Month: September 2021

The doctor wished for a miracle drug, pain and regret in a bottle.

Inside the room, his colleague was dying of Covid-19. Outside the room, the doctor — Dr. Stephen Threlkeld, a Memphis infectious disease expert — waited with members of the dying person’s family.

“We wished we could bottle the pain and regret of that process, to give people just a taste — a drop — of that to realize that this is now a choice that people are making, to get this illness and to die of it. There is no reason for this to continue.”

Eighteen-Month Pandemic Check-Up

Covid’s second verse is the same as the first in many ways. It’s come with familiar things like mandatory face masks, social distancing, and an unshakable worry about what comes next. But we now know the second verse, the Delta variant, is more infectious, faster, meaner, catching on with a younger audience, and — maybe the most frustrating part — it’s mostly preventable.

Experts here say late summer’s record-setting rise in cases is a “surge of the unvaccinated.” Healthcare leaders say 99 percent of Covid patients they see now are unvaccinated. That’s a stat, not hyperbole.

That figure is, of course, likely heavy on those now broadly called “anti-vaxxers,” right-wingers who put personal freedom before public health. Many, too, are otherwise healthy people in their 20s and 30s whose reluctance to get a vaccine remains a mystery to many health officials.

But a huge chunk of Shelby County’s population are unvaccinated not by choice. No vaccine is yet approved for children under 12. Pediatric Covid cases comprised nearly 40 percent of the county’s active cases late last week. The kids are getting sick. There’s no medicine to protect them. And we’re sending them to school with hundreds just like them.

Thanks to the more contagious Delta variant and vaccine hesitancy, the Covid situation in Shelby County last week was as dire as it’s ever been before. Historic high rates of new cases, hospitalizations, test positivity rates — the fundamental data used to measure the Memphis area’s Covid health — make that dire situation an unfortunate reality.

Last Thursday, Doug McGowen, the city’s chief operating officer (COO), reported two grim milestones. More people were being treated in Shelby County hospitals at one time — 721 — than in any previous time in the 18-month pandemic. Area intensive care units (ICUs) were treating 203 patients, and 518 people were in acute care. Across the county, 163 people were intubated, setting another Covid record here.

Through the difficult data, however, rises a sort of delicate optimism. Some numbers started to soften, officials said. But predictions on the figures came laden with plentiful anxious caveats from experts bitten by Delta’s global surprise.

New case rates blasted past records Memphians thought terrifying in January. The week after Christmas, nearly 18 percent of Covid tests were coming back positive, significantly more than the previous high of about 15 percent. Consider that for the past three weeks, the figure has hovered at around 21 percent. But it has hovered, and some officials harbor that the spread may have stabilized.

Officials at Baptist Memorial Hospital-Memphis said Covid cases there crested at 172 this past winter. Weeks ago the hospital had 10 Covid patients, but Delta cases there stair-stepped and hit 152 recently. That number has since stabilized, too. The figure encourages Threlkeld and others at Baptist, who say that, if the number holds, they may have receded from the brink of a dire logistical situation. But optimism is indeed delicate and truly tempered with anxious caveats.

“I am flat through underestimating this pandemic,” Threlkeld said at a press event at the hospital last week, “so you will not get me saying it’s going to be fine anymore.”

​​It’s from this high and tenuous peak that we look back at the long slog through the Memphis version of the global Covid-19 pandemic. From here, we can look back on the early days when we couldn’t even test for the virus, when some of us learned to live and work from home. Others, frontline workers, especially grocery store workers, were heroes. Every commercial began with “in these tough times.”

We can recall the early optimism in Operation Warp Speed and the race to build a vaccine to stop the spread of the disease. When it arrived, there was a dash to sit in long lines at the Pipkin Building. Some posted photos of vaccine cards to social media, sometimes exposing sensitive information if a finger was in the wrong place.

Those vaccines are the difference-maker now as we turn to look ahead, to the future side of this peak. They saved the day, almost. Covid case rates got so low, we pulled our masks off and gently kissed normalcy. But that was fleeting, as we know, ripped away by a virus variant propagated in the unvaccinated, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the chief medical adviser to President Joe Biden and a medical adviser to former President Donald Trump.

