By The Washington Post · Cleve R. Wootson Jr., Isaac Stanley-Becker, Lori Rozsa, Josh Dawsey · NATIONAL, HEALTH, POLITICS, SCIENCE-ENVIRONMENT
"I never received information about what happened with my ideas or results," said Thomas Hladish, a University of Florida research scientist whose regular calls with the health department ended June 29. "But I did hear the governor say the models were wrong about everything."
DeSantis, a Republican, this month traveled to Miami to hold a roundtable with South Florida mayors, whose region had emerged as a novel coronavirus hot spot. But the Republican mayor of Hialeah was shut out, weeks after saying the governor "hasn't done much" for a city disproportionately affected by the virus.
As the virus spread out of control in Florida, decision-making became increasingly shaped by politics and divorced from scientific evidence according to interviews with 64 current and former state and administration officials, health administrators, epidemiologists, political operatives and hospital executives. The crisis in Florida, these observers say, has revealed the shortcomings of a response built on shifting metrics, influenced by a small group of advisers and tethered at every stage to the Trump administration, which has no unified plan for addressing the national health emergency but has pushed for states to reopen.
DeSantis relies primarily on the advice of his wife, Casey, a former television reporter and host, and his chief of staff, Shane Strum, a former hospital executive, according to multiple Republican political operatives, including a former member of his administration.
"It's a universe of three - Shane and Casey," said one Republican consultant close to DeSantis's team who spoke on the condition of anonymity to offer a candid assessment.
The response - which DeSantis boasted weeks ago was among the best in the nation - has quickly sunk Florida into a deadly morass. Nearly 5,800 Floridians have now died of covid-19, the disease caused by the virus - more deaths than were suffered in combat by Americans in Afghanistan and Iraq since 2001. One out of every 52 Floridians has been infected with the virus. The state's intensive care units are being pushed to the brink, with some over capacity. Florida's unemployment system is overwhelmed and its tourism industry is in shambles.
DeSantis began the year as a popular governor, well-positioned to help his close ally President Donald Trump win this crucial state in November's election. DeSantis is now suffering from sagging approval ratings. Trump has fallen behind Democrat Joe Biden in recent polls of Florida voters. And both men, after weeks of pushing for a splashy Republican convention in Jacksonville, succumbed to the reality of the public health risks Thursday when Trump called off the event.
Trump asked DeSantis in a phone call in May if he would require masks for the convention and whether the virus would be a problem, according to a person with knowledge of the conversation. DeSantis said he would not require masks and the virus would not be a major problem in August in Florida.
"You were elected to be the governor of our state and make decisions about what is best for us in Florida," Hialeah Mayor Carlos Hernández said of DeSantis. "If he was more concerned with what the president thought of him, the outcomes are here."
DeSantis's office did not respond to interview requests or to a set of detailed questions sent by The Washington Post. In response to questions, a spokesman for the health department said the governor and Rivkees, the surgeon general, "are continuing to remind all Floridians to protect the vulnerable by avoiding the Three Cs: Closed Spaces, Crowded Places and Close-Contact Settings and by wearing a mask in public."
The spokesman, Alberto Moscoso, did not explain why the department had ended its work with the university modeling team or why Rivkees appears only once this month on the governor's schedules, which have been released through July 23.
During the same period, DeSantis spoke regularly to members of the Trump administration. He appeared twice on Fox News and called in to Rush Limbaugh's radio show.
"Ron DeSantis is doing a great job and will go down in history as a great governor of Florida," the president told The Washington Post through a spokeswoman.
Those who defend the governor's approach point to his early efforts to protect nursing homes. They also dispute claims that he has been inflexible, emphasizing his decision to re-close bars and clubslast monthafter a spike in infections. The governor's allies have also commended him for securing more remdesivir, an antiviral drug used to treat the most severe coronavirus patients, which is in short supply across the country.
Rep. Matt Gaetz, R-Fla., said the governor's relationships in Washington have benefited Florida. In the spring, the state emerged on top "in terms of supplies and resources," because, in the telling of Trump, "we're really good at asking for stuff," Gaetz said.
Jared Moskowitz, a former Democratic state legislator who now heads the Florida Department of Emergency Management, said DeSantis has been "completely accessible" and "open-minded in our conversations."
He continued: "Anything that I have needed or asked for, dollars that are going to be required to respond appropriately have always been available."
The department's command center was temporarily shuttered this month after a series of infections among staff working there.
Some of Florida's woes are shared by other states, especially in the Sun Belt: Economies powered by tourism and hospitality whose leaders sought reasons to invite people back to their states; skeletal public health systems that could not adequately respond with contact tracing and other interventions; and holiday celebrations that caused residents, particularly young people, to flout guidelines.
