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The Pandemic

Memphis Vs. Nashville: bluff city’s higher COVID death rate exposes inequalities

Officials expect poverty, inequity to delay journey to reopening

As rural West Tennessee begins easing coronavirus restrictions Monday, April 27, Memphis leaders are busy crunching numbers and taking political temperatures for when to launch our own long-awaited reopening.

“The process of reaching consensus could only be days away,’’ a cautiously optimistic Shelby County Mayor Lee Harris said Friday, April 24.

Memphis Mayor Jim Strickland wrote Friday in his weekly update that plans for a gradual, phased-in reopening “will be released early next week’’ — any day now — emphasizing that “each phase will be implemented based on clear, scientific, and transparent criteria.’’

Though not part of the official reopening metrics, the inevitable second-guessing will come:

Has Memphis kept pace with peer cities in the region?

Lee Harris

How do its coronavirus response and recovery plans fare with its great rival to the East — Nashville — which already has published a plan to reopen gradually over the coming months?

“There’s a huge difference in the marketplaces,’’ said Greater Memphis Chamber President Beverly Robertson, who anticipates Memphis will have greater difficulty kick-starting its economy and recovering than will more-affluent Nashville.

<strong>Beverly Robertson</strong>
Beverly Robertson

“It’s certainly no surprise that there are a lot more people of color who have rougher issues because of the disparities, the historic disparities that have existed in this marketplace. And that has created many of the problems that we have, whether it’s substandard housing or poverty or education or transportation. Economically, that’s not the case in Nashville….

“We’re now in a position where we get to see what some of these inequities create.’’

Already, the inequities have shown up in the two cities’ responses in fighting the novel coronavirus.

Testing has been more robust in Nashville. And the pandemic has been far less deadly there.

The fatality rate among COVID-19 patients in Memphis-Shelby County is double that of Nashville-Davidson County.

“Seventy-eight percent of our fatalities have a cardiac comorbidity underlying. And that’s very important,’’ the county’s chief of epidemiology, David Sweat, said last week, addressing the 43 coronavirus deaths reported here through Friday. Though he didn’t address it directly, many of the underlying health risks leading to severe COVID infection and death are exacerbated by poverty and inequity —vulnerabilities that pose special challenges as Memphis attempts to revive its economy.

<strong>David Sweat</strong>
David Sweat

“Those four risk factors — obesity, diabetes, a respiratory condition or cardiac problem — those are the four most important risk factors nationally. And they’re also the foremost important risk factors locally among our residents who’ve had the worst outcomes.’’

It’s those health risks and a myriad of other medical and economic factors that make the already difficult transition all the more challenging.

Gradual reopening

In a way, the transition to reopening has already started. In announcing his decision last week to keep his safer-at-home order in place until May 5, Mayor Strickland said some measures have been strengthened while others have been lessened.

<strong>Jim Strickland</strong>
Jim Strickland

“These changes were made with an eye towards the future or the time when we can get back to business safely,’’ Strickland said.

One change involves golf. Several city golf courses reopened over the weekend subject to social distancing requirements.

Another change — this one more restrictive — involves big box retailers like Target, Kroger’s, Wal-Mart and Walgreens. The retailers now must limit the number of people in their stores “such that people can easily maintain a 6-foot distance from each other,’’ Strickland said. The retailers also must establish marked waiting lines to keep customers 6 feet apart, provide hand sanitizer at entrances and mandate that employees wear face coverings. The stores must provide an hour of daily controlled access for customers over 55 or who are pregnant or have serious underlying health conditions.

“We must get back to business the right way,’’ Strickland said, recounting criteria steeped in “medical advice and data’’ needed to begin reopening in earnest: a steady decline in the number of new cases and an ample number of available hospital beds along with increased testing and tracing capabilities.

“We cannot squander all the good that we have done with our social distancing efforts to slow the spread of the virus.’’

Still, pressure is building.

Bill Lee

Gov. Bill Lee has said he will not extend his safer-at-home order — among the last in the nation — past Thursday, April 30. Already, he is allowing a restricted reopening today of restaurants in Tennessee’s 89 rural counties, including two abutting Shelby County — Fayette and Tipton counties.

“My nature and a lot of the nature of people in Atoka is to hug. Well, we don’t even do that anymore, you know. So, it’s altered life in that way,” Mayor W. Darryl Walker said of the pandemic’s effect on his community. He was photographed at Atoka Town Hall Sunday, April 26, 2020. (Ziggy Mack/Special to Daily Memphian)

“They are really excited,’’ said W. Daryl Walker, mayor of Atoka, Tennessee, a town of about 9,400 people just across the Shelby line in Tipton County. Walker said he expects some of the town’s 15 or so restaurants to open today for dine-in eating at 50 percent capacity — an energizing development expected to lift the town’s spirits after weeks of social distancing.

“My wife goes in the morning from seven to eight to Kroger. And she said, ‘You know, Daryl, I walked around. Nobody will say anything. They looked just face forward. And don’t smile. Don’t do anything. Like a zombie type thing.’ So, it’s kind of altered that type of thing. Now, we still try to be polite. Don’t get me wrong. But everybody tries to keep their distance,’’ Walker said.

