Local COVID-19 cases and hospitalizations suddenly and surprisingly spiked last week.

Officials debated whether to reset the clock on easing social-distancing restrictions, and not reopen the economy until mid-May at the earliest.

Business owners and suburban mayors pushed back. Memphis and Shelby County mayors asked the health department to take another look.

Your quick list of what can open on Monday

Conflicting reopening plans poised to end countywide alliance on pandemic

Medical experts analyzed the numbers and agreed the spikes were easily explained and anomalous.

The sudden rise in COVID-19 cases was the result of an outbreak at the Shelby County Jail. It was serious but contained and not a sign of increasing community transmission.

The surprising rise in virus-related hospitalizations was the result of a new policy. Patients bound for nursing homes must wait at the hospital until they test negative for COVID-19.

The clock kept moving.

“We’re at a good place right now,” Dr. Jon McCullers of UTHSC said Friday. “We have a stability in the situation with the pandemic. It is currently under some degree of control. But we’ll be watching this on a daily basis.”

That’s the sort of daily data analysis that will be required to keep a lid on the virus as business restrictions begin easing Monday, officials say.

It’s also a preview of the challenges officials face in the days and weeks ahead.

As the local economy gets “Back to Business” Monday, officials say their biggest concern isn’t reopening too soon. It’s reopening badly.

“We’ve done a good job, so far, but the job isn’t over. The virus is still spreading,” said Dr. Jeff Warren, a physician, City Council member and local COVID-19 Task Force member.

“If we go back to business as usual, we’ll just feed the virus and we’ll be right back where we were six weeks ago.”

Six weeks ago, the challenge was to flatten the lethally upward curve of the COVID-19 pandemic and not destroy the economy.

Starting Monday, the challenge will be to flatten the dangerously downward curve of the economy and not reignite the virus.

Officials are trying to limit the risks by allowing local businesses to reopen in carefully controlled stages with rules that maintain social distancing and other protective measures.

But a growing number of variables could make those rules more difficult to maintain and the risks more difficult to control.

Conflicting policies that allow surrounding suburbs and rural counties to reopen sooner and faster.

Inconsistent policies that allow “close-contact” businesses such as hair and nail salons to reopen sooner in some places than others.

Unpredictable efforts to allow churches and other houses of worship to resume larger gatherings.

Insufficient testing and tracing that fails to identify and contain outbreaks at prisons, nursing homes or other high-density settings.

The biggest variable is human behavior and a general complacency that the most dangerous part of the pandemic has passed.

On the contrary, local officials warn. The coronavirus isn’t gone. It lurks. On surfaces we touch, in the air we breathe, in people we encounter. It thrives on social interaction.

“Social distancing worked. We flattened the curve, but we can’t go back to business as usual,” said Dr. Manoj Jain, the local infectious disease specialist, told members of the Memphis Medical Society in a Zoom conference call Thursday.

”Things are different now. We have to be careful and cautious without being paralyzed or paranoid. We can’t reduce the risk to zero, but we can keep the risk as low as possible and function.”

CONFLICTING POLICIES

On April 2, 83 people were in Memphis area hospitals with COVID-19 issues. Six days later, that number had increased 50% to 125.

If that trajectory had continued, local hospitals would have been overwhelmed by the end of the month.

Instead, daily COVID-19-related hospital admissions began to stabilize -- and are down down slightly -- since April 8.

That’s a significant date. It came two weeks after the mayor’s March 23 “Safer at Home” order began.

The daily rate of new cases also has stabilized since April 8.

Symptoms of COVID-19 appear within two to 14 days after exposure.

The first phase of “Back to Business” begins Monday, but the timing of the second and third phases will depend on the success of the first.

Over the next two weeks, local officials will keep a close eye on the number of new COVID-19 cases reported every day and the number of people being hospitalized as a result.

And for the first time since the virus was detected in Memphis, local officials will be watching to see where the patients are coming from.

In January and February, local doctors assumed that flu-like symptoms were caused by the flu unless someone had been to China recently or been with someone who had.

The first local COVID-19 cases were people who had traveled to New Orleans and Florida.

“Then community transmission began and people here in Shelby County were infecting each other,” Jain said. “But we may be seeing COVID-19 become a sort of travel-related disease if we start seeing more cases from surrounding rural counties.”

So far, about one in four people who have been admitted to Memphis area hospitals for COVID-19 are from counties other than Shelby.

Officials are concerned that could grow and that Memphis area hospitals will bear the brunt of conflicting policies that allow surrounding rural counties and suburbs to reopen sooner and faster.

Tennessee Gov. Bill Lee began easing coronavirus restrictions on businesses in rural West Tennessee counties a week ago.

In Mississippi, retail stores reopened last week with limited capacities, but Gov. Tate Reeves said Friday he would not reopen more businesses this week due to a spike in new cases.

Gyms and fitness centers are reopening Monday in Arkansas, and hair salons probably later this week.

Medical experts have pushed the city not to allow barber shops, beauty shops and other “close contact” businesses to reopen until the second phase begins at least two weeks from now.

But owners of those businesses are pushing politicians to allow them to reopen this week.

Gov. Lee relented Friday and agreed. Mayors in Arlington and Collierville said Friday they plan to follow state guidelines and allow them to reopen later this week.

