After different paths, Kansas and Missouri governors converge on reopening.
As the coronavirus crept into Kansas and Missouri last month, Govs. Laura Kelly and Mike Parson adopted sharply different approaches at critical moments in the escalating crisis.
Kelly became the first governor in the nation to close school buildings for the rest of the academic year. She issued a statewide stay-at-home order early and limited even church services to 10 people, drawing a legal challenge.
Parson resisted calls for similar statewide action, leaving decisions about schools and stay-at-home orders to local officials. He did ban large gatherings, but when he issued a statewide stay-at-home order in early April it was criticized as too porous.
Now, nearly eight weeks later, as Parson moves to reopen Missouri, Kelly is following close behind. Parson announced his reopening plan Monday; and Kelly plans to unveil hers in a radio and television address scheduled for Thursday evening.
Both will begin relaxing restrictions this coming Monday.
Each governor, in their own way, faces immense pressure from lawmakers and business owners to reopen. In particular, Kansas Republicans have grown more critical of Democrat Kelly and intensified calls over the past week to release a plan.
Whatever their past differences, the twin relaunches mean Parson and Kelly are now confronting many of the same challenges and risks.
Like much of the country, widespread testing remains elusive in Kansas and Missouri, even though health authorities are in wide agreement testing is key to swiftly containing outbreaks once restrictions are lifted. Still, Parson and Kelly — who have both voiced concerns over testing in the past — are moving forward.
Both administrations are putting their best foot forward, emphasizing gradual testing improvements, hospital surge capacity and the ability to acquire and clean valuable personal protective equipment for front line workers.
“I think we’re getting better numbers now and we’re much more comfortable,” Kelly said Monday.
“With favorable data and approval from state health officials, we are ready to take another step forward in the recovery of Missouri,” Parson said the same day.
Stay-at-home orders and mass gathering bans, as well as fear of the virus itself, have kept storefronts shuttered and customers away for weeks — exacting a heavy economic toll. Between the two states, more than 618,000 people have lost work.
Parson has made it clear: Unless a local ordinance forbids it, all businesses will be able to reopen their doors on May 4, with most required only to adhere to social distancing guidelines. Bans on large gatherings will be lifted.
Kelly hasn’t revealed the details of her plan, but, like Parson, is also expected to allow gatherings that adhere to social distancing guidelines and permit local authorities to enact tighter regulations.
Easing restrictions will help revitalize commerce, but will also undoubtedly spread the virus further and faster. Projections show Kansas and Missouri coming off the peak of the pandemic, but experts have warned reopening too quickly will trigger a second wave of infections.
“Just because we open up doesn’t mean that COVID-19 is any less of a risk,” said Steve Stites, chief medical officer of the University of Kansas Health System. “Once you start going back out … you’ll see a rise in cases.”
More tests ‘always better’
Missouri recorded its lowest tally of new COVID-19 cases in nearly a month on Tuesday, with the outbreak slowing everywhere in the state except the St. Louis region.
Of the 134 new cases reported Tuesday, 100 were in either St. Louis, St. Louis County and St. Charles County. Most other new cases center around hotspots, such as meat packing plants in Buchanan and Saline counties.
“We are successfully flattening the curve,” Parson said.
In Kansas, cases have surged over the past week. Officials have attributed the rising numbers to outbreaks at a half-dozen meatpacking plants. The federal government sent the state thousands of tests to help contain the spread of the virus through the plant.
Still, 80 percent of the state’s cases remain concentrated in just eight counties. Roughly 80 of the state’s 105 counties have fewer than 10 cases, or no cases at all, according to an analysis compiled by Kansas Senate Majority Leader Jim Denning, an Overland Park Republican.
“We will, without question, continue to see an uptick in the total number of cases as we do more testing,” Lee Norman, the Kansas state health officer, said. “And that’s going to be a challenge in how to communicate that to people because it looks like things are getting worse in the case count, but it’s not.”
As both states prepare to lift restrictions to slow the spread of COVID-19, testing must increase to a level that public health authorities and the public can feel comfortable that the number of cases is low and trending downward, said Joshua Michaud, associate director of global health policy at the Kaiser Family Foundation.
“More tests will always be better, and most public health experts would agree that almost every state in the U.S. is behind where they need to be in testing,” Michaud said.
On sheer numbers of tests, Michaud said both states are falling short of what experts believe is needed .According to data compiled by the COVID Tracking Project, Missouri tested 15,839 people for COVID-19 last week, up from 10,737 the week before, but down from 18,257 two weeks ago.
Kansas tested 8,097 people last week, up from 5,787 the week prior and 4,765 two weeks ago.
But on other metrics, there are signs of hope.
Michaud said high positivity rates, those above 10 percent, are a sign states are missing some cases and not enough testing is being done. The percentage of positive tests in Missouri is right at 10 percent, Michaud said, while Kansas’ is 16 percent.
Parson set a benchmark for Missouri to increase its testing capacity at state and private labs to 50,000 tests a week, a goal he said Monday has been achieved.
But a lab having enough capacity doesn’t mean they can actually conduct that many tests.
Michelle Altrich is president and clinical laboratory director for Viracor Eurofins, a lab in Lee’s Summit that has been conducting COVID-19 tests nationally. Since the beginning of the outbreak, the lab has performed around 2,000 tests in Missouri and 680 in Kansas.