“My nature and a lot of the nature of people in Atoka is to hug. Well, we don’t even do that anymore, you know. So, it’s altered life in that way.’’

Reopening Louisville

It’s those many small towns and rural counties stretching across Tennessee and Middle America that so worry some people.

A widely circulated Buzzfeed article earlier this month compared the coronavirus responses in the bordering states of Tennessee and Kentucky. The article reported that Kentucky Gov. Andy Beshear’s early state of emergency order had seemingly led to a drastically lower number of infections. As of April 4, Kentucky reported 1,840 COVID-19 cases and 94 deaths compared to 5,308 cases and 101 deaths in Tennessee, Buzzfeed reported.

Critics like Mike Stewart say Lee, a Republican, not only acted slowly, he could have done more to promote statewide testing.

“Nobody should be untested in the state of Tennessee because of a financial issue,’’ said Stewart, the Democratic Caucus Chairman in the state House of Representatives. “Because every week this thing goes on it’s another week in which we’re intolerably suffering significant loss of life and a dramatic decrease in the functioning of our society as a whole.’’

 Yet, as of Friday, the Tennessee-Kentucky comparison appeared a bit more muddled:

Kentucky had 3,779 COVID-19 cases and 200 deaths. Tennessee had 8,726 cases – nearly 5,000 more than Kentucky – but just 168 deaths, 32 fewer than its neighbor to the north.

Kentucky had its own problems gaining access to testing — a challenge compounded by widespread underlying health issues in the Bluegrass State, where nearly one in four adults smoke.  

“Our weaknesses have been a lack of testing materials,’’ said David James, president of the Louisville Metro Council. Like Memphis, Louisville is playing catchup. Demand is so great, a testing site planned this week for underserved west Louisville clogged with appointments before even opening, James said.

David James

“A week’s worth has already filled up with people that have made reservations,’’ he said.

The similarities between Memphis and Louisville run much deeper than differences forged over a decades-long college basketball rivalry: Both are river cities. Both are major logistics hubs. Both have large segments of the population living in poverty.

But coronavirus fatalities appear much higher in Louisville. According to data published by the local health department, 78 people had died of COVID-19 in Louisville-Jefferson County as of Friday, April 24. That’s 10.2 deaths per 100,000 people. By the same date, 43 people had died in Memphis-Shelby County —4.6 deaths per 100,000 residents.

Just as in Memphis, the coronavirus in Louisville has hit the minority community hard. African Americans represent more than a third of the deaths there despite comprising just 22 percent of Jefferson County’s population — a phenomenon attributed to longstanding inequities in healthcare, housing and other essentials.

”The pandemic did not cause these inequities. People did,” Mayor Greg Fischer was quoted as saying in the Louisville Courier-Journal. “… It’s hundreds of years (in the) making for our African American population, so we need to make sure that we have elected officials today that understand the fact that this is not acceptable.”

Greg Fischer

Fischer last week unveiled a blueprint for a gradual, phased-in reopening called “Build Back Better, Together,’’ that relies on criteria similar to the Memphis plan and starts with a note of caution: “We are making progress, but until a vaccine against COVID-19 is found, our lives will be changed.’’

Metro council president James said health data and steady improvement will drive a reopening that could drag on over many weeks.

“We’re just going to go by the metrics and the science and let that guide us,’’ he said.

Roadmap for Nashville recovery

Nashville Mayor John Cooper unveiled his own recovery plan last week called “Roadmap for Reopening Nashville,’’ outlining a phased-in process that could drag on for months before the city returns to normalcy.

The plan is the culmination of weeks of struggle there.

The pandemic hit Nashville sooner than Memphis, and for a time, it seemed the COVID crisis was more a Middle Tennessee problem.

On March 19, as the coronavirus started spreading across Tennessee, Shelby County reported just 10 cases.

Davidson County had more than 70.

“The majority of those (cases are) still in Middle Tennessee,’’ Shelby County Health Department Director Alisa Haushalter said then, providing a degree of comfort that would later fade.

Alisa Haushalter

Memphis soon narrowed the gap. By Friday, Memphis-Shelby County reported 1,981 cases compared to 2,176 for Nashville-Davidson County.

Memphis far eclipses Nashville in deaths. Shelby County reported 43 deaths by Friday — a death rate of 2.2 percent among those testing positive for COVID-19. Davidson County reported 22 deaths or a 1 percent death rate. Shelby also led in deaths per capita: 4.6 fatalities for every 100,000 residents compared to 3.2 in Davidson.

A constellation of data points underscores that disparity: Median household income is 14 percent higher in Davidson County than in Shelby. Davidson has more homes with computers, more internet access and greater numbers of college graduates. The poverty rate is 29 percent lower there.

Inside Memphis proper — where one in four people live below the poverty line — the inequity gap grows even wider.

“This is a two-front war,’’ Shelby County Mayor Lee Harris said last week, saying authorities are waging one war against COVID-19 and a second one to protect people caught in a crushing poverty that makes them especially vulnerable to the disease.

“The second fight is a fight to save and preserve livelihoods. That second fight is also important because we know that lives have been shortened by poverty, by food insecurity and by loss of job.’’

