Health care worker Olga Duran tests a patient for COVID-19 at a Unidos en Salud (United in Health) testing site on 24th and Mission streets in San Francisco on Nov. 30, 2020. The effort is a collaboration between UCSF and the SF Latino Task Force to help vulnerable populations during the pandemic. (Beth LaBerge/KQED)
From the outset of the coronavirus pandemic, the governors of California and Florida have taken almost polar opposite approaches to managing an unprecedented health crisis: California Gov. Gavin Newsom shut down his state early, prioritizing public health; Florida Gov. Ron DeSantis largely kept his state open for business, prioritizing the economy.
California just fully reopened on Tuesday, while Florida has been open all year, save for a short lockdown last spring.
The split mirrors the political divisions that have bedeviled the United States during the pandemic — with both sides claiming victory at various times. But now, more than a year of data is offering some clear takeaways on which state’s approach has produced better outcomes on a number of fronts.
In short, thousands more people per capita in Florida have been infected with, and died from, COVID-19 than in California. And while unemployment remains about twice as high in California, some economists are now predicting a faster overall recovery in states like California that locked down early and kept those restrictions in place.
Still, given the two states’ widely contrasting approaches to the pandemic, some experts say they would have expected even more disparate health outcomes.
"I think most public health officials would say that Florida humbles us and makes us realize there are parts of this that we understand and there are parts of this that we don't exactly understand," said Dr. Bob Wachter, a leading epidemiologist and chair of the Department of Medicine at UCSF.
“It's easy to criticize California,” Wachter added. “The overall numbers of cases and deaths are so high. But that's irrelevant, really. You have to look at the per capita rates because California is so much bigger than any other state.”
By Wachter’s math, if Florida’s COVID-19 death rate had been closer to California’s, there would have been nearly 2,400 fewer people dead there. As of this week, transmission rates in Florida remain five times higher than in California, according to the Centers for Disease Control and Prevention. In all, 57% of all Californians have received at least one dose of the vaccine, compared to about 48% of all Floridians.
And beyond health and economic impacts, there have been other trade-offs each state made, with outcomes that may take years to fully evaluate: For one, most Florida kids have been back in school since the fall; most California students did not return until this spring, and even then, not always full time.
For Wachter, assessing the success or failure of each state is complicated — and to some extent subjective.
"I mean, I think some of that will come down to how you value human life," he said. "I don't want to sugarcoat it. The number of deaths in Florida per capita is significantly higher than they are in California."
For community leaders on the ground in both states, the decisions made by DeSantis and Newsom had far-reaching implications — especially for communities of color, who were generally hardest hit by the pandemic.
Last spring, as the coronavirus was spreading across the nation, and the world, community leaders in San Francisco’s heavily Latino Mission District realized things were poised to get bad — quickly.
Although heavily gentrified in pockets, the Mission is still a largely working-class neighborhood. It’s home to many low-income families who often live in homes shared by multiple generations, allowing little room to quarantine if needed.
Jon Jacobo, who grew up here and is active in local politics, said he and others watched with concern in March 2020 as San Francisco officials, and then state leaders, announced some of the nation’s first stay-at home orders — even as spring break continued to draw tourists to Florida.
"The immediate thoughts, I think, for everybody were, 'What is going to happen to the folks that are going to lose their jobs? ... What's going to happen to the individuals that have to go to work?' " he said. "Because there's a lot of people that don't have that luxury or that privilege."
Jacobo and other volunteers — many of them Latino community members themselves — banded together to create what they called the Latino Task Force. Fearful of a coming wave of infections, they started asking the city for resources, including testing, tracing, rental assistance and food donations.
But at the time, tests were in short supply and the virus was spreading rapidly — more so in this neighborhood, it seemed to them, than in other nearby communities. So in April 2020, the Latino Task Force and other community leaders partnered with UCSF to set up a testing site in the neighborhood and put some numbers behind their hunch.
“We recruited volunteers. We knocked on 1,400 doors over four days and registered people at the door, handed out fliers. We phone-banked — treated it like a traditional political campaign,” Jacobo said.
In the end, over 4,000 people came to get tested. About 40% were Latino.
In response, the city expanded testing opportunities and other help for people of color and essential workers throughout the city — in partnership with existing groups like the Latino Task Force, who already had deep ties to city neighborhoods. It’s a lesson San Francisco learned decades ago during the AIDS crisis: The best way to get to hard-to-reach populations, people who might distrust the government, is to use the networks they already trust.
