Miami-Dade preparing to lift some COVID rules again. Is another spike a given?
Last week, Miami-Dade Mayor Carlos Gimenez was on a conference call with health experts and local government administrators about pressure the county is feeling to ease COVID restrictions as the infection rate continues to decline.
A familiar, gravelly voice on the other end of the line had a piece of advice.
“Stay the course,” Dr. Anthony Fauci said on the call, according to three participants in the weekly discussion White House health officials hold to monitor COVID progress in Miami-Dade and other hot spots across the country.
Gimenez, a Republican candidate for Congress being pushed by city mayors, business owners and leaders of his party to lift rules, asked Fauci: “Can I quote you?”
On Friday, the county mayor laid out a course that landed somewhere in the middle of an immediate end to business restrictions and extending the current rules indefinitely.
He said he planned to begin meeting with restaurant owners and casino executives next week to plan for lifting some restrictions on those businesses if COVID statistics continue to improve at testing sites and in hospital intensive care units. He also hinted at an end to a ban on spectators at Hard Rock Stadium, telling reporters to expect an announcement next week on the NFL facility.
“Believe me, I’m the first one who wants to get our economy moving again. If we start to open before conditions are right, we could... be forced to go back and close again,” he said during an online press conference. “The good news is we’re heading in the right direction.”
The Aug. 14 call with Fauci included other prominent members of the White House team on COVID, including Dr. Deborah Birx, Surgeon General Jerome Adams and Dr. Robert Redfield, director of the Centers for Disease Control and Prevention.
The regular calls began earlier this month with Gimenez, Miami Mayor Francis Suarez and their aides, and they’re described as the federal leaders asking questions about the local response and conditions.
“They’re trying to get a feel for how the other communities are dealing with COVID,” said Jennifer Moon, a deputy mayor under Gimenez. “And look at the work we’re doing.”
Moon said Fauci advised Gimenez to continue the restrictions until the infection rate gets lower. Though Gimenez hasn’t set a firm target, he said the county wants the portion of COVID tests that come back positive to be close to 5% over a two-week average. That average rate hovered above 11% in Friday’s report.
A second reopening plan
Miami-Dade last began lifting restrictions in May and June as the first COVID surge in cases from the spring began to ease.
But the relief was short-lived, and Gimenez used his emergency powers ahead of the July 4 weekend to close casinos again and impose restrictions on restaurants that included a 10 p.m. countywide curfew aimed at discouraging late-night gatherings. He also imposed a countywide mask requirement.
At the time, COVID spread was hitting levels far higher than when the crisis began in March. In July, COVID patients in hospitals hit a record 1,300 admissions.
That number would climb to a peak of more than 2,300 COVID patients in late July as Gimenez ordered more restrictions, including closing restaurant dining rooms.
COVID statistics have been improving through August, with the daily rate of positive cases in the county dipping below 10% over the last three days for the first time since June. But Miami-Dade still hasn’t gotten back to the hospital conditions present the last time Gimenez lifted business restrictions.
“Even though we are heading in the right direction... we’re still not where we were in May when we started to reopen,” said Dr. Lilian Abbo, a Gimenez adviser on coronavirus restrictions and an infectious disease specialist at the University of Miami. “We have way more cases than we had back then [and] our hospitals have way more cases than they did then... This is not over.”
At his press conference, Gimenez said the county wouldn’t consider lifting all restrictions until a COVID vaccine is in place. He described a reopening effort that would unfold over the next several weeks — a timeline that may maintain most or all of the restrictions in place through the Labor Day holiday weekend.
One option to boost businesses at restaurants without allowing indoor dining would be switching to a later curfew. That would allow restaurants to reclaim more of their dinner hour before clearing out their outside tables to comply with the 10 p.m. shutdown order.
Will the public let down its COVID guard?
Suarez, the Miami mayor, criticized Gimenez’s restaurant closures in July and supports a later curfew to help local businesses. But he said other mayors have expressed concern about risk in reversing current restrictions too, thanks to a misguided signal it may send to the public that the COVID threat has ended.
“It’s not so much the one extra hour,” he said. “It’s will this be taken as a sign that everything is good, and start to encourage unhelpful behavior?”
