In October, Dr. Alex Garza, chief medical officer for St. Louis-based SSM Health, sat down to write an article titled “Guns, Germs and Health Care: Lessons Observed and Learned.”
It was a chilling foresight into what our region is now facing.
“In many ways, however, infectious diseases are similar to gun violence,” Garza wrote. “They affect the poor and vulnerable disproportionately and can span from small intense episodes, such as a case of meningitis or sepsis, to full-blown disasters, such as the H1N1 pandemic or recent Ebola virus outbreaks.”
He wrote the article before the first novel coronavirus case was reported on November 17 in China.
Now Garza is the face of the St. Louis region’s medical response to COVID-19. He is the incident commander for the St. Louis Metropolitan Pandemic Task Force, which includes four major health care systems: BJC HealthCare, Mercy, SSM Health and St Luke’s Hospital.
Every day, he gives a briefing on the task force’s COVID-19 statistics that represent 2.8 million people in the larger St. Louis region.
“It’s weird because it’s now playing out,” Garza told TheAmerican, regarding the October article.
Unlike their colleagues in Illinois, the Missouri Department of Health and Senior Services officials have not released data on race in COVID-19 statistics — though elected officials can confirm that the department is collecting it. In Illinois, groups of color accounted for 48 percent of confirmed cases and 56 percent of deaths, while only making up 39 percent of the state’s population, according to the Kaiser Foundation. Missouri is expected to follow this trend.
Based on conversations with his fellow healthcare leaders, Garza told TheAmerican on April 7, “Our largest share of patients have been coming from North County. That is concerning. That shows the disease does disproportionately affect those that are disadvantaged in society.”
Race and ethnicity are boxes that medical providers must check on the Centers for Disease Control and Prevention’s COVID-19 reporting forms that go to state and local health departments.
Health departments in the St. Louis region have not released race data because officials said many of the CDC’s forms — called Persons Under Investigation (PUI) forms — were incomplete and often didn’t contain data related to race and/or ethnicity.
But on Wednesday, April 8, St. Louis County Executive Sam Page provided TheAmerican with some preliminary data that confirms what Garza is seeing in the hospitals. The county doesn’t know the race or ethnicity of about 40 percent of its cases. But of the other 60 percent, 54.6 percent were African American compared to 36.9 percent white.
According to the county’s calculations on rate per 100,000, African Americans were being infected at a rate four times higher than white county residents.
Dr. Fredrick Echols, director of the City of St. Louis’ health department, said the city’s rate could potentially be worse than this, but wanted to finalize the data before releasing it. He did share in a commentary the stunning fact that all 12 deaths in the City of St. Louis from COVID-19 to date were African Americans.
“The COVID-19 situation highlights the health inequities and disparities that pre-existed in our community,” Dr. Echols told The American.
Page said he “understood” this situation a month ago at the outbreak of the pandemic locally.
“That’s why we made the decisions we made before we had the data to prove it,” Page said. “My administration looks at every complex policy through a lense of equity and applies it aggressively and directs resources to where they are needed. And in this COVID-19 infection, they are going to be needed in our minority communities.”
Jason Q. Purnell, a professor at Washington University who is advising Page’s pandemic response team on racial equity, announced on April 8 the creation of a regional task force on social services to direct more resources in the areas hardest-hit by the pandemic. The COVID-19 Regional Response Team will address social needs in the bi-state area.
Page also said they are formalizing a contract on a new software program to allow them to report data more efficiently, including statistics on race. His administration has been focusing on “saving lives and data will follow promptly behind,” he said.
African Americans getting sicker
Dr. Laurie Punch, a trauma surgeon with BJC HealthCare, has been working on the frontlines in the intensive care unit (ICU) at Christian Hospital in North County.
“The hospital has experienced a rapid influx of patients with COVID-19, and the overwhelming majority of them are black,” Punch said. “That fits with two sets of numbers that we have.”
