On Friday, one day after he issued a mandatory statewide Stay at Home order, Gov. Bill Lee traveled to Knoxville to brief local leaders on his directive and on efforts to increase hospital capacity and stockpiles of vital medical supplies in anticipation of a surge in COVID-19 patients.

The Knoxville Expo Center will house 350 beds for COVID-19 patients, and the U.S. Army Corps of Engineers is looking at Thompson-Boling Arena and other facilities in Knox County for temporary hospital space.

Lee has said the surge in novel coronavirus cases is expected to hit during the third week of April, though he acknowledged it’s difficult to predict the pace of the contagion with precision.

The governor and members of his Unified Command met with Knoxville Mayor Indya Kincannon, Knox County Mayor Glenn Jacobs, Knox County Health Department Director Martha Buchanan and state Sen. Becky Duncan Massey before briefing the media at the University of Tennessee on Friday. 

“We have a tremendous challenge ahead of us as Tennesseans,” Lee said.

Case counts in Tennessee continue to rise, with close to 1,000 new cases reported since April 1 for a total of 3,633 as of Sunday. According to the state Department of Health, Knox County’s case count has doubled since March 30 from 57 to 115. Forty-four Tennesseans have died from COVID-19, the disease caused by the novel coronavirus, including one from Knox County.

Kincannon said the meeting helped local leaders get some clarity about what the statewide response would mean locally. “I was glad to hear directly from the governor what the state would do in case of a surge,” she said.

Hospital Capacity

Only 16 of the county’s patients have required hospitalization at some point during their treatment, according to Knox County Health Department figures, though the number of current hospitalized patients has not been released. “Right now, we’re in a good position with our hospitals,” Jacobs said.

Lee warned that hospitalizations will rise with the tide of cases on the way. He said the state’s pandemic modeling indicates 7,000 additional beds will be needed statewide in the coming weeks.

The U.S. Army Corps of Engineers, working with the state’s Unified Command, is identifying locations where temporary hospitals can quickly be housed. The Unified Command was set up “to expand the capacity of the healthcare system across the state so we can meet the surge we know is coming,” Lee said.

The only Knox County location identified so far, the Knoxville Expo Center on Clinton Highway, will provide 350 beds for COVID-19 patients who need hospitalization but not critical care. The governor said it should be up and running within three weeks.

Additional beds might be required to handle the surge, but on Friday Lee would not give the total number of beds estimated to be needed in Knox County. “That effort will be coordinated with local healthcare providers as they expand their own surge capacity,” he said. “We know we’re going to need the first round of beds.”

Representatives from local hospitals and local governments have been talking about increasing capacity, but Kincannon said they formed a regional task force over the weekend in light of Lee’s visit. Dr. Keith Gray, chief medical officer at University of Tennessee Medical Center, is coordinating the initiative, which was first reported by the News Sentinel.

“It’s basically a more focused effort to get the hospitals in the region to work on their surge capacity,” Kincannon said. “If we get a surge, we want to know how many they can accommodate.”

According to Kincannon, Knox County hospital officials say they have a combined 1,726 beds. Of that total, 288 are in intensive care units. A little less than one-third of the ICU beds are currently available, she said. 

“They have a lot more capacity than you might guess from the baseline,” Kincannon said. “Some of the regular beds can be converted to ICU beds. They can convert space to that kind of work.”

Jacobs confirmed that the Corps is looking at using Thompson-Boling Arena on the University of Tennessee campus as a second temporary hospital. Another possibility might be the Civic Coliseum, which served as a shelter for evacuees from a devastated Louisiana after Hurricane Katrina hit in 2005.

“The governor’s preparing for the worst, as are we all, and hoping for the best,” Jacobs said.

Converting space for use as a hospital is more complicated than using the square footage for a shelter, however. Among the needed upgrades, treatment areas must be fitted with ventilation systems that produce negative air pressure to reduce the risk of spreading contamination, and oxygen lines have to be installed.

“There are not many facilities that are set up for a quick turnaround,” the governor said.

According to Kincannon, the governor said the state would help with the construction of the converted facilities but local entities would take the lead in their operations.

Ventilators and PPE

Lee was optimistic that the state would at least come close to having enough ventilators for COVID-19 patients who require critical care. He estimated Tennessee would need 1,900 ventilators during the surge and that hospitals have about 950 on hand that are not being used. 

Knox County hospitals have 277 ventilators, according to Kincannon, with about two-thirds available for new patients.

Five hundred ventilators have been ordered for use statewide, Lee said, that should be delivered in time for the influx of patients. Also, the state hopes to gather at least 200 more from Tennessee medical facilities that have suspended elective surgeries.

“Those are easily mobile,” Lee said. “If Knoxville needs ventilators and we have them in Nashville, they’re going to go to Knoxville.”

The governor said personal protective equipment, or PPE, is making its way into the state and the Tennessee Emergency Management Agency is shipping items to all 95 counties. 

As Lee was meeting with local leaders and speaking to the media, Knoxville area residents and business owners were dropping off N95 masks, non-latex gloves and other needed items for first responders at the Jacob Building in Chilhowee Park.

A drive-through coronavirus testing event was being held on the other side of the park at the entrance to Zoo Knoxville. So far, test results have come back for 1,409 Knox County residents — 0.3 percent of the county’s population. 

“There is a very concerted effort in communities from one end of the state to the other,” Lee said.

Working Together

Jacobs raised civil liberties and economic concerns about Lee’s Stay at Home order last week but on Friday both downplayed any differences they might have.

Jacobs said he didn’t broach the subject with the governor on Friday. According to the county mayor, he didn’t need to. “We’ve talked quite a bit during this crisis and he shares many of my concerns,” Jacobs said.

Lee cited economic dangers and emphasized personal responsibility in resisting the issuance of a Stay at Home order longer than most governors. He has said he only issued Tennessee’s order when data showed the state’s residents weren’t voluntarily following social distancing guidelines.

Lee characterized the Knoxville meeting as productive. State and local leaders, he said, are working to achieve the highest level of safety for individuals with the least amount of damage to businesses.

 “What’s most important is that we work together on this,” said Lee, who added that input from Jacobs, Kincannon and other leaders is valuable. “We may have nuanced approaches, but we all have the same thing in mind.”