Healthcare Leaders Reflect on City's Past, Present & Future Efforts
On March 8, 2020, days after a tornado devastated portions of Middle Tennessee, Nashville Mayor John Cooper announced the city's first case of COVID-19. As numbers climbed and "social distancing" became a buzzword in every home, Davidson County soon accounted for more than 4,500 of the state's 25,000 positive cases and over 40 of 380-plus COVID-related deaths. Today, those numbers have more than doubled, yet
Months (seemingly years) later, city leaders are navigating Phase 3 of Metro's "Roadmap for Reopening Nashville" master plan. After Phase 2 was delayed slightly, the city moved into Phase 3 on June 22 with an expectation of staying in this phase for a minimum of four weeks. As the city emerges, healthcare leaders are cautiously optimistic about the future, while recognizing the fight is far from over.
Alex Jahangir, MD, MMHC, chairman of Metro Nashville's Board of Health, has been pleased with the responsiveness from city and healthcare industry leaders and residents. "When this broke out we knew it would require a different response than anything we've ever done," he stated.
Three days after Mayor Cooper's announcement, Jahangir assembled leaders from Nashville's largest healthcare players including Ascension Health, Vanderbilt, Meharry Medical College, HCA, the Tennessee Hospital Association, American Red Cross, and state and city officials. "The caliber of being able to host a meeting like that last minute demonstrated the urgency everyone recognized it was," said Jahangir, who was appointed to lead Nashville's COVID Task Force the following day.
"The Mayor was still dealing with the tornado but recognized the importance of having someone looking at this, not just from the health perspective but how it would affect every aspect of our city. Not many cities were doing what Mayor Cooper did," said Jahangir, noting many other major cities were weeks later in establishing their own COVID task forces. "He was really ahead of his time, and I commend him for his leadership."
On March 23, Nashville became the first city in the Southeast to enact at Safer at Home order, which Jahangir credits with mitigating widespread disaster. Leaders also recognized the need to build public health infrastructures for testing, leading to the establishment of three no-cost assessment centers staffed by local hospitals. While others across the country struggled to get tested, Nashvillians had easily accessible options at the assessment centers. At press time, those centers accounted for nearly 35,000 of the city's 87,000 tests performed - two-thirds of those from minorities.
James Hildreth, PhD, MD
James Hildreth, PhD, MD, president of Meharry Medical College, credits increased efforts for lower-than-average COVID rates among Nashville's African American communities. Nationwide, black Americans experience a death rate of 3 percent compared to Tennessee's 1.5 percent. "The disease burden and number of deaths among African American communities here has been much better," he said.
Jahangir also credits local business owners for the city's relatively stable transmission and hospitalization rates. "People are taking it seriously ... but are also tired," he said. "Even with fatigue, Nashville is resilient, and people are still using science and evidence to reopen. That 'Nashville Strong' mentality has really been seen in this."
Vaccines & Herd Immunity
As vaccine development moves forward, Hildreth has urged the public to continue social distancing and taking the threat seriously. That's because vaccine discovery doesn't ensure rapid production or distribution. In fact, he doesn't anticipate a vaccine being available to the public until 2021 due to the lack of biological bioreactors required to produce hundreds of millions of doses, as well as inefficiencies in distribution.
"We want a vaccine that's at least 80 to 90 percent effective," said Hildreth, who was recently appointed to Operation Warp Speed, the national program to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics and diagnostics (medical countermeasures). "Anything less for a pandemic would be helpful but not solve the problem."
Still, he said it's encouraging to know that all possible vaccine approaches are being tested, from inactivated viruses to genetic material. "I'm feeling excited about the fact that any idea you might think of is being tested somewhere on the planet right now," Hildreth said.
In the meantime, protective measures are crucial in preventing herd immunity. "When a herd or species achieves 60 percent resistance or immunity to an organism or microbe, it can no longer spread quickly, so the chances of an infected person traveling to someone who's not immune is low," he said. "For the U.S., that would mean 200 million-plus infected and 10 million dead. Clearly we don't want to take that route."
Nashville has already seen case numbers rise and key metrics fluctuate as the city has begun moving through the reopening phases. "The battle with this pandemic is not over. While as a city we have been able to do well in keeping mortality rates and hospitalization rates low, we are starting to see an increase in cases," said Jahangir. "Part of why this is happening is that people are letting down their guard with the most basic, yet proven concepts - wearing a mask, social distancing and hand hygiene." In late June, the Metro Board of Health unanimously adopted a measure to make wearing masks mandatory in public in an effort to slow the spread of COVID-19.
As summer fades into fall, the reality of a second wave - mixed with traditional flu season - has many fearful, as well. "Until there is a second wave, we have to be in a new reality," Jahangir said. "Everyone is worried about it. As providers we have to know, 'is it flu or not?'"
He said patients should be extra diligent about receiving the flu shot and getting tested when symptoms develop. "The difference between now and March is that we are more aware of the fact that COVID is in the community," he said. "We can mitigate flu with vaccines, and COVID testing is easier to get now."
He also encouraged government and public health leaders to continue advocating for social distancing, wearing masks and leading by example. "Even if there's a second wave, it will be more controllable," Jahangir said. "As healthcare leaders, we must continue to encourage vigilance in these concepts to prevent our city's success from being eroded."