But the crisis in Florida has been particularly acute, infectious-disease specialists say, because politics have dictated the response at crucial junctures - never more so than with the state's reopening, which was cast by the governor as a return to normal rather than as a new and even more precarious phase of the pandemic.
Trump told aides that Florida's early success gave other states a justification to reopen, according to three administration officials. Meanwhile, DeSantis quickly turned presidential rhetoric into gubernatorial orders, all while rejecting measures, including a statewide mask mandate and an extended stay-at-home order, that helped other states contain their outbreaks.
Officials involved in the local health and emergency response say DeSantis has selectively highlighted favorable metrics, such as a decline in the median age of people who are testing positive, rather than developing more serious mitigation strategies.
"I think we're on the right course," he said as cases surpassed 400,000 and he continued to push for schools to open for in-person classes in a few weeks.
Some on the front lines are drawing different conclusions.
"The numbers are up, my man," said Frank Rollason, the emergency management director in hard-hit Miami-Dade County. "They speak for themselves."
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The governor's small inner circle stands in contrast to the number of people tapped for his reopening task force in April. The group included more than 100 participants but only five doctors, who were placed on a working group alongside representatives from the elder-care industry and farming leaders.
The working group met twice for 2.5 hours, said one member, dentist Rudy Liddell, and did not develop written recommendations or provide continued input once the report of the executive committee was released at the end of the month.
The guidelines that emerged from the executive committee closely mirrored the reopening recommendations issued by the White House. There were few specific benchmarks following the first phase of a statewide reopening on May 18 - after about six weeks of sweeping restrictions - with movement into new phases premised instead on "adequate health care capacity" and the absence of a resurgence of the virus. In early June, DeSantis announced that much of the state could move into the second phase, lifting restrictions on bars and movie theaters, on the same day the state recorded 1,317 new cases, the largest surge in six weeks.
"It was outcome-determinative - they knew what they wanted to do," said Sen. Gary Farmer, the incoming Senate minority leader. "It was a joke. . . . It was, 'Here's the plan. Here's the chance to rubber stamp it.' "
As the state shifted into reopening, the Republican National Committee announced plans for its convention. The National Basketball Association opted to finish its season in Orlando. Disney World reopened July 11.
Compliance in April with the sweeping stay-at-home order brought the state's numbers down to a point that reopening looked feasible, said Cindy Prins, an epidemiologist at the University of Florida. The problem, she said, was the speed with which the state moved through the subsequent phases of its economic restart.
"There was hardly enough time for the new infections even to show up," she said.
The governor's quest to put the pandemic behind him undermined the very message - that the virus was still a deadly threat - that could have made his reopening a success, said Glenn Morris, director of the University of Florida's Emerging Pathogens Institute.
"One of the areas where we failed in Florida was in convincing people that as things began to open up, that we still had a serious situation, that the virus was still present in the community and that there remained a critical need to maintain the basic practices recommended by the [Centers for Disease Control and Prevention]," he said.
Critical mitigation strategies remain inadequate, according to lawmakers and experts, owing to years of disinvestment in the state's public health infrastructure. One estimate, by a researcher at Florida International University, found that the state had slashed public health spending 35 percent between 2009 and 2015.
The health department's 2017 budget request warned of "insufficient individuals at the local level who have the skills to perform epidemiological analyses" and manage outbreaks.
Contact tracing, which has been central to controlling outbreaks in other settings, has been highly limited in Florida. State Rep. Rene Plasencia, a Republican representing parts of Orange County and Brevard County, said not a single family member or friend sickened by the virus has been contacted by the health department.
With the virus tearing through urban centers, "we're at a point where I don't even know how you would do contact tracing anymore," Plasencia said.
The lesson of the pandemic for Florida, said Charles Lockwood, dean of the University of South Florida's College of Medicine, was, "Never declare victory until the referee blows the whistle." When the wave of cases predicted this spring did not initially crash down on the state, Tampa General Hospital and the University of South Florida used the time to order ventilators and stockpile personal protective equipment, Lockwood said.
Meanwhile, steps he suggested to health officials in his county were not acted upon, including a recommendation to use cellphone technology to track at-risk patients and encouragement to stand up a more robust system of contact tracing. In both instances, he said, local health officials indicated they were constrained because these were functions controlled in Tallahassee, the state capital. The health administrator in Hillsborough County, Douglas Holt, declined to be interviewed.
Efforts to offer advice on contact tracing at the state level were rebuffed as well, according to experts involved in the response. Hladish, the infectious-disease researcher, said he and other specialists had tried to raise the subject during one of their calls with department staff but were told contact tracing was handled by a different team.
