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Longmont United Hospital nurse Brooke Schroeder holds a sign supporting nurses December 2, 2021. Nurses say the hospital is severely understaffed and they’re trying to form a union. Hart Van Denburg/CPR News hide caption toggle caption Hart Van Denburg/CPR News Longmont United Hospital nurse Brooke …
Essentia Health CEO Dr. David Herman sees the pandemic impact on hospitals as heartbreaking in many ways. But for him, what stands out are the unvaccinated patients who are very ill with COVID-19 and on a ventilator. “Many of the sickest patients that we see, …
A Kansas City Health Department worker tests a resident for COVID-19 during an event last year. Following a letter from Attorney General Eric Schmitt, several health departments in rural Missouri counties have halted their COVID-19 response work.
tljungblad@kcstar.com
A growing number of local health departments across Missouri are ending their COVID-19 response after Attorney General Eric Schmitt demanded the agencies comply with a court ruling that appears to severely limit the authority of local health officials.
Since Thursday, more than half a dozen departments have announced they are suspending coronavirus-related work after Schmitt, a Republican campaigning for U.S. Senate, sent letters earlier in the week.
The announcements come from health departments in mostly rural counties — none have been issued from the Kansas City or St. Louis metropolitan areas. Rural Missouri counties have struggled throughout the pandemic to contain cases amid low vaccination rates, pushback from the public and limited funds.
In his letters, Schmitt outlined a Nov. 22 decision by Cole County Circuit Court Judge Daniel Green, who ruled the Missouri Department of Health and Senior Services (DHSS) didn’t have the authority, under the Missouri Constitution, to “permit naked lawmaking by bureaucrats across Missouri.” He struck down regulations giving local health departments the power to issue quarantine and other public health orders, such as closing businesses.
But the judge’s decision may have sweeping consequences for the nuts and bolts of Missouri’s pandemic response, potentially crippling the ability of local health officials to investigate outbreaks and conduct contact tracing to notify individuals who may have been exposed.
The growing realization of the ruling’s possible effects comes amid the emergence of the omicron variant and as COVID-19 cases and hospitalizations have been on the rise in Missouri. Just over half of all Missourians have been fully vaccinated.
In southeast Missouri, the Stoddard County Public Health Center said in a Facebook post that it “has been forced to cease all COVID-19 related work at the current time. This includes: case investigation, contact tracing, quarantine orders, and public announcements of current cases/deaths, etc.”
The announcements from the health departments contained remarkably similar wording. The agencies called the suspensions a “huge concern” but said they had no other choice but to follow Schmitt’s “orders.” The agencies said they were awaiting additional direction from DHSS.
“While our agency remains determined to protect the health of our county residents, it should be understood that this ruling greatly affects how we will be able to proceed with ALL highly communicable diseases in the future,” the departments said.
DHSS hasn’t publicly commented on the ruling since last week, when director Donald Kauerauf wrote local departments suggesting they get advice from attorneys. On Tuesday, after Schmitt sent his letter, state health officials told local departments they were collecting questions about the court ruling to develop a “consistent and uniform response.”
“In the meantime, I urge you to consult your local legal counsel for further guidance in the immediate timeframe,” Kauerauf wrote in an email to county health administrators that was obtained by The Star. “We hope to issue our response as soon as possible.”
At least six departments had issued similar statements halting COVID work as of Thursday night, including agencies in Pemiscot, New Madrid, Scott and Dunklin counties — all in the Bootheel — and Laclede County, northeast of Springfield.
McDonald County Health Department officials in southwest Missouri also issued a statement and told residents in Facebook comments that they will continue only to report case numbers and call people who test positive to inform them of recommendations from the Centers for Disease Control and Prevention.
“We have talked to other health (departments) and several lawyers,” the department wrote. “The way it is written we are unable to enforce any public health orders therefore we can not isolate positive cases.”
Asked if it could order isolation for other illnesses, McDonald health officials wrote, “We are unable to do that now as well.”
Two departments covering four counties north of Kansas City — Daviess, Gentry, DeKalb and Worth — said they would no longer issue quarantine orders for schoolchildren, while Carroll County in north central Missouri said simply that it would comply with the court decision. Several others said they were unsure how to proceed.
In November, attention initially focused on how Green’s ruling effectively stopped local health officials from issuing quarantine and other orders absent approval from a local governing body. Many of the rules Green struck down were already limited this year by passage of a new state law that requires local public health rules to be approved by governing bodies such as county councils.
