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In Tennessee, delta spreads across a population divided on masks, vaccines

Covid-19 cases and hospitalizations are rapidly increasing in the Volunteer State, including among children, as students return to school and hospital beds fill up.

(CN) — As the delta variant spiders its way through Tennessee’s unvaccinated — infecting a few vaccinated people in its path — the state is faced with mounting concerns.

Covid-19 cases and hospitalizations are rapidly increasing, including among children, as the school year began this week. Hospital beds are running out and medical workers are burning out. There is a growing divide between the pro-mask and anti-mask sides. And the state’s 73 House Republicans have asked the governor to convene a special legislative session to “address misdirected and mandated responses to Covid-19 by local entities and officials.”

With delta’s high infection rate, far more people will need to get vaccinated in order to get ahead of the coronavirus, warned Dr. William Schaffner, medical director for the National Foundation for Infectious Diseases and professor at Vanderbilt University Medical Center in Nashville.

“One of the ways you can think about it is those firefighters fighting all those big fires out West. If they're getting ahead of a fire, good. That's great. But all of a sudden, as the fire moves off in a new direction, they have to change what they're doing, and we’ve had to do that [too],” he said.

Coronavirus cases in Tennessee children grew from roughly 1,800 new cases per week in mid-July to nearly 4,500 — a 150% increase — by Aug. 1, according to Tennessee Department of Health officials and data. They now make up 21% of all cases, which have also spiked to levels not seen since January.

The rolling seven-day average for new cases rose to 3,808 as of Thursday, eight times higher than it was on July 12 when the seven-day average was just 468, according to the latest department of health data. That number had already more than doubled from a June low of 174.

Covid-19 hospitalizations have also risen dramatically from 281 hospitalizations on July 12 to more than 2,078 as of Thursday — over 90% of which are among the unvaccinated, officials said. In children, that number grew from seven to 50 within the same timeframe.

Hospitals in Middle Tennessee have run out of ICU, emergency room or surgical beds, Geoff Lifferth, chief medical officer for Sumner Regional Medical Center in Gallatin, wrote in a Facebook update.

“As an ER doc and a healthcare administrator, this past week has been one of the most exhausting and disheartening of my career,” Lifferth wrote.

Across the state, just 7% of UCU beds and 10% of floor beds are available as of Friday, according to the health department.

In Memphis, Fire Chief Gina Sweat warned that the city’s EMS system is overwhelmed due to Covid-19 emergency calls.

“First responders are running on fumes,” she said during a news conference Thursday. “There are times when you may call for an ambulance, and we may not have one available.”

Meanwhile, hundreds of thousands of children have returned to school this week, but only some school districts — including three of the state’s four largest metro areas — require masks.

The school board in Williamson County, the state’s richest county just outside Nashville, voted on Tuesday to temporarily require masks in elementary schools, sparking a large uproar from anti-mask parents. They threatened doctors, nurses and other medical experts, who are parents themselves and were advocating for mask requirements to protect children.

“We know who you are. You can leave freely, but we will find you,” one anti-mask protester yelled at a man who was in favor of masks trying to leave the meeting.

The outburst drew attention from President Joe Biden on Thursday.

“This isn’t about politics,” Biden said during a news conference. “This is about keeping our children safe … Our health care workers are heroes.”

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The Williamson County sheriff has said his department is investigating the incident.

Less than 24 hours after the meeting, Tennessee House Speaker Cameron Sexton, R-Crossville, asked Republican Governor Bill Lee to call a special session to “curtail the overreach by independent health boards and officials … and protect all Tennesseans from misdirected mandates designed to limit their ability to make their own decisions.”

Lee’s office said on Friday it is “currently reviewing the request.”

Monroe Carell, Jr. Children's Hospital at Vanderbilt, also known as Vanderbilt Children's Hospital, in Nashville, Tenn. (Image by SenatorDF from Wikipedia Commons via Courthouse News)

Children under 12 years of age still cannot be vaccinated, but it’s not just the coronavirus putting young children in hospitals and leading to capacity issues in Tennessee and across the country.

Other respiratory illnesses — which are typically only seen in the dead of winter but didn’t surge this season due to social distancing and mask usage — started emerging this summer as families with young children began to relax and get “out and about,” Tennessee Health Commissioner Lisa Piercey said during a recent virtual news conference.

Children affected by those illnesses, especially those under 2 years old, often have to go to the hospital.

“So when you combine the unusually high amount of non-summertime infections with the normal summertime admissions that children’s hospitals typically have [such as trauma cases], plus a shortage in staff, you really have a situation where you have capacity concerns,” Piercey said.

Staffing shortages are a major concern for hospital leaders working on the front lines in both adult and children’s hospitals.

Even before the pandemic, the country already had a shortage of medical workers. But now, a wave of health care workers across the country have left the bedside due to the physical and emotional toll the pandemic has taken.

“It's been a long 18 months, and these patients are sick and they need a lot of care. And then on top of that, in order to protect ourselves, we have to wear personal protective equipment, and it's heavy and it's hot and it makes doing the job that much harder,” Dr. Todd Rice, director of the medical intensive care unit at Vanderbilt, said in a recent interview.

Rice said some nurses have confided in leadership, telling them, “‘We don't know if we can do this again,’” he said. “‘We are so emotionally drained, physically tired and exhausted and, you know, we just are not sure that we can do this whole thing all over again.’”

Coronavirus patients stay in the ICU for weeks on end, and nurses and doctors grow attached to them, Rice said.

“We get to know them, and we get to know their families, and when they have a bad outcome, you know, that is really, really, really tough,” he said. “[It] makes people really think long and thinking about ‘What are we doing?’ And, you know, ‘Am I making a difference, really?’ ‘Does any of this matter?’ And that, just that sort of almost helpless and hopeless feeling.”

It’s frustrating, he said, to see cases in the unvaccinated because “we recognize that there was a way to prevent this and it didn't have to be this way.”

It’s also frustrating to see breakthrough cases in fully vaccinated people because “it's just really disappointing and sad when many of them got vaccinated, they did what we asked them to do, and they still ended up catching the virus, mainly because of how it's spreading in the community.”

Breakthrough cases in vaccinated people, at least in Middle Tennessee, Rice said, have predominantly been among immunosuppressed patients, such as those who have had organ transplants or have rheumatologic diseases.

“The hope is that masking, even without vaccination, would decrease the transmission of the virus,” he said. “But ultimately, the best way to really decrease the transmission of the virus and the severity of the cases is by continuing to encourage folks to get vaccinated.” 

The state finally reached 40% of its population fully vaccinated on Friday. But that’s still far behind the national average of 50%. And while the state’s vaccination rate has significantly increased in the past month, infectious disease experts estimate it will take several months to get ahead of the virus if Tennesseans don’t speed up their pace to get the shot.

“The increase in vaccination is great,” Dr. Schaffner said. “I wish the increase was double or triple that.”

Follow Rosana Hughes on Twitter

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