Massive public health response will be needed for next wave

By Updated: April 07, 2020 1:07 PM CT | Published: April 07, 2020 4:00 AM CT

In the lull after the surge, expected to end about May 11 here, Shelby County leaders need a plan for how to attack the second wave.

“We need a greatly expanded team for identifying cases and contact tracing,” said Dr. Jon McCullers, “that hopefully will allow us to navigate additional waves without shutting down the economy.”

If COVID-19 follows the trajectory of the Spanish flu of 1918, the second wave could be worse than the first.


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McCullers doesn’t know that, but in a two-hour COVID-19 symposium the University of Tennessee Health Science Center created and streamed on its website Monday, April 6, he was clear that governments, hospitals and public health agencies in the region must share data so it can be tracked nearly in real time, analyzed and shared with the community, right down to the number of hospital beds and ventilators.

And because Shelby County shares borders with two states, the eight-county metro area, plus surrounding rural areas, have to be on the same page for coordinated decision-making, he said.

Anything less, including the lack of shelter-in-place orders in Arkansas, results in a patchwork of prevention and endangers the people of Shelby County.

The symposium was an overview of the work UTHSC is doing in the community on COVID-19, including work with Methodist Le Bonheur Healthcare to prepare hospitals for the pandemic and UTHSC’s own research to identify strains of the virus active in Memphis and create new drugs and therapies to slow the progression. More than 1,500 registered to attend the meeting held on Zoom, a videoconferencing site.  

The symposium was an overview of the work UTHSC is doing in the community on COVID-19, including work with Methodist Le Bonheur Healthcare to prepare hospitals for the pandemic and UTHSC’s own research to identify strains of the virus active in Memphis and create new drugs and therapies to slow the progression.

More than 1,500 registered to attend the meeting held on Zoom, a videoconferencing site.

But without a massive increase in public health work, including widespread testing and vast upticks in the number of people doing contact tracing, the severity of the first wave could repeat over and over, McCullers said.

With each will come further deterioration of the economy.

“I hope we will learn,” he said. “We have to redesign health care, expand health coverage to everyone in Tennessee.”

And if this pandemic isn’t instructive, he said, there will be others.


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“Other viruses do the same thing. We have to put in the work, we simply did not put in for this pandemic.”

The comparison is South Korea, where the first case was reported on nearly the same day as the first in the U.S.

South Korea responded with mass testing and was able to contain the hot spots to fewer than 1,000 total cases.

“In deaths, we have blown through at 80,000,” McCullers said. “South Korea has 100.”

Shelby County, which McCullers said got up to a two-week early start, should assume it will follow a similar course of regions that were not prepared.

“There will be a three- to four-week ramp up, then it will peak. Then, we will have three to four weeks of not many cases,” he said.


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So far, 8,915 tests have been given in Shelby County, which includes multiple tests people hospitalized with COVID-19 receive before they are cleared for discharged. There is currently no way to factor out the duplication.

As of Monday, testing across the county was producing an 8.9% positivity rate.

“What that tells us is that we are testing the right people,” said Shelby County Health Department director Alisa Haushalter, who was one of the presenters.

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But because response rates in some communities have been significantly low, positivity rates vary, she said.

It’s also been true that there have been delays of 6-10 days between when people were tested and when the public health department got notice. If the positives weren’t properly quarantining, the virus was running unchecked in the community, even though people had been tested.

The number of cases here is doubling about every eight days, Haushalter said, compared to international models where cases doubled in 5-7 days.

And in Shelby County, the number of positives skew toward females (55%), a metric Haushalter said indicates that women are more likely to seek care.

The scope of unanswered questions remains large, including that there is no current guidance on when sickened health care workers should return to work.

“It’s very important that we be data- and science-driven as we approach this,” McCullers said. “The Centers for Disease Control guidance says if you are symptom-free for 72 hours, you can return to your workplace. We don’t know if that is true. We don’t know the answer when it is safe to go around other people.

“We need to be very careful to test it in areas where it is critical — in hospitals, police and fire stations. It’s something we have not done. I cannot give better guidance at this time.”

The discussion among the regional joint task force here is equally fractured on whether the public should wear face masks.

“We’ve had a lot of debate on recommending face coverings in part because the evidence is not 100%,” Haushalter said. “For people not accustomed to wearing them, they may touch their face more and make themselves more at risk if we under-represent the importance of hand-washing.”

Masks give some protection, McCullers says, but not long-lasting for people who do not have the virus.

For people who do, “it will prevent some droplets” from getting into the environment “but not all.”

But the problem is, masks are largely unavailable.

“The national stockpile was distributed to Shelby County,” Haushalter said, noting that requests for masks can be made to Homeland Security offices here or through the joint task force.

The priority list, she says, starts with EMS and first responders.

“All efforts are underway to locate and purchase and get more here.”

UTHSC is testing ways to decontaminate N95 masks, which have been in critically short supply for weeks.

“We need to reuse these masks as much as possible,” said Colleen Jonsson, director of the Regional Biocontainment Lab on campus and professor in the department of microbiology, immunology and biochemistry.

One of the questions is how often the mask can be decontaminated with heat and other methods before it begins to deteriorate.

“This is a big week for us,” Jonsson said. “This is the week we add the third leg. If we put virus on the mask material, can we prove we can actually remove it?”

A recording of the symposium can be viewed by clicking HERE.

Topics

UTHSC Coronavirus Symposium Dr. Jon McCullers Alisa Haushalter Colleen Jonsson
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers healthcare and higher education for The Daily Memphian.


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