Public health experts say Florida heading in wrong direction on COVID testing for omicron
Gov. Ron DeSantis and Surgeon General Joseph Ladapo — who have both questioned the efficacy of masks and vaccines — have responded to Florida’s record-breaking omicron surge by recommending limits on testing.
Cutting back on testing at a time when Florida cases are spiking and setting new records every week flies in the face of expert opinion and could have dire consequences, including increased hospitalizations and deaths, public health experts said.
“These policies could be a recipe for disaster in Florida and nearby areas,” said Julie Swann, head of systems engineering at North Carolina State University. “If my grandparents were still living, I would make sure they left Florida for the winter, to head somewhere safer.”
Her work focuses on public health policy, epidemiology, supply chain management and disaster response, and she’s been leading a team assembled by the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists to develop forecasts and decision models to support state decision-making during the COVID pandemic.
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“Less testing means hospitalizations will increase. Full hospitals means more deaths,” Swann told the USA TODAY Network - Florida. “Just because a disease isn't reported or identified doesn't mean it isn't there, lurking and spreading.”
Florida already has one of the highest infection rates of any U.S. state, with 256 of every 100,000 residents infected daily, and a positive test rate of 39%, according to the latest data available from the CDC. The state has seen a 566% increase in new cases in the past two weeks.
Hospitalizations have increased dramatically in the past week, too, from 3,948 to 7,071. At its summer peak, when Florida led the nation in daily infections and hospitalizations, about 15,000 hospital beds were filled with COVID patients.
Test sites around the state have been crushed with people waiting in line for hours to get tested, which has led to criticism that pharmacy companies and the federal government are not producing and distributing tests quickly enough.
After more than two weeks of silence while Florida caseloads hit new record highs and hospitalizations doubled, DeSantis and Ladapo this week announced they would be rolling out a policy to limit who gets tested for COVID-19.
“If you don’t have symptoms, you’re not a case,” Ladapo said, recommending tests only for those who have symptoms and are at high risk of getting infected – the elderly and people with underlying health problems.
Testing should focus on “populations for whom testing is more likely to change outcomes,” Ladapo said Tuesday. Risk factors and benefits will be the driver determining whether or not a test is "actually likely to make a difference."
DeSantis reiterated Wednesday that the state should move to “high-value testing” only, a term usually reserved for determining who should receive expensive diagnostic testing, not cheap and quick epidemiological testing.
Undermining severity of Florida COVID case surge
Their announcement drew immediate outrage from public health experts, including Ashish Jha of Brown University, who said Florida should be doing the exact opposite of what DeSantis and Ladapo are recommending.
Reduced testing will only serve to “underestimate the severity of the present surge and give Floridians a false sense of security,” said Dr. Frederick Southwick, former head of infectious diseases at the University of Florida. “Stopping testing is a way to game the system and hide the severe consequences of the Governor’s and Legislature’s laws prohibiting the mandating of masks and vaccines.”
He was also critical of the governor’s decision not to require masks and not to push vaccinations.
“Masks, avoiding public spaces and, most important, vaccination are the way to reduce fear and reduce cases,” Southwick said.
Testing and omicron
Testing is important, Southwick said, especially among the asymptomatic.
“Because omicron can often cause minimal symptoms in early infection it is important to identify potential carriers to prevent person-to-person spread and also to institute early treatment with monoclonal antibody infusion if available,” said Southwick.
Southwick also said testing will be important to identify people at higher risk of complications so they can receive the Pfizer anti-viral pill, which recently was granted emergency use authorization by the Food and Drug Administration.
“Without testing these individuals will never be identified," he said.
For omicron, Swann said, one of the most important factors in outcomes is how full the hospitals will be.
“When hospitals are full, more people die, even for non-COVID causes,” Swann said. “People with a mild case or who are pre-symptomatic can spread the disease to others, while testing can reduce that.”
"Sending someone into the community with undiagnosed COVID is a little like letting them drive drunk," Swann said. "They may or may not die if they cause a car crash, but the other party may."
U.S. pediatric hospitalizations in particular have seen a record high, too.
“Sending children to schools without masks and without testing will make hospitalizations even higher,” she said.
Limited testing and a lack of planning
On the other hand, Swann said, if limited testing is a problem, then it makes sense to prioritize testing for people who are symptomatic and can benefit from early treatment, while still expanding testing for everyone.
“It makes sense because monoclonal antibody treatments have to be given in the first three days of diagnosis,” Swann said.
Florida decided to shut down state-run testing sites months ago, long before the delta variant surge, leaving testing to the local county departments, CVS, Walgreens and other private pharmacies. Fewer sites are available with fewer people running them.
Swann ascribed the long lines and delays in testing to a lack of planning at every level, from a lack of staffing and funding for local governments to run the test sites to companies not anticipating the demand around the holidays for testing.
"At the end of the day it's expensive and they are not sure that demand is going to come in," Swann said. "One of the great failures of our health system is we didn't plan for testing."
Jeffrey Schweers is a capital bureau reporter for USA TODAY NETWORK-Florida. Contact Schweers at firstname.lastname@example.org and follow him on Twitter @jeffschweers.
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