Donald Kauerauf, the director of the Department of Health and Senior Services, speaks during a press conference at the Missouri Capitol in Jefferson City on July 21, 2021 (Photo courtesy of Missouri Governor’s Office).
Mask mandates saved lives and prevented COVID-19 infections in Missouri’s biggest cities during the worst part of the delta variant wave, an analysis by the state Department of Health and Senior Services shows.
But the analysis, conducted at the request of Gov. Mike Parson’s office in early November, was never made public and was only obtained by The Missouri Independent and the Documenting COVID-19 project after a Sunshine Law request to the department.
The study compared infection and death rates in St. Louis, St. Louis County, Kansas City and Jackson County with the rest of the state. New state health Director Donald Kauerauf wrote in an email that the study’s findings showed the effectiveness of mask mandates and forwarded it to Parson’s office.
The analysis wasn’t included in material the department prepared for cabinet meetings, the emails show. Neither the health department nor Parson’s office responded to requests for comment asking why the data has not been shared publicly.
The comparison showed infection rates in “masked” jurisdictions were higher than the rest of the state in the six weeks prior to the emergence of the delta variant. Case rates then fell below other regions as the surge gathered force in late May and have remained lower since that time.
The statewide data shows that, from the end of April to the end of October, jurisdictions with mask mandates experienced an average of 15.8 cases per day for every 100,000 residents compared to 21.7 cases per day for every 100,000 residents in unmasked communities.
The four jurisdictions imposed their mask mandates in late July and early August, as the delta variant wave was peaking.
Mask requirements remain in place in St. Louis and St. Louis County. The Jackson County Legislature voted to end its requirement in early November, and the mandate in Kansas City ended Nov. 5 except for schools and school buses.
There are a number of variables that impact infection and death rates, the health director wrote in a Nov. 3 email. But the effectiveness of masks is clear, he wrote.
"I think we can say with great confidence reviewing the public health literature and then looking at the results in your study that communities where masks were required had a lower positivity rate per 100,000 and experienced lower death rates,” Kauerauf wrote.
Mask mandates have been one of the hottest political issues of the year, pitting the authority of local officials against political opposition to masks led by Republican state officials.
Parson has spoken out repeatedly against local mask mandates, calling them "WRONG" in a tweet and a contributor to the erosion of public trust. Attorney General Eric Schmitt has gone a step further, suing St. Louis, St. Louis County, Kansas City and Jackson County to block enforcement of their mask mandates.
“Jackson County has imposed an unlawful, arbitrary, and capricious mask mandate that is not supported by the data or the science,” the opening sentence to Schmitt’s lawsuit against Jackson County states.
Schmitt has also sued Columbia Public Schools for instituting mask mandates.
The state’s analysis backs up St. Louis’ push to keep its mask mandate, said Nick Dunne, spokesman for St. Louis Mayor Tishaura Jones.
“More than anything it confirms for us what our public health experts have been saying, that masks are an effective tool for reducing community transmission,” Dunne said.
Although Schmitt has sued, Parson and the state health department have allowed local jurisdictions to decide the health measures suited to their constituents, St. Louis County Executive Sam Page said in a statement issued Wednesday.
"This data shows that the public health experts, the St. Louis Metropolitan Task Force, and the St. Louis County Department of Public Health make good decisions to protect our community," Page said.
The records show the analysis was produced in response to a request from Alex Tuttle, Parson’s liaison to the health department.
“Can you provide examples of local mandates and how those mandates impacted the spread of COVID in those areas?” Tuttle wrote in an email sent Nov. 1 to Kauerauf.
The department completed the analysis about 48 hours later.
Despite opposition from Parson and lawsuits filed by Schmitt, Kauerauf, backed masks to control the spread of the coronavirus in his first news conference.
“I rely (on) the experts at the CDC on that. Everything I’ve read, everything I’ve seen: masks work,” Kauerauf said at his first news conference after starting his job in September.
The Independent and the Documenting COVID-19 project provided Schmitt’s office with Kauerauf’s emailed comments and the charts created by the health department. The analysis will not change its stance against mask mandates, spokesman Chris Nuelle wrote in an email.