But Schmitt’s letter this week has drawn renewed attention to the ruling and highlighted the judge’s more far-reaching pronouncements.
Green declared unconstitutional entire sections of Missouri regulations dealing with infectious diseases. Those include provisions that go beyond quarantines and closing businesses to include “notification to potentially exposed individuals” and “notification to the public of the risk or potential risk of the disease” and providing information to avoid or “appropriately respond” to the exposure.
Schmitt’s letter, citing Green’s ruling, threatened legal action if local health departments do not drop mask mandates, quarantine rules or other public health orders. Kauerauf’s letter to local health agencies last week noted the ruling curbed departments’ powers to issue isolation and quarantine rules, and left unclear whether they could still require people who may have been exposed to the virus to isolate or quarantine.
Chris Prener, an assistant professor of sociology at Saint Louis University who tracks COVID-19 data in Missouri, said on Twitter that the developments represented “multiple local health departments throwing in the towel at an incredibly dangerous time for our state, all thanks to a malicious lawsuit and a judge’s incredible overreaction.”
Schmitt has made overturning COVID-19 mitigation rules in municipalities and school districts across the state a central goal of his office as he campaigns for higher office. But a spokesman suggested on Thursday that he only intended to stop local health departments from issuing orders, not halt the COVID-19 response of counties altogether.
“We’re grateful that the Laclede County Health Department has ceased their COVID-19 public health orders like their quarantine order,” Schmitt’s spokesman Chris Nuelle said in an email on Thursday in response to Laclede County’s statement, the first to draw widespread attention. “Any further decisions beyond ceasing quarantine orders or similar public health orders should be directed to them.”
Green’s decision may not be the final word on Missouri law. His ruling came in a lawsuit brought against COVID-19 health orders last year by St. Louis-area resident Shannon Robinson, Church of the Word and Satchmo’s Bar and Grill, a Chesterfield restaurant that had fought St. Louis County’s indoor dining restrictions. The Satchmo’s owner, Ben Brown, is now running for a state Senate seat.
Schmitt doesn’t plan to appeal the ruling, leaving it unclear whether anyone will attempt to intervene to escalate the case to a higher court. Kauerauf had asked the attorney general to appeal but was refused; the department also said it would not appeal using outside counsel.
DHSS didn’t comment on Thursday.
“This is what it’s come to,” House Minority Leader Crystal Quade, a Springfield Democrat, tweeted. “With a new variant we’re learning more about, during cold and flu season, when Missourians are planning Holiday gatherings, AG Schmitt is threatening local health authorities into not reporting anything COVID related.”
In Laclede County, health administrator Charla Baker warned local health care providers and businesses of the suspension of COVID work on Wednesday, a day ahead of the public announcement. It prompted questions from the manager of the Jordan Valley Community Health Center clinic there, according to emails obtained by The Star through a public records request.
“This means I will need to inform my medical team not to report positives to your office and also not to tell the patient to expect a call from the Health Dept with quarantine instructions?” the clinic manager wrote.
Baker responded that she would continue tracking county cases internally with information the clinic reports to the state, and confirmed there would be no calls from the health department. She said the situation was “complicated” and could change with more DHSS guidance, but called that “unlikely.”
She also told the county’s Office of Emergency Management of the decision, writing: “WHAT A MESS WE NOW ARE IN!!!!!!”
On Friday afternoon, the Laclede department made another announcement on Facebook, clarifying that it would still post case numbers. It was accompanied with a report on the county’s weekly case numbers that was more limited in details than past reports.
“’Internally’ our work has changed very little,” the department wrote. “The staff of Laclede County Health Department will continue to track positive cases, deaths, and statistical data for our county. Additionally, we want to continue to provide statistical information to our county residents, as permitted.”
This story was originally published December 10, 2021 9:26 AM.
Jonathan Shorman is The Kansas City Star’s lead political reporter, covering Kansas and Missouri politics and government. He previously covered the Kansas Statehouse for The Star and Wichita Eagle. He holds a journalism degree from The University of Kansas.
Phil Galewitz, Kaiser Health News For nearly a month, the Centers for Disease Control and Prevention’s online vaccine tracker has shown that virtually everyone 65 and older in the United States — 99.9{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} — has received at least one covid vaccine dose. That would be …
SPONSORED — Cheers to the parents and guardians who keep their kids safe and healthy. The dad who cooks a meal with something green in it, even though he’s tired and drive-thru burgers were tempting. The mom who calms down the little one who loudly …
People protest a COVID-19 vaccine mandate for municipal workers on Oct. 28 in New York City. Polling, vaccination and mortality data all suggest that Republicans are the biggest group of unvaccinated Americans and are suffering the worst consequences as a result.
