An investigation conducted by the Missouri Independent and the Documenting COVID-19 project unearthed hundreds of memos and emails that suggest discord between Missouri state and local officials. The miscommunication may have hurt the state's response to the delta variant wave, reported the Missouri Independent on Oct. 28.
"Poor communication or miscommunication, or lack of planning, or unclear roles and expectations — that's probably characterized the COVID-19 response since the beginning of the pandemic," said Sue Anne Bell, PhD, MSN, an assistant professor at the University of Michigan School of Nursing. "People have died across the country because of it."
The miscommunication between state and local officials started when researchers from the University of Missouri first detected the delta variant in wastewater in early May and promptly told the state Department of Health and Senior Services. The state responded to local officials, telling them not to cause "mass hysteria or concern."
Robin Trotman, DO, an infectious disease specialist at Springfield, Mo.-based CoxHealth, also wanted to sequence COVID-19 patients to help definitively identify the presence of the variant and prepare for the surge. The state lab, however, was only running 200 samples per week and said it was unable to sequence data from more patients because of lack of funding and staff. Despite the University of Missouri offering help, the state refused outside assistance, deeming it unnecessary, the investigation found.
Dr. Trotman wrote in an email July 15 to Springfield-Greene County officials, "This is soooo frustrating." The top epidemiologist in the state later wrote in an email that if the state had received more sequenced patient samples in early May, they could have identified the surge sooner.
On July 19, officials from Springfield asked the state for help setting up a standalone care site to treat COVID-19 patients. Department of Health and Senior Services officials questioned the motives of the site, with the director saying the construction of the site would be "asking the government/taxpayers to pay for an expansion of their private hospital." In late July, though, as the need got more pressing, the DHSS greenlit the plan, even pleading the case to the White House. However, Springfield leaders then withdrew their request, stating that hospitals had already built surge capacity in the meantime.
The miscommunication and tension occurring throughout the surge may have been indicative of larger problems of preparedness and resources, according to the Independent. Dr. Bell said: "Without structural or systemic change, you can't pull resources out of thin air. I think that's what local public health departments and health systems have been asked to do."
Dr. Trotman told the Independent that in the future, having a mass sequencing plan ready to go will be a priority for identifying future threats and assessing the need for alternate care sites. Other experts said it will be important for health systems to have enough staff to handle surges.