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At the dawn of the 1800s, tuberculosis was a ferocious enemy, killing one-seventh of all people who lived and dramatically changing behavior.

COVID-19 has killed 50,000 around the world in under four months, and is much more infectious, health department director Alisa Haushalter said Thursday.

As case numbers rise in Shelby County and Tennessee, Haushalter stressed that people who have been tested or are feeling ill must understand what isolation means.

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“People being tested now have to understand they have to remain isolated until that test comes back. I have personally talked to some very intelligent people who did not isolate during that time period,” she said.

People sick enough to be tested now should behave as if they are infected, she said.

“You remain in isolation until the test returns. Isolation means you stay in a separate part of the house. You don’t come in and you don’t go out. The only time you would go out is to a medical appointment, and you would wear a mask.

“If the test comes back negative, all is well. If it comes back positive, a person has to remain isolated a minimum of seven days and be free of fever and symptoms for at least three days,” Haushalter said.

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Haushalter, who has been in the public eye every day since early March, is a longtime registered nurse. As a public health official, she spent “many, many years” working to stop the spread of tuberculosis.

“It’s a passion of mine,” she said in a light moment in her daily 2 p.m. briefing with reporters at the county government offices on Mullins Station Road.

“With tuberculosis, generally you have to be in close contact with somebody for four hours while that person is actively infectious.

“Compare that to COVID, where you have contact with somebody for 10 minutes and less than six feet,” she said.

“And more data is coming out that people are infectious two to three days prior to becoming ill. … There’s a lot of opportunity for transmission before a person really knows they are ill.”

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Since officials still say that more than 80% of the population will recover fine without hospitalization, it will be critical going forward for families to know how to care for their sick and keep others safe.

Locally, the surge is expected to happen between the third week of April and early May, when potentially tens of thousands could be sick, living with someone sick or in isolation.

Public health officials now shift their priorities to contact investigations in high-risk areas, including nursing homes where Thursday the CDC began advising employees to wear masks and be allowed to bring them from home if supplies are tight.

In the shift, the general public and health care workers will be expected to carry more load in ensuring that people are properly isolating or quarantining, including people identified who had contact with positive cases.

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“If you are a contact to somebody who tests positive for COVID, it’s important that you quarantine for 14 full days. You stay in your house. You don’t really go out except for a medical appointment if need be, and wear a mask. You don’t have people coming in and out of your house,” Haushalter said.

Family members who are more at risk may be best moved elsewhere, she said.

It’s not clear how thousands of Memphis families living on income of $10,000 a year or less will be able to isolate in small apartments and houses.

Hotels and motels have stepped up to accommodate homeless people who need to be isolated.

“We have a variety of places that have offered locations,” Haushalter said. “What we really need for individuals who are being isolated or quarantined is a facility that has separate heating and air conditioning, not a central heating unit. And ideally one that has a refrigerator and a place where food can be stored so the person does not have to leave to get food.”

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In the event of mass fatalities here, a makeshift morgue would be set up by the West Tennessee Regional Forensic Center, which is managed through the University of Tennessee Health Science Center.

As people become aware of the life stories of those who have died in the county from COVID-19, including at least one under the age of 40, Haushalter says the graveness of the epidemic is settling in.

“We all have a part to play in making a difference. And we all need to get the message out that this is serious,” she said. “I’ve been in practice nearly 40 years. This is probably the biggest epidemic I’ve been involved in.

“This is a once-in-a-lifetime epidemic. It’s important for those of us who know that to say that so that people understand this is something very serious.”

COVID-19 in Memphis and Shelby County: April

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