As Shelby County COVID-19 restrictions ease, experts fear 'a tsunami of new cases'

The fall wave of COVID-19 has reached Shelby County’s shores. Seven months into the pandemic, cases are climbing again. The hospitals are getting fuller. The worsening data mirrors national trends.

The novel coronavirus, which Shelby County and the United States never quite subdued, is now more prevalent and widespread than it was before the spring shutdowns. The weather is getting colder, pushing people indoors.  

Business restrictions are almost gone in Shelby County. Restaurants and bars are open until midnight. Capacity is no longer limited. Beyond a full crowd at a sporting event or going to a strip club, nearly everything is fair game as long as you wear a mask and maintain social distancing. 

Health experts acknowledge that fatigue is setting in. People are sick of staying home. They are tired of wearing masks. That weariness and the approaching winter have doctors worried. They are concerned about whether the public is mentally prepared to keep fighting off the virus and if people understand that the struggle is far from over. 

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“We have been seeing, I think, what is just the leading trickle of what could be a tsunami of new cases…,” Dr. Steve Threlkeld of Baptist Memorial Hospital-Memphis said Monday. "And I think, unfortunately, we may be about to be slapped a bit." 

On Monday, Dr. Manoj Jain, who advises the city of Memphis,  also noted the fatigue, "Many are still not accepting that this is the new normal for months or years." 

'It's like you're voting every day'

On Oct. 14, dozens of people stood outside Greater Lewis St. Baptist Church in Midtown ahead of polls opening at 9 a.m. Rush-hour traffic, back after a springtime hiatus, whooshed by the line of voters standing, masked-up along Poplar Avenue.

Through Monday, more 120,000 people in Shelby County had voted in person, showing that the pandemic had not dampened the public's desire to exercise its collective will. Campaigns, disrupted throughout the spring and summer, have resumed door-knocking— rapping on the door and then moving back a safe distance. 

The uptick in activity is a sign of adaptation. Life, once dammed by the rock that is the pandemic, is now flowing around the rock like water in a stream. 

According to Jain, Threlkeld and national experts, that collective will, the one seen in the desire to vote, still dictates the local and national outcomes.

"It's always in the hands of the people... It's the decisions that individuals are making, which is having a collective impact," Jain said. "We can literally in real-time see the impact of individual decisions... It's like you're voting every day. And it's profound. Because what we realize is [that it's] the whims in individual decisions is what's been leading to the many changes that are the ups and downs that we see in the curve." 

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Threlkeld pointed out the risk of the coming winter, colder temperatures forcing people indoors and to closer proximity to one another. Those emerging risks, coupled with the public's mental exhaustion with safety measures, could spell problems, he said. 

"Some of that increased risk could be averted if we weren’t just tired of the whole thing. Being out just a bit around the weekend, there are a lot of people who just aren’t wearing masks. That is for sure. And an unfortunate reality that we face," Threlkeld said. 

'We’re starting this upturn with 50 people in our hospital' 

Last week, when he told the public that the fall wave of COVID-19 was beginning to hit Shelby County, David Sweat, the deputy director of the health department, said the county's projections showed a February surge in hospitalizations. 

At the same time, he said, as he did in July, that such projections were not the county's "destiny," and could be avoided through social-distancing, masking and discipline. When Sweat talked about destiny the first time, on July 30, Memphis and Shelby County were still feeling the effects of the summer surge.

The number of people in Memphis-area hospitals with COVID-19 would peak the next day, at 384. Hospitalizations fell from there and bottomed out on Oct. 3, at 150. Over the two weeks that followed, hospitalizations jumped again and sat at 210 as of Sunday evening — an increase of 40 percent in just 15 days. 

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The late-summer dip in reported cases and hospitalizations did not change the fact that the disease is far more prevalent in the population than it was at the beginning of the pandemic or even during the early summer surge — a fact Threlkeld acknowledged Monday. 

“There are a lot more people in the population with it. It is more widely seeded throughout the country now… We’re starting this upturn with 50 people in our hospital instead of zero or 10… The thing that we worry about, in addition to the lives lost or just infection, is the fact that this can overwhelm city, states or even country’s healthcare systems."

'It will take six to 12 months more'

During the heady days of late-summer and early fall , as cases in Memphis and the U.S. dipped after their early-summer peak, optimism flowed about the prospect of a working, effective and safe vaccine available to the general public by the end of the year. 

Now, after pauses in some clinical trials for safety reasons, it is becoming clearer that widespread vaccination in the U.S. remains months away, at the earliest. That lack of vaccine and mass vaccination could push a return to normal deep into 2021 or even longer, local and national experts say. 

“I think November, December, January, February are going to be tough months in this country without a vaccine,” Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, said to STAT News.

Locally, Jain and Threlkeld are encouraged by the progress toward a potential vaccine, which remains far ahead of historic norms. Threlkeld has praised the pauses in clinical trials, saying that such temporary holds are a sign of "the system working." 

However, Threlkeld thinks that COVID-19 may not disappear once one, or several, vaccines are found to be successful. He thinks there's a chance that SARS-CoV-2, the virus that causes COVID-19, may linger with humanity like its milder coronavirus cousin, the common cold. 

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There may be a need for annual vaccine for SARS-CoV-2 like influenza, Threlkeld said last week. 

Jain said it is time for the public to grasp that the end of the struggle is not as near as people would like. 

"I don't see it ending by the end of the year, I think we have to be very clear that we're in for a long haul. It will take six to 12 months more," Jain said. "I know, it may sound depressing but I think preparation and being realistic about it is going to be important."

Samuel Hardiman covers Memphis city government and politics for The Commercial Appeal. He can be reached by email at samuel.hardiman@commercialappeal.com. 

Commercial Appeal reporter Corinne S Kennedy contributed reporting.