‘A highway away’: Delta variant, low vaccine rates cause COVID spike across Missouri

Kendra Findley had thought the Springfield area had seen the worst of the COVID-19 pandemic in December — a month when cases regularly surpassed 200 a day and that saw a record 98 residents die of the virus.

Looking back, that was when the Alpha variant, first identified in the U.K., was burning through the population when vaccines weren’t yet widely available.

Now, Findley, the administrator of community health and epidemiology at the Springfield-Greene County Health Department, fears the highly transmissible Delta variant will blaze through the remaining susceptible residents if vaccinations don’t increase. In mid-May, the Delta variant made up about 70 percent of the area’s cases tested for variants. In the last three weeks, it’s risen to 93 percent.

“I don’t want any more people within my community to die because of COVID,” Findley said. “We’ve been at this for more than a year now… And I’ve read too many death summaries. I don’t want to do that.”

Springfield is just one of the growing number of Missouri communities being overtaken by the Delta variant’s spread.

Missouri leads the nation in new COVID-19 cases per capita according to a The New York Times analysis of states’ data. The surge is being driven in part by the Delta variant, which was first detected in India and now has taken hold firmly in Missouri and reported in the wastewater of the state’s major metros.

Genetic surveillance of COVID cases at a state level found at least one case of the Delta variant in 35 counties across all regions of the state, with the southwest region accounting for just over 67 percent of all Delta cases identified, according to a health advisory DHSS issued Wednesday.

Its rapid spread has contributed to the worst outbreaks some rural communities in the northwest part of the state have experienced thus far and has driven an explosion in new cases in the southwest.

“Time will tell whether the outbreaks we’re seeing where we are are because of low vaccination rates or whether it’s just that’s perhaps where it got first,” said Marc Johnson, a professor of molecular microbiology and immunology at the University of Missouri who has been working with the state to collect and analyze samples of wastewater for COVID variants.

On Thursday, Missouri reported 1,232 new cases — the highest daily count since Feb. 11. The seven-day average of reported cases, 759 per day as of Thursday, is up 90 percent since June 1.

If cases continue to rise at their current rate, it’s anticipated Missouri will surpass 616,000 total cases by early next week — which would mean roughly 10 percent of the state’s entire population has been sick with COVID-19 since March 2020.

Experts say the actual case count is likely higher.

Gov. Mike Parson told KMIZ that while the variant is a cause for concern, the state is “comfortable” with where things are as testing continues and vaccines are available.

“COVID’s going to still be here for a while. We know that a lot of people still haven’t been vaccinated yet, but it’s still going to be here,” Parson told KCRG-TV. “We know people are being tested every day with it, and so we’ve just got to continue to monitor it. But again, we are in such a much better place than we were a long time ago, and everybody has an opportunity for a vaccine that wants a vaccine now, so a lot of positive things happening on the front.”

This time, health officials have the tools at their disposal and know what strategies work. The method that offers the best protection: vaccines, but rates have dropped off a cliff.

Missouri’s seven-day average of vaccines administered dropped to roughly 8,500 on Monday — the lowest levels seen since early January. Statewide, 43.8 percent of residents have received at least their first dose as of Wednesday.

“We’re offering the vaccines. We’re offering the tools,” said Connie Werner, the clinic supervisor for the St. Joseph Health Department. “But if the community doesn’t take us up on that, if they don’t meet us halfway, we can only make such an impact.”

The state was notified of the first result of the Delta variant through genomic sequencing on May 8, Lisa Cox, a spokeswoman for the Department of Health and Senior Services, said Thursday. Local public health agencies are notified as soon as the state has the results from their areas, she said.

While the state has been monitoring and working with local health departments to identify the variants’ spread, they’ve been less vocal than local officials about sounding the alarm and warning that each instance the virus has to spread increases the odds new mutation will emerge. In India, a potentially more transmissible “Delta plus” variant has already been detected.

