Missouri state lab director talks pandemic at Hancock Symposium

Missouri State Public Health Laboratory Director Bill Whitmar speaks in a Zoom call.
Missouri State Public Health Laboratory Director Bill Whitmar speaks in a Zoom call.

From supply shortages and misinformation to a lack of long-term planning, the COVID-19 pandemic has been hallmarked by disappointment and challenges.

Missouri State Public Health Laboratory director Bill Whitmar outlined how the public health response to the pandemic evolved, from the first sporadic cases scattered across the country to today's still-high case counts in a Wednesday lecture.

Whitmar spoke as part of Westminster Colleges's Hancock Symposium. A video of the Zoom lecture can be viewed on the college's YouTube channel.

In January, the first cases of the virus had begun to spread. By February, epidemiologists, labs and health care professionals were ramping up in the U.S. and overwhelmed in Europe and China.

In March, the World Health Organization declared the illness a pandemic and cases worldwide continued to increase, but it hadn't yet hit Missouri in large numbers. At the same time, Whitmar said, state public health labs saw delays and problems with the U.S. Centers for Disease Control and Prevention SARS-COV-2 test.

"We had a problem: we couldn't determine the scope of COVID-19 within each state," Whitmar said. "If we can't tell how much COVID-19 there is in the state, then we can't say we need to take these public health measures to minimize the amount of COVID-19 in the state. That's a problem."

Some states, like New York, responded by developing their own tests. Calls to have everyone tested became hard to fulfill considering worldwide shortages - there aren't enough swabs to test everyone.

'The bottom-line - we are on our own and that is a scary situation for states who have little resources at this time because we're all still ramping up," Whitmar said.

In April, states were testing only those who are symptomatic and sharing supplies between labs. At this point, supplies from countries like South Korea and China begin arriving.

Supplies also start coming in from U.S. manufacturers who received federal contracts.

"But those supplies are very low in quality and sometimes just not usable for laboratories and for medical solutions," Whitmar said.

The Missouri state lab has several pallets of unsuitable swabs in a warehouse.

By May, many states and cities had implemented behavioral modifications like shutdowns and mask mandates. These measures are successful - giving labs a chance to breathe as the supply situation improves and case counts become more manageable.

"We're seeing this is a really great thing for the COVID-19 and people seem to think, 'Wow, we're making a difference,'" Whitmar said.

But then people begin returning to normal - the economy opens up, people go on summer vacations and many stop social distancing. These factors all come together, leading to a rise in case counts.

"People resist the recommendation to social distance themselves in spite of the altruistic intents of the mitigation efforts," Whitmar said.

The case increases of June and July were not second waves, Whitmar said, but a surge of the first wave.

"All of us in this community of providing for tests and medical care have to buckle up because guess what?" Whitmar said. "It's Groundhog Day again."

Labs are again facing supply shortages.

Into August and September, schools are opening and cases are still rising. Positivity rates are topping 60 percent in some parts of Missouri.

"Anything over 10 percent is what we call pretty darn bad in public health," he said.

The federal government responds by delivering tests and masks to schools and nursing homes.

Test numbers now seem to be stabilizing, Whitmar said, but that might be because some people aren't getting tested out of fear or discomfort.

"This is something we really need to take seriously," he said.

Nearly 900,000 have died globally. The U.S. has had over 6 million cases.

"We're not really assessing the longer term effects of this disease at this point in time but we do know there is damage to the heart muscle, damage to the alveoli, strokes and seizures from blood clots and chronic fatigue syndrome and probably innumerable other longer-term effects other than obviously the death," he said.

Whitmar also addressed why the U.S. and Missouri didn't do better, citing the political aspect of the election year, the societal will against mitigation and the decision to put economics over public health interventions.

The focus must be on number of public health mitigation efforts used simultaneously, even if none are implemented perfectly.

"I have seen time and time again during this response that our leaders will say, 'this is the silver bullet, this is the one thing we need to do.' And how many times have we heard the term 'game-changer?" Whitmar said. "If I hear that one more time I think I'm just going to lose my breakfast over that term. There's not a game-changer to ending this pandemic."

Similarly, efforts must be made over time.

"Let's not think we're going to do this for a three month period and then it's going to be over," he said. 'The one overarching failure was that the traditional public health mitigations were not adopted or implemented fully."

The country had the right tools, it just didn't bother to pull them out of the toolbox, Whitmar said.

Whitmar also recommended viewers look to the CDC for their information.

"If you're getting your information from Facebook or social media about COVID-19, please stop," he said. "Honestly, please stop because there is no way to verify your source with social media."