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Monday Update

March 23 - Nashville is now under the Safer at Home Order (see below for links to details). During the morning Metro briefing, the number of COVID-19 confirmed cases in Davidson County has risen to 184 with one death. A second death was reported yesterday by Vanderbilt University Medical Center officials but was outside of Davidson County. Information on Nashville directives in the response to coronavirus is available at: ASafeNashville.org.

The Tennessee Department of Health released updated numbers of cases in the afternoon. State cases are now at 615 across 46 of the state's 95 counties. As reported this morning, Nashville only saw an increase of 5 cases over a 24-hour period from Sunday to Monday. However, Metro Coronavirus Task Force Chairman Alex Jahangir, MD, MMHC, said he doesn't think there is a slowing of new cases as much as a backlog at labs. "I want to be very clear. I do not believe this is the beginning of the downtrend of this virus," he sated. Jahangir encouraged the continuation of social distancing that is now in effect in Nashville to flatten the curve.

James E.K. Hildreth, PhD, MD, president and CEO of Meharry Medical College and a renowned HIV/AIDS researcher, added scientific context to the Safer at Home Order that went into effect at 12:01 am this morning. He noted there is no herd immunity to COVID-19 since it is a novel coronavirus that, as far as scientists can tell, was detected for the first time late last year. "Over many, many thousands of years, we have developed immunity to many, many pathogens. This is not one of them," he stated. Since this virus belongs to a family with 39 members, he said it was critical to develop a long-term strategy as the expectation is this type of event will occur again. He called on everyone to protect "the T zone" ... eyes, nose and mouth, which are the portals of the disease.

Hildreth added the best option currently is to flatten the curve and ask everyone to sanitize and distance appropriately. The near-term strategy, he continued, is to find an effective drug to treat the virus and added there are clinical trials ongoing. The long-term strategy is to find a vaccine. "Thankfully," he added, "these virus have a stable genome ... that is to say they mutate less frequently than other viruses do." Unlike HIV, which has been so challenging, the stability with coronavirus makes researchers more hopeful that they can develop an effective vaccine. "Please keep in mind that the fastest vaccine ever developed took six years, and that was Ebola. Most vaccines that have been developed took decades," he said, adding a vaccine is part of the long-term strategy. The best near-term strategy "is for each of us to do our part by social distancing and protecting our T zones."

Hildreth also reminded providers that the receptor for the virus is found in the gut, as well as the lungs. "As a matter of fact, there are more receptors in the gut than in the lungs, and that means some individuals may present with GI symptoms. So we need to be very aware that the lungs and the gut are hosts for the virus and need to be vigilant about looking for those symptoms."

Over the weekend, Gov. Bill Lee signed an executive order closing dine-in service at restaurants statewide through April 6. Takeout, delivery and drive-thru orders are still allowed. Additionally, he ordered the closing of bars (but allowed the sell of alcohol by takeout or delivery if accompanying food for those 21 & older) and all workout facilities until April 6. Other recent measures prohibit the gathering of more than 10 people, request all schools to be closed by this Friday statewide, and limits visits to skilled nursing facilities and other senior housing facilities to essential care only.

Weekend Update

March 22, 9:45 am - Effective 12:01 am Monday morning, March 23rd, Mayor John Cooper has ordered all non-essential businesses in Davidson County to close. The Safer at Home Order order also directs residents throughout Davidson County to stay home when possible, immediately limit movement outside of home beyond what is absolutely necessary and avoid gathering in groups of more than 10 people for non-essential purposes. In addition to healthcare facilities, first responders, pharmacies and essential government agencies, other businesses including grocery stores, gas stations, banks, laundromats, veterinary and pet supply businesses, construction, childcare, warehousing and logistics, postal services and delivery services, among others are allowed to continue operations. Additionally, restaurants may continue to operate for takeout, drive-thru and delivery. The full order and complete list of essential services is available here.

The Sunday morning announcement also included an update on cases in Davidson County. Currently, there are 179 cases with 1 death, 27 recovered and 151 active cases. Two patients are currently hospitalized with the remaining cases self-isolating at home with mild or manageable symptoms. The age range in Nashville is 11 to 73 years of age for those with confirmed cases. The current case count in Nashville represents an increase of 46 over the past 24 hours. Statewide numbers will be updated at 2 pm today.

