Updated March 30, 5:00 pm central
Note: We will be updating this explainer as the situation changes, as regularly as possible.
We want to furnish Missouri health care supporters with the best possible information available, giving you the suggestions and resources with which to make the best possible decisions for you and your family.
While we are not public health professionals, we’ve used our experience as a health care advocacy organization to curate information from reliable sources to share with you in this explainer.
What is the latest?
The pandemic is gathering speed across the U.S. and in Missouri. While New York City is currently bearing the heaviest outbreak, cases are rising rapidly in Missouri, with a 600% increase in just one week, the highest increase rate in the nation. It is widely expected that the impacts here will continue to increase. It is also broadly believed that the current caseload is far higher than official numbers, due to very limited testing. In fact, Missouri Health Care for All staff has spoken with individuals who have symptoms exactly matching COVID 19 symptoms but who are unable to get tested.
Health care facilities are continuing to scramble to acquire the supplies and equipment they need to meet expected (and in some cases, current) community needs. Many facilities and providers have a shortage of “personal protective equipment’ (PPE), such as masks, to keep providers from becoming infected. In addition, health system leaders continue to warn that the U.S. does not have enough hospital beds or mechanical ventilators to meet the anticipated or possible surge of cases. There are efforts at the institutional, state, and federal level to step up production of these critical supplies and equipment, but it is not yet clear whether the efforts will be sufficient or timely enough.
While many Missourians, and many Americans, are following social distancing rules, whether due to personal responsibility or government order, many health care providers and public health experts warn that there is still too much social mixing happening to have the impact needed. They also warn that the full impact of the pandemic in the United States is still to come. Despite previously announcing that he intended to have the country “open” by Easter (April 12), President Trump has now extended social distancing guidelines through at least April 30.
What are the current guidelines and rules?
Guidelines and rules are coming from three levels: Federal (national), statewide, and local. There is a lot of variability among these, which has caused quite a bit of confusion. Here are the guidelines and rules as of this writing:
- Requirement that people not gather in groups of more than 10 people (with a number of exceptions)
- Recommendations on social distancing
- Missouri has issued social distancing orders, prohibiting gatherings of more than 10 people, again with exceptions.
- Governor Parson has not yet issued a statewide stay-at-home order, despite repeated requests from health care experts. Click here to send him a message urging him to do so.
- More than 20 of Missouri’s 115 counties in Missouri have issued “shelter in place” or “stay at home” orders, which require people to stay home except for certain exceptions. Businesses in these regions have been instructed to close, with exceptions for certain types of businesses (grocery stores, pharmacies, laundry facilities, and more). All businesses are permitted to do what is needed to maintain essential operations like payroll. Because these orders have been made on a regional / county basis, you should check with your local county for your specific rules. The Missouri Times is tracking regional/county orders here.
Businesses / Schools / Organizations:
- Decisions to close schools are still officially being made at the district or county level. However, all Missouri schools are currently closed.
- Several utility companies, including Ameren and Spire, have suspended service disconnections during the crisis.
What is coronavirus? Is it like the flu? I saw it on the back of disinfectant spray so what’s the big deal now?
“The” coronavirus causing this outbreak is now called COVID-19 (“coronavirus disease 2019”) and is also referred to as “the novel coronavirus.” Novel because it’s never been seen before. There are many viruses in the coronavirus family, including the common cold and the flu. COVID-19 is very different from the seasonal flu we’re used to.
Coronavirus is the technical name for a grouping of virus types. And many cleaning agents and disinfectants can kill them. Covid-19 is a new type of coronavirus but is also able to be removed by thorough cleaning.
How do I know whether I have COVID-19 or just a “regular” flu or cold?
Symptoms can be similar to some forms of flu but more aggressive and severe. For COVID-19 the symptoms are usually fever; persistent, dry cough; and difficulty breathing. So far, a runny nose, a productive (wet) cough, sneezing, or chills are not indicators of the novel coronavirus.
It’s important to remember that one can have this form of coronavirus and not have any symptoms. And it’s possible that someone can spread the virus without showing any or very mild symptoms. So that’s why methods such as social distancing and thorough handing washing with soap and water are so important.
When will the vaccine be ready?
It will take at the very least 14 months to develop a vaccine and then go through the rigorous clinical trials to insure the vaccine is safe and effective.
