Medical equipment is still strewn around the house of Rick Lucas, 62, who has been home from the hospital nearly two years. He picks up a spirometer, which measures his lung capacity, and takes a deep breath, though not as deep as he’d like.
The Metro Public Health Department closed its drive-thru vaccination sites over the summer, but some community groups, like FiftyForward and key houses of worship, continue to host smaller vaccine events that remain free and open to the public.
St. James Missionary Baptist Church in North Nashville is offering booster shots on Wednesdays for the foreseeable future. Pastor George Brooks doesn’t just allow his church building to be used for vaccinations. He talks about shots from the pulpit, reminding parishioners that the vaccine boosters are now more protective against the omicron variant.
“I don’t look at it as pushing it on anyone,” he says. “It’s stating the facts and leaving it up to them how they deal with the facts.”
The vaccines have been credited with helping keep down hospitalization rates and fatalities. Even though Tennessee’s vaccination rates lag much of the country, hospitalizations have dropped by more than half since a small surge in July and August.
Pop-up vaccination events (see the schedule here) are available most days in Davidson County, though doses for kids are not always available. The new bivalent booster is not authorized for children as young as five years old.
The YMCA and the Boys & Girls Club are planning nearly 10,000 new childcare spots across Tennessee with the state’s help. The money is coming from what’s left of COVID stimulus funding.
The state already works with these nonprofits and subsidizes childcare for those who qualify. That money also comes from the federal government each year through a block grant. But, it can only be used toward teachers and supplies, not buildings and transportation, according to officials from the Department of Human Services. So, this $19.4 million in COVID stimulus money will help offset the cost of establishing at least 60 new centers.
Many will go in rural communities, says DHS assistant commissioner Cherrell Campbell-Street, “particularly in those areas that we have designated as childcare deserts. There are actually several counties in our state that do not have reliable childcare centers.”
DHS officials say they believe the childcare spots can be sustained even when the stimulus money runs out. The YMCA is offering spots starting at six weeks of age. Boys & Girls Club will work with children starting at age 5.
The proposal got a green light from the Financial Stimulus Accountability Group on Friday, pitched as a way to get more parents back to work.
“If we have any hope of meeting our goals of increasing Tennessee’s labor participation rate, healthy, safe and affordable childcare is at the base of that,” DHS Commissioner Clarence Carter says.
The FSAG, as it’s known at the state capitol, is made up of mostly Republican officials, including Gov. Bill Lee, and has directed the spending of roughly $3 billion. But there’s been limited public participation. The meetings are quietly held each month in a small conference room or virtually.
Ivermectin will soon be available without a prescription in Tennessee. Both the state House and Senate have given final approval to the bill intended to make the anti-parasitic more easily available to treat COVID, despite a growing body of research that finds no benefit.
Democrats noted that some people have shown up to emergency rooms after taking too much ivermectin, often because they purchased the de-worming medication meant for livestock.
The sponsor of SB2188, Sen. Frank Nicelely of Strawberry Plains, said no matter what people believe about ivermectin, his bill should improve safety.
“It’s a lot safer to go to your pharmacist and let him tell you how much ivermectin to take than it is to go to the co-op and guess what size horse you are,” he said.
By late summer of 2021, outpatient prescriptions for ivermectin jumped 24-fold, and the Centers for Disease Control and Prevention was warning the public against using formulations found in feed stores. Since then, there’s been a growing body of evidence that ivermectin does not work against COVID, including a double-blind, randomized trial published March 30 in the New England Journal of Medicine.
Even the maker of the drug, Merck, has warned against using it for COVID treatment.
The lone Republican to raise questions and vote no was Sen. Richard Briggs, a surgeon from Knoxville, who said he may have a “pro-science bias.” He said he wasn’t too concerned about people overdosing on ivermectin, given that it’s been taken by hundreds of thousands of people in Africa to treat parasitic infections. But he didn’t want the public to get the idea that ivermectin could help treat COVID when there are proven antivirals readily available.
“Quite frankly, I think the science of this shows you’re taking a sugar pill,” Briggs said. “If we had nothing to offer, I think it would be fine to go on and do this.”
Still, Republicans were nearly unanimous in their support in both the House and Senate. Even the pharmacists in the General Assembly, including Senate Speaker Randy McNally, voted in favor.
Once signed by Gov. Bill Lee, the law will take effect immediately, though the Board of Pharmacy does have to create some processes. Not every pharmacy has to dispense ivermectin under the law. Those that do will have a standing, non-patient-specific prescription, similar to how they dispense naloxone. The bill also shields pharmacists from any liability that could arise from dispensing ivermectin.
