Photography by Kevin A. Roberts
Dr. Randall Williams
In the Before Times, Dr. Randall Williams, the director of the Missouri Department of Health & Senior Services, listed tick-borne illnesses and Legionnaires’ disease among public health concerns. Those have slid down the list of priorities, for obvious reasons. Over the past five months, Williams has overseen the state’s reaction to the COVID-19 pandemic. The novel coronavirus is an unflagging adversary, he says: Even during our sauna-like summers, it has been spreading among those who were not taking precautions. But “we are not powerless,” he insists. It’s still possible to treat the illness to some extent, and to decrease morbidity and mortality—provided young people cooperate more. We spoke with Williams in late July, shortly after the federal government added Missouri to a list of states designated as a “red zone” for cases.
What message do you want residents to take away from the state’s designation as a “red zone”?
I hope they’ll take it as it’s intended, which is to have people take notice that as we’ve opened up, we have seen a resurgence of COVID-19. The governor has always said that as we open up, COVID-19 is still here… Vulnerable people who are older have very much heeded that message. On the other hand, we’re seeing a marked increase in positives among young people, especially the demographic of late teens, twenties, and thirties. We need young people, especially, to social distance, to use good handwashing, and to wear a face mask.
Besides taking precautions, in the short term, what immediate steps are being taken to curb the number of cases?
We put out $500 million of CARES Act funding to our 113 county commissioners—St. Louis and Kansas City got money separately—and when we looked [in late July], we polled 81 health departments and 80 percent hadn’t gotten any money. What we’re working on is we really need those county commissioners to push that money out to their local health departments to do contact tracing, case investigation, more testing, and provide PPE. We need them to get those resources to their local health departments.
How can counties and cities work more collaboratively to ensure a consistent response?
Certainly, you see in Kansas City, St. Louis County, St. Louis City, Springfield, and now Branson that they’ve become more regulatory in looking at things like bars and social gatherings and wearing face masks. As the governor has always said, if [local leaders] think that’s what they need to do, because of what they’re seeing in their community, we certainly understand that. On the other hand, we’re very aware that in many communities in Missouri, you’re not seeing nearly that penetration of cases. Fifty percent of cases in Missouri are in five areas, basically. So as much as people would like to apply a one-size-fits-all strategy, the situation on the ground is very different in many of [the state’s other] counties than it is in St. Louis and Kansas City.
How much has the politicization of the pandemic complicated the ability to get a handle on the virus from a public health perspective?
You have to understand that for the first time in 100 years, an infectious disease has been approached through a whole-of-government approach. It’s not unusual at all during a tornado, a hurricane, or a flood, where the first thing that happens is the state emergency management association comes in and coordinates and the governor leads those efforts. But this is the first time in my lifetime—and really the first time in 100 years, when you look at Ebola and Zika and H1N1—that we’ve had a whole-of-government approach to infectious disease... I mean, we’ve been isolating people with tuberculosis forever, but it’s 100 times per year and nobody knows about it and nobody has ever asked any questions. I’m not sure it’s really politicization. [The COVID-19 pandemic] has brought to the forefront the quarantine and isolation and closing-down powers we’ve always had to the public consciousness in a broad way for the first time. I think that what you see is a natural result of that, [which would happen] even if it wasn’t an election year.
