Living with COVID-19, Toward a Safe "New Normal" 04/12/2022

Joint City/County Policy Statement

During this time of relatively low levels of COVID-19, we have the opportunity to chart a longer-term plan for managing the virus. Unfortunately, it has become clear that COVID-19 is not going away. What “living with” COVID-19 looks like largely depends on how well we control it. 

Here is what we know: 

• The toll COVID-19 has taken over the last two years is huge. For comparison, 12,000 – 52,000 Americans die of the flu per year. In 2021, about 450,000 Americans died of COVID-19—10 to 30 times more than the flu.  For every person who dies, many more are hospitalized, and even more face long COVID-19 symptoms.
• Our fates are linked. With a highly contagious disease that spreads through the air we breathe, risk is shared. Public health is a public responsibility. By continuing to be careful, you protect yourself and friends and family who may be more vulnerable.
• We have tools to control the virus. We know how it spreads in the environment, which informs prevention measures. We know how it impacts the body, which has led to remarkable advancements in vaccines and treatments that can prevent infection, minimize symptoms from infection, and lessen the risk of death or long-term effects.
• An uncontrolled virus can cause significant disruptions to our lives. At the height of the Omicron surge, so many people were sick at the same time that schools, businesses, and health care facilities couldn’t operate normally.
• To manage this virus and minimize the impact it has on our daily lives, we must acknowledge that we cannot go back to a pre-pandemic “normal”. We now live in a world with this very contagious pathogen that can cause severe illness and death. The past two years have revealed substantial gaps in our global health security.
• We can move forward. We now know what we can achieve with coordinated action. We can rise to the current challenge and settle into a “new normal” that is safer and healthier for all of us. 

Below are actions we can take to prevent spread of the virus, limit the progression of infection to severe disease, monitor the burden of disease, and maintain preparedness over the long term. These actions can also protect against other respiratory infections such as the flu and potential new pandemic pathogens. The stakeholders addressed here are:

• Saint Louis County Department of Public Health (DPH) and the City of St. Louis Department of Health (DOH): As the agencies tasked with protecting the health of St. Louis City and County residents, DPH and DOH commit to remaining up to date on the latest science, sharing evidence based public health recommendations, and doing everything we can to prevent illness and death with a focus on those most impacted.
• Institutions: These recommendations may apply to entities like stores, restaurants, workplaces, schools, and others. Such institutions have the opportunity to promote the health and safety of employees, customers, students, and patrons through a range of policies and practices.
• Individuals: By taking protective measures when public health guidance recommends them, individuals can both protect themselves and also decrease the risk they pose to family, friends, neighbors, and coworkers. 

Prevent Spread of the Virus

The only way to completely eliminate COVID-19-related risks of severe illness, hospitalization, long COVID-19, losses to livelihoods, education, health systems, and death is to prevent COVID-19 from spreading. Additionally, the rampant spread of COVID-19 would create more chances for it to mutate, potentially creating new variants with unknown transmissibility, severity, and immune evasion. 

What DPH and DOH can do

• Advise the public on evidence-based protective measures to keep themselves and those around them safe
• Provide vaccination with a focus ensuring equitable access 
• Provide accurate and culturally appropriate information for people with vaccine questions 
• Continue offering diagnostic testing and ramp up volume when disease prevalence increases
• Conduct outbreak investigations and advise high risk settings on how to prevent outbreaks

What institutions can do 

• Encourage employees to stay home and get tested if they have symptoms or have been around someone with COVID-19
• Consider expanding paid sick leave so employees do not have to choose between a paycheck and potentially infecting coworkers and customers
• Encourage masking, vaccination, and lower occupancy when indicated by public health guidance
• Improve indoor air quality with strategies like better ventilation and air filtration. 
• Provide additional accommodations for people at high risk of severe illness and for people who are experiencing chronic long COVID-19 symptoms

What individuals can do

• Get vaccinated and stay up to date with boosters 
• Get tested and do not go to work or school when you are symptomatic or have been around someone with COVID-19  
• Follow CDC guidelines for isolation and quarantine
• DPH and DOH strongly recommend wearing a mask when in crowded indoor settings and when around people who are at risk of severe disease. This includes:
• Those who can’t get vaccinated, such as children under 5 years old
• Adults who are over 65, and
• People who are immunocompromised
• When alerted that case rates are extremely high, add multiple protective measures and consider limiting non-essential activities outside the home, especially in crowded indoor spaces 

Limit the Progression of Infection to Severe Disease 

Not all infections will be avoided, so we need to use all the tools at our disposal to prevent infections from leading to severe illness and death. Here’s how:

What DPH and DOH can do

• Provide vaccination and continue encouraging residents to stay up to date with vaccinations with a focus on equitable access
  • Vaccination remains an important strategy to both limit risk of disease spread and decrease chances of infection resulting in severe disease; it is therefore represented in both sections.
• Refer people to treatment during the course of case investigation

What institutions can do 

• Require (when legal and feasible) or otherwise promote vaccination amongst employees / patrons / students  

What individuals can do

• If you are at high risk of severe outcomes, it is important you get tested as soon as possible after symptoms start     
• If you are at high risk of severe outcomes, plan a discussion of pre- and post-infection treatment options with your health care provider. 
• Stay up to date with COVID-19 vaccinations, including recommended boosters. Visit revivestl.com to find out where you can get vaccinated

Monitor the Burden of Disease

Knowing how much virus is circulating helps emergency services, health care systems, and the community make decisions about what protective measures are appropriate at any given time. 

What DPH and DOH can do

• Track the impact of COVID-19 in the community using metrics such as new cases, testing, hospitalizations, and death rates and use data to create strategic responses
• Continue updating public-facing COVID-19 data to provide the public with up-to-date information about the burden of disease

What institutions can do 

• Stay informed about levels of COVID-19 in the community to know what appropriate protective measures should be in place

What individuals can do

• Stay informed about levels of COVID-19 in the community 
• Self-report at-home test results to DPH/DOH so we can understand how the virus is spreading

Maintain Preparedness

When the virus is not circulating widely in the community, we can be more relaxed about protective measures such as masking and avoiding crowded indoor gatherings. We should also use these times to prepare for future risks, whether from another COVID-19 wave or another pandemic. 

What DPH and DOH can do

• Maintain a strong, response-ready public health department with enough supplies, staffing, and funding to ramp up testing and vaccination as needed
• Stay up to date on variants, evidence-based prevention practices, new treatment options, and other relevant topics
• Work with community partners toward a unified, community-wide response capacity  

What institutions can do 

• Build and retain capacity for flexible working arrangements 
• Develop continuity contingency plans for critical job functions
• Consider making improvements to indoor air quality, which can reduce risks of COVID-19, influenza, allergens, and asthma
• Keep track of changes in guidance to create the safest environment possible

What individuals can do

• Keep good quality masks and home testing kits available in the event of another surge.
• Consider your and your family’s general emergency preparedness. Visit Missouri Department of Health and Senior Services’ “Ready in 3” site for information. 

We do not know precisely what the future of the pandemic holds. By working together to prevent spread of the virus, limit the progression of infection to severe disease, monitor the burden of disease, and maintain preparedness, we can move forward and minimize the impact of the virus on our lives.