Tennessee’s health chief said Tuesday that the state is expecting to receive its first doses of a COVID-19 vaccine around Dec. 15.

In a press conference, Lisa Piercey said the new information comes after having conversations this week with the federal government.

“We are ready to deploy those immediately upon receipt,” Piercey said. “The first people that will get this is what we call our Phase 1A participants. Phase 1A will be frontline health care workers and first responders.”

Piercey said it’s unclear how many doses the state will receive, and that the state will continue progressing through the different phases as they continue to receive doses.

Last week, Pfizer announced that Tennessee was one of four states selected to participate in a pilot program for the delivery of its COVID-19 vaccine.

According to a news release, the states were chosen “based on their differences in size, population diversity and immunization infrastructure. Lessons learned through this program will help support all states in development of effective immunization programs for this COVID-19 vaccine.”

With Thanksgiving around the corner, Tennessee has its worst numbers yet during the pandemic, and it’s not alone. Every state except Hawaii is battling another surge in COVID-19 cases, hospitalizations and deaths.

Nearly half of the nation — 22 states, along with Washington D.C., Puerto Rico, Guam and the U.S. Virgin Islands — have placed restrictions upon travelers as a method of fighting the virus. Those who visit the state are either mandated or encouraged to quarantine for two weeks upon arrival or come armed with proof of a negative coronavirus test.

Some, including Illinois, Massachusetts and Pennsylvania are even prepared to issue fines to travelers who ignore their rules. In New York, a violation could cost as much as $10,000. Hawaii’s capped its fine at $5,000 but adds the potential for a year in prison.

Know before you go: Check out WPLN’s interactive map below to see the restrictions by state for travelers from Tennessee. Please confirm on the state’s website for the most up-to-date information.

Hospitals in much of the country are filling up with COVID-19 cases, approaching 84,000 patients at the start of this week. But space isn’t the main concern. It’s staffing. And bringing in backups from out of town isn’t the solution it was early in the pandemic, when the surge was concentrated in a handful of cities.

Finding reinforcements really wasn’t a problem with the first wave of COVID-19 back in the spring. Hospitals in most of the country were seeing fewer patients than normal, resulting in mass layoffs, so nurses were excited to catch a flight and join the effort.

“It was really a hot zone, and we were always in full PPE and everyone who was admitted was COVID positive,” says Laura Williams of Knoxville, who helped launch the Ryan Larkin Field Hospital in New York City.

“I was working six or seven days a week, but I felt very invigorated.”

After two taxing months, Williams returned to her nursing job at the University of Tennessee Medical Center. The COVID front had been relatively quiet — until now, with record hospitalizations in Tennessee nearly every day, increasing by 60% in the last month.

And backup is getting much harder to find.

Tennessee built its own overflow field hospitals — one in the old Commercial Appeal newspaper offices in Memphis and another on two unused floors of Nashville General Hospital. But right now, the state would have trouble finding the doctors and nurses to run them because hospitals are struggling to staff the beds they have.

“Hospital capacity is almost exclusively about staffing,” says Dr. Lisa Piercey, who heads the Tennessee Department of Health. “Physical space, physical beds, not the issue.”

Hospitalizations in Tennessee have been rising steadily for weeks.Courtesy TDH

COVID creates a compounding challenge for staffing.

As cases rise to new highs, record numbers of hospital employees are out themselves with COVID-19 or because they have to quarantine.

“But here’s the kicker,” says Dr. Alex Jahangir, who chairs Nashville’s coronavirus task force. “They’re not getting infected in the hospitals. In fact, hospitals for the most part are fairly safe. They’re getting infected in the community.”

Some states, like North Dakota, are already allowing COVID-positive nurses to keep working as long as they feel OK, though they’ve faced a bit of a backlash. Colorado, California and Illinois have asked retired nurses and doctors to consider returning to the workforce.

In Tennessee, Gov. Bill Lee has granted an emergency order dropping some restrictions on who can do what within a hospital, giving them more staffing flexibility.

