In March 2020, as COVID-19 began to overwhelm the country, health officials in the Kansas City metro acted in lockstep.
The CORE 4 — the name for the pandemic partnership between Kansas City and Jackson County in Missouri, and Johnson and Wyandotte counties in Kansas — moved together early to close businesses and eventually issue a broad stay at home order.
The coordination came at a time when Kansas and Missouri state officials had not yet acted. Local authorities said they wanted to send a clear message, and avoid confusion across state and county lines. The swift action likely saved lives.
“We don’t live on an island here in Kansas City,” Mayor Quinton Lucas said in June 2020.
But such concerted action will be harder to execute in future emergencies.
State lawmakers, concerned about governmental overreach and pressured by business groups, have stripped local public health officials of much of their near-unilateral power. The changes to emergency management laws in Kansas and Missouri have established a new set of rules for the next health crisis.
Local health officials in both states will now need approval from elected city and county councils for business closures of more than 30 days and other measures intended to disrupt the spread of disease.
Sanmi Areola, the Johnson County public health director, lamented how public health had become entangled with politics. Coordination early in the pandemic, he said, was “absolutely critical” for effective messaging and public compliance with masking and distancing as well as school and business closures.
Now, he has no authority over schools and will need approval for business closures, gathering limits and mask mandates. Prevention of future public health crises, Areola said, will be challenging under the new laws.
“It’s definitely going to be more difficult moving forward. In public health if we wait until what we think will happen happens it is too late.” he said. “And that’s why it’s difficult for people who are not trained to see that our job is to prevent bad things from happening.”
Lisa Tremmel Freeman, CEO of the National Association for City and County Health Officials, said “every minute counts” in a public health emergency. The general public, Freeman says, often doesn’t realize how quickly public health officials act before a potential emergency comes near the scale of COVID-19.
“They come about all the time and you just don’t hear about them and the reason is that public health is doing its job,” Freeman said. “If Ebola were to reemerge and the dangers of that were not able to be addressed quickly by public health officials, think of the horrible consequences for the country.”
Lucas put it more bluntly. “If there was an Ebola outbreak in Kansas City tomorrow and it was spreading quickly, do you want to wait for a three-week notice and public comment, or are you going to take the action?”Although Ebola is not as easily transmissible as COVID-19, it is far more lethal, with death rates as high as 90%.
In Missouri, Kansas and other states, decisions were made that will slow the entire process down, Freeman said. Those decisions, she said, failed to consider a different type of pandemic or public health emergency.
Local health officials in Kansas cannot take any action without a local governing body convening. Moreover, any order approved by a local body can be challenged by impacted residents or businesses. Portions of the Kansas law surrounding legal challenges could soon be overturned by a Johnson County judge.
While Missouri officials can take swifter action, their decisions can be repealed any time by a city or county council with a simple majority vote, and must be extended by the council every 30 days. The law mentions capacity and attendance limits specifically, but applies to any health order that “directly or indirectly closes, partially closes, or places restrictions on the opening of or access to” businesses, schools or churches.
In both Kansas City and Jackson County, public health orders on businesses last year included capacity restrictions and rules requiring masks to enter.
Parson signed the bill last week in Jefferson City, flanked with restaurant industry representatives.
He said while he supported local control, “there was overreach on the local levels” last year. He counted limitations on private gatherings and the ability of residents to attend church among them.
“There’s freedoms that outweigh consequences,” he said.
For multi-county health authorities, the law requires approval from the city or county council of each individual health department jurisdiction — essentially eliminating the coordinating ability of a group like the CORE 4 to act uniformly across the Kansas City metro.
“At the point where one of them decides we may not want to do this anymore, we can have that reverse domino effect where that then puts pressure on your elected officials” in a neighboring county,” said Dr. Rex Archer, director of the Kansas City Health Department.
“If we do that in one jurisdiction, folks can just go to another jurisdiction to either work or participate in those businesses. This problem of playing each jurisdiction off against each other, this is going to really hamper us.”
The CORE 4 coordination was clearest in the early days of the pandemic. In joint statements and press conferences, health professionals outlined nearly identical stay at home orders and business closures.
As the metro began to reopen, the jurisdictions started to diverge. KCMO and Wyandotte County were the first to implement mask orders but were followed weeks later by Johnson and Jackson counties.
In the fall, as COVID-19 cases began to spike, each locality took a slightly different approach to imposing new restrictions. Likewise, the lifting of restrictions in the spring was staggered. Johnson County was the first to remove its mask mandate by a vote of the county commission but it was quickly followed by the other jurisdictions.
Throughout this, Areola said, local health officials still met and coordinated messaging and general goals.
Rep. Fred Patton, a Topeka Republican who helped draft the Kansas emergency management bill, acknowledged that there would be barriers to collaboration with the new rules but said it would remain possible.
“It’s a challenge when you try to get governing bodies to work together because one sees a situation one way and the other sees it a different way,” he said. “But oftentimes, whether it’s a pandemic or economic development, they put those differences aside and do what’s best for the region.”
Despite the initial coordination, Bill Teel, executive director of the Greater Kansas City Restaurant Association, said rules were not enforced uniformly across jurisdictions.
For instance, Johnson County accepted plexiglass as a replacement for social distancing indoors while Kansas City did not. And as restrictions were lifted then reimposed in the summer and fall, each county offered slightly different hour and capacity restrictions.
Teel said he wished business owners had a stronger voice during the early days of the pandemic and believed the new rules in Kansas and Missouri would ensure that.
“We as restaurant operators were very cognizant of the risks and what was needed to operate safely,” Teel said. “I don’t know if they didn’t trust us or they just wanted to be more restrictive but it felt like they were more restrictive than they needed to be.”