The Washington Post - 11.03.2020

A18 eZ re the washington post.wednesday, march 11 , 2020

the coronavirus outbreak

BY LENA H. SUN

A shortage o f specialized m asks
has prompted federal health offi-
cials to loosen their recommenda-
tions on the face protection that
front-line health-care workers
should use to prevent infection
from the highly contagious dis-
ease caused by t he coronavirus.
Instead of recommending that
health-care workers use special-
ized masks known as N95 respira-
tors, w hich filter out a bout 95 per-
cent of airborne particles, the Cen-
ters for Disease Control and Pre-
vention posted new guidelines
Tuesday that said “the supply
chain of respirators cannot meet
demand” and that looser fitting
surgical face masks “are an a ccept-
able alternative.”

The more commonly worn sur-

gical masks will limit — but not

eliminate — the chance of inhaling

large, infectious particles c irculat-

ing near the f ace.

Until Tuesday, t he CDC had r ec-

ommended that health-care work-

ers interacting with coronavirus

patients or suspected cases wear

N95 respirators, along with

gowns, gloves and eye protectors.

The N95 filters must be custom-

fitted and cost more than surgical

masks.

The CDC guidance has been in

discussion for days, and more

than a d ozen unions h ad previous-

ly said they were opposed to any

changes in recommendations be-

cause emerging diseases such as

covid-19 pose an occupational

hazard for workers on the front

lines, especially health-care work-

ers.

“We are strongly opposed to any

measures that fail to provide opti-

mal protection and infection con-

trol standards,” they wrote in a

March 6 letter to CDC officials.

The unions include National

Nurses United, the American Fed-

eration of Teachers, a nd the Trans-

port Workers Union o f America.

The CDC guidance said the

changes were prompted by the

shortages. Surgical face masks

will block the respiratory droplets

produced by patients who cough

or sneeze, which is the primary

way the v irus i s spread.

The CDC is recommending t hat

N95 respirators be reserved for

protecting workers in the riskiest

situations, where fine aerosol is

likely to be generated. These in-

clude certain medical procedures

like intubation, which helps a se-

verely ill patient breathe.

The CDC’s guidelines also rec-

ommend that health-care facili-

ties consider alternatives to the

N95 masks, such as more elabo-

rate (and expensive) powered air

purifying respirators.

“I recognize that individual fa-

cilities may face shortages of cer-

tain types of personal protective

equipment, including N95 respi-

rators, but there is no evidence

that surgical masks are adequate

to prevent exposure of front-line

health-care workers to the virus

that causes covid-19,” said Rep.

Robert C. “Bobby” Scott (D-Va.),

chairman o f the H ouse Committee

on Education and Labor.

During the height of flu season

over four years, researchers stud-

ied flu infection rates among

health-care workers at seven U. S.

medical centers. Some workers

were randomly assigned to wear

N95 respirators and others surgi-

cal m asks. The two groups s howed

no significant difference in flu in-

fection rates, according to the

study, which was published in

September in the Journal of the

American Medical A ssociation.

State and local officials rely o n a

federal stockpile, known as the

Strategic National Stockpile, for

public health emergencies. But

the federal government has not

maintained supplies fully, includ-

ing of face masks.

Federal health officials have an-

nounced plans to buy 500 million

N95 respirators over the next

18 months for the stockpile, “part

of a broader effort t o maximize the

availability of personal protective

equipment for health care work-

ers who are on the front lines”

fighting the spread of the virus.

At a briefing of the coronavirus

task force on Tuesday, Vice Presi-

dent Pence s aid the Trump admin-

istration favors legislation that

“would extend temporary liability

protections, so [N95 respirators]

made for industrial use could be

sold so hospital workers could be

protected.”

He said such a measure would

“make m ore N95 masks available.”

[email protected]

emma Brown, Beth reinhard and amy

Goldstein contributed to this report.

