More Mitigating Measures

More Mitigating Measures

As Tennessee healthcare professionals prepare for a tsunami of COVID-19 patients, they ask Lee for greater public restrictions.

by scott barker • March 23, 2020
Pulmonary assessment tent at University of Tennessee Medical Center (Photo courtesy of UTMC).

Gov. Bill Lee’s executive order placing stringent restrictions on dining and gathering in Tennessee aims to slow the spread of the novel coronavirus, but a swelling number of healthcare professionals is saying it’s not enough.

The University of Tennessee reported the first presumed positive coronavirus case on its Knoxville campus on Sunday.

With case counts rising and students returning from spring break, the group of prominent physicians and other medical workers wants to see stricter measures implemented.

Meanwhile, Knoxville hospitals are taking steps to prepare for an anticipated influx of patients stricken with COVID-19, the disease caused by the novel coronavirus.

Issued Sunday, Lee’s order closes bars and restaurants, except for carryout, drive-thru and delivery service. Gyms must close, and all public gatherings of more than 10 people are forbidden.

Doctors who signed a letter to Lee over the weekend urged him to go further, as Nashville Mayor John Cooper did Sunday by mandating that all businesses in Metro Nashville-Davidson County close except those deemed essential in a “Safer at Home” order. 

“It is our estimation that we have little time to ‘flatten the curve’ on the current situation,” the letter read. “China and South Korea  have made great progress by imposing restrictive measures. We ask that Tennessee do the same.”

Case Updates

The number of presumed positive cases of coronavirus in Tennessee jumped to 505 on Sunday, a fivefold increase since Wednesday, according to the state Department of Health. Two people have died in Nashville, according to the Metro Public Health Department as reported by WSMV-TV, both patients with underlying medical conditions.

Knox County has five cases, up from four on Saturday, and the University of Tennessee announced Sunday that a staff member has become infected. It is unclear whether the UT employee is included among the five presumed positive tests on the state’s list, as the state and the Knox County Health Department have reported conflicting figures. Neither the state nor the county health department has responded to a request for an explanation of the discrepancy between the numbers. 

In a letter to UT Knoxville faculty, staff and students, Chancellor Donde Plowman wrote that the staff member was last on campus March 16 and is now home in self-isolation. UT and health department officials are reaching out to anyone who might have come in contact with the patient, and staff will conduct a thorough cleaning of his or her work areas, she wrote.

“Our thoughts right now are with this member of our campus community. I wish them a speedy recovery, and we are committed to providing them with care and support,” Plowman wrote.

She said UT will continue pursuing “aggressive measures for social distancing” to help limit community spread and protect those who are particularly vulnerable to the coronavirus. UT has suspended in-person classes for the remainder of the spring semester and has canceled commencement ceremonies.

Many students are scattering to their hometowns. Jamie and Lorenda Sweeney of Murfreesboro were in town on Saturday, checking out an almost deserted downtown with their son, Graison.

“Our son goes to UT. We’re here to move him out,” Jamie Sweeney said, adding that the family is taking precautions when out in public. “We’re trying to be optimistically cautious,” he said, inverting the cliché.

Hospitals Prepare

Local hospitals have taken steps in the past few days to prepare for an anticipated influx of patients, including tighter visitor restrictions and the discontinuation of nonessential procedures. 

Knox County’s hospitals have suspended nonessential adult procedures to free up beds. East Tennessee Children’s Hospital is limiting certain nonessential pediatric procedures.

Nonessential procedures are defined as those that if not conducted “will not likely contribute to significant progression of disease or harm to the patient, or symptom reduction measures are available to the patient during the delay,” according to a joint statement issued by Tennova Healthcare, Covenant Health, University of Tennessee Medical Center and East Tennessee Children’s Hospital.

“Ultimately, hospitals will rely on providers to use clinical judgment and standards of care in determining when to complete a procedure,” the providers said.

In an analysis published last week, ProPublica determined that the Knoxville region’s 3,190 beds, including 300 in intensive care units, would only be enough to handle a surge of cases under the best-case scenario — 20 percent of the population infected over an 18-month period. A higher infection rate or shorter timeframe would require an expansion of hospital capacity.

The area hospitals had said they had plans to address the pandemic, but no details were forthcoming until this past weekend.

Dr. Martha Buchanan, director of the Knox County Health Department, said last week that she had been meeting regularly with hospital executives about readiness for a patient surge. “I do feel like we’re prepared,” she said. “It will be a stress on the community and a stress on the medical community.”

The University of Tennessee Medical Center has erected a tent outside its walls where personnel will assess patients arriving with respiratory problems to keep them out of the emergency room and away from other patients. UT Medical Center is the region’s trauma center.

Area hospitals also have placed severe restrictions on visitors, which can be found on their Facebook pages. 

Until further notice, no one will be allowed to enter Knox County’s hospitals unless they are visiting loved ones for end-of-life care, are vital to the care of patients (language interpreters, for example) or are accompanying patients in certain situations. One person can arrive with a patient undergoing surgery or testing, or with a woman giving birth. One parent can stay with a child in neonatal intensive care units.    

Lee’s statewide executive order also limits visits to nursing homes, retirement homes, and long-term care or assisted-living facilities to those involving essential care.

Front Lines

The healthcare professionals in Middle Tennessee who spearheaded the effort to send the letter to Lee are on the front lines of Tennessee’s response to the novel coronavirus.

Metro Nashville-Davidson County remains the center of Tennessee’s outbreak with 167 cases. Neighboring Williamson County has 48. In all, at least 41 of the state’s 95 counties have presumed positive cases. 

Nearly 2,000 medical professionals in Tennessee have signed onto the letter, including Dr. Adele Lewis, the state’s chief medical examiner. Close to 9,000 healthcare workers have signed a petition to the same effect.

After noting the rapid spread and high mortality rate of the novel coronavirus, plus an anticipated shortage of hospital beds under most scenarios, the doctors and other healthcare professionals asked for a 14-day shelter-in-place requirement, plus quarantines for all traveling to Tennessee from out of state — including students returning from spring break.

“There are going to be further steps needed as we tear into this problem,” Dr. Devin Sherman, a pulmonologist at Williamson Medical Center, said in an online video news conference via Zoom.

Hospitals across the country, particularly in hard-hit areas such as New York and California, are already stretched thin and scrambling to find enough beds, ventilators and protective equipment to treat COVID-19 patients.

Wearing the proper protective equipment — masks, gowns, gloves and more — is mandatory when dealing with the highly contagious and potentially deadly coronavirus. “We do not have the luxury of choosing not to wear it,” said Dr. Tufik Assad of Williamson Medical Center.

A shelter-in-place order would help slow the rate of transmission to allow hospitals to get the gear they need. “What that does is buy us time which will allow us to get the personal protective equipment we need,” said Dr. David Aronoff, director of the infectious disease department at Vanderbilt Medical Center in Nashville.

The novel coronavirus has arrived fairly quickly — the first case in the United States was confirmed just two months ago  — but Knox County Mayor Glenn Jacobs, in his weekly video address, warned that measures to combat its spread will extend for some time into the future. 

I think there is a fallacy going around that we’re all going to hunker down for 15 days and this thing will pass,” Jacobs said. “The truth is, it could be many months and we should be prepared for that.”