Rutherford County’s mask mandate will end today at 5, as the mayor discontinues the rule about a week earlier than expected.

Bill Ketron credits masks with driving down infections for the past two months.

The mayor is still urging voluntary mask wearing, hand washing and social distancing — a trio branded as hashtag “#RutherfordResponsible.” In a letter, he asks residents to honor the wishes of local businesses that request mask-wearing.

“We are encouraged by the data trends and want to continue down that path!” Ketron said. “This does not discount the fact that the virus is here and not going anywhere anytime soon.”

Montgomery and Williamson counties have already lifted their mandates.

Robertson, Sumner and Wilson counties are requiring masks through the end of the month, as authorized in the governor’s executive orders.

Davidson County’s mandate is not contingent on state action, and remains in effect.

Thirty-two new deaths from the coronavirus in Tennessee would have been every headline for days in March. But six months later, the rising death toll jumped on Friday with almost no attention from the public. The first confirmed death in Tennessee was a Davidson County man, March 20. He was 73 with underlying conditions — like many who’ve been claimed by COVID-19. More than 2,216 people in Tennessee have died since then, with no end in sight.

The current number of fatalities exceeds the initial projections from the Institute of Health Metrics and Evaluation at the University of Washington in March, which were dismissed by many at the time as impossibly high.

Local pandemic modelers at Vanderbilt University School of Medicine have steered clear of trying to predict deaths and instead focused on hospitalizations — which tend to go hand in hand.

“It’s very difficult to say with any degree of precision whether things will get better or worse from here, at least projecting out farther than a month or two,” says Vanderbilt health economist John Graves.

The University of Washington is one of the few places making state-level predictions. Their models say Tennessee could see death totals eclipse 6,000 by the end of the year if restrictions keep lifting. But with universal masking, the projections suggest fatality rate could be held in check.

Tennessee has never mandated masks but it was quick to lock down nursing homes after some early outbreaks. Epidemiologists credit that move with helping keep the mortality rate below much of the country.

Younger people who tend to survive the virus are also driving many of the new cases. And hospitals have learned how better to treat COVID-19 patients since the early days of the pandemic.

Just as Tennessee rolled out a plan Thursday to increase visitation to nursing homes, the federal government issued its own revised rules in responding to the improving coronavirus infection rates. And they’re not optional, says Centers for Medicare and Medicaid Services Administrator Seema Verma.

“It is a requirement,” Verma says. “If you’re in part of the country where there is not significant spread — you’re in a green zone or yellow zone, which means the positivity rate is below 10% — then, yes, you have to facilitate visitation. I mean that’s part of the responsibility to the patient to ensure that they have quality of life.”

On Thursday, Tennessee Health Commissioner Lisa Piercey stressed that visitation would still be up to the individual nursing home, if administrators thought it couldn’t be done safely.

Otherwise, Tennessee’s new rules largely align with the federal guidance that happened to be issued on the same day. Piercey said she had been waiting nearly a month for federal guidance but decided to move ahead anyway. A health department spokesperson says the agency is reviewing to determine whether any updates are required.

The state’s rules take effect Oct. 1. For facilities that haven’t had a new coronavirus case among staff or residents in 14 days, visitors can be welcomed immediately.

Gov. Bill Lee has rejected Metro Nashville’s request for an additional $83 million in COVID-19 relief funding.

During a press conference on Thursday, Lee cited Metro’s decision to continue imposing restrictions on businesses as one reason not to accept the request.

He said that approach is not consistent with the state’s.

“Metro Nashville is the least rapidly recovering economy of all metro regions in the United States, as of right now,” Lee said. “That means, in my view, that our strategy in that particular place from an economic standpoint is not an effective one.”

In a statement Thursday evening, Nashville Mayor John Cooper said his office followed the guidance coming from the White House. He defended his request and said it is his job to advocate for the city.

“The deep economic injury from the pandemic is still with us,” Cooper said. “We should, of course, ask for any available help to serve our people and our businesses during this crisis.”

Lee’s public comments came on the same day Nashville eased some capacity limits on bars and restaurants. However, Lee had sent a letter to Cooper on Wednesday notifying him of his decision.

In it, Lee said Metro Nashville has already received $2.5 billion from the state, making it the highest per capita relief of any other county in Tennessee.

“I must share my deep concern that, of the $93 million in Coronavirus Relief Fund dollars spent to date by your administration, only $5.7 million has been budgeted to relief to businesses,” Lee said in the letter. “This concern is heightened by the ongoing challenges ahead for Nashville business owners who have already endured some of the most restrictive limitations on commercial activity, as well as a recently enacted property tax increase.”

