Blake Farmer

The country’s largest hospital chain is getting into the manufacturing business. Nashville-based HCA says it’s entered into a new joint venture with a health care products manufacturer to make masks, gloves and gowns in North Carolina.

HCA is responding to the global shortage of personal protective equipment that rose to crisis levels early in the pandemic and have persisted. Most of the country’s PPE came from China, which had its own COVID-related needs.

“The recent surge in demand for PPE due to the pandemic has underscored how dependent we have been on supplies from overseas and the importance of working to diversify our supply chain,” chief medical officer Dr. Jonathan Perlin says in a statement.

Tennessee lawmakers rarely debate consequential legislation in the first few days of a session. But the General Assembly is forgoing precedent to alter how the state’s Medicaid program receives federal funding, and in the process will be altering roughly a third of the state budget before the Biden administration takes over.

Passage is a given. The same Republican majority told TennCare to seek this so-called “block grant” for Medicaid, which has been a dream of conservatives. Now that dream is nearly reality.

But in less than a week, the country will have a Democrat in the White House, leading a party that has opposed block grants for Medicaid and argued that they only lead to cutting benefits and beneficiaries from programs.

Tennessee ended 2020 with more COVID deaths than some of the worst early predictions. And those same models now show fatalities in the state could double by April 1.

The state ended the year reporting nearly 7,000 confirmed and probable fatalities from COVID-19. That number will increase since there’s usually at least a two-week lag for reporting COVID deaths.

More than a third of the deaths were reported in the month of December, meaning the pandemic is still accelerating. Roughly 2,400 deaths were reported last month, making it the most deadly month of the pandemic — by far.

Gov. Bill Lee is calling a special session of the legislature to address urgent education issues related to the pandemic.

In an announcement released Tuesday, Lee says that the state expects proficiency in math and English test scores to drop by more than half. In a special session, he says the legislature will equip teachers and school districts with “resources and supports” needed to combat learning loss.

It’s unclear what that will mean in practical terms, though the governor’s office says the bills will address funding, teacher and district accountability for test scores, literacy and teacher pay.

Some COVID-19 vaccines are already in use, but the clinical trials roll on. In fact, they’re still recruiting participants, and they’re particularly focused on signing up people of color.

At first, speed was the top priority. Now diversity is, says Dr. Stephan Sharp, who leads a vaccine trial site at Clinical Research Associates in Nashville. He recently held a Facebook event with Kurdish young professionals.

“We want folks from all different ethnic backgrounds. because it’s possible that the vaccine works better in one group or lesser in another group, and the only way to find out is to test it,” he said.

Hospital capacity has become so tight in Tennessee that patients who would normally be airlifted to Vanderbilt University Medical Center are often being diverted away from Nashville altogether.

Over the weekend, COVID-19 hospitalizations reached nearly 2,700 statewide, setting a new record for the pandemic. Some rural hospitals don’t have intensive care units or the ability to manage patients on ventilators.

“Nashville has reached maximum capacity for their bed space, so now we’re having to utilize some of our larger rural hospitals to transfer from some of our smaller rural hospitals,” says flight nurse Mark Tankersley, who is stationed in Murfreesboro at one of Vanderbilt LifeFlight’s bases.

Even Tennessee’s largest hospital is running into capacity issues, with more than 200 staffers out sick with COVID-19 or quarantining because of close contact.

Tennessee hit a new high for hospitalizations over the weekend. Dr. Matthew Semler, a physician in the intensive care unit at Vanderbilt University Medical Center caring for COVID patients, says patients are arriving from as far away as Arkansas and southwest Virginia because so many hospitals can’t take more patients.

“We’re already in a state where the vast majority of our patients now in the intensive care unit are not coming in through our emergency department,” he says. “They’re being sent hours to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion.”

As COVID-19 hospitalizations set new records nearly every day in Tennessee, doctors are speaking out about the dire situation they see in their emergency rooms with patients traveling hours to find a hospital that has space for them.

Physicians from Vanderbilt University Medical Center, Saint Thomas Health and TriStar spoke Wednesday on a video call, primarily reiterating their pleas for a statewide mask mandate. But they also revealed a more desperate situation than most hospital administrators have been sharing publicly.

“We have been frequently on diversion, meaning we don’t take transfers from other hospitals. We try to send ambulances to other hospitals because we have no beds available,” Dr. Jessica Rosen says.

Tennessee hospitals are calling off elective procedures again, doubling up hospital rooms and converting recovery rooms into intensive care units, according to the Tennessee Hospital Association. These changes come as hospitals are seeing twice as many patients with COVID-19 as they were in early October, surpassing 1,800 current hospitalizations on Monday.

Rooms and beds haven’t been the problem in Tennessee. It’s the nurses and doctors to staff them.

“I anticipate in the coming week(s) authorizing a complete cessation of ALL non-emergent surgeries and procedures in our hospitals so we can redeploy staff to care for an expected increase in cases,” Ballad Health CEO Alan Levine wrote on Facebook over the weekend.

Rather than cash-strapped, Tennessee is actually quite flush. The latest tax revenues from October show the state has already built up a $1 billion surplus in tax collections.

The state started the fiscal year in July expecting less revenue, and instead collections have grown substantially, with another $134 million more than budgeted in October.

But Finance Commissioner Butch Eley says federal stimulus money is still propping up household spending. From direct payments to families, grants to small businesses and coronavirus relief funds the state doles out, a total of $14.6 billion has poured into the state, according to a state stimulus dashboard.

Tennessee is looking for the best way to spend $272 million in coronavirus relief funds by the end of the year, and the money will likely go to familiar initiatives.

“Ultimately, we’ll have plenty of options available to exhaust the remainder of the coronavirus relief fund,” says, Tony Niknejad, policy director for Gov. Bill Lee.

The financial stimulus accountability group is charged with overseeing the spending but has largely followed the governor’s lead. The governor’s office has three priorities for the remaining money.

A study that’s causing public health officials to grow more concerned about COVID spreading between loved ones is based primarily on families in Nashville. Researchers hope it’ll reveal the most common ways relatives and roommates get each other sick.

The existing research on household transmission of COVID-19, like this study from New York, mostly relies on looking back at contact tracing data, which can have big holes. So Dr. Carlos Grijalva, a Vanderbilt University epidemiologist, decided he would create his own data set.

His research team has now followed nearly 200 households, mostly in Nashville with some also with a research site in Wisconsin. When one person gets sick, they get consent from the patient and members of the household, then begin interviewing them and taking nasal swabs and collecting saliva for 14 days.