Missouri plans an official ‘end’ to the COVID-19 pandemic as early as March, the document says • Missouri Independent
Missouri plans an official ‘end’ to the COVID-19 pandemic as early as March, the document says • Missouri Independent

Missouri plans an official ‘end’ to the COVID-19 pandemic as early as March, the document says • Missouri Independent

The state of Missouri is planning an official end to the COVID-19 pandemic as a public health crisis and will move on to treating the virus as endemic, just as it does seasonal flu.

The target date for when Missouri’s public health agencies would begin treating COVID-19 as endemic is mid-March, the second anniversary of when the virus first appeared in the United States, according to internal meeting notes.

But The Missouri Department of Health and Senior Services said in a statement that no specific date has been set.

“There is no fixed timeline in place,” the department spokeswoman said in a statement. “When the time comes, we believe our approach is sensible and flexible should the need arise to return to the standards of reporting, contact tracing and case investigations as they exist today.”

Treating COVID-19 as an endemic disease will have far-reaching consequences for Missouri and other states that follow similar paths, according to internal meeting minutes on the transition achieved by the Documenting COVID-19 project and The Independent as part of a Sunshine Law request. (The full PowerPoint presentation can be found here.)

Missouri State Epidemiologist Dr. George Turabelidze said according to the minutes of the meeting that the endemic change “will snowball really fast when a few states move in this direction.”

Among the planned changes:

  • Case studies and contact tracing, where employees of local health departments reach out to people exposed to the virus in the workplace or in other public settings, will cease unless a new, more transmissive or deadly variant emerges;
  • Daily reports of COVID-19 cases and deaths from the State Department of Health will be replaced by aggregate weekly reports. In some cases, metro health departments, including those in St. Louis and Springfield, are likely to continue collecting and disseminating daily reports, but the state will stop its reporting;
  • The positivity rates will be phased out as they are already difficult to interpret, as many Americans have switched from PCR testing to antigen testing at home. Most people do not report their findings to local health departments. Missouri officials said in January they were ready to be a “trendsetter” in eliminating reporting of positivity rates.
  • Hospitalization data will become even more important, and state health officials hope to make reporting more timely;
  • Wastewater monitoring will become a more reliable data point for public health officials as a way to spot COVID-19 early in its life cycle and identify potential hot spots. Missouri is a leader in wastewater monitoring as the state has the highest number of collection points reported a new CDC dashboard.

The state has been internally planning the shift since December, even as the omicron variant of the virus rose across the United States The Missouri Center for Public Health Excellence, a nonprofit organization representing local health departments in state affairs, works with its members “to help tailor our questions, ideas, and opportunities for how we can all address COVID as a system,” he said. it in an announcement.

“We are pleased to work with the state to plan the next phase of the pandemic,” the group said.

‘Crystal ball has been broken every time with COVID’

Missouri’s shift to treating COVID-19 as endemic is not entirely unexpected.

The Biden administration has been working internally to change its COVID-19 strategy towards an endemic model. The Association of State and Territorial Health Officials, which represents U.S. health agencies, has in recent weeks convened calls among its members to develop guidelines and recommendations.

Other states have begun working behind the scenes on endemic transition plans, including California and Coloradohoping to bring a sense of normality given that many Americans have become more and more tired and frustrated by changing public health announcements

Despite the trend, some epidemiologists have criticized the political use of the term “endemic”, saying that a desire to return to a pre-COVID normal is inconsistent with the actual science of how pandemics end.

Ellie Murray, an epidemiologist at Boston University’s School of Public Health who has been particularly vocal on this issuehas defined an endemic disease as “controlled at or below an acceptable level.”

This “acceptable” level is typically determined by health experts based on the risk posed by the disease to humans. But an endemic status should not lead to less data collection, Murray wrote in a recent Medium post. “Endemic means that someone ALWAYS thinks of covid,” she wrote.

For seasonal flu – a common comparison to “endemic COVID” – thousands of scientists and health care providers work to monitor and respond to this disease each year.

Internal meeting notes from the Missouri Department of Health and Senior Services show the challenges of making a focal point as Murray described, going from an all-around approach to fighting the virus to something more like regular flu surveillance – albeit a pivot that is not tied to clear measurements indicating that the disease has reached an acceptable level in Missouri.