Two of every three COVID-19 patients here are African American.

Among those who have died, more than 70 percent are black (the county is 54 percent black).

“Most of those persons (who have died) have heart disease, congestive heart failure or high blood pressure — some cardiac involvement,’’ said the Health Department’s Sweat. “And simply being hypertensive — somebody who takes blood pressure medicine every day — that is a significant co-morbidity and risk factor for poor outcomes.’’

Though more tests have been conducted here — 21,655 COVID tests had been conducted in Shelby by Friday compared to 20,890 in Davidson — Davidson led in tests per 100 residents, 3 to 2.3.

Nashville is perhaps a step ahead, too, in the push to reopen. But even there it won’t be easy.

Mayor Cooper’s “Roadmap” for reopening calls for a four-step process to be rolled out over weeks — and perhaps several months — if authorities can contain the coronavirus.

John Cooper

“A safe rollout must be data driven, not date driven,’’ Cooper was quoted as saying by The Tennessean news organization.

Cooper’s plan calls for moving to Phase One after 14 days of “positive improvement,’’ including steady declines in COVID cases. In Phase One, restaurants, retailers and commercial businesses would open at half capacity with employees wearing masks. Nail salons, gyms and beauty shops would remain closed. After another 14 days of improvements, the city could move to Phase Two: three-quarters capacity for restaurants, retailers and commercial businesses with nail and hair salons opening by appointment only.

With another 14 days of improvements, the city could move to Phase Three — schools and gyms reopening and gatherings of up to 100 allowed among other things — and eventually to Phase Four, when those over 65 or at high risk would still be required to stay at home and when the wearing of masks in public would become optional.

Any serious setback in the metrics would require returning to an earlier phase.

Reopening Memphis

In Memphis, the metrics seem positive. The spread of the coronavirus has been slowing.

“The data has given us reason to have some guarded optimism,’’ Harris said. “The data suggests that this is the right time to begin entering the next phase.’’

The data in question is the number of new COVID-19 cases reported daily. Following a high mark on April 15, when the county reported 108 cases and April 16, when it had 115 — 223 cases over two days — totals have dropped and remained steady.

Each successive day brought hope: April 17 – 35; April 18 – 41; Then 50, 37, 37, 50.

“We’ve been on a plateau, a stable plateau, averaging 35 to 50 new cases per day,’’ said the Health Department’s Sweat. “And that is good news.”

“The Plateau’’ is a great source of discussion among officials.

“Recent data is showing a plateau,’’ Strickland wrote in his weekly update, “and our medical experts are of the opinion that our community can seriously plan to lift restrictions and ‘reopen.’ ‘’

Whether the plateau will persist or blow up remains to be seen. A report released Sunday, April 26 indicates the daily total jumped by 95 cases over the previous day.

Nonetheless, officials are pushing forward.

Critical to the reopening question are daily meetings of the city and county mayors’ economic recovery task force as well as community input of the sort to be received Tuesday, April 28, when county government and the Chamber host the “New Normal Virtual Summit.’’

It features four micro-conferences, one for government sector employers, another for the county’s large employers along with separate conferences for food and hospitality employers and small business.

“We’re in one of the most transformative periods in U.S. history,’’ said Harris, who said he plans to ask the County Commission soon to commit more money to the $2.5 million in COVID relief already pledged.

Calling it “COVID relief part two,’’ Harris said he’ll seek funds sometime in the next month to beef up the Health Department’s abilities to do contact tracing and provide other services to battle the coronavirus.

“We want our public health department to be at its strongest possible capacity,’’ he said.

The long transition back to normal will require many adjustments including possibly wearing masks in public for some time to come.

In issuing his revised safer-at-home order, Strickland said he “strongly encourages’’ residents to wear facial coverings in public “when engaging other folk’’ or “entering a place of business.’’

<strong>Jeff Warren</strong>
Jeff Warren

Dr. Jeff Warren said the public should expect to wear masks possibly for years to come.

“So, this is so the new normal: We’re all going to be wearing masks. And when we go to a restaurant, we’ll be sitting 10 to 15 feet away from other people. And we’ll order in our masks with our waiter in his mask. And he’ll bring the food. We’ll take our masks off and eat with our friends that we know have been tested,’’ said Warren, a Memphis city councilman, physician and member of the COVID-19 Task Force.

“And that’s how it’s going to be in public service places. When you come to my (doctor’s) office, I’ll have a mask on for the next two to four years.’’

Despite the uncertainty about the future, most officials agree recovery will come slowly and with many bumps along the way.

“It’s not like any city or any state has just turned on the switch and we’re back to the way it was in January and February,’’ Strickland said. “They’re all phasing things in.’’

This story first appeared at dailymemphian.com under an exclusive use agreement with The Institute. Photos reprinted with permission of The Daily Memphian.

Marc Perrusquia
Written By

Marc Perrusquia is the director of the Institute for Public Service Reporting at the University of Memphis, where graduate students learn investigative and explanatory journalism skills working alongside professionals. He has won numerous state and national awards for government watchdog, social justice and political reporting.

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