Brian Cui | Student Life

The Washington University School of Medicine published the study, Sep. 1.

The Washington University School of Medicine published a study this month concluding that early health orders issued by St. Louis public officials likely prevented thousands of hospitalizations and deaths, saving the city from a much larger crisis.

The study, led by Washington University Professor of Medicine Dr. Elvin H. Geng, found that a delay of just two weeks in implementing social distancing measures would have led to a “nearly six-fold total increase in deaths,” using a model of the COVID-19 pandemic in accordance with St. Louis’ demographics and policies. Such a short delay could have created a situation resembling that of a more heavily affected area, such as New York City.

The study also concluded that, among multiple behavioral theories, immediacy is the most crucial component to creating a successful public health procedure.

Washington University medical anthropologist and professor David Ansari, who was not part of the study, said the research is not just another piece of academic groupthink but is instead highly relevant to effective public health policy.

“I think we can generalize from these findings and see that, had certain measures been put into place even earlier on, it could have had a much different effect, which would have translated to the saving of lives and protecting people from this really dangerous pandemic,” Ansari said.

If the response was delayed by one week, the study calculates that the number of deaths by April 15, 2020 would have reached a median projection of 219 instead of the actual observed number, 115. As a result, larger cities like New York and Boston can learn from St. Louis, where county and city public officials acted swiftly in issuing health orders before the severity of the pandemic was apparent.

“When an epidemic is taking off, at that moment, it’s important for leaders to have the courage to make a decision that could be unpopular and to do so before it’s obvious,” Geng said. “There are instances in America where we did it [issuing health orders] too late. New York City did it too late. There were tons of people saying we need to close things down, and New York waited and waited until the hospitals filled up, by which time it was too late. By the time it’s obvious, it’s too late.”

The state of Missouri, its more rural counties in particular, also fell behind St. Louis, highlighting the disparity between health orders in the different areas.

“I think there was [a disconnect],” Geng said. “The severity of the epidemic is worse in rural places than in urban places. That is in part because people living in urban places had more in the way of sustained behavior change.”

“I think that Missouri would be much better off in terms of its numbers, both in terms of infections but also in terms of deaths, if similar approaches were followed as were implemented in St. Louis and in the surrounding communities,” Ansari said.

Ansari also argued that disparities in vaccination rates between St. Louis and Missouri overall have had an even worse impact than disparities in public health orders. At the time of publication, there are 26 counties in Missouri where the vaccination rate is below 30%.

Ansari explained that the unvaccinated population of Missouri affects the vaccinated population both by allowing the virus to continue to spread, as well as having a demoralizing effect on the vaccinated population.

“We need to have a certain threshold in the general population that’s vaccinated in order to reach a certain level of safety,” he said. “To know that there’s a significant portion of the state that isn’t even getting close to that threshold, I think it does take a kind of psychological toll, more broadly.”

An emerging area of scholarship is focused on why people do or do not follow public health orders or get vaccinated. Dr. James Stellar, a professor of behavioral neuroscience at the University of Albany, argues that emotion plays a large role in these decisions.

“The emotional brain circuits that you carry with you do influence your cognitive decisions and often in ways that you don’t understand,” Stellar said. “Here, I think what’s happened is that people have gotten tribal. ‘It’s my tribe telling me not to do this.’ [This logic] often happens unconsciously.”

Because of this emotional element, Stellar argued that certain public health decisions are best issued at the local level, since people are more likely to listen to someone they feel like they know and trust.

“If these orders come out from the top, they might have an opposite effect. People will think, ‘Oh, that’s just the government pushing me,’” Stellar said.

One of the other conclusions of the study is that local decisions matter just as much as, if not more than, those made at the national level. However, Ansari admitted large scale national planning also brings certain advantages.

“I think it is important to attend to the needs and resources in a local context, but at the same time, if we did have a coherent approach that was nationally dictated in this country, we would have been much better off in terms of where we are with the pandemic now,” Ansari said.

Geng said that the fight against anti-science and the disregard for public health is “a lasting struggle.” However, he maintained the importance of scientific research centers, such as the School of Medicine, in producing knowledge.

“People generally believe what they believe, and if you look on the internet, you can find supporting evidence for whatever you want to believe,” Geng said. “I’m not totally hopeful that some study based on an epidemiologic model is going to change a lot of opinions. On the other hand, I still think there is a role for science in society and we will hopefully get to a point in the future where we can have these conversations.”