‘Steep part of the curve’: Missouri faces growing COVID cases, hospitalizations

Randall Williams, director of the Missouri Department of Health and Senior Services, addresses the media as Gov. Mike Parson looks on. (Photo courtesy of Missouri Governor's Office)

JEFFERSON CITY — The main source of COVID-19 spread in Missouri, state Health Director Randall Williams said Thursday, are the places people feel safest.

During Gov. Mike Parson’s weekly briefing, Williams warned that winter weather driving people indoors will require additional precautions to bring the disease under control.

“We believe that people are contracting it from people they know,” Williams said. “It is not going to Schnucks or Walmart as much as it is the six people you know, that your son, your daughter, your family, your friends, the people you gather with at different occasions, that is where we think we are seeing the transmission.

Williams spoke a few hours after his Health and Senior Services Department reported 3,553 new infections with the coronavirus that causes COVID-19. That is 492 more than reported Oct. 29, the previous daily high.

Another new high was set Friday morning, when the department reported 3,931 new cases, driving the total since March to 200,507. In the past seven days through Friday, the department reported 20,307 new infections, more than any seven-day period this year. 

“Right now we are in the steep part of the curve going up a hill,” Williams said. “And that is throughout the Midwest.”


Parson’s weekly news conference began as the gavel was going down in legislative chambers to start a special session to appropriate federal coronavirus relief funds

The vast majority of people who are infected will recover, noted Parson, who along with his wife Teresa tested positive for COVID-19 in September. Teresa Parson reported mild symptoms, while the governor did not report any.

But he acknowledged that there are many thousands who have not recovered.

“There are many Missourians who are hospitalized, on ventilators, or passed away,” Parson said. “We do not take this lightly and our thoughts and prayers are with Missourians and their families.”

Fresh off a landslide election victory Tuesday, Parson lamented the focus on masks as a campaign issue. It detracted from the larger message of how to stop the spread, he said, by maintaining social distance, not being with people for more than 15 minutes, wearing a mask when that is not possible and handwashing.

“I know that COVID fatigue has set in for many people,” said Parson, who has faced criticism when he’s chosen not to wear a mask during campaign events. “However, it is critical we stay focused and continue to be disciplined in our efforts, especially with winter, flu season and the holiday season approaching.”

And while the public may be fatigued, he said, the stress on health providers is enormous.

“For almost nine months our health care workers have been on the front lines without a break,” Parson said. “They are tired and overwhelmed. But they continue to rise to the challenge and take care of Missourians and we cannot thank them enough.”

Hospital stress

During a conference call Oct. 29 with hospital administrators, rural hospitals complained to Parson and Williams that they cannot find larger facilities to take transfer patients who need higher levels of care. 

One of the issues, Williams said Thursday, is that many COVID-19 patients are being treated with high-flow oxygen rather than being placed on ventilators, which are used as a last resort for life support.

Ambulances used to transfer patients aren’t equipped to administer high-flow oxygen, so hospitals that will take the patients will only accept those placed on ventilators, he said.

The health department reported that 1,925 people were being treated as inpatients in Missouri on Thursday, one below the peak set Wednesday. The seven-day average of hospitalizations stood at 1,774, the highest of the pandemic.

Part of the solution for rural hospitals is to reduce the number of patients requiring transfer to larger facilities, Williams said. 

“We are very much focused on that, how can we help these rural hospitals care for those people in place,” Williams said.

The state has adequate hospital capacity and there are steps that can be taken to conserve bed space, Parson said. He noted BJC’s decision to postpone elective procedures and said that policy could be put in place by other providers if necessary.

The state has supported expansion of nursing education to provide an additional 1,000 nurses annually, Parson said, but acknowledged it takes time to achieve that number.

And he repeated his worries that current providers are overwhelmed.

“All of this is a worry, so all of it is a concern, but i think the one thing that probably concerns me a little bit more is the people on the front lines. They just haven’t had a break,” Parson said. “And there’s no magic cure for that.”

Vaccine

The only real relief in sight, Williams said, is a vaccine.

Vaccines are being manufactured, including at a Pfizer plant in Missouri, and will be shipped to states as soon as an Emergency Use Authorization is issued by the FDA. Then, actual administration of the vaccine will begin when it receives final regulatory approval, Williams said.

“There is a top of the hill and when you get to the top of the hill it gets easier,” Williams said, “and we think that’s the vaccine.”

For most Missourians, that plateau is months away. Last week, on the conference call, Williams spoke encouragingly of a vaccine arriving for storage by Nov. 15, with only a final approval needed for use. The department will announce Friday commercial and research partners where ultracold storage, 90 degrees below zero, will be used for storage, Williams said.

Under the state plan, the first people who will receive a vaccine are health care providers, followed by first responders and people in congregate facilities such as nursing homes, where the risk is highest.

The Pfizer product is a two-dose vaccine and Williams in the call estimated that inoculations for the general public would begin in March. 

That timeline was based on Pfizer shipping the vaccine when it requested the FDA approval. That has been changed to shipping when the approval is received, Williams said Thursday.

The request is expected now at the end of the month, Williams said.

After the FDA approval is received, final regulatory approval is in the hands of the Centers for Disease Control and the National Vaccine Advisory Council, he said. There is no timeline for those clearances, he said.

Williams said the first distributions of vaccine will be based on state population and other factors.