In response to Mayor Cooper's order, Jeff Balser, MD, PhD, president and CEO, Vanderbilt University Medical Center, and dean of Vanderbilt University School of Medicine said, "With the number of cases of COVID-19 rising rapidly, Nashvillians need to take every step now to slow the spread of the virus - to preserve precious healthcare resources to care for those who will soon need them. Mayor Cooper's Safer at Home Order will save lives. By following the order, we can reduce the number of people who need hospitalization all at once, enabling us to manage the coming COVID-19 patients while also serving people with many other conditions, like heart disease and cancer, who will continue to need us."

Recognizing the heavy toll Safer at Home will have on businesses across the city, the Nahsville Area Chamber of Commerce also came ut in support of the mayor's decision. Officials noted, the order would ultimately help reduce the spread of COVID-19 and get everyone back to work sooner. Additionally, the Chamber has created a coronavirus resource page, which is updated daily with new information, to help businesses impacted by the coronavirus.

For more information on Metro Nashville's response, go to asafenashville.org.

Daily Update

March 20, 2:06 pm - Updated numbers from the Tennessee Department of Health show 228 cases in Tennessee with 26 counties now affected. Numbers in the Nashville MSA are as follows:

Davidson: 110

Cheatham: 2

Dickson: 2

Maury: 1

Robertson: 2

Rutherford: 1

Sumner: 11

Williamson: 35

Wilson: 3

March 20, 9:42 am - In an update by Mayor John Cooper and other key COVID-19 response team members, it was announced confirmed cases of the novel coronavirus in Nashville have doubled in 24 hours. Currently, there are more than confirmed cases in Davidson County ranging in age from 11-73. However, the good news is only two people are hospitalized at this point and the city has not reported any deaths, yet.

Also announced, Metro Nashville Director of Health Michael C. Caldwell, MD, MPH, will order restaurants to close for all in-person dining and gyms and workout facilities to close later today, as well. While restaurant dining rooms will be closed, take-out, delivery and curbside pick-up will continue.

Bradley Shares Insights on Families First Coronavirus Response Act

Attorneys with Bradley share information on the new Families First Coronavirus Response Act that was just signed into law and goes into effect on April 2.

Click here for their insights on how the provisions will significantly impact employers with fewer than 500 employees.

Daily Update

March 19 - Tennessee COVID-19 cases jump to 154 with more than 100 in Davidson and Williamson counties.

For more information on Nashville's coronavirus response, click here.

Campbell: 1

Cheatham: 1

Cumberland: 1

Davidson: 75

Dyer: 1

Hamilton: 1

Jefferson: 1

Knox: 2

Montgomery: 1

Robertson: 2

Rutherford: 1

Sevier: 1

Shelby: 4

Sullivan: 1

Sumner: 3

Williamson: 30

Wilson: 1

Residents of Other States/Countries: 26*

*Cases among Tennessee residents are counted by their county of residence. Residents of other states who were tested at Tennessee healthcare facilities are counted as "Residents of Other States/Countries".

Daily Update

March 18 - Mayor John Cooper declares state of emergency in Nashville and President Donald J. Trump invokes Defense Production Act, which will allow the federal government to direct private business to increase U.S. production of medical equipment and masks should it become necessary. Other quick notes:

• New study results show younger Americans also at risk for severe disease.
• Gov. Bill Lee's amended budget includes $200 million to local governments for pandemic relief and infrastructure needs.
• Former U.S. Senate Majority Leader Bill Frist, MD, has been tapped to lead the advisory committee for the United Way of Greater Nashville's COVID-19 Response Fund.
• Number of cases in Tennessee hits 100 with the vast majority being centered in the Nashville MSA
• Brad Paisley, Kimberly Williams Paisley & Belmont University are using their philanthropic food pantry, The Store, to get food in the hands of the area's elderly residents in need. The Store is also open during regular hours at this point with free groceries available to those who qualify. Please bring proof of income. Learn more about referrals and services here.
• Second Harvest & the Red Cross are in desperate need of donations.