“It’s been tough for those businesses throughout this process, and I feel it’s important to allow them to open, even if under reduced capacity and strict guidelines,” Arlington Mayor Mike Wissman said Friday.

INCONSISTENT RESTRICTIONS

The health risk of reopening the local economy Monday won’t be known for at least nine days.

That’s generally how long it takes for someone who is infected with the coronavirus to show symptoms, get concerned, get tested and get the test results back.

By then, of course, an infected person who doesn’t self-isolate might infect dozens of others, who can infect hundreds more and so on.

That’s why COVID-19 spread so quickly from Chinese villages, Mardi Gras festivals, Florida beaches and New York City subways.

Testing has shown that about .05% of the general population is infected with the virus at any given time.

That’s one in every 200 people.

“As we’ve seen in cruise ships and choirs, nursing homes and jails, that one person can spread the virus to dozens of people,” Jain said.

That’s why the first phase of the “Back to Business” plan prohibits the gathering of “purposeful groups of more than 10.”

That restriction was going to include local houses of worship. But on Friday, Lee issued an executive order that prevents local governments from regulating crowd sizes at places of worship.

Both Lee and Strickland are encouraging religious leaders to exercise caution and have their staffs and members wear masks and maintain social distancing while gathering in person.

Rev. Dr. Scott Morris, founder of Church Health, is being more direct.

“We would make a mistake if we went straight back into in-person worship,” he wrote Friday on behalf of Memphis Clergy COVID-19 Response.

“God, who created our intellect, expects we will use it. Our first priority as faith leaders is to keep God’s people safe.”

Limiting large gatherings is one way local officials are trying to prevent outbreaks.

Broad, rapid, accurate and targeted testing is another.

The joint COVID-19 Task Force is working on a plan to expand symptomatic and asymptomatic testing with new self-administered tests.

Current testing methods require health care workers draped in personal protective equipment to collect samples from deep inside a patient’s nasal cavity.

The new tests allow patients to swab their own noses and the samples to be tested 10 at a time.

That would make it easier, and a lot less expensive and painful, to test high-risk populations such as hospital and nursing home workers once a week.

More testing will require more efficient and effective contact tracing. Local and state officials are working on plans to bolster the health department’s capacity to do that.

“Public health departments across the country have been defunded in recent years,” Alisa Haushalter, executive director of the Shelby County Health Department, said Friday. “Shelby County is always in need of adding resources to our infectious disease control.”

PREVENTING ANOTHER LOCKDOWN

The moment they heard Shelby County had confirmed its first COVID-19 case March 8, Paul Martin and Jeff Warren, medical leaders of Trezevant Manor, began locking the place down.

Visitors to the 14-acre retirement community, which includes a nursing home, rehab center and assisted living, had to wear masks. Then visitors were prohibited.

Group gatherings and outside trips were canceled. Residents who went to the doctor or hospital had to quarantine for 14 days when they returned.

All staff wore masks and sanitized everything all the time. Residents ate all meals in their own rooms.

As of Friday, there have been no suspected or confirmed cases of COVID-19 at Trezevant Manor, officials say. More than 400 employees have been tested and all results were negative.

“We were lucky, but we also were very proactive and aggressive,” said Warren, the City Council member who is Trezevant’s medical director.

State and local officials are pushing all nursing homes to follow the same procedures, even as the economy begins to reopen.

Meanwhile, Warren is pushing the Council to pass an ordinance this week to require Memphians to wear masks in all public places during a public health emergency.

“I wear my mask to protect you, and you wear a mask to protect me,” Warren said. “That’s the intent. We’re all going to have to be very careful for a very long time.”

The “Back to Business” plan will require just as much coordinated care and daily discipline as the “Safer at Home” orders issued March 23, local officials say.

It requires or encourages employees in various work settings to wear masks and gloves.

It requires or encourages employees to stay home and quarantined if they’re showing any flu-like symptoms, or if they’ve tested positive for COVID-19.

It requires or encourages employees and customers to maintain social distance of at least six feet in stores, restaurants, houses of worship and other public places.

And it limits the size of “purposeful public gatherings” to no more than 10 -- except for houses of worship.

“Just because you can go out doesn’t mean you should go out,” Strickland told the public Friday. “If we don’t abide by the social distancing requirements. We could see a surge in the virus that could result in rolling back the opening and losing the progress we’ve made so far.”

Reopening badly could be devastating for public health and the local economy.

“Over the last month, we have entered into the COVID-19 depression with the depth and duration still in doubt,” said Dr. John E. Gnuschke, director of the Sparks Bureau of Business and Economic Research at the University of Memphis.

“The costs are massive increases in unemployment and economic hardship. Even with federal subsidies for businesses and newly unemployed people, the costs will linger long beyond the initial reopening. Reopening with caution is the best policy and the caution shown by most of our political leaders is warranted.”

Gnuschke has been advising the local task force. He told them that political, business and medical leaders must keep working together to assess and balance the risks of reopening with the risks of closing down again.

He also told them they can’t do it without the public’s cooperation.

“It is like a three-legged stool for milking cows, but someone cut off the legs,” he said.

“Medical, political and economic — all three are far too short. People in Memphis can only count on the help of others in Memphis.”