Editor’s note: Due to the serious public health implications associated with COVID-19, The Daily Memphian is making our coronavirus coverage accessible to all readers — no subscription needed.

When Memphis Mayor Jim Strickland declared a state of civil emergency Thursday, shutting down many aspects of the city’s life, he had to rely on assumption more than fact.

The assumption, albeit a medically valid one, was that the 10 confirmed cases of the novel coronavirus in Shelby County indicated a “community spread,” or the beginnings of a spread from person to person within the community rather than transmission from a source who brought it in from elsewhere.

Germantown declares state of emergency

A day later, the number of confirmed local cases would increase to 30, offering added confirmation of what Strickland and health professionals expected. It was what those health professionals advised Strickland was likely to happen. And Strickland has touted an approach to fighting the spread of the virus that relies on the facts at hand and the best advice from the city’s leading medical and public health leaders.

Assumptions are the currency leaders have to use to make important decisions — because no one knows how many people have been tested.

And the difficulty in getting such numbers is the result of a bifurcated process involving public health agencies and private providers, differing philosophies on who needs to be tested and a dispersed chain of command for distributing test kits.

But there is sign of progress. For the first time since the COVID-19 crisis, Memphis is getting an idea about the state of testing in the metro area. Officials have tested at least 3,500 people, according to data compiled by The Daily Memphian.

Politics Podcast: Notes from the pandemic

“We don’t have enough tests,” Strickland said Friday morning. “But every city in the country is struggling. We don’t have enough test apparatus. We are working very hard to get that done so we can open the drive-thru testing. But it’s a struggle nationwide.”

It’s also a struggle locally to get a definite answer on how many people have been tested in Memphis. While the local hospitals contacted by The Daily Memphian have released their information, several local private companies performing tests — Quest Diagnostics, AEL and LabCorp — have refused to say how many people in Memphis have been tested. A total of 41 labs are authorized to do the work. And Shelby County’s Health Department director said Friday knowing how many people have been tested “is not as important.”

Locally, the city’s two largest private hospitals have tested thousands of people in the past two weeks. Baptist Memorial Health Care, as a system, has done a total of 3,058 tests since its first one Feb. 24 – 624 at Baptist-Memphis alone. Methodist Healthcare has tested 320.

St. Jude Children’s Research Hospital has conducted another 95 tests that are on-campus screenings of patients and staff with symptoms.

Saint Francis did not respond to a request for test numbers.

On the public side, the state has distributed just 630 test kits statewide from the Centers for Disease Control and Prevention.

Shelby County Health Department Director Alisa Haushalter said Friday she didn’t know the total number of people tested in Shelby County. The health department’s totals are only the number of positive tests, which stood at 30 Friday afternoon.

And, Haushalter said, the number tested isn’t as important as the number of positive results.

“The number tested, relative to the number sent to the lab, is not as important,” she said. “It’s the positive results that are most critical. We can see those numbers are going up exponentially nationally. What’s happened is about every fifth day in communities, the number doubles. And so, if you start projecting outwards, within a month we’ll have significant increases.”

While Haushalter downplays the importance of the raw number tested, many others disagree. 

As The New York Times noted in a March 19 opinion piece, the World Health Organization has pushed a combination of social distancing and aggressive testing as the way to get the spread of the virus under control.

“Every region that has managed to get a coronavirus outbreak under control has succeeded thanks to a combination of social distancing and aggressive efforts to test as many people as possible,” The Times noted. “South Korea, for example, has tested some 274,000 people since February. The United States has tested just 82,000, the vast majority of them in the past few weeks.”

30 cases as of Friday afternoon in Shelby County

Dr. Stephen Threlkeld, co-director of the infectious prevention program at Baptist, sees the recent numbers of confirmed cases as confirmation the process is working.

“This is a very critical time,” he said. “This is really the first snapshot we have of how much virus we have. We needed this data and now we have them. … It (the virus) is here.”

Threlkeld says the nation was behind in its response initially. “I think we are catching up,” he said. “Clearly, we have tested 364 in the last 24-48 hours. That is a lot.”

Baptist can test more than 1,000 people a day by his estimate.

“We just thought it was important to ramp up testing. We have done that significantly,” he told The Daily Memphian. “All of those people are able to get tested with supervision, mind you.”

That means those who don’t have the novel coronavirus but have another ailment can be tested for that and treated.

“All of those things are on the table for them,” Threlkeld said.

Infectious disease expert takes COVID-19 questions

Jon McCullers, pediatrician in charge at Le Bonheur Children’s Hospital and associate dean at the University of Tennessee Health Sciences Center, describes the test as “trying to get a piece of the virus from out of the person’s mucus membrane.”