Updated Tennessee COVID-19 Numbers

March 17 - Confirmed cases of COVID-19 in Tennessee have risen to 73 (from 52 yesterday) with the vast majority in the Nashville MSA.

Campbell: 1

Davidson: 42

Hamilton: 1

Jefferson: 1

Knox: 2

Rutherford: 1

Sevier: 1

Shelby: 2

Sullivan: 1

Williamson: 21

Guidance on Coronavirus-Related Employment Matters

Matthew Kroplin and Stephen Price, both partners in the Nashville office of Burr & Forman, shared helpful resources that offer guidance on employment-related matters in the face of the current coronavirus pandemic.

The best overall coronavirus guidelines for employers to follow is the CDC's interim guidance, which can be found at the following link: Interim Guidance for Businesses and Employers | CDC. Here are few more links to some other coronavirus guidelines recently issued by the U.S. Department of Labor or U.S. Equal Employment Commission on other more discrete employment-related issues:

• Family and medical leave: COVID-19 or Other Public Health Emergencies and the Family and Medical Leave Act Questions and Answers | U.S. Department of Labor;
• Wage and hour: COVID-19 or Other Public Health Emergencies and the Fair Labor Standards Act Questions and Answers | U.S. Department of Labor;
• Occupational health and safety: U.S. Department of Labor Offers Guidance For Preparing Workplaces for Coronavirus | U.S. Department of Labor; and
• Disabilities: What You Should Know About the ADA, the Rehabilitation Act and the Coronavirus and Pandemic Preparedness in the Workplace and the Americans with Disabilities Act.

We are continuing to monitor the status of the proposed federal Family First Coronavirus Response Act, which is currently under consideration by the Senate and which will likely impose a variety of paid leave requirements on most employers. More information can be found on the Burr & Forman Coronavirus Resource Page.

President Announces Expansion of Telehealth Services

March 17 - In a press conference today, President Donald J. Trump announced enhancement of telehealth services and loosening of CMS regulations for Medicare to help reduce burdens on the health system. Efforts to care for those via technology comes as Emergency Departments are seeing large numbers of patients worried about COVID-19. Currently, more than 4,500 cases have been diagnosed in the United States and the number of deaths now approaches 100.

"Administrator Verma took strong steps today to enhance the nation's digital healthcare capacity during the COVID-19 pandemic by lifting Medicare restrictions on the use of certain telemedicine services. The American Medical Association (AMA) applauds this important Medicare policy change to support social distancing measures that slow the spread of the novel coronavirus, while providing safe screening and treatment to patients through remote care," said AMA President Patrice A. Harris, MD, MA, in a statement. "The Centers for Medicare & Medicaid Services (CMS) also noted that penalties will not be imposed on physicians using telehealth in the event of noncompliance with regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). The AMA had urged the administration to be flexible, and the steps CMS has taken demonstrate the agency was listening.

Harris continued, "The use of telemedicine and remote care services are critical to the management of the COVID-19, while also ensuring uninterrupted care for 100 million Americans with chronic conditions. The AMA encourages any private payers that are not already covering telehealth services to remove those limitations now. The AMA stands ready to help physicians expand their use of telemedicine and continues to invest in resources that provide physicians with a proven path for integrating telemedicine and digital health technologies into patient care."

(Please see link at the top of this page or click here for the complete statement and links to physician telehealth resources)

In addition to the health crisis, COVID-19 has sparked a global economic crisis. During the press conference, Treasury Secretary Steven Mnuchin announced a number of fiscal policy decisions to help cushion the economy. By 11:20 am Central, the Dow Jones was up about 1,000 points from yesterday. Mnuchin also said he is working closely with Congress on relief measures for the millions of Americans whose work has been disrupted by the virus, causing financial hardships. He added those measures could include directly sending checks to Americans. Touching on payroll tax cuts, Mnuchin said he realizes that would take time to be felt (and would not help those who aren't getting a paycheck in the wake of coronavirus layoffs). "Americans need cash now," Mnuchin said, adding he is looking at relief efforts that will go into effect very quickly.