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Florida is a poor model for the next pandemic response

John Hood’s recent column comparing the Covid response in North Carolina with that in Florida lacks important context and draws conclusions that will likely make a future pandemic more deadly.

First the context: When Covid arrived in the U.S. in mid-January 2020 there was much we didn’t understand about this novel virus. We didn’t know that it would sicken 5-10 percent of people to the point of needing hospitalization, didn’t realize that it was spread by airborne particles that could hang in the air for up to an hour, or that people could spread the virus several days before they developed symptoms. Unfortunately, by the time all this was understood in mid-March, one case had exploded to over 330,000 confirmed cases and hospitals in locations first affected were overwhelmed. Moreover, those who were sick demonstrated confusing organ failures as immune systems unfamiliar with this new virus went haywire. Models predicting over 3 million deaths and 20 million hospitalizations in the U.S. called for strong measures to stem the spread of the infection until vaccines and therapeutics could be developed.

Public health officials initially imposed travel restrictions, conducted case identification, quarantine, and contact tracing as the first steps to contain the contagion. But these efforts were quickly overwhelmed. Shortages of test kits, personal protective equipment, mechanical ventilators, hospital beds, and even space in morgues and funeral homes showed us quickly how ill-prepared the country was to respond to an event like this. In Henderson County local heroes in the Health Department, hospitals, clinics, nursing homes and first responders struggled to stay ahead of the flood of patients.

The initial lockdowns were implemented to keep events from reaching worst-case scenarios. The federal government provided income support to workers and businesses shuttered by the pandemic. As the first therapeutics came online and testing kits became readily available, we began to see the first signs of slowing the infection and death rates. The miracle of Operation Warp Speed produced several highly effective vaccines, tested and scaled to unprecedented levels, followed closely behind by mass vaccinations of the most vulnerable. By March of 2021 schools had reopened to in-person instruction in North Carolina, and most businesses were allowed to reopen with social distancing, masking and vaccination requirements as needed.

As Mr. Hood correctly points out, North Carolina and Florida economies have both largely returned to pre-pandemic robustness. It is also true that 80 percent of the deaths were in people aged 65 and older, and Florida had more deaths per capita because they have more elderly citizens. But those over 65 whose lives were cut short by Covid take little comfort that the age-adjusted death rates in Florida and North Carolina were similar. A life cut short is still a life lost. Older Americans could not isolate and let the rest of the country get on with life and with getting Covid as some argued, as they also need to shop for essentials, go to doctor appointments, or have caregivers. Social isolation is just as damaging to older people as it is to children.

How North Carolina officials handled the pandemic was in stark contrast to the Florida response. Gov. Cooper and Dr. Mandy Moore, a public health expert who now leads the CDC, conducted weekly open public briefings on the official response, presenting the scientific data on which those decisions where made, and as the pandemic abated allowed local municipalities to make informed decisions about how and when to reopen. Once vaccines where widely available community leaders/medical professionals were given the latest data to counteract what became a flood of misinformation about the safety of vaccines and the risk/ineffectiveness of unproven therapies. Schools reopened in March 2021 when the majority of teachers could be protected as the mortality of unvaccinated people under 65 was still an astonishing 20 percent of total deaths.

Florida reopened its schools in September 2020 before any protections for teachers were available, and since then has passed a number of state laws prohibiting most of the common-sense proven public health measures that will be needed in future pandemics. In the midst of the pandemic, the Florida governor appointed Joseph Ladapo, a cardiovascular physician with no prior public health experience, to lead Florida’s public health department. Dr. Ladapo quickly drew widespread condemnation among infectious disease specialists for overstating risks of vaccines and promoting unproven therapies that the FDA had removed from emergency authorization citing strong evidence to their ineffectiveness. Sadly, although the virus cannot distinguish between a Republican or Democrat, party-affiliation became a risk factor for Covid deaths. A study published in JAMA this month found that “in this cohort study evaluating 538,159 deaths in individuals aged 25 years and older in Florida and Ohio between March 2020 and December 2021, excess mortality was significantly higher for Republican voters than Democratic voters after Covid-19 vaccines were available to all adults, but not before. These differences were concentrated in counties with lower vaccination rates.”

There is almost certain to be another pandemic in the future. In a free society like ours there is a deeply held view by most on both the left and right that individuals should have the right to make their own decisions. But our social contract puts restrictions on those rights if those decisions cause harm to others. For example, you can drink excessive alcohol if you want, but you can’t get behind the wheel and endanger others. You can own and carry a gun, but you can’t randomly shoot that gun on Main Street. And if you can spread a deadly virus that can kill others, even if it’s mostly people over 65, shouldn’t we allow some collective action to keep others safe?

If we take Florida’s example, there will be a lot more deaths the next time we experience a public health emergency. Let’s all try to keep North Carolina a model of local collaborative, cooperative and evidence-based public health.

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Steven Crane, who earned his M.D. degree at Case Western Reserve University in Cleveland, holds a master’s degree in health economics from Stanford. He is a professor of medicine at UNC at Chapel Hill and a member of the North Carolina Institute of Medicine. He has practiced family medicine in Henderson County since 1989.