Face mask shortage propels CDC to loosen guidance for health-care workers

BY LORI ROZSA,

TIM CRAIG

AND JOEL ACHENBACH

PALM BEACH, FLA. — The corona-
virus has arrived in the Sunshine
State — and so have the spring
break crowds.
Even as the burgeoning health
crisis poses potentially dire rami-
fications for an aging population
in a place that relies heavily on
people wanting to visit, the viral
outbreak so far has not stopped
Florida from being Florida.
“I think people will still want to
come down h ere,” s aid Blake Papa-
lia, a local real estate agent sun-
ning himself on Palm Beach. “It’s
clean, it’s safe and people still
want to come to Florida and de-
compress. My Airbnb is booked
every day six months in advance,
and nobody is canceling.”
His friend, Ava Nicole, sitting in
the sand next to him, chimed in:
“The media is really pumping up
the fear.”
That kind of beach-life compla-
cency has been coming up against
what Florida health officials and
government leaders say is a major
threat to the nation’s third-largest
state, where a quarter of the popu-
lation is older than 60, and where
many people have chronic illness-
es that make them more vulnera-
ble t o the serious e ffects of the new
pathogen. In the worst-case sce-
nario, the state’s health system
could be woefully overloaded.
“You have to fear everything,”
Miami Mayor Francis X. Suarez
said in an interview. “You fear
widespread infections, you fear
for the vulnerable and the elderly
in your community, you fear the
economic impact because if this is
not contained in a short period of
time.... It could be something
that is crippling, n ot j ust to Miami,
but the world.”
The coronavirus already is
starting to have a major effect on
the s tate’s largest industry — tour-
ism — which brings in more than
$86 billion a year and employs
1.5 million people. The cruise ship
business is in crisis. American A ir-
lines, one of the largest employers
in South F lorida, a nnounced Tues-
day that it will reduce domestic
and international flights. The Uni-
versity of Florida has told profes-
sors to transition to online classes.
So far, 14 residents have fallen
ill as a result of the coronavirus in
Florida, according to the state
health department, including five
with no history of recent interna-
tional travel. T he state has record-
ed two deaths — one i n southwest-
ern Lee County, and one in Santa
Rosa County in the panhandle.
On Tuesday, t he F lorida Depart-
ment of Health reported that three
of the coronavirus cases in Bro-
ward County have been linked to
Port Everglades, where cruise
ships dock along the Atlantic
Coast i n Fort L auderdale. Officials
said the three men worked for
Metro Cruise Services, which pro-
vides greeting and o ther hospitali-
ty services at the port.
“The Florida Department of
Health recommends all individu-
als experiencing symptoms who
have recently traveled through
Port Everglades to immediately
contact their county health de-
partment or health care provider
and self-isolate for 14 days,” the
agency said. “The Department
also recommends employees of
Metro Cruise S ervices a t Port E ver-
glades with any association to
these cases self-isolate at home.”
The company declined to com-
ment.
Although there are no con-
firmed coronavirus cases in Mi-
ami-Dade County, Suarez said he

has been preparing his city for

several weeks and questions

whether all local South Florida

leaders are taking the threat seri-

ously enough.

Miami, for example, has settled

on a policy that calls for t he cancel-

lation of any gathering that is

expected to draw 25,000 or more

people. The policy has resulted in

the cancellation of the mammoth

Ultra Music Festival as well as the

annual Calle Ocho Festival in Lit-

tle Havana, where 250,000 people

were expected.

“We know there is probably not

enough testing going on to really

measure what the infection rate is

in our community and in our

state,” S uarez said. “ So, i n our view,

the economic impact of postpon-

ing festivals pales in comparison

with the economic impact of hav-

ing a large part of your p opulation

quarantined and unable to go to

work.”

Suarez’s stance has been met

skeptically by some other South

Florida leaders. The beaches and

spring festivals on South Beach,

for example, are continuing. Car-

los A. Gimenez, the mayor of Mi-

ami-Dade County, also has argued

against the mass cancellation of

events.

According to the state tourism

bureau, Florida receives 130 mil-

lion visitors annually, about

10 percent of whom come from

outside of the United States. A

study in 2017 estimated that Flori-

da tourists spent $89 billion on

lodging, food, entertainment,

shopping and transportation.

Nathaniel Line, an associate

professor a t the D edman School of

Hospitality at Florida State Uni-

versity, said hotel managers are

reporting widespread cancella-

tions from convention business.

The cancellation of five major con-

ventions in Orlando during the

past few days has resulted in a

$280 million hit to the local e cono-

my, according to the O range Coun-

ty Convention Center.

Line said the tourism industry

is trying to evaluate whether its

losses will extend into the sum-

mer. “Large markets that rely on

air travel will be hit the hardest as

people right now really do appear

to be avoiding the high-density

travel environments,” he said. “But

the good news is, Florida does a

tremendous drive-in market, and

there is certainly a possibility that

people who are canceling vaca-

tions typically associated with an

airplane m aybe change their vaca-

tions and drive into Florida.”