"We were told that they were too busy to talk," he said.
Even health department staff were constrained in the nature of the advice they could offer, according to multiple state health officials stationed in counties, who spoke on the condition of anonymity because they were not authorized to discuss the ongoing response. They said conversations with stateofficials have recently included reminders that they were not authorized to advise school districts about whether to reopen, but simply to "provide them with information," as one official put it.
These officials said calls that once occurred daily with Rivkees, the surgeon general, have been scaled back to three times a week. Rivkees, a pediatrician whose specialty is not epidemiology or disease surveillance, was escorted out of a news conference in April after saying Floridians may have to practice social distancing and wear masks for up to a year, a prediction at odds with statements from DeSantis and Trump.
Some of his top staff have left the department mid-pandemic.
The administrator of the department's surveillance section left in March for a job at Pfizer. Rebekah Jones, who had been managing the department's public-facing data portal, was dismissed in May after a dispute over changes to the dashboard, which she said were designed to hide relevant information. State officials, who accused Jones of "insubordination," said the changes were aimed at increased accuracy. Scott Pritchard, who headed the department's investigations unit, left last month. He informed his team he was leaving on the day DeSantis announced plans to reopen schools at "full capacity," according to people familiar with the matter.
Pritchard, who did not respond to a request for comment, then left the state altogether.
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DeSantis has left Florida for the White House numerous times during the pandemic.
At an April briefing in the Oval Office, Trump offered to hold the governor's foam display boards as DeSantis detailed how Florida had corralled the coronavirus better than almost any other state.
"Everyone in the media was saying Florida was going to be like New York or Italy, and that has not happened," DeSantis said.
The number of confirmed coronavirus cases in Florida now eclipses New York's caseload by more than 3,300. Florida has at least 168,000 more cases than Italy, a country with about three times the state's population.
DeSantis joined Trump for a White House event on drug pricing Friday, when the state recorded 12,444 new cases of the virus and 136 deaths.
DeSantis was a little-known congressman in the first half of the Trump administration who made a name for himself with appearances on Fox News denouncing the investigation into Russian interference in the 2016 election.
He netted the president's endorsement in the 2018 Republican gubernatorial primary, riding it all the way to the governor's office.
"What's the old phrase - dance with the one who brought you," said Gary Farmer, the incoming Florida Senate minority leader. "That's what he's doing. His political fortune in becoming governor was not just closely tied, but almost exclusively tied, to the Donald Trump train."
Trump feels bonhomie with DeSantis, likes having him in the Oval Office and regularly speaks with him on the phone, even though many around the president do not trust the governor, people familiar with the matter say. DeSantis also regularly consults with Brad Parscale, the president's recently deposed campaign manager.
Florida's intimal ability to skirt the worst effects of the virus was a boon for DeSantis and for Trump: The governor's aggressive efforts to jump-start his economy were right out of Trump's playbook, perceived at the time as a benefit in the battleground state. Administration officials regularly sent reports and others clips of DeSantis bragging about Florida not having cases early in the outbreak, to argue that many states were overreacting, and at times, that seasonal heat could cure the virus.
Now, with the virus spreading uncontrolled in Florida, former health officials think DeSantis has joined the president in seeking to manage expectations about its consequences rather than formulate a plan to bring it under control.
"They keep hoping it's going to go away by itself," said Richard Hopkins, an epidemiologist who spent 19 years at the Florida Department of Health. "I don't know what's going on - whether they're afraid that they will get primaried by someone to their right if they take appropriate public health action."
Approval of DeSantis's handling of the pandemic has fallen by double digits since April, when 50 percent of registered voters in Florida backed the governor's approach. Now, 38 percent of residents approve of his response, while 57 percent disapprove, according to a Quinnipiac University poll released Thursday.
The return this summer to crisis conditions has felt like whiplash for front-line workers.
In June, employees at the six-hospital Memorial health care System based in Hollywood, Fla., thought they had dodged a wave of coronavirus patients that threatened to overwhelm their hospitals.
Exhaling workers began to dismantle surge areas from auditoriums and classrooms that had been converted into treatment areas. But it was premature. By the end of the month, covid-related hospitalizations had begun to soar, said the system's chief medical officer, Stanley Marks.
"We converted them back," Marks said. "By early July we again were in full emergency mode."
Darlene Dempsey, a nurse at the good Samaritan Medical Center in West Palm Beach and a lifelong Republican, said she could no longer support Trump or DeSantis, both of whom had chosen to "gaslight nurses" instead of using the time in March and April to ramp up production of medical equipment and develop a testing plan.
"The fairy tales about all being under control are nonsense," she said. "Our government has failed us."