A week before Thanksgiving, Dr. Alex Garza sounds grim but resigned on the phone.
"I guess I view Thanksgiving as just one more thing in the pandemic," Garza says. "I think it will most likely contribute to more cases of COVID if people are out traveling around and visiting and things like that — we're sort of counting on that. So are we dreading it? I think we're just kind of expecting it."
This spring, in the early days of coronavirus' entry in Missouri, the largest health-care systems in greater St. Louis began working together to coordinate their strategies. Garza was the obvious choice for a point person. The 53-year-old chief medical officer of SSM Health had cut a winding, impressive path through the medical world, from driving ambulances as a young man in Kansas City to medical school and into the military. A colonel in the Army Reserves and a Bronze Star winner, Garza helped rebuild the medical system in Iraq during Operation Iraqi Freedom and was later appointed as the chief medical officer of the Department of Homeland Security. In that role, he helped game out how the country would react to multiple threats, such as bioterrorism. Perhaps most notable in light of the crisis unfolding in St. Louis, he led the United States' response in 2009 to the swine flu pandemic.
All that was preparation for his work now as the incident commander of the St. Louis Metropolitan Pandemic Task Force, and yet he hadn't foreseen the full challenge ahead of him.
"I don't think we really appreciated the depth of the politicization, the way this would be politicized," he says.
Across the United States, health-care workers have struggled against skepticism and defiance as they have warned of the virus' deadly reach. The resistance to even basic health measures, such as wearing a mask, ranges along a continuum from conspiracy theorists insisting COVID-19 is a grand hoax to those falsely claiming that the pandemic has been no more deadly than the flu to those who acknowledge the virus is real and dangerous, but insist that a population that includes people who berate checkout clerks at Target over masking policies will take "personal responsibility" and voluntarily follow the steps that experts say are needed to slow transmission.
Health experts have watched in baffled horror as the United States' response to the pandemic has become intertwined with one of the most politically divided moments in the nation's history. In a country where a significant swath of the population believes against all evidence that the presidential election was stolen through mass voter fraud, scientists and doctors are just one more pillar of the establishment not to be trusted.
The cynicism and skepticism has only hardened as the country heads into Thanksgiving. The timing is dangerous for fighting COVID-19. At a November 13 public briefing, Garza and others from the task force all but begged Missouri Gov. Mike Parson to issue a statewide masking order before the holidays. At the same briefing, they pleaded with the public at large to forgo their big family gatherings in hopes of heading off a post-Thanksgiving surge in cases. Garza pointed to record-breaking numbers of hospitalizations that are on pace to overwhelm hospital intensive care units.
"Our health-care workers have fought valiantly day after day, but we have no reserves," Garza said at the briefing, holding back tears. "We have no backup that we can suddenly muster to come in and save the day. If we stay on the path that we're on even just two more weeks, we will not have the staff we need to care for patients."
Later on the phone, Garza says their projections didn't account for what will almost surely be an influx of Thanksgiving cases. If anything, the doom scenarios he laid out were probably conservative, and he sees little help on the horizon. In a news conference last week, Parson flatly rejected calls from the Missouri Hospital Association and others, including Garza, for a statewide masking mandate. The doctors, Parson said in his explanation for dismissing their advice, were looking at the pandemic from a "medical perspective." He encouraged Missourians to wear masks and alter their Thanksgiving plans to be safe but ultimately said the choice was best left to individuals.
"For people that say it's government's responsibility, it's not," Parson said.
Interviewed prior to Parson's news conference, Garza had anticipated the governor's response. He will spend Thanksgiving at home with his wife and three boys, skipping the usual trip across the state to gather with his in-laws in Kansas City. It will technically be a day off, but he'll be looking at his laptop, checking the numbers and wondering what is happening in all those other households across St. Louis and beyond.
He knows some will follow experts' advice to wear masks, stay home and practice social distancing. But others will not. They will head to the airport or open their homes to huge gatherings. And in two weeks, he and the beleaguered ranks of nurses, technicians and doctors will be asked to deal with the consequences.
"Sometimes I think about this in terms of a war," Garza says. "And when you see what's coming down the road and you look at your workforce, I feel like I'm sending my troops into battle knowing they're not going to win, they're going to get overrun by the enemy. They just are, and I have no way to prevent this."