Alabama hospitals were nearing capacity when Governor Kay Ivey spoke with reporters on Thursday. Despite a dearth of tests, there were more than 630 confirmed Covid-19 cases in the state, more than 100 of whom were hospitalized, and dozens of patients on ventilators. Local reports suggested that the actual number of those hospitalized with the virus might have been closer to 300, but many patients suffering from acute respiratory illnesses went uncounted.
At that time, more than half of all Americans were living under state-issued shelter-in-place orders in an attempt to curb the spread of the novel coronavirus. Ivey had not issued such an order. And she had no plans to, she said on a press call.
“Y’all, we are not Louisiana, we are not New York state, we are not California,” Ivey said, emphasizing the devastating impact more stringent social distancing measures could have on the state’s economy. “Right now is not the time to order people to shelter in place.”
Her own lieutenant governor disagreed. The day before, Will Ainsworth wrote a memo to Ivey’s pandemic task force sharply criticizing the governor’s piecemeal response to the crisis and urging stricter social distancing measures. “A tsunami of hospital patients is likely to fall upon Alabama in the not too distant future,” Ainsworth wrote, saying the governor’s task force and the state “are not taking a realistic view” of the crisis. “Time is our enemy, and each moment that we lose by not preparing for the coming deluge will result in the loss of life and the crippling of our healthcare infrastructure.”
By now, the spreading pandemic has led state and local officials to order more than two-thirds of Americans to shelter in place. But some states have resisted, even as the virus’s toll mounts. In Alabama, Florida, Mississippi, Oklahoma, South Carolina, and South Dakota, calls from public health experts to institute strict social distancing measures have largely fallen on deaf ears.
Instead, governors in these states have opted for a more laissez-faire approach, putting the onus of high-stakes public health decisions on city and county officials. As the disease’s toll worsens, some governors have implemented piecemeal strategies—temporarily closing some businesses and public spaces, or issuing shelter-in-place orders for a portion of the state—but it’s far from enough, experts say.
“One thing that this outbreak reminds us of is that infectious diseases observe no borders—and that’s true if they’re international borders, state borders, or county lines for that matter,” said Ben Lopman, a professor of epidemiology and environmental health at Emory University’s Rollins School of Public Health. “At this point, you really can’t be too aggressive in control measures in terms of having an impact on the trajectory of this epidemic … We’re in this exponential growth phase [where] any time lost—any transmission that is allowed to happen in the community—will have ripple effects for weeks to come.”
In Florida, where the number of confirmed cases topped 6,300 as of Tuesday, with 77 deaths, Governor Ron DeSantis has faced criticism from Democrats in the Florida Senate, former governor Rick Scott who is now a US Senator, and groups of health care workers over his reluctance to issue a state-wide shelter-in-place order, citing potential economic and social drawbacks. DeSantis declined to cancel spring break activities earlier this month, when thousands of young people crowded onto Florida beaches.
“That is the dumbest shit I have heard in a long time,” state senator Oscar Braynon said of DeSantis’ behavior on March 24, after the governor ignored calls for a shelter-in-place order in favor of instituting travel restrictions on visitors from coronavirus hot spots, such as New York. “This is a day-by-day crisis.”
DeSantis said on March 23 that he did not think a statewide shelter-in-place order was necessary as “this is not a virus that’s impacting every corner of the state.” He doubled down on the decision on Tuesday, adding that the White House has not recommended a statewide order.
Some governors have complicated local officials’ efforts to contain the virus. Mississippi governor Tate Reeves on March 24 signed an executive order declaring most types of businesses “essential” and thus exempt from local mandatory closures. The original text of the order led local officials who had adopted shelter-in-place orders to believe that their ordinances had been superseded. Two days later, Reeves issued an addendum to his order clarifying that local officials could still adopt their own lists for which businesses could remain open.
In an interview with Mississippi Today on Monday, Reeves defended his handling of the crisis and his decision not to issue a statewide shelter-in-place order. “What’s happening in New York, California, and Washington, and particularly in where they are in the cycle and the curve, is very different than what’s happening in Mississippi and Alabama and other Southern states,” Reeves said, adding that when he reached out to the White House, members of the task force headed by Vice President Mike Pence recommended that he not issue a statewide order.
The inconsistency among and within states “is a pretty direct reflection of the absence of clear federal guidance,” says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development and a member of a World Health Organization committee on health emergencies. “The president had more or less told the states to just go figure it out on their own. And we were hearing from the mayors’ and the governors’ offices that we were talking to, that they felt they were sort of flying blind.”
The Center for Global Development, with outside experts, created a comprehensive guide to help local officials develop effective strategies to combat the outbreak in the absence of federal guidance. Konyndyk says that he and his coauthors have been surprised at the outpouring of demand from local officials in the US and abroad since the guide was released in late March.