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.