On Feb. 19, The Daily Memphian published a column written by Dr. Manoj Jain under the following headline: “Epidemiologist: Why I fear the coronavirus COVID-19.”

In his opening paragraph, Jain did not employ purple prose to predict doom — imminent or otherwise. Rather, he simply said: “If the virus enters the general population in cities across the globe as it has done in Wuhan, China, then day-to-day lives in affected cities will be greatly disrupted.”

Epidemiologist: Why I fear the coronavirus COVID-19

If anything, “greatly disrupted” feels like a gentle description for where Memphis and the rest of the country now are.

At the time, however, Jain got pushback: Why are you scaring people?

In fact, he met enough resistance that he took a few seconds to wonder if he had gone “overboard” with his assessment, which went on to note that COVID-19 could be difficult to distinguish from cold or flu, that the virus spreads among close contacts (less than 6 feet), and that the death rate is greater than that of the seasonal flu.

Any concern that he had gone too far soon passed. He’s a scientist. An infectious disease specialist. He was watching COVID-19 cut a deadly swath through Wuhan the way a meteorologist might track the formation of a supercell thunderstorm, waiting for the tornado outbreak it might spawn.

“I knew something bad, unprecedented, was happening,” Jain said.

Fast-forward to March 8: Jain was on hospital rounds when he looked up at a TV and saw the press conference where it was confirmed Memphis had its first case of COVID-19 in a person who had traveled to Mardi Gras in New Orleans. By the morning of March 10, he was receiving a text from Memphis Mayor Jim Strickland asking if he would advise the administration during the pandemic.

“In the afternoon, I was there,” Jain said. “The mayor’s whole team was there.”

Six days after the first confirmed case, or on March 14, the Memphis and Shelby County Joint COVID-19 Task Force was meeting for the first time and being headed up by city chief operating officer Doug McGowen.

By March 19, Jain says, Memphis and other Shelby County municipalities had shut down restaurants, bars and gyms. By March 24, “greatly disrupted” lives had reached the point there was an active “Safer at Home” order.

Shelby County Mayor Lee Harris recalls that in meetings held in late February and early March, before the first confirmed case, area leaders didn’t yet envision this coronavirus being able to put society on pause. Nor did they imagine a time, many months later, when the start of the next fall semester for public schools would be anything but a certainty.

“We thought the worst-case scenario was maybe one school closing for deep cleaning or something like that,” Harris said.

Instead, metro Memphis essentially would close down, then come out of the shutdown into Phase 1 reopening, then progress to Phase 2, only to then have to halt the move to Phase 3 because cases again spiked.

Now, as other states such as Arizona, Florida and Texas take on “hot spot” status, Memphis and Shelby County are trying to navigate a way forward that allows the local economy to function without risking a major outbreak that claims more lives and overwhelms local hospitals.

As of Saturday morning, July 18, Shelby County had an overall positivity rate of 9.3% after 170,246 total COVID-19 tests. The daily positivity test rate for Friday, July 17, was 14.9%.

In shorthand: It could be worse, but it also could be a lot better. No one wants to mirror Phoenix, Arizona — rife with cases after embracing re-opening.

“I’d say we’re at the tipping point, quite frankly,” McGowen said. “We could go either way.”

Define 'safe enough’

Last week, the local community received two very different messages about the state of the pandemic here.

First, Rhodes College announced it would offer only remote learning in the fall rather than allowing students to choose between attending class or virtual learning, or a combination of the two.

Rhodes College to continue remote learning for fall

Rhodes president Marjorie Hass said that after consulting with health experts, sustaining in-class learning just didn’t seem tenable.

“Unanimously, they advised that no plan could make up for that fact that conditions in Memphis are increasingly severe,” Hass said in a statement. “They told me that based on the current facts and trends, we should expect that campus outbreaks of COVID-19 would quickly outpace our ability to provide an appropriately safe environment for our students and staff.”

In other words, the virus is still well ahead of those trying to combat it.

Meantime, local pro soccer club Memphis 901 FC announced a limited number of fans would be allowed at their match next Saturday, July 25 at AutoZone Park. Club president Craig Unger cited “assistance from the (Shelby County) health department, the city administration” and medical experts in putting a plan into place.

