how many contacts of confirmed cases have been successfully traced and isolated.
Both Nuzzo and Levine recommend the public look for patterns and trends in their state’s hospitalization, daily new cases and testing data to see how the pandemic is developing in their state or county.
Florida’s COVID-19 “Data and Surveillance Dashboard” has a variety of features, including updated tallies of total cases, total deaths and total hospitalizations at the state and county level.
But it doesn’t have any information about “recovered” cases.
Rebekah Jones, the woman who created Florida’s nationally praised COVID-19 dashboard, built her own “Florida COVID Community Action” website, which is not affiliated or approved by Florida’s Department of Health.
Her new dashboard went online last week and looks almost identical to the state’s official dashboard, except, according to Jones, it provides a more accurate representation of Florida’s COVID-19 crisis, including an estimate as to how many people have recovered from the novel coronavirus. The dashboard also has a higher total count of confirmed cases in the state.
Jones says she was fired last month for going public with her concerns about the Department of Health’s commitment to “accessibility and transparency.” Florida Gov. Ron DeSantis says she was fired for “insubordination.”
The unofficial dashboard uses the “CDC’s guidance on counting “recovered” cases to show by-county estimates of the number of recovered people,” according to Jones’ website. “This calculation includes all cases diagnosed more than six weeks ago where no death, hospitalization or ER admission is on file, for both residents and non-residents.”
According to Jones’ unofficial dashboard, 23,430 people are estimated to have recovered from the novel coronavirus in Florida in the last six weeks.
Miami Herald staff writer Gwen Filosa contributed to this report.
This story was originally published June 17, 2020 at 6:19 AM.