For months, staffing in much of the county had been a concern behind the scenes. But it’s becoming palpable to any patient.

Dr. Jessica Rosen is an emergency physician at Saint Thomas Health in Nashville, where diverting patients has been rare over the last decade. Now she says it’s a common occurrence.

“We have been frequently on diversion, meaning we don’t take transfers from other hospitals,” she says. “We try to send ambulances to other hospitals because we have no beds available.”

Even the region’s largest hospitals are filling up. This week, Vanderbilt University Medical Center made space in its children’s hospital for non-COVID patients. Its adult hospital has more than 700 beds. And like many hospitals, it’s had the challenge of staffing two intensive care units — one for COVID patients and another for everyone else.

Arriving from hundreds of miles away

“The vast majority of our patients now in the intensive care unit are not coming in through our emergency department,” says Dr. Matthew Semler, a pulmonary specialist at VUMC who works with COVID patients.

“They’re being sent hours to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion.”

Semler says his hospital is taking patients from as far away as Arkansas and southwest Virginia. It would typically bring in nurses from out of town to help, but there is nowhere to pull them from right now.

National systems are still moving personnel around, though increasingly it means leaving somewhere else a little short-staffed. In Texas, Dr. James Johnson with the physician services firm Envision has deployed reinforcements to Lubbock and El Paso this month.

Dr. James Johnson is an anesthesiologist and worked four weeks in New York City early in the pandemic.Courtesy Dr. James Johnson

He says the country hasn’t hit it yet, but there is a breaking point.

“I honestly don’t know where that limit is,” he says.

And the limitation at this point won’t be ventilators or protective gear. In most cases, it will be people.

So Johnson, who is an Air Force veteran who treated wounded soldiers in Afghanistan, says he’s more focused than ever on trying to boost morale and stave off burnout.

He’s generally optimistic, especially after serving four weeks in New York City early in the pandemic.

“What we experienced in New York and happened in every episode since is that humanity rises to the occasion,” he says.

But it shouldn’t just be sacrifices for health care workers. Johnson says everyone bears a responsibility to keep themselves and others from getting sick in the first place.

Starting next week, Nashville restaurants and bars must go back to operating at 50% of their capacities under the latest health order from the Metro Public Health Department. 

Those establishments also have to offer last call and stop accepting new customers by 10 at night, to ensure they can close an hour later. Previous orders have allowed bars and restaurants to stay open until 11 p.m., but it wasn’t clear whether they had to stop serving then or shut their doors.

The White House Task Force says Nashville should reduce capacity to 25%, but Mayor John Cooper dismissed that idea last week. The city’s rule has been that restaurants must space customers out and barred them from having more than 100 customers on a floor, but had dropped the 50% maximum capacity rule earlier this month.

Even Tennessee’s largest hospital is running into capacity issues, with more than 200 staffers out sick with COVID-19 or quarantining because of close contact. 

 Tennessee hit a new high for hospitalizations over the weekend. Dr. Matthew Semler, a physician in the intensive care unit at Vanderbilt University Medical Center caring for COVID patients, says patients are arriving from as far away as Arkansas and southwest Virginia because so many hospitals can’t take more patients. 

“We’re already in a state where the vast majority of our patients now in the intensive care unit are not coming in through our emergency department,” he says. “They’re being sent hours to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion.”

The Nashville Post reports Vanderbilt has begun converting beds in its children’s hospital to take non-COVID adult patients. The state has built out an empty floor at Nashville General Hospital to be used for COVID patients, but right now hospitals don’t have enough doctors and nurses available to use all of their existing capacity.  

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In a sea of new daily COVID cases, health officials are often looking for clusters — a group of cases linked to a particular time and place. But what can be even harder to figure out is how each outbreak spreads from its source and spawns even more clusters in the region.

Starting Monday, Nashville will cap private gatherings to eight people, with no more than two households represented. Previously the limit was 25.

It marks a shift in the focus of pandemic restrictions from public events to private spaces.

“We need to be just as good in private as we are in public,” Mayor John Cooper says.

