In March, before a positive coronavirus case had been recorded here, Oklahoma’s Chief Operating Officer John Budd sat in a meeting with Gov. Kevin Stitt and state health department leaders. The topic was Oklahoma’s “level of preparation,” Budd said. The governor asked how much protective gear the state had at its disposal.
“The answer was one day,” Budd told The Frontier.
Despite being one of the last states in the nation to feel the full force of the coronavirus, Oklahoma still found itself in a tight spot, ill-equipped in those early days to mount an adequate response to the virus, which continues to spread at record rates many months later.
State and civic leaders told The Frontier that similar to many states, Oklahoma was unprepared to handle a pandemic. For years, officials had neglected to invest in the state’s public health infrastructure, they said. When the virus arrived in March, the state was sorely lacking some of the vital components for an effective response. Oklahoma didn’t have the adequate testing capacity and contact tracers that were needed to track the spread of the virus.
Antiquated systems slowed the reporting of test results, and in the midst of a national shortage, there wasn’t enough personal protective gear, such as respirators, face shields and gloves to send to frontline workers.
Oklahoma surpassed 100,000 cumulative recorded cases of COVID-19 on October 12 and has continued to see record numbers of hospitalizations and new daily infections over recent weeks. It took more than four months for the state to record 1,000 new cases in a day, but since then Oklahoma has reported daily case loads of more than 1,000 about 40 times.
Unlike some states, such as Oregon and Ohio, where outbreaks have been met with strict measures such as mask mandates and stay-at-home orders, Oklahoma’s response, led by first-term Gov. Kevin Stitt, has been more subdued.
Oklahoma was one of the last two states to declare a state of emergency when Stitt issued one on March 16, which he has continued to extend since then. He ordered the temporary suspension of elective surgeries on March 24 and issued a safer-at-home order, directing vulnerable populations to stay home. However, there has been no statewide mask mandate or stay-at-home order.
Stitt has maintained that Oklahomans value freedom and wouldn’t follow a statewide mask mandate. He’s left much of the decisions surrounding restrictions up to local governments.
The governor started the state’s reopening plan in late April after ordering the closure of businesses deemed nonessential on March 24. The governor fully reopened Oklahoma on June 1, months ahead of some other states, such as Louisiana, New Mexico and Florida.
However, leaders told The Frontier the state has come a long way and experts know much more about the coronavirus today than they did in March.
So what’s being done in Oklahoma to prepare both for further coronavirus infections and for an eventual recovery?
‘Baling wire and duct tape’
Coronavirus testing was “a huge problem early on,” Budd said. Early models were predicting thousands of hospitalizations and deaths, numbers Budd called “mind-boggling.” And the state didn’t have the testing capacity necessary to fully understand how the virus was impacting Oklahoma during the spring months.
A national supply shortage of testing kits and the key chemicals needed to process the kits, also known as reagents, had drastically limited testing.
“We were sending our early tests out of state for processing,” Budd said. “We had to stand up our in-state capacity to have good turnaround times. The White House was telling people ‘If you want a test, get a test.’ But we couldn’t do that.”
Dr. Lance Frye was named the interim commissioner of the Oklahoma State Department of Health in late May. He replaced Gary Cox, whose nomination was never taken up by the state Senate.
Responding to the pandemic hasn’t been an easy task, Frye told The Frontier in a recent interview, but he believes state leaders have learned some valuable lessons and taken the opportunity to improve agency functions.
He said he hopes some of those improvements are within the state’s public health infrastructure, which for years has lacked the proper investments. The shortcomings made the initial pandemic response more challenging.
Oklahoma leaders spent the first couple of months of the pandemic struggling to build up the state’s testing capabilities and hospital capacity, and scrambling to gather life saving protective gear for frontline workers.
In the midst of the scramble, the state auditor agreed to launch an investigative audit in April over concerns of the health department’s spending, as critics said the agency’s methods to secure equipment were too risky.
State leaders spent $2 million to buy a supply of hydroxychloroquine, a malaria drug touted by Trump to treat patients with COVID-19 that the CDC has cautioned against using for coronavirus treatment.
