No ICU beds available in northeast Missouri, where low populations translate into small hospitals

New cases from the Delta variant wave that has killed more than 1,150 Missourians since June 1 have plateaued but hospital ICUs continue to fill — and small, rural hospitals are among the hardest hit.

There were 690 patients in ICU beds across the state on Tuesday, the most recent day reported by the state Department of Health and Human Services. That is three short of the peak, set on Aug. 18, and five more than the highest number of severe cases treated during the winter peak for all infections.

In northeast Missouri, where low populations translate into small hospitals, there were no ICU beds available. In southeast Missouri, one of only two regions of the state where infection rates increased over the past seven days, about 30 percent of ICU beds were available but at least one hospital had no ICU beds for new patients on Friday morning.

On Friday, the state health department reported 2,764 additional COVID-19 infections and 26 deaths. The seven-day average of newly reported cases stood at 2,346 per day is down a little more than 20 percent from the Aug. 5 peak.

The decline, however, has been much slower than the ascent, with daily cases well above the July average. The state has recorded more than 150,000 new cases over the past 87 days, more than 70,000 during August.

There have been 750,180 COVID-19 cases identified by lab and rapid testing since March 2020.

The new deaths brought the total for August to 402, with 540 deaths in July and 215 in June. The state has reported 10,435 COVID-19 deaths, but the true figure is approaching 12,000 because the state only includes lab-confirmed cases.

Gov. Mike Parson on Friday revoked his broad-based declaration of a statewide emergency, originally issued March 13, 2020, to “prevent a substantial risk to public health” and “protect the safety and welfare of Missourians.”

Those dangers no longer exist, Parson stated in a replacement emergency declaration narrowly tailored to provide emergency support to hospitals treating patients from the Delta variant wave.

“The conditions that placed Missourians at risk of serious infection, death, and hospitalization are overwhelmingly mitigated by the efficacy of the COVID-19 vaccine,” Parson stated in the declaration, noting that the state has administered 5.5 million doses and more than 50 percent of the population “has initiated the vaccine process.”

Parson’s action could mean more difficulties for local governments and school districts that require masks. A law passed this year and cited by Attorney General Eric Schmitt’s  in his lawsuits to suppress mask requirements issued by local governments and school districts.

Schmitt, in his cases against St. Louis, St. Louis County, Jackson County, Kansas City and the Columbia Public, has argued mask rules violate individual rights, are not grounded in science and violate the law.

The bill that included the provision was upheld in a case filed by Overland, a St. Louis County city, challenging the validity of another section and charging constitutional violations in its enactment.

The biggest immediate impact could be in St. Louis County. The St. Louis County Council on Friday voted 4-0, with three abstentions, to require masks in indoor spaces, the St. Louis Post-Dispatch reported. The resolution supporting the order issued July 26 by County Executive Sam Page reverses a vote against the order on July 27.

But Parson revoked the emergency order two hours before the council vote. The new law could mean the mask order needed a two-thirds majority to take effect.

As he has gone on the anti-mask crusade, Schmitt has not responded to requests from local officials to discuss his opposition.

The superintendent of Parson’s hometown district, Richard Asbill of Bolivar R-1 Schools, criticized Schmitt for failing to respond to an inquiry about school district mask rules he made two weeks before Schmitt sued Columbia Public Schools.

“I didn’t feel like my request was abnormal or not due a return call or clarification,” Asbill said. “I thought it was appropriate.”

Parson’s proclamation says the danger is over but the Delta variant wave has current rates for new infections six times higher than the lowest level of the year, in early June.

Over the past two weeks, the per capita infection rate in 16 northeast Missouri counties has been exceeded only in southeast Missouri and the Kansas City metro area. For August to date, the infection rate in those counties is more than 50 percent higher than the July rate and 20 percent above the statewide rate.

At 99-bed Hannibal Regional Medical Center on Friday morning, COVID-19 patients occupied seven of 12 ICU beds, with two beds available, hospital CEO Todd Ahrens said.

His staff is exhausted, Ahrens said.

“Morale is not good,” he said. “It is pretty much like life, things got better in terms of the number of positive cases and the number of people needing to be hospitalized. People were thinking we got through this and in the summer we see Delta, more patients and an unusually high non-COVID patient census.”

The St. Louis metro area and a 23-region county of southeast Missouri were the only areas of the state where infection rates increased in the past week. 

