In a pattern repeated over and over across the nation, Memphis and Shelby County’s official response to the initial wave of novel coronavirus appeared confused, even chaotic.

There were critical shortages of tests. Far too few health investigators. Substantial delays in test results and daunting challenges getting the public to take social distancing seriously.

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Troubling, too, were the gaping holes in information: How many people had been tested? What percent were positive? How many were in the hospital? Officials couldn’t say.

“We certainly weren’t (prepared),’’ said Dr. Jon McCullers, infectious disease expert at the University of Tennessee Health Science Center, who attributes much of the struggle to contain COVID-19 both here and nationally to the country’s broken public health system rather than the ineffectiveness of individual leaders.

“There were a number of countries – Singapore, South Korea, Taiwan, Iceland – who were very well prepared and have handled it fine. But the United States clearly was not one of those,” McCullers said. 

Experts say it may take months to fully realize the consequences of those early missteps.

Complicating matters was the reluctance of Gov. Bill Lee to take firm action. His “safer at home’’ order on April 2 – among the last in country – came only after fitful political struggles and data he could no longer ignore that suggested social distancing recommendations simply weren’t working.

Yet as the nation marveled at the South’s lethargic response to the COVID-19 pandemic, Memphis and Shelby County rebounded quickly.

When Doug McGowen took the podium earlier this week, coronavirus-plagued Memphis began to have the feel of military occupation.

“Yesterday you saw a model that said the surge was not going to be as bad as we originally thought,’’ said the buttoned-down, ex-Navy officer.

As chief operating officer for Mayor Jim Strickland, McGowen helps guide the COVID-19 Task Force – a virtual army that’s assembling stockpiles of medical equipment and is even preparing temporary field hospitals as it braces for a surge that could start as early as April 15 and possibly kill thousands.

Results of a controversial computer model released Monday suggest a much lower death toll, but McGowen wasn’t buying it.

“I am suspect myself anytime the data changes that dramatically overnight,’’ he said.

But for now, it really doesn’t matter which computer model is correct, which university analysis is more on point. Memphis is about to get the answer in raw, human terms to the central question it faces as the deadly COVID-19 surge arrives: 

Did we do enough – soon enough – to avert a catastrophe that overwhelms local hospitals?

“We shut things down here in Memphis well before the rest of the state. OK? So, we were moving pretty progressively compared to everybody else,’’ said Dr. Jeff Warren, a Memphis City Councilman.

Yet even Warren has his doubts.

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Setting aside differences that often plague Memphis’ cumbersome bureaucracy – two mayors, two governing bodies – Strickland and County Mayor Lee Harris swiftly organized a “combined’’ COVID task force, a broad array of medical professionals, political leaders, logistical personnel and others.

 “The only question we’ve got is – were we fast enough? Did we get it? Did we get it in there quickly enough?’’ Warren said.

“And part of that is a combination of you’ve got to have enough people understanding what’s going on to make it work. You’ve also got to have people who are in the leadership knowing what’s going on. So, Strickland and Harris have helped us with that.’’

Early struggles

For a time, it seemed, Memphis didn’t get it.

Even as the first COVID-19 patients fell ill here last month, County Mayor Harris boarded a jet and flew off on a promotional trip overseas.

Shelby County’s first COVID patient had already tested positive when Harris left with a delegation on March 11 for the Republic of Ghana, the honored country in this year’s Memphis In May International Festival. During the scheduled nine-day visit another person tested positive back in Shelby County. Harris cut his trip three days short and returned to deal with the suddenly exploding coronavirus threat.

Dozens more would test positive in the days after his March 17 return. The venerable Memphis in May and Beale Street Music festivals have been postponed.

“No one saw this national calamity at this scale and at this speed when I left … We were in long-term planning mode. The worst-case scenario was what if we close down a school,” Harris told The Daily Memphian shortly after his return. “And even that discussion was more generalized and not isolated to a particular school. And we didn’t think that was going to happen any time soon.”

Harris emphasized his departure for Ghana came before the World Health Organization declared a pandemic, yet others sensed trouble with the trip. County Commissioner Tami Sawyer had also planned to go but decided against it.

“My dad was concerned that with the coming pandemic, we’d be stuck out of the country,’’ she said.

Even before the trip, fast-moving COVID outbreaks in New York and on the West Coast were making national news. New York Gov. Andrew Cuomo declared a state of emergency on March 7, just two days after New York City Mayor Bill de Blasio rode the subway as a demonstration the situation was safe in hand.

Harris was right about the speed of the outbreak: Five days after his March 17 return from Ghana, Shelby County had 58 confirmed cases. Four days after that, on March 26, the county logged its first death. By April 8, the Shelby County Health Department had reported 897 cases of COVID and 21 deaths.

Officials, in turn, moved quickly too. Three days after his return – on March 20 – Harris signed an executive order requiring the closure of on-site dining at restaurants and the on-premises consumption at bars, microbreweries and other establishments. The order came a day after a similar one by Memphis Mayor Strickland.

“We are in a moment unlike any other that any of us have ever experienced,’’ Harris said at a press briefing days after his return. “This community has not had an epidemic of this magnitude or this seriousness for nearly one hundred and fifty years when yellow fever struck and devastated our community. We are taking this public event seriously.’’