With such a sample in a solution that preserves the virus, the molecular test then looks for the specific genome of COVID-19.

UTHSC is trying to develop its own test to be used locally, perhaps in two weeks. There’s not just a shortage of the kits nationally, there’s a shortage of the swabs used in the most basic part of the test.

“Right now, we would love for doctors who are worried about a patient having coronavirus to be able to test them,” McCullers said on the WKNO Channel 10 program “Behind The Headlines.”

“That would be the first line of that. You’d like it to be easy to do. You’d like it to be cheap or free to do. Secondly, you’d like to be able to test contacts,” he said.

Behind the Headlines Podcast: Local efforts against COVID-19

There are three commercial testing labs in the city. If the tests taken locally don’t go there, they go to other places in the country under a system of testing labs that is centralized.

Some of the Memphis tests have gone to labs as far away as California in an environment where travel of people and goods is being restricted.

McCullers says it takes five to six days to get a test back from those out-of-town labs.

“The test only takes four hours (to process),” he said. “So if you are running it a couple of times a day, you can get results back in 12 to 24 hours.”

Strickland announced plans for drive-thru testing at Tiger Lane and possibly other sites last week in advance of getting more tests. Working with UTHSC, Strickland said the Fairgrounds site will be ready for the public soon, but not this weekend.

Christ Community Health Services will begin drive-thru testing for the virus starting Saturday, March 21, from 8:30 a.m. to 11:30 a.m. at its 3360 Third St. location. The testing is by appointment only through an online form, with 50 free tests to those who have symptoms including a temperature of more than 100 degrees, shortness of breath and a dry cough.

Christ Community to open appointment-only COVID-19 test site

All seven of the Christ Community clinics in Memphis are also serving as assessment centers — centers that basically screen who needs to get a test based on symptoms.

When the Fairgrounds testing site is ready, it probably won’t test anyone who drives up, but instead those who show symptoms or have some kind of recent history that suggest they are likely to have the virus.

“I think the overall goal should be to test everybody who wants to be. But until you have enough tests, then the medical providers have to make decisions,” Strickland said. “Until we have a lot more tests, I don’t think everyone will get tested.”

Le Bonheur pediatric infectious diseases specialist Dr. Nicholas Hysmith admits that who to test is a “hotly debated” question.

“I think there are some communities that are looking at it as if you have symptoms, stay home unless they are severe. There are other communities that are looking at it as everyone with symptoms should be tested. That way, they can sort of stay away from grandma and grandpa and young children,” he said on “Behind The Headlines.”

“I think that’s probably the way we are headed, is testing the majority of individuals that have symptoms. I think that’s a way to sort of get the spread under control,” Hysmith said.

Strickland points out that government doesn’t dictate the guidelines private hospitals use for testing.

And the tests coming from the CDC aren’t in the possession of the state.

“I called the governor’s office and despite what some thought was happening, the governor does not have access to the tests or the component parts of the test,” Strickland said.

Untangling the testing process: With state shortage, who is getting tested and how

In the past two weeks, some of the ground rules for testing have changed. 

“Until a few days ago, the only means for testing in the state of Tennessee was through the State Health Department,” a statement on the UTHSC website reads. “The state was only issued a limited number of testing kits by CDC (around 50 to start, then 80, and more recently 500) as the bulk of the kits went to hard-hit areas like Washington State.”

The statement goes on to say the state’s decision used “very stringent criteria” including “a compatible illness and exposure or travel to a high risk country.”

But the conditions changed Friday, March 20, with an executive order from Tennessee Gov. Bill Lee that allows any health care facility in the state to test with the commercial test that became available late last week.

“We expect that testing will ramp up quickly now as many hospitals are testing more broadly using a doctor’s judgment rather than the strict criteria from CDC,” the UTHSC statement reads.

State of emergency: Strickland closes restaurants, bars, gyms

Strickland says as more data comes in, he’s hopeful the curve can be flattened, as experts say is the goal in order to prevent overwhelming the health care system.

“... We’re now seeing the real data, so to try to tamp down the spike as much as we can, that’s why we’ve emphasized so much social distancing and why we’ve closed our libraries and community centers and closed bars and restaurants to sit-ins,” he said. “… We’ve got to keep people away from each other.”

As suburban towns and cities and Shelby County government followed the city’s lead Friday with similar business shutdowns, Strickland said there will be further restrictions as the city’s number of confirmed cases continues to climb.