Three meatpacking plants are closed in two central Missouri counties as health officials chase COVID-19 infections tied to those workplaces.


Conagra and Cargill plants in Saline County are shut down, as is the Burgers’ Smokehouse in California.


The largest outbreak is in Saline County, where the county health department is now reporting 106 infections and trying to track who has the disease.


“We're seeing a little bit of everything at this time,” Saline County Health Department Administrator Tara Brewer said.


In Moniteau County, there are 33 known cases. There are also 26 probable cases, which means the person is showing symptoms and has been in close contact with a known COVID-19 case.


With the latest figures, Saline County has the state’s highest infection rate and Moniteau County has the fourth-highest rate. Saline, which has a population of 22,761, has 465 infections per 100,000 people. In Moniteau, which has a population of 16,132, the infection rate is 204 per 100,000.


The second-highest infection rate in the state is in St. Louis, with 294 per 100,000.


The state is responding to the two outbreaks with rapid testing equipment, support for the local health departments and a focus on workplace issues in rural Missouri, state Health Director Randall Williams said Wednesday.


"We are going to be do a fairly intensive, robust, targeted testing in at least one of those communities I know of, to increase our testing there to get at what might be the underlying cause of that,“ he said.


The daily number of new cases statewide has declined in recent days, but where the new cases are emerging is changing, Williams said.


“We are already seeing in rural Missouri, an increase in cases, as we plateau in other places,” Williams said. “The thing we get concerned about is those patients tend to be older and they also can have more chronic health diseases so we worry about their outcomes.”


COVID-19 poses a unique challenge to smaller rural health care systems. Fitzgibbon Hospital in Marshall is the only hospital in Saline County and has conducted 1,038 tests on a 24/7 basis.


Manager of Business Development Amy Weber said Saline County’s numbers are likely higher than surrounding areas in part due to the facility’s rigorous testing.


“We have counties in Missouri who have few if any cases, but they don’t have the testing capacity,” Weber said.


The hospital has tested residents from 19 jurisdictions, according to its website.


As a nonprofit, standalone provider, the hospital is not associated with a larger hospital system. Fitzgibbon was forced to source adequate personal protective equipment (PPE) and administer the necessary testing without the support of partner facilities.


“It is a resource-intensive project,” Weber said.


According to the Missouri Hospital Association, 27 hospitals in the state are reporting a shortage in N95 masks and surgical masks. Four hospitals are reporting a critical shortage.


Weber said Fitzgibbon has had to find alternative sources for PPE in order to continue offering 24/7 testing outpatient testing onsite. So far, the supplies are holding.


But with local cases increasing and no way of knowing when precautions against COVID-19 will cease, CEO Angy Littrell said maintaining supply lines will continue to be a challenge.


“We have had to seek that collaboration because … the shortage in supplies,” she said. “As our testing has increased, that's put a strain on those supplies, we’ve been forced to have those collaborations. Who knows how long those supplies we have obtained through those collaborations will last?”


Fitzgibbon has seven beds available in its ICU. So far, three Saline County residents have required hospitalization. One was transferred to University Hospital in Columbia.


“I think our decisions there are to keep the patients’ best interest in mind,” Littrell said. “I think we know that access to specialty physicians in that ICU environment is really important. Rural hospitals don’t have all those sub-specialists at hand, so while we have the capacity to care for those patients, it’s really in their best interest to have access to the specialty care.”


There is no hospital in Moniteau County. Health Department Environmental Specialist Darrell Hendrickson said at least one person has needed hospitalization, but they had to be transferred to a hospital in the surrounding area.


Although a lack of local health care providers does pose a challenge in Moniteau County, Hendrickson said the real challenge is convincing people of the seriousness of the threat.


“The hurdles that I’m seeing in my county is the false belief that it’s not really a problem,” he said. “The biggest age bracket is the 30-year-olds. It’s not the elderly — it’s the individuals that are 10 feet tall and bulletproof.”


Of the county’s 59 cases, which includes probable cases, 21 affect people between 30 and 39.


“We can beat it back but we gotta be smart, guys,” Hendrickson said. “We are vulnerable.”


Like many rural counties, many of Moniteau’s residents are elderly. The health department is continuing to test residents in hopes of containing the spread of the virus.


But with each positive test, a litany of tasks begins.


“For us that’s really when the work is really starting,” Hendrickson said. “We will be doing phone interviews and doing contact tracing and doing the investigative work that we are required to do.”


That might mean dozens of phone calls. There are three nurses skilled in public health communications at the Moniteau County Health Department. A former employee even came back to help, which made four. The health department administrator is also a nurse, so she is assisting with contact tracing, which leaves Hendrickson to field media inquiries.


“We have had to supplement the resources,” Hendrickson said.


Saline County is facing a similar set of hurdles. Tara Brewer, the health department administrator, said she sent two vulnerable employees home, which left nine to 10, all of which have been reassigned to support COVID-19 response efforts.


“Everyone is all hands-on-deck and no is doing their ‘normal’ job anymore,” Brewer said.


Katy Trail Community Health began offering tests in both Saline County and neighboring Pettis County last week.


With local testing continuing and additional testing becoming available, the number of positive cases is likely to rise. However, both health departments said that community leaders have been responsive to the growing health care needs.


“The working relationships that we’re having with the business and government leaders … is a real testament to rural America,” Hendrickson said.


Although the task at hand is daunting, Hendrickson said he remains optimistic of what’s to come. He sees this as a chance to take care of the most vulnerable in his community. But for now, he hopes local leaders will remain strong in their messaging to residents regarding social distancing and limiting exposure.


Moniteau County doesn’t have a local stay-at-home order, meaning restrictions on public gatherings will expire when the state order does on May 3. Locally, leaders are beginning to discuss a loosening of existing orders in the coming weeks.


“I’m a little concerned when leaders are talking about the modification of the stay-at-home orders,” Hendrickson said. “We gotta be very very cautious about taking our foot off the gas, because this thing could slide back very quickly.”


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