“The county’s health system is robust, so they are in a different position to move forward,” said Dr. LJ Punch, an assistant professor of surgery at the School of Medicine at Washington University, an anti-violence activist and St. Louis County police commissioner. “Does the county recognize the vulnerability will directly impact the county or does the county simply want to move forward and it’s taking a posture that says we’ll work with the city but the city has what the city has?”
The disparity between the efforts being mounted by the two governments has taken on new urgency as both begin the process of lifting stay-at-home orders, and allowing more businesses to reopen this week.
Familiar commuting patterns will return. City residents will go into the county and county residents will go into the city. As more people across the region interact, opportunities for the virus to spread are likely to increase.
But the city — which has had a higher rate of infection than the county — is ill-equipped to address the need. While the county is in the process of hiring 100 contact tracers — the people who interview those who test positive for COVID-19 and track down their contacts to get them tested, too — the city has just 10 to 13.
That reflects, in part, the disparity in resources available to the two governments. The county, because of its size, was able to get some $173.5 million in direct aid from the federal government under the Coronavirus Aid, Relief and Economic Security, or CARES, Act.
The city, which has less than a third of the population of the county, is getting just $35 million in assistance through the state.
At a meeting of the city’s Joint Boards of Health and Hospitals on May 7, chairman Dr. Will Ross noted that a “critical” step toward opening businesses in the city was the health department’s ability to interview people who test positive for the coronavirus and track down and test their contacts.
But Ross and Dr. Fredrick Echols, the city’s health director, agreed the city didn’t have millions of dollars to spend on that task like its well-funded neighbor.
“We can’t sit back and say woe is us, we don’t have all the funding,” Ross said. “We have to make it happen with the resources we have.”
At the city hearing, Echols explained the city didn’t need more staff members, because it has software to automate much of the process. Rather than having a contact tracer call a person twice a day for temperature checks, he said, the person being monitored could respond to automatic notifications. He reiterated in an interview on Friday that the city’s technology — which cost $12,000 — is saving hundreds of staff hours.
Shortages All Over
A national organization of city and county health officials recently recommended that health departments have 30 tracers per 100,000 residents. In St. Louis, that would mean 90 contact tracers. There are no immediate plans to hire more, but Jacob Long, a spokesman for Mayor Lyda Krewson, said on Friday the city would hire more if it needed them.A review by the Associated Press found states are often hundreds — even thousands — of people short of targets for their contact tracing programs. Public health experts have consistently said robust programs to test more people and trace their contacts are needed for states to safely reboot their economies and prevent a resurgence of the virus.
Cook County, Illinois, has just 29 contact tracers serving 2.5 million people living in suburban communities around Chicago. Los Angeles County, which at more than 10 million people has a population slightly greater than Michigan, has just 400 of the estimated 6,000 contact tracers it will need under California’s criteria for a broader reopening.
Some areas of the country have used aggressive contact tracing to root out cases of asymptomatic carriers of the disease. A team of 12 contact tracers in Fremont County, Wyoming, for example has found 180 cases, the most in the state.
The state of Illinois is hiring 3,800 contact tracers. But Missouri is offering no help to local governments with hiring tracers.
Many are worried the city can’t make it happen, and that will make it difficult for the region to emerge from the pandemic. Because of that concern, they say, St. Louis County should have an interest in lending a hand.
Alderman Cara Spencer, D-20th Ward, last week scheduled an aldermanic hearing to look into the city’s readiness for contact tracing. She said on Saturday that Echols had initially agreed to attend but had backed out.
“There is no excuse right now for not having a regional approach to contact tracing and testing,” Spencer said. “And by regional approach, I mean collaborating, sharing resources, recognizing that the city doesn’t have the level of funding per capita that the county has. And recognizing that we have a higher infection rate in the city.”
Spencer, who is running for mayor, added, “We should never under any circumstances be out of step with each other on at least those issues. … We cannot continue to operate in these silos.”
Alderman Megan Green, D-15th Ward, said that “on the calls that the aldermen have with the mayor and Dr. Echols, probably once a week somebody asks, ‘Do you have enough contact tracers? We have constituents of ours who seem to be pretty knowledgeable who are willing to volunteer their time to help with this,’ and, what we’ve been told is that there’s not a need for volunteers, that we have everything covered.”
“I don’t know that that’s true. I don’t know that it’s not true. But when we see what the county is doing versus what the city’s doing, you know, it has to give us pause about whether we do have the mechanisms in place to be able to do this.”
Across the state, Jackson County is weighing a $5 million investment in contact tracing, including renting a building for its staff, although the board chairman wants to include some firefighters already on fire district payrolls. Jackson County includes most of the state’s biggest city, Kansas City.
Bridgette Shaffer, the Jackson County health director, told the county legislators that her existing staff has been handling contact tracing but she needed them to get back to their regular duties providing immunizations and preventing other diseases that will spread when the economy resumes.
“We need a lot of resources to do this and do this smartly,” she said.
Quarantine Question
Quarantine data posted on the city’s online portal raise questions about whether the city is identifying close contacts of COVID-19 patients.The U.S. Centers for Disease Control and Prevention recommends that any person who had contact with a positive person should stay home for 14 days and maintain a six-foot distance from others at all times.
There were 451 city residents who tested positive for COVID-19 from May 1 through May 14. But, on Thursday, the city had just 61 people under quarantine due to exposure. Echols said the low number was a reflection of people being isolated during the stay-at-home order.
By comparison, between May 1 and 14, St. Louis County had 900 positive cases, and had 393 people under quarantine on Thursday. St. Charles County added 88 cases over that time and had 370 in quarantine.
Some St. Louis officials are saying the county should do more to help the city make it happen — or else.
“It does St. Louis County no good to have all the contact tracers just focusing on St. Louis County,” Lewis Reed, president of the Board of Aldermen, said in an interview. A virus that has traveled the globe, he said, “isn’t going to have any problem going between St. Louis city and St. Louis County.”
St. Louis County Executive Sam Page said Friday that county officials were regularly working with and talking to city health officials, but the county would not be sharing any of its federal relief funds.
“Humanitarian relief is coordinated regionally,” he said. “Our public health departments work regionally. So I’m sure there’s some overlap and resources, but as a general rule, the requirements from the federal government for the funds that were given directly to St. Louis County is that they should be spent within St. Louis County.”
As for contact tracing, he said, “I am familiar with what’s happening in St. Louis County. We’re working very vigorously to set up our contact tracing program. I would expect that the city, St. Louis, would have a responsible program as well. I just don’t know the details of it.”
Punch said the result of any failure to trace contacts in St. Louis would be that the virus spreads, and that black and brown people across the region would continue to suffer inordinate harm.
“This is a financial and manpower issue, and the question I have for the city is, how are you appropriating funds to properly support the hard workers that are doing their best in the city health department? It’s clear to me that it just doesn’t have the staff it needs to be able to do this enormous job.”
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