As COVID-19 has spread across the globe, the primary fear of observers worldwide is the threat of collapse of the health-care system. More severe infections than a state’s intensive-care units have the capacity to treat will dramatically increase the risk of death. The most grave manifestations of the virus, without ventilators and professionals to operate them, would be a death sentence. This is the “curve” that necessitates dramatic actions as lockdowns and mass-gathering bans.
But in the estimation of Mississippi Gov. Tate Reeves and President Donald Trump, America’s response to COVID-19 can bring another catastrophe. They fear an overreaction to the virus: too many businesses closed for too long causing an economic downturn that threatens the livelihoods of Americans, and leads to evictions, foreclosures, hunger and poverty.
In their own words, this catastrophe is ideological as well as material. “Mississippi will never be China,” Reeves said in his address to the public on March 23, specifically in response to a question about emulating that country’s successful measures of intense quarantine. Two days later, Reeves elaborated in a Twitter post. “Because we pray and reject dictatorship models like China they say we are ‘untroubled,’” Reeves posted.
The governor pushed back against Mississippi mayors who sought broader restrictions on essential businesses than his executive orders allowed, interjecting politics in an interview with Mississippi Today.
“In some of the more liberal jurisdictions, they wanted to shut down every business, and there’s just some things we believe are essential,” Reeves said.
The Chinese model is thus unacceptable for the leadership of Mississippi, and it appears, the leadership of the United States. For a time, Trump seemed dedicated to a swift end to America’s already limited lockdown, planning to throw the gates back open to mass gatherings by Easter, just midway through April and less than two weeks away.
“Wouldn’t it be great to have all the churches full?” Trump said during a virtual town hall on Fox News March 24. “You’ll have packed churches all over our country. … I think it’ll be a beautiful time.”
By March 29, those plans had evaporated. A much-sobered Trump extended the nation’s social-distancing guidelines to April 30, as his top infectious disease expert, Dr. Anthony Fauci, braced the nation for “between 100,000 and 200,000” deaths resulting from COVID-19.
By the end of that week, the Mississippi State Department of Health was reporting 847 cases in 75 counties in the state with 16 deaths.
Mixed Messages and Confusion
Just the week before Trump extended the national guidelines, the devolving situation triggered an executive order from Reeves that set a baseline of social-distancing habits for the state to follow, while also ordering that “any additional freedom of movement or social distancing limitations on Essential Business or Operation, restricts scope of services or hours of operation of any Essential Business or Operation, or which will or might in any way conflict with or impede the purpose of this Executive Order is suspended and unenforceable during this COVID-19 State of Emergency.”
The order went on to list “essential businesses,” which covered a massive swathe of the state’s private enterprises.
The impact of Reeves’ executive order was immediate. Mayors from across the state called the governor’s office to determine if their efforts to force curfews and shut down dining halls could persist through the executive order.
After negotiation, some like Oxford Mayor Robyn Tannehill, found that their efforts could co-exist with the governor’s new order because it allowed them to still regulate businesses and operations Reeves did not consider essential and, in effect, had left to locals to figure out anyway.
Others, like Moss Point Mayor Mario King, said Reeves’ order undid his previous “shelter in place” decree, re-opening restaurants, retail outlets and churches alike.
Numerous private-sector employees reached out to the Jackson Free Press on background, speaking of sudden changes in company policy as a result of the executive order. Businesses that had previously established protocols for work-from-home started calling employees back on-site.
Department stores shuttered early in the crisis were devising plans to reopen with the belief that their businesses had the protection of executive fiat, employees told the JFP. In fact, department stores occupy a special place in Reeves’ order, along with shopping centers, offices and factories that are not listed as “essential” in his list further below.
Still, Reeves exempted them from 10-or-fewer gatherings, creating a gray area that scared large retail employees believed would help force them back to work.
After the Jackson Free Press reported on that confusion that led to a hodgepodge of department stores being open or closed in his own town of Flowood the weekend of March 28, the governor downplayed the inconsistency, saying it was up to local authorities to both further regulate and enforce his social-distancing requirements on non-essential businesses, even as his order had exempted groups of them.
This newspaper also reported on the override clause in Reeves’ executive order that forbade locals from enforcing distancing and gathering rules on essential businesses, such as gun stores and churches. He soon attempted to scale back some of the enthusiasm for a return to normalcy in an amendment to his executive order that explicitly made his previous decree the baseline minimum during the crisis, though the amendment still prevented interference with the broadly defined “essential businesses” on the part of Mississippi’s mayors.
That is, local officials could only further regulate non-essential businesses (beyond those he said were exempt), but could not touch any essential businesses—reflecting his original order. He also kept repeating that companies should allow employees to work from home “if they can.”
On Twitter, Reeves warned, “Large businesses that do not allow employees who could work from home to do so are risking some serious lawsuits down the road if major outbreaks can be traced back to them.” At press conferences and live streams held throughout the week, Reeves repeatedly reminded Mississippians that the crisis was “likely to be towards the beginning than ... towards the end.”
More Expansive Testing
Two days after Reeves issued his now-infamous executive order and the day after he issued an addendum that affirmed what was in it, he held a Thursday afternoon press conference with State Health Officer Dr. Thomas Dobbs. There, Dobbs laid out the formal approach Mississippi was taking in response to the COVID-19 crisis. The model to emulate, Dobbs said, was South Korea.
