It’s been about a month since the COVID-19 novel coronavirus came to southwest Missouri.
Precautions for the pandemic began in Christian County ramped up on March 11, and escalated into full stay-at-home orders on March 26. Three weeks have elapsed since the stay-at-home orders in Ozark, Nixa and the rest of Christian County went into effect, and the confirmed count of lab-tested positive COVID-19 patients from Christian County is now 18.
Missouri logged its first coronavirus case March 7, in St. Louis. The first case in southwest Missouri was confirmed on March 14, in Greene County. The first positive cases in Christian County occurred with persons from Ozark on March 18.
The count now stands at 10 patients from Nixa, four from Ozark and four from Sparta.
What it all means, according to Christian County Health Department Administrator Cindy Bilyeu, is that the preventative measures to slow the spread of the virus are working.
“We must all assume that we could be infected by any person we encounter and any home or business we enter. Everyone must physically distance themselves and continue to practice thorough hand-washing techniques,” Bilyeu said. “As we learn more about COVID-19 with each passing day, we will continue to work with our partners across the county to carry out our mission to protect the health of Christian County’s citizens.”
A regional approach, Bilyeu said, is the best approach.
In neighboring Greene County, where about 80 percent of Christian County’s working population would travel to several days per week for employment, there have been 81 documented cases of COVID-19. As of April 15, 43 of those persons are considered “recovered” from the virus under CDC guidelines, 30 cases are still active and eight people are dead.
Springfield-Greene County Health Department director Clay Goddard said that it’s difficult to gauge the overall impact that the virus has had on southwest Missouri due to a limited supply of COVID-19 tests across Missouri.
“In this past month, testing has been limited, and that there have been people who have sought testing who did not qualify for that testing that they desire. In recent weeks, our community has worked hard to expand access to testing,” Goddard said.
Goddard announced on April 14 that health care providers in the Springfield area have worked to lessen the restrictions on COVID-19 testing, “to further expand our understanding of the spread of COVID-19 in our area.”
“Expanding testing capacity in our community will be an important part of our strategy moving forward as we look to what’s next. We have to be looking at data and science to inform our next steps in containing this disease,” Goddard said.
Goddard cautioned southwest Missouri residents who may feel that the proverbial curve has been flattened, or that Springfield and the surrounding areas have hit the peak of the pandemic.
“I am very much encouraged that our numbers seem to be moving in the right direction, but this isn’t the time to declare, ‘mission accomplished.’ We have to remain vigilant. We have to be taking precautions for our health, and we have to stay the course,” Goddard said.
Social distancing and stay-at-home orders have given southwest Missourians a measure of influence over the virus, according to Goddard, but he is not crying out victory.
“Ignoring the practices that got us to this encouraging moment only puts us at risk of going right back to where we started as a community,” Goddard said. “This means continuing to stay at home and finding the right phase-out approach to coming out of these orders.”
Social distancing orders in Christian County are set to expire at 11:59 p.m. on April 24, barring extensions from the mayors or Ozark and Nixa and/or the Christian County Commission.
Springfield’s main hospitals
Christian County does not have a hospital within its boundaries, which means patients in need of care usually travel to Cox or Mercy hospitals in Springfield, especially in emergency or urgent care situations.
Mercy Springfield has a total of 914 hospital beds, 99 of which can be used to treat patients in negative pressure settings. Negative pressure is a technique used to prevent cross-contamination from one hospital room to another, and is used to isolate contagious diseases, such as the coronavirus.
Data from the Missouri Department of Health and Senior Services shows CoxHealth’s south Springfield hospital has 100 negative pressure beds.
In March, both Mercy and CoxHealth renovated existing spaces within their main Springfield hospitals to accommodate more negative pressure capacity, and in turn, more COVID-19 positive patients should the needs arise.
CoxHealth rebuilt a floor of its hospital into ward-style areas for COVID-19 patients who require ventilator support.
“When Cox South doubled in size five years ago, several floors of the new tower were left empty so we could develop the space as needs arose,” says Steve Edwards, president and CEO of CoxHealth. “A need in our community is now here, and we are ready to help our patients have the best chance of recovery that we can give them by developing some of that space. I pray it is never used.”