David Dee Delgado/Getty Images
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People protest a COVID-19 vaccine mandate for municipal workers on Oct. 28 in New York City. Polling, vaccination and mortality data all suggest that Republicans are the biggest group of unvaccinated Americans and are suffering the worst consequences as a result.
David Dee Delgado/Getty Images
Since May 2021, people living in counties that voted heavily for Donald Trump during the last presidential election have been nearly three times as likely to die from COVID-19 as those who live in areas that went for now-President Biden. That’s according to a new analysis by NPR that examines how political polarization and misinformation are driving a significant share of the deaths in the pandemic.
NPR looked at deaths per 100,000 people in roughly 3,000 counties across the U.S. from May 2021, the point at which vaccinations widely became available. People living in counties that went 60{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} or higher for Trump in November 2020 had 2.7 times the death rates of those that went for Biden. Counties with an even higher share of the vote for Trump saw higher COVID-19 mortality rates.
In October, the reddest tenth of the country saw death rates that were six times higher than the bluest tenth, according to Charles Gaba, an independent health care analyst who’s been tracking partisanship trends during the pandemic and helped to review NPR’s methodology. Those numbers have dropped slightly in recent weeks, Gaba says: “It’s back down to around 5.5 times higher.”
The trend was robust, even when controlling for age, which is the primary demographic risk of COVID-19 mortality. The data also reveal a major contributing factor to the death rate difference: The higher the vote share for Trump, the lower the vaccination rate.
The analysis only looked at the geographic location of COVID-19 deaths. The exact political views of each person taken by the disease remains unknowable. But the strength of the association, combined with polling information about vaccination, strongly suggests that Republicans are being disproportionately affected.
Recent polling data that show Republicans are now the largest group of unvaccinated individuals in the United States, more than any other single demographic group. Polling also shows that mistrust in official sources of information and exposure to misinformation, about both COVID-19 and the vaccines, run high among Republicans.
“An unvaccinated person is three times as likely to lean Republican as they are to lean Democrat,” says Liz Hamel, vice president of public opinion and survey research at the Kaiser Family Foundation, a nonpartisan health policy think tank that tracks attitudes toward vaccination. Political affiliation is now the strongest indicator of whether someone is vaccinated, she says: “If I wanted to guess if somebody was vaccinated or not and I could only know one thing about them, I would probably ask what their party affiliation is.”
It was not always this way. Earlier in the pandemic, many different groups expressed hesitancy toward getting vaccinated. African Americans, younger Americans and rural Americans all had significant portions of their demographic that resisted vaccination. But over time, the vaccination rates in those demographics have risen, while the rate of Republican vaccination against COVID-19 has flatlined at just 59{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d}, according to the latest numbers from Kaiser. By comparison, 91{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of Democrats are vaccinated.
Being unvaccinated increases the risk of death from COVID-19 dramatically, according to the CDC. The vast majority of deaths since May, around 150,000, have occurred among the unvaccinated, says Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine.
While vaccine hesitancy exists in many different groups, Hotez suspects that the deaths are “overwhelmingly” concentrated in more politically conservative communities. “How does this make sense at any level?” he asks.
The consequences for individuals are real. Mark Valentine still remembers when his brother called him to tell him he had contracted coronavirus. Valentine is a trial consultant in North Carolina. His brother Phil, 61, was a well-known conservative talk show host in Nashville, Tenn., who often expressed skepticism about vaccination.
Conservative talk radio host Phil Valentine (right), pictured with his brother, Mark (second from left). Phil had been skeptical about COVID and the COVID vaccines, sometimes mocking them on his talk show. Earlier this year, he contracted the virus and died.
Courtesy of Mark Valentine
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Courtesy of Mark Valentine
Conservative talk radio host Phil Valentine (right), pictured with his brother, Mark (second from left). Phil had been skeptical about COVID and the COVID vaccines, sometimes mocking them on his talk show. Earlier this year, he contracted the virus and died.
Courtesy of Mark Valentine
Neither brother was vaccinated, and neither one was particularly worried about Phil’s positive result. His brother said he was trying several alternative therapies commonly promoted in conservative circles. “He said, ‘I’ve got the ivermectin, I started it this morning, and I don’t think it’s going to be a big deal,’ ” Mark Valentine recalls. “And frankly I didn’t think about it anymore.”
