Ron DeSantis doesn’t want a statewide stay-home order in Florida. Health experts say he should

Many of the states with more than 1,000 coronavirus cases have told their residents to stay at home to limit the spread.

Not Florida. Gov. Ron DeSantis is against it.

DeSantis prefers a "surgical" approach, with measures tailored for the hardest-hit counties that spare ones with few or zero cases from the economic hardship of a mandatory shelter-in-place.

"Some people think that the governor should just be a dictator and just order everyone in prison in their homes," he said March 24. "And I don’t think that would be an effective approach, but it’s certainly not warranted in certain parts of the state. So everyone’s doing their part and I think that’s going to be the better approach."

The Republican governor’s decision stands apart from those made by governors in New York, California and Louisiana, and so Democrats at all levels have taken notice. The criticism comes from local leaders, like St. Petersburg Mayor Rick Kriseman, state Agriculture Commissioner Nikki Fried,  several members of Florida’s congressional delegation, and presidential candidate Joe Biden.

"While other large states continue to take strong, urgent, and sweeping action to stop the spread of COVID-19, Florida has not," Biden said. "I urge Gov. DeSantis to let the experts speak to the public and explain why this is the case."

The pressure isn’t just political, however. It’s also coming from health care workers and public health experts.

They point to scientific models that show less action leads to more infections and death, and they warn that the situation in Florida’s rural regions may not be what it appears.

Florida had the seventh-highest number of cases in the country as of March 27, and we haven’t seen signs of a turnaround. So we wanted to lay out DeSantis’ arguments against a shelter-in-place order statewide and talk to health experts about potential consequences for a full picture of the current situation.

DeSantis’ philosophy is to not interfere in areas with "sporadic cases," and to focus more tightly on areas of concern.

Twenty-one of Florida’s 67 counties had zero positive COVID-19 tests as of March 27, mainly in the northern region of the state. About half of Florida’s cases are in Broward, Miami-Dade and Palm Beach counties.

In that part of the state, DeSantis has taken more action. For example, he issued more stringent orders for Broward and Palm Beach counties, closing beaches and limiting restaurants to delivery or take-out. The order aimed to put the counties in line with an order already set by Miami-Dade County. 

Several larger counties enacted their own stay-at-home policies, including Pinellas, Hillsborough and Broward, and DeSantis has emphasized his willingness to "work with any of the local communities."

Business leaders are supporting DeSantis' approach at a time when claims for unemployment in the state have already shattered records without a statewide order.

DeSantis and President Donald Trump appear to be on the same page, too. Trump has called for classifying counties as low, medium or high risk across the country so the government can better focus its response, allowing places with low or no cases to resume normal activities.

DeSantis has also pointed to comments by Dr. Anthony Fauci, a key adviser to the White House on COVID-19. In a TV interview, Fauci said that a stay-at-home order isn’t needed for every single region in the nation. Fauci was not asked about Florida specifically.

The calls for a statewide stay-at-home order have been mounting. More than 900 Florida health care workers signed a letter to DeSantis on March 27 urging him to issue an immediate statewide shelter-in-place order.

"Strict limitation of social contact is the only hope of limiting peak incidence and overall mortality rates, as can be seen empirically from other countries," the letter says. 

Stay-at-home orders across the country vary in scope and enforcement. In general, residents can still go to the grocery store and pharmacy and can also exercise outdoors. And people with jobs deemed "essential" (here’s California’s, for example) can still go to work.

While DeSantis has issued orders that limit group gatherings, experts raised several concerns about a lack of uniform rules statewide.

Rural county test results may not reflect reality. The fact that there are few, or even zero, reported cases in some counties doesn’t mean there are few or zero cases. It means that is what test results show, so far.

By the time someone is so sick that they get a test and it shows positive, that person could have spread the virus to multiple people over a couple of weeks.

"It's very likely that the virus is circulating in parts of the state that haven't reported cases yet," said Cindy Prins, an epidemiology professor at the University of Florida. "If stay-at-home orders in Florida differ from city to city or county to county, then it's like plugging one leak in a pipe while letting other leaks remain. The end result is that you still have leaks and are still risking a flood."

The situation is rapidly evolving. Natalie Dean, a University of Florida biostatistics professor said she would recommend a statewide stay-at-home order because the full picture in Florida is not really known. Like the country, the state was slow to start testing, which remains limited.

"It’s better to overreact early and ease up than to underreact and try to catch up," she said.

It’s still easy for people to leave their counties. A stay-at-home order in one community can  prompt people to leave for another community. 

"If we do piecemeal, we risk infecting other communities that are not infected, because it will tell people, ‘Well in my county I can't do this, but I can do it in the next county,’ Tracy Zontek, associate professor of public health at the University of Tampa who called for a statewide approach, told WUSF. "So the piecemeal approach is really going to increase our number of cases because we won't have controlled anything."

The health care system could be overwhelmed. A key reason why medical experts have urged people to stay at home is that they fear running out of hospital beds and medical equipment including ventilators and supplies.

Some people cite the Covid Act Now model, created by health officials and data scientists to anticipate the points of hospital overload and deaths as a result of a specific state policy over three months. It has limitations, as it is based on early estimates and does not account for strict local measures. (The model is "designed to drive fast action, not predict the future," the methodology states.)

That model offers a bleak outlook for Florida with a largely voluntary approach of social distancing. To prevent hospital overload, it says a statewide shelter-in-place model should be implemented by April 17-22.

And in Florida, that action should include a unified and strict stay-at-home policy, said Nirav Shah, a Stanford medical professor and former commissioner of the New York State Department of Health who helped develop the model.