Blake Farmer

The agency tasked with enforcing workplace safety rules in Tennessee has rejected a directive from state lawmakers to abandon federal COVID rules adopted in late August.

On Monday, the Joint Government Operations Committee voted for a “negative recommendation” toward the emergency rules, which govern masking, testing and distancing in hospitals and nursing homes. But at the hearing, officials with the Tennessee Occupational Safety and Health Administration warned that if the state refused to enforce the safety rules, federal authorities would likely intervene.

“The statutory language regarding rules does not authorize the withdrawal or the stay of a rule once the rule has become effective,” writes Tennessee Labor Commissioner Jeff McCord in a letter to Rep. John Ragan, R-Oak Ridge, who chairs the Joint Government Operations Committee.

Vanderbilt University Medical Center’s deadline for complying with a vaccine mandate passed Thursday, following a surge of COVID shots being given to hundreds of employees in order to keep their jobs.

At this point, 97% of the health system’s workforce has now “complied” with the vaccine mandate, a figure that also includes those who received an exemption. That’s up from 95% early this week and up from 72% two months ago, when the mandate was announced. But even the big jump leaves roughly 900 who could lose their jobs.

Vanderbilt is now making sure employees didn’t receive a vaccination elsewhere and just not tell their employer.

The hospital on post at Fort Campbell has been full of COVID patients, and most are unvaccinated. That’s despite a mandate for all soldiers.

Active-duty soldiers in the U.S. Army have no choice about taking the COVID vaccine at this point, but they don’t have to be fully vaccinated until Dec. 15, according to plans outlined last week by the Department of Defense.

But Blanchfield Army Community Hospital at Fort Campbell also serves the families of soldiers and local retirees. And health officials on post are becoming more emphatic about encouraging them to take the vaccine.

Maj. David Henley, the physician who leads inpatient care at BACH, says the hospital is seeing large numbers of patients under the age of 40.

“In fact I’ve had several in their 20s who are getting critically ill with COVID-19,” he says.

COVID hospitalizations are beginning to ease up in parts of Tennessee. But intensive care units remain dangerously full, creating a backup in hospitals across the state.

The critical access hospital in Bolivar usually only has two or three patients at any one time. Right now, the rural West Tennessee facility has a dozen patients, and half of them are sick with COVID, according to CEO Ruby Kirby.

“In normal times, we would be able to get those patients out to a higher level of care,” she says.

Some are on ventilators being cared for in the small emergency department and need to be transferred to an ICU in Jackson, Memphis or Nashville. But there are no openings, Kirby says.

“We’re managing them, but it is putting a strain on the system, trying to hold these patients in these hospitals until we can get them moved,” she says.

Tennessee has reopened a fund to help hospitals fly in temporary nurses as they’re short on staff. But hospitals are finding that there’s not much money left, even though the shortage is more critical than when they needed staffing help during the winter surge.

It’s a competition between hard-hit states where hospitals are overwhelmed and understaffed. Texas has a Texas-sized program. Mississippi has committed $10 million a week to bring in a thousand travel nurses. Meanwhile, Tennessee has $10 million total remaining from what was originally a $100 million fund.

“The money, thus far, that the state has committed to is not putting us into a position where we can compete very well,” says Dr. Wendy Long, the CEO of the Tennessee Hospital Association.

Some Tennessee hospitals are already treating more COVID patients than ever. And the statewide total is likely to hit a record this week — surpassing the peak of the winter surge.

ICUs have never been so strained. Nearly a third of the more than 3,000 COVID patients in Tennessee are so sick that they’re being treated in the ICU.

“We have beds. We don’t have the staff to take them. That’s the scary part,” says Taylor Wylie, a charge nurse in the ICU at Centennial Medical Center in Nashville.

Since the surge stretches across the under-vaccinated South, Wylie says they’re getting transfer requests from as far away as Texas and usually having to say no. Alabama, for instance, has a running deficit of ICU beds. Tennessee, at the moment, is at 94% capacity statewide.

The Tennessee Guard is now pitching in at 13 hospitals that requested staffing assistance, including the largest hospitals in the state.

Vanderbilt University Medical Center in Nashville is included in a list of six medical centers who have started receiving help since Monday. Also leaning on the guard are the University of Tennessee Medical Center in Knoxville and Regional One Health Medical Center in Memphis.

