During the height of New York City’s climbing COVID-19 cases and deaths in March, the city formed a rapid response coalition. The goal was to lower the death rate among low-income communities and seniors with chronic conditions.
It connected almost every agency that would touch a COVID patient — hospitals, Medicaid plans, social service organizations, pharmacies, transportation companies, translators, telemedicine and technology companies.
In early April, one organization released a playbook for New York’s response, so that other cities could start creating their own coalitions before it was too late.
At that point, St. Louis had created the St. Louis Metropolitan Pandemic Task Force, which included the region’s four main healthcare systems. Jason Purnell, associate professor at Washington University’s Brown School, was creating the COVID-19 Rapid Response Team to connect social service providers on both sides of the river. The region’s public health departments had formed a response coalition.
Yet nothing connected them together.
In early April, Dr. Will Ross, who chairs the City of St. Louis’ health board and also advises St. Louis County Executive Dr. Sam Page’s response team, said, “What we need is a packaging of all these efforts into a joint response team, using NYC as a model. We have more challenges than NYC because of our fragmented political leadership, but this can still be done.”
Unfortunately, it never happened.
The American asked Rebeccah Bennett — who helps lead the Rapid Response Team as well as the PrepareSTL outreach campaign — whether there was any movement to connect all of St. Louis’ pandemic response efforts.
Her answer dove deep.
“Our systems and structures have been chronically under-resourced and divested for decades,” Bennett said. “Even our health infrastructure — the way it is organized — has left whole swaths of our community medically underserved or unserved.”
It should not be a shock that the current public health crisis is showing the brokenness of these systems.
“In many ways, we are decades behind,” she said. “So when you’re like, ‘We are not doing what New York is doing,’ that’s the consequence of structural inequalities.”
Other cities have systems that support the coordination of resources and collaboration at the scale needed to address this particular challenge, she said. Because St. Louis lacks this, the region is falling back on our relationships.
“At least we have some of those,” she said.
People like Michael P. McMillan, James Clark, Ross, Purnell, Bennett, and many others in our region who are connectors have become hyper-activated in the pandemic response. And there’s a reason for that.
“We are relying on relationships to do the work that our systems should be doing,” she said. “And where the relationships are fragile, then what happens? Nothing.”
Addressing homelessness in the City of St. Louis is an example of an area where relationships have been tarnished for a long time. Where city leaders and agencies that serve homeless individuals could be working together to create enduring change in addressing this issue, unfortunately, the relationship has devolved into lawsuits and name calling.
“Infrastructure has the bandwidth and the strength to support scale,” Bennett said. “The relationships will get taxed, and at some point we’ll say, ‘Oh, gosh, we’re tired.’ That is what’s happening right now.”
‘See, that’s infrastructure’
There is some good news, thankfully. Where relationships are strong, Bennett said, lasting change is happening. One example is the recent changes to the United Way 2-1-1 response line that were put in place on Friday, May 9. Previously when people called the 2-1-1 line, they would be given phone numbers to other organizations that could provide services they needed — such as rent assistance, food, medical assistance, etc.
However, over the past month, service providers came together to make a change that could mean life or death for home-bound seniors or people with disabilities.
As of Friday when these populations call 2-1-1, the United Way will serve as navigators in connecting them to service providers.
“It’s the difference between calling someone and them giving you somewhere else to call or calling someone and getting the services you called for met, including a live body at your house,” Bennett said.
This is something that the COVID-19 Regional Response Team — which Bennett also helps lead — coordinated, but it was the brainchild of the Salvation Army and Catholic Charities. For the next three months, this will be a pilot program that’s focused on seniors and people with disabilities. But the goal is to expand it.
“Imagine, for a moment, if we could expand beyond those populations to get access to direct service,” Bennett said. “You’ve got a web network of service providers whose technological platforms are directly connected to our 2-1-1 system that can activate medical experts and other people to provide immediate service and support. See, that’s infrastructure.”
This is an example where relationships can help build the infrastructure, so the region doesn’t have to rely on the relationships — and it will benefit the entire region past the pandemic, Bennett said.
‘Should we tolerate people being disadvantaged?’
Dr. Alexander Garza is the incident commander for the St. Louis Metropolitan Pandemic Task Force. Since April 5, he has been giving regular briefings regarding the state of the hospitals and the spread of the virus in the community. During his Friday, May 8 briefing, he answered a question from The American about whether or not leaders of social-service networks are included as core members of the task force.
Garza responded, “Remember, back when the task force was formed, it was essentially the healthcare services.”
The idea was to work collaboratively with public health departments, elected officials, Federally Qualified Health Centers (FQHCs) and social service providers, he said.
“The Regional Health Commission and Integrated Health Network are part of the task force, but we never meant it to be this ever-expansive task force,” he said. They wanted to be a “very deliberative body” that could help educate and inform the region. Social services are “extremely important,” Garza added, and “they are part of the discussion.”
Angela Clabon, president of CareSTL Health, said Garza toured the FQHC in late April for the first time and has been connected with her since. Clabon said the task force was helpful when CareSTL’s testing supply order was delayed in April. Where the city or state couldn’t provide supplies, the task force stepped in to make sure testing could keep happening at the FQHCs testing sites — which are located in the areas hardest-hit by the virus.
Garza strongly believes in the importance of social services.
“It’s a public policy and society decision,” Garza told The American. “Should we tolerate people being so severely disadvantaged within our communities? I think the answer is no.”
Rather, we are giving “tax breaks for wealthy people” instead of putting an emphasis where it needs to be, Garza said.
“People like to compare us to other countries,” Garza said. “Even though we spend more per capita on health care, we spend less on social programs than other countries. And that’s probably why we end up spending more on health care because we don’t have those social programs for the entire society.”
And, he said, we should have those programs.
“It’s a pay me now or pay me later game,” Garza said. “They will live healthier lives. You won’t spend as much on that medical care because we will have done all those preventative things. That all comes back to COVID. It’s a representative of how disease disproportionately affects those that are disadvantaged.”