This story was updated at 8:05 p.m. on March 31, 2020, with more information.
NASHVILLE — A Franklin, Tennessee, physician is sharply criticizing Gov. Bill Lee's "safer at home" coronavirus executive order issued Monday, calling it "weak leadership" that is generating public confusion.
"This order doesn't go far enough to save lives and keep Tennesseans in their homes," said Dr. Aaron Milstone, a pulmonary specialist treating COVID-19 patients in Williamson County, in a statement and video. "Gov. Lee's weak leadership has created confusion, and that in turn is undermining the strong, early steps many of our cities' mayors took to protect families."
Milstone said that "some Tennesseans are separating from others, but many are not — and this means this virus keeps spreading. Urging separation is not enough."
Lee's Executive Order 22, one of two he signed Monday, cites a "Safer at Home" policy. It states "because staying at home as much as possible for a temporary period of time will protect the health and safety of Tennesseans by limiting the spread of COVID-19 and preserving health care resources, all persons in Tennessee are urged to stay at home."
It includes a lengthy list of exclusions in areas including medical services, food shopping and many outside activities.
"This is not a mandate for people to shelter in place," Lee told reporters Monday. "This is an urging of citizens to not utilize non-essential businesses. And the reason is it is urging them to stay in place and change behavior."
Lee's other order, Executive Order 21, directed the closure of "non-essential" businesses including barber shops, hair salons, waxing salons, threading salons, nail salons or spas, spas providing body treatments, tattoo services, tanning salons, massage-therapy establishments or massage services.
It also directs entertainment and recreational gathering venues to shut down, including nightclubs, bowling alleys, arcades, concert venues, theaters, auditoriums and performing arts centers.
Lee told reporters Monday that by closing the businesses, he is ensuring they won't serve as places where the coronavirus can be spread.
"I think it sends a strong message to Tennesseans," he said. "It certainly changes the environment in which they will operate in every county across our state. And it will strengthen the social distancing across our state, which we all know will help slow the spread."
During his teleconference call on Tuesday with reporters, Lee said he gets advice from "experts all across the United States and not just Tennessee." That "certainly" includes medical experts, the governor said.
Lee said "there is a lack of real evidence as to what decisions are actually producing real results."
Pointing to the experience of New York Gov. Andrew Cuomo— at one point Cuomo issued far stronger orders regarding nonessential workers only to later back off— Lee said the governor "maybe came to the conclusion that was bad policy."
Cuomo said last week in an interview, "I take total responsibility for shutting off the economy in terms of nonessential workers, but we also have to start to plan the pivot back to economic functionality. You can't stop the economy forever."
Lee said he seeks to account for sometimes conflicting information, adding, "we've tried to determine the right time" to have the "right impact" on the coronavirus curve.
In a teleconference call with Tennessee reporters Tuesday afternoon, Dr. David Aronoff, director of infectious diseases at Vanderbilt University Medical Center, stressed the importance of social distancing and curbing outside activity generally.
After displaying a chart showing the rising number of Tennessee COVID-19 positive cases through March 30, Aronoff said, "it's hard not to find a county [in Tennessee] not affected, and that's just 11 days from March 19."
And he cautioned that data on infection trends and hospital bed capacity, including intensive care units, suggest "we may overrun our health care capacity if we're not able to limit the number of infections over time" in Tennessee and "if we don't do more in mid- to late April."
While crediting Lee with taking some actions, Aronoff stressed that "stay-at-home orders I think are very important.
But Lee did not rule out further restrictions. Several cities, including Chattanooga and Nashville, have acted more quickly to address the virus. So have states such as Kentucky, California and New York.
In fact, Kentucky Gov. Andy Beshear is telling Kentuckians to avoid Tennessee if they can unless they are going to work, to help a loved one or to the grocery store, the Lexington Herald-Leader reported Friday.
House Democratic Caucus Chairman Mike Stewart of Nashville said Monday that Lee's plan "does not go far enough. He should be listening to the thousands of doctors that have told him that what Tennessee needs is a shelter-in-place order and nothing less."
Tahra Johnson, a member of the National Conference of State Legislatures' Health Program, said various states have issued different types of orders to encourage people to remain at home and leave only for "critical tasks," including seeking health, safety and food.
"They vary," she said of the approaches in a video posted to the conference's web site, later adding the idea is that "the best way to lower" the infection rate is to "avoid being exposed."
Dr. Milstone and a number of fellow physicians strongly disagree that Lee's latest actions are sufficient and say the crisis demands far stronger steps immediately.
"It's 11 days, our state now has 2,000 cases and now we're up to 13 deaths since more than 2,000 doctors and health care workers sent a letter to Bill Lee pleading him to issue a stay-at-home order," Milstone said in his video. "Multiple health experts have deemed a statewide order as essential if Tennessee is going to save lives by mitigating the strain on our hospital system and on medical equipment supplies."
Milstone said the Republican governor's "failure to act early and listen to the plea of doctors has really allowed things to get a lot worse in our state. His urging [Monday], really in my mind does not go far enough to save lives and keep Tennesseans in their homes."
Contact Andy Sher at email@example.com or 615-255-0550. Follow him on Twitter @AndySher1.