Gov. Mike Parson’s strategy to contain the spread of COVID-19 was simple: local officials know best.
Statewide mandates emanating from Jefferson City didn’t make sense in a state as diverse as Missouri, Parson argued amid the pandemic’s peak while rebuffing calls for him to take statewide action.
But on Tuesday Parson is set to sign a bill curbing local health departments’ authority — exactly one year after the social distancing order he put in place was allowed to expire.
House Bill 271, sponsored by House Speaker Pro Tem John Wiemann, R-O’Fallon, started out as a bill focused on local government transparency, but grew to include restrictions on health orders and vaccine passports in the final weeks of the legislative session.
The Missouri State Medical Association was one of the organizations who had urged Parson to issue a mask mandate last year. Heidi Geisbuhler Sutherland, the group’s director of government relations, said the group is disappointed Parson chose to sign the bill.
“When the state refuses to act during public health emergencies involving highly contagious diseases,” she said, “the duty ultimately falls to local governments to make hard choices to protect their citizens.”
Sutherland said the bill “will make those agencies’ duty to protect the health and quality of life of their citizens even more difficult.”
Jan Morrow, the director of the Ripley County Public Health Center in southeast Missouri, said she was sad to see the provisions tacked onto another bill late in the session and felt it was “sneaky.”
“I think that tells me a lot about their integrity,” Morrow said.
Under the bill, local health orders aimed at curbing the spread of a contagious disease during a state of emergency are limited to 30 days in a 180-day period. In order to be extended for an additional 30 days, restrictions that affect the opening of businesses, churches and schools, must receive a simple majority vote of the local health authority’s governing body — such as a county commission, city council or elected board.
A report must also be provided outlining the need for such an extension.
Outside of a state of emergency, restrictions would be limited to 21 days in a 180-day period and require a two-thirds majority vote for extensions.
Those same local governing bodies may also terminate any health order by a simple majority vote. Health departments under multiple counties would need approval from each governing body in the county.
Parson had pointed to local control as the reason for forgoing statewide restrictions, like a mask mandate. But earlier this year, he said there were instances within the healthcare system where “probably people didn’t do as good of a job as they should have” at a local level, and that reevaluating “is a good thing.”
The bill also contains a provision that bars counties, cities, towns or villages that receive public funds from requiring residents show proof of COVID vaccination to access public transportation or other public accommodations.
In order to prevent “the threat of government overreach,” the provisions limiting local health orders include an emergency clause, meaning they will become law upon the bill’s signing.
‘We’ve been handed hard deals before’
For some local health departments, like Morrow’s, it’s already a standard part of the process to consult with local officials and the department’s governing board on whether to issue restrictions.
The Ripley County Public Health Center is governed by a five-person elected board of trustees. It’s typically never been a political position, Morrow said.
“There’s no money involved for people to serve on these boards,” Morrow said. “They do it because they believe in public health and want the best for their county.”
In early March, when news of the virus was surfacing, one of Morrow’s first steps was to pull together city, county and school officials to discuss what might happen. Those meetings have continued weekly, and sometimes more often, throughout the pandemic.
In Ripley County, officials didn’t issue a mask mandate, but allowed businesses to decide to require them — which most did, Morrow said. Issuing restrictions isn’t a decision she takes lightly.
“We’ve been handed hard deals before. And when you’re in a public health department, you have to make some tough decisions sometimes to protect people,” Morrow said. “I find it sad that they want decisions to be local, but then they take away the power for it to be local.”
Others didn’t pass local mandates amid the pandemic, because there hadn’t been buy-in from local officials. Instead, they followed the state’s lead.
“I reached out to them in the beginning asking them if they wanted a mask mandate, if they wanted help writing one, and no one seemed to be very interested in doing that,” said Cheryl Eversole, the administrator of the Dallas County Health Department. “So we didn’t really pursue that.”
Scott Clardy, the assistant director of the Columbia/Boone County Department of Public Health and Human Services, said he didn’t believe the new restrictions would have a major impact, in part, because the department has already been operating under a similar standard. A city ordinance was passed that required city council approval if restrictions were to go past 21 days.
“We clearly had the authority to make the orders that we did,” Clardy said. “I think some people may not like us having that much authority. This is the first time in probably over 100 years that we’ve had to use this kind of authority, so a lot of people really weren’t aware of it.”
Lawmakers attempted to pass limits on local public health authorities on numerous bills. An earlier Senate version went as far requiring approval from state lawmakers when health orders passed a 14-day period in two years.
Supporters of the measures argued it was necessary to prevent what they viewed as extreme and far-reaching restrictions, with many restaurant owners from the St. Louis area describing difficult decisions they were forced to make in the face of shutdowns.
Sen. Bob Onder, a Lake St. Louis Republican, argued the limits would help ensure residents who elect the officials governing most public health departments have the final say.
“Although it puts limits on the total duration of these shutdown orders, it empowers the locally elected legislative body that are accountable to the people,” Onder said in late March on an earlier version of the proposal.
Danger of a surge
As vaccination rates wane across the state, pockets of outbreaks in northern Missouri and southwest Missouri have concerned public health officials and epidemiologists who have urged residents to consider getting vaccinated if they haven’t already in order to stave off variants’ rapid spread.
“There is nothing that prevents us from having a major surge if we’re careless with what ground we’ve gained,” said Clay Dunagan, the senior vice president and chief clinical officer at BJC HealthCare, who noted that recent COVID hospitalizations have been among younger residents, and that the approaching fall weather will help the virus flourish.
Fourteen months after its creation, the St. Louis Metropolitan Pandemic Task Force — which is a collaboration between the metro’s four largest hospital systems of BJC HealthCare, Mercy, SSM Health and St. Luke’s Health System — is ceasing its periodic briefings, which have slowly declined from every day to three times a week to just once a week.
The task force is not alone in making a transition. In recent weeks, the state ceased its weekly calls with vaccinators and has scaled back large-scale mass vaccination events as providers instead focus on more targeted, tailored outreach.
But task force officials said they will still monitor and collect data on the virus. Alex Garza, the incident commander for the task force, said that to better prepare for pandemics to come, a reinvestment in public health is needed.
“This has been decades in the making with the chronic underfunding of public health, and not just that but other societal issues,” Garza said, later adding: “There’s no wonder drug that we’re going to come up with or perfect test that’s going to figure this all out. The bottom line is if we can become better as a community, and part of that is public health infrastructure, then we’ll be better prepared for the next pandemic.”
In recent years, Missouri ranked last in the nation in terms of per capita state funding for public health, and amid the pandemic, some local public health departments struggled to receive federal CARES Act funds allocated to their counties.
“Here locally, I get about $19,000 in state general revenue, and that’s just over a dollar per person for my county,” Eversole in Dallas County said. “And that is really not adequate to serve my county effectively.”
The last year-and-a-half has been one of the hardest in Morrow’s time as a public health director. But despite its new challenges, there was one thing that was consistent.
“The one thing that has been constant is, you will see the best of people in a time of a pandemic,” Morrow said, “and you will see the worst of people. And we’ve seen that.”
This story was republished with permission from the Missouri Independent, a nonpartisan, nonprofit news organization covering state government, politics and policy.