Edwards has been forthcoming on Twitter with his thoughts and with statistics as the timeline of the COVID-19 pandemic has progressed in southwest Missouri.
On April 13, Edwards tweeted stats from CoxHealth’s share of COVID-19 treatment in southwest Missouri. The figures showed eight patients in the hospital with positive COVID-19 tests, and 17 patients who were awaiting test results from the lab. At that time, CoxHealth had reported six deaths, and had discharged seven patients who showed signs of improvement to their homes. CoxHealth has treated a total of 54 COVID-19 positive patients. Four of those patients were intubated and on ventilators as of April 13, according to Edwards.
At the moment, Springfield has adequate negative pressure capacity and ventilators to handle the workload that the coronavirus currently presents.
Herb Kuhn, president and CEO of the Missouri Hospital Association spoke at a gubernatorial press briefing on April 13.
Kuhn said that Missouri hospitals have been part of the federal Hospital Preparedness Program (HPP) since 2002. It started as a way for hospitals to acquire equipment. It has evolved, Kuhn said, as a way for hospitals to share information and create training opportunities.
“All of that has helped us to prepare for the state surge as we move forward,” Kuhn said.
Missouri Gov. Mike Parson has been holding weekly conference calls with leaders from every hospital in the state.
“We are in constant communication with doctors and hospitals across the state. From converting ICU beds to training health care personnel and establishing remote testing sites, our hospitals and health care workers have responded to COVID-19 without hesitation,” Parson said.
Like Goddard in Greene County, the governor said that Missouri would use mathematical data to determine when to relax social distancing guidelines and stay-at-home orders.
“We’re going to look at Missouri data to figure out how we’re going to make those decisions, and where these cases are. Where are the hot spot areas? And how do we get pieces—and it probably will be pieces—how do we start the economy back up? And that’ll probably be in phases,” Parson said.
Missouri Hospital Association members also maintain mutual aid agreements with one another, allowing for the shifting of people and supplies to deal with capacity issues in the events of crises.
“When the coronavirus reached the shores of this country, a lot of folks thought that it would attack the country evenly as we went forward, and whether a mutual aid agreement would be effective,” Kuhn said. “But what we’ve seen is the coronavirus is acting more like the flu, and as a result, this mutual aid agreement, as it moves from community to community, will be very helpful for us to deal with issues if we need them.”
That doesn’t mean that the coronavirus is like the flu in the way that it attacks the body or in the rate that it spreads.
Examining death rates: COVID-19 vs. influenza
According to data from the Johns Hopkins University School of Medicine, influenza typically impacts about 1 billion people around the globe, including anywhere between 9.3 million and 45 million cases in the United States every year.
The death rate for medical patients with influenza computes to about sixth hundredths of a percent (0.06) worldwide. Using maximum case rates and maximum death totals from Johns Hopkins, we calculate a maximum influenza death rate of 0.135 percent (1.35 tenths of a percent) in the United States, using the high sides of the range
Using the high side of the American death rate against the low side of the total cases range, i.e. an unlikely yet possibly statistical case, we can calculate a death rate of 0.006 percent (6.5 tenths of a percent).
As of April 15, there have been 127,601 deaths from COVID-19 across the globe. According to the Johns Hopkins data, 26,059 of those deaths are in the United States.
As of April 15, the worldwide death rate (persons who have died of COVID-19 divided by the total number of reported cases of COVID-19) is 6.38 percent. The death rate for Americans with documented cases of COVID-19 is 4.2 percent.
The Centers for Disease Control, in an ongoing report comparing COVID-19 deaths state-by-state with deaths from influenza and pneumonia, warns that COVID-19 deaths may be misclassified due to a shortage of COVID-19 testing in some areas.
“Deaths due to COVID-19 may be misclassified as pneumonia or influenza deaths in the absence of positive test results, and pneumonia or influenza may appear on death certificates as a comorbid condition,” the report reads. “Additionally, COVID-19 symptoms can be similar to influenza-like illness, thus deaths may be misclassified as influenza. Thus, increases in pneumonia and influenza deaths may be an indicator of excess COVID-19-related mortality.”
The estimates from the CDC are based on provisional data from the National Vital Statistics System. the CDC classifies death causes in accordance with guidelines from the World Health Organization.