Unprepared for COVID-19: Did Memphis, state missteps early on cost us?

Click here for the full, in-depth article by Marc Perrusquia, to which I contributed.

State delays

After weeks of insisting that the deadly novel coronavirus threat could be contained by “encouraging’’ residents to stay at home, Bill Lee on April 2 issued a two-week “stay at home’’ executive order. It requires Tennesseans not go out in public “unless they are carrying out essential activities” such as law enforcement and healthcare.

By the time the second-year Republican governor signed it, nearly 50,000 people globally had died of COVID-19 – 40,000 in March alone. The death toll now tops 80,000.

For weeks, Lee was shown mathematical models predicting that, without mandated social distancing, around 4,000 Tennesseans could die and up to 1,800 could be left without critically needed ICU beds. Those numbers dropped to less than 600 and zero, respectively, after the executive order was issued.

Offering no economic or social-distancing models others hadn’t tried, Lee nevertheless said his constituents — many among the most health-compromised in the nation — didn’t need to be “ordered’’ to do the right thing.

On March 18, two days before he closed schools in the state, Lee said his administration would issue “guidance and strong suggestions.’’

“We don’t have to mandate people not to do certain behavior because Tennesseans follow suggestions. They follow guidance,” he said.

Tennesseans could be trusted to take “personal responsibility” to “flatten the curve,” he said.

Science proved him wrong.

Cell phone traffic-tracking data showed that while Tennesseans stayed relatively put the second week  of March, their average travel distances rose exponentially through the end of the month.

“By April 1, we were despondent,” said Aaron Milstone, a critical care pulmonologist who rallied more than 10,000 medical workers, and dozens of Tennessee mayors and local leaders, to lobby Lee for a statewide mandate.

“As doctors we usually shy away from politics,” said Milstone, but they were desperate to make the governor see that “lives and the economy are intertwined, and you cannot save one without the other.”

Yet two weeks into the campaign, Milstone said, not only had it “clearly not moved the needle,” Lee contended in daily press briefings that the medical community was “divided” over the mandate issue – a reference to a letter he received from several hundred rural doctors who didn’t think their communities needed a mandate like densely populated urban centers did.

Then, that evening, Milstone got what he calls his “nuclear option”: An email from Bill Frist, chair of Lee’s COVID-19 Response Fund. The renowned heart surgeon – like Lee, a Republican – and former Senate majority leader would publicly join the push for a mandate.

In his email, Frist also wrote: “Confidentially, I have strongly recommended a mandatory stay-at home to all at the top. To all.”

The next day, the executive order was announced.

Added pressure

Many believe Lee’s slowness to issue a statewide order could have devastating effects.

Some of Tennessee’s rural communities have no hospitals. That potentially could add pressure on Memphis hospitals, where rural West Tennessee residents may seek care. And with limited Internet access in some rural areas, social distancing messaging becomes more difficult.

Democratic Congressman Jim Cooper worries that “one church service in a rural area can devastate a community, if people are unprotected and don’t realize there’s aerosol transmission (of the virus).”

Tennessee also has high rates of diseases that make adults of all ages particularly susceptible to COVID-19. In addition, there are more than 675,000 uninsured people. The state has applied for federal Medicaid funding, Lee said, to cover all potential COVID-related testing and treatment.

But more Tennesseans will likely join their ranks as they lose their jobs and health insurance in the shutdown. On April 6, Lee said the state would “do everything to provide relief for them,” except ask for permanent Medicaid expansion, to cover them if they don’t find jobs immediately. 

Lee also said he has no plans to extend his statewide mandate, even as traffic patterns showed Tennesseans engaging in more “non-essential visits” than they did mid-March and as clusters of people were seen still picnicking and playing Frisbee in Nashville parks or walking down sunny streets.

Still, debate continues over whether Tennessee’s vast rural stretches require the same strict measures as were imposed in the state’s densely populated metro areas.

Cooper thinks they do. Despite a long-standing rural-urban divide in Tennessee, he said the cheapest gas prices in years means “people are traveling more than ever and they’re spreading the disease. It doesn’t matter where you live.”

Infectious disease specialist McCullers sees more nuance.

“A lot of governors have struggled with that,’’ he said, maintaining it’s way too early to know for certain what the impact of Lee’s actions will be.

“Do you do something different for the cities versus the rural areas? Are there different rules depending on where the virus is in its timeline in each area of the state? And we just don’t know the answers right now. But we’ll know in a few months and we’ll be able to look back and say that was right or wrong and I guess blame whoever we need to blame or whatever. But it’s just tough to prognosticate on this stuff sometimes.’’

Even pulmonologist Milstone struggled with taking a stand on coronavirus, not moving to pressure Lee until after thousands of Chinese and Italians, and others, had died.

”I think Americans think that our healthcare system is better, that our population is more robust... The reality of it is, I think when you’re looking from afar at China, you sat there for the first month and said, ‘That’ll never happen here. We’re not going (to have) all our citizens wearing masks, we’re not going to see our citizens being in their homes or apartments and not being able to come out for weeks and weeks on end.’

“And I think it was that surreal disconnect that we were better than them and that we weren’t going to have the same problem, and that led to very little action at the federal, state and even local level.’’