Eight deaths in Shelby County reported as of Friday morning took a sobering turn late Friday when a health official warned as many as 20,000 local residents could perish in the pandemic that has gripped the nation.

Nonessential businesses, ordered to close last week, will be forcibly shut down, starting at midnight Friday, if they continue to endanger a community on edge and a surge in coronavirus patients still thought to be weeks away.

The message Friday from the health department’s chief medical officer was equally stern for essential businesses, including groceries, liquor stores, medical offices, even media outlets.

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“I want to say a word to you,” Dr. Bruce Randolph said, speaking slowly and deliberately.

“I’m requiring you to operate in accordance to the CDC guidance and guidelines and OSHA regulations. At the very least, you are required to ensure that your patrons and employees are safe.”

For groceries and other large businesses, it will mean strictly enforcing 6 feet of distancing for all, including employees. Essential small businesses must limit the number of people inside to 10 or fewer or abide by the 6-foot rule, whichever is more stringent.

Businesses like dry cleaners should allow one customer in at a time.

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Restaurants serving in drive-up lanes may continue to operate.

Citizens who see infractions are asked to call 311 in the City of Memphis or the Shelby County Mayor’s Action Center, 222-2300.

For days, the health department has received calls about nonessential businesses openly operating, including churches holding services and meetings, and groups congregating in parks and gas stations.

“This is serious,” Randolph said. “This is a life-and-death moment. The actions that we take now will make a difference in the number of deaths that occur as a result of COVID-19.”

By one estimate, he said, 20,000 people could die in Shelby County if stay-at-home orders and social distancing is not rigorously applied.

Evidence from cellphone records and traffic cameras here show travel dropped by 45% after the mayors’ stay-at-home directives went into effect, starting March 24.

“That is good, but not good enough,” said David Sweat, county epidemiologist, noting the measures won’t be effective until traffic is down 60%.

Anything less poses “catastrophic impacts on our health care system,” he said.

According to county travel data by Cuebiq, travel in Shelby County for the week of March 30 was down 31.8% over the week of March 23.

As Memphis settles in for another quiet weekend, it does knowing that Saturday’s positive counts will jump significantly, in part because the two positive cases reported Friday did not include 60 or more cases reported after reports were filed on Thursday, Sweat said.

“It’s not a compliance issue. The numbers just came in after we pulled the Friday reports,” he said.

Along with the rest of the nation, local officials are coming to terms with the number of people expected to die.

Friday, the health department convened a teleconference with heads of nursing and assisted living facilities in the county.

“Our conversation was about the surge and the impact or extended impact on nursing home facilities and the unique role that the leaders of those facilities play,” said Alisa Haushalter, head of the health department.

Workers in the settings are to wear masks all day, including people in housekeeping, janitorial services or even food delivery. Front-line workers are to step up vigilance in monitoring the elderly in their care.

“I’ve noted before, they may not have a fever first,” Haushalter said. “They may have other symptoms including GI problems as well as confusion. Any change in their status could be an indicator.”

All patients showing any symptoms are to be separated from other residents.

“It’s also an opportunity to talk about end-of-life decisions. That is something we should all think about and make our decisions and have our living wills in place,” Haushalter said.

Last weekend, the health department did intensive testing at Carriage Court assisted living facility on Massey Road in East Memphis after a second positive case was reported.

In the additional testing, four others, all residents, tested positive.

There has been no report on their condition, although Haushalter did confirm that none had died.

She warned this week that there would be other outbreaks in residences for the elderly. The teleconference Friday was to outline the responsibilities managers have for residents and staff in 55 senior living centers in Shelby County.

Their responsibility is similar to what is expected in essential businesses, including that sanitation be rigorous and protective gear be provided to employees.

“You’re required to provide the appropriate personal protection equipment, PPE, to your employees,” Randolph said, “and take steps to enhance personal hygiene of employees,” including strict hand-washing rules.

“I am also requesting all essential services, especially grocery stores and pharmacies, to make best efforts to establish hours when only seniors and vulnerable populations can access the facility.”

He also said employers have a mandate to allow staff to work from home and set up shifts to optimize social distancing.

While nonessential businesses continuing to operate has been a problem, most of the calls Randolph has received are about distancing abuses in essential businesses.

“You are exempt because you are essential. But if you violate the directive, you will be closed, too.”

The disconnect continues about the actual amount of PPE in hospitals. Hospital leaders here report having plenty. But nurses and other workers repeatedly say supplies are scarce.

In a survey of Tennessee nurses conducted by the Tennessee Nurses Association between March 18-25, 48% of nurses in West Tennessee said their workplaces were ill-equipped to manage COVID-19 cases.

Slightly more than a third (39%) of nurses in large hospitals said they had appropriate support in protecting themselves and others from the outbreak.

“There is PPE in the Memphis area, however, knowing that even more will be needed, some units are waiting for the surge of COVID-19 cases before releasing more supplies,” Tina Gerardi, executive director of the TNA, said in an email late Friday.

“Nurses are currently working without access to the PPE that’s being saved for the surge, and they are being asked to reuse PPE per CDC crisis guidelines.”

Their fear, she said, is they could contract COVID-19 before the surge because they do not know who is infected. In many cases, patients are not being tested if they are not showing specific symptoms.