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No end in sight for Tennessee Covid surge

Only 43% of the state's population is fully vaccinated and rural counties, which are seeing the highest rates of new coronavirus cases, have an even lower vaccination rate, hovering between 20-30%.

(CN) — With Tennessee emerging as the worst state in the nation for Covid-19 infections since the pandemic began, a return to normal is not in sight as medical workers are pleading with the public to get vaccinated.

Covid-19 is here to stay for the foreseeable future, said Dr. William Schaffner, medical director for the National Foundation for Infectious Diseases and professor at Vanderbilt University Medical Center in Nashville.

“It's part of our microbial ecological system in which we live,” he said in an interview. “It's not going to just disappear. We cope with influenza each year; we will have to cope with Covid in an ongoing fashion.”

That is something that will be an uphill battle for states like Tennessee, where only 43% of the population is fully vaccinated — a 3% increase from last month. Rural counties have an even lower vaccination rate, hovering between the 20 and 30% range, according to New York Times Covid-19 data.

The state has had the most coronavirus cases per capita since the pandemic began, just a few hundred ahead of North Dakota as of Friday, according to the New York Times and the Centers for Disease Control and Prevention.

“We're seeing perhaps a leveling off [of new Covid-19 cases] in some parts of the state now but not a distinct downturn yet,” Schaffner said, adding that the surge could “smolder on at a reasonably high level well into the fall … But it might take us a long time, and by that time, we will have paid a very substantial ‘price’ for this. Many more people ill, many more people hospitalized and more people having died.”

For the number of cases to go down, the number of people susceptible to the virus — those who don’t have immunity — has to go down, said Loren Lipworth, an epidemiologist at Vanderbilt.

“Unfortunately, that's part of what's contributing to why this surge is just continuing to rise, is that we're not seeing a parallel uptick in vaccinations, which then takes the susceptible group of unvaccinated people sort of out of the denominator,” Lipworth said.

So without more people getting vaccinated, it’s “probably a little too optimistic” to think there won’t be another surge over the holidays, she said.

Meanwhile, Tennessee Governor Bill Lee joined other Republican governors in threatening to fight President Joe Biden's vaccine mandate that calls for businesses with more than 100 employees to require vaccinations or weekly Covid-19 tests.

“To be clear: the vaccine is the best tool we have to combat the pandemic but heavy-handed mandates are the wrong approach,” Lee said.

On Thursday, Tennessee Attorney General Herbert H. Slatery III and other conservative attorneys general sent a letter to the president expressing concerns that the “unprecedented assertion” of the Occupational Safety and Health Administration’s emergency power “does not comply with the requirements of the OSH Act or the restraints of the U.S. Constitution.”

At the same time, the federal government is putting limits on its distribution of Covid-19 antibody treatments amid concerns that a handful of southern states — including Tennessee — were receiving a disproportionate amount of the national supply, POLITICO reported Tuesday.

Tennessee Gov. Bill Lee speaks at McConnell Elementary School in Hixson, Tenn., in August 2021. (Troy Stolt/Chattanooga Times Free Press via AP, File)

Monoclonal antibody treatments have been a back-up plan for conservative governors, like Lee, who have touted their effectiveness in treating the unvaccinated who contract the virus. At least 72 centers offer the treatment in Tennessee, Lee said last month.

Until recently, the federal government sent the treatments to states on an as-needed basis, but demand from southern states exploded, reaching up to 70% of all orders in early September, POLITICO reported.

In East Tennessee, where several of the hardest-hit counties are, several hospital leaders held a news conference Wednesday pleading with the public to get vaccinated and shedding light on the domino effect caused by the influx of Covid-19 patients in ICU beds, the majority of whom are unvaccinated.


“If this many patients are on a ventilator or breathing machine in the ICU, that means that sicker patients than normal are outside the ICU, and I think we're all experiencing this,” said Dr. James Shamiyeh, senior vice president and chief quality officer for the University of Tennessee Medical Center.

On top of that, some Covid-19 patients will develop kidney failure and will need temporary dialysis, he explained.

There is a limit on ICU beds. On Wednesday, for example, only 6% of beds were available in the East Tennessee region. Across the state, there were just 5% of beds available.

But that number fluctuates throughout the day, and in East Tennessee, the doctors noted that it’s common for there to be zero adult ICU beds available at their 1 p.m. “community capacity call.”

The lack of beds is clogging emergency rooms, too, which are seeing twice as many patients as normal for this time of year. That is due, in part, to an increase in 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.

All of that is leading to longer wait times in emergency rooms, not only for patients to be seen but for patients to be transferred to ICU departments.

“The health care delivery system cannot sustain — this cannot be the new normal for the healthcare delivery system,” Shamiyeh said. “I mean, this is not something … this is not something that we can do long term.”

“We don't want this to go any further,” said Dr. Harold Naramore, chief medical officer at Blount Memorial Hospital in Maryville. “None of us have a crystal ball about how long this will last or how bad it's gonna get. But we can work together in our community to improve where we're at … but it does require us working together to do it, and none of us can do without your help ... We need our community to help, and we need the help now.”

The physical and emotional weight of caring for patients is taking its toll on the workers as well.

“If you're a nurse, and you're working in a Covid situation, which is very physically tough because of the PPE requirements, the isolation you experience — because you're in an isolation room all day long — the suffering of the patients, the suffering of the families, the loss of life — and this time it’s young, young people who are losing their life — it's really tough,” said Robin Steaban, chief nursing officer at Vanderbilt.

There is a mixture of emotions that nurses are internalizing, she said, and “it tends to occupy their mind when they're not here, and makes it hard for them to be present for the other parts of their life, just mentally.”

Some patients regret not getting vaccinated and apologize to their nurses, while there are others whose family members “stand at the bedside as their loved one is dying, saying ‘this is not Covid’ — that gets people going,” Steaban said.

“We have to fight misinformation, not one another, and move forward in the spirit of protecting ourselves and others around us in a way that stops this disease,” she said, “so nurses can return to not having to face the death of a patient who did not need to die every day. I just wish people would be able to see that.”

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