(CNN) Warning signs about a Covid-19 spike have been flashing red in Florida this fall: Coronavirus hospitalizations have been rising since November, the test positivity rate is double what it was in early October, and the tally of new daily cases is nearing the state's July peak.
But Floridians who rely on Gov. Ron DeSantis and his administration might hardly know the pandemic is still a serious danger.
The Florida health department's social media feeds have barely mentioned Covid-19 in months, breaking the silence only this week to celebrate the arrival of the first vaccines. DeSantis has consistently downplayed the severity of the pandemic, following President Donald Trump's lead in denouncing mask mandates and restrictions on businesses. The governor has blocked local governments from enforcing their own measures to protect residents from coronavirus, and sidelined health experts even as he promoted questionable science, according to CNN interviews with more than a dozen Florida officials and experts.
Two Florida health department employees told CNN that the agency's former communications director ordered them in late September not to focus on Covid-19 in their public messaging. They said they believed their jobs would be in jeopardy if they pushed back.
"We're putting politics in front of lives," said one of the health officials, who asked not to be named to avoid retaliation. "We are being handcuffed and kept from keeping the public properly informed so they can make informed decisions to protect their lives and the lives of others."
Governors have emerged as the key figures in America's response to the coronavirus pandemic, with decisions by individual leaders broadly shaping policy in their states. As cases climbed around the country, even some Republican governors who previously opposed mask mandates or social distancing rules have reversed course, with GOP leaders in Iowa, North Dakota, Alabama and elsewhere putting new restrictions in place as their states spiked.
DeSantis has so far refused to do so this fall, and his administration has continued to air misinformation about the pandemic, as investigations by the South Florida Sun-Sentinel and other news outlets in the state have previously found. To the frustration of local mayors from both parties, he continues to ban cities and counties from enforcing mask mandates or setting stricter capacity limits on businesses and restaurants.
"I gave up talking to the governor a while back," said Hialeah Mayor Carlos Hernandez, a registered Republican, who said that his calls and letters to DeSantis pleading for more flexibility have gone unanswered for months. "It's a large city here, but I feel sometimes we have been left alone."
DeSantis' office did not answer CNN's questions about the state's handling of the pandemic or make the governor available for an interview, and the health department did not respond to repeated requests for comment. In public statements, DeSantis has argued that the state's response was focused on protecting the elderly and vulnerable while keeping businesses open.
More than 1.1 million Floridians have tested positive for Covid-19 so far, about 5% of the state's population. Florida is the 26th highest state by per capita confirmed cases, according to data from Johns Hopkins University, putting it in the middle of the pack for the country. On Thursday, the state reported its highest new daily case count since July.
Some parts of the state have been hit harder than others: Miami-Dade County, Florida's largest urban center, has the highest per capita rate of confirmed coronavirus cases of any of the 50 most populous counties in the US, a CNN analysis of the Johns Hopkins data found.
As a close ally of President Trump, DeSantis seems to have modeled his approach to the pandemic on the President's strategy of denial. And in the key swing state, some observers see the governor's unwillingness to air bad news in the months before the election as a political gift to Trump.
"I think this governor is absolutely following whatever the President says and does, and I think he thinks this is going to help him get elected," said St. Petersburg Mayor Rick Kriseman, a Democrat. "It's really quite remarkable, the lack of leadership."
Unlike in many states, Florida counties don't have their own independent health agencies. Instead, county health offices are local bureaus of the state department, funded through a mix of state and county revenues.
That means that the state health department -- and ultimately DeSantis -- have even more direct power to shape the public health messaging and pandemic response affecting the state.
The two Department of Health employees who told CNN they felt constrained to share more information with the public said that Alberto Moscoso, the department's former director of communications, instructed county health spokespeople not to focus on Covid-19 during a conference call in late September. Instead, they said, he urged them to practice "blue sky" messaging -- a PR tactic that prioritizes good news in order to distract attention from crises.
The department's Twitter feed was a textbook example of how that messaging strategy works. In the first few months of the pandemic, the health department had a prolific presence on social media: Between March and August, the department's account sent out an average of about 139 tweets a month that included the words "coronavirus," "covid" or "pandemic" -- more than four a day.
But that changed dramatically after DeSantis signed the order initiating Florida's final phase of reopening on September 25. Starting that day, the state health department almost completely stopped sending tweets mentioning the virus. Instead, it shared messages on topics like the dangers of infections from floodwater, the importance of screening for hearing loss in newborns, and suggestions for how to safely defrost a turkey.
The Twitter account made no mention of how daily tallies of newly confirmed coronavirus cases, hospitalizations and deaths were on the rise -- although it did retweet a handful of tweets from DeSantis that touted upcoming vaccines, and also posted an image and link to a Covid-19 safety tip sheet.
The Covid messaging drought lasted until the state's triumphant announcement this week that the first doses of a Covid-19 vaccine were being administered.
The department's Facebook page saw a similar scarcity of Covid messaging in recent months. And on the department website's homepage, announcements promoted diabetes awareness month and flu shots, while a message about Covid was relegated to a small banner at the top of the page, according to recent snapshots captured by the Internet Archive's Wayback Machine.