South Korea is an unsurprising choice for attempted imitation in Mississippi. Early in the virus’ spread, its proximity to China made it one of the original hotspots for the transmission of the virus.
Now the nation of 51 million has seemingly contained the novel coronavirus outbreak. After reporting a peak of 909 new cases as of Feb. 29, the country has now declined to a trickle of cases per day.
Most importantly, this massive arrest of the virus’ growth in South Korea came without the intensive lockdown measures used to successfully defuse the situation in China. For a state looking to interdict COVID-19 while keeping businesses running, the South Korean model is appealing, and Mississippi’s public-health leadership argues that it can work here.
“You know, there will be resource constraints, but we have a great team and we’ve overcome those serially. So I have every confidence that as we find new bottlenecks, we’ll find new solutions,” Dr. Dobbs said on March 26.
Experts point to differences in the demographics, environment, and laws between Mississippi and South Korea, many of which complicate MSDH’s attempt to borrow that nation’s strategy—and a few that may help it work here.
It is difficult to compare the two countries epidemiologically, Dr. Anthony Mawson, professor of epidemiology at Jackson State University, explains.
South Korea’s population is 51 million, and Mississippi’s is roughly 3 million. And South Korea is a densely packed nation, with roughly one-third of the entire population living in or immediately around the capital city of Seoul.
“Jackson is a little bit different from the rest of the state, but nothing like South Korea, like Seoul,” Mawson said. Such a close-knit urban setting provides a more immediate challenge to preventing viral transmission.
In recent weeks, Mississippi has pursued some, but not all of South Korea’s tactics for flattening the curve of the novel coronavirus pandemic.
Mass testing, some performed at drive-thru testing sites deployed to hard-hit areas, is key to the strategy.
“What should you do to control an outbreak is … identify cases. And so we want to really do more expansive testing,” Dobbs said last week. As of March 31, the State declined to provide testing specifics, including numbers and timing of how many tests have been conducted in each of Mississippi’s 82 counties.
But South Korea’s COVID-19 containment strategy relies on other cornerstones that will never apply to Mississippi, for better or for worse.
South Korea’s response to the COVID-19 crisis was lightning fast, deploying thousands of tests while the confirmed case totals were still in the double digits. The U.S. and Mississippi have consistently lagged behind. In his March 29 live stream, Reeves estimated the total number of tests, public and private, completed thus far in Mississippi to be somewhere around 8,000, a number he suggested was “two-thirds” of what South Korea had accomplished, on a per capita basis. But the timelines for that level of progression in testing do not match up.
By March 10, South Korea’s public-health agencies had reported roughly 7,500 cases of COVID-19 in the country, as well as 210,000 completed tests. That puts Mississippi between one-third and one-fourth of South Korea’s case-to-test trajectory, per-capita numbers aside.
Mawson suggested that individuals should strongly consider self-isolation if they feel they may have COVID-19 even without a test. State Epidemiologist Dr. Paul Byers echoed that sentiment at Reeves’ March 31 press event.
Of Clusters and Tracing
Contact tracing is the other linchpin of the South Korean strategy. “The idea is to find out who the person who is infected has been in contact with,” Mawson said. Through retracing an infected individual’s steps, a web of their close contacts can build out a heat map of where the virus may have travelled. Testing and isolating the viral contacts can snuff out the spread of COVID-19. And this appears to be the primary focus of Mississippi’s strategy.
Dobbs said in the Sunday Facebook address that seeking clusters, rather than locking the entire state down as many states are doing even as many Mississippians want a lockdown, is how the State of Mississippi will flatten the curve here.
“Quarantining the whole state is obviously not sustainable, we can’t do that. But what we can do, if we can identify the individuals and then the cluster of their close contacts, understanding who’s really at risk—instead of looking at the whole population, we can say hey, you group of 10 folks, y’all are at high risk. We’re gonna have you guys go in quarantine for a couple weeks,” Dobbs explained to Reeves.
He compared the strategy to “pruning the bush, instead of burning the bush.”
The South Korean strategy, The New York Times reports, involved tracing phone and financial records, as well as trawling through surveillance footage from urban environments. While Dobbs rejected those elements of the strategy as “not appropriate” for Mississippi, he did suggest that individuals identified to have been in contact with infected Mississippians would carry “a legal obligation for quarantine, so that we don’t have subsequent spread beyond that level.”
There is no certainty that Mississippi can replicate the success of the South Korean model, even with the hope that climate and population density work in the state’s favor. And one key lesson from the outbreak in Korea remains. More than half of all infected Koreans can trace their virus back to gatherings of the Shincheonji Church of Jesus in the city of Daegu, a secretive religious cult.
Trump may not get his wish for “packed churches” on Easter, but any large gatherings—religious, commercial, or otherwise—can wildly spiral out of control, leading to mass infections even in a country utterly prepared for the disease.
Read the JFP’s coverage of COVID-19 at jacksonfreepress.com/covid19. Get more details on preventive measures here. Read about announced closings and delays in Mississippi here. Read MEMA’s advice for a COVID-19 preparedness kit here.
Email information about closings and other vital related logistical details to [email protected].
Email state reporter Nick Judin, who is covering COVID-19 in Mississippi, at [email protected] and follow him on Twitter at @nickjudin. Seyma Bayram is covering the outbreak inside the capital city and in the criminal-justice system. Email her at [email protected] and follow her on Twitter at @seymabayram0.