Tennessee officials trying to distribute the last of the state’s federal stimulus funding have set aside $230 million for hospitals and nursing homes. They’re reopening an application process for facilities to allow them to make a case for some of the money.
The Financial Stimulus Accountability Group (FSAG) includes lawmakers and members of the governor’s cabinet. They thought they would give money directly to hospitals that asked for it. But with the quick timeline, it was mostly the largest facilities requesting money, like Vanderbilt University Medical Center and Ballad Health.
“I just know when push comes to shove and people start applying, sometimes it’s the slickest proposal that gets the most attention,” Secretary of State Tre Hargett says.
So instead, the FSAG decided last week to give $230 million to the Tennessee Department of Health, which will re-start the application process in July and make awards in January 2023 (see general outline here). The state will consider construction projects to expand hospital capacity, technology upgrades or other needs. Nursing homes are encouraged to propose infection control projects. But the proposals must link back to the pandemic.
A department official says proposals that help small facilities in rural communities will get priority.
Last week, the FSAG did approve direct grants to three nonprofits — $6 million for Teach for America, $15 million for Habitat for Humanity and $12 million for Goodwill. The state also wants to put some of its final COVID stimulus funding into child care services but hasn’t figured out how just yet.
The FSAG will have roughly $300 million remaining after the most recent allocations.
Two caskets sit by holes in the ground — one silver, one white. It’s a small, graveside service on a humid afternoon in the town of Travelers Rest, South Carolina.
Through tears, the family sings “I’ll Fly Away.” They had lost a mom and dad, both to COVID.
“They died five days apart,” says Allison Leaver, who now lives in Maryland with her husband and kids.
Leaver’s parents died in the summer of 2020. It was a crushing tragedy. And there was no life insurance or burial policy.
“We just figured we were just going to have to put that on our credit cards and pay it off, and that’s how we were going to deal with that,” the public school teacher says with a laugh.
But then, in April of last year, FEMA started offering to reimburse funeral expenses — up to $9,000, which is roughly the average cost of a funeral. And it was retroactive.
So Leaver applied ASAP.
“If this horrible thing had to happen, at least we weren’t going to be out the cash for it,” she says.
A year into the program, the federal government has paid out more than $2 billion to cover funeral costs for COVID victims. But in Tennessee, fewer than half of COVID deaths have resulted in an application for the money, and a WPLN News analysis finds most states have even lower participation.
Many surviving family members have run into challenges or still don’t know the money is available.
For those who know
FEMA launched a big call center, hiring 4,000 contractors in Denver. Everyone has to call to initiate the process. FEMA received a million calls on the first day, leaving many waiting on hold until they could get through.
Once she talked to a representative, Leaver started assembling the death certificates and receipts from the funeral home and cemetery. She uploaded them online — and heard nothing for months.
Eventually, she called and learned the receipts she submitted had different signatures — one from her husband, another from her sister. That was a problem. And even though it was a joint funeral, to get the full amount per parent, she had to have separate receipts. It was frustrating, but she was determined to get it done, “come hell or high water.” Plus, she says, it was summer break, and she had time.
But many haven’t.
Clerical challenges have discouraged some participation, especially for those with deaths from early in the pandemic, says Jaclyn Rothenberg, FEMA’s chief spokesperson.
“Some people with death certificates didn’t necessarily have COVID listed as the cause of death,” she says. “We do have a responsibility to our taxpayer stewards to make sure that that is, in fact, the cause.”
But Rothenberg says FEMA is trying to work with everyone. Even though the agency has spent the $2 billion initially budgeted, Rothenberg says there’s a new pot of stimulus funding from the American Rescue Plan Act.
Many don’t know
WPLN News analyzed FEMA’s data compared to official COVID fatalities through February 15. States with the highest participation are clustered in the South. North Carolina, South Carolina and Mississippi all have more than half of deaths resulting in applications. Other states are far below half. Arizona and Oregon have had just one-in-four participate.
It’s generally not a question of eligibility. One of the few disqualifiers (listed here) is if someone pre-paid for their funeral. And there’s still no deadline.
“We need people to continue helping us get the word out,” Rothenberg says. “We know we have more work to do.”
FEMA is launching an ad campaign to promote the program since there’s plenty of money left, Rothernberg says. But they’re also leaning on community groups connected to those who need to know about the money.
COVID Survivors for Change, founded by Chris Kocher, has been helping people navigate the process, including through a Facebook webinar.
“We were able to connect people to some of the survivors that had been through that process already just to help them walk through it,” he says.
