Florida and Ontario - Why the divergence in Covid results?

Simple people like simple solutions.  We've had it drilled into our collective little brains that the only measure to fight the novel and mostly benign coronavirus is with social distancing and isolation measures, more broadly referred to as "locking down".  Hence when one jurisdiction has differing results from another the automatic assumption by many is that the results are directly linked to these measures.

Florida has opened up businesses like bars and restaurants and has seen a spike in identified cases, hence the argument is that one caused the other.  While I don't doubt for a second that opening up businesses somewhat increases the rate of transmission I do believe there are other important factors that are being ignored.  And in my mind the biggest factor is testing.  Florida is processing a massive number of tests when compared to Ontario.  On Friday the Sunshine State conducted over 78,000 tests, a record number.  

Ontario by contrast only conducted 33,492 tests, also a record for this province, but less than half of what Florida tested.  Given the number of people who contract the virus without being aware of it because the symptoms are either incredibly mild or totally absent, it stands to reason that if Ontario more than doubled the number of tests, then our identified case number would also climb substantially.  

Just to put this into even more perspective, the 78+ thousand tests conducted by Florida in one day is more than the nation of Taiwan has conducted altogether since the start of the pandemic.  

Taiwan is a country people like to point to as having done a tremendous job in battling this novel virus, and I would argue a large part of their success can be attributed to the lack of testing.  Call it the Donald Trump approach.  If you want to make it look like you're doing a good job just don't conduct the necessary measurements to gauge the results.

So we have a couple factors in play now that could reasonably be pointed to as explaining why Florida has seen its number of identified cases climbing.  One being the opening up of the economy with places like bars and restaurants able to operate again, and increased testing to catch more of the mild and asymptomatic cases. 

Are there perhaps other reasons why Florida is seeing more cases than Ontario, even on a per capita basis?  I think there are several more, the biggest one being population density.  

Florida has more people living in a smaller space than Ontario.  Florida's population density is 136.4 people per square kilometre, while in Ontario it's only 14 per sq km.  I know some might argue that a large number of people in Ontario live in the GTA, and that's true at about 6 million.  But that's about the same as in the Greater Miami Area.  After that the comparison breaks completely down though as Florida has more large population centres.  The sprawling Ottawa area in the only other Ontario metropolitan centre with around 1 million people, Florida has Tampa at 2.4 million, Orlando at 1.5 million and Jacksonville at 1.3 million.  

Also consider agriculture, we've seen in Ontario how hard migrant workers have been hit in the Windsor Essex region.  Florida also has a large farming industry, and as in Ontario a large number of migrant workers are employed.   While Ontario's agriculture sector is just beginning to ramp up with the harvesting of crops like asparagus, Florida's by contrast is largely year round.

Another major consideration is our differing health care systems.  While Canadian provinces have a single payer government run system where the focus is on reducing costs, for American hospitals the goal is profit.  Ironically this pandemic has hammered the U.S. health care industry with reports of hundreds of thousands of workers being laid off as hospitals (like in Canada) operating far below capacity.  The recent surge is probably being welcomed by American hospital administrators staring at a lot of red ink lately.  

With so many other health services curtailed or stopped completely, Covid is in many ways the only game in town for hospitals to generate revenue right now.  And with government funded Medicare and Medicaid each patient that can be treated for Covid means much needed billings, Medicare reportedly pays up around $30,000 for each Covid patient put on a ventilator.  The profit motive in my mind is a dangerous thing when it comes to delivering quality health care.  

Beyond increased testing, a denser population and for profit health care there are other socio-economic reasons that I believe contribute to Florida being worse off than Ontario in controlling the pandemic.  The United States does not have a social safety net that runs as wide and as deep as we have in Canada, and poverty is proven to be a big driver in negative health outcomes.  Add in the larger numbers of people likely to be Vitamin D deficient in Florida as compared to Ontario and that just adds to the numbers.

Bottom line is that there is no silver bullet.  Ontario is not Florida, and there are multiple factors in play that can explain why their numbers are so much worse that what we're seeing in Ontario.  Ultimately the solution to making the situation look good in either jurisdiction may be to simply follow the lead of countries like Japan and Taiwan and hardly do any testing.  

If a tree falls in the forest and nobody is around, does it make a sound?  Conversely if someone contracts the novel coronavirus but never gets sick or tested, then is that really a case?