I hear people say this is an outbreak and some people say it’s a pandemic. What’s the difference?
Technically, each relates to how widespread a sickness is.
Disease outbreaks “happen when a disease occurs in greater numbers than expected in a community or region or during a season.” Outbreaks tend to be considered “local” (same city or same country) even as occurrences pop up in different locations.
An epidemic is the sudden increase in the number of cases over and above what is normally expected. Epidemics usually describe an outbreak which is out of control in a limited number of locations.
World Health Organization (WHO) has declared COVID-19 a pandemic. Pandemics happen when epidemics affect more varied areas than outbreaks. They spread in multiple countries and continents at the same time. Pandemics are diseases for which there is no known human immunity.
All of these terms are sometimes used interchangeably but the official designation of Covid-19 as a pandemic is significant.
What is social distancing and why is it such an important recommendation?
In the beginning of this outbreak, COVID-19 cases were traced to certain travelers who have gone to specific places (like Italy, China, Iran or South Korea). So the public health strategy most effective at that point was “containment” where those infected individuals were quarantined and all the people they interacted with are contacted and tested.
Right now in the United States, we are experiencing the beginnings of “community spread.” So we’ve moved to a second phrase called “mitigation,” because more people are contracting COVID-19 after being exposed to people not directly connected to international travelers.
“Social distancing” is avoiding public gatherings, work meetings, entertainment venues and anywhere else crowds gather so that the spread of the virus can be slowed down. This is a way to manage the influx of people who become really, really sick at any given time to hospitals, emergency rooms, ICUs, and clinics. This prevents these facilities from being overwhelmed with people.
If you cannot avoid all public places or private gatherings, it’s good to keep at least six feet (2 meters) away from others or the greatest practical distance. Hand-shakes should be replaced with non-contact greetings or fist bumps, elbow touches, waving, or whatever minimizes contact.
However, staying at home and avoiding other people as much as possible is really the most effective strategy communities can deploy to mitigate the negative effects of this outbreak. Researchers call this an important means of “flattening the curve.”
I want to visit my loved one in the nursing home. We go every week. Should our visits continue?
Not that often, no. It is really best to limit person to person visits because people over 60 with chronic health conditions (heart disease, respiratory problems, diabetes, etc.) are particularly vulnerable. Nursing homes and assisted living facilities have been centers of outbreaks in other states.
There may be times where you need to see your loved one. Nursing homes are encouraged by CMS to make accommodations which will allow for safer visits. Contact the facility to request such arrangements.
Who else is vulnerable?
Anyone can catch this virus. However, those in the most jeopardy, according to current understanding, are:
- People over 60. People over 80 years old are most vulnerable.
- Older men appear more susceptible than women.
- Any one of any age with underlying chronic health conditions like heart disease, respiratory problems, diabetes, high blood pressure, etc.
- People who are obese.
- People with compromised immune or respiratory systems.
- Health professionals and caregivers in our communities.
Children 14 years old and younger are so far not being adversely affected by COVID-19. However, like other forms of coronavirus, kids are usually common carriers and can spread Covid-19 even when they are experiencing no or mild symptoms.
What else should we do to protect ourselves and our loved ones?
Wash hands with soap and water, lathering up for at least 20 seconds is the most effective way to keep hands clean. Resist the habit of touching your face and eyes, especially in public.
Hand sanitizer with at least 60% alcohol content is effective when water/soap/time is not available or impractical. Vodka (usually with only 40% alcohol), essential oils and herbs have proven ineffective at killing germs. When using hand sanitizer, make sure hands are dry and without oil or grease.
If you take medications, have an ample supply that allows you to stay home as much as possible. Same thing goes for other supplies.
If you and/or your loved one has insurance, contact the health plan and ask questions about coverage and costs of both testing and treatment. While there have been various announcements declaring that testing will come at no costs and surprise medical bills will be prohibited, it’s good to confirm these facts before you need to seek treatment.
I’m really not feeling well and I think I might have the coronavirus. What should I do?
If you have a fever, a dry cough and/or difficulty breathing, and you believe it is likely you may have been exposed, then call your doctor or your emergency room. Do not simply go to the hospital or emergency department unless you are experiencing an emergency.
Talk with them about your symptoms, your concerns and follow their guidance. They may not ask you to come in right away so be prepared for that instruction.
