Tennessee state government plans to lift social-distancing measures as health care crisis looms

By Warren Duzak
25 April 2020

A social catastrophe is threatening to occur as Tennessee Republican Governor Bill Lee prepares to lift the state’s mandatory two-week “safer at home” response to the COVID-19 pandemic. Lee, who only reluctantly established the two-week stay-at-home order, has set May 1 for the restriction to be lifted in 89 of the state’s 95 counties.

The major cities and metropolitan areas of Nashville, Knoxville, Memphis and Chattanooga, along with two other counties will be exempt from the lifting of restrictions. Those exemptions, according to Lee, are because the various localities have their own health departments. The remainder of the state relies on the Tennessee Department of Health for services. Lee, along with Republican governors in Georgia and South Carolina has put plans into motion or has already implemented plans to partially lift COVID-19 restrictions.

As of Friday, the state of Tennessee has recorded 8,266 cases and 170 deaths, as well as 3,828 recovered. Shelby County, which includes the city of Memphis, had the second highest number of cases, 2,001, and the highest number of deaths with 42. Nashville had only 10 more cases, 2,011, but exactly half the number of deaths at 21. These numbers are likely to be vast underestimates due to the relatively limited number of tests that have been provided in the state. The rate of testing in the state is roughly 16 people per 1,000, or about 1.5 percent.

“As of Tuesday… More than 181,100 people have been tested in Tennessee so far, a small fraction of the more than 6.8 million people who live in the state,” stated Tennessee’s NewsChannel 5 Investigates television program.

Lee’s decision, which is based on nothing more than cold-blooded financial calculation, amounts to a policy of social murder. The decision has been met with immediate criticism from the medical and scientific community. Dr. Aaron Milstone, a pulmonologist who several weeks before organized a petition of 9,500 physicians and healthcare workers urging Lee to adopt basic social distancing measures, lambasted the governor’s latest move.

“Rolling back health protections like the stay at home order without first the ability to quickly identify new cases, break chains of transmission, and protect first responders and health care workers from infection only jeopardizes lives and the economy and it goes against the very recommendations of the Centers for Disease Control,” Milstone said in a press statement reported by the Chattanooga Times Free Press.

“Covid-19 can spread asymptomatically, showing no symptoms, for weeks and is highly more contagious than the typical flu and there is no cure or vaccine. Do you want to be the employer responsible for employees or patrons getting sick or ... dying?” he added. “You have this saw-tooth pattern [in which new numbers of cases go up and down]. What you want to see is you want to see a decline in those new cases over a two-week time period,” the physician noted.

Dr. Melinda Buntin, a Vanderbilt health policy professor, highlighted the immense likelihood of a COVID-19 resurgence under the circumstances of loosened social distancing measures: “Our model says the over 4,000 cases we have in the state of Tennessee right now could have been sparked by as a few as 10 patients six weeks ago. So it doesn’t take many of those cases out there … to spark a huge resurgence in cases across the state of Tennessee.”

“I personally can’t find anyone who really thinks that Tennessee has reached its peak numbers,” said Dr. Brenda Butka, retired Vanderbilt Medical Center pulmonologist. “Modeling projections is a fraught enterprise, and projections are never precisely accurate, but this seems to be too early to feel any confidence about pulling back on business closures.”

As with the White House, Governor Lee’s decision to remove social distancing measures is being buttressed with questionable data provided by the Institute for Health Metrics and Evaluation, an independent global health research center at the University of Washington.

“We don’t really know that much about COVID-19, so nobody can pretend in a model that they know the trajectory in every location through some assumptions,” said Dr. Christopher Murray, director of the IHME, to the Times Free Press. The IHME has released findings this week suggesting as many as 30 states, including Tennessee, may be in a position to undo social distancing measures by May 20. The IHME has released projections on the pandemic which have been widely discredited in the press and scientific community.

One Tennessee constituent, however, was overjoyed by the Republican governor’s decision. Hospital Corporation of America (HCA) CEO Sam Hazen, whose annual compensation is $27 million, was quick to applaud Lee’s action, telling the Nashville Business Journal that he was ready for a “reboot” despite others in the health care industry that showed concern about the governor’s decision.

“We’re excited about Tennessee and we anticipate other states starting to relax some of these procedures and policies over the course of the next few weeks, allowing us to start back on some of the care that’s needed in the communities,” Hazen said.

According to the Business Journal, “[d]espite the pandemic, HCA reported $12.8 billion of revenue for the first quarter, up from $12.5 billion for the same period last year.” HCA’s inpatient admissions and surgeries and well as outpatient procedures have declined by between 30 and 50 percent for the month of April. “We’ll just have to process it and hopefully have it behind us at the end of the second quarter,” Hazen said.

HCA is the largest for-profit health care provider in the United States and the largest private-pay health care provider in the United Kingdom. HCA is also known for taking hundreds of millions of dollars in tax breaks and incentives from Nashville and the state over recent decades. Among its more noteworthy uses of public tax dollars are the purchasing of a “Guitar Pick Table” for $4,190.18 and, a “Tuxedo Sofa” for $6,540.45. In 2003, HCA paid more than $1 billion in fines for defrauding the federal government in the biggest Medicare fraud case in history.