The Delta variant thrives in a state of political and public health contention

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ST. LOUIS – The day after Missouri Governor Mike Parson wrapped up his bicentennial bus tour to boost tourism to the state in mid-July, Chicago issued a travel advisory regarding visiting Missouri.

Earlier this summer, as the number of covid-19 cases began to rise when the highly transmissible delta variant took hold in the state, the Republican-majority legislature successfully enacted laws limiting public health powers. and exempting companies from legal exposure to covid.

The state health worker job has been vacant since Dr Randall Williams suddenly resigned in late April – leaving Missouri without a permanent chief as the number of covids soared. And Springfield mayor Brian Steele, who is at the epicenter of the swelling cases, faces a recall vote for his hiding term that ended in April.

Hospitals in southwest Missouri are overflowing. As of July 19, data from the Centers for Disease Control and Prevention shows Missouri to be the worst in the country for rates of covid cases over the past week, and in the last 15 states for vaccinations against the potentially deadly virus. . Although cases are not even half of what they were during the winter peak, they continue to rise rapidly, sending a warning to other states with low vaccination rates about the devastation that the delta variant of the coronavirus can. to bring.

Divisions abound in Missouri, where vaccines are widely available but only 40% of the state has been vaccinated. Public health mitigation measures to curb the growing number of cases would be hugely unpopular in a state that has never had a statewide mask mandate. And the more the virus circulates, the more likely it is to mutate further into something more transmissible or deadly, even for people who have already been vaccinated.

The escalating political backlash to public health efforts has the state watching the barrel of a potential impending disaster, said Kelley Vollmar, executive director of the Jefferson County Department of Health.

“Missouri is the Show Me state,” Vollmar said, as the state grabbed the headlines for its growing cases among its many unvaccinated residents. “I just wish we could do it for the right reasons.”

Kelli Jones, a spokesperson for the governor, said the national media’s spotlight on Missouri was misdirected. Flare-ups where vaccination rates are low are to be expected, she said, adding that hospitals in those areas may be overloaded, but that’s in part because a backlog of elective procedures is being carried out during this iteration of the pandemic.

“When the national media catch things, they don’t have all the facts of all the details,” she said.

Jones and Lisa Cox, spokespersons for the Missouri Department of Health and Seniors Services, both highlighted a $ 5 million multimedia campaign to encourage vaccinations. They were encouraged to see an increase in vaccine orders from vaccinators – last week it was more than triple the usual demand, Cox said.

However, vaccines take a long time to work.

Meanwhile, the Springfield hotspot has requested state funding for an alternative covid care site to treat patients, saying healthcare systems are at full capacity. The Springfield-Greene County Health Department Facebook page shows the stark contrast between those vaccinated and those who resist the call, as it is littered with belligerent comments, some containing misinformation about the vaccine.

Will Marrs, a lobbyist for the Association of Local Public Health Agencies of Missouri, was born and raised in the heavily affected area of ​​Springfield. He tried to persuade his high school friends to get vaccinated, but said it was difficult to break into echo chambers of disinformation.

Marrs accuses national politics of seeping into the Statehouse and political lifeblood of Missouri, arguing that state lawmakers are following the national trends of the Republican Party instead of shouting from rooftops the importance of vaccinations. Earlier this month, at the Conservative Political Action Conference in Dallas, attendees applauded the country for not hitting vaccination rates.

And the State Senate delegation is showing the trend: Senator Josh Hawley, a Republican who is considering a senior national office, appeared on Fox News compare vaccine disinformation initiative from President Joe Biden to a “surveillance state” that is “outside of Beijing”. His counterpart, Republican Senator Roy Blunt, who has often stressed the importance of getting vaccinated, is not seeking re-election.

“We are in a crisis not only here in Missouri but across the country and around the world, and we are acting as if it is business as usual,” Democratic State Senator Jill Schupp said of the republican leadership of the state. “They chose to take the side that says, ‘I’m going to close my eyes to this, to this pandemic and to this variant, and I’m going to pretend it doesn’t exist. “”

Parson urged Missourians to get vaccinated to prevent covid. But he also publicly shot the federal government, Tweeter: “I have asked our Department of Health to let the federal government know that sending government employees or agents door-to-door to force vaccination would NOT be an effective strategy OR a welcome strategy in the community. Missouri!

Local public health officials, not federal agents, have been going door-to-door in Springfield and elsewhere in the state to encourage vaccinations.

Jones said some of the criticism that Parson wasn’t doing enough to promote vaccinations came from an ideological divide: the governor doesn’t think the government has the power to impose such things, just like he believes. no requirement for masks, she said. .

“It comes down to a certain personal responsibility; the governor said that from the start, ”she said. “And people are just going to have to decide, you know, hopefully get the shot. “

Amid the spike in cases, the White House announced it was sending an “emergency response team” to help Missouri.

That “team” currently consists of a field epidemiologist in southwest Missouri and a vaccination specialist offering virtual support, numbers based on what the state has said it needs. Cox said the state is asking for more resources.

But two people – one at a distance – are barely enough to fight decades of underfunding and a year and a half of political vitriol, said Brian Castrucci, CEO of the Beaumont Foundation, which advocates for public health.

“We are forced to apply bandages where we don’t have the resources for stitches,” he said.

Back in eastern Missouri, Vollmar County is gradually pushing up the chart of covid cases. She suspects everyone went to tourist (and delta) hot spots in southwest Missouri during July 4.

While she’s thrilled to have the game-changing vaccine, only about 30% of Jefferson County is vaccinated. Unlike last year with a similar increase in the number of cases, she believes she lacks the political buy-in in her region for mitigation measures like masking. Candidates from his local school board came forward and won on the idea of ​​eliminating mask mandates in schools.

The state health department’s notices to hotspots say “social distancing, masking and other precautions remain important,” but do not require them.

Vollmar also warned of a lack of funding for contact tracers and other necessary public health measures for the wave she fears. Funding has been slow to reach local health departments, just like last year when some state county commissioners suspended funding for local services, angry at closures and other restrictions. Platte County, in the Kansas City area, gave about the same pandemic relief funding to a local cruise line as its health department, which has served nearly 90,000 people.

“We were all hoping that once the elections were over it would stop,” Vollmar said. “If you don’t have the support of your leaders, you don’t have the support of the community.

Without a state health worker coordinating the response or getting the governor’s ear, Vollmar said, local officials like her are interacting more with federal officials. The governor’s office said a new director would be announced on Wednesday. Cox said acting director Robert Knodell – Parson’s former deputy chief of staff, who has no public health background – had been “heavily involved” in the response.

A 2020 KHN and AP survey found that Missouri’s public health spending was one of the last 10 in the country at $ 50 per Missouri per year before the pandemic. Missouri’s public health workforce fell 8% from 2010 to 2019 with the loss of 106 full-time employees.

Williams’ departure was one of at least 10 departures from Missouri’s public health leadership this year, according to another KHN and AP investigation. Nationally, this report found that at least 248 state and local public health officials had left since the start of the pandemic – leaving nearly one in 6 Americans without a local public health official for a period of time. time.

But Schupp asked, given recent legislation and the political climate in Missouri, will a qualified state health worker want to come? “We don’t allow anyone to do a good job,” she said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.

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