But a week later, Mark said he got a call from his brother’s wife saying that the two were going to the hospital. “Before I knew it, he was in there and I couldn’t get to him, couldn’t talk to him,” Valentine recalls. “His situation took a nosedive like you can’t believe.”
Phil Valentine died in August about five weeks after he announced he had tested positive for COVID-19.
Misinformation appears to be a major factor in the lagging vaccination rates. The Kaiser Family Foundation’s polling shows Republicans are far more likely to believe false statements about COVID-19 and vaccines. A full 94{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of Republicans think one or more false statements about COVID-19 and vaccines might be true, and 46{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} believe four or more statements might be true. By contrast, only 14{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of Democrats believe four or more false statements about the disease.
Belief in multiple false statements highly correlates with vaccination status, Hamel says. “If you believe that the vaccines can damage your fertility, that they contain a microchip and that the government is inflating the number of COVID-19 deaths, you’re going to think really differently about whether to get vaccinated.”
Perhaps the most pernicious pieces of misinformation have to do with the perceived severity of COVID-19 itself. The most widely believed false statement was: “The government is exaggerating the number of COVID-19 deaths.”
Hamel says that underestimating the severity of COVID-19 appears to be a major reason why Republicans in particular have fallen behind in vaccination: “We’ve seen lower levels of personal worry among Republicans who remain unvaccinated,” she says. “That’s a real contrast with what we saw in communities of color, where there was a high level of worry about getting sick.”
Complacency around the risks of contracting COVID-19 certainly seemed to be a major reason why the Valentine brothers avoided vaccination. While not conspiracy theorists, they were staunch Trump supporters. The arrival of coronavirus just ahead of the presidential election of 2020 seemed like “the most fortuitous pandemic in the history of the world” for the Democratic Party, recalls Mark.
Despite the media coverage, Phil Valentine didn’t believe COVID-19 was serious as long as you were healthy: “He said, ‘The likelihood of me getting it is low. In the unlikely event that I do get it, the likelihood that I will survive it is 99-plus {b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d},’ ” Mark Valentine recalls.
Vaccine researcher Peter Hotez is deeply troubled by the current state of affairs. A winter surge in COVID-19 cases is brewing, and the newly discovered omicron variant has the potential to make things far worse.
He thinks the elements of the Republican Party that are endorsing anti-vaccine ideas need to take a big step back. “I’m not trying to change Republican thinking or far-right thinking,” he says. “I’m trying to say: ‘The anti-science doesn’t belong; it doesn’t fit. … Just stop it and save lives.’ ”
Before his illness, Phil Valentine had sometimes promoted unproven alternative therapies and taken a mocking tone toward vaccination. As his situation deteriorated, Mark says the talk show host realized he needed to encourage his listeners to get vaccinated. Phil told his brother, “‘My fear is that because I didn’t get it, other folks may not get it,” Mark Valentine recalls. The family put out a statement in support of vaccination, and Mark went on to his brother’s talk show to encourage listeners to take the shot.
He also headed to his local Walmart to get vaccinated. “The guy comes out; he said, ‘Do you have any questions or concerns?’ ” Mark Valentine recalls. “I said, ‘Hell yeah, I’ve got both, but do it anyway.’ “
Methodology
Vaccination rate data are the rate of vaccination among all people 18 years of age or older, as of Nov. 30. They are from the Centers for Disease Control and Prevention.
COVID-19 deaths per 100,000 residents are calculated by dividing the deaths from COVID-19 in a county since May 1 by the county’s population. County population data come from the U.S. Census Bureau’s 2020 decennial census. May 1 was chosen as the start date of our analysis because that is roughly the time when vaccines became universally available to adults ages 18 and older. COVID-19 death data is collected by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University and is current as of Nov. 30.
2020 election result data are from MIT Election Data and Science Lab.
Alaska does not report election results by county-equivalent area, so it is excluded from the analysis. Nebraska is excluded from the analysis because does not report county-level COVID-19 statistics. Hawaii is excluded because it does not report county-level vaccine data. Some counties that have reported no COVID-19 deaths since May 1 may have stopped reporting. These counties generally have very small populations and have a negligible impact on the weighted averages. Erring on the side of caution, we include all data unless it is known that they are in error.
All averages are weighted by county population. The overall average represents the average of the 3,011 counties included in the analysis.
Emily Gurley, Professor of the Practice and Emily Pond, Research Data Analyst, both of Johns Hopkins Bloomberg School of Public Health helped review our methodology.
NPR’s Huo Jingnan contributed to this story.
