St. Louis County Executive Dr. Sam Page and City of St. Louis Mayor Lyda Krewson announced on Tuesday, May 5 that they would begin to ease public health restrictions on May 18.
However, just a day before, they both said during briefings they were not ready to set a date because the hospitalization trend in St. Louis still showed a “very serious situation.”
Hospital inpatient data is currently the best barometer for understanding the amount of transmission and community spread of COVID-19, local experts say. The trend line for the number of patients currently hospitalized for COVID-19 shows a “plateau” and not a substantial decline. The trend line for new patients — which doctors now say is more timely data — is heading down but has seen some substantial spikes recently.
“Right now, the trend is in the right direction — it’s just not a robust trend,” Page said during his briefing on Wednesday, May 6. “I wouldn’t expect to see a large change in that trend until we start easing the social-distancing guidelines. If we see something unexpected, we may modify our orders.”
Both Page and Krewson said they rely on guidance from the St. Louis Metropolitan Pandemic Task Force, which compiles daily reports on hospitalizations for the region’s four major health largest healthcare systems: BJC HealthCare, Mercy, SSM Health and St. Luke’s Hospital.
On May 5, there were 683 patients hospitalized who either tested positive or were suspected of having COVID-19, the task force reported. On April 21 — around the region’s likely peak in the pandemic’s first wave — there were 750 people hospitalized. Hospitalizations are still up about 45 percent higher from than the beginning of April.
The St. Louis American asked Dr. Alexander Garza, incident commander for the task force, what caused the elected officials’ sudden change of heart to solidify a date?
“It’s a couple different things,” Garza said. “People like to have some sort of clarity of what’s going to happen. There was some pressure on the elected officials. You can only go so far with not setting down a specific date. That’s human nature.”
In addition, Garza said there’s always going to be some political pressure, “even if it doesn’t make much sense.”
The best thing the task force can do is to give advice on how safe it’s going to be for whatever date is chosen, Garza said. The stay-at-home order, which went into effect on March 23, will have been in place about eight weeks by May 18, which is consistent with past pandemics, he said.
“I believe by the time the 18th rolls around — barring any jumping cases or anything else occurring — it’s probably as good as any other date that you would pick going forward,” he said. “You never know what’s going to happen.”
It may be difficult to get the transmission rate any lower than it is now without “shutting everything down,” he said.
However, he said, people have to be invested in the “new normal” of social distancing, wearing masks, washing hands and spraying down surfaces in order to keep transmission down — or it won’t work.
Later this week, Page and Krewson will further outline what the new guidance will look like. In addition to the things Garza mentioned, it will include avoiding large crowds and staying home when possible, they said.
On Wednesday morning, Page said the upcoming order will require all businesses and their employees to wear masks. They will also allow businesses to refuse to serve anyone who comes in without a mask. When asked about enforcement, he said, “I will be very surprised if businesses whose employees are not wearing masks will get much traffic.”
Public health interventions also must be firmly in place, Garza said, and that includes robust testing, contact tracing, isolation and quarantine.
During the 1918 influenza pandemic, Garza said, the St. Louis region relaxed its social distancing restrictions too soon and there was a second wave of infections that was more devastating than the first. We have a chance to learn from that mistake with the COVID-19 pandemic, he said.
If Garza could design his ideal process of lifting restrictions, he said he would put the majority of resources in the places that have the highest transmission rates. Right now, those places are nursing homes, North St. Louis County and North St. Louis city. Those targeted resources include tests, masks, gloves and a robust educational outreach on ways to prevent spread.
Most importantly, he said, it includes supportive services, such as child care, food and financial support.
In his visits to federally qualified health centers in North St. Louis, he heard from center leaders that people don’t want to be tested because they can’t afford to take off work if they test positive.
“The whole goal is to decrease transmission,” Garza said. “Everything that we should be focusing on should be directed towards that goal. If there are things that are negatively impacting that goal, such as people don’t want to get tested because they can’t afford to take off work, then you have to support them so they can take off work. Otherwise you are going to just keep increasing your chance of transmission.”
Data indicators
During his daily briefings, Garza regularly talks about the seven-day “moving average” of the total number of people in the hospitals — which he has said is a good indicator of transmission in the region. That trend line is currently “plateauing,” he said.
However, the task force is now finding that because people are not leaving the hospital for long periods of time, so looking at new hospital admissions is a better indicator of what’s happening currently.
On Monday, he provided this trend line data for the first time — the seven-day moving average of new hospital admissions. On April 9, that seven-day average stood at 59, and on May 5 the number was down to 43.
“And that’s a really encouraging trend,” Garza said.
He noted that there was a spike in this data on May 2. He said that it was probably a result of people getting together for Easter.
“It’s a good lesson for us that gives us a little bit of a signal that this is real,” Garza said. “If people aren’t following all the guidance, this could happen.”
The American asked if he worries that the hospitals will be overrun or will run out of protective equipment, seeing that they currently have nearly 700 COVID-related patients in the hospitals — which is not that far off from the 750 they had during the region’s peak.
Garza said hospitals are still not up to their “pre-COVID level” of supplies, but they have learned to conserve.
“When we talk to our supply-chain people, they are nervous by nature because they experienced this phenomena,” he said. “But most of them feel supplies are starting to loosen up now and we’re starting to build up our reserve.”
He said they will be okay with protective supplies if restrictions lift, as long as there isn’t a “huge surge.”
“It all has to fit together like this big jigsaw puzzle,” Garza said. “If we want to bring the economy back on line, then we have to put protections in place to decrease transmission. If we can align all of those things, where we feel comfortable that we can control the transmission rate, which means we’re controlling the number of people coming to the hospital, then, yes, we feel confident that we can take care of them.”
