Many have watched the footage of people crowding into bars in Wisconsin after stay-at-home orders were lifted, said Dr. Alexander Garza, incident commander of the St. Louis Metropolitan Pandemic Task Force.
“That’s absolutely the wrong thing to do,” said Garza, who is chief medical officer for SSM Health. “That is a surefire way for transmission to get kicked up and for us to be right back where we started from.”
During his Friday, May 15 briefing, Garza said that his major concern with the shelter-in-place orders easing in the City of St. Louis and St. Louis County on May 18 is that people will equate relaxing the public-health restrictions with the virus being gone.
“That’s not equal,” Garza said. “The virus is still out there. It’s still circulating in the community. There’s still a significant proportion of the population that’s susceptible to the virus.”
The only way the St. Louis region can safely ease stay-at-home orders is if everyone continues to practice the preventative measures that have helped decrease the spread of the virus, he said. Those practices include keeping gatherings to fewer than 10 people, wearing protective masks, staying six feet apart from each other, washing hands and staying home as much as possible.
Garza showed a model of what could happen if people do not continue to follow the guidelines after May 18. It could lead to a second peak in hospitalizations — around 663 inpatients — as early as June 24, the model shows. That would be slightly higher than the peak we experienced in late April, with 621 inpatients. Hospitalizations wouldn’t drop back to current levels until July 2020 without additional measures to contain the virus, the model states.
“These are probabilities,” Garza said. “This doesn’t have to be our reality.”
One way to measure transmission of the virus in the community is to look at the reproduction number, which is currently 0.8, the model shows. That means that each person who contracts the virus will likely infect fewer than one other person. That’s a good indicator that the region has been successful in suppressing transmission, Garza said. When the task force started collecting hospitalization data of COVID-19 patients in late March, the number was 5.0 — meaning each new case would likely produce another five cases.
If people don’t follow the guidelines, then the reproduction number could jump up to 1.5, which could cause the second wave of hospitalizations.
However, Garza also presented a slide of hospital inpatient numbers since mid-March, and it shows the beginning of a downward curve. The data represents hospital patients who tested positive for COVID-19 within the task force’s hospital systems: BJC HealthCare, Mercy, SSM Health and St. Luke’s Hospital. Garza is confident that the region can continue to follow this trend with proper public-health guidelines in place, he said.
On May 19, the task force reported that there are 455 people currently in the hospital who have either tested positive for COVID-19 or are awaiting test results. The number of patients in the intensive care units is 98, and the number of people on ventilators is 70. The number of new hospital admissions was 25. (All the reported data lags by two days.)
On May 18, Garza also showed a series of trend lines in hospital data. The seven-day rolling average for new hospital admissions shows a steady decline since early April, he said. This number is currently at 28, which is down from 59 on April 9.
“This is a really important trend, and it’s an indicator of the level of suppression that we have of the virus in the community,” Garza said. “We know it will never reach zero until we have a vaccine, but we would like to see it continue to come down.”
The seven-day moving average of the total number of COVID-19 patients in the hospitals was also the lowest it’s been at 476.
“As this number continues to come down, it helps us be confident that the steps we’re taking are working,” Garza has said, “and the hospital systems are going to be ready and able to take care of COVID patients without becoming overwhelmed.”
Across the system hospitals, 32 COVID-19 patients were discharged, bringing the cumulative number of patients discharged to 1,924, as of May 19.
Looking at the trend of new hospital admissions is the best way we can currently evaluate the spread of the new coronavirus in the St. Louis community, Garza said.
Now that the stay-at-home orders have been lifted in the city and county, this is the trend line that the task force will be tracking to make sure the region doesn’t experience a surge in COVID-19 cases and hospitalizations, he said.
“The relaxing of social distancing orders is an important time and a sign of progress this region has made in stopping the spread of the virus,” Garza said. “But it’s still important to remember that the virus is still here; it’s still contagious and it’s still very dangerous.”
Racial disparities persist
Racial disparities in the impact of COVID-19 persist in the region. As of May 20 in St. Louis County, 141 of the 350 deaths from the disease were black, and 1,863 of the 4,410 cases were black. That’s 40.3% of the deaths and 42.2% of the cases, when blacks form only 24.9% of the county’s population,
As of May 19 in the City of St. Louis, 65 of the 108 deaths and 1,096 of the 1,705 cases were black. That’s 60.2% of the deaths and 64.2% of the cases, when blacks form 45.9% of the city’s population.