She said her lab, which conducts tests from across the country, has the capacity to do 2,000 tests a day, “and we are really ramping up to 4,000 to 5,000 tests a day.”
The biggest challenge limiting the number of tests her lab can actually perform each day, she said, has been shortages of collection supplies like cotton swabs, containers and chemicals needed to make the test work.
“Almost every lab is facing the same thing that we’re facing,” she said.
She said she’s hopeful supply-chain issues are beginning to ease, and expects that “two to three weeks from now we won’t have a swab problem.”
To boost testing, Missouri officials loosened the guidelines for obtaining a test and are encouraging doctors to order tests for their patients. Missouri is also expanding community surveillance testing and assisting local health departments with contact-tracing.
“We are well aware that many of our local health departments don’t have the resources to do the contact tracing we must do,” Parson said.
To boost tracing capacity, Kansas officials are building a 400-person volunteer army to perform tracing, providing them training on how to track COVID-19 cases. Norman said volunteers are being brought on 50 at a time. The Centers for Disease Control and Prevention has also sent half a dozen employees to the state.
“As we look toward reopening the state, the key to this will be testing and contact tracing,” Norman said.
Kansas is also working with dentists who have special 3D printers to produce thousands of nasal swabs.
Dr. Karen Joynt Maddox, co-director of the Center for Health Economics and Policy at the Institute for Public Health at Washington University in St. Louis, said the bottom line is that to reopen safely “we will need to do many more tests than we’re doing now.”
“Once we start to reopen,” Maddox said, “we will need to be able to test anyone who thinks they might have COVID even if they are not very ill, so that we can quickly trace and isolate any potential contacts and figure out who is safe to remain at work, and who cannot,” Maddox said.
Some places may even want their employees tested before they re-start at work, she said.
“Collectively, that’s a much larger group of people,” Maddox said, “so we need to anticipate that demand for testing will go up quite a bit as we reopen.”
Hospital use falling
As widespread testing remains out of reach, Kelly and Parson point to other areas of progress.
Hospitalizations have fallen significantly across Missouri, with the exception of the St. Louis region, Parson said Tuesday. The Kansas City region has experienced a 41 percent drop since the state’s April 7 peak in hospital use, he said.
“The overall trends in the data show that Missouri’s health care system is under control,” Parson said.
Dana Hawkinson, medical director of infection prevention and control at the University of Kansas Health System, said Tuesday that “we may be at a new steady state, or normal as far as the hospital goes.”
As of Wednesday, the hospital had 20 patients, with 10 in intensive care. More than 100 have been released.
In Kansas, at least 253 of 504 patients hospitalized statewide have been discharged. While providing few specifics, Norman has said hospitalizations and the per-capita death rate from COVID-19 is falling.
“You have to read beyond just the numbers, but to see what the trends line are,” Norman said.
As an example, he said that even though Kansas has identified 378 cases at meatpacking plants, no one has died related to those outbreaks and very few have been hospitalized. Most who have tested positive in the meatpacking clusters have either no symptoms or very mild symptoms. He didn’t explain why.
Neither state is expected to have a shortage of hospital beds or intensive care beds in the coming days, according to forecasts by researchers at the University of Washington.
Roughly 200 beds will be needed in Kansas when hospitalizations peak on May 3, the model projected as of Wednesday morning. That’s well under the more than 4,000 available.
Missouri’s hospital use peaked on April 22, the model says. No shortages were reported.
Cindy Samuelson, a spokeswoman for the Kansas Hospital Association, said hospitals are preparing for the reopening of society. Even before the pandemic, facilities regularly drilled for patient surges.
But that isn’t expected to happen, at least not now.
“I think from all the projections we’re seeing right now, things are looking good,” Samuelson said.
The flow of personal protective equipment remains a trickle across much of the country, but Parson and Kelly have both expressed confidence over their states’ supplies. Their faith stems in large part from decontamination units the federal government has provided in recent days.
Each state has a Battelle decontamination station capable of decontaminating much-needed N95 masks up to 20 times. Kelly said Kansas plans to run the station “day and night” to clean up to 80,000 masks a day.
The system uses vaporized hydrogen peroxide to sterilize the masks.
“While this new system won’t fully resolve the shortage, it will go a long way toward protecting our frontline workers,” Kelly said.
‘No blueprint’
On the Missouri side of the Kansas City metro, Parson’s decision to lift statewide restrictions has set off squabbling among some local leaders over whether they need to follow suit.
Cass, Clay and Platte counties have decided to lift local stay-at-home orders along with Parson.
Jackson County and Kansas City will leave orders in place until May 15.
Kansas City Mayor Quinton Lucas has been vocal in his frustration with the situation, saying some are bowing to political pressure instead of listening to public health experts. On Wednesday, he laid out his own plan for reopening the city on May 15, which included strict limits on the operations of non-essential businesses.
Across the stateline in Kansas, Kelly is keeping most details about her reopening plan under wraps until Thursday evening.
Kelly has said the plan will relinquish control back to local governments, who will have the power to set more restrictive rules if needed. Counties have spent the last few days crafting their own reopening strategies and are expected to release details soon after Kelly’s announcement.
“This will be a gradual rollout,” Kelly said last week. “There is no blueprint for what comes next.”
