Has Gov. DeSantis been too cautious in moves to deal with coronavirus? Some experts say yes.

Mar. 21--TALLAHASSEE -- There is no handbook for governing in the time of the coronavirus, but as the number of positive cases of COVID-19 has grown five-fold in Florida in the last week, Gov. Ron DeSantis has proven to be more cautious than governors in similarly situated states, including some with even fewer fatalities.

DeSantis has followed a pattern of first allowing local mayors and city officials to make the tough calls about closing beaches, bars and businesses to contain the spread of the virus, before taking more dramatic action.

But as the delay in testing for the virus has been slow for state officials to track its real-time spread, DeSantis has also avoided imposing more restrictions that get ahead of the Trump administration's directives, and the guidelines advanced by the Centers for Disease Control and Prevention.

On Friday, DeSantis issued the most widespread mandatory statewide restrictions on businesses to date -- closing gyms, fitness centers, and limiting restaurants to in-person dining but allowing them to remain open for deliveries. By Saturday morning there were 658 positive cases in Florida and there have been 12 deaths.

But in other states, governors were acting more aggressively.

Late Thursday night, California Gov. Gavin Newsom, whose state has 1,006 cases among its 40 million residents, ordered people to stay home except when visiting gas stations, pharmacies, grocery stores, farmers markets, food banks, convenience stores, takeout and delivery restaurants, banks and laundromats. People are allowed to leave their homes to care for a relative or a friend or seek healthcare services, and the measure exempts workers in 16 federal critical infrastructure sectors, including food and agriculture, healthcare, transportation, energy, financial services, emergency response and others.

In quick succession, three states followed California's lead and imposed mandatory statewide restrictions on the public. In New York, which has more than 8,500 positive cases among 19 million people, Gov. Andrew M. Cuomo ordered nonessential businesses to keep all of their workers home.

Connecticut Gov. Ned Lamont followed swiftly with a similar order. New Jersey Gov. Philip D. Murphy and Illinois Gov. J.B. Pritzker said they will also order nonessential businesses to shut starting Saturday.

Florida Agriculture Commissioner Nikki Fried wants the state to follow suit.

On Friday, she became the first statewide official to call for a "stay-at-home" order, closing all non-essential businesses for a reasonable time, after which time the situation could be reassessed.

In a late-night letter to the governor, she said she recognized the difficult choices he has had to make and "shutting down one of the nation's largest states is a decision that will have an economic impact -- but it is a decision that will save lives."

But DeSantis has resisted calls for more restrictive containment strategies outside of South Florida.

In Miami-Dade, Mayor Carlos Gimenez announced Wednesday the county would closes all retail shops, salons, malls, private colleges and other businesses deemed "non-essential" shift, escalating from a targeted effort to reduce gatherings with limited exceptions. Late Wednesday, Miami Beach Mayor Dan Gelber said the county would also close all its beaches.

In a letter to Miami residents on Thursday, Miami Mayor Francis Suarez -- who has tested positive and is in self-isolation -- wrote urging people to "shelter in place to the extent possible and to avoid any and all unnecessary interactions with others."

"Scientific evidence shows that at this stage of the emergency, it is absolutely essential to slow virus transmission as much as possible to protect our most vulnerable residents -- particularly the elderly and those with preexisting conditions -- and to prevent our health care system from being overwhelmed," he wrote.

Meanwhile, as spring break crowds gathered from the Keys to the Panhandle, people continued to fill the beaches as DeSantis kept them open.

On Friday, the governor selected only Broward and Palm Beach counties to close the beaches and bars, restaurants, movie theatres, concert houses, auditoriums, playhouses, bowling alleys, arcades, gymnasiums and fitness studios. The governor's executive order noted the directive was "in accordance with the President's "15 Days to Slow the Spread", initiated on March 16, 2020."

Fried said her position is based on data that shows that Florida is "a week behind California's vast increase in COVID-19 cases" and "as the nation's third largest state, we need to go further, and we cannot afford to lose another week."

DeSantis defended his approach on Friday, suggesting he didn't want to impose limitations on people going outdoors until it was essential.

"There's a limited duration that the society is going to be able to do it," he told reporters. "I mean, that's just the reality, how long? Maybe people could disagree."

He said he has told people to "practice the social distancing, but you don't have to necessarily just shut-in 24 hours a day."

"That's a more sustainable model," he said. "And the more people are shut in, I think the more anxious they get."

He pointed to the lifestyles of the central Florida retirement communities of The Villages where he said the golf courses are full of players.

They wipe down the golf carts, and only one person sits in the carts at a time, "they don't shake hands with who they're playing with. They don't touch the flagstick. So they practice social distancing and every aspect of that, but are at least able to get out, you know, have fun," he said.

In addition to relying on the CDC guidelines and the patterns seen from the positive COVID-19 test results, the governor has been looking at hospital infection rates, his advisors say.

But epidemiologists say it takes 2 to 4 weeks for an infection to require hospitalization, and some public health experts warn that DeSantis may be waiting too long to take more comprehensive measures.

Mark Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, said during a phone call with reporters Friday that while tests show that more than half of Florida's COVID-19 cases are in South Florida, evidence is mounting that there is widespread transmission throughout the state and "more stringent measures are needed."

He mentioned hospital data across the state that shows a spike in emergency room visits for people with cough and fever, and data from a smart thermometer company that echoes those findings.

"High levels of syndromic disease at this point, of fever and cough, which in most states are monitored by emergency departments and other systems, should be indicative that something is very strange," he said, "and the fever data from the company add to that concept."

"It's a fairly safe assumption -- although not certain -- that a significant proportion of that disease is COVID-19, so I think treating it as if that were the case would be very wise," Lipsitch said.

He added that one of the lessons public health experts learned from the coronavirus crises in Italy and China is that the infections today will take two to four weeks before leading to a spike in demand for hospital critical care and ICU beds.

"There is a long day delay, between 3 or 4 weeks, between implementing control measures and seeing a downturn in need for ICUs," he said.

Absent more data in Florida, he said there are clinical approaches to gathering more data to verify "whether there is an unusual level of fever and cough and what proportion of it has to do with COVID-19."

For example, he said, the state's public health department could "do surveillance with tens of hundreds of tests among mild cases of respiratory infection in order to ascertain the trajectory of the epidemic."

Short of that, he warned, it is "bad health policy to wait to see if you have a strain on the health system" because that means the epidemic has reached the point of "exponential growth."

Within the governor's own party, leaders are divided over how far to impose statewide restrictions.

On Saturday, House Speaker Jose Oliva, Miami Republican who has repeatedly suggested people are overreacting, tweeted a Medium article about hysteria: "At what point is the cure worse than the virus? We are all deeply concerned but should we all be deathly afraid?

Meanwhile, Jacksonville Mayor Lenny Curry, the former chairman of the Florida Republican Party, tweeted on Friday: "The data is clear. Social distancing is the answer. And it's not casual distancing. We must isolate ourselves to our families to the extent we can."

DeSantis told reporters he wishes Florida had more data on which to base his decisions.

"The more you test, the less restrictive some of these things are going to need to be on society," he said. "South Korea never did a lockdown because they did over 200,000 tests.

"They understood where the virus had gone and they were able to contain it amongst a pretty big, large group of people," he said. "We have not had the data to do that."

Miami Herald reporter Ben Conarck contributed to this report.

Mary Ellen Klas can be reached at [email protected] and @MaryEllenKlas

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