They may ask you to set an appointment which will give them time to properly prepare for your arrival. Don’t be disturbed, frightened, or angry if the staff who greet you are wearing protective gear, including masks and gloves. This is for your protection and their safety as they are on the front line of this outbreak.
It is also possible that the provider or facility will instruct you to self-quarantine for up to 14 days and to contact them if your symptoms worsen.
What’s the difference between social distancing, self-quarantine, quarantine, a state of emergency, and a national emergency?
Social distancing is a strategy that can be used in a variety of legal contexts. Right now, all social distancing calls have been based on voluntary compliance. No law enforcement officials are checking to see how often you leave home or whether you shake hands or not.
It is left to the discretion of the individual. Social contact is not legally prohibited but simply strongly discouraged.
Self-quarantine is likewise largely voluntary but one is instructed to stay isolated, strictly avoid venturing into any pubic space and not to have any contact with people for a limited period of time, usually 14 days. One can decide to self-quarantine or they can be told by a health professional to do so. But any quarantine means an individual and anyone living in the household are not going into public spaces at all.
Quarantines are usually declared by a public health official in the event of an outbreak so severe that people are legally required to stay isolated from the public. Quarantine orders generally have the force of law, meaning if they are violated a person can be placed in a more restrictive setting against their will until the quarantine period expires.
People who have active symptoms or full-blown sickness can be put into isolation. Technically a quarantine is for folks who may have been exposed to a pathogen or virus but who are have no symptoms, and isolation is for people who are already sick.
How this works varies from city to city, region to region, and state to state.
In Missouri, the director of the Department of Health and Senior Services (DHSS) has the authority under statute to declare areas of the state under quarantine. However, as of this writing, they have not exercised that authority, leaving most decisions regarding public health to local officials in coordination with the state.
Some states have declared a state of emergency, which bestows more statutory powers, increased access to funding and more responsibilities upon state government. Governor Parson signed an executive order declaring a state of emergency in Missouri on Friday, March 13.
President Trump declared a national emergency which gives him the authority to use $50 billion of funds allocated by Congress for disaster relief to address the coronavirus pandemic. Federal Emergency Management Agency (FEMA) can also coordinate disaster response and aid state and local governments.
What about my rights? Can they make me stay home?
In any public health crisis there will be a natural tension between individual rights and community need. However, more and more states, localities, and businesses are following guidance from the CDC to prohibit group gatherings and to close bars and sit-down style dining. Schools are also closing across the country. CDC guidelines, and a Missouri order, against gatherings of more than 10 people.
Most public institutions and private business/corporations are voluntarily restricting or cancelling events. The NBA (and all other major sports leagues), Broadway, Disney theme parks, concert promoters, and more all decided on their own to shut down or cancel events to encourage social distancing and prevent rapid community spread, even before federal, state, and local rules would have required them to do so.
Even in areas with “shelter at home” orders, businesses are allowed to maintain essential operations, such as payroll and security.
Missouri’s General Assembly decided to curtail legislative session for the foreseeable future.
Because public health is a governmental responsibility, officials have significant powers under certain circumstances to limit public activity. But most of those powers have not be used in this situation and were not exercised during the H1N1, SERS, MERS, or Zika outbreaks.
President Trump declared the Covid-19 pandemic a national emergency which he said will give states and territories access to $50 billion in federal funds to combat the spread of the novel coronavirus. The director of Health and Human Services (HHS) was given broad new authority to wave regulations to give health care providers and hospitals more flexibility as they confront this emergency.
I’m concerned about our civil liberties and the abuse of these emergency powers. What can I do?
So far public officials in both parties have been careful not to overreach. However, we must stay vigilant and as engaged as possible.
The powers of local and state officials in a public health emergency are expansive and civil liberty protections during an outbreak are not settled law for the most part.
By contacting local and state officials with questions and/or concerns about COViD-19, they stay engaged with constituents and will be more attuned to community concerns about rights and the role of government.
Follow Missouri Health Care For All on social media channels (@MoHealthCareAll on Facebook, Twitter, and Instagram) and on our website (https://missourihealthcareforall.org/), as we will share more information about advocacy opportunities and other developments.
DHSS Coronavirus 24 Hour (Phone) Hotline: 877-435-8411