NASHVILLE, TN – Metro health officials do not know how many tests are available to screen for the coronavirus in Davidson County. “I just don’t have that answer,” said Dr. Alex Jahangir, Board of Health Chairman. The Metro Health Department reported 10 confirmed cases of Covid-19 last Friday.
“We’re working with every single critical provider to make sure that they have the capacity and they know what to do and how to test their patients and we’re going to be communicating with them. We don’t have all the answers at this moment,” Jahangir said.
As of Monday, the Tennessee Department of Health reported 52 coronavirus cases in Tennessee. Davidson County had 31 of them; by Wednesday morning there were 46 here; by Thursday there were 75.
On Tuesday the total number of cases in Tennessee had risen to 73. By Thursday, the number had doubled to 154. The number of unknown people who are infected is probably much higher. Commercial and private laboratories do not report the number of tests they perform to the TN Dept. of Health.
So local health officials do not know the number of people who have been screened and do not know the number of people who are self-quarantined at home either. Jahangir said he would provide information when he got it. Mayor John Cooper tapped Jahangir to lead the Metro Coronavirus Task Force last week.
Cooper mistakenly told reporters March 13 that Nashville has the resources to combat the coronavirus. There was upbeat messaging about Nashville being the country’s healthcare capital.
Cooper submitted an amended capital-spending plan March 13 for more money to repair tornado damage and contingency funds to deal with coronavirus.
Dr. William Schaffner, a Vanderbilt expert in infectious diseases, delivered reassuring remarks about preventing the spread of the virus with social distancing and common sense. But the virus is spreading and Davidson County is now the epicenter of the disease in Tennessee.
On Sunday, March 15, the Metro Board of Health declared a public health emergency and ordered bars on lower Broadway to close and restaurants cannot serve more than 100 sit-down customers.
Local health officials like Jahangir are asking people to see their doctor to get tested. Of course, not everybody has one and while there is still limited capacity to test here, Jahangir said Metro’s testing protocol will not change. It is not clear if or when it will.
White House has ordered millions of tests from private companies like Roche, Quest, and Thermo Fisher. The samples are taken manually but the test processing is automated. Large testing companies can process up to 1,000 samples in an 8-hour shift.
Last week the White House promised a million drive-by nasal swab tests “coming soon”. They haven’t arrived in Tennessee yet. At a March 15 White House briefing, Vice President Mike Pence said at least 10 states have set up drive-through testing sites.
Other states have set up parking lot testing centers outside of big box stories like Walmart. Pence said testing for the virus should prioritize people over 60, people with underlying chronic diseases, and first-responders.
On Monday, March 16, Governor Bill Lee announced that 15 testing locations will be set up in metro areas by this weekend. Lee said the more testing that can be done, the sooner the spread of COVID-19 can be slowed.
“We do not want anyone in the state who has a need to be tested to be turned away for any reason,” he said. But Lee sent a mixed message by adding that only people showing symptoms need to be tested. That is not how China or South Korea is handling the crisis. They are testing asymptomatic people, too. Metro is only testing sick people.
But the national response to the virus is changing quickly. Many more people will be tested much more rapidly than in previous weeks. Traditional state health laboratories can only process about 50 tests per day.
Dr. Brett P. Giroir, is a four-star admiral in the U.S. Public Health Service Commissioned Corps and also serves as Assistant Secretary for Health in the Trump administration. “We will have 1.9 million of these high-throughput tests available this week with numerous labs, up to 2,000, starting to turn the lights on beginning this week,” Giroir said. He said the added capacity will be a game-changer to beat down the virus.
Giroir said the Public Health Service corps, kind of like the U.S. Marines of healthcare, worked with the Federal Emergency Management Agency (FEMA) to create 30-40 testing pods, each one capable of screening 2,000-4,000 people a day. States can use them with their own public health people or ask U.S. Public Health and FEMA personnel to run tests for them. The pods are hooked into federal and state databases so results can be reported quickly.
Federal ”virus-busters” wear full protective gear, and going into a pod to get tested would seem like being in a science fiction movie. Tennessee has not asked for any testing pods but is setting up assessment centers instead.
Sheri Fink reported in the New York Times that as many as 200,000 to 1.7 million people could die from COVID-19. A lot depends on how effective communities are in halting the spread of the disease. As of Wednesday morning, the U.S. has 5,800 confirmed cases and 107 people have died.
Metro’s Early Response
When the first corona case was confirmed here officials responded with a plan that was neither comprehensive nor effective. Director of Schools Adrienne Battle said schools would not be shut down, a decision she reversed less than a week later. Schools will be closed until at least April 4.
Dr. Michael Caldwell, Director of Health, told reporters that the department’s guidance for the community would remain the same. “Everyone can do their part to help by remaining informed and continuing to take routine health precautions,” he said.