Many just need someone to complete the application for them.
Stephanie Smith of Carlisle, Kentucky, lost her father to COVID. Her mother, who was 83 at the time, had no chance.
“She’s a very smart, spunky lady, but she’s never used a computer,” Smith says.
At a minimum, applying requires scanning or faxing.
“She probably would not have attempted to do it because the whole process would have been overwhelming for her,” she says.
But Smith was able to jump through the hoops without much trouble. And $9,000, she says, is enough to make life considerably easier as her mom adjusts to being a COVID widow.
There’s no evidence that Tennessee’s fired vaccine chief purchased the dog muzzle that was sent to her amid heated controversy last year, according to a memo from the Nashville District Attorney’s office.
Over the summer, Dr. Michelle Fiscus was fired from the Tennessee Department of Health. The commissioner, Dr. Lisa Piercey, claimed the firing was due to job performance, but Fiscus said it was political.
Lawmakers had been upset about an information campaign about vaccinating teenagers, as well as an opinion she issued that confirmed, under state law, teens could be vaccinated in some circumstances without parental consent.
Fiscus revealed that in the weeks before she was fired, someone sent a muzzle to her office. It was purchased with a credit card in her name, but the new report finds that it was likely the result of fraudulent activity. Fiscus’ personal information had been compromised. She cancelled an American Express card in May of 2020, but charges continued to go through more than a year later.
In the report, the district attorney’s office notes that it’s too soon to tell whether the muzzle was meant to be a political statement, but says the events appear “too coincidental to be random” — and recommends further investigation by federal authorities.
Hospital capacity shortages have largely stayed out of sight during the pandemic. But a new study from Vanderbilt University Medical Center that followed patients in dire need of high-level life support finds that the shortages resulted in unnecessary deaths.
For critical COVID patients, ECMO is a risky, last-ditch effort to save their lives. Their blood is piped out of their body and a machine does the work of the heart and lungs. Usually, ECMO is only considered once a ventilator is no longer keeping their blood oxygen level high enough for survival.
During the Delta variant surge late last summer, ECMO was in short supply across the South. Vanderbilt’s unit was taking 10 to 15 calls a day from hospitals without ECMO looking for an open bed. Even patient families were making calls on the behalf of dying loved ones.
“‘There’s no beds. There’s no nurses. There’s no machines. There’s just not enough. We just physically can’t,'” nurse practitioner Whitney Gannon says she would tell people calling from hospitals around the South. “It’s the worst feeling in the world.”
But Gannon grew curious about what happened to the patients she had to turn down — especially those who were young and healthy enough to be good ECMO candidates with a higher likelihood of survival. She started checking back, informally. Many of them had died, including a pregnant woman.
So within a matter of weeks, she helped launch an official study. And Gannon’s team started taking every call, even when no beds were available.
“We wanted to know: Is this patient truly medically eligible for ECMO? Would we provide ECMO? And if we didn’t, we wanted to know what happened to that patient,” Gannon says.
Anne RaynerCourtesy VUMC
An ECMO machine takes over for the heart and lungs when one or both fail. Vanderbilt University Medical Center only launched its ECMO center a year before the pandemic. And usually it had one or two patients. Even now, the max capacity is seven, largely because each patient requires so much staffing.
The results, published in the American Journal of Respiratory and Critical Care Medicine, are grim. Nearly 90% who couldn’t find a spot at an ECMO center died. And these were the patients who were young and previously healthy, with a median age of 40.
James Perkinson of Greenbriar is one of the lucky ones who found a bed. The 28-year-old machinist was taken off ECMO in late February after more than six weeks.
“It’s a miracle that I’m even able to have this second chance because of the ECMO,” he says from his hospital bed where he’s still recovering.
Being sedated for so long, Perkinson says he will have to relearn how to walk and use his arms, which could take more than a year to fully recover. But he’s alive for his wife and two young children.
The effectiveness of ECMO, which stands for extracorporeal membrane oxygenation, has been questioned throughout the pandemic, even as use of the therapy spiked. Many centers slowed down after a study was published in The Lancet in late September, finding that the number of COVID patients dying on ECMO had worsened 15% since the beginning of the pandemic.
Even early on, roughly half weren’t surviving. And as the pandemic dragged on, more hospitals with less experience were using ECMO, and some expanded criteria to include older patients or those with risk factors like obesity who’ve been thought not to do as well. But there has been limited data.
