JEFFERSON CITY — As hard-hit areas in Missouri continue to confront the COVID-19 pandemic, the end of the statewide stay-at-home order means more pressure on local health departments, especially in smaller, rural cities and counties.
The first phase of Gov. Mike Parson’s reopening plan, which goes into effect Monday, allows businesses, religious services and social gatherings to resume — as long as people continue to abide by social distancing rules.
Some local stay-at-home orders will stay in place, including in St. Louis and St. Louis County. That continues what has been a patchwork of city and county restrictions across the state, reflecting different opinions on how best to deal with the interlocking public health and economic crises.
Meanwhile, a handful of rural counties are still grappling with high rates of COVID-19 cases, and some are enacting their own stay-at-home orders for the first time. Other rural areas with lower rates of infection have cut short their orders, citing better numbers and the governor’s messaging as the main reasons.
Still, several local health department officials contacted by the Post-Dispatch are concerned about a surge in COVID-19 cases when stay-at-home orders expire. Their agencies have been taxed by the crisis, with employees putting in already long hours. Many are exhausted, and their critical role in slowing the spread of the virus is not over.
Lynelle Phillips, vice president of the Missouri Public Health Association, said it’s not clear what the end of Parson’s order will mean for public health.
“We’re all trying to figure out if it’s a good idea,” she said.
Phillips, who is also a professor of public health at the University of Missouri, said the coronavirus will continue to spread as people leave their homes. And the burden of dealing with a new wave of cases will fall on local public health departments.
“They’re exhausted,” she said. “They’re actually going to have to step up more when they’re running on fumes. So we’re worried about them.”
Beginning late last month, a string of counties and cities in Missouri adopted local stay-at-home orders. More than 40 had restrictions as of last week.
Some, like Scott County in southeast Missouri, are allowing their orders to end along with the state’s.
Barry Cook, administrator for the Scott County Health Department, said the decision was based on the county’s case numbers, which had been improving in the past week or two.
The health department will keep an eye on what happens now in the county of 39,000 residents, he said. And if there’s a jump in cases, officials will consider putting the stay-at-home order back in place, Cook said.
“I truly expect everywhere to see a little bit of a resurgence because of opening things up,” he said. “I can’t see how we can’t have resurgence.”
Cook said he’s hopeful, but also said the county’s high case rate is still a concern. Scott County’s numbers are above the statewide rate, at 1.81 cases per 1,000 people as of Friday.
“Don’t get me wrong — I know that we have a significantly higher number than rural counties around us,” he said.
Meanwhile, Reynolds County, which had two reported cases, also decided to cut short its stay-at-home order, originally set to last through May 11.
Frances Vermillion, director of the county health center, said Parson’s decision meant people weren’t going to stay home any more.
“Once the governor said we were going to open, it was moot,” she said.
In late March, Vermillion told the Post-Dispatch she wanted Parson to issue a statewide order, saying it was the only way to get a handle on the virus.
Reynolds County enacted its own order in early April. The county is a tourist destination, and the restrictions were aimed at discouraging outsiders from visiting, Vermillion said. She remembers seeing campers and license plates from all over the country: Utah, California, even Alaska.
“We had simply seen way too many people from out of state here,” Vermillion said.
Rural hot spots
Other rural counties are grappling with much worse outbreaks. For now, some are staying in lockdown.
Saline County, which has a population of around 23,000, has the highest per capita rate of known COVID-19 cases in the state. On Friday, the county had 190 cases and a rate of 8.22 per 1,000 people, according to a Post-Dispatch analysis of data.
On Friday, the Saline County Health Department announced on Facebook that its own “mitigation order” would remain until May 10.
“In the next week, we encourage businesses to come up with a plan for a soft opening,” the department wrote. “Every business, restaurant, and facility: you must be responsible for yourselves and the people coming in your establishment.”
Meanwhile, Moniteau County, which also has a high rate of cases, is enacting a local stay-at-home for the first time.
“It’s essentially just the state order extended out a little so I can get my cases to drop a little,” said Darrell Hendrickson, spokesman for the Moniteau County Health Center.
He said the county needed to see a decline in new cases for 14 days before it could lift the order. The county’s just not there yet, he said.
“We started to level off, and we’re starting to come down,” Hendrickson said.
When asked whether lifting the state’s order would hurt the county’s efforts, Hendrickson again cited his own declining numbers and said he was hopeful.
“We’re looking good today,” he said Thursday.
At least some of the cases in both counties are tied to outbreaks of COVID-19 at meatpacking facilities.
The continuing outbreaks in Saline and Moniteau are also of concern to nearby Boone County, which plans to lift its own stay-at-home order on Monday.
Stephanie Browning, director of the Columbia/Boone County Department of Public Health, said in a news briefing Thursday that the department would continue to monitor those counties.
Columbia and Boone County are following a reopening blueprint similar to Parson’s, though slightly more restrictive.
Mayor Brian Treece said the county and city have had a sustained reduction in positive cases for the past two weeks.
Boone County’s success is an example of a successful public health approach, said Phillips, the professor of public health.
“They’ve been able to step up and really get their arms around their cases,” she said.
As stay-at-home orders are removed and testing becomes more widespread, new cases will emerge. The responsibility for dealing with them will fall to already exhausted local agencies, said MU’s Phillips.
The main issue is contact tracing — the labor-intensive process of tracking and monitoring the contacts of people infected with a disease to prevent them from spreading it.
“It’s a gazillion phone calls,” Phillips said.
While other states are hiring hundreds or even thousands of new workers for the job, Phillips said she hasn’t heard anything from Missouri about doing so.
The National Association of County and City Health Officials has recommended that states hire 30 contact tracers for every 100,000 people.
“Yeah, it’s expensive, but it’s expensive not to,” she said. “Suppose the contact you miss is a nursing aid in a nursing home.”
On Thursday, Commissioner of Higher Education Zora Mulligan said at a news briefing that the state would be working with colleges and universities to recruit new contact tracers, but she provided few details.
Meanwhile, St. Louis County said last week that it’s hiring 100 new workers for the job. Previously, the county had 70 people in its contact tracing workforce.
Missouri’s public health system remains chronically underfunded, which continues to be a problem, Phillips said.
She posed an analogy: When you’re on an airplane and oxygen masks drop down, they say put yours on first before helping others. It’s like that, she said.
“Fund your local public health department first and they can take care of everybody else,” she said.
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