Among the “routine” measures residents were urged to take were things like washing your hands for at least 20 seconds; avoid touching your eyes, nose, and mouth; don’t go near sick people; clean and disinfect frequently touched objects, and to use elbow bumps instead of shaking hands. These measures might keep you from getting the virus but won’t stop it from spreading.
Isolated cases are popping up here and there. The disease is infecting people via what public health experts call “community spread”. Metro officials are urging people to stay home if they feel sick. That will protect others from catching the disease. But it is an inadequate public health response to a nasty bug like Covid-19 that has become a pandemic.
Last week both Governor Bill Lee and President Donald Trump declared a state of emergency because of the virus.
Why Things Will Get Worse
The best way to slow an epidemic is to test widely for the disease and experts say testing has to begin early in an outbreak. “Surveillance testing” is the best way to track an outbreak of a disease like Covid-19 in order to isolate the infected and slow it down.
So far, Metro’s response to the coronavirus has been just the opposite. Officials have been playing a game of whack-a-mole with suspected cases. They have been testing people who are already sick and then investigating who they have been in contact with.
Health officials are going to have enough tests soon, if they don’t already, to find out where the disease is prevalent and how quickly it is spreading. If people don’t know how many people around them have the virus, they don’t know if they have been exposed either.
Researchers from Columbia’s Mailman School of Public Health have found that asymptomatic or undetected carriers caused the initial rapid outbreak of Covid-19 in Wuhan, China. This so-called “stealth transmission” made it much harder to contain.
“So it’s very, very difficult for either public health authorities to calibrate the response properly or individuals to calibrate their own actions,” said Dr. Steven Goodman, associate dean at Stanford Medical School.
The U.S. lags far behind other countries in preparedness for COVID-19. Since February, South Korea has been using corona tests developed by the World Health Organization (WHO). It can test 10,000 people a day. The Center for Disease Control (CDC) developed it’s own corona test but had to recall it because it didn’t work well. They started all over again. Last week, the CDC reported shipping 53,000 corona tests—a month behind other countries like Italy.
Goodman said the decision to make a separate U.S. test instead of using the one WHO developed was “a big mistake”. The CDC has approved other labs to develop and deliver their own tests. Goodman said labs like his at Stanford had trouble making and distributing a valid test under CDC’s protocols.
Not being able to get tested has caused panic and anger in the U.S. Until last week, the CDC was telling state health departments to ration corona testing. Only people who had recently travelled abroad or had been in contact with an infected person, could get tested. TN State Health officials and, in turn, Metro health authorities, followed the CDC directive.
CDC has finally allowed other labs to develop and test for the virus and it can no longer dictate who gets tested. And people wearing masks have been going to clinics and medical offices all over town.
This story was updated 3/19/20 9:22 pm.
At this time, Vanderbilt clinicians will not assess patients for COVID-19 who are not exhibiting symptoms of fever, new onset cough or shortness of breath. VUMC clinics at Walgreens locations will not be screening or treating patients for respiratory illnesses.
For patients and employees with respiratory illnesses who need assessment for COVID-19, Vanderbilt Health has established these designated assessment sites:
- Vanderbilt Health Walk-In Clinic Mt. Juliet, 64 Belinda Parkway, Suite 200A
- Vanderbilt Health Walk-In Clinic Melrose, 2608 8th Ave. S, Suite 102A
- Vanderbilt Health and Williamson Medical Center Walk-In Clinic Spring Hill, 3098 Campbell Station Parkway, Suite 100
- Vanderbilt Health Walk-In Clinic Bellevue, 7069-B, Highway 70 South
- Vanderbilt Health and Williamson County Walk-In Clinic, Cool Springs, 1834 W McEwen Drive, Suite 110
- Vanderbilt Health and Williamson Medical Center Walk-In Clinic, Brentwood, 134 Pewitt Drive, Suite 200
- Vanderbilt Health and Williamson Medical Center Walk-In Clinic, Franklin, 919 Murfreesboro Road
- Vanderbilt Health and Williamson Medical Center Walk-In Clinic Nolensville, 940 Oldham Drive
- Vanderbilt Primary Care Clarksville, 800 Weatherly Street, Suite 201B
- Vanderbilt Health Walk-In Clinic Belle Meade, 4534 Harding Pike
- Vanderbilt Primary Care Gallatin, 300 Steam Plant Road, Suite 430
If you do go to a clinic with fever, cough or shortness of breath, please call ahead so that our staff can meet you with a mask for your safety and the safety of other patients and our staff. You can also call the Vanderbilt Coronavirus hotline (888) 312-0847 daily, 7 a.m.-7 p.m.