After months of being stuck at home in Madison, Illinois, Towanne Russell decided to venture out on a Sunday in mid-June.
“Being locked up in the house, it kind of messes with you mentally, physically, emotionally,” she said. “And I needed to get out before I lost it!”
Many people in the St. Louis regions are eager to emerge from months of quarantine to meet with friends, or get their hair cut. So far, so good: Since officials in St. Louis and St. Louis County in May lifted restrictions aimed at limiting the spread of the coronavirus, the average number of new cases has remained relatively constant.
But some public health experts worry that people in the region are resuming their routines too soon.
When Russell’s niece called her and asked her to join on a trip to Washington Avenue in downtown St. Louis, she was in. After all, hundreds of others had started doing the same thing.
“There’s more people coming out, you know what I’m saying?” She said with a laugh. “I’m trying to make it as normal as possible.”
But others are concerned returning to “normal” could lead to a spike in coronavirus cases similar to what Arizona and other states that reopened quickly are seeing.
Already there may be some cause for concern. In Missouri there were about 310 cases reported per day for the week that ended Sunday, up from about 110 per day in the previous week.
A calculated risk
Until there’s a vaccine, allowing people out of the house is almost certainly going to cause more virus spread, said Dr. Alexander Garza, head of the St. Louis Metropolitan Pandemic Task Force, which comprises the region’s four largest hospital systems.
“You have to think about it from an infectious disease and public health perspective and a sociological economic perspective,” he said. “If you talk to people who are purely wanting transmission to be at zero, they would say we can’t reopen until a vaccine is here. You have to balance those two to what is safe.”
Officials in St. Louis and St Louis County lifted stay-at-home orders after COVID-19 hospitalizations at the region’s largest hospital systems began to decline. In mid-June, hospitalizations ticked up by a couple more people each day, but they’re mostly holding steady or going down.
Still, doctors are diagnosing more than 100 people in St. Louis with COVID-19 each day. In the last week, doctors in the St. Louis region have diagnosed more than 100 people with the disease daily. Statewide, there are 200 people becoming ill with COVID-19 every day, and cases are rising outside Kansas City and St. Louis.
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Health officials need to pay attention to those case numbers, Garza said, but they’re one of many factors to consider. Health departments are now able to pinpoint where outbreaks are occurring, and they’re often in packed settings such as jails and nursing homes. That means they can be more precise in putting restrictions in place.
“Instead of using very blunt instruments in a community like everybody has to shelter in place or we have to close all restaurants, [we ask] where are these cases coming from, and is there any commonality?”
Hospitals have come a long way since the start of the coronavirus pandemic in March. Doctors know more now about how to treat patients – even though there isn’t a vaccine or treatment – and how the virus spreads. The region could avoid a spike in cases because local officials put restrictions in place quickly and lifted them more slowly, said St Louis County Executive Sam Page.
Jumping the gun?
But others still don’t think St. Louis is completely ready. Alderwoman Cara Spencer, D-20th Ward, has said the city doesn't have enough contact tracers, workers to track down people who may have been in contact with someone who tested positive for the virus.
“Frankly, it doesn’t feel like reopening entirely is the right course of action right now,” she said. “I think we should all remain extremely cautious and diligent about how we’re interacting in the public.”
Spencer worries the lifting of restrictions sends the message the pandemic has been solved. Already, people have been gathering in crowds and leaving masks at home, as seen on Washington Avenue and other gathering places.
At Flannery’s, tables were spaced out and restaurant workers wore masks. But at another watering hole in south St. Louis on Sunday, patrons packed together. Few were wearing masks, even as a "60 Minutes" episode featuring the risks of the pandemic aired on a television above the bar.
“My fear is our community is becoming complacent, and we cannot forget the virus is still out there, and it’s just as deadly as it was several months ago,” Spencer said.
Others are worried a spike in cases could deplete the precious supplies of protective equipment clinics and hospitals have stocked up on to keep patients and health workers safe.
“I know that there's a lot of people wanting to get back to work and wanting to reopen,” said Emma Crocker, a registered nurse with a doctorate in nursing and population health. “And we did get to the point where we flattened the curve, and I'm so proud of us for doing that. But if we quickly reopen without the proper protective equipment for essential workers, we're only going to increase our risk more.”
Health workers are still reusing N95 respirator masks and conserving other protective gear by wearing it throughout visits with multiple patients, Crocker said.
“Hospitals are constantly fighting against each other right now to get masks,” she said.” I can't imagine what it means to throw other businesses in the mix competing with hospitals and different provider clinics across the region, especially in our rural areas outside of St. Louis in Missouri.”
A crucial test
Experts point to two main public health interventions to contain the spread of the coronavirus: Governments need plenty of contact tracers and the ability to perform thousands of coronavirus tests each day.
St. Louis and St. Louis County have announced they’re planning to hire dozens more contact tracers in the coming weeks. The region is also able to test more than two thousand people a day for the virus, Garza said.
Those measures are encouraging, but St. Louis had a slow start in rolling them out, said Dr. Elvin Geng, an infectious disease expert at Washington University Medical School.
The next few weeks will be a crucial test of whether the region’s reopening plan is working, he said.
“I do think that we are still on a precipice,” he said. “And that is something I think a lot of infectious disease people and epidemiologists sort of recognize, but I’m not sure the public does.”
The rising number of other states should set off a warning the virus could start spreading widely again, he said. Officials need to be prepared to pause reopening plans or put restrictions back in place, something St. Louis Mayor Lyda Krewson has said she’s willing to do.
“Even though it’s been very painful already so far, that the virus is merciless,” Geng said. “It doesn’t give us credit for the pain that has already been incurred. We may have to step on the gas a little bit at some point maybe in the not-so-far distant future.”
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