Memphis has only two confirmed cases of COVID-19, but schools and activities are being closed and canceled at levels that rival areas where the outbreak is far more severe.

Experts say the virus likely has been in our community for weeks now, though it’s been undetected either because people aren’t showing symptoms or have such mild cases, they think they have the flu or a cold.

Every time they are in contact with others, it’s very likely they are spreading it. And then those people expose other people, and soon, it becomes the very definition of exponential growth.

“One or two known cases doesn’t mean we don’t have quite a few we don’t know about,” said Dr. Stephen Threlkeld, infectious disease expert at Baptist Memorial Health Care.

“Quite a few people are second-guessing this design (of closings). It will be six months down the line – if ever – before we see if it was a genius move or an overreaction,” he said.

“We may never know.”

But based on data from the global outbreak, places that initiated aggressive closing measures in the beginning, including Hong Kong and Singapore, have had lower percentages of transmission than China or Italy, which took slower paths, Threlkeld said.

It’s important, he said, not to get behind the curve “because it’s difficult to catch back up.”

“Testing is very critical now. We need to be ramping up. We now have three industry tests available.”

Threlkeld sent one off for analysis early Thursday.

From his contacts with local primary care offices, doctors across the city are seeing high levels of concern, which will translate into more testing. 

“You have to know how many have the infection. That is when we can take more rational, data-driven steps. Right now, it is conjecture,” he said.

The drawback with industry tests is it can take up to five days to get results back.

“These tests will be given to people not ill enough to require hospitalization. That is how you are going to see these tests bolster the system. They can keep people out of the hospital,” Threlkeld said.

He is a member of the medical team caring for the coronavirus patient recovering at Baptist Memorial Hospital-Memphis.

“The patient is in very good condition with very good spirits,” he said.

The second person in Shelby County, announced Thursday by the Tennessee Health Department, has not been hospitalized.

The first case in the state was a Williamson County man who had traveled to a medical conference in Cambridge, Massachusetts, in late February. According to media reports quoting Massachusetts health officials, 77 of the 95 cases confirmed in Massachusetts as of Wednesday were linked to the conference; 12 other cases in other states, including Tennessee, also have been linked to the event.

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Cases linked to a single point of contact are called a cluster.

“We expect that the pandemic will proceed in a patchy fashion in the early going, with small clusters turning into larger ones and some areas being hard hit while others appear to be spared,” said Dr. Jon McCullers, chair of the Department of Pediatrics in the College of Medicine at University of Tennessee Health Science Center and pediatrician-in-chief of Le Bonheur Children’s Hospital.

“Over time, almost all areas should experience outbreaks,” he said, estimating the number of confirmed cases in Memphis-Shelby County could escalate in a matter of days.

In 24 hours, the number of cases in Tennessee doubled from nine to 18.

McCullers is not surprised.

“I expect that trend to continue and perhaps accelerate,” McCullers said.

In six to 12 weeks, he predicts Memphis will have many cases that require hospitalization and that deaths will have escalated among the elderly.

The state of affairs the nation finds itself in has created a new lexicon, including common words like quarantine, which now have a specific meaning.

People who self-quarantine have chosen to isolate themselves and monitor for symptoms out of caution either because they have been in contact with someone who is sick or they have traveled to an affected area.

People in monitored quarantine have been told to isolate themselves at home. In the case of diagnosed coronavirus, the health department is checking daily on their condition and to make sure they are complying with the rules of separation.

A monitored quarantine has the force of law behind it, Threlkeld said.

“We saw this with tuberculosis,” he said. “If you have been diagnosed, you have no right to wander around the community.”

Isolation happens in health care settings like hospitals.

“It differs, based on the type of threat and degree of protection required,” McCullers said.

“A forced quarantine would be like holding someone on a military base.”