The hospitalization rate for COVID-19 in St. Louis has been “flat and stable” for the past week, said Dr. Garza, chief medical officer of SSM Health, on Tuesday, April 28.
“If our modeling holds true, we should start to see a taper over the next week or so,” Garza said. “And it will start to move back down gradually. That’s when we’ll know that we are, in fact, on the downward side of this initial wave.”
Garza is the incident commander for the St. Louis Metropolitan Pandemic Task Force. The task force includes four major health care systems: BJC HealthCare, Mercy, SSM Health and St Luke’s Hospital.
Every day, Garza gives a briefing on the task force’s COVID-19 statistics that represent 2.8 million people for an area that encompasses surrounding counties in Missouri and Illinois in the larger St. Louis region.
At his Tuesday briefing, Garza showed a graph of the “seven-day moving average” of hospitalizations for the task force’s healthcare systems.
“We want to keep this trend coming down over time, and that will require continued vigilance and discipline,” Garza said. “We are not heading downward yet, but this plateau is encouraging. And it’s only possible because of the sacrifice and dedication from everyone in the region.”
Garza has said many times that hospitalization data is the best “barometer” for community spread and transmission of the virus. Looking at this, he said that regional leaders’ decision to continue stay-at-home orders “are absolutely the right move because of the continued high number of hospitalizations.”
Despite all of the progress in flattening the curve, Garza said there are still about 45 percent more patients in the hospital because of the virus than there were on April 5, when Garza started giving the briefings.
During the 1918 influenza pandemic, he 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.
Regional leaders also need to ensure that the health care systems have recovered enough from the first wave. That includes ensuring that there’s adequate protective medical equipment for healthcare workers.
“If we loosen restrictions, again you’re increasing the probability of transmission, which could result in a rebound of cases,” Garza said. “What we don’t want to happen is for those cases to rebound and then the health care system not adequately be able to take care of that amount of patients.”
On Tuesday, Garza reported that there were 678 people hospitalized, 159 of whom were in the intensive care units and 115 were on ventilators. Hospitalization numbers reflect both people who have tested positive and those who are awaiting COVID-19 test results.
Across the system hospitals, Garza reported Tuesday that the cumulative number of COVID-19 patients discharged was 1,167.
‘Science and math’ of decreasing spread
The St. Louis region has made “important progress” in slowing the number of infections by staying home and taking precautions, said Garza.
“It is based on science and math,” he said. “With any contagious, dangerous virus like this coronavirus, you have to slow or stop its ability to spread from person to person. That is the reproduction factor.”
The goal is to keep the reproduction factor below 1, he said, which means each infected person is infecting less than one other person, on average. “That is how you stop a virus,” he said.
The estimated reproductive factor takes into account both asymptomatic and symptomatic people. Garza has estimated that 70,000 people of the 2.8 million within the task force’s statistical area will become infected with COVID-19. And 30 percent of those 70,000 — or 21,000 people — will be asymptomatic cases.
When the region saw its first infection, the task force estimated that the reproduction factor was running above 5, meaning that one infected person was spreading the virus to approximately five additional people, on average, at that time.
“At that pace, we would be overwhelmed as a health system and we would lose many, many people to this virus,” Garza said.
When the stay-at-home orders went into place in the region in the third week of March, the task force leaders estimated the reproduction factor was around 2.
“That also would have been a very difficult situation for the entire community,” he said. “But, because of the work everyone in this region has been doing to stay home, wash hands and practice social distancing, right now we believe we have brought the reproduction factor below 1. That is tremendous progress and allows us to keep this virus in check if it continues.”
If that reproduction factor spikes, Garza said, we could easily see larger numbers of people becoming infected, getting sick and dying.
“We want to do all we can to keep that reproduction rate down below 1 as we consider how to begin the stabilization and recovery process,” he said.
Testing will help manage the virus and keep the reproductive factor below one when restrictions begin to lift, he said. However, testing must be paired with contact tracing, isolation and quarantine.
“It really doesn’t do us any good to test, if we don’t have those other mechanisms in place,” he said. “That will be essential to keeping the reproductive factor below 1 and avoiding a second wave of infections.”
Currently the region is largely only doing “diagnostic testing,” and not the surveillance testing that needs to be done, he said. More testing is becoming available now, he said, but the “floodgates haven’t opened up, where we can do large-scale prevalence testing.”
St. Louis County Executive Sam Page announced on Friday, April 24, that the county will be hiring 100 people to do contact tracing, in addition to the 70 people who are already currently doing this work at the county’s health department. On Wednesday, April 29, Page said they have received 800 applications for those positions, and increasing the contact-tracing workforce is an essential part in lifting the stay-at-home orders.
For more information on working as a contact tracer or to apply, visit http://ow.ly/nXqu50zqOmm or call 314-615-5182.
Dr. Garza gives daily briefings on the St. Louis Metropolitan Pandemic Task Force Facebook page at 3:30 p.m.