Gimenez is facing increased calls from restaurant owners and city mayors to end restrictions on restaurants, and have Miami-Dade’s rules mesh with Broward’s. Broward County announced Friday that restaurants could stay open until 11 p.m., and indoor dining is already allowed there.
The mayor of Miami-Dade’s most Republican city, Manny Cid of Miami Lakes, uses the hashtag #savemainstreet to object to the county’s current restaurant rules.
“Forget about take-out. Everybody is going to Broward County to eat... Large corporate-owned restaurants throughout the county can definitely survive the pandemic. But the mom-and-pop restaurants definitely can’t,” said Cid, a restaurant owner. “We need to reopen our economy immediately.”
Julio Barrero, owner of the Trigo Cafe in Hialeah, said it’s not the closing time that’s most responsible for a 75% plunge in sales. It’s the fact that Miami-Dade law bans him from using indoor tables. “Lunchtime is terrible because people don’t want to sit in the sun at noon,” he said. “Customers tell us they’re going to Broward.”
Unlike during the first reopening period, Miami-Dade police and inspectors are issuing hundreds of citations to businesses and individuals for violating mask orders and other COVID restrictions. A tally from the county clerk’s office from early August showed 1,914 citations issued, including 179 against individuals.
Harvard expert says wait longer
Reopening businesses, schools and other public spaces while Miami-Dade continues to see more than 1,000 new cases a day, would likely leave the county vulnerable to more outbreaks and the health department unable to respond effectively, one public health expert said.
Michael Mina, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health, said aggressive social distancing, face mask mandates and broad closures are the most effective tools public officials have at the moment to control COVID outbreaks.
Without a robust and rapid testing and contact tracing program in place to quickly contain outbreaks, Mina said, partial reopenings will allow the disease to continue spreading.
“We’re going to keep living and dancing around this middle ground where cases continue to burn, people continue to die and the economy continues to waffle about whether or not it’s opening,” Mina said, “and the middle ground is kind of the worst place to be.”
in July, Miami-Dade agreed to spend up to $14 million for the health department to add 250 contact tracers and investigators in the county.
Since then, the health department, which has sole authority over contact tracing in the state, has increased the number of contact tracers in Miami-Dade to 627.
But despite the addition of more contact tracers for Miami-Dade, the effort has produced limited results.
On Friday, Yesenia Villalta, administrator of the health department’s Miami-Dade office, said contact tracing shows that the three most common responses to questions about where local residents were exposed to the coronavirus remain relatively unchanged since July 30.
“It’s still the same three we’ve been seeing historically,” she said, noting that the leading answer to the question of where an infected person was exposed to the coronavirus continues to be the home, followed by unknown and then the workplace.
Even those insights are limited.
A recent report covering the health department’s contact tracing efforts in Miami-Dade over the past month shows that the number of people who have declined to participate or who could not be contacted far exceeds the number cooperating.
More than 27,000 people have declined to participate or could not be reached compared with 14,204 individuals who have participated in contact tracing efforts.
With an under-performing tracing operation, Miami-Dade can’t count on controlling a future upswing in COVID cases under looser business restrictions. Mina, the Harvard expert, said Miami-Dade would be better off waiting until a much more dramatic improvement unfolds.
Mina said communities should aim to reduce transmission of the disease to “one or two cases per hundred thousand populous” before reopening.
For Miami-Dade, that would mean no more than 27 to 54 cases a day.
On Friday, the health department reported 1,143 new confirmed cases of COVID, raising the county’s total to more than 150,000 since March.
By reducing cases to a few dozen a day in Miami-Dade, Mina said, public health officials can more effectively respond and potentially close down small sectors of a community to contain an outbreak.
Mina emphasized that Miami-Dade is not an island — and that until Florida’s statewide case count drops considerably from the current average of about 4,000 to 5,000 new cases a day, it’s unlikely that any county can safely reopen without increasing transmission.
“If Miami-Dade were to get this thing under control and then open up, there’s so many other cases happening around the state overall that very quickly those will flood into Miami-Dade and you’ll end up seeing major outbreaks again,” Mina said.
This article was updated to correct the spelling of Dr. Lilian Abbo’s name.
This story was originally published August 21, 2020 at 6:43 PM with the headline "Miami-Dade preparing to lift some COVID rules again. Is another spike a given?."