Covid-19 in Knox County: Then and Now

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By Lori Moots-Clair, Knox County Health Department Administrator

As we enter the eleventh month since the first interview with The Edina Sentinel regarding Covid-19 we have seen many changes in Knox County, MO.  For the first four months, we saw no cases locally, while the metropolitan areas of the state were overwhelmed with cases.  We also had virtually no testing opportunity in the rural communities, unless affiliated with healthcare procedures in larger hospitals.   

In July 2020 the cases began to climb, and the level of quarantine by the end of the month was as high as we had seen.  Thanks to local providers and Scotland County Hospital confirmatory (PCR) testing in the area grew, and symptomatic quarantined individuals were able to access testing.  Numbers looking back showed 15 active cases and 50 quarantined individuals the first two weeks of August 2020. 

Cases were affiliated with large gatherings and travel.  It was with this first burst of cases we began to see the critically ill.  Several hospitalized, one receiving the first trial-based treatment for Covid-19.  It was also the first time we’d seen large groups of people participate in 14-day quarantine and the burdens both socially and economically were witnessed. 

As we entered Fall we saw our first fatality and a lull in cases as we engaged in primarily outdoor activities.  After months of preparation in our school district and other businesses, we appeared to be winning the Covid-19 spread prevention battle through distancing, masking, hand washing and rural fortitude. We also received a round of funding from the federal C.A.R.E.S. Act dollars through the local commission. 

With that we took opportunity to purchase local rapid tests for county residents, antibody tests for use to see if disease was leaving the bodies response behind, to provide for the purchase of flu vaccine supplies to provide no cost barrier to flu shots (in hope of warding off two respiratory outbreaks in fall and winter 2020/2021), and to purchase enough protective equipment to start providing on site testing to ill residents when the brunt of indoor activity and viral spread began to make its way in Knox County. 

By Thanksgiving 2020 we had began to rise in number again, cases growing in congregate settings throughout the area.  School saw its first virtual necessity due to staff shortage, and a public health plea for businesses to tighten down on their own (mask mandates, distancing, occupancy levels, etc.) and for residents to celebrate holidays with minimal households (if not within just their own) and for all unnecessary gathering to stop (ex.  Parties, multi-household gatherings, etc.).  As sports moved inside, we saw the challenges that basketball would bring (ex. Large crowds, a contact sport, bus riding, etc.) and again quarantining and cases began to grow.  With this the Dept of Elementary and Secondary Education distributed rapid testing for schools, the Abbot Binax Now 15-minute end of the nose test).  With only one school nurse and a small office, the health department opted to do those tests onsite for the district and with this tool, would have the opportunity to slow the spread in kids, thus to adults, and again shut the spread of Covid-19 down in Knox County.  This antigen test, and many like it, were also distributed to long term cares throughout the state, and became the primary testing option at the “Shopko” Quincy, Illinois drive through testing that has become so widely utilized by residents throughout the area.  

In fact, we began to see FREE testing, provided by the state and federal governments of Missouri and Illinois available to almost anyone who wanted them.  And with increased testing, came increased numbers.  By mid-December 2020 numbers in Knox County were beginning to climb again.  As a health department we began to speak to High-Risk individuals who needed and wanted to stay Covid-19 free.  Community activities surrounding the holiday began to increase, mask wearing began to decrease by visual surveillance, and it was apparent that viral fatigue and social demand were prevailing.  From a public health department perspective, it felt as if the closer vaccine got, the harder it was to fight the Covid-19 tide.  What had become weekly phone calls about testing and quarantine, was soon transitioning to vaccine.  And as with all things Covid-19, multiple things had to happen at once.  We were told the Centers for Disease Control would recommend (and the state would support) new quarantine guidance.  For all close contacts we would transition from a 14-day quarantine to a 10-day quarantine with a 7 day test out option, if the option existed.  With wide spread antigen testing, the known educational and financial burdens of quarantine, it was an easy transition for local health—easy in idea more demanding and costly in testing hours and testing supply.  By Christmas, this was in full swing, along with multiple weekly calls about vaccine.  It was noted that the federal government would contract with local long-term care and residential care facilities to provide vaccine through Walgreens and CVS, that the state would preposition vaccine for tier 1a Missouri residents who were patient facing healthcare workers to travel to and receive, and that as local public health we should prepare for onsite distribution for community residents falling into the tiers identified by the state.  

