What we know and don’t know 1 year after Florida’s first coronavirus case

After 1 year, knowledge of COVID-19 grows but more information still needed

Monday marks one year since the coronavirus pandemic first arrived in Florida.

It has been a year that saw virtually every facet of life change for Floridians as the state worked to “flatten the curve” and slow the spread of COVID-19.

Being a “novel,” or new, virus, there were many unknowns about COVID-19 at the outset of the pandemic. While understanding of the virus has grown considerably in the 365 days since it was first detected in Florida, there are still significant gaps in knowledge of COVID-19, even among the medical community.

On March 1, 2020, Gov. Ron DeSantis announced that two Floridians tested positive for the coronavirus. One was a 29-year-old Hillsborough County woman who had recently traveled to Italy, and the other was a 63-year-old Manatee County man who had contact with someone who tested positive.

Dr. Rajiv Bahl, an emergency medicine physician, said at that time hospitals and health care workers were scrambling to prepare for an unknown future.

“There were a lot of people who didn’t know what we were going to see in the coming months,” Bahl said. “There was a lot of uncertainty. You know this meant everything from PPE (personal protective equipment) to how do we prevent citizens from getting this and what do hospitals and provider capabilities really look like?”

The rush to procure PPE became a problem in parts of the world. At the time, the World Health Organization warned of severe disruptions in the supply, caused by high demand along with hoarding and misuse.

[TIMELINE: The spread of coronavirus in Florida]

“Without secure supply chains, the risk to health care workers around the world is real,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “We can’t stop COVID-19 without protecting health workers first.”

That rush for PPE supplies also happened in Florida. However, Bahl said that hospitals in the state were largely successful in shoring up their supply.

“Don’t forget, this thing came about quite quickly, so we needed to gather as much as we could,” Bahl said. “Most hospital systems were able to actually maneuver that quite quickly and diligently to make sure that their employees and staff were protected.”

It took only seven days for the first case of the virus to be confirmed in Central Florida, when a 66-year-old Volusia County woman contracted COVID-19. Within another week, Florida had more than 100 confirmed cases. By the end of March, there were more than 6,700 confirmed cases of COVID-19 across the state, 85 of whom died. On April 1, the governor issued a statewide stay-at-home order.

“Hospitals went immediately to work to create plans in areas of hospitals that they would take care of these patients, to really help segregate them from the general population who is still coming in with medical conditions,” Bahl said. “So when these patients would come in, we would have to wear goggles, respirators to PPE gowns, and we’re still even doing those practices today even. They (worked) well one year ago and they’re still working today as well.”

Even with protocols in place to protect patients and health care workers, there was no standard treatment for patients with the disease, an issue that persists a year later.

“The initial steps of this virus was to figure out who are our sickest patients and how to best treat them,” Bahl said.

Today, there are more treatment options, including remdesivir, monoclonal antibodies and convalescent plasma, each with some scientific evidence showing “some efficacy with treating this virus.”

“So many people have received remdesivir, and they’ve gotten great responses... now does everybody? Absolutely not. You know, this isn’t a silver bullet that we’ve seen at this point to really save people,” Bahl said. “The best way to, not the best way to (protect) yourself from COVID-19, is to not get it in the first place.”

When the first wave of infections hit the state, there were many who compared the coronavirus to the flu. The two viruses do share some similarities in their symptoms: cough, congestion and fatigue are common in both. However, there are significant differences between the two.

“The nature of this virus tends to be a little bit more deadly in causing a little bit more long-term side effects, including the lungs and other processes throughout the body,” Bahl said. “This virus tends to be a little bit more cruel, you could say.”

In the early days of the pandemic, there was disagreement over how best to protect one’s self and others from catching the virus.

“There’s no reason to be walking around with a mask,” said Dr. Anthony Fauci during an interview with 60 Minutes in March 2020.

U.S. Surgeon General Dr. Jerome Adams also, at the time, advised against wearing a mask. However, Fauci, Adams, the CDC and the World Health Organization all changed mask guidance since then. There remains some, mostly political, debate over wearing masks; however, there is largely a consensus among doctors and health experts that masks are among the best options for preventing the spread of the virus.

