TAMPA BAY, Fla. _ As the novel coronavirus has spread across Florida, much has remained uncertain about how long it will stay, how many it will infect and how many lives it will take.
But the virus' grip on the state's older adults is tragically clear.
In Florida, 83% of those who've died of the virus were over 65 years old. One in four people over 85 with a confirmed infection has died.
Outbreaks have devastated nursing homes in nearly every corner of the state, from the Panhandle down to the Atlantic coast. Some of the deadliest have occurred in the greater Tampa Bay region.
The percentage of deaths tied to care centers has been steadily increasing over the past several weeks. Now, at least 43% of deaths statewide can be attributed to long-term care facilities _ the equivalent of 875 lives lost.
Gov. Ron DeSantis has listed the safety of the state's most vulnerable as his top priority during the epidemic. He has touted Florida's lower fatality rate, comparing it to less-populous states with higher death tolls.
But since the end of April, the death rate in Florida's long-term care facilities has doubled.
Florida's coronavirus deaths have not reached the levels some experts feared, or that some academic models predicted were possible. Still, on Saturday the state death toll was 2,040.
Among the dead are:
_ Bob Barnum, a 64-year-old St. Petersburg real estate agent who loved theater and championed equal rights for the LGBT community.
_ Luis Alpiste, 79, a former construction worker and father of four in Miami who used to wake his children at midnight on their birthdays.
_ Joyce Lee, a 96-year-old great-great-grandmother, who lived in Miramar, last worked as a housekeeper and loved her garden of fruits, vegetables and flowers.
To better understand the lives claimed by the coronavirus in Florida, the Tampa Bay Times analyzed data and reports from the Florida Department of Health and medical examiners offices around the state. The Times analysis includes deaths counted by medical examiners through May 13.
Medical examiners count anyone who dies within the counties their offices serve, including residents of other states.
The health department's published counts only include deaths of Florida residents, excluding visitors or some snowbirds. State officials do track nonresident deaths in their fuller data.
In Florida, under state law, only medical examiners can determine whether a death was caused by the coronavirus.
Health department officials count anyone who tested positive for the virus and later died, no matter the cause of death, said Alberto Moscoso, a Florida Department of Health spokesman.
"For example, if an individual tests positive for COVID-19 and then dies as a result of an accident, that case would be included in the department's list of deaths associated with COVID-19," Moscoso told the Times.
It's unclear what methodology health officials are using to calculate the numbers, or how many deaths not directly caused by COVID-19 are being counted. As of May 13, the state's death count stood 6.7% higher than the medical examiners' master list. In prior weeks, the medical examiners' tally was higher.
Moscoso said health officials receive reports of deaths from many groups of people, including medical examiners, hospitals, nursing homes and families.
The Times gathered records from medical examiners in 21 of the state's 22 districts, accounting for 1,539 deaths. Separately, the Times received a copy of a master list of coronavirus-related deaths from the state's Medical Examiners Commission.
Most people who had a specific cause of death listed, beyond COVID-19, died of acute respiratory distress syndrome or pneumonia.
Among the medical examiner offices that included information about symptoms in their data, the most commonly reported ones were fever, cough and shortness of breath.
The average age of those who've died was 77 years old. Fifty-seven percent were men. About 63% were white.
Cities and states across the country have seen significant over-representations of black residents dying of the coronavirus.
Black Floridians account for about 20% of the state's fatalities, and 16% of Florida's overall population, according to an analysis of data from medical examiners. In some counties, such as Broward and Manatee, the disparity in deaths among black residents is larger. In Broward, black residents make up roughly 28% of the population but 37% of deaths. In Manatee, black residents account for about 9% of the population and 17% of deaths.
Hispanic Floridians represent about 22% of the deaths, according to a Department of Health report. That's an under-representation when compared to the overall state population, where 26% identify as Hispanic.
The highest death rate in the state is in Suwannee County, where one of Florida's deadliest nursing home outbreaks occurred. Among larger counties, the highest is in Manatee, where outbreaks in several nursing homes have killed dozens.
Manatee's rate of 2 deaths per 10,000 residents is higher than the rates in Miami-Dade, Palm Beach and Broward counties, which together have formed Florida's epicenter for the virus. Combined, those South Florida counties represent 57% of recorded deaths.