But the city will not “undo” any permissions already granted to larger groups, who have had to seek approval for their protocols from the Metro Public Health Department. MPHD board chair Dr. Alex Jahangir says none of the events that have worked with the city have led to clusters of new coronavirus cases.

That means that Nissan Stadium can still host thousands at sporting events, for example, and the Opry House can hold concerts with limited attendance still in the hundreds. The city also isn’t following recommendations from the White House task force to limit indoor dining to 25% capacity.

The mayor acknowledges the appearance of inconsistency.

“It is hard for all of us all the time to understand exactly different words and applying this. I think there’s a difference between ‘groupings’ and ‘gatherings,’ ” Cooper says. “Even though the ‘gathering; may appear to be larger, you’re carefully managing the ‘groupings’ to limit the risk that already exists between these people.”

Cooper says large “gatherings,” like a concert, can still keep smaller groups away from each other, though he says health officials will tighten up on future permissions for public events. He notes that private gatherings are where people seem to let their guard down with minimal mask-wearing and distancing, leading to the current record case counts in Nashville.

City officials are encouraging surrounding communities to join the “rule of eight” requirement, noting that the state of Kentucky has already instituted the same restriction.

As COVID-19 hospitalizations set new records nearly every day in Tennessee, doctors are speaking out about the dire situation they see in their emergency rooms with patients traveling hours to find a hospital that has space for them.

Physicians from Vanderbilt University Medical Center, Saint Thomas Health and TriStar spoke Wednesday on a video call, primarily reiterating their pleas for a statewide mask mandate. But they also revealed a more desperate situation than most hospital administrators have been sharing publicly.

“We have been frequently on diversion, meaning we don’t take transfers from other hospitals. We try to send ambulances to other hospitals because we have no beds available,” Dr. Jessica Rosen says.

In nearly a decade at Saint Thomas, Rosen says the Midtown ER had almost never been on diversion — even at the height of flu season. In the last few months, it’s happened more times than she can count.

Passing Hospitals To Get To Nashville

As more hospitals turn away people, Vanderbilt University Medical Center has been accepting intensive care patients from as far away as Arkansas, Alabama, and western Virginia.

“We’re already in a state where the vast majority of our patients now in the intensive care unit are not coming in through our emergency department,” says Dr. Matthew Semler, Rosen’s husband. “They’re being sent hours to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion.”

Nearly 2,000 COVID patients are in hospitals statewide, which is a 25% increase over the last two weeks. Like the state as a whole, hospitals now have more nurses than ever sick with COVID or quarantining for two weeks because of exposure. State officials have asked that any recently retired nurses and doctors consider returning to the workforce to help hospitals manage the pandemic.

“Our capacity is limited by our nurses’ staffing abilities,” says Dr. Katrina Green at HCA’s TriStar Skyline Medical Center. “A lot of them do work overtime, but there’s a limit to how much overtime someone can work, and it’s very taxing — not just physically but emotionally — to take care of COVID patients.”

Tennessee’s record-setting COVID cases have prompted the suspension of all jury trials through the end of January.

The order from the state’s Supreme Court came down Tuesday, reinstating rules that initially ran from March through most of May.

The justices say they’ve heard reports of lacking compliance, including COVID-positive people attending court.

The statewide order also reminds attorneys and judges that masks are required in courtrooms. Virtual hearings are encouraged wherever possible, and the justices ask that in-person hearings are scheduled so as to minimize wait times in hallways.

The halt to jury trials takes effect Monday, with exceptions to be granted only by approval of Chief Justice Jeff Bivins.

Because of record breaking increases in Covid cases, TN jury trials are suspended through Jan. 31. Virtual hearings encouraged. Masks mandated. Persons who test positive do not come into court. Let’s work together to make our courts safe. pic.twitter.com/JLf6HDy12q

— Justice Sharon Lee (@JusticeLeeTN) November 18, 2020

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Tennessee schools are starting to shift back to virtual learning after months of mostly managing small outbreaks of the coronavirus. The state was one of the first to reopen schools, but is now taking the lead in COVID-19 infections.