Florida’s COVID-19 cases and hospitalizations are surging, but state has 2nd-lowest death rate. What’s going on?

FORT LAUDERDALE, Fla. — With COVID-19 cases skyrocketing, Florida is experiencing one of the worst waves of the omicron variant in the United States.

Yet Florida’s death rate over the past seven days is the second lowest in the country, after only Alaska. What’s going on?

Even as record COVID-19 cases in the U.S. were reported last week, deaths dipped slightly, and still, Florida’s death rate is distinctly low, particularly in a state with a large, vulnerable elderly population.

Experts say several factors could explain the currently low rate: Florida’s horrific toll from delta and its acquired resistance and vaccination rates may be buffering the state at a time when others states are contending with two variants. Or, because of the way Florida reports COVID deaths, which already tend to lag infections and hospitalizations, the true death rate from this recent wave may be too soon to know.

Only months ago, the state’s death rate was among the highest in the nation. The delta wave hit Florida hard, taking the lives of more than 22,000 people between June 15 and Oct. 15. On its worst day for deaths during the delta wave, 403 people succumbed to the disease in Florida.

“Florida had the worst or second-worst outbreak in the country for delta,” said Dr. Howard Forman, a Yale physician, professor, and COVID tracker. “Because of that, there are a lot of people in Florida with infection-acquired immunity and vaccine acquired immunity against delta. By the time the omicron wave came, Florida had almost no delta, where places like New York were just beginning a delta wave when omicron appeared.”

Globally, omicron has not appeared as deadly as the delta variant.

World Health Organization officials noted that may be due to several factors — including rising vaccination rates in some places and signs that omicron affects the nose and throat more than the lungs, which previously triggered COVID deaths.

But it still may be too early to know how deadly omicron will be in the Sunshine State.

Florida’s distinct method for reporting deaths

Florida is the only state that reports COVID-19 deaths to the Centers for Disease Control and Prevention by the date the death occurred rather than the date reported to the state, or a combination of the two, according to a notation on the agency’s website. The way Florida reports can give the appearance overall deaths are decreasing, the CDC notes. “This does not reflect a true decline and data should be interpreted with caution.”

In the last nine days, Florida has seen a slight uptick in in-hospital COVID-19 deaths.

The average number of deaths per day has risen to 33 over the recent 9 days, from 16 deaths on average for the nine-day period prior. That’s still way less than the 286 deaths per day on average for the nine days during the worst of the delta wave, according to data compiled by University of South Florida epidemiologist Jason Salemi.

The age distribution of new COVID hospital admissions was not that different than now, he notes.

“The in-hospital deaths are certainly higher than what we had been seeing. ... It’s a noticeable uptick,” Salemi said. “But relative to hospitalizations, you would have expected the numbers to be much higher than they are.”

Florida’s seven-day average as of Friday was of 0.09 deaths a day per 100,000, or the state with the second-lowest rate in the country. Wyoming had the highest rate of all the states, with 1.14 deaths per 100,000. Overall, more than 62,000 people have died of COVID in Florida.

Possible explanations

Amira Roess, professor of Global Health and Epidemiology at George Mason University’s College of Health and Human Services, agreed that Florida’s low death rate was surprising and suggested several possible explanations.

One possible reason is the vaccination rate in Florida picked up much later than other parts of the country, and Floridians also got the disease later than people in other states, meaning they acquired resistance more recently, which would make it stronger, Roess said.

Another explanation, she said, is Florida’s high death rate in the delta wave could be holding down the death rate now. “It’s possible that the individuals that were most susceptible to the virus already had it, were very sick or died,” she said.

But with the soaring infection rates of the past few weeks, she said it’s too early to conclude that Florida’s low death rate will persist.

“Death rates is one of those lagging indicators,” she said. “What we’re going to want to keep an eye on is the death rates for the next two or three weeks. And two or three weeks after the peak of reported COVID cases. Then you’re going to really want to pay attention to the death rate and the hospitalization rate.”

Typically as a pandemic wave begins, cases rise, then hospital COVID wards and intensive care units fill up and eventually reported COVID deaths will follow.

Omicron’s extraordinary transmissibility has been evident since it was first detected in South Africa when cases rose quickly. But cases in South Africa are now declining as are hospitalizations — and deaths have not come close to the highs seen over the summer and last winter.