“I was being proactive to try and protect Oklahomans,” Stitt said at a news conference in late April.
Officials also struggled to build a robust workforce of contact tracers.
“You know, 90 percent of this we did with baling wire and duct tape,” Frye said. “We don’t want to have to do that again.”
Leadership relied heavily on partnerships between state agencies, universities and public entities to mount a stronger response against the pandemic, Frye said.
State officials are now encouraging the public to continue mitigation efforts, such as mask wearing and social distancing, but they’re also looking forward to a vaccine. Frye said he hopes to see one by the end of 2020. The specifics of a vaccine are unknown — the federal government has yet to deem one worthy of widespread distribution and it’s unclear how much vaccine Oklahoma would initially get.
State officials plan to distribute the vaccine in a phased approach, with the most vulnerable populations receiving it first, Frye said.
Frye said he believes that compared to other states, Oklahoma has fared well in the pandemic.
Oklahoma is among the 10 states with the lowest death rates with 30 deaths per 100,000 people, according to the Centers for Disease Control and Prevention.
“From my perspective, I think when we look back on this, historically, we’re gonna say that we, that they, did a really good job,” Frye said. “I had no idea when I took this job how politically and emotionally charged that was going to be for everyone”
Oklahoma leaders were able to slow the spread of the virus until they could build up the state’s hospital capacity and supply of protective gear, Frye said.
As of Wednesday, hospitals had an average of 28 days worth of protective supplies available, according to state health data.
“We knew eventually that when we started opening up the economy, it’s inevitable that the cases were going to come back and you’re going to have a surge,” he said. “But you also have to live your lives. It’s not going away so you have to have a balance of personal health, mental health and economic health, and figure out how to get through this.
“And I think that we’ve done that very well.”
Aaron Wendelboe is the former interim state epidemiologist and an associate professor of epidemiology at the University of Oklahoma Health Sciences Center.
He agreed that “years of neglect of investment” in Oklahoma’s public health infrastructure hindered pandemic response, including a shortage of nurses and other health care workers.
There initially weren’t enough contact tracers in the state, Wendelboe said.
“It really became evident because within the first couple weeks there in March, we were overwhelmed by the number of cases to do case investigation,” Wendelboe said.
Contact tracing is a core tool used by public health staff to control the spread of disease by working with confirmed patients and connecting with everyone they had close contact with while the patient might have been infectious.
The process, which can take several hours or several days, helps infected people and those who were exposed isolate themselves in an effort to prevent further spread.
“We had been essentially running on a skeleton crew,” Wendelboe said of the contact tracers. The state’s public health workforce was quickly overwhelmed.
In late April, the Oklahoma State Department of Health had 150 contact tracers with the goal of building the workforce to 1,000, officials said at the time.
Antiquated technology also slowed the response.
The state’s disease surveillance program, the Public Health Investigation and Disease Detection of Oklahoma — known as PHIDDO — is antiquated, officials have said throughout the pandemic. The program, which is in the process of being replaced for COVID reporting, is supposed to provide real-time reporting of disease outbreaks, but it hasn’t always been able to keep up with the demands of the pandemic.
That has led to delays and backlogs in reporting test results.
“The stakes couldn’t have been higher with regard to a pandemic,” Wendelboe said. “We’re still struggling to replace PHIDDO, and I know we’ve made a lot of changes, but it’s just unfortunate that it took a global pandemic for the investment to be made to make these updates.”
Has the state made more investments in public health since the pandemic started?
“Well, they were forced to,” Wendelboe said.
Congress passed the Coronavirus Aid, Relief and Economic Security, or CARES, Act this spring. It allotted funding to all states, including $1.2 billion to Oklahoma. Officials must spend the money before the end of the year.
“I think that, unfortunately, just still politics got in the way. Where this lack of investment comes, is that I’m not sure there were enough people at that high level to know the background of what the priorities should be,” Wendelboe said.
“They’re still smart people, and they’re good people. … But the fact is, if you haven’t been working in public health to know the history, then you’re making decisions based on a limited knowledge set rather than knowing the whole context.”