Where are we now?  We continue to look for tier 1A doses to serve an approximate 50 individuals that are patient facing in the county, and are currently leading discussion among 15 Northern rural counties to see if we can place an order and divide/distribute/deliver all of those doses in the time necessary to be viable.  In addition, we are still waiting and monitoring sitting paperwork and requests for the 1B population of Knox County.  It is predicted based on CDC information that this will be those seeking vaccine that are:  over 65, 18-64 believed to be high risk, critical infrastructure and essential workers.  We highly anticipate when this vaccine drops, we will be able to access it in quantities necessary to cover the population in Knox County seeking vaccine.  We are keeping a list of tier 1A individuals who might be off of the radar (ex. Those in private service, those working for medical agencies outside Knox County, Eye Drs, Dentists, Hygienists, etc.), but are not keeping a list of tier 1B at this time.  We encourage those who feel they will fall in 1B to continue to check with us for delivery information.  And we remind everyone that the Knox County Health Department Facebook page is updated nearly daily with new Covid-19 information.  

As we wait for vaccine, or we wait for second doses of vaccine, it has never been more important to practice prevention.  One great disparity between our agency reporting and state of Missouri reporting is antigen testing.  Nearly 95% of all testing conducted in Knox County and in Northeast Missouri is now rapid antigen testing, most of which is supplied by the federal and state governments.  This testing is shown to be 98% reliable when combined with symptomatic status, close contact to positive case status and community condition interpretation by local public health.  The difference between antigen (probable) and PCR (confirmatory) testing is the diagnostic type and essentially the amount of viral product present to produce a positive result.  We find use of the antigen testing is best at 3-4 days symptomatic and with respiratory symptoms (ex. End of the nose viral particles), we like to follow up with a PCR test if symptoms are early onset, or nearly non existent and there is no close contact situation.  These tests are also point in time, for those who are only lightly symptomatic, hours and days can mean declining virus to the point of non-detection or increasing virus that is not to the point of detection.  Bottom line, if the test is conducted appropriately and the intake staff collects corroborating data; these tests are highly effective for stopping the spread of Covid-19—and in our opinion are justifiably distributed by the states and federal government.  

We continue to question why if distributed the probable number is not included in both negative results and positive results by the state.  In the week prior to the new year and the first week of January 2021, Knox County Missouri has seen its largest Active case level in the history of Covid-19 Knox County.  The spread has been the highest and the level of illness has been the highest.  Our largest reported number of hospitalized patients at one time with Covid-19 (6); and our largest fatality number two date (2).  Yet if you look at the Missouri Dashboard, it says no positivity rate and no cases—this is not true.  It is simply that all tests have been Antigen (Probable).  Individuals in the county who look to state data will interpret that we are in a great place with regard to Covid-19; and this is simply not true.  We encourage you to look to our dashboard and look at the Active Case number (currently 17, last week 37) and new case number per day (81 cases added since December 14, 2020).  And we assert that if these tests are good enough to be distributed, why aren’t they good enough to be counted?  These residents are just as sick as any we have seen before.  In fact, today more report moderate to severe symptoms, than lack of symptoms.

Covid-19 fatigue is real.  Our citizens have it, and we have it.  But soon vaccine will be available to all that want it, and weather will be warming making way for outdoor activities and we will all be able to “breathe easier”.  Right now, respiratory illness is common for many reasons (ex. Influenza, Pneumonia, Cold Air induced COPD/Asthma/Emphysema exacerbation, RSV, Bronchitis, etc.) and the addition of Covid-19 is a complication we don’t need.   Whether you’ve been Covid positive or not, you need to wear a mask if medically tolerated and you shouldn’t tempt fate with round 2—those round 2 cases are beginning to pop up throughout the area. We want one thing for Knox Countians in public health, and that is to Be Well!   Call our office with any questions.