Hospitalizations and deaths from COVID-19 are on the rise in Missouri, especially in parts of the outstate with fewer hospital resources. Smaller rural hospitals are referring patients to larger more resourced hospitals in major outstate cities including Springfield and Columbia.
For Steve Edwards, the earliest warning signs started popping up in July. As the CEO of Cox Health in Springfield, Edwards has seen hospitalizations spike since the start of September. Nearly 70 COVID-19 patients were hospitalized at Cox as of Thursday and more than 90 people have died from the disease at Cox facilities.
"It's gone up exponentially like we had worried about," Edwards said.
As the largest locally-owned health system in southwest Missouri, Cox has borne the brunt of the outbreak in the region.
“We’re trying to balance protecting our community with protecting our staff, and not exhausting our staff who are working so hard right now to care for all these patients,” Edwards explained.
Edwards has also noticed an increasingly common trend in hospitalizations. According to the Springfield/Greene County Health Department, only around 40 percent of people hospitalized in the city are from Greene County: the rest come from all over southern Missouri. It's a region which largely doesn’t require face masks.
“Springfield is an entity that’s masking in a sea of surrounding areas and counties that don’t mask,” Edwards said.
Like Springfield, Columbia and Boone County have a mask mandate, but are surrounded by counties that don’t. While Springfield is currently seeing the bulk of new COVID-19 hospitalizations, the trend of rural areas feeding into mid-sized cities is playing out in mid-Missouri too.
Dave Dillon, vice president for media relations with the Missouri Hospital Association, says the central region of the state is an area for concern.
“If you look at Columbia, Columbia has pretty good healthcare assets, they’re not quite up against the wall the way we could see in Springfield,” Dillon said. "But we know that the reproductive rate of virus is higher in Central Missouri, the higher that is, the more likely we’ll need hospitalizations in the near future.
Dillon says the best way to ease the burden on hospitals in the outstate is by reducing infections in the first place through masks, handwashing, and other preventive measures.
For months, even as daily new coronavirus cases have continued to increase, Missouri governor Mike Parson has resisted a statewide mask mandate. Parson argues the bulk of cases have come in urban areas that already require masks. But even now, with outbreaks hitting rural Missouri, Department of Health and Senior Services director Randall Williams says the state is focused on outreach, rather than mandates.
“We just have to double down on our message that no matter where you are in Missouri, if you can’t social distance, you need to wear a mask,” Williams said.
According to Williams, his department has also worked to increase the availability of testing, and encourages people to get tested, especially with the start of flu season in October.
Flu season is a worry for providers like MU Health Care's chief medical officer Mark Wakefield.
“Community adoption of flu vaccination is always important, it’s just especially important this year to avoid outstripping the capacity of the healthcare system,” Wakefield said.
Even a handful of COVID-19 patients in intensive care can strain resources. Patients on ventilators, for example, can stay in the ICU for weeks, and staff working with them need additional personal protective equipment.
“We do know that taking care of patients with COVID, either in the ICU when they’re ventilated or in a regular room where we have our other patients isolated … is physically and emotionally exhausting for healthcare providers,” Wakefield explained.
Boone County has hit all-time highs for hospitalized COVID-19 patients in the past two weeks, as well as patients in intensive care and on ventilators. Like Springfield, a majority are from outside the county.
In Springfield, Edwards echoes Wakefield’s concerns about his staff, who have been caring for COVID patients for six months now.
“We need a break. Our staff will work hard but they can only work so much. So we hope that this will settle down," Edwards said. "But we’re also realistic and we know the U.S. leads the world in infections and leads the world in deaths.”
Edwards says the metrics his staff looks at suggest hospitalizations will peak in the next week. Nevertheless, he says Cox is currently working to add 36 more beds, just in case.