“All these cases where the virus is replicating and replicating and replicating in a person, every time there’s a chance that a new variant will arise that the vaccine does not protect as well or at all against,” said Catherine Troisi, an infectious disease epidemiologist at UTHealth School of Public Health in Houston.

Across the state, vaccination rates can swing wildly between a high of nearly 50 percent of residents receiving at least one dose in Boone County in mid-Missouri to lows of around 20 percent in others.

If vaccination rates don’t significantly increase, experts predict the state will continue to find itself in a cycle of trying to predict where outbreaks may take hold in lower-vaccinated communities that could jeopardize the entirety of the state and region.

“Overall, if we continue to struggle with where we’re at with vaccines, I think it’s just going to be cyclical, and the spikes will continue happening across cases and hospitalizations and deaths,” said Matthew Holloway, who has been collecting and posting data on COVID in Missouri since the start of the pandemic.

Health officials whose communities are on the edge of some of the worst outbreaks are bracing for what’s to come.

A matter of if, not when

When Mike Chambers saw cases explode to the west in the counties of Linn and Livingston, it wasn’t a question of if the virus would come down the U.S. Route 36 highway to his county of 15,000, but when — and how bad it would get.

In April, Macon County was seeing about six cases a week. In May, it went up to nearly ten a week. This month, it’s been at least 20 each week, said Chambers, the administrator for the county health department.

Out of the more than 60 cases the county has seen in the last month or so, only two people were vaccinated, said Chambers.

“And I know that we’re not done in Macon County, and I believe we’re going to continue trending up,” he said. “It’s just a matter of whether it’s going to trend up at what kind of a rate.”

To the east on the edge of the Missouri-Kansas state line, St. Joseph is seeing a similar rise. 

Last week, some elementary and middle school students in the district were switched to online summer school after COVID cases were reported. Like Macon County, cases are primarily among the unvaccinated and they have started to trend younger. 

In Missouri, vaccination rates decline the younger the age group, with less than 20 percent of those between 12 to 14 years old having received at least their first dose.

“Cases are just a highway away,” Werner said, later adding: “Ultimately, the actions don’t change. So getting vaccinated is number one.”

With roughly 20 percent of county residents initiating vaccination, Werner said residents should assume that only one out of every five people in the area are vaccinated.

In the Springfield area, 167 residents were hospitalized due to COVID-related illness as of Thursday, the most since January. The average age of confirmed cases for the Delta variant in the area was around 27 years old, Findley said.

On Tuesday, the chief administrative officer for Mercy Springfield Communities tweeted that they were treating a child less than one years old who had tested positive for COVID.

We have a COVID+ under 1 year of age @MercySGF. My prayers are with this little one. I hope as a community we can start to see the reality of this virus. It does not discriminate. It doesn’t care what you think. Please retweet. Tell your neighbors. Tell everyone. Vaccinate.

— Erik Frederick (@CAOMercySGF) June 23, 2021

Local health officials said they continue to post information about rising cases, hoping residents can use the data to help inform their decisions. The numbers speak for themselves.

But while the state has been doing work behind the scenes, they’ve been less vocal publicly about the explosion of new cases.

Sounding the alarm

Findley said the state health department first notified them of the Delta variant’s presence in the Springfield area on June 9. The result came from a sample tested on June 3 and had been identified through the Centers for Disease Control and Prevention’s genomic surveillance program that sequences random positive samples to identify variants.

Greene County, which averaged nine cases per day in April, has averaged 74 cases per day this month. The state health department dashboard showed 182 additional cases on Thursday.

“From there, it was like wildfire. It just exploded,” Findley said. “I wish we would have known that it was coming from other areas of even in the Midwest — that it was headed our way.”

Each week the Springfield-Greene County Health Department also sends five samples to do genomic testing at the state public health lab. Findley said the state’s assistance has been key to monitoring the variant’s prevalence, but that her department hasn’t waited on them to get the word out.