More COVID deaths ahead

Still, even if omicron’s symptoms are milder, the variant is killing people and experts are predicting an uptick in Florida’s death rate.

Forman said he initially predicted 5,000 deaths during the newest COVID wave in Florida. He now has adjusted the number upward to at least 10,000.

“I think it will pass last winter’s wave in Florida. People have been lulled into believing omicron is benign, and it’s not benign. Florida is probably approaching a peak in cases. My expectation is deaths will follow.”

The Yale professor tweeted Friday: “Last year, it took us until January 8 or 9 for deaths to rebound from the holiday/artificially depressed levels. I am expecting that we will see substantial growth in deaths for the next several weeks, as massive numbers of less virulent Omicron cases work their way through.”

Jeremy Redfern, press secretary for the Department of Health, offers an explanation on why he believes Florida’s death rate is lower at this time than other states.

“Vaccines are still great at what they should have been marketed for which is preventing severe illness, hospitalizations, and deaths,” he said.

Redfern notes that, according to the CDC, 79% of the state’s eligible population has had at least one dose of a vaccine, and “that does confer some level of protection.”

Redfern also agrees that Florida was poised better than other states when omicron arrived: “In theory, Florida has already dealt with what was going to happen during delta, and other states are still catching up in their COVID deaths.”

“Florida will likely see an increase in deaths from COVID in the weeks to come, but as long as the current pattern holds, it is not expected to be anywhere near what the state experienced during the delta wave,” he said.

He also noted that Florida’s death toll could have been worse if delta had resurged this winter. “We probably would have seen an uptick in deaths from delta if omicron had not become the dominant variant.”

Mary Jo Trepka, an infectious disease epidemiologist at Florida International University, said Florida’s death rate now is a reflection of November when the infection and hospitalization rates were low.

“We won’t really start to see omicron deaths for a few more weeks so people shouldn’t feel good about it yet,” Trepka said. “Any time you see a lot of hospitalizations, you will start to see more deaths. " With delays in reporting and certifying COVID deaths, she said, “I don’t think we will even have an idea until March about mortality related to this surge.”

ICU beds are filling up

Throughout the pandemic, one of the main predictors of COVID deaths has been the number of patients with the disease in intensive-care units.

In late November, when omicron first made its way into the country, only about 4% of ICU beds in Florida were filled with COVID patients, the lowest in many months.

And now, while the number of patients hospitalized for COVID-19 in Florida has jumped 150% in the four weeks, ICU beds occupied with COVID patients increased 125%. The percentage of ICU beds filled by COVID patients in Florida’s intensive-care units is up to 17%.

At Jackson Memorial Hospital in Miami-Dade, Dr. Lilly Lee, chief of emergency medicine, says most of the health system’s COVID patients are not in the ICU. “With delta so many were on high-flow oxygen or required intubation. We rarely see that need at all now.”

But Lee said she can’t be sure the COVID death rate will remain at its low levels. “Some patients do still get very sick with this variant, especially if they are unvaccinated or have no immune response. They still end up on ventilators, but we have a high vaccination rate in the county and we are not dealing with delta.”

In recent months, Florida Gov. Ron DeSantis has promoted “early treatment saves lives,” encouraging Floridians to get monoclonal antibodies when testing positive to prevent severe disease, especially if someone is high risk.

“There is no doubt that many lives have been saved as a result of making these treatments widely available,” the governor said during a news briefing earlier this week.

The Department of Health reports Florida has given out 130,000 treatments since Aug. 12. However, evidence suggests these same treatments are losing their effectiveness in the fight against the mutating virus and likely will not work as well to lessen the effect of the disease during the new wave.

If Florida’s low death rate stems from the preponderance of treatment, a reporting backlog, or the lack of severity in the age group most infected, the next few weeks should offer some insight into how the state fares, COVID trackers say.

On Friday, Florida broke its single-day record with 76,887 new COVID cases.

However, more than a third of Florida’s cases are people ages 20 to 29.

“We could end up with a situation where we have a ton of cases, a lot of people hospitalized and a much better chance of keeping people alive,” Salemi said. “If omicron is less severe, it’s less likely to kill the younger people who are getting infected in Florida in a higher proportion.”