August virus figures signal ’long haul’ ahead for Missouri

By Rudi Keller The Columbia Daily Tribune

As Missouri approached the end of June, a rise in new coronavirus cases didn’t cause much concern for state officials.

Health Director Randall Williams said that what the state was seeing was a spike, which he expected would cool. Only a sustained surge would force the state to review whether to reimpose restrictions relaxed in May, he said.

University of Missouri students social distance while studying at the Student Center. [Don Shrubshell/Tribune]

Record case counts were being driven by workplace outbreaks in a few locations, Williams said.

And in a briefing on June 23, Gov. Mike Parson said he was confident the pandemic was under control.

“We are not overwhelmed,” Parson said. “We are not currently experiencing a second wave and we have no intention of closing Missouri back down at this point in time. We remain confident that Missouri is on the road to recovery.”

And by the two most reported measures, total cases and deaths, Missouri was relatively well off. It had the 39th highest per capita infection rate of 50 states and the District of Columbia on July 1 and the 32nd highest death rate.

But since then, case numbers have continued to rise. In the period since July 1, the state has the 17th highest infection rate and the 14th highest since Aug. 1. And for the first five days of September, Missouri has the fifth highest rate.

With the discovery that a coding mistake means the state count missed 72 deaths in June through August, the state death rate per 100,000 residents is 22nd for the period since July 1 and ninth for deaths reported in the first days of September.

The 280 cases per day reported for June, the highest full month average up to that point, seems today like a goal rather than a danger signal after August saw an average of 1,109 new cases per day.

What has happened, said David McKinsey, an infectious disease specialist with HCA Midwest Health Research Medical Center in Kansas City, is similar to the 1918 flu pandemic. McKinsey’s hospital has treated more than 500 COVID-19 patients, and he has seen the impact of the disease on people of all ages.

In 2018, he was a co-author of two articles looking back on the 1918 flu published in the Journal of the Missouri State Medical Association.

“Some similarities between 1918 and the current COVID pandemic is the length of time the pandemic persists and the amount of resolve among the population to do that proper social distancing to bring the pandemic to a close,” McKinsey said in an interview last week.

“There is no doubt that reopening businesses and having more people out congregating in the community leads to an increase in cases,” he said. “That is the type of story I have heard over and over again, not just in our part of the country, but worldwide.”

Death rates

Exactly where Missouri stands nationally for death rates was complicated Saturday when the Department of Health and Senior Services reported it had found 72 deaths that should have been counted in June through August as COVID-19 deaths.

But overall, the state is below the national average for death rates per capita, with the highest rates in states that were hit hard in March and April.

McKinsey said Missouri had time to prepare, and that treatments that have helped save lives are now better understood.

Remdesivir, dexamethasone and convalescent plasma have all played a role in saving people, he said.

“Although the aggregate data nationwide are somewhat controversial, in our experience there have clearly been individuals who have improved after receiving convalescent plasma,” he said.

The future

“Our numbers for Missouri are close to peak levels for the pandemic,” McKinsey said. “And there is no end in sight until we see a vaccine, and there is no idea when that will be.”

And while younger people may be at less risk of dying from COVID-19, that doesn’t mean it is of little consequence for that group.

“Some younger people who have relatively mild cases of COVID have debilitating fatigue that can persist for several months,” he said.

Those with lung issues can have long-term shortness of breath. And it causes scarring and blood clots in the lungs that blocks oxygen, he said.

McKinsey said he won’t be surprised if case numbers continue to increase.

“I expect the pandemic to heat up as the temperatures cool down,” he said.

The public differences over the virus, with large numbers telling pollsters they won’t take a vaccine and demonstrations against masks convincing smaller community town boards to reject mandates, is aggravating the crisis, he said.

“This is a long haul,” McKinsey said. “We can't wish away the pandemic because we are tired of it.”