Longtime Columbia physician Elizabeth Allemann is leading an effort — joined, so far, by 49 other health professionals, community members and one Nobel Prize winner — to persuade decision-makers in Boone County to take a stricter approach to combating COVID-19, according to an open letter.

The letter urges the closing of all bars; limiting all restaurants to outdoor seating and take-out only; and shutting down all indoor movie theaters, arcades, bowling alleys, exercise facilities and concert and music halls.

The “request for regulations” is placed in the context of the infection rate in Boone County, which was 7.7% as of the end of July.

The letter notes that:

  • “In the U.S., case counts of COVID-19 are growing at an accelerated rate in several states, and an unsustainably high number of new daily cases are being identified.”
  • In Missouri, case counts of COVID-19 have been increasing and accelerating consistently since mid-June and Missouri has been designated a “red zone.”
  • Missouri fluctuates between the highest and the second-highest Rt value in the nation, indicating that the rate of spread is high.
  • Boone County cases of COVID-19 are also increasing, and the county falls among the state’s top 10 for total case counts.
  • In Boone County, the positivity rate exceeds the World Health Organization’s threshold for reopening of 5% or lower for at least 14 days, indicating that insufficient testing is being conducted to know how much of the virus is spreading within the community.”

The Rt value, also known as the effective reproduction rate, is “the average number of people who become infected by an infectious person,” according to Rt COVID-19. The measurement tool was designed by Instagram co-founder Kevin Systrom and data scientist Thomas Vladeck.

Missouri had a high effective reproduction rate of COVID-19 of 1.13 on Thursday. That means the virus will spread more quickly than in states with Rt values lower than 1.

In a federal report July 26, Missouri was listed in the “red zone” with 20 other states that “had more than 100 new cases per 100,000 people in the past week,” according to The New York Times. The Columbia/Boone County Department of Health and Human Services said in a Thursday news release that the seven-day rolling new-cases rate for the period of July 29 through Tuesday was 106 cases per 100,000.

The letter points out that in Boone County, infection has grown among young adults, “with 25% of the positive cases in Boone County between the ages of 20 and 24.”

Meanwhile, thousands of students, faculty and support staff are arriving, or about to arrive, at Columbia’s colleges.

Allemann said she asked a public health person recently what keeps her up at night, and the person responded, “August.”

The health department has struggled to keep up with the demands of contact tracing as cases have shifted to a younger age group, which tends to have more contacts than older people.

The letter asks decision-makers to prioritize funding the needs of the Health Department through the federal Coronavirus Aid, Relief, and Economic Security Act funding and any other potential federal and state resources.

The city and county are nearing final approval of a contract that would provide $1.8 million in CARES Act money for additional contract tracers. Final approval won’t come until later this month.

“Initially, I thought that the most important thing to stay focused on was to do everything I could do every day to make sure our hospital systems didn’t get overwhelmed,” said Allemann, a family practice doctor. “Turns out that the system that gets overwhelmed before our hospitals is our public health system.

“It is our first defense.”

The letter also asks leaders to lay out step-by-step plans for a complete shutdown of all nonessential activities, if necessary, and similar steps before reopening.

“I’m really concerned that we’re not going to be able to keep our schools open if we do all the other things inside, especially things we can’t do with a mask on, like eating and drinking,” said Allemann, 60, who has been a family practice physician for more than 30 years.

Allemann emphasized that she didn’t want to appear critical of the decisions leaders have made as they’ve attempted to balance public health with economic survival. But she was moved to act after a City Council member, whom she did not name, asked her to publicly voice her concerns because her words would have impact.

Nobel Prize winner George Smith and his wife, Marjorie Sable, a professor emerita of social work at MU, also signed the letter.

“It seems quite clear that both in the country as a whole and in our state, we are removing restrictions,” Smith said. “Actually, we had very few statewide restrictions to begin with. But we’re removing our restrictions too soon at a time when there isn’t a sufficient downturn of the pandemic to warrant the relief of such restrictions.”

Smith said that bars, in-room dining, indoor movie theaters, arcades, bowling alleys, concerts, music halls and exercise facilities are not essential activities or businesses and increase the risk of spreading the virus.

To preserve businesses, education, social and cultural life, Columbia needs to get creative, Allemann said. For example, she suggested closing a couple of downtown streets to allow for more outdoor dining, drinking and listening to live music, in light of the relatively lower risk of being outdoors during the pandemic.

She also thinks outdoor educational activities should be given more consideration whenever possible.

“Right now, it looks like moving everything outside is what we need to do,” she said.

Besides, it’s good for our physical and mental health, she added.

I am cheered up by seeing a couple of private schools announce all-day outdoor educational activities,” she said. “Our children need to be with peers and adults that care about them and are invested in their psychological development.”

On the other hand, she said she was very concerned that the Columbia Public School District’s plans would be “unlikely to provide the stability and routine that help children and families thrive.”

Allemann has been following the development of the new coronavirus pandemic closely since last December. She has seen other pandemics and hoped lessons had been learned.

“When I was in medical school, we noticed that something was happening that was killing gay men,” she said. “For people of my age, this is not our first pandemic. We didn’t control that one, and it is now with us permanently.”

For more COVID-19 related news, see our section dedicated to COVID-19 updates.
  • General assignment reporter, summer 2020. Studying news reporting. Please reach me at feiyusu@mail.missouri.edu, or in the newsroom at 882-5720.

  • I'm the public safety and health editor at the Missourian and a professor in the School of Journalism. I'm experienced in directing investigative projects. Call me at (573) 882-1792 with story tips, ideas or complaints.

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