“We’re not necessarily waiting on the state to take the lead, because we’re the ones that are responsible for our local community,” Findley said.

The state health department has been in contact with local departments that are seeing spikes, and in recent weeks created a map of hotspots that compares county’s case rates to each other by combining case rates for both confirmed positive PCR tests and probable cases through positive antigen tests.

Nathan Koffarnus, the assistant bureau chief of DHSS’ Bureau of Communicable Disease Control and Prevention, touted to public health officials on a June 8 call that the tool could be used to help predict “not where the hotspot is currently, but where it’s headed.”

But residents would only be able to access that map if they know where to look. It’s on a webpage that is not accessible to search engines.

When a local public health official asked if they could share the map with the public, Adam Crumbliss, the director of DHSS’ Division of Community and Public Health, said officials could share the map with their partners but that the department was concerned about creating “mass hysteria or concern.”

“Obviously, the data is the data and it is not something that we would say is secret or closed record,” Crumbliss said on the call. “We just want to make sure that if you do share it, that it’s done in an appropriate and thoughtful context of what our public health situation is.”

It wasn’t until last week — more than a month after the state was aware of the Delta variant through genetic sequencing and it was detected in wastewater in Branson on May 10 — that DHSS put out a news release urging residents to get vaccinated.

On Wednesday night, a week after the news release was issued, the department posted a video of George Turabelidze, the DHSS state epidemiologist, discussing the variant’s spread. That same day the department also issued a health advisory on the variant’s spread, noting that the four-state region that contains Missouri has the highest proportion of cases of the Delta variant detected, according to the CDC. 

Cox declined an interview request after the news release was published, but said in a written statement last week that the state has been consistently engaged with the CDC and local public health departments on reporting variants and rising cases.

“We are now engaged in a targeted and aggressive state public education effort encouraging those Missourians not yet vaccinated to do so,” Cox said last week. “This is the Show-Me State and Missourians are skeptical.”

Cox did not provide details about what those specific steps are. The state previously said it planned to launch a $5 million advertising campaign, and has issued $20 million worth of contracts to local public health agencies out of $55 million in funding the CDC has made available to boost vaccinations.

In Shannon County, which has a population of a little over 8,000 in southern Missouri, zero cases in recent weeks has gone up to 11 active cases as of Tuesday. Kandra Counts, the health department’s administrator, has been trying to find other avenues to sway residents to get vaccinated. They recently filmed an interview with a local doctor who has been practicing in the area for 40 years. She hopes people will listen to him.

The rising case numbers might be the push some people needed to get vaccinated, she said. For an upcoming vaccination event there were eight people signed up as of Tuesday.

“We were pretty much down to nobody was calling,” Counts said. “So it looks like it helped a little bit.”

Other states have launched lotteries, with prizes ranging from everything from guns to college scholarships, to incentivize taking a shot. But Parson said last week he was hesitant to do so.

“Now, when you start giving away incentives to do that, I think you’ve really got to think through that, because what’s it going to be next year if it’s something else?” Parson said. “Are we going to start rewarding people to take a vaccine? And is that really what we should be doing?”

Counts said she agrees. She hopes people will make their own choice to get vaccinated, rather than bribing residents to do something they may not want to.

“I have elderly parents. They’re in their 80s. And they’ve chosen not to get vaccinated,” Counts said. “So I made the choice to get vaccinated not only for me, but to protect them as well.”

Holloway said the situation is so dire now that he doesn’t think there’s an overnight solution that could fix it and he’s not confident consistent communication from the state would make much of an impact after officials have previously declared Missouri is fully open.

Vaccinations are residents’ best defense, public health officials and experts said. If vaccination rates don’t increase, they have a grim outlook for what’s to come.

“We’re going to have another variant, because life will always find a way to live,” Findley said. “And that’s what this virus is doing.”

This story has been updated since it was first published.