As far as the COVID-19 pandemic has gone, October was, by most metrics, the worst month yet for southwest Missouri.
In the past four weeks alone, Greene County recorded roughly half of its 154 coronavirus deaths.
The region’s two major hospitals, Cox and Mercy, continue to see a sustained, high number of coronavirus patients, stretching resources and stressing staff.
And at least nine southwest Missouri counties added cases at a rate of 101 or more per 100,000 people between Oct. 17 and 23, putting them in the “red zone” for growth, according to the most recent White House coronavirus task force report.
Those numbers are a far cry from the spring, when it appeared Greene and surrounding counties had escaped the worst of COVID-19.
Case rates remained relatively low amid widespread stay-at-home orders, giving hospitals time to stock up on personal protective equipment and prepare extra beds in case of a surge later on.
But in the intervening months, a News-Leader analysis of data, reviews of previous coverage and interviews with key players showed that a patchwork of regulations and inconsistent adherence to public health recommendations has allowed the virus to spread with few checks since June.
It has lead to community transmission and infected enough people to cause high numbers of hospitalizations and increased deaths.
Here’s what you need to know about how we got here.
Springfield’s stay-at-home order
In March, Republican Gov. Mike Parson arrived in Springfield with his state health department director Randall Williams to announce that Greene County was the site of the second confirmed coronavirus case in the state.
He said at the time the case was travel-related. The person was self-isolating.
“I know there is a growing concern around the state and the nation right now, but I want to assure you that we are taking all necessary steps to protect the people of this state,” Parson said at the time. “We knew this was coming, and we are taking every precaution we can.”
At the time, case numbers across the state were low, in part due to the fact that testing was limited to people with the most severe symptoms.
On March 24, officials issued a stay-at-home order.
Local hospitals shut down for elective procedures and stocked up on personal protective equipment, wading through bidding wars and watching out for counterfeit materials flooding the market.
Cox built a 51-person COVID-19 ward out of a former storage room. CEO Steve Edwards said he hoped they’d never use it.
Gov. Parson’s COVID-19 response
Gov. Parson, meanwhile, resisted calls from public health professionals and hospital leaders to issue a stay-at-home order as governors across the country took steps to “flatten the curve” of exponential case growth.
Parson maintained, as he has throughout his response, that local governments are best equipped to make calls on which restrictions are best for their communities and issued nonbinding recommendations to cancel large gatherings.
But on April 3, Parson changed his tune, restricting occupancy at ‘essential’ businesses like grocery stores but not ordering anything to close down.
A month later, he lifted the stay-at-home order, giving much of the state a green light to go back to business as usual.
Springfield, for its part, took a more measured approach, opening businesses slowly to limited occupancy, then allowing people to eat at restaurants and visit bars with some restrictions.
Cases in Greene County for months stayed well under control — a result of the increased public health, testing and hospital capacity that had been gained during the stay-at-home orders, experts said at the time.
Then came June.
That’s when Paige Behm, the McDonald County Health director, started noticing the cases.
She said in an interview last week she had set up a COVID-19 testing site weeks earlier and noticed more people had been testing positive. Just over the border in Arkansas, cases were spiking, too.
Coronavirus hot spots emerge around Missouri
By the time the Tyson chicken plant outside of Noel had tested all its workers weeks later, more than 370 were infected, turning the county into the country’s No. 1 hotspot for weekly case growth.
Behm said she and her employees worked hard to contact people who had tested positive and tell them to isolate, but at that point, it had already been spreading around the community.
Similar hot spots appeared in nearby Jasper and Newton Counties.
Days later, Joplin’s largest hospital warned that their coronavirus unit was nearly full. Springfield hospitals started taking transfers.
Gov. Parson, for his part, brushed off the characterization that there was a “second wave” of infections. His public health director, Williams, said his department was “boxing in” infections through testing and bolstered contact tracing.
Local officials, in many cases following the state’s example, declined to impose new restrictions either.
Joplin’s City Council narrowly struck down a masking ordinance, and commissioners in Newton, Jasper and McDonald counties said they had no appetite to make any changes.
“I think this flu is just like the rest of them,” said Jasper County’s Presiding Commissioner John Bartosh at the time. “We tried the quarantining, staying home and all that and obviously that did not work. I think it’s just going to have to run its course.”
And in many ways, it still is running its course.
People, by their very nature, don’t stay in one geographic county. They visit, work and shop in nearby metropolitan areas and travel to other areas in the region.
So when Clay Goddard, Greene County’s health director, saw the virus spiking in nearby communities, he knew what was coming.
“I’ve heard it referred to as a tsunami or a forest fire coming in your direction,” he said.
And, in many ways, it did.
On July 2, health officials warned that Greene County was seeing an increase in “community spread,” where public health officials couldn’t pinpoint the source of an infection and couldn’t track who has it.
They said, as they would in subsequent months, that the virus was taking advantage of human behavior. People were letting their guard down and gathering without taking precautions.
On July 10, assistant health director Katie Towns told the Springfield City Council the department had maxed out its capability to “contact trace,” or get in touch with people who tested positive or were directly exposed to someone who was.
“In light of this, we do expect we will not have the level of control over this virus that we want,” Towns said. “We will be falling behind, and that leaves us vulnerable to the disease spreading more and more.”
