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What No One Could've Predicted

07/23/2020

Cora Faith Walker (’09), former state representative for Missouri’s 74th District, joined St. Louis County Executive Sam Page’s cabinet as director of policy less than a year ago.

Elected to the House General Assembly in 2016, Walker sat on the Health and Mental Health Policy Committee and on the Children and Families Committee. Prior to that, she worked as an attorney in health law and policy. A graduate of SLU LAW’s health law program, Walker served as the Health Law and Policy Fellow for the Center for Health Law Studies in 2014-15 and also has an M.P.H. from Washington University in St. Louis.

Walker joined the County cabinet hoping to use her extensive health policy expertise and legislative experience to improve the lives of residents through local government, but found herself as green as everyone else in addressing the unprecedented COVID-19 pandemic. One of the actions she took right away was recommending Prof. Rob Gatter to be named to the County Health Department’s COVID-19 Response Team, where he has been consulting on the legality of quarantine policies and the constitutionality of stay-at-home orders.

In this Q&A, Walker discusses what it has been like directing County policy through this crisis.

When did your team realize the scope of the COVID-19 threat, and how did you begin preparations?

Maybe two weeks before the first case in Missouri was confirmed – and that was in St. Louis County – I sent a note to the senior leadership team in Dr. Page’s administration asking, do we want to sit down and meet with our public health department about the coronavirus, what our plans are, etc. Our Department of Public Health had been in communication with other folks and other departments of public health a little before that point in time, but that was when we as an administration all sat down, and we ended up activating our Office of Emergency Management’s emergency operating center two days before the first case was confirmed. So we certainly tried to be as proactive as possible and were also kind of ahead of the game and didn’t wait.

How did your health law education influence your decision-making process during this crisis?

My health law background has been critical in all this because many of the policies that we are making, the public health orders being issued, are all law or some sort of law or regulation in some fashion. So having that background and that perspective has been really helpful throughout, even just as a way of thinking about the policies we’re making. My training in administrative law and that class was certainly something that has continued to prove incredibly valuable in all of this – working to be sure that the regulations we’re developing are legally sound. And we’ve got a wonderful and talented group of folks in the County Counselor’s Office, but this is the first sort of public health crisis like this that we’ve seen since 1918.

It really put us in a place as a local jurisdiction to one develop a lot of policies and procedures on our own, but two – we also kind of had to do it in the absence of clear guidelines from the federal government. Having my health law background was and continues to be invaluable.

What has surprised you during this pandemic? What would alumni be surprised to learn?

The inconsistency or lack of clear and consistent guidelines from either or both the federal and state government. The idea ‘We’ll leave it up to the local jurisdictions’ has been both surprising and really brand new when it comes to things like communicable diseases that aren’t necessarily restricted by people who draw maps and our jurisdictional boundaries.

I’m just the policy director from St. Louis County, and being on the phone with medical suppliers in Switzerland is something one wouldn’t necessarily have expected or could’ve predicted.

I don’t think anything could’ve prepared me for this, but having conversations with the National Guard or U.S. Army Corps of Engineers about temporary medical facilities, planning for hospital surge fatality facilities, all those sorts of things – quite frankly nothing was expected, and most everything was certainly a surprise. But when I think about the way in which local government and even state government have been placed in a position where we are having to compete with other states and countries for supplies and equipment, I don’t think anyone could’ve predicted that.

I also was pleasantly surprised by our response, the region’s response and our community’s response in adhering to the orders and making some very difficult but very responsible decisions to follow those orders to stay home so that we could get to a place where our hospital system wasn’t overwhelmed.

Beyond policies like quarantine, social distancing and masks, what policies have you had to work on?

The way we’ve approached the response in St. Louis County has been looking at the public health part but then also keeping a focus on and being very deliberate about supporting the humanitarian response, or social support and services, and then economic response. So things like utilities and evictions and even how court proceedings occur – early on we did a lot of work with the 21st Circuit about how they had continued to operate.

One other thing that makes this whole pandemic even more unique is the fact that this is an election year, so trying to figure out how people are going to be able to vote during a pandemic is happening right now. We’ve got a municipal election in June, a primary election in August and then depending on the second wave that is predicted, elections in November. Trying to plan around all that – it’s not in my ‘program planning and implementation for public health,’ I gotta tell you.

What are you proud of in the county’s policy response?

I’ve been incredibly proud at the ways in which the folks in St. Louis County led the effort in coming up with these solutions and these approaches, and doing so in a way that was at the forefront of how the region and then the state approached the recovery. Just building a lot of the infrastructure – and the policies and laws around the infrastructure – that became models for the region and the state is something I’m pretty proud of.

I think the very aggressive and proactive measures that we took early on helped flatten the curve and helped us beat some really dire predictions and projections that were shared by epidemiologists and other folks early on. We avoided that worst case scenario. We didn’t even get to the somewhat worst case scenario that we developed ourselves. The early projections and models were very close to that.

Any points of optimism or bright spots?

One thing that has been really encouraging is the level of coordination that has occurred between hospital systems, local public health departments, federally qualified health centers, health providers and the region as a whole. Pretty early on, folks understood that we can’t have a situation where one hospital is competing against another to have the most tests. There has to be collaboration; there has to be cooperation across all systems. That has been really promising and encouraging, and quite frankly we wouldn’t have had the outcomes we’ve seen so far without that collaboration.

Hospitals are absolutely better prepared now. There’s no question. That’s the thing about dealing with a pandemic, you can hope for the best, but you have to be prepared for the worst. There’s not a question in my mind that those aggressive policies that we put into place early on avoided the real worst case scenario where we had an overburdening of our hospital system.

I would also add how grateful I am for Rob [Gatter] and his expertise. That’s one of the things that we were incredibly fortunate to have in St. Louis and in the region – the number one health law program in the country. Being able to pick up the phone and reach out to experts in the area has just been critical to our response, and I want to express my gratitude for that.

— Edited by Maria Tsikalas