“We dispute this premise and these charts,” Nuelle wrote. “We’ve been clear that Missourians should have the right to make their own decisions, and that government bureaucrats shouldn’t be mandating masks or vaccines. We will continue to fiercely litigate our lawsuits against mask mandates in Missouri.”
In a follow-up statement, Nuelle questioned whether mandates caused cases to be lower in masked communities. In the period before the delta variant wave, when those communities also had a mask rule, case rates were higher than the rest of the state, he wrote. Case rates for the four jurisdictions fell below the rest of the state when those original mask orders were lifted.
"When those jurisdictions reimposed mask mandates in late July/early August, case trend lines were nearly identical in both 'mask mandate jurisdictions' and non-mask mandate jurisdictions," Nuelle wrote. "Lastly, since the beginning of the pandemic, case rates and deaths are lower in many non-mask mandate jurisdictions than they are in 'mask mandate jurisdictions.’"
State health department data alone can’t explain the effectiveness, or lack thereof, of mask mandates, without a fuller analysis of vaccination rates, behavior and time. But the data does show that in three of the four jurisdictions – Kansas City, St. Louis and St. Louis County – per capita case rates for the pandemic are in the bottom quarter of 118 local health jurisdictions, and per capita deaths are in the bottom third.
Jackson County has the highest case and death rates among the four, ranking 52 out of 118 in per capita cases and 27 of 118 for per capita deaths.
Officials in Kansas City and Jackson County have not provided comment on the health department’s analysis.
Missouri is by no means an outlier in terms of lacking a statewide mask policy or discouraging local governments from creating their own; Missouri is one of six states that never implemented a statewide mask mandate during the pandemic.
But Missouri's decision not to release public health data showing a demonstrable difference in COVID-19 infection and death in masked communities is notable and reflects the deep political polarization surrounding pandemic policies, one expert said.
"It's devastating to see what the Missouri governor did since mask policies do reduce the spread of COVID-19 and would reduce the number of people who become sick and die in Missouri," said Julia Raifman, an assistant professor of health law, policy and management at Boston University who oversees the COVID-19 U.S. State Policies Database. "It's devastating to see policymakers not implement policies that would reduce the number of children who are growing up without their parents."
The delta variant was first detected in Missouri in early May by researchers at the University of Missouri who analyze wastewater samples collected weekly. Since the arrival of the variant, the state health department has reported new infections for about 5.3 percent of all Missourians.
Infections have been reported for about 5.1 percent of the residents of the seven-county St. Louis Metropolitan Statistical Area tested positive in that period and about 5.7 percent of residents in the 10-county Kansas City Metropolitan Statistical Area.
But in three of the four jurisdictions with mask mandates, case rates were below other jurisdictions in the metro areas. That was especially true in St. Louis and St. Louis County, where coronavirus infections equaling less than 4 percent of the population have been reported since April 30.
Along with lower case rates, the health department analysis showed masked jurisdictions had fewer deaths per capita as well, an average of 0.2 deaths per 100,000 residents each day from May 1 to Oct. 30, compared to 0.28 deaths per day per 100,000 residents. Stated another way, unmasked communities recorded one death per 100,000 every 3½ days compared to one death per 100,000 residents every five days where mask mandates prevailed.
Schmitt’s lawsuits against all four jurisdictions remain active, despite the actions in Kansas City and Jackson County to end the mandates.
At a hearing Tuesday in St. Louis, a judge left the St. Louis County mandate in place but scheduled a hearing for Dec. 9 for more arguments, KTVI reported. The St. Louis County Council declined to vote Tuesday night on an extension of the mask order, the St. Louis Post-Dispatch reported.
A major issue in Tuesday’s hearing was the impact of a decision by Cole County Judge Daniel Green, who ruled last week that health orders designed to stop the spread of COVID-19 that were issued by local health departments violated the Missouri Constitution.
There is a hearing scheduled for Wednesday afternoon on Kansas City’s motion to dismiss Schmitt’s lawsuit.
This story has been updated since it was initially published.
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