Gov. Bill Lee said this past week there's no need to declare a state of emergency, as Chattanooga hospitals and health care providers reported being pushed to the brink by an omicron-fueled COVID-19 surge that many frontline workers are calling the most stressful of the pandemic so far.
Lee told reporters during a news briefing Thursday at the Watts Bar Nuclear Plant that emergency declarations are "a tool we should use when we absolutely have to have it" and he doesn't believe that's the case now.
"Hospitalizations are still lower than they were at their peak during the delta surge, so we don't have a plan for a state of emergency right now," Lee said.
Dr. Jensen Hyde, a hospitalist treating COVID-19 patients at Erlanger Medical Center who holds a master's degree in public health, said that although the omicron variant seems to cause less severe disease in individual patients when compared to the delta variant, the stress it's putting on the health care system is far greater.
Because omicron is so contagious and has infected so many more people, Hyde said patients regularly come in for other reasons - such as heart attack or stroke - and wind up testing positive for COVID-19.
(READ MORE: Omicron surge is undermining care for other health problems)
Some of those patients would normally be transferred to a rehab facility once stabilized, but because they're COVID-19 positive, those facilities won't take them due to safety protocols. That means those patients must stay in the hospital - often until 10 days from their first COVID-19 symptoms or until testing negative for the disease - which has resulted in a large backlog of patients and few open beds for not only coronavirus patients but other medical emergencies.
"We have seen hundreds and hundreds and hundreds of these patients, so for an already stressed health care system to have that, and then to have it causing delays in discharge has really, really, really stressed hospital capacity," Hyde said. "That's nationwide - that's not at all unique to Erlanger, it's not at all unique to Chattanooga. But it's hugely stressful on the system, and the system has been stressed. We did not need to be subjected to any more stress."
Even though those COVID-19 patients with incidental infections aren't critically ill, Hyde said they still require special care and must remain in isolation due to the highly contagious nature of the disease. At the same time, omicron can still pack a serious and deadly punch - particularly in the unvaccinated - which is compounding the issue in a region with low vaccination rates.
The potential for COVID-19 patients to overwhelm the health care system so that hospitals aren't able to care for those in need has been a top concern since the early days of the pandemic and a primary reason why states and local governments issued emergency orders and policies to limit transmission, such as face mask mandates and crowd restrictions.
Tennessee was under a state of emergency from March 2020 to mid-November, which is when Lee allowed the order to expire. November was also when Lee signed a new law that would allow local governments to implement mask mandates for COVID-19 only when the governor issues an emergency order and counties report 1,000 new cases for every 100,000 residents in the past 14 days. The Tennessean reported this week that every county in the state had surpassed that threshold.
As of Friday, there were 252 COVID-19 inpatients in Hamilton County hospitals, according to the Hamilton County Health Department. Though that figure is not as high as the peak of 372 patients seen during the early fall delta surge, it surpasses another high point of 242 set Dec. 31, 2020, and prompted Hamilton County Mayor Jim Coppinger to reconvene the area's Joint COVID-19 Task Force for an emergency meeting.
Coppinger previously told the Times Free Press, when omicron began to surge in late December, that even if the governor declared a state of emergency he did not have plans to reimplement a mask mandate.
"We're limited as to what we can do, and I don't know that it would be necessary," Coppinger said Friday. "I've always said that with the vaccine here, that's that best preventive measure for staying out of the hospital or a fatality, but I thought it was important to reach back out to [the task force] to see if there were any resources that we could collectively provide to each other.
"I wanted to see what they were seeing in the hospitals, because the numbers have consistently gone up. Staffing is an issue, and just the whole pandemic fatigue of everybody growing tired and weary," he said.
Rae Bond, chair of the COVID-19 Task Force and CEO of the Chattanooga - Hamilton County Medical Society, said the current staffing challenges in health care go far beyond the hospital walls.
"Virtually every kind of practice setting is struggling with the staffing issue, because we have folks out for a variety of reasons, including being out with COVID symptoms," Bond said, adding that the sharp increase in childhood COVID-19 cases is also taking many adults out of work. "I do think that's an ongoing issue that's causing difficulty for every kind of medical practice."
(READ MORE: COVID-19 cases are higher than ever in Hamilton County Schools)
Hyde said hospitals have the physical beds and space for patients, but they don't have the staff - particularly nurses - to care for more people.
"Even if you were able to find a whole class of nursing students that would sign on, they wouldn't have any experience, so it's a huge patient safety issue," Hyde said. "What we do, to try and keep patients as safe as humanly possible, is that we will close down beds so that we can maintain some sort of sane staffing ratios, so nurses aren't being forced to take care of 20 patients, and that means that our capacity continues to go down."
Hyde said the situation has regionwide implications because there isn't room to transfer patients who need more specialized care to Chattanooga, so they wind up either delaying needed treatment or getting sub-par care somewhere that isn't able to meet their needs.
"I think people were hearing [omicron is] milder, and they're not necessarily willing to take the same precautions. But if you're somebody who takes a public health view, or you're somebody who happens to work in a health care system, you might have a better understanding of the fact that the individual considerations are not the only consideration," she said. "Unfortunately, I think the vast majority of people either don't understand that or don't necessarily take that view, and hospitals are suffering."
Staff writer Dave Flessner contributed to this story.
Contact staff writer Elizabeth Fite at email@example.com or follow her on Twitter @ecfite.