The need for a masking ordinance

On Tuesday, July 7, Steve Edwards, president and CEO of CoxHealth, sent the following letter to Springfield Mayor Ken McClure in support of a citywide masking ordinance. We wanted to share it here to help explain the rationale and need for this action in our area.

Honorable Mayor McClure,

With this letter, I am responding to a request from city leadership for input about a possible masking ordinance, and what metrics we would recommend to trigger such a measure.

The bottom line: We believe the time is now for such an ordinance.

Our physician disease experts cannot point to a particular trigger point, because there really is no science that has evidence on when it is too early to mask. We only have science that tells us when it is too late to mask. They feel we are approaching that point rather rapidly.

At CoxHealth, we experienced a 43% growth in total positive lab results last week. We have also seen the percentage of positive rates increase from about 0.5% a month or so ago to 10.7%. Combined with high prevalence in our surrounding catchment area, rapidly growing prevalence in Greene County, and strained regional hospitals, we believe we are at our triggering point. This may appear to be a shift of thinking since our last meeting, but most of our indicators have increased by nearly 50% in the past two weeks. We have gone from four inpatients to 17 in the past week.

The rate of COVID positivity at CoxHealth has risen from about 0.5% to over 10.7%. This is likely a lead indicator of possible exponential intensity of disease growth. This undermines the argument that we have more positives simply because we have more testing. We have more positives because the disease is beginning to rapidly grow in prevalence, leading to great concerns for our community’s health and future.

With these rising figures, some might also wonder if they are adjusted due to antibody testing and “diagnoses” from other situations. This is not the case: We have higher testing rates, and more positives, but even more importantly a higher percentage of those being tested are positive. It is important to note that we are relying on the more highly accurate polymerase chain reaction, (PCR) testing. PCR testing identifies actual virus or antigen, and generally picks up active disease. Our figures do not include the results of antibody testing, which can show a positive from many months ago.

Fundamentally, the virus is rapidly growing in our area. I understand there are now 80-plus positive cases from Kanakuk. Our Springfield-Greene County Health Department reported 35 new cases yesterday. Northwest Arkansas is in a surge, their hospitals are gasping, and Joplin appears to be in the throes of a near similar surge.

Nearby hospitals are becoming strained. Freeman, in Joplin, indicates they have a realistic capacity of 23 COVID patients, and they are at 25. Last weekend, they sent CoxHealth three COVID transfers; we received nine total transfers from outside of Springfield over the weekend. Our neighboring catchment communities have a prevalence so high it has made national news, and the CDC is on the ground.

Additionally, while we have physical capacity at this point, and plenty of PPE, we do have limitations on important medications such as Remdesivir. The allocation of this drug is tightly controlled by the state government due to scarcity; we have enough for ten patients at this point. We also do not have unlimited access to convalescent plasma. These two medical therapies working in conjunction have demonstrated strong evidence of their value in reducing length of stay and mortality. In many of our most acute patients, we would not want to treat without both therapies.

Given there is no compelling evidence that masking causes harm, and certain compelling evidence that it can slow the transmission rate, there seems no logical trigger point other than now or as soon as possible.

It has become clear in city after city that, once this disease gains momentum, the time to mitigate has most often already passed – and is after hospitals become overwhelmed. It has become clear that with the high volumes of COVID patients, the quality of care can become quickly compromised due to limited and strained resources such as pulmonology staff, other clinical staff, and treatment options including Remdesivir and convalescent plasma.

I imagine that when our political leaders weigh this decision, they will look at factors other than science, including societal factors. But we are convinced science indicates the need to mask is now or as soon as possible.

We ask that we become the community that acts before it is too late. That we disrupt the trajectory of this disease through the simple act of masking, in hopes it buys us time for the advancement of more therapies and even a vaccine to protect our community.

Sincerely,

Steven D. Edwards
President and CEO