The changing face of coronavirus in Florida: Younger victims, and what that means

The age of typical coronavirus victims has plummeted in Florida, shifting away from the elderly, in a change with significant implications for the disease’s future.

The median age for coronavirus victims went from 65 at the beginning of March to 36 this week, according to the Florida Department of Health.

The decline reflects both increased testing and the disease’s broader spread through the state’s population, as lockdowns fade and businesses reopen, according to epidemiologists. While younger, healthier coronavirus patients will make fewer demands on Florida’s hospitals, experts say they will tend to spread the disease more widely, as they eat out, return to work and behave less carefully than older people fearful of a disease that has taken a severe toll among the elderly.

“I think our older populations are taking more precautions, protecting themselves a little bit more,” said Cindy Prins, associate professor of epidemiology at the University of Florida. “And I think that our younger populations have moved back into the community as these stay-at-home orders have been lifted. They’re more likely to be going out, socializing and getting exposed to the virus. We’re seeing the younger population getting exposed and less of the older folks getting exposed.”

Evidence of the younger age set has shown up at Florida hospitals, which have been able to treat coronavirus patients more effectively and treat more of them as outpatients.

At Holy Cross Hospital in Fort Lauderdale in the early days of the epidemic, elderly nursing home patients came in for coronavirus treatment and typically died, since there was “not much we could do,” said Dr. Margaret Groensek, an infectious disease specialist at the hospital.

“Now it’s the younger infected and we can do more, especially if they don’t have severity of underlying conditions,” she said. “Because younger people arrive at the ER and are not critically ill, the hospital is able to send them home. They are admitted if they are having trouble breathing. Otherwise they are sent home to follow up with primary [physicians] or our physicians that follow positive cases.”

In statements over the past few days, Gov. Ron DeSantis has highlighted the age decline, saying it indicates that a larger percentage of coronavirus victims will recover without significant harm to their health.

“A trend that’s very important is what is the median age of those people who are testing positive,” he said Friday at a news conference in Miami. “We know now, having dealt with coronavirus for all these months, mortality and morbidity is very closely linked to age. Those under 40, in particular, who don’t have any underlying conditions are much, much less likely to be hospitalized or to suffer a fatality.”

The governor gave the latest median age figures for South Florida, with Broward County at 33, Miami-Dade at 41 and Palm Beach at 40.

Although Florida is racking up record daily counts for new cases, the daily number of deaths has declined and the age of the people dying has been going up.

The state reported 43 new deaths Friday, down from a late April peak of 83. Scientists warn that deaths are what’s called a lagging indicator, tending to reflect the number of patients who got sick weeks earlier, so it’s unknown what impact the record numbers of new infections reported in the past week will have on future death tolls.

But one reason for the reduced death toll is that physicians have gotten better at treating the disease, said Dr. Aileen Marty, an infectious disease expert at Florida International University’s Herbert Wertheim College of Medicine, who has been advising Miami-Dade County on coronavirus.

“All of us now have several months’ experience managing COVID patients,” she said. “We’ve learned all kinds of tricks. The times of the meds we’re using has shifted, which meds we use at different times has shifted. The timing and use of ventilators has shifted. All of that has improved patient outcomes.”

And hospitals report that incoming coronavirus patients tend to be younger and healthier, requiring shorter stays or only outpatient care.

“The severity of what we are getting has declined,” said Gino Santorio, chief executive officer of Broward Health, the four-hospital system that serves most of Broward County. “The average length of stay is six days versus 10. Initially, Broward Health had the really sick COVID patients, those from nursing homes and cruise ships. Now, that has changed, as the demographics have shifted.”

“The number that need to be admitted, the percentage with symptoms, has declined,” he said. “The number we admit that need to be in ICU and ventilated is declining. We are able to get them out of the hospital in a shorter time period than a few months ago.”

At Wellington Regional Hospital, the number of new patients remains steady, but fewer require hospitalization, said spokesman Allen Poston.

“We continue to have a decent number of COVID-19 patients coming to the ER to be checked,” he said. “For the most part, they are younger. Some are being admitted, but a vast majority are being discharged to self-care at home.”

At first, with insufficient test kits in stock, only those with symptoms could be tested, a limitation that naturally skewed the results toward the elderly, who were more likely to get sick. But now testing is more widely available, with many younger people getting swabbed as a condition of returning to work.

But experts say the decrease in age of the typical infected person is not simply a function of more widespread testing. They say it reflects the disease’s attack on a wider group of people, as elderly people stay home and younger people head back into restaurants, offices and gyms. Although nursing home outbreaks have been particularly deadly, they have by nature been largely confined within the walls of their institutions. As younger people contract their illness, they will spread it more easily and more widely.

In other diseases, the tendency of younger, healthier people to get sick could be portrayed as a possible development, since they could develop immunity at a time of life when they could best withstand the illness. But since it appears that COVID-19 infections may not confer immunity, there may be little advantage to defeating the disease as a young person, said Dr. Marty, of Florida International University.

“If these younger people, who are less likely to get sick mounted a successful immune response, then [the virus] shifting to a younger age group would be good, because by the time they got older, everything would be better because they’d be more resistant to it,” she said. “Unfortunately, with this disease, we don’t mount a long-lasting immune response. We never have mounted a very good immune response in any of the other six coronaviruses.”

And despite their higher odds of survival, young people still can suffer damage to their health or die from the disease.

“They can still get very sick, they can still get hospitalized, and they can still spread it to other people,” said Prins, of the University of Florida. “As you see it spreading in the younger age group, they are still spreading it to older people in their lives.”

David Fleshler can be reached at [email protected] or 954-356-4535

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