The infection rate in southeast Missouri over that period is double the St. Louis rate and on Tuesday, the state health department issued a hotspot advisory for Cape Girardeau, Mississippi, Perry and Scott counties. 

The availability of ICU beds in southeast Missouri was the highest for any region of the state, at 28 percent on Tuesday, but some individual hospitals have reached their capacity.

Friday morning at Missouri Delta Medical Center in Sikeston, all 12 ICU beds were full and eight held COVID-19 patients.

“There are times when you are trying to  find an ICU bed and we are not able to find them in neighboring states,” said Eric Slaughter, infection control nurse at the 125-bed hospital.

If conditions worsen, he said, the hospital can convert a section of its emergency department to provide four additional ICU beds and it can also use the surgical recovery room for four or five more.

The issue, Slaughter said, is finding staff. The hospital has lost employees through normal turnover it is finding hard to replace and the cost for temporary nursing staff has shot up since last year.

Like the staff at Hannibal, the staff at the Sikeston hospital is struggling to keep its spirits up.

“Every single one of us would tell you here it has really hit us hard as far as morale goes,” Slaughter said. “We got to the summer months and our numbers were way down and everybody breathed a sigh of relief. We were warned, as we were going from June to July, that the forecast models were showing a surge hitting Missouri.”

More cases among children is creating worries about possible pediatric inpatients, Slaughter.

The problem, he added, opposition to masks and vaccines. On Tuesday, a meeting of the Cape Girardeau County Health Board ended early because of disruptions by anti-mask residents.

“You have a lot of pushback from a large part of the population who are either anti-mask or tired of masks,” Slaughter said. “It is a struggle, as this has dragged on and they have politicized this so much. I think there is an obvious line in the sand on these topics.”

The first hint of a Delta variant wave arrived in late May, when infection rates in Linn and Livingston counties in northwest Missouri shot up to nearly 2,000 cases per 100,000 residents, almost eight times the statewide rate for the month.

The wave then hit southwest Missouri, where infection rates jumped in the tourism corridor from Branson to Lake of the Ozarks in the first weeks of June. For the month, infection rate for 22 southwest counties was more than 2½ times the statewide rate of 311 cases per 100,000.

As the surge gathered momentum, infection rates more than tripled statewide Missouri in July, to almost 1,000 per 100,000. In southwest Missouri, the July infection rate was double the state rate.

This month, the infection rate statewide is approaching 1,200 per 100,000 with 83 local health departments reporting infection rates above July figures. There are 26 health departments where infection rates are double the July rate and 13 where it is three times the July rate or higher.

Seven of the counties with the highest rates for the past week are in southeast Missouri. The highest infection rates for the month are in Carter County in southeast Missouri and Lewis County in northeast Missouri.

Southeast Hospital in Cape Girardeau is seeing a steep increase in the number of COVID admissions, particularly among the unvaccinated, Dr. Matt Janzow, chief medical officer, said in a statement issued to The Independent.

“Patients are also younger, and in many instances, severely ill,” he said.

The hospital was treating 31 COVID-19 inpatients Thursday, 30 of whom are not vaccinated, with 13 on ventilators.

“We are managing well but cautious about accepting patients from too far away simply because we need to be sure to have the ability to continually serve our communities that are close by,” the statement read.

State data shows how the age range of new cases has shifted during the Delta variant wave. In the early part of the pandemic, cases among school-age children averaged about 10.5  percent of all infections and people over 65 made up almost 18 percent. This week, nearly 17 percent of newly reported cases are among children under 18 and only 12 percent are among those 65 and older.

Asbill, who said he asked to speak to Schmitt but never got a call back, isn’t the only public official who has a standing offer to discuss mask mandates with the attorney general. Kansas CIty Mayor Quinton Lucas challenged Schmitt to debate masks after issuing a mask order for his city.

He also asked for Schmitt to discuss the issues he had with a mask order before it was promulgated.

“Despite our office’s effort, the mayor has not had any direct communication with the AG since the request for a meeting, though Mayor Lucas welcomes a meeting between the two,” spokeswoman Morgan Said wrote in an email.

Chris Nuelle, Schmitt’s spokesman, said the office has fielded “hundreds of calls from concerned constituents regarding mask mandates,” including Asbill.

“As you know, we do not provide legal advice, which is the way his call was interpreted by our office,” Nuelle wrote. “Moreover, the Attorney General has been extremely outspoken, for months now, on his views on the illegality of mask mandates.”