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Overwhelmed

Officials quickly followed with lockdown measures. On March 23, as the Health Department reported that 80 Shelby County residents had tested positive for COVID, Memphis Mayor Strickland issued a “safer at home’’ order to take effect the following day. It required Memphians to stay home unless on essential tasks or services. The county’s other six municipal mayors soon followed suit. On March 25, Harris issued a “safer at home” order affecting unincorporated Shelby County.

It’s hoped the speed of those actions made eight to ten days before Gov. Lee’s order – light years in the fast-moving COVID crisis – will help flatten the curve and reduce the demand for hospital beds when the surge hits.

Yet from the start, Memphis and Shelby County faced daunting obstacles that kept authorities from adequately addressing the crisis.

“I think it was twofold,’’ said McCullers, the infectious disease specialist. “It was the inability to test and then it was an inability to be able to trace, to do identification contact tracing and isolation on every single person who turns positive.’’

In short, the city and county were overwhelmed.

Capacity for diagnostic testing was severely limited – there were nowhere near enough tests available to meet the need. As early as March 19, UT Health Science Center announced it would open a drive-thru testing site on Tiger Lane, the first of several testing sites that would open across the city. But they’ve made only a dent in the problem.

Even now, as authorities aim to ramp up testing on a much larger scale, it continues to lag. Authorities need to test about 2,000 to 3,000 people a day, McCullers said. Yet by April 8 – 31 days since the first positive test – the Health Department reported testing 9,913 people, about 320 a day.

And when tests were completed, and positive results obtained by private providers, it often took days for those results to reach the Health Department. That placed impossible demands on contact tracers, whose job is to interview individuals who test positive, identify people with whom they’ve come into close contact, and quarantine them.

As the coronavirus threat deepened, the Health Department at times had as many as 30 contact tracers working cases. But they need more. And when an expected second wave hits sometime in the fall or winter, they may need hundreds, McCullers said.

But in those early days there were many distractions.

Some complained officials were shielding critical details from the public. Deficiencies eventually were corrected, yet initially the Health Department wasn’t releasing the total number of tests conducted by public and private labs. And it didn’t publish the percent of tests that had tested positive, an important metric in understanding the spread of the disease.

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Even the messaging on social distancing seemed compromised. Daily news conferences were held in a meeting room where reporters stood or sat closely together.

By April the briefings were held via video feed.

“I’m glad we have a space where we can practice what we preach about social distance,’’ Harris said at an April 7 briefing. “That’s why there are no press physically present at this briefing. That’s why the other speakers, speakers that you’ll hear from today are to my right and to my left 6 feet from me. We want to model and remind everyone around the importance of social distance.’’

All those confusing and at times contradicting computer models consider social distancing a critical part of the equation along with other variables including the number of vulnerable people with underlying health issues and how many new cases each infected person causes.

Yet cell phone data shows Shelby County residents reduced their average mobility by 40-55 percent in March, short of the 65 percent benchmark health officials believe is needed to contain the virus.

Still, outside of Nashville, few jurisdictions in Tennessee could rival the speed of Memphis in addressing the threat.

“The rest of the state, you know, kind of relied on Governor Lee. And I think the state was very slow to implement these measures,’’ McCullers said.

State delays

After weeks of insisting that the deadly novel coronavirus threat could be contained by “encouraging’’ residents to stay at home, 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.’’

 ‘Good a job as anyone’

Just as Lee’s actions pose troubling concerns, many question the federal effort. Much has been written nationally about President Trump’s response, including his reported indifference to early warnings of the pandemic by intelligence agencies, and how that may have effectively handicapped local officials.

McCullers said local officials also have been hamstrung by years of retrenchment in the federal public health system that’s lessened the effectiveness of the CDC as well as state and local health departments.

“For decades, we’ve just massively underfunded those and cut their influence and cut their authority to the point where nowhere in the country is (anybody) prepared for this,’’ he said. “But it’s basically a federal issue that the government’s chosen to de-emphasize prevention and public health at the expense of other priorities.’’

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Other variables affecting the effectiveness of the local coronavirus battle include actions in bordering Arkansas, which still has not issued a safer at home order. Just across the Mississippi River this week in Marion, Arkansas, a nursing home reported that nine residents and two employees had tested positive for COVID.

“We worry about that,’’ McCullers said of measures in Arkansas.

Marion is the seat of government in Crittenden County, which recently exhibited the steepest rate in increase in COVID in the eight-county Memphis metropolitan area.

“Now, that may not be real,’’ McCullers cautioned. “It may just be that they’ve ramped up their testing recently. … Or it may be that they’re having more cases because they’re not doing the safer at home. So over time, if we see that continue and accelerate even more, then we can blame the lack of safer at home measures.’’

None of that has slowed Memphis chief operating officer McGowen.

His near military-scale logistics campaign includes plans for opening two temporary hospitals – with help from the U.S. Army Corps of Engineers – and requisitioning stockpiles of equipment, including 2.5 million masks.

Time will tell what damage those early stumbles created, but officials express growing confidence they have gotten out in front of the curve and can significant lessen death and suffering. 

“I think we’ve done as good a job as anyone,’’ McGowen said.

“But obviously, you can Monday morning quarterback this thing and say, ‘I wish I would have done things.’ But with the information that we had at our hand at the time, I believe that we made the most prudent decisions that were possible for us.’’