The two other large Memphis systems — Baptist and Methodist Le Bonheur — were announced last week. And Ballad Health in northeast Tennessee is using 20 guardsmen.

In total, 155 soldiers have deployed to Tennessee hospitals. They represent military medics and non-clinical troops, but they’re generally not being asked to take on clinical roles. Instead, the idea is for troops to take on administrative tasks and free up nurses to work more closely with patients. Staffing has been the primary limiting factor to hospital capacity in Tennessee.

The pandemic has never been so hard on Tennessee children as it has been the last few weeks. Cases surpassed the previous high set in the winter surge, and hospitals are feeling the pinch.

The 7-day average for school-age is now close to 1,400 new cases a day, with nearly 16,000 new infections statewide in 5-18 year-olds over the last two weeks, according to state data.

At this point, nearly a third of all new cases are among Tennessee kids 18 and younger — also a record for the pandemic.

Pediatric hospitalizations still represent a tiny fraction of the overall totals, which are climbing every day. But already children’s hospitals, which have less flexibility than adult hospitals, are having to make space for COVID patients.

Tennessee may risk federal civil rights inquiries if the state continues on its current track, allowing parents to opt out of school mask mandates for no reason at all. The U.S. Department of Education has put eight states on notice that their current guidelines conflict with federal policy meant to offer a safe, in-person learning environment.

In a memo, Secretary Miguel Cardona says his department may “initiate a directed investigation if facts indicate a potential violation of the rights of students as a result of state policies and actions.” He says the department will also respond to complaints from parents of students “who may experience discrimination as a result of states not allowing local school districts to reduce virus transmission risk through masking requirements and other mitigation measures.”

Hospitalizations just keep climbing in Tennessee. The state is nearing 2,500 patients with COVID. And administrators know the worst is likely yet to come with new infections still surging and nearly 5,500 new cases confirmed on Wednesday alone.

Hospitals in Tennessee are already — in effect — full. Nurse Jerusha Robinson works at Vanderbilt University Medical Center, where the stream of patients is constant.

“Especially with our COVID patients, we know when we have someone who moves from our ICU to our stepdown unit, very shortly after, we’re going to get another ICU patient who is just as sick as that patient or even more sick,” she said Wednesday after her overnight shift.

The limiting factor keeping hospitals from being able to handle more patients, at the moment, is not the number of beds — it’s the number of nurses. And COVID patients often require more attention. For example, those near death on an ECMO machine that oxygenates their blood have to have their own dedicated nurse.

Misinformation is spreading among Tennessee Republican lawmakers, like that the governor is planning for “quarantine camps.” So his office is trying to cut off the “conspiracy theories unfortunately being shared as fact.”

In an email to legislators sent Thursday and obtained by WPLN News, staffer Brent Easley tells lawmakers that an executive order signed Friday to relieve hospital staffing shortages (without explanation at the time) is being distorted. Among the claims are:

• That it creates quarantine camps.
• That the National Guard plans to round up people who are unvaccinated for quarantine or forced vaccinations.
• That it lays the groundwork for permanent lockdowns.
  

In a letter to Tennessee’s governor requesting a special session, House Speaker Cameron Sexton says, “there is a need to curtail the overreach by independent health boards and officials” and “protect all Tennesseans from misdirected mandates.”

He specifically notes he wants to “confirm a parent’s right” to make decisions about their children’s health. His letter also says the legislature needs to “evaluate the ongoing discrimination” against people prevented from entering buildings because they haven’t been vaccinated against COVID-19.

Sexton had threatened a special session earlier this month as schools debated mask mandates, though Senate Speaker Randy McNally dismissed the idea. And in a statement Wednesday afternoon, McNally does not endorse a special session but says if one occurs he would want to keep it focused on keeping kids in classrooms, healthy and safe.

The people getting sick with COVID in Tennessee nursing homes has flipped: Instead of residents falling ill, now it’s mostly the staff.

Of the 120 long-term care facilities reporting cases among staff or residents, 93 have more staffers than residents testing positive. The totals, updated each Friday, put staff cases at 213 compared to 135 among residents over the past four weeks.

In one way, the reversal is a positive sign. Vaccinations are protecting those who were most likely to die from complications.

“Given the coinciding fact that deaths have dropped significantly in long-term care facilities since the vaccine effort has started, we know that vaccines are effective,” says health policy researcher Priya Chidambaram of the Kaiser Family Foundation.