“Don’t forget, early on in the pandemic it was thought that some of the resources were a little bit more scarce and so we didn’t really know what the future really held and so we wanted to make sure that we had N95 respirators and masks for the health care workers who needed to actively stay healthy to take care of these patients as they were coming into the hospital system,” Bahl said.

At the same time, cloth masks were originally believed to be ineffective against preventing the spread of the disease, however, they have ultimately been found to be effective, especially if they have multiple layers or used in conjunction with a disposable mask.

“This is a science. Data changes day to day, " Bahl said. “COVID-19 has really just stepped on our doorstep for the past year, year and a half at this point, and so we’re learning a lot of information about the particles of this virus, very quickly. The original thoughts of this virus surrounding masks, ventilators, medications have evolved greatly. And this is actually normal in the scientific process.”

Florida was spared the large number of infections many parts of the country saw during the early days of the pandemic. However, the state was unable to completely avoid that wave of disease. The summer months saw massive numbers of new COVID-19 infections.

The dramatic rise in cases roughly coincided with most of Florida entering phase two of the governor’s reopening plans; however, it remains to be seen if the two are related. During this phase, bars were allowed to reopen on June 5 after having been closed since March; however, just 21 days later, all bars in the state were ordered to no longer serve alcohol for on-site consumption. This order came down after the Florida Department of Business and Professional Regulation found problems with people keeping socially distant at bars. In Central Florida, with 152 cases of COVID-19 were linked to one bar near UCF.

The state hit a weekly peak of 78,861 new cases during the summer wave in the week of July 18. This remained the highest number of new cases in a single week until it was surpassed in the final week of December 2020.

The summer wave that hit Florida also created the highest number of hospitalizations from the disease. The peak of COVID-19 patients in hospitals, 3,423 new hospitalizations during the week of Aug. 15, actually hit a few weeks after the peak of new cases.

Despite those numbers, Florida’s hospital systems were never overwhelmed in the same way states like New York or Washington saw when the pandemic began. Bahl said that the punishing number of cases those two states endured ultimately benefited Florida and other parts of the country when the summer wave hit.

“Washington and New York really got hit first. We have to give our hat off to those two states and the health care workers there that took care of patients and taught the rest of the country so much about this virus,” Bahl said, adding, “The health care systems here in Florida, especially around Central Florida, are very strong. They worked really diligently.”

Following the peak of the summer wave, Florida saw weeks of declining case numbers until finally leveling off in the second week of September. By Sept. 25, DeSantis shifted the entire state to phase three of his reopening plan, which lifted most social distancing guidelines, including any capacity limits on restaurants and bars.

“You know it’s difficult to say when the right time to open up a country or even a state or locality is,” Bahl said. “Some states took it a little bit sooner than others, for example, Florida did. Was that the right move? Was it the wrong route? It’s difficult to say at this time.”

Florida ended up seeing about five weeks of stability in its new case numbers following the summer wave, though the state never returned to the relatively low numbers that were reported prior to June. The numbers began to steadily rise again starting in the first full week of October. Around the holidays, the number of new cases rose even more dramatically.

“Pandemic fatigue was really starting to kick in,” Bahl said. “A lot of people hadn’t seen their family members in quite some time. So, I feel like a lot of people might start to relax some of their measures that they had been taking earlier on in the year; keeping that 6 feet of distance, wearing that mask.”

The doctor added that the winter months typically see virus numbers increase and COVID-19 was no exception.

In addition to the third rise in cases, two other big developments occurred around the holidays. Pfizer became the first drug manufacturer to have a COVID-19 vaccine approved for emergency use authorization in the U.S. and scientists first became aware of the B.1.1.7 variant of the coronavirus.

The first vaccine was made available at a rapid pace, historically speaking. Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, predicted early on that vaccine could be ready within 12 to 18 months. Health experts, at the time, noted that most vaccines take eight to 10 years to develop.