The Latino Task Force did this in the Mission by not only focusing on testing: They set up a resource hub at a large building at 701 Alabama St. Funded by the city, the street outside morphs every Thursday into a pop-up COVID-19 testing site, and now, a place where people can make vaccine appointments.
But it’s also offering all the other things low-income residents have needed during the pandemic. For more than a year, the site has handed out groceries — serving as many as 9,000 families each week. There is also a community wellness team on-site that partners with families when someone tests positive to make sure they have the resources to survive quarantine. Mental health services and job training — all offered in multiple languages — are available as well.
San Francisco Mayor London Breed called the collaboration — one of many across the city — a game changer.
"Part of working with the Latino Task Force had everything to do with making people feel comfortable about getting tested, no questions asked," she said recently.
All this government and community support didn’t erase the disproportionate burden of COVID-19 cases on Latinos in San Francisco during its summer and winter surges. But Jacobo said it did offer a safety net for vulnerable residents — and it left the city and community with a playbook when the vaccines started to roll out.
"We have a community health team providing info on what the vaccine is or what the vaccine isn't. And we'll literally sign you up for your appointment here," Jacobo said. "So you don't have to do anything."
It worked: By early June, San Francisco reported that more than 70% of residents in the neighborhood had received at least one dose. Citywide, more than two-thirds of Latinos are vaccinated. And as California lifts nearly all COVID-19 restrictions — San Francisco officials this week announced more 80% of residents have received at least one dose.
Breed credits San Franciscans for trusting the science, the data and one another.
“I must say, I am really proud of how San Franciscans, for the most part, handled this crisis, because if people didn't comply and didn't trust the information, we wouldn't be here,” she said.
The same cannot be said across the country in Miami Gardens.
Located in Miami-Dade County, Miami Gardens is the largest Black-majority city in Florida — African Americans make up roughly 71% of the population. And like the Latino community in San Francisco’s Mission District, it is not a monolithic group — there are Bahamians, Jamaicans, Afro-Cubans, residents from West African countries like Nigeria and Ghana; some are Florida natives, some are immigrants.
Overall, Miami-Dade County is doing pretty well when it comes to vaccines: About 58% of the total population has received at least one dose, according to county data from June 3.
However, that number plummets among the county’s Black residents, only about 20% of whom have received at least one shot.
The vice mayor of Miami Gardens, Reggie Leon, said he feels that disparity is probably due to a combination of inaccessibility and mistrust.
"We knew that people of color had some trust issues, especially with vaccines. So [my office] started reaching out,” said Leon, who is Black. “We started reaching out to different groups."
One of the major vaccination sites was a state-run location at the Hard Rock Stadium in the city — home to the Miami Dolphins and where the 2020 Super Bowl was held shortly before the coronavirus hit.
Despite the state previously offering testing at the site, Leon said the location just didn’t work for many residents of his city.
"The stadium wasn't enough because you had people coming from everywhere to get into the stadium and the stadium didn't have the flexibility for walk-ups and they didn't have the flexibility for those people that didn't have transportation," he said.
It wasn’t just about access, said Dr. Dwight Reynolds, an emergency physician working with the city of Miami Gardens. Many Black men like him were uncomfortable with the stadium site, he said, noting that it was set up by the state with help from the National Guard, and had a lot of security.
"Imagine for a moment that you are a male of color. You go into a place where you see white officers — let's tell it like it is — with guns,” Reynolds said. “OK, would you feel comfortable pulling up to that site although it's free? Probably not.”
So to try to increase vaccination rates among residents, the city partnered with a Black-owned company to open its own pop-up vaccination site at Brentwood Community Pool, about 2 miles away from the Hard Rock Stadium. At its pop-up site, the city offers doses of the Moderna vaccine, with Black nurses and doctors, including Reynolds.
Reynolds said he regularly hears from Black Floridians that they feel more comfortable with him holding the needle.
"To have people that look like you, talk like you, that's kind of important," he said. "We look like them. We talk like them. And guess what? We are them."
Faith Heywood, a Black nurse herself, got her first shot there in mid-May.
"I've been looking online and it's, you know, very complicated," she said. "I'm ready today. I don't want to think about Monday or Tuesday."
Despite the location and ease, though, it’s been hard to attract people: On one Friday in May only about four or five people came for a shot all day.
