ST. LOUIS — For Markita Jackson, COVID-19 started out as a cough. She got tested in mid-January and learned she was positive the next day.
But, as of Tuesday afternoon — 10 days later — she still hadn't been contacted by the city health department, she said.
Health departments typically try to contact residents who test positive as soon as possible to explain what can be confusing federal guidelines for those who catch the coronavirus, and to ensure they're isolating. Such a separation from the public is a key part of the country's strategy to slow down transmission.
Right now, the U.S. Centers for Disease Control and Prevention recommends at least five days of isolation and often 10, depending on the situation. But several city residents said the St. Louis Health Department didn't contact them for more than a week after their positive test, and, in some cases, 10 days later.
For Jackson, that kind of information, and reassurance, would have been helpful. She lives with her 12-year-old daughter and 65-year-old mother. She was able to take time off from work to isolate but didn't know if she should keep her daughter home, too, and wanted additional information.
"I was looking for some more guidance," said Jackson, 38, of the Ville neighborhood.
The city health department said it is aware of the issue, and is working to fix it.
Valerie Newbern, a public health program supervisor in the communicable disease section, said staff try to send notification letters out within a day or two of receiving test results. But recent volumes have meant more letters, and everyone is busy, she said. "This is no one's fault," she said.
The city also sometimes texts residents regarding positive cases. But letters and phone calls are the default, she said, because a lot of the community doesn't have access to text messages.
A spokesman for Mayor Tishaura O. Jones said she recognizes the important work of the department and is encouraged it is listening to the community's concerns.
Looking for guidance
Guidance around COVID-19 is nuanced, and has changed throughout the pandemic — most recently in late December, when the CDC shortened the recommended isolation periods, generally to five days but up to 10 or longer if symptoms continue.
Still, residents in some other area counties generally haven't reported such delays.
The St. Louis County health department attempts to reach people by text, email and letters. It usually sends text messages within an hour or two of receiving results, through a system that is largely automated. Staff also call as many positive cases as they can each day, especially those they can't reach via text or email.
"When you get a positive COVID test, it's kind of just terrible news," said Nebu Kolenchery, director of the St. Louis County Department of Public Health's Division of Communicable Disease Response. "Most people kind of freak out."
The county also sends letters, in case none of the other methods work.
St. Charles County sends emails and calls those without email addresses, a health department spokesman said.
And residents in those two counties contacted by the Post-Dispatch generally said they were reached by their counties in one to four days.
Deborah Billing, 62, of Wentzville, learned she was positive for COVID-19 on Dec. 30. She talked to her doctor, who advised her to stay home for 10 days. She received a call from her doctor's office each day.
"I am privileged enough to have a physician," Billing said. "I got the extra care because every day they were checking in on me."
Billing's email from the health department didn't arrive until Jan. 3, four days after her result, but she didn't mind. It had been a holiday weekend.
"I also know the amount, just the massive amount of people that were diagnosed the same time I was," Billing said. "In light of everything, I thought it was fine."
Indeed, Billing was one of 4,552 people to test positive in St. Charles County that week — and one of 925 who tested positive on Dec. 30 alone — a huge spike in cases.
'Surprised'
Bridget Kastner, 39, of the city's St. Louis Hills Neighborhood, said her 1-year-old daughter's COVID-19 test came back positive on Jan. 20. Kastner and her husband then also went and got tested, and their results came back positive the next day.
All three had relatively mild cases. Still, Kastner was surprised when she didn't hear from the city health department. She said that she had, in the past, been contacted after a case of food poisoning, and felt that the staff did a thorough job investigating it.
On Saturday, nine days after their first positive COVID test result, the family received a letter from the health department.
"I was surprised," Kastner said. "You can't just guarantee everybody knows what to do."
Case numbers in the region are now dropping. New cases have fallen to 155 per day on average in St. Louis from a peak of 517, according to city records, and to 758 in St. Louis County, from a high of 2,700.
Contacting people and investigating disease outbreaks is the "bread and butter" of public health, said Kolenchery. But the COVID-19 pandemic has escalated that work to a level not seen before.
"We've been doing this forever," Kolenchery said. "Just not at this scale."