Caught between instructions from the central office and providing accurate information during the biggest public health crisis in a generation, the two health officials told CNN they felt like they were walking a tightrope.
"It is difficult, but it is doable," one of the health department employees said. "Sometimes, I ask my partner organizations to use my messaging or get it out through interviews with experts... we all just figured out different ways to get around the rules."
The other health official said it was frustrating to see misinformation about the pandemic going viral and finding themselves unable to respond with facts.
"We could have saved a lot more lives if we were allowed to do our jobs," the official said.
Still, other employees working in the county health offices insisted that they hadn't experienced any kind of directives from the state preventing them from talking about Covid -- or said that it made sense that state officials would set standardized messages.
"I've never felt I was being asked or pressured about what information we could share with the public regarding Covid," said Melissa Watts, the public information officer for the state health department's branch in Pasco County. "There was no interaction about what we could or could not tweet. I shared any information I considered appropriate in doing my job."
The state and county governments did continue to publish information and data about Covid over the last few months. The state health department put out a daily press release about the latest virus numbers, and updated an online dashboard with a variety of statistics and maps about the pandemic.
Moscoso, the communications director who the two employees said had delivered the order to stay silent on Covid, left the department on November 6, and did not respond to requests for comment. The Sun-Sentinel has also reported allegations from health officials that they were muzzled by the former communications director.
DeSantis and the health department did not answer CNN's questions about the officials' claims. Fred Piccolo, the governor's spokesperson, told the Sun-Sentinel that "messaging on prevention and COVID-19 has reached saturation," arguing that Floridians are already doing everything they can to stop the virus' spread.
But experts said they were surprised by the lack of Covid messaging from the department. Dr. Marissa Levine, a public health professor at the University of South Florida and the former health commissioner for the state of Virginia, called it "very concerning."
"Denial may be our biggest challenge," Levine said. "It's a really important time to be putting out messages in all media that are consistent and coherent."
Delays in when Florida reported coronavirus deaths have also raised questions about how transparent the state was about the severity of the pandemic in the run-up to Election Day.
There's often a delay between someone dying from Covid-19 and their death showing up in Florida's public statistics. But from late October through mid-November, the state saw a significant decrease in reporting deaths that had taken place more than a month earlier, according to estimates collected by USF health professor Jason Salemi, a trend that was first reported by the Sun-Sentinel.
Throughout most of the fall, the state reported dozens or hundreds of these backlogged deaths every week. But from October 24 to November 7, the state reported a total of just four deaths that had taken place more than a month earlier.
The reported drop in deaths wasn't because the state had caught up on its backlog -- it went back to reporting dozens of month-old deaths during the week after Election Day and in the weeks that followed. The temporary decline painted a rosier picture of the pandemic in Florida as voters were going to the polls.
It's not clear whether there was any political motivation behind the change, and the health department did not respond to questions about the data. On October 21, a few days before the drop in backlogged cases began, the department said it would scrutinize reported Covid deaths more closely to make sure they were caused by the virus. That shift in procedures could have led to the dip in the data, Salemi said.
"It could be they're taking more time with certain deaths," Salemi told CNN. "This to me is all a bit of a black box."
Over the course of the pandemic, DeSantis has followed in Trump's footsteps in criticizing policies designed to slow the virus' spread, such as mask mandates and restrictions on restaurants and bars. And as cases have risen this fall, he's refused to allow cities to put in place stricter rules than the state -- leaving local mayors feeling defenseless.
A CNN review of DeSantis' public statements about Covid over the last nine months found that he has been quick to comment on vaccines or therapies but slow to talk about increasing case rates or methods to slow the spread.
Nearly from the start of the crisis, DeSantis denounced what he described as "draconian, arbitrary restrictions that have nothing to do with public health" in other states around the country. In a Fox News interview in mid-May, he argued that "some of this stuff... has devolved into social control" and "absolutely it's gotten out of hand."
He all but declared victory over the virus at a May 20 press conference, comparing Florida to New York and boasting that "we have a lower death rate than the Acela corridor, DC, everyone up there... We've succeeded and I think that people just don't want to recognize it."
The following month, however, cases began to spike. While DeSantis urged Floridians to follow social distancing guidelines, he still found ways to play down the virus, arguing that the pandemic was mostly hitting younger Floridians who faced far lower death rates than their parents and grandparents. And he parroted Trump's approach of blaming rising cases on increased testing and touting unproven drugs like hydroxychloroquine.
In mid-July, daily Covid cases hit a record peak of 15,300 and hospitalizations soared. Hospitals in Miami-Dade County -- the epicenter of the crisis -- had to convert regular beds to ICU beds. And DeSantis had to face reality -- he sent nurses and health care workers to Miami-Dade and other counties to tend to the sick.
After cases declined in August and September, DeSantis announced on September 25 that he would move the state to "phase three" reopening -- lifting all state restrictions on businesses, banning local governments from enforcing mask mandates with fines, and limiting those governments' ability to cap restaurant and bar capacity. "Every business has the right to operate," he said at a press conference. "You can't just say 'no' after six months and just have people twisting in the wind."