Three days later, the Springfield City Council passed a mask mandate.
But infections continued to increase, as did hospitalizations, which experts have chalked up to a “patchwork” of inconsistent regulations in an interconnected region.
Eventually, Branson, Joplin, Ozark and Nixa would implement mask requirements, but the growing consensus among local officials, health directors and public health leaders was that spots of compliance wouldn’t do enough to change the situation.
Parson, for his part, continued to maintain that an approach lead by local governments was best and recommended that people wear face coverings, keep physical distance and wash their hands.
But things in southwest Missouri continued to get worse, with early August outbreaks at “institutional settings” like the Greene County jail and long-term care facilities indicating even more virus prevalence in the community.
Then, students returned to Springfield’s colleges, and cases surged among young people.
For a while hospitalizations and deaths remained relatively low despite the case increase, in part due to the fact that the younger people who had the virus and weren’t as likely to get critically ill.
But health experts call hospitalizations “lagging indicators” because it takes a while for increased spread to incubate and send people to the hospital.
Eventually, it did.
On Sept. 6, there were 74 COVID-19 patients were at Cox and Mercy in Springfield.
By Oct. 16, there were 184.
In response, the hospitals have increased capacity to care for people, called on help to staff their coronavirus wards, and relied on experienced nurses and workers to help treat patients through the surge.
But despite those efforts, Renee Fesperman, a nurse at Cox, said people are “dying left and right.”
“It’s been brutal,” Goddard said this week.
Meanwhile, Gov. Parson continued his campaign for governor, giving a weekly COVID update last week from a campaign bus tour of the state.
He had a positive message for Missourians, highlighting promising unemployment rates, good consumer spending reports and an abundance of available testing.
He also unveiled a new page on the state’s website called “Conquering COVID-19” that highlights all the things the state has done to respond to the virus and repeated a statistic from the state health department’s dashboard, which says half the state’s hospital beds are empty.
‘Hospitals are really full’
Hospital leaders, however, point out the bed capacity number isn’t really accurate because it refers to a metric called “licensed beds” that doesn’t consider staffing levels or equipment resources.
“The reality is Kansas City, St. Louis, Springfield’s hospitals are really full,” CoxHealth’s CEO Edwards said in a recent interview.
In Greene County, the situation is a mixed bag.
The health department finally caught up with contact tracing in recent weeks thanks in large part to a $2.7 million contract with Maximus Federal Services.
COVID-19 fact check:Are Missouri hospitals really only half full?
Greene County’s most recent positivity rate, which is an indicator of how prevalent the virus is in the community, fell the previous week, though it is still 9 percent — much higher than the roughly 1 percent in the early days of the pandemic.
And despite a 15 percent increase in this week’s seven-day average last week, the county was coming off a relatively steady decline in the rate of case growth since Oct. 1.
“I feel good about where we are right now, but I’m very, very nervous about the next 90-120 days,” Goddard said.
That’s because as the weather gets colder, people head inside for gatherings, where the virus is more likely to spread. People travel around the country to visit loved ones and let their guards down.
And nearby counties are also seeing high virus prevalence. Taney County’s case rate per 100,000 people has jumped 14 percent over the past two weeks, and Jasper, Joplin and Newton Counties have seen an 11 percent jump.
Goddard said he’s hopeful his worst fears won’t come to pass, but it’s hard to ignore that local hospitals are still seeing sustained high numbers headed into what could be the worst season yet for the virus.
What happened in Springfield?
When asked how the Springfield area got to this point, Goddard identified two areas where he could’ve seen an improvement.
The first was messaging.
Early on, the health department highlighted that people who died often had “underlying conditions” like their age that put them more at risk of getting critically ill.
“I think it led people to draw conclusions that were probably inaccurate,” he said. “These (people who died) weren’t on death’s doorstep. These were people that still had lives to live.”
The second area was something Goddard himself couldn’t control but that he and other experts have said left communities like Greene County vulnerable: a patchwork of mitigation strategies across the region.
“I’m a big believer in local politics and localism, local control. It’s a Missouri value,” Goddard said. “But the worst time to have local control is in a time of crisis, particularly of this magnitude. I really do believe that the only way you can get ahead of these things is to have more blanket approaches.”
That has become especially evident in recent months as cities like Springfield and Branson have passed mask mandates to curb the spread of the virus.
In McDonald County, there’s been no such movement, despite recommendations from Behm, the health director.
“In my perfect world, we’d have had a mask mandate from the start,” she said. “I truly believe that in every public space, everybody should be wearing a mask. I don’t think we’d be in the situation we’re in if we had that.”
Local leaders across the state, including Springfield’s mayor and hospital leaders from throughout Missouri, have urged Parson to follow the path of Republican-lead states like Arkansas and Indiana in passing a statewide requirement.
But the governor has repeatedly declined.
In September following a meeting with a member of the White House’s coronavirus task force, Parson said the places with the highest case growth in Missouri already had mask mandates, even though many counties the task force had labeled “red zones” did not.
When asked recently about his general response, Parson said, “In the state of Missouri, I think we’ve done as well as we can do.”
Katie Kull covers local government for the News-Leader. Got a story to tell? Give her a call at 417-408-1025 or email her at firstname.lastname@example.org. You can also support local journalism at News-Leader.com/subscribe.