From history, we know that the second wave of a pandemic can be more devastating than the first, said Dr. Alex Garza, chief medical officer for SSM Health, on Thursday, April 23.
This happened during the 1918 influenza pandemic, he said, when the St. Louis region relaxed its social distancing restrictions too soon. We have a chance to learn from that mistake with the COVID-19 pandemic.
“And we can do that,” Garza said. “But first, we have to remember where we are right now. We are still in the middle of what our modeling shows to be the initial crest of our first wave of infections. Now is not the time to let our guard down against the virus.”
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.
Garza reported on April 23 that there are 694 people currently hospitalized within the four medical systems, who have either tested positive for COVID-19 or are awaiting test results. Of those, 170 are in the intensive care unit (ICU) and 126 are on ventilators. The good news is that 52 people were discharged.
“In the coming days, we will continue to see an increase in the number of infections and hospitalizations,” he said.
The task force projects that the region will see its peak of the pandemic this weekend — where about 600 to 700 people could be hospitalized. That’s the lower end of the projections, which is where the region is currently trending. However if the community does not abide by the social distancing restrictions and stay-at-home orders, then the region could trend toward the worst-case scenario, which is about 1,500 hospitalizations.
People should also expect a slow decline in cases, rather than a sharp downward curve, he said.
The task force is meeting everyday regarding staffing, Personal Protective Equipment (PPE) supplies, and needs for the intensive care units (ICUs), Garza said. The stay-at-home orders are working in slowing and preventing the spread of the virus, he said.
“They should remain in place until we have robust testing and tracing capability and have seen reductions in our infections,” he said. “Even as other regions, cities and states talk about reopening businesses and loosening their restrictions, we have to remain vigilant. We have not seen the worst of what the virus can do in our region.”
While some surrounding counties may show a slow increase in cases and no deaths, Garza said this could be from limited testing. In urban areas, almost all the testing being done currently is for people with symptoms or diagnostic testing, he said, and almost no surveillance testing, which needs to be in place to loosen restrictions. Testing is even less prevalent in rural areas, he said.
“We have known from previous pandemics that the spread makes it ways from the urban areas into the rural areas,” Garza said. “Part of it is timing, part of it is some geographic distancing. It’s probably a combination of all that.”
St. Louis County and city will extend their stay-at-home orders based on the criteria he discusses at the daily briefing, he said.
“The number of hospitalization is the best barometer we have for community spread,” he said.
They also need to know that the health care systems have recovered enough from the first wave. That includes ensuring that there’s adequate PPE 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 able to adequately be able to take care of that amount of patients.”