Fans will be allowed at AutoZone Park for Memphis 901 return

Such contrasting courses of action reflect, in many ways, what the local community has been seeing and hearing from the federal level on down for the last five months.

“We know wearing a mask works,” Shelby County Health Department director Alisa Haushalter said. “What we need is more consistent messaging” at all levels. “There’s so much competing information.”

And the latest is this: Going to class isn’t safe enough, but going to a pro soccer match, if wearing a mask and social distancing, apparently is.

New rules for living

Shortly before Memphis had its first confirmed case, Dr. Jeff Warren, a general physician and Memphis City Council member, returned from a National League of Cities conference in Washington, a “no-handshakes conference,” he said.

He was armed with more information about this novel coronavirus than he had just a few days earlier and says he shared it with Strickland and others. But throughout the pandemic, local leaders everywhere often have found that they don’t have all the knowledge they need in real time.

Kristin Wilson, who is chief of operations in the Nashville mayor’s office, answered questions from The Daily Memphian via email. She says throughout the pandemic, the largest challenge has been the uncertainty and that has left them to “make the best decisions we can off incomplete information.”

Wearing a mask, for example, would prove controversial from the start.

“And I do think in the beginning people were being selective as to when they would social distance,” Haushalter said.

Jain says sheltering in place may seem like a “sledgehammer approach,” but if a sledgehammer is what is needed, a mere pick hammer won’t do.

At the point the task force agreed that citizens would be safer in their own homes, members were imagining what would happen if they didn’t institute what amounted to a soft quarantine.

“We had community transmission,” Jain said. “It was like somebody flipped a switch. We had to make sure the virus did not reach the level of New York. If we hadn’t (installed shelter-in-place), we would have seen an astronomical rise in the numbers.”

Haushalter also believes that even those people who were willing to wear a mask — and not everyone was before Strickland signed a mask ordinance into law in June — did not do it consistently.

“We know some workplaces, from our deeper investigations, people were wearing facial coverings when performing their duties,” Haushalter said, “but then would go to lunch and not wear a mask or socialize after work and not wear a mask.”

About a week ago, the health department closed some bars amid renewed concerns about COVID-19 transmission. In turn, some of the bars that were shut down banded together to sue the health department because there were other bars allowed to remain open.

Bars sue Health Dept. over COVID closing

Restaurants and gyms have been allowed to stay open in what Haushalter described as a “modified Phase 2.”

Warren stresses the need for continued monitoring of restaurants, gyms and bars that are open, but also called bars a “luxury,” and saying if people want to gather and drink outdoors while practicing social distancing, well, it’s easy enough to do.

“You can pull your mask down to take a sip of beer and then pull it back up, I guarantee you,” Warren said. “Because I’ve done it.”

Multitasking

The joint COVID task force is trying to balance all the concerns. Arlington Mayor Mike Wissman says constituents don’t necessarily know how something like the mask ordinance even came to be.

“The question I get is, 'Why put in a mask ordinance?’” Wissman said. “We have to abide by the health department. That’s county-wide.”

For some people, though, that’s still not enough of an answer.

“Residents lose confidence in their elected government if they think they don’t have any authority,” Wissman said.

And that’s just one snapshot of the competing pressures and differing perspectives in play every time the joint COVID task force tries to reach consensus.

“Some of my contemporaries around the country have not always enjoyed the cooperation we have,” McGowen said. “Doesn’t mean it hasn’t been hard. But when we look back at this, forming the task force when we did will be one of the good things.”

Wissman says he knows there has been criticism of the health department and how government has handled some things.

But he also knows something else: “There’s never been anything like this and none of us have ever done this before. It’s easy to Monday-morning quarterback. It’s like training for any disaster. Until you have to execute … that’s the challenge. But I think we’ve done a good job under the circumstances.”

Wilson, of course, knows too well about disasters.

“Nashville/Davidson County has unfortunately had experience with both flooding and tornados,” she said. “They are awful, acute emergencies with a long response tail. We still today are developing resilience from tragic flooding that occurred 10 years ago …

“Those are hard events, but the emergency response itself lasts days or weeks. Then the focus is on recovery for months and years …

“This is a sustained emergency for months now,” she said of the pandemic. “Time has an entirely different dimension for us all now than it did before mid-March. We are pushing ourselves constantly to move fast when we learn something, because we know it can have consequences for lives saved or people protected.

