With hospitalizations now at highs registered during the summer peak and the virus doubling every 42 days, the region is on course to have serious holiday infections.

For weeks, health officials have been warning of the challenges to come. Tuesday, Shelby County Health Department Director Alisa Haushalter noted the time had arrived. 

“It’s critical that we continue the course and focus really on individual decision-making, decisions for our families and decisions for our communities,” she said.

Besides being hit harder now by the levels of infection in surrounding counties, the reproduction rate in Shelby County is 1.23. The Harvard Global Health Institute shows the seven-day average is 402 new cases.

A COVID record 835 new cases were reported on Tuesday.

By Christmas Day, models say 473 people will be in Shelby County hospitals with COVID. As of Sunday, the number was 361.

The Health Department is exploring options for what kinds of restrictions to impose with the rising caseloads and transmission. The restrictions are outlined in the tripwires.

Health Department officials did not say they planned to soon enact restrictions, but through 450 contact tracing interviews it did last week, it knows that transmission is happening when people gather and take their masks off.

The categories mentioned most frequently in the interviews are socializing in small groups, eating in restaurants and working out in gyms.

“We see those activities are over-represented among people with COVID-19 disease. And so that gives us clues that those environments, as Dr. Haushalter mentioned earlier, are the kinds of places where you take your mask off,” said David Sweat, deputy director of the Health Department.

The decision to close businesses is based on scrutiny of daily data, including case numbers, hospitalizations, reproductive rate and capacity of the Health Department to do contact tracing.

Colleagues, including Dr. Manoj Jain and Dr. Jon McCullers, are asked to assess the data and report what they are seeing on the ground and hearing from colleagues around the country.

The data is shared with elected officials, which sometimes involves “heated debates,” Haushalter said.

Ultimately, it is the Health Department with Haushalter, medical officer Dr. Bruce Randolph and Shelby County Mayor Lee Harris working with legal oversight to enact the health directives.

The economic impact of any decision in a directive is debated first, along with how quarantining people might impact their ability to feed themselves, their families and pay their bills, she said.

As holidays approach, the safety of small, intimate gatherings is taking on a renewed urgency for families gathering with even one or two others outside their household.

To illustrate the danger, the upper school at St. Mary’s Episcopal School went to remote learning Nov. 5 after six girls tested positive in the school’s weekly assurance testing.

“St. Mary’s follows the pattern we are seeing in the national and international news,” said Albert Throckmorton, headmaster. “We are not seeing on-campus transmission. Two of the girls traced their activity to off-campus gatherings.”

St. Mary’s Upper School will continue with remote learning the rest of this week. It intends to resume in-person classes Nov. 30.

Municipal districts reported 56 positive student cases and 26 among staff in the last seven days. Besides the six cases at St. Mary’s, other independent schools in Memphis-Shelby County have reported 31 cases.

If the Health Department does close businesses or issue restrictions, it does not have authority to dictate what happens in churches, even though it knows transmission is happening in congregations.

St. Ann’s Catholic Church in Bartlett canceled all services for this week after it was announced Saturday, Nov. 14, that Father Ernie DeBlasio, pastor at St. Ann’s, had tested positive the day before.

From contact tracing interviews, the Health Department also knows that four out of five people have symptoms and that large percentages of people who are not feeling well continue to work and socialize up to three days with symptoms.

One worker, who likely was symptomatic, went into various buildings at work in the course of three days.

“Ultimately, for that one individual, approximately 40-45 people will quarantine. Out of those 45 people, some may end up with COVID,” Haushalter said.

“That’s a critical piece we keep messaging. If you’re sick at all, even minor symptoms, please go get tested and stay home.”

The county has capacity to test 14,000 people a day in a variety of drive-up clinics across the city. For a listing, go to shelby.community.

While masking surveys continue to show high percentages of use in retail settings, the cloth slips when people are in small gatherings.

“Where people are probably not quite there yet is wearing a mask around someone like a family member who doesn’t live in their household,” Haushalter said. “In the beginning, we talked about wearing a mask in public, but now we’re really saying wear a mask when you’re around anyone who’s not in your household.”

The news continues to be good around vaccinations and treatments. But even with the high efficacy of the vaccine candidates, it will be weeks before there is any distribution here and months before they are widely available, Harris said.

“So until then, we have to all work to continue the course,” he said. 

Harris, who had led the push for mask mandates outside Shelby County, is working this week to to champion that cause in West Tennessee and across the region, including DeSoto County, where case rates per 100,000 are now on par with Shelby County.

“The Health Department and other stakeholders and yours truly will be meeting with those leaders,” Harris said. “There are some 21 counties across West Tennessee, and there are 70 cities across West Tennessee. And so, we will try, as best we can, to encourage all who can to adopt a mandatory masking approach. That will help everyone in our region.”