A month ago, local health care leaders were preparing for the worst.
With some projections indicating a COVID-19 surge would hit Tennessee around mid-April, the state was racing forward in a furious effort with the U.S. Army Corps of Engineers to re-fashion and equip arenas and convention centers with medical equipment and 7,000 overflow hospital beds.
A chief concern was having enough ventilators to sustain patients in respiratory failure, a mark of severe infection in the coronavirus global pandemic.
In Chattanooga, the plan was to outfit a 400,000-square-foot building on the Alstom property with enough staff and beds to treat around 1,500 patients. Multiple loads of personal protective equipment from the Tennessee Emergency Management Agency were delivered and distributed to acute care hospitals across the region to alleviate supply shortages.
Scarce data due to a limited amount of COVID-19 testing left local decision makers largely in the dark. Chattanooga's peak in cases was expected to come a couple of weeks behind the state's based on what was happening in Nashville and Memphis — which saw cases sooner and were where most of Tennessee's data was coming from.
Officials said they would rather overprepare than wind up in a situation like New York, where a Navy hospital ship was sent to relieve stress on New York City hospitals. Hospitals there are still overwhelmed with coronavirus patients, although the pandemic's trajectory in the state is steadily improving.
But Chattanooga's anticipated surge never happened — a strong indicator that social distancing and stay-at-home orders slow the spread of the virus.
And while plans, including the Alstom site, are still in place, they're on hold until if and when a second wave comes.
Some experts say data on hospitalizations — which generally occur a week or two after infection — is the best representation of an outbreak's severity. That's because case count data is subject to how much testing is being done, and most people with coronavirus don't require hospitalization. But the more people are infected, the more people with COVID-19 wind up in hospitals.
At this point, the highest number of coronavirus patients hospitalized at the same time in Hamilton County was 14 on April 25 and May 1, according to data from the Hamilton County Health Department.
Although the county's COVID-19 cases spiked last week, the burden on local hospitals has remained small and manageable. County Mayor Jim Coppinger attributed much of the rise in cases to an increase in testing. He said during a news conference Thursday that none of the newly diagnosed residents (21 that day) were hospitalized.
"We look and focus on the number of people that we have in the hospitals and also the number of beds that are available. We don't want to be caught with a surge of people in the hospital and not have capacity, and we're in great shape with all of those indicators," Coppinger said.
On Friday, there were nine coronavirus patients in Hamilton County hospitals, some of whom may be from outside counties. Six of the patients with COVID-19 were being treated in the intensive care unit.
Since April 1, the county's Emergency Operations Center has tracked how many ventilators, general hospital beds and ICU beds are available in the three major health systems: Parkridge, Memorial and Erlanger. Overall, there are 1,000 general beds, 184 intensive care unit beds and 434 adult ventilators spread across those hospitals.
Hospitals had the most open beds on April 11. At that time, all elective procedures had been placed on hold to save room for the anticipated surge. There were 79 adult ICU beds, 373 adult general beds and 354 ventilators available that day, not taking into account pediatric beds and ventilators, which the county is also tracking. In desperate times, some pediatric beds and ventilators could also be used for adults, who typically experience far more severe cases of coronavirus than children.
After weeks of watching and waiting, the governor lifted his executive order and the hospitals resumed elective procedures this week. As a result, Thursday saw the lowest number of available beds and ventilators — 155 general beds, 37 ICU beds and 365 adults ventilators sat unused.
On Friday, representatives from each of the hospitals gathered to recap their first week of returning — at least somewhat — to normal.
"We have started on a, sort of, scaled approach, so that we are doing approximately 50% of our normal volume. That is our goal for now and not to go above that," said Dr. Matthew Kodsi, vice president of medical affairs at CHI Memorial. "We're going to watch that approach for at least a period of a few weeks, given the fact that this virus takes up to about two weeks from once you catch it to possibly showing symptoms. So we're going to watch, and we're going to see.
"We've been incredibly fortunate to avoid some of the predicted peaks that we heard about early in the disease, and we'd like to keep it that way," Kodsi said, adding that all three hospital systems have maintained strict infection control and visitation policies to ensure safety.
Even if the disease itself largely spares Chattanooga, the impact of COVID-19 on local hospitals is staggering. Aside from the financial toll, they're seeing the ramifications in their patients, many of whom have delayed care to the point that their condition significantly worsened.
Dr. Mark Freeman, an orthopedic surgeon at Erlanger Medical Center, said the hospitals never stopped treating emergency care, which is necessary to sustain life. But there's also urgent care. Although it may not be immediately life threatening, it's still significantly time dependent, Freeman said.
"Elective is still medically necessary," Freeman said. "There have been many patients who have delayed medically necessary care because they thought it was elective, and they ended up with worse outcomes — out of the fear of a possible COVID infection, when in reality, they had a real, current condition that could have been treated better in a more timely fashion."
Freeman said providers are poised to help patients make those decisions about when and how to seek medical care.
"If you need a colonoscopy because you have a large family history, or a history of yourself that needs to be monitored, don't delay in getting your colonoscopy," he said. "Talk to the provider. If the provider has hesitations about the timing now, they will tell you."
And just because the data looks good today, doesn't mean that won't change tomorrow.
"From the very beginning as we started to open up, we said we're taking baby steps," Coppinger said. "I keep reinforcing that. And we've said that if we needed to pause, if the numbers were different, or if we needed to put the brakes on, or if we needed to do a reversal, we'd keep all of those things on the table. Nothing's changed.
"It's still the same virus that it has been all along," he said. "It's still extremely contagious, and we have to take every measure we can to protect ourselves and to protect others from any exposure."
Contact Elizabeth Fite at firstname.lastname@example.org.