Bahl credits the quick turnaround on the type of vaccines being used, mRNA vaccines. According to the CDC, mRNA vaccines are a new type of vaccine which “teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies.”

“mRNA vaccines have actually been studied for over a decade,’ Bahl said. “We had over 70,000 people quickly enroll in these vaccine trials to make sure that they were safe and efficacious, and we’ve gotten to the point where we’re able to create them quite rapidly.”

Bahl added that is still too early to say whether this rapid pace of vaccine development will become the norm moving forward.

“My hunch is that we’ll probably go back to our older ways, but we’ve done so much research regarding mRNA that it may be a possibility that we’ll see a lot more vaccines based around this technology,” Bahl said.

The first vaccinations in Florida happened on Dec. 14. Two days later, the first health care workers in Central Florida received their first dose of the Pfizer vaccine.

By the end of December, the Florida Department of Health identified the first confirmed case of the B.1.1.7 variant in the state of Florida. Since then, Florida has led the country in cases of the more contagious mutation. Another new mutation, P.1, which was first seen in Brazil, has now also been confirmed in Florida. The rise in mutations is causing concern among Central Florida health leaders.

“We have to hurry and get vaccinated so that any future mutations of the virus do not affect the effectiveness of the vaccines,” said Dr. Raul Pino, of the FDOH in Orange County, on Feb. 4, the same day he confirmed the first Orange County resident with the B.1.1.7 variant.

However, even with the vaccine seeing widespread distribution, there are still many unknowns about how patients’ bodies react to the virus after inoculation.

“We know that they are safe to give to the large masses, but the points at which people are having adverse reactions is still a little unknown. Also, we know that this vaccine can help prevent symptomatic spread, but we still don’t know about asymptomatic spread,” Bahl said.

The doctor added that this lack of knowledge is why people who are vaccinated are still encouraged to wear masks and maintain social distancing, to prevent any potential asymptomatic spread of the virus.

In addition to the vaccine, there is much that remains unknown about COVID-19 and what it does to the body. One of the biggest ongoing mysteries of the pandemic is the patients known as “long haulers,” people who continue to experience symptoms of the virus for months after their initial infection. Additionally, the long-term impacts of the virus on patients still remain to be seen.

“What does this do to our bodies, long-term? And how long are we actually protected from COVID-19, after the first time you get it? Our body creates antibodies, and we are starting to see that it does hold you away from reinfection for multiple months, but we won’t know until many years into the future if our bodies are still holding on to these antibodies to prevent us getting this in the future as well,” Bahl said. “This virus has only been on our doorstep for only a year at this point. We need to keep working on this and really understanding more about this and that’s only going to take a matter of time.”

Bahl again stressed, because of this uncertainty, that the best way to protect one’s self from the virus is to never get it in the first place.

“It may not be for several years or even a decade until we know everything there really is to know about COVID-19,” Bahl said.

The doctor said that the speed of vaccination will ultimately determine how quickly the U.S. and the world can figure out what a “new normal” will look like post-pandemic. Current estimates suggest that 70% to 85% of the population will need to be inoculated to reach herd immunity, according to Bahl.

One year into the pandemic, the future remains largely uncertain. Scientists and doctors are still learning about the virus that has taken over everyone’s lives -- both in terms of understanding how it functions and the best ways to prevent and treat infections. It is a scientific process and new information is constantly coming forward, sometimes contradicting previous data.

“Things change and evolve, but unfortunately with the rapid nature of this, I feel as though the public might have lost a little bit of trust in the health care system, but I can assure you the health care system really is working to help keep you and all of us safe as well,” Bahl said.

It is that loss of trust in health care that the doctor believes may be among the biggest setbacks of the pandemic.

“Although many things are coming out very quickly, there’s starting to be a little bit of uncertainty with the scientific community about what could be going on. I’d like to remind everybody that this is a scientific process. Things change. The things that we were doing one year ago may not be the same as what we’re doing today and this is the same thing as the way we take care of other illnesses that we used to take care of back in the 80s, and the way we do it today as well.”


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