Now, two and a half months after the reopening order, cases and hospitalizations are again rising, with the average daily cases topping 10,000 this week -- not far from the seven-day average in mid-July. This time, however, DeSantis has held firm on avoiding new state mandates and blocking local governments from going further.
There will be "no lockdowns, no fines, no school closures" in Florida, DeSantis declared on November 30 -- a few days before the state recorded its highest new daily cases in more than four months. "No one's losing their job because of a government dictate," he said. "Nobody's losing their livelihood or their business. That is totally off the table."
Local mayors told CNN that the lack of autonomy to set their own policies on issues from masks to bar restrictions had hamstrung their ability to respond effectively to the pandemic.
Hernandez, the Hialeah mayor, said that while he wants to keep businesses open, too, the best way to do that is with common-sense regulations. Under DeSantis' executive order, the city can fine businesses -- but not the people breaking the rules.
During the summer, "people in public places were wearing masks because they knew they could be fined," Hernandez said. But now, he said, some people walk around in public without any face covering because they know the government can't force them to put on a mask.
"I think that's why you see these numbers go up," Hernandez said.
The mayors also said they were befuddled by the lack of communication from the governor and his office, which they said had failed to even respond to their requests to discuss new policies.
"From the beginning, the communication from the governor's office has been atrocious," said Kriseman, the St. Petersburg mayor. He said that DeSantis' order reopening the state, and his comments denouncing restrictions, had led to a widespread impression among the public that "masks were not required any more, social distancing was not required any more." DeSantis' approach "has resulted in additional cases," he argued.
Still, political observers in the state say DeSantis is unlikely to pay any political price for his handling of coronavirus. If anything, Trump's recent Sunshine State victory suggests DeSantis' messaging proved effective, said Steve Vancore, a Florida pollster and political consultant who has worked with candidates and groups of both parties.
"Any negativity about his handling of coronavirus did not translate on Election Day," Vancore said, adding that the President's three percentage point win was "as much a victory for DeSantis as it was for Trump."
Throughout the pandemic, DeSantis followed the President's lead on another issue: the experts he's listening to. DeSantis has surrounded himself with commentators who have denied or played down the severity of the pandemic, even as his administration has sidelined experts both inside and outside the state government.
In August, DeSantis held a series of events with Dr. Scott Atlas, a California radiologist who served as an adviser to Trump, in which Atlas touted the governor's laissez-faire approach to the pandemic, the Sun-Sentinel reported. Atlas, who had pushed for a herd immunity strategy widely criticized by most mainstream health experts, has been condemned by his own colleagues at Stanford University and resigned from his White House position earlier this month.
And in one especially questionable hiring decision, DeSantis' administration hired a former Ohio sports blogger and Uber driver who had aired conspiracy theories about the virus to be a data analyst with a portfolio that included Covid-19 work.
In tweets and posts on a sports blog, Kyle Lamb had previously claimed that masks and lockdowns don't work, that Covid-19 is no more deadly than the flu, and that the pandemic might be part of a Chinese "biowar." He joined the state's Office of Policy and Budget last month, an appointment first reported by the Tampa Bay Times.
Lamb declined comment for this story. A DeSantis spokesperson told the Times that he wouldn't work "exclusively" on issues related to the pandemic and that his work would be reviewed by other staffers.
Meanwhile, more prominent voices in state government who had aired early warnings about the pandemic seemed to disappear from public view. Florida's surgeon general, Dr. Scott Rivkees, has largely avoided public messaging after he suggested at an April news conference that social distancing practices could be necessary for another year. Rivkees did not respond to an interview request.
And the department has also been reluctant to share its copious data on how Covid is spreading in the state. Early in the pandemic, the Miami Herald and other state news organizations had to threaten to sue the state before it released numbers about cases in nursing homes and assisted living facilities. More recently, the Orlando Sentinel sued the governor this month after his office failed to provide White House coronavirus task force reports about Florida.
Top scientists at the University of Florida College of Medicine told CNN that deans at private and public medical schools requested the health department share other data earlier this year, so that the schools could provide the state government with free, advanced statistical modeling and help officials better understand Covid-19's spread.
During an initial conference call, health department officials were receptive to the idea, said Thomas Unnasch, an infectious disease expert at USF. But the effort soon ran into red tape: the health department told the group that they couldn't access the data unless they filed a separate application for every modeling project the scientists wanted to do, Unnasch said.
The response from the department was "basically slow walking everything," Unnasch said. "It was, 'Well, thanks, but we're really not interested in collaborating with you."
"It was like being ghosted after a date," he said.
The plans for a partnership soon unraveled. If the health department had opened up its data to the experts, the professors said they could have determined whether Floridians were being diagnosed in consistent ways throughout the state, identified any flaws in the data and helped to fix them, and conducted sophisticated mapping of the virus' spread.
Dr. Jay Wolfson, the senior associate dean for health policy and practice at USF, told CNN that he had expected the agency to relish getting help crunching the numbers. He said he didn't understand why the department was reluctant to partner with the experts.
The pandemic was "like a tidal wave coming at us," Wolfson said, and instead of rushing to higher ground, "we were told to swim."