The rates in Tampa Bay's largest counties are much lower. Pinellas has a rate of .67 deaths per 10,000 residents, while Hillsborough has a rate of .34.
Many people who have died of the coronavirus in Florida had an underlying medical condition, which is among the highest risk factors for becoming seriously ill from the disease.
Not all medical examiner offices provide detailed information about existing illnesses in their records. Among the ones that do _ including Miami-Dade, Pinellas, Hillsborough and Orange _ similar patterns can be seen.
The most common conditions were hypertension, diabetes and cardiovascular disease. Hundreds also had asthma, lung disease, cancer and kidney disease.
Dr. Erin Michos, a preventive cardiologist and associate professor at Johns Hopkins University School of Medicine in Baltimore, said people already living with a serious disease can have a harder time bouncing back from a new illness, such as COVID-19.
The coronavirus infects the lungs and can lead to pneumonia. As a person's lungs become inflamed and filled with fluid, breathing gets harder and harder. Many people with the virus develop very low oxygen levels, Michos said, because the infection in the lungs makes it harder for the body to circulate oxygen into the bloodstream.
The heart and the lungs work closely together to power the body: when there is stress on one, there can be stress on the other.
Having an existing medical problem, such as cardiovascular disease, means your body already is under stress. A new virus attacking the respiratory system makes the strain greater and greater.
"There's nothing more stressful than not being able to breathe," Michos said.
Experts say two things largely make older adults more susceptible to complications from COVID-19. The older you are, the more likely it is that you have existing health problems that limit your body's ability to respond to a new threat. As you age, your immune system naturally weakens, making it harder to fight off pathogens.
The likelihood of becoming seriously ill to the point of hospitalization also correlates with age.
In Florida, 39% of people 65 and older with confirmed infections were hospitalized at some point. Forty-three percent of people 75 and older were hospitalized.
The highest fatality rates in Florida have been seen in the oldest age groups of coronavirus patients.
About 1 in 12 people between 65 and 74 with confirmed cases died.
About 1 in 6 people between 75 and 84 died.
And about 1 in 4 people 85 and older died.
The Florida Department of Health has not recorded any coronavirus deaths among children.
The youngest confirmed fatality is a 26-year-old man in Miami-Dade County. He had a history of alcoholic cardiomyopathy and died at a hospital after developing pneumonia caused by COVID-19.
In Leon County, a 27-year-old man with a history of congestive heart failure, diabetes and hypertension endured a cough for a week and shortness of breath before going to a Tallahassee hospital. In the emergency room, his body went into acute respiratory arrest. His cause of death determined by the medical examiner: "acute respiratory failure due to pneumonia as a consequence of COVID-19."
In Palm Beach County, a 33-year-old woman, described as possibly immunocompromised, died after developing pneumonia from her COVID-19 infection.
Across Florida, more than 300 people under the age of 65 have died. Most of the deaths of people younger than 40 years old have occurred in South Florida.
About 19% of people who've become infected require hospitalization at some point. Of the hospitalizations, about 45% were among people who were younger than 65.
About 15% were younger than 45. And about 7% were younger than 35.
Of the people hospitalized overall, about 19% have died.
In some healthy, younger adults, doctors have seen the body's immune system over-respond to the virus, which can cause cardiac injury, Michos said.
"It's sort of a fallacy to think of this as just a disease of older adults," she said. "Really anybody is vulnerable."
Statewide, 4.5% of confirmed cases of coronavirus have ended in death _ a percentage that is lower than the national rate, which is about 5.7.
Calculating a case fatality rate, however, is problematic. The total number of coronavirus cases is unknown. People are believed to get sick and go undiagnosed. Some are asymptomatic. And some die from causes attributed to other things, such as pneumonia, with no mention of COVID-19.
It's more useful to watch the number of coronavirus deaths to essentially evaluate the epidemic's behavior in Florida than to predict someone's chances of dying, said Dr. Mary Jo Trepka, an infectious disease epidemiologist and professor at Florida International University in Miami.
"It's good to look at the case fatality rate, and to watch it over time," she said. "If for example, we see that it's going up, that could indicate fewer people are getting testing, or that different groups of people are being infected."
Regionally, according to state figures, residents and staff of long-term care centers account for at least 159 coronavirus deaths.
