In the past two weeks, COVID-19 case numbers in Florida have skyrocketed. While most days in early to mid-June saw between 2,000 to 4,000 new cases, those numbers shot up to the 8,000 range in late June, spurring Gov. Ron DeSantis to shut down bars. In the past 10 days, the state’s cases have continued to trend upward, with several days of case counts above 10,000.
DeSantis has continually played down Florida’s high numbers, focusing on data showing that many 20- to 30-year-olds account for new cases. “For the people that are testing positive at the highest rates in Florida, those 20-year-olds and the 30-year-olds, by and large, they’re presenting very mild or asymptomatically and that’s obviously a good thing,” DeSantis said at a public appearance in the retirement community the Villages this week, according to Click Orlando. In another public address on Monday, he said the state is working on increasing personnel and resources at hospitals. To give further context, he mentioned that 40 percent of patients visiting Jackson Health System in Miami-Dade County for non-COVID reasons are testing positive (a stat that Sen. Marco Rubio of Florida tweeted about Friday). DeSantis also said that while asymptomatic people, who are often young, “don’t need to be hospitalized for COVID,” the ensuing protocol requires patients to be isolated and “requires a lot of care and a lot of manpower.” (I reached out to Jackson Health to ask about the stats DeSantis gave as well as its procedures for treating and isolating patients, and will update this piece with its response.)
The next day, Fox News’ Steve Doocy spoke about DeSantis’ statement but with considerable editorializing. Doocy claimed that the governor called hospitalization numbers “deceptive”—DeSantis never used this word, and nothing in his talk implied this—and Doocy went on to explain that as asymptomatic patients test positive, “they gotta keep ’em in the hospital … so that’s why the numbers are going up.” This is a spin on what DeSantis mentioned about COVID-19 patients requiring “procedures” and “manpower”; Doocy seems to have taken those details and reached the conclusion that patients are being forced to stay in the hospital as a result of their COVID-19 positive status, which inflates the state’s hospitalization numbers. (In any case, it’s unclear how much hospitalization numbers are going up, because Florida has still not released reports on COVID-19 hospitalizations, despite DeSantis’ promise last week that the state would begin reporting those numbers.)
If Doocy’s claims are true, this would require a few protocols to be in place at hospitals. First, for non-COVID-19 patients to be declared virus-positive, they’d need to be tested upon entry, and two, to “juice” hospitalization numbers, patients would need to be admitted to the hospital and classified as COVID-19 patients, seemingly against their will. I dug into both these claims by contacting infection preventionists, doctors, and nurses across the U.S. to ask about their hospitals’ standard procedures.
No Florida health care professionals responded to my requests for comment, but I asked several health workers elsewhere in the U.S. to get a sense for testing protocols and how a positive test might affect patients’ treatment. Are hospitals administering COVID-19 tests to people who come in for non-COVID-19 reasons? And if so, is it possible that they’re being forced to stay as a “COVID-19 patient”? Though none of the health care professionals I spoke with were authorized to speak on the record, what I learned was there’s some variation in standards at different hospitals. But for the most part, patients coming in for non-COVID reasons are tested in advance; for instance, patients with non-urgent planned procedures are tested if they expect to be admitted in advance, and if they do test positive, their procedures are typically postponed. If patients coming in for non-COVID reasons come in for an emergency, they’re typically only tested if they show symptoms of COVID-19. For instance, someone who’s been in a car crash and requires emergency surgery would likely be admitted and, therefore, would need to be tested so that health care workers know whether to send them to designated COVID and non-COVID spaces. Patients coming in for emergency outpatient procedures, like a scan of a broken bone, would not be kept overnight and would probably not get tested unless, in the course of receiving care, a physician observes COVID symptoms; for instance, if your lungs look suspect in a chest scan, a doctor might order a COVID-19 test.
But unless those outpatients are somehow sick enough to suddenly require hospitalization, they do not count in hospitalization numbers unless they are actually admitted. Even then, some hospitals may not count them among “COVID patients” unless that’s their primary reason for being admitted. And at hospitals that only report the number of overall COVID-19-positive patients, you’d need a lot of people requiring emergency hospital admission testing positive to inflate the number of hospitalizations. For instance, if everyone who got into a car crash or accidentally cut off a finger happened to test positive for COVID-19, that could still be concerning because it would show significant community spread of the virus.
Perhaps most importantly, health care professionals cannot force patients into treatment. “We do not tackle people at the door and drag them into the hospital,” an ER physician in a major city told me with a laugh. “If there’s no reason to be admitted to the hospital, we absolutely do not admit them. There are plenty of people we see who test positive, who had mild-enough symptoms to not require hospitalization.” An ER nurse in a hard-hit area said their staff has pleaded with some patients to stay, but they refuse out of concerns about cost or think they can receive adequate care at home—and in some cases, even patients who want to stay are turned away because the hospital’s resources are limited: “Every day, we discharge people who are COVID-positive, much to their anxiety and sometimes against their will, because they don’t meet admission criteria.” The ER physician says his colleagues in New York have been trying to keep people out of the hospital as much as possible, sometimes even sending patients home with tanks of oxygen. Given that dozens of Florida hospitals’ ICU beds are at capacity, it seems highly unlikely that any hospital would be forcing asymptomatic patients to stay in the hospital—and if patients were coming in for something minor, it’s even unlikely that they’d have detected the virus in asymptomatic patients at all.
These incorrect claims about inflated hospitalization numbers are similar to other conspiracy theories about hospitals profiteering from COVID-19. For instance, one website claimed that hospitals were “getting paid more to label cause of death as Coronavirus.” When Scientific American dug into this claim, it discovered that doctors typically don’t determine cause of death; coroners do, and they don’t have any incentive to mark an incorrect cause of death. Another popular post claimed that hospitals were getting paid more to treat COVID-19 patients, implying that there was a financial incentive for hospitals to inflate COVID-19 cases. While it is true that the Coronavirus Aid, Relief, and Economic Security Act pays hospitals an extra 20 percent on top of its usual Medicare rates for COVID-19 patients, that doesn’t necessarily offset hospitals’ additional costs for supplies and “the construction of temporary facilities,” according to an analysis from the Kaiser Family Foundation. “They definitely pay us more for these patients but we still lose money for every [Medicare] patient that we provide this care,” Julie Lonborg, senior vice president of the Colorado Hospital Association, told the Denver Post in the newspaper’s investigation of this same claim back in May.
I mentioned these profiteering claims to the ER physician I spoke with, who thought they were funny. His hospital has scaled back pay, hiring, and professional development, among other things; budgets have been slashed across the board. Health care workers risk their lives working in hospitals every day, and yet many still can’t access proper PPE. It’s laughable to accuse the overworked professionals on the front lines of the pandemic of making money off a virus they’ve seen kill so many patients and health care workers.
The facts of the pandemic have not changed; in fact, they have only gotten worse in recent days. But pundits and politicians are digging deep to find ways to explain away the surge in cases driven by their premature reopenings. Though it’s certainly possible a few patients have been admitted to Florida hospitals for COVID-19 after showing up at the hospital for non-COVID reasons, that’s not driving the surge in numbers. Illness is. And until politicians can soberly look at and accept the numbers, and take steps to mitigate them—even if that means closing things back up—they’ll continue to climb.
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Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.
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