From this frightening precipice, though, some experts believe they may even be able to see the end, the real one.

How It Happened

Memphis didn’t blow it. Covid trend lines look basically the same for Shelby County, Tennessee, the U.S. at large, and the world. In fact, government bodies in Memphis were far more conservative than those in other parts of the state when it came to letting down our Covid guard.

Consider that in late April, even as Covid seemed to start winding down in Shelby County, Memphis Mayor Jim Strickland extended the city’s state of emergency, the same one issued as the pandemic began in March 2020.

“Covid-19 continues to present a danger to public health through community transmission, which has resulted in significant loss of lives in Shelby County due to the virus and has strained the hospitals and public health system,” reads the order, which was recently extended.

Seven days after Strickland’s new emergency order, Tennessee Governor Bill Lee was ready to call the game and get back to work. His order lifted any mask mandates in 89 counties, those without their own health departments.

“Covid-19 is now a managed public health issue in Tennessee and no longer a statewide public health emergency,” Lee said in an April statement. “As Tennesseans continue to get vaccinated, it’s time to lift remaining local restrictions, focus on economic recovery, and get back to business in Tennessee.”

We know now that Covid is far from “managed,” but that’s not to malign Lee. No one predicted Delta’s rise. Leaders here were so sure the thing was done, they closed the $51 million Covid overflow hospital in the former Commercial Appeal building on Union without ever seeing a single patient. But it wasn’t only government leaders who were caught off guard.

“I was certainly not expecting the way this has played out,” said Dr. Diego Hijano, an infectious disease expert at St. Jude Children’s Research Hospital. “We knew the virus would move through the vulnerable and we always thought about the unvaccinated.

“Obviously, it makes sense that all the kids who were isolated are getting infected and that’s driving a lot of what we’re seeing. But I did not expect things to change so dramatically.”

Looking nationally, researchers told The New York Times in mid-July that the coast was clearing. Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, said he thought the “United States has vaccinated itself out of a national coordinated surge, even though we do expect cases pretty much everywhere.” Kristian Andersen, a virologist at the Scripps Research Institute, said, “I don’t expect that we will get close to the kind of mayhem we saw earlier.”

At the end of June, the national seven-day rolling average of new cases was around 12,000, according to the Centers for Disease Control and Prevention (CDC). On July 27th, it was 60,000. At the same time, Shelby County’s average rose from 46 new cases to 358. The figure’s latest peak was August 24th at 821. It fell slightly to 746 on August 27th, the latest figure available as of press time.

In the Hospital

Remember “bending the curve”? The phrase seems an Alpha-variant relic these days. But it was a major goal of pandemic-management tactics like mask mandates, indoor capacity limitations, and social distancing. Hospitals and healthcare professionals are essential to everyone, and no one wanted them overrun with Covid patients. So, we wanted to “bend” the new-case trend line downward.

With little appetite left for Covid restrictions, no one talks much about bending the curve anymore, but hospital capacity remains a red-hot issue.

Shelby County Mayor Lee Harris saw the situation firsthand last week on a tour of Baptist Memorial Hospital-Memphis. Every room in the ICU was full and it seemed “every patient was in a very, very serious situation,” Harris said.

“I was struck by the idea that not everyone in this community that will be struck by Covid, will be safe because there’s not enough experts around and not enough technology to go around.”

The area’s hospitalization record set last week surpassed numbers only seen in the previous week. The number would be astronomical if older residents had not been prioritized in the vaccination effort.

While children (age 0-17) now represent the highest number of active cases in the county, many don’t require hospitalization when they get sick. (As of last week, Le Bonheur had 28 Covid patients, seven of them in the ICU.) The age range of hospitalized adults with Covid is now largely between 20 and 40 years old. That’s “not normal,” according to Shelby County Health Department Director Dr. Michelle Taylor.

“I am personally ill when I think about the number of young people — or people of any age — but particularly those in their 20s and 40s with little children [being treated in the hospital for Covid],” said Dr. John Craig, a thoracic surgeon with Baptist Medical Group. “It is sad beyond description, and to see this go through my community, it’s a terrible thing.”