Some local health departments in the subway, including those in Springfield and St. Louis, is expected to continue collecting case-specific COVID-19 data to track the spread of the virus in hard-hit communities. The State Department of Health’s planning document notes that at least six health departments may have “problems” with the shift from daily to weekly reporting, while also noting that the change could provoke “some media criticism” and questions from the public.

Some health departments already have stopped sending COVID-19 data after the state attorney general and a Cole County court judge said health departments cannot issue their own local COVID-19 orders.

“We need to think about entire operating systems that need to change how data is collected, stored and disseminated,” said Lynelle Phillips, who serves as vice president of the Missouri Public Health Association and president of the Missouri Immunization Coalition. “We do not have a single system in Missouri, and it is good to set a timeline for these discussions.”

And several public health experts have warned against setting a specific deadline for the endemic transition that Missouri plans to make, given the ever-changing nature of the virus and its variants.

“Most epidemiologists will say that their crystal ball has been crushed every time with COVID. I’m very unsure to say that in March it’s all a good idea,” Phillips said.

Waiting until the COVID-19 infection rate was at a low, sustained level for at least two full incubation periods, possibly as long as four weeks, would help Missouri’s health departments prepare for the transition, said Enbal Shacham, an epidemiologist and professor of behavioral science. at Saint Louis University.

“We had hoped for a quiet season last spring and summer, and it did not happen,” Shacham said. “Unlike the flu, it does not stay dormant.”

But from a practical perspective, deadlines help policy makers, giving employers time to make operational decisions and agencies time to introduce new reporting methods, said Dr. Georges Benjamin, a former emergency room physician who serves as executive director of the American Public Health Association, a nonprofit who represents public health leaders.

“You have to decide a date on which to proceed,” said Benjamin, who has previously served as Maryland’s health secretary.

Given declining cases and hospitalizations after the winter’s rise in Omicron, Benjamin called the Missouri endemic transition process “a fair debate.” Still, he said three measurements related to the virus stand out as particularly important to continue – hospitalization rates, community prevalence of COVID-19 and vaccination rates.

155 sewage test sites in Missouri and a few holdouts

The emergence of wastewater monitoring as a reliable tool for identifying COVID-19 variants and dispersal is something new. Missouri is one of a handful of states and jurisdictions that publicly report weekly results of wastewater analysis at 155 sewer facilities across the state.

In early February, the CDC added wastewater tracking to its COVID-19 data dashboard. Wastewater has been an important COVID tracking tool throughout the pandemic, but it has gained more public interest in recent months as omicron’s rapid spread proved its usefulness as an early warning system.

Experts say this monitoring is especially useful in the era of quick tests at homebecause everyone is part of a sewer house, whether or not they can access a PCR test that would be reported to the public health system.

Missouri’s wastewater monitoring system, which includes genetic sequencing for variants, identified Delta cases last summer weeks before PCR testing did so. However, then the state failed to respond to this sewage warning; it was only when beds were filled up at Springfield hospitals that DHSS made additional resources available to deal with the highly contagious variant.

Some public health officials warn that publishing wastewater results can stigmatize communities, but those involved in wastewater sampling say test sites cover large enough areas to avoid individually identifying those infected.

“Philosophically, I almost always advocate for transparency,” said Marc Johnson, a virologist at the University of Missouri who oversees state sewage work. “In Missouri, we started by limiting the information and have gradually made the information more public. So far, there have been no negative consequences of publishing data that I am aware of. ”

Only a handful of Missouri counties have opted out of the program, either due to lack of funds to pay for sampling or another political or privacy-related concern.

One such example: In December, Macon County, an agricultural region with 15,000 inhabitants in northern Missouri, rejected federal funding to continue wastewater monitoring. It amounted to about $ 100 per. sample tests for up to $ 6,000 per year,

The reason for the refusal is unclear, however Macon County made headlines last summer when the local forensic pathologist acknowledged that he let families decide if they would omit COVID-19 as the cause of death on death certificates.

The Independents Tessa Weinberg contributed to this report.

The Documenting COVID-19 project, supported by Columbia University’s Brown Institute for Media Innovation and MuckRock, collects and shares government documents related to the COVID-19 pandemic and works on investigative journalistic projects with partner newsrooms.

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