Reynolds said he's often been in the difficult position of deciding whether or not to open a vial — and risk having doses go bad.
"Let's say at 3 o'clock, 4 o'clock — if you ... can't move those ones that you have left, then you end up having problems," he said, adding he’s taken to driving extra doses as far as Coral Springs — some 30 miles away.
It’s been slower going here than in San Francisco, where a deeper level of trust had already been established in some lower-income communities by the time the vaccines arrived.
Local leaders in both Miami Gardens and San Francisco’s Mission District have centered their efforts around building trust on the ground, but say they have been both helped and stymied by the decisions made at their own state capitols.
'I Would Not Declare Victory Now'
In Florida, Gov. DeSantis followed the lead of his ally, former President Donald Trump: He refused to institute many restrictions recommended by health experts, like a statewide mask mandate.
And by spring 2021, DeSantis also made it harder for local governments to enforce their own COVID-19 safety rules. In March, for example, he overturned fines cities and counties administered to individuals and businesses for breaking health restrictions.
Epidemiologists in both states agree that while the two governors’ decisions did influence health outcomes, so did the individual decisions of the millions of residents in each state — who sometimes acted in spite of their leaders’ examples.
Cindy Prins, a University of Florida epidemiologist, said that’s probably one reason why things aren’t as bad in Florida as some experts predicted they would be.
"I think a lot of people continued to wear masks, not go to restaurants, physically distance in some cases, in spite of the fact that things were opened up," Prins said.
"It's very hard to judge success because we don't have the comparison group of what would have happened if everything was open the whole time," she continued. "What's the comparison if everything's closed?"
Still, Wachter, from UCSF, stressed that this pandemic isn’t over.
"I don't think the Florida story is fully written yet," he said. "There's a lot of the variants down there. The variants are nastier. So I would not declare victory now in Florida."
Meanwhile, the actions of individual Californians — especially at family gatherings over the holiday season — prompted a major winter surge. Yet Wachter said those outbreaks were notably worse in the southern half of the state, showing that Newsom’s restrictions only went so far.
"The state had the same rules and standards. But people in L.A. and people in some of the other southern counties were acting differently than the people in the Bay Area were tending to. And you saw a divergence," he said.
This was the major finding of our collaboration last spring, early in the pandemic: the huge significance of individual actions, particularly in the absence of a coordinated national response. We all ended up being the Dr. Fauci of our own homes, so to speak.
Where We Go From Here
Now, with vaccines widespread, the U.S. is entering a new phase of this pandemic.
But even now, DeSantis and Newsom are still being guided by their opposing ideologies.
After 15 months, California lifted nearly all restrictions Tuesday, but counties are still permitted to enforce their own, and all unvaccinated residents are still being asked to mask in most public spaces. Attendees at indoor events with more than 5,000 people will have to either show they’re fully vaccinated or provide a recent negative COVID-19 test result; and Newsom’s administration is in the process of creating a digital “vaccine verification system,” allowing businesses to more easily check people’s vaccination status (though he’s quick to stress that using it is not required).
Meanwhile, in Florida, DeSantis recently overrode all remaining local emergency pandemic-related orders and restrictions. He also signed a bill making it illegal for businesses, schools and governments to require proof of vaccination. Recently, he's been in a legal battle with the CDC over requiring vaccines on cruises.
In many ways, each governor is playing to his political base — with mixed results.
Despite better health outcomes in California, Newsom is facing a recall attempt largely fueled by anger over his strict lockdowns. Yet just months after the recall qualified, Newsom is looking increasingly strong as his state emerges from the pandemic.
Meanwhile, DeSantis’ star is also on the rise in the GOP — even though, or maybe because, he flouted many public health guidelines.
The coming months will be crucial from a public health perspective. But the debate over whether DeSantis or Newsom best led his state through this crisis will likely drag on, especially given the two governors’ ambitious political aspirations: Both are thought to have presidential hopes.
Correction: Dr. Bob Wachter’s initial estimate of how many fewer COVID-19 deaths there would have been in Florida if it had the same death rate as in California was miscalculated. The original version of this story states:
By Wachter’s math, if Florida’s COVID-19 death rate had been closer to California’s, there would have been roughly 5,000 fewer people dead there.
In fact, the correct estimate of fewer deaths (based on each state’s COVID death rate at the time of publication) is less than half that: 2,389.
WLRN's Verónica Zaragovia contributed to this story.