The third and fourth likely cases of the deadly coronavirus prompted Gov. Mike Parson on Friday to declare a state of emergency for Missouri.
"We don't know where this is going at this point but we have to prepare for the worst and hope for the best," Parson said.
The executive order will allow the state to tap state emergency funds while at the same time speeding up the ability to use federal money coming to the state, Parson said.
"I want to be clear, that the declaration has not been made because we feel our current health care system is overwhelmed or unprepared," Parson said.
The announcement came on a day when President Donald Trump declared a national emergency because of the virus named COVID-19 by the World Health Organization. Nationally, about 1,600 people have been confirmed with the disease and about 40 deaths have been blamed on it. There are about 128,000 cases worldwide, with a death rate of about 3.5 percent.
Schools, colleges, businesses and other entities have announced steps to close and conduct their business remotely, and many entertainment and sports venues have canceled events.
"The declaration is not intended to close public schools," Parson said. "Schools should seek the guidance of local health officials."
The state has tested 94 samples from people who suspect they have coronavirus, with the four presumptive positive results. The positive results must be confirmed by the Centers for Disease Control.
The University of Missouri and Washington University are working with the state to expand the ability to test patients, Parson said.
Parson did not give any details about the locations where the people in the two new cases live, saying that not everyone involved had been notified.
The second case, announced Thursday, was in Springfield and involved a person who had recently traveled to Austria. The first case, in St. Louis County, involved a woman who had recently traveled to Italy.
Democratic lawmakers had asked Parson to declare an emergency Thursday afternoon. State Auditor Nicole Galloway, who is running against Parson for governor this year, joined the call Friday morning.
"Now is the time for decisive action to stop #COVID19 from sweeping across MO," she tweeted. "The #MOGov must issue an emergency declaration so we can access funds and take actions to respond to this growing public health emergency."
The decision to declare an emergency before there is community spread of the virus is the right choice, said Dr. Christelle Ilboudo, an assistant professor of clinical child health at the University of Missouri.
"From what I understand, if it means we have more resources available, to test, to provide certain equipment and the necessary tools to our providers, this is the time to do it," she said.
While the steps taken as part of the emergency response will not prevent infections, it could reduce the impact, Ilboudo said.
"We should assume we will see more cases in Missouri," she said.
In communities that did not move quickly to limit exposure, the 1918 flu epidemic spread very quickly and killed 10 percent of the people infected. COVID-19 has a death rate of about 3.4 percent worldwide, but that number could be misleading since many people who have milder cases do not get tested, medical experts said Friday.
David McKinsey of Metro Infectious Disease Consultants in Kansas City co-wrote two articles in 2018 about the 1918 flu for the Missouri State Medical Association Journal.
"I think it is a wise move," McKinsey said. "The governor is being proactive and although we have very few cases at this time, by canceling classes in colleges and universities, the epidemic is likely to not get as much of a foothold here."
Some steps, such as shutting down major sporting events and other gatherings, will also help, McKinsey said.
"I think the steps that have been taken over the last few days are proactive and should have a demonstrable impact on reducing the number of cases of COVID," he said.
Other actions may not be as effective or useful, McKinsey said.
"I am not sure that further social distancing such as closing businesses or having people work from home in places where there has been no cases of community spread will provide much benefit," he said.
Fourth Ward Columbia Councilman Ian Thomas will engage in social distancing in his communications with constituents, moving his weekly availability from a coffeehouse to an online setting.
The announcement came on a day when schools, colleges, businesses and other entities announced steps to close, conduct their business remotely and cancel events.
The University of Missouri, after suspending classwork, is moving instruction online beginning Monday on its Columbia campus. The other three UM System campuses are following suit, with UMKC and UMSL resuming work online on Monday and the Missouri University of Science and Technology resuming classes online on Wednesday.
"Leaders on your campus and at the system level are continuing to receive updates from our emergency management experts and incident command teams to communicate with students, faculty and staff on safety precautions, travel guidance and other necessary actions as needed," UM President Mun Choi wrote in a message sent out to faculty, staff and students.
"Now more than ever, our collaboration is necessary so we can maintain learning and working continuity while preserving the health and safety of our community," he added.
Columbia Public Schools, in a message to parents, stated that classes will be in session Monday and parents would receive an update at that time.
The district is "working on alternative academic options for students at all levels, including elementary, middle, high school, English Language Learners, and special education should a closure be necessary," the message stated.
Stephens College and Columbia College are also moving their coursework online. Stephens will begin online Wednesday and continue after spring break. The college hopes to resume in-class instruction on April 13.
Columbia College, which had already moved online in Washington state, will move instruction online at its home campus and all satellite locations through the end of the spring semester on April 25.
"The health and well-being of our students, faculty and staff around the country is our main focus every day, and this situation obviously requires increased scrutiny and action on our part," President Scott Dalrymple said.
Moberly Area Community College will move its classes online through April 6.
In nearby communities, Central Methodist University in Fayette will transition to online coursework on March 30, William Woods University in Fulton will do so on Monday and Westminster College will extend spring break and move online on March 28.
The Daniel Boone Regional Library has suspended all programming and events, including tax help, meeting room use and bookmobile stops, until further notice. The library will remain open at its main Columbia location and its branch locations in Ashland and Fulton.
Shelter Insurance, as of Friday, "is encouraging employees who have the ability to work from home to do so," the company stated in a news release. "This means the home office and branch locations will be operating with significantly fewer employees on site."
The Springfield News-Leader contributed to this report.