The surge of cases being reported in Shelby County is a result of transmission that happened at Thanksgiving and a grim portent of what early January could be.

Intensive-care beds across the region were 97% full late Monday, Dec. 14, a record high for the pandemic. In some hospitals in the Methodist Le Bonheur system, nurses are working five 12-hour shifts a week instead of three.

The seven-day and 14-day new-case averages have risen since the Health Department increased restrictions on bars and restaurants on Nov. 23.

The seven-day average then was 450; it is now 670. As of Dec. 10, the 14-day average was 558.

Under Health Directive 15, more restrictions are required if the seven-day average reaches 650. The Health Department had resisted imposing more restrictions as of Tuesday, Dec. 15. They could include stricter enforcement or more targeted education. They could also limit gatherings to ten or fewer people.

A new health directive has been expected for days.

Initially, it was to clarify language for restaurant and bar owners and stipulate when tents are considered outdoor venues.

“However, as the numbers have continued to go up, we are holding the health directive to make sure if there are any other clarifications that need to occur,” Dr. Bruce Randolph, health officer of the Health Department, said at the COVID-19 task force briefing Tuesday.

“So while we thought we might release it this week, we may not. I will be honest, at the current time we just really urge everyone to continue the course. What’s in the current health directive is still what’s important,” he said.

Businesses may stay open at 50% capacity; masking, other rules strictly enforced

If there are more restrictions, they will be made in concert with the COVID-19 task force and elected officials, said Alisa Haushalter, director of the Shelby County Health Department.

“We know that there is a significant challenge to the authority of any health department, and not limited to ours. And that is going to be critical if we have to take broader interventions,” she said.

Decisions to tighten or loosen restrictions have been made with the counsel of local mayors and others.

“Our process for decision-making and how those decisions come into the health directive has always been a robust process. We have never sat in our offices and issued policy. We work closely with the mayors. We work closely with others. We ask for input from colleagues. ... 

“If there are more stringent interventions needed, then we would also ask that our elected officials support us in that or that they take the lead on that,” she said.

In the last week, the Health Department closed six businesses for non-compliance with one or more stipulations in Health Directive 15: Chardonnay Bistro, 4205 Hacks Cross Road; El Corral, 3870 Macon Road; Agavos, 2924 Walnut Grove Road; Carolina Watershed, 141 E. Carolina; Legacy Bar & Grill, 11695 U.S. 70; and Smoker’s Abbey, 2382 N. Germantown Pkwy. 

It is not clear if the new health directive would include more restrictions, but with 5,434 active cases now, and a reproduction rate of 1.o6, numbers are expected to grow exponentially over the next two weeks.

“The City of Memphis is offering significant testing on the weekends, and there are now some open drive-through sites that are available from 5 to 8 in the evening. We really encourage people to get tested, and particularly those under 40,” Haushalter said. (See testing locations at Shelby.community.)

While hospitals are strained, her message Tuesday was that people who need care should still seek it, including in the emergency room.

“People have many other illnesses, particularly this time of year,” she said, noting that heart attacks, strokes and trauma do not slow down in pandemics.

“The hospital systems are doing everything they can to meet the needs of this community, as individual health systems but also as a collective group.”

Vaccines

The rollout of vaccines in Tennessee, which was to start early this week, has been pushed back to Thursday.

The Tennessee Health Department Monday said it had received an initial shipment of 975 doses of the Pfizer vaccine, which it was holding in case any hospital shipment was damaged.

Front-line hospital workers in Mississippi and Arkansas began receiving vaccines on Monday.

Baptist Hospital-DeSoto will begin vaccinating staff members Wednesday, Dec. 16.

“Thursday is when the vaccine is set to arrive from Pfizer, and Pfizer is shipping directly to providers across the state,” said Gillum Ferguson, a spokesman for Gov. Bill Lee.

It will be shipped Wednesday to 28 sites in the state and cover distribution to 78 hospitals, including those in Memphis.

Some hospitals in the state eventually will also receive the Moderna vaccine, which has less rigorous refrigeration requirements.

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Hospitals have to apply for their allotments. The state is distributing based on access to the level of refrigeration each vaccine requires.

The Shelby County Health Department is expecting to receive the Moderna vaccine soon. That vaccine is expected to receive FDA approval on Friday. Test results confirmed Tuesday it has 94% efficacy.

“We anticipate beginning to receive some of our shipments prior to FDA approval,” Haushalter said, “so that we will have it and are ready to go.”

She expects the Health Department could begin immunizing first responders and staff and residents in nursing homes by Dec. 28.

“We’re coordinating with the municipalities, particularly their EMS providers, to make sure that they are first in line,” she said.

The initial supply of vaccine will come in “dribs and drabs,” but should even out in early in 2021, Haushalter said.

On Monday, the state announced it was cutting back live testing in 89 counties with state-run health departments from five to two days a week to marshal labor for the statewide vaccinations.

It will offer self-test kits from those sites on Mondays, Wednesdays and Fridays beginning Dec. 21. On these days, public health staff members at each TDH COVID-19 testing site will provide self-testing kits to adults who wish to be tested. Individuals will remain in their vehicles while completing paperwork and collecting their samples. Health departments will submit the samples for testing.

The self tests are for adults only. The results will be reported to to them online.

The state says its testing sites account for only 16% of all tests administered in the state and the change, it said, will not affect testing offered by private providers in the state.