“We talk about recovery, but the reality is that we aren’t out of emergency response yet.”

Testing, tracing, masking

The number of COVID cases, ICU beds in use, deaths, tests given, and number of recovered patients and the positivity rate are all part of the ongoing data collection and sometimes winding narrative.

The numbers spin daily, like some giant public health slot machine.

But in general terms, some of the trends — including 91% of ICU beds in use in Shelby and Lauderdale counties in Tennessee, Crittenden County in Arkansas, and DeSoto County in Mississippi, are concerning. Almost 40% of those ICU beds are filled with confirmed COVID cases or patients suspected of having it.

“About three weeks after Memorial Day, we saw a rise in the numbers — not just here, but across the country,” Jain said. “Sometimes the downside of success is people becoming complacent.”

Because of the ongoing slowdown in obtaining test results, it’s possible, Jain says, that the full impact of the July 4 holiday has not been seen yet.

Haushalter says for a while test results were available in about 48 hours. But now labs are backed up and it’s taking several days to process tests. The tests then go to the state, which has its own overloaded system where results are logged, before the results come to the county health department.

The entire data journey might take seven or eight days.

“It’s not an effective way to manage COVID at the local level,” she said.

And a person testing positive, who might not know for a week, is potentially spreading the virus everywhere they go.

“All that time lost,” Jain said. “And contact tracing is a huge challenge. It requires long hours.”

Nor are there enough contact tracers, although the health department is adding more.

Of late, Memphis has been able to save money as an early adopter of “pool testing.” A lab can run results on 10 specimens at once and pool testing has been used for the city’s fire and police, and frontline health care workers, among others.

“If they’re all negative, great,” Haushalter said. “If there’s even one positive, then you go back and get the individual tests done. It’s a more efficient use of resources.”

Several weeks of social/racial injustice protests here also had the potential to impact the number of COVID cases, but Haushalter said: “From our look at the data, we do not have a direct correlation between protests and an increase in cases. We do have an increase from the holidays.”

Birmingham was ahead on a mask ordinance, implementing on May 1. The Memphis ordinance was signed into law on June 25, and the Nashville Board of Health voted unanimously to mandate face masks in an emergency meeting on June 26.

In Indianapolis, masks were not required until July 9.

Real world fallout

Meanwhile, other government business goes on. Meetings have to be held. Budgets have to be addressed.

“Like everybody else, our revenue’s down from last year and we’re having to tighten our belt,” Collierville Mayor Stan Joyner said, adding that they balanced the budget without raising taxes or cutting services.

Sales tax makes up about 25% of the Memphis revenue stream, McGowen said, and the pandemic has had a negative impact: “We’re about two months behind.”

Any city budget is a labyrinth under the best of conditions. Due to COVID-19, the maze has become especially intricate and challenging. For the fiscal year starting July of 2020 and running through June of 2021, McGowen says the projected $710 million budget would take an $80 million hit.

“You can think of it this way,” he said, “if you get a $710 paycheck, every two weeks, your employer comes to you and says for the next two weeks you will get a $610 paycheck. So, you start saving more. Maybe you borrow money from your brother or look for coins in the couch cushions. You don’t go to the movies and you don’t eat out as often.”

Memphis didn’t have to borrow from a sister city or flip over cushions in the mayor’s office, but it did tap its “Rainy Day” fund, McGowen said, and other expenses are being offset by drawing from the $113.6 million it received in federal CARES Act funding.

“We were able to avoid layoffs,” McGowen said. “And we’re still providing core services from solid waste to police and fire, 9-1-1, parks … And we’ve been able to do that without doing anything to property taxes.”

Whether the latter remains the case going forward is an open question. About 45-50% of the city’s revenue is in property taxes, McGowen said, and though no increase is planned now, “It’s too early to tell.”

A difficult evaluation

City Council member Jeff Warren believes one of the best things the task force did was not move from Phase 2 to Phase 3.

“It’s one reason we’re not as bad as Texas and Florida and Arizona,” he said. “They didn’t hold the line on Phase 2.”

That said, the virus is still spreading.