Last week, the city and county released data maps that show COVID-19 cases based on zip code. They show that North City and North County have three times higher incidence of COVID-19 than West and South County, Punch said.
She has been strongly urging BJC Healthcare officials to offer data analysis on race, explaining, “If you don’t get this story out, it’s going to come out in a way that’s going to cause so much more harm. We have to get in front of this and make sure people know what’s going on.”
On April 7, Washington University and BJC provided Punch with some “very” preliminary data to share with the media. It showed that African Americans have a 2.5 times higher odds of being admitted to the hospital with COVID-19. They are 2.2 times as likely to be transferred to the ICU once they are admitted and four times as likely to end up on a ventilator. They do not yet have data on the deaths, she said.
“There are two very different but specific things going on,” Punch said. “There is a higher incidence overall in North City and North County, and once (black) people get the disease, they’re getting sicker.”
COVID-19 is not just a “viral pneumonia,” Punch explained. It’s a whole body infection that causes tremendous organ damage to the kidneys, heart and liver.
“So if you have anything that would compromise your kidneys, heart or liver, you’re more likely to get really sick,” Punch said. “If you have something that compromises your lungs, you’re more likely to get really, really sick.”
The black population experiences higher rates of diabetes, heart disease, among other compromising chronic conditions, so it’s “no mystery” that African Americans are getting sicker from COVID-19, she said.
However, because family members are not allowed to visit and the public is not allowed to “see” the disease, Punch believes it is important to describe it. From the first day she got to Christian Hospital — she normally works at Barnes-Jewish Hospital — she noticed an eerie emptiness in the halls.
“Patients are in rooms closed off, so we can keep the air circulating inside the rooms and reduce the transmission,” Punch said. “The patients are behind these glass windows and doors, on ventilators, on dialysis machines, with IVs pumping adrenaline into their bodies to keep blood pressure up. They are so sick.”
Because people are not able to witness this, it’s very easy for this to not feel real, she said.
“It’s easy for young people to not understand the role they have in spreading it and being around older family members who are vulnerable,” Punch said. “It’s easy to be upset about the impact this social, physical distancing has created and not recognize that it’s being done so that less people die.”
She wants people to know that at the hospitals, it’s “full on.”
“Multiple doctors, nurses, technicians and therapists are literally risking their lives to be on the frontline of this virus,” Punch said. “If people could see that, I think they would be like, ‘Oh, damn.’”
Failure of society
Garza reported on April 7 that there were 586 people currently hospitalized in the St. Louis region — an area that encompasses surrounding counties in Missouri and Illinois and represents 2.8 million people. Of those, 239 were in the ICU and 186 were on ventilators. He anticipated that the region will see its peak in COVID-19 cases in two to three weeks — where anywhere from 1,300 to 3,000 people could be hospitalized at any one time. At the peak, about 80,000 of the region’s 2.8 million people could be infected with the virus — though about 30 percent will be asymptomatic.
Garza said the disease will be felt most by those who are disadvantaged, and the pandemic is shining a light on the failures of society.
“The issue is: how do we help everybody make a living wage to support their families, have access to good food, access to good education and access to good health care?” he said.
Garza pleaded that the region not just focus on the needs in the medical insitutitions but in the community at large. He pointed to the Ferguson-Florissant School District not being able to deliver food because two bus drivers passed away from the virus.
“The school system has become a social support system,” Garza said. “All of those things add up on how much burden there is placed on those communities. Those are other ways that we need to think about this, not just purely about delivery of medical care. But how do we help out the entire community?”
Punch and Garza have met in the past about finding ways to address the gun violence pandemic. And they share many of the same views: that more needs to be done to ensure people make a living wage, have food security and safe housing in general — but especially during the pandemic.
“What’s happening right now is wildly different from anything I’ve experienced, but at the same time just like everything I do around the issue of violence anyway,” Punch said. “What we understand about violence should completely help us understand what we are seeing when it comes to the virus. The virus and the bullet are both vectors of structural racism.”