One example of that was the struggle to hire an adequate workforce of contact tracers, Wendelboe said.
Another example, he said, was the replacement of Cox, who was the interim state health department commissioner until mid-May. Cox, who has worked in public health for more than 50 years, did not have his nomination taken up by the state Senate after some lawmakers raised concerns he did not meet the qualifications to hold the position. Cox didn’t hold a master’s degree in science, one of the statutory requirements to serve.
Oklahoma leadership has done “pretty well” responding to the pandemic and preventing deaths, but there’s room for improvement, Wendelboe said.
‘It’s become a lot more politicized’
Budd said that in March and April, a time when Oklahoma was still seeing only about 100 coronavirus cases per day, state leaders were watching New York Governor Andrew Cuomo give daily updates as New York was being hit hard.
“He was facing the brunt of this virus,” Budd said. “We were all interested in what he had to say.”
Cuomo, a Democrat, has since become a favorite target of President Donald Trump and other conservatives as more than 30,000 New Yorkers have died from coronavirus infections, the highest number of any state in the nation. And yet most of the infections and deaths there came very early in the pandemic, in March and April. New York’s seven-day rolling average of infections dipped under 1,000 per day in June. Meanwhile, Oklahoma’s seven-day rolling average has mostly stayed above 1,000 per day since late September. Both Oklahoma and New York average between 7-10 coronavirus deaths per day now.
“It’s clear now that masks are a political issue,” Budd said. “Let’s just say that folks on one side of the aisle are bigger believers (in the virus). It’s crazy because it’s a public health issue.”
For a brief moment this summer Tulsa became the epicenter of national news when Trump announced he would hold his first post-pandemic rally in the city in mid-June.
The city was at the beginning stages of a spike in COVID-19 cases and some feared the rally would act as a superspreader event, leading to untold new infections and deaths in Tulsa and across Oklahoma. City leaders estimated as many as a million people might come to Tulsa for the rally.
In the end, thousands of mostly un-masked people descended on Tulsa’s downtown for the rally and counter protests and within weeks, cases in Tulsa and Oklahoma began their still ongoing surge, leading Bruce Dart, executive director of the Tulsa Health Department to say “connect the dots.”
Dart told The Frontier recently that he “never could have forecast” that masks and preventative measures would turn into a political statement.
“Never in a million years would I have thought the conversation around masks … would have had any political connection or connotation to it,” Dart said. “I’ve worked H1N1, many other infectious diseases, and this is the first time I’ve seen a component of protection be so politicized that people aren’t wearing masks due to their political ideology.”
Even as COVID-19 cases in Oklahoma continued to increase, Stitt often declined to wear a mask, and was routinely photographed in meetings around other people without wearing one. It wasn’t until late June when Stitt finally donned a mask during a press conference, saying “it’s this easy.”
But he still eventually contracted the coronavirus, the first governor in the country to report an infection. Later that month Stitt returned to work, saying he had recovered from the virus. And he again began to appear in public without a mask, saying that he had “already contracted” the coronavirus, so he didn’t need to wear one.
Oklahoma still is reporting high levels of COVID-19 transmission. The White House Coronavirus Task Force’s latest report ranked the state No. 11 in the U.S. for its rate of case growth.
The state is averaging about 1,235 new cases per day over a seven-day period, an all-time high, according to data tracked by The Frontier. As of Thursday, a record 956 people were hospitalized with COVID-19, according to state health data.
Wendelboe, the associate professor of epidemiology, agreed masks have become a political issue. He said he hoped Oklahomans learn from the mistakes surrounding the politicization of masks when it comes to a vaccine.
So far, he’s encouraged by preliminary research that vaccine makers have released.
“There’s still political spin on the vaccine, and we still have an opportunity,” Wendelboe said in an interview last week. “Maybe we’ve stumbled a little bit in the past with trying to listen to politicians versus scientists on mask wearing. Let’s really see what the science has to say about the vaccine and not make it a political issue and make it a science issue.”