Dr. Jeff Wright, medical director for Baptist Memorial Hospital-Memphis’ critical care program (which includes the ICU), said the average Alpha-variant ICU patient was around 60 or 70. The average age of death in ICU patients is now 30, and these deaths average once a day.

“These were not 35-year-olds that had lots of medical problems,” Wright said. “They all had jobs … and families. It was tragic.”

These patients die of single-organ failure, lung failure, Wright said. Most times Covid isn’t stressing an existing comorbidity (like cancer or liver disease) in these patients like it did before in older patients. Younger patients also tend to stay in the hospital longer than older patients, he said, sometimes three to four weeks, instead of the two weeks older patients typically stayed, keeping hospital beds full and capacity low.

There’s a higher cost.

“Nurses are in there eight hours a day on end, FaceTiming with families of dying patients,” Threlkeld said. “You lose a little piece of yourself when that happens, and it’s happened a lot to those folks.”

How It Ends (Probably)

Richard Webby thinks we’re still halfway through the pandemic, or maybe 75 percent of the way. Not only does he have an infectious disease lab at St. Jude with his name on the door (the Webby Lab), he’s also the director of the World Health Organization’s Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds.

“There’s no way of knowing, right?” Webby said. “I think this is as bad as this virus is going to get in terms of speed of replication, how potentially transmissible the virus could get.

“I’d like to think that once we do get through this and get more population immunity both through national infection, unfortunately, and through vaccinations, we’ll get back down again, and maybe we’ll stay a little bit lower and get through it.”

Webby thinks Covid will likely settle into a winter disease, somewhere between the flu and the cold. Threlkeld agreed, noting four other coronaviruses — which may have started as pandemics hundreds of years ago — circulate as colds these days.

“What we hope is that by getting everyone vaccinated, it will drive this disease into becoming something like the current coronaviruses that caused the common cold,” he said. “They infect many people and their kids, and [kids] do well compared to adults with those types of infections. So, they have some immunity, but it’s not perfect. They’ll get it again later but it won’t be as severe. Then, by the time you get it multiple times as an adult, you just don’t get very sick from it at all.”

In the shorter term, Threlkeld said case counts could rise again in the winter as everyone heads indoors, just as the numbers spiked last year. But he said, “[W]e might see this thing really taper off when we look at the springtime.”

Hijano said he’s stopped predicting the virus because “sometimes when we think we’ve got it, we really don’t have it all.” The timeline is up to us, he said.

“We’ve had the tools in our hands,” Hijano said. “But as we keep resisting vaccination and mitigation strategies, it will prolong the time.”

The health department’s latest mask mandate said restrictions may be loosened if case counts fall or if 700,000 of people in the county get vaccinated. As of Friday, 467,296 had been vaccinated, nearly 67 percent to the goal of 700,000. Average daily vaccinations last week were 1,854. If that rate continues, it would take about 125 days (four months) to vaccinate the remaining 232,704 people to get to 700,000. Keep it up and Shelby County would have a major reason to toast New Year’s Eve.

Until then, Dr. Aditya Gaur, director of St. Jude’s clinical research on infectious diseases, knows what works and knows how you feel.

“I know you are tired of hearing the same thing over and over about wearing your mask, staying home, and not socializing,” he said. “A part of that is that the people who have been doing it intensely are the ones who continue to do it intensely, although they are tired of it. But the people who never had the appetite for it still don’t have an appetite for it.”

McGowen, the city’s COO, is likely tired of talking about Covid, too, directing much of the area’s response to the pandemic and giving regular updates on the situation. Last week, he asked for help.

“We’re asking that everybody, that you just do the right thing,” he said. “We understand this has been a rough 18 months for everyone in our nation. But it is not the job of the city government or county government or the health department to navigate this alone. Nor is it the responsibility of the hospitals to navigate this alone and be just the net receiver of those who are very sick.

“It is individual by individual, person by person, who complies with common sense and doing the right thing that will get us through this pandemic.”