Hospital capacity crunches have been central to the debate because ECMO requires even more staffing than patients on ventilators. And sometimes the patients stay on the therapy for months, not just weeks. Those patients need a one-on-one nurse around the clock because of the risk of blood clots or if one of the tubes pulled from the patient’s body.
One patient currently at Vanderbilt, which has just seven ECMO beds, has been there since the Delta surge last year, says Dr. Jonathan Casey.
“So you can imagine how it doesn’t take much to fill this resource even during a small wave,” he says.
Even during the ongoing Omicron surge, Casey says Vanderbilt has had times where transfer requests for ECMO were turned down. In Middle Tennessee, only the three largest medical centers — Centennial, Ascension Saint Thomas West and Vanderbilt — offer ECMO currently.
While the odds of survival with critical COVID patients are still roughly 50-50, the Vanderbilt study shows what happens if the therapy is unavailable.
“I’m trying to convince people that this is a resource worth investing in and then hoping people invest in those resources over time,” says Casey, who helped author the study.
Until there is broader access to ECMO, Casey says the country also needs to find a better way to decide who is prioritized for treatment, similar to how organ transplant allocation works. There is a national ECMO organization called the Extracorporeal Life Support Organization, but it doesn’t get involved with triaging patients yet.
The Vanderbilt researchers also conclude that it’s important to stick with patient criteria and limit ECMO primarily to those most likely to survive. A COVID patient who is more likely to spend months on ECMO only to die means several other patients may not get the opportunity.
“I still stand by this,” Gannon says. “I think patient selection is the most important component of ECMO care across the board.”
There are no firm guidelines for who should receive ECMO, which means each patient requires an individual judgement. So Gannon says she has compassion for those families who have called, desperate to find an open bed to give their loved one a last shot.
“I feel for those families completely,” she says. “I think they should keep fighting and shouting. And I can tell you if it were my family member, I would be the same way.”
On Saturday, Tennessee hit two years since the first case of COVID was confirmed in Tennessee. By the numbers, the state has tracked more than 2 million cases and will likely break 25,000 deaths this week.
Those who’ve been treating the sickest of the sick say they’re “tired-er than tired.”
“Going into year three of the pandemic, even just saying that kind of sends a shiver down my spine,” nurse Meg Cockrum tells This is Nashville.
At the start of the pandemic, Cockrum was a cardiac nurse but volunteered to work in the Vanderbilt COVID unit after she saw her colleagues could use a break. The early days were uncertain, but less demanding.
“Each year of the pandemic has had its own unique flavor,” she says. “The first year being — total fear, unknown stress, shut down. In the second year, when the vaccine came out, a lot of hope and excitement and hoping that this would be the end of it. And then, thinking about year three? I mean, that just brings instant fatigue.”
Hospitals remain short-staffed, even though in Tennessee they’re caring for roughly a third of the COVID patients from the peak periods. Some are leaving the bedside or the profession altogether. Others have left permanent staff jobs to take traveling roles that still pay substantially more.
The job remains taxing for those who work in intensive care units. Tennesseans are still dying at a pace that was unimaginable early in the pandemic, with an average of 72 deaths per day in late February.
“In this career, you see death and dying up close,” says Vanderbilt flight nurse Neil Stinson, who has also been working with COVID patients throughout the pandemic. “You’re immersed in human tragedy. I think it’s impossible to witness these things and participate in these things without getting awfully close to an emotional and physical, spiritual level of burnout.”
Tennessee’s oversight board tasked with spending billions of dollars in stimulus money is hitting a snag with the last $275 million. The federal funds were issued to help states deal with the coronavirus.
More than 60 organizations — both nonprofit and for-profit — have applied for the funding earmarked for “external” groups. They range from Vanderbilt University Medical Center’s request for $50 million to add ICU beds to the Fort Campbell Historical Foundation asking for $28 million to fund the long-awaited Wings of Liberty Museum.
A $232 million request from the state’s nursing home association would alone eat up most of the funding. But some of the smaller requests are more loosely aligned with the goal of the stimulus money, including support for festivals and the Music City Bowl.
Members of the Financial Stimulus Accountability Group met Wednesday and told Finance Commissioner Butch Eley that they are somewhat uncomfortable with the process of narrowing the proposals and weighing their merits.
“I think what’s been said here today is totally accurate in that you don’t want to pick winners and losers,” he said in summary of their comments.
The panel is regrouping. Instead, they’ll look at funding particular needs the state has coming out of the pandemic — like childcare.
The group was supposed to start making decisions about the external funding at next month’s meeting. It’s unclear whether they’re still on track to meet their timeline.
Anne Rayner Courtesy VUMC
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