On Tuesday afternoon, Dec. 1, hospitals across the city were telling ambulance drivers to expect delays at emergency rooms across the city. All of them, with the exception of Le Bonheur Children’s Hospital, were full.

Memphis ERAlert sent a tweet at 2:19 p.m. saying all EMS personnel should expect long offload times.

Health Dept.: Inspectors made multiple visits to All Black Affair

Hospitalizations hit 501 as of 5 p.m. Monday. Two weeks ago, Shelby County Health Department modeling predicted that many would be hospitalized on Christmas Day. Now the median Christmas projection is 583, within a range from 478 to 710.

What the count actually becomes depends on how well citizens abide by pandemic rules.

While the number hospitalized has ballooned, the reproduction rate of the disease is 1.03, down from 1.2 last week. The test positivity rate is 10%, which means community transmission is in full bloom.

“We always want that less than 10%, and ideally less than 5%,” said Alisa Haushalter, director of the Shelby County Health Department.

In addition to setting up widespread assurance testing to detect cases earlier, the Health Department is also working to help find employees who could tend the sick in the event hospitals become overwhelmed.

With a shortage of nurses nationwide, it is increasingly clear cites will not be able to recruit staffing from other areas to help.

“We are going to have to rely on our local resources to be able to staff those hospital beds,” Haushalter said.

The shortage is complicated by the immediate need for staff to help with COVID-19 vaccination clinics.

The Pfizer vaccine, which requires two doses 21 days apart, is expected to arrive by mid-December with about 33,000 doses earmarked for Shelby County. The Health Department will receive 22,000. The rest will go to the hospitals for their frontline workers.

The Pfizer vaccine must be stored at ultra-cold temperatures of -97 F, which will stretch the supply chain.

“We need to make sure that once it is received, we are able to get it to the field quickly and administered quickly,” she said.

The Health Department expects to run two drive-thru sites, which will require 25-35 people per shift.

“So, you are talking about 50 to 60 people. And obviously, people can’t do that every day, so you want to at least try to double that so that you have backup personnel,” she said.

“We anticipate having a close-to-finished plan by the end of this week.”

The Health Department will start by vaccinating first responders and paramedics.

In a meeting with the state’s unified command, Doug McGowen, chief operating officer for the City of Memphis, said anyone who wants a vaccine will be able to receive it by June, according to minutes from the Memphis-Shelby County COVID-19 Task Force meeting.

McGowen is also meeting with hospital administrators to discuss staffing solutions, which are expected to include “skilling up student nurses and medical students” to add capacity.

While these people may not have enough skill to care for the sickest patients, “they may be able to provide support elsewhere, so that more either trained or experienced people can go to the ICU,” Haushalter said.

$51M field hospital ready, but ‘there are not enough nurses’

The Health Department is meeting with local schools that graduate nurses, physicians and pharmacists this week “to see how we can partner,” she said.

The college of nursing at the University of Tennessee Health Science Center is exploring ways to participate in vaccine distribution.

“These are initial discussions, and we are not sure how this effort will look yet, but all hands must be on deck to assist our communities in receiving the vaccine,” said Wendy Likes, dean of the college.

Hospitals are dealing with their own shortages. Last week, 231 employees at Methodist were out either because they had been exposed or had tested positive. Tuesday, more than 200 were out at Methodist.

At Baptist, 92 staff were out due to screening or quarantine issues.

By late Tuesday afternoon, a number of Methodist hospitals were on critical advisory.

“The advisory status does not impact the ability to accept and treat patients at our facilities, instead, it is intended to help assist flow of emergency ambulances in the community,” Methodist said in a statement.

“The advisory status also fluctuates frequently throughout the day.”

Baptist issued a similar statement.

The temporary medical staffing agencies that held promise early in the pandemic now offer less hope because cities across the nation are turning to the same sources.

The Medical Reserve Corps in the state is also being tapped. Its members are often retired medical staff who are still licensed and register to be called in during emergencies.

“We’re looking at all of those to see what are the best options and how do we bring every solution that we possibly have to bear,” Haushalter said, noting her concern, particularly for ICU staffing.

“Critical care intensive care beds really require specifically trained nurses and other health care professionals. And ideally, you want those individuals to be experienced as well.”

Because health care is such a “team sport,” Dr. John Rodney, a family practitioner in Shelby County, expects there are equal shortages in housekeeping and other parts of the hospital the public hears nothing about.

“Think about it, there are more rooms being used, more patients with COVID in the halls, waiting to be seen. I experience the shortage because I deliver babies,” Rodney said. “Last weekend I had several C-sections. I had to wait because it is taking much longer to turn over the (operating room) because of the cleaning demands put on housekeeping staff.

“The infection and cleaning standards are so much higher, it takes two to three times longer to clean a room,” he said.

“People have touched on it when they talk about the under-recognition of working in hospitals. It’s nice to give credit to doctors and most certainly to the nurses, but the housekeeping staff are on the frontline as much as anyone.”

He feels for medical and nursing students potentially being asked to roll up their sleeves and help.

“It sounds like an involuntary draft at the height of the Vietnam War.”

Methodist, which is offering $4,000 bonuses to new nurses that complete a 16-week employment stint, said Wednesday it had hired 71 nurses through the program.