“It’s like a forest fire coming your way,” said Warren. “We have to do all we can not to give it fuel.”

Within a certain context, Warren believes Memphis/Shelby County has done well handling the pandemic.

“If I grade on a curve for cities in the South, I give us an A- for being able to deal with political ramifications,” he said.

“As far as grading us against European nations, South Korea and Japan, we’re a C- or a D+. We’re not where we need to be.”

Kristin Wilson, Nashville’s chief operating officer, won’t even entertain grading on a curve.

“I don’t think any city in the U.S. should look at itself relatively,” she said. “We should look at ourselves absolutely.”

Of course, all the efforts to fight what Wilson called “an uncertain threat,” still come amid incomplete, or sometimes conflicting, information.

And as everyone in the trenches knows, the opponent is formidable.

“It’s very stealthy, this virus,” Dr. Jain said.

It’s why he is glad that the old Commercial Appeal building was transformed into a 400-bed COVID facility. At the time, he thought it definitely would be needed. It hasn’t been put into use so far, but Jain said, “It’s good to have in your back pocket.”

He is encouraged that the death rate from the coronavirus had declined and says doctors have learned better strategies for managing it and treating patients — from the drugs they use to avoiding intubating patients if at all possible.

Still, for every 1,000 positive COVID tests, he says there could be another 10,000 people carrying the virus who have not been tested.

And every test, Haushalter reminds, is strictly “a moment in time.”

So consider the possibility of pool testing students at the University of Memphis or Christian Brothers University. It might yield encouraging results for the start of classes, but a negative test one day could become a positive test five days later.

“You could have a false sense of security,” Haushalter said.

She also says that the “asymptomatic” carriers can be a little bit of a deceiving concept.

“We talk about being asymptomatic, but it’s like when you’re getting the flu or a cold and there’s a day or two when you’re not quite feeling like yourself,” she said. “Afterward, when people have tested positive, that’s what a lot of them say.”

More challenges lie ahead

Whether schools can open remains one of the primary questions for the task force. And if a decision is made in, say, early August to go forward with elementary and secondary classes, will that decision remain relevant?

“What about September, October, November, December?” Shelby County Mayor Lee Harris asked. “Because our on-the-ground environment probably will be substantially the same.

“We don’t control our borders and there’s too much community-wide transmission already. The task force is in marathon mode.”

Higher ed preps for an academic year shaped by the coronavirus

Joyner, the Collierville mayor, noted that in a recent task force meeting that area leaders learned the “surge” is predicted for late October.

So what happens from now till then, is crucial.

McGowen says people seem to be following the masking ordinance when going into stores and “our code enforcement folks are out there looking.”

Less definite is the degree to which people are practicing social distancing and wearing a mask in their personal lives.

“That really is the challenge,” McGowen said. “That’s the space you feel safe in. So if there’s a grandchild’s birthday or a wedding, you have to think those things through.”

Said Jain: “We will go through a very difficult time in the next two or three months. We want to get the peak reduced for the next three to six months that we’re not going to have a vaccine.

“We have to wear masks. We have to not shake hands.”

And if it feels like this has how we’ve been living forever …

“We understand why people could be fatigued,” McGowen said. “But we’re asking folks to buckle up and stay with it.”

If they don’t, there inevitably will be consequences.

“What is our openness to risk as a community?” Haushalter said. “How much death do we tolerate? How much illness do we tolerate?”

And how do the health department and others continue to deliver messaging that reminds the public of the seriousness of COVID without crossing over into inciting panic, which Harris believes the national media stirs up on a regular basis.

“We’ve got to not show panic ourselves, but what people hear on the national news is you should be panicked,” he said.

So, as it turns out, what Dr. Jain wrote on Feb. 19 – that this coronavirus is serious – has proven to be 100% correct.

He wasn’t championing panic then and he’s not championing it now. But he does continue to advocate for giving COVID its respect, for finding a balance between public health and personal liberty.

It took a long time, after all, for America to change the way it felt about smoking, Jain says, to ban smoking in most public spaces for the benefit of non-smokers.

The point being that public health and personal liberty previously have been at odds. Only now, the stakes are higher, and the threat is unprecedented, immediate and exponential.

“And second-hand smoke,” Jain said, “isn’t transmitting infectious disease to another person.”