One area where residents seem

especially wary is the Villages, a

sprawling retiree community in

central F lorida where 1 20,000 res-

idents are scattered across three

counties. “They are all concerned,

and I am too,” s aid Jim Richards,

77, the mayor of Lady Lake com-

munity in the Villages. “ We a re not

going to travel too far from home

and just stay as low as we can.”

Richards said local and state

officials have been working to

identify the locations of “isolation

chambers” should someone need

to be quarantined.

“There is awareness, but the

concern is w hat if t here is just t hat

one person who got away,” Rich-

ards said. “That one person can

infect 40, and then they all can

infect another 40, and then every-

thing just goes from there.”

Resident Joan Bernbach said

her husband’s softball team was

told not to do high-fives anymore.

Bernbach and a friend were on

an Asian cruise when coronavirus

cases in China started spiking in

January and February. Nobody

onboard tested positive for the

virus, but the ship was denied

entry in several countries, she

said. When they finally returned

home to the Villages, neighbors

were welcoming.

“Nobody is avoiding us or any-

thing,” Bernbach said. “I do have

friends who a re a larmed about the

virus, but I don’t think there’s any

way to completely safeguard this

place.”

Kristen K napp, a spokeswoman

for t he Florida Health C are Associ-

ation, said nursing homes and

assisted-care facilities have been

working for weeks to try to man-

age the risks. There are about 700

nursing homes a nd 1,300 assisted-

living facilities in Florida, serving

about 160,000 people.

After deadly missteps during

hurricanes, Knapp said the indus-

try and state officials became bet-

ter p repared f or keeping the popu-

lation safe. To protect nursing

home patients, for example, the

association now recommends that

facilities tightly restrict visitors.

In Tallahassee, the Florida l egis-

lature took an emergency break

Monday after five members said

they had attended the Conserva-

tive Political Action Conference in

Washington, where someone has

since tested positive for covid-19,

the disease caused by the corona-

virus. A cleaning crew dressed in

protective gowns, masks and

gloves scrubbed down the House

chambers, and the r epresentatives

briefly put themselves in isolation.

Gov. Ron DeSantis (R) an-

nounced a state of emergency a

few hours later, elevating a state

response that elected officials

have criticized as slow and

opaque. DeSantis said he would

leave it up to local governments to

decide how to handle school clo-

sures and the cancellation of pub-

lic events.

“It’s going to be a bottom-up

effort,” DeSantis s aid. “ We’re going

to be working with local commu-

nities, but certainly not going t o be

dictating the decisions.”

Both Rep. Charlie Crist (D-Fla.)

and Sen. Rick Scott (R-Fla.) have

written letters critical of the state

response and lack of information

about the virus’s spread. Crist said

he was told representatives of

tourism-related industries have

been lobbying behind the scenes

to tamp down on coverage of the

coronavirus outbreak in Florida.

“That’s the deeper problem,

money over lives,” Crist said.

“The lack of publicly released

information surrounding these

cases i s alarming and unfair to t he

missions of families across the

nation who are worried about

their well-being,” Scott wrote on

Sunday to the two local Florida

health departments where the

deaths occurred and to several

federal agencies.

Lee County officials say it is too

early to tell whether tourism has

been affected. County Commis-

sioner Brian Hammond likened

the c oronavirus to a hurricane and

the red tide and blue-green algae

blooms that killed sea life and

closed businesses in the state two

years ago.

“ Red tide and blue-green algae

hit us really hard, but the tourists

came back,” Hammond said.

Leslie Driver’s business, Island

Living To urs, depends on visitors.

She gives guided tours on Palm

Beach, and she said she has seen

the contradictory attitudes about

the coronavirus play out in real

time. She said seven tour groups

from corporate clients have can-

celed in recent days, citing the

virus as a concern.

“I think it was mostly a concern

about flying here,” Driver said.

What she sees on Palm Beach is

business as usual.

“The restaurants are packed,

people are still shaking hands,”

Driver said. “It’s a serious thing,

but everybody here is putting on a

happy face.”

[email protected]

[email protected]

rozsa is a freelance journalist based

in Florida.

Outbreak puts Florida’s elderly — and tourism — at risk

Brynn anderson/associated Press

Seniors gather for announcements at Little Havana Activities and Nutrition Centers of Dade County in Miami, where nursing homes and other facilities remain at high risk.

Many hope beaches will

still draw visitors even as

the virus spreads

tori lynn schneider/tallahassee democrat/associated Press

Gov. Ron DeSantis (R) addresses coronavirus concerns Monday in Tallahassee. The outbreak is already

having a big effect on tourism, Florida’s largest industry, which brings in more than $86 billion a year.