Lee said giving Nashville additional money would take away funding from other counties in the state that might need it.

This story was updated Thursday night to include a comment from Mayor Cooper.

Nashville is easing up on capacity limits on bars and restaurants and allowing them to stay open later starting this week. The further loosening is in response to continue improvement of coronavirus metrics. But it also comes as the city is being accused of overblowing the risk of restaurants and bars.

The truth is, the actual confirmed coronavirus cases directly linked to restaurants and bars isn’t an eye-popping number — roughly 80 at the end of July. And internal emails recently published by Fox17 show city officials have been careful with how they share these statistics.

At his weekly press conference, Mayor John Cooper says he has nothing to hide. His office published those emails itself shortly after being questioned on Thursday.

pic.twitter.com/j6sYKcAdk4

— Mayor John Cooper (@JohnCooper4Nash) September 17, 2020

 

“Of course we’re happy to share all information, but we want the right interpretation,” Cooper says.

The city’s interpretation is that any case traced back to a restaurant or bar likely represents the tip of a much larger iceberg. That’s because the largest bars and restaurants are in downtown’s tourist district, which has also been the focus of the most intense policing related to the city’s mask mandate.

City health director Michael Caldwell says most patrons are from elsewhere, and his department may never hear about those cases.

“When we do see numbers, even a small number, that raises big flags for us,” Caldwell says. He notes that few Nashvillians visit — apart from workers and musicians — but crowds come in from elsewhere.

City officials say their restrictions on bars have also been driven by a recommendation from Dr. Deborah Birx of the White House, who personally visited Nashville when the coronavirus was surging and recommended bars close down before cases got out of hand.

Caldwell says Lower Broadway hits all his top concerns: indoor, no masks and close contact combined with alcohol.

“We know what raises the risk of COVID, and when we see that, we want to do what we can to reduce that risk,” he says.

But with continued improvement, the city is allowing bars and restaurants to stay open until 11 p.m. and increasing indoor capacity to 50% per floor — a change directed at the multistory honky tonks downtown. The city is also giving the Tennessee Titans permission to fill Nissan Stadium to 10% capacity for games in October.

Tennessee will relax visitation rules for long-term care facilities starting Oct. 1, removing the requirement that the county has to have limited coronavirus spread in order to allow nursing homes or assisted living facilities to welcome visitors.

Starting next month, facilities will be judged primarily on how many cases have been confirmed among its own residents and staff. If they’ve gone 14 days with no new cases, they can allow outdoor visits and limited indoor interaction with masks and social distancing. For residents, communal dining can also resume as well as social activities and visits from barbers and beauticians.

“It’s time to reunite residents and their families in a safe and disciplined manner so we can better balance the physical and emotional needs of older Tennesseans,” Dr. Lisa Piercey, Tennessee Health Commissioner, said in a statement.

Facilities that go 28 days without a new case would be allowed to start what’s being called an “essential caregiver program.” As many as five family and friends who help care for a resident will be able to see them regularly, though they will have to get tested for the coronavirus every week, just like nursing home staff.

Currently, roughly 260 facilities (listed here) have reported at least one coronavirus case in the last 28 days. So any facility not on the list, and many who are, would have the option to begin the visitation program next month.

More: Download Tennessee’s long-term care facility visitation guidelines released Thursday afternoon.

In a background call with reporters, health department officials acknowledge there will be a heightened temptation to conceal new COVID-19 cases. But they say nursing homes would be deterred from deceit since they could lose all federal reimbursement if found in violation.

Last month, Piercey said it was time to loosen restrictions on nursing home visitation but that she was waiting on federal guidance she believed to be imminent. The Centers for Medicare and Medicaid Services still hasn’t acted, but health officials say Tennessee has run the plan by the feds to at least get a verbal blessing.

Other states, including Colorado and Florida, have recently taken similar steps to resume nursing home visitation.

Tennessee experienced early outbreaks at nursing homes that resulted in dozens of deaths. But the state acted more quickly than many others to require coronavirus testing of all residents and staff. Epidemiologists have credited the surveillance testing with keeping Tennessee’s mortality rate relatively low, since elderly patients are among the most likely to die from COVID-19.

The state required weekly testing of staff starting in July, months ahead of a similar federal requirement. The Tennessee Department of Health was also paying for those testing programs but will stop Oct. 1, as the new rules take effect.

Earlier this month, a half-dozen patients gathered in a cramped conference room on campus. They snacked on turkey sandwiches and potato chips and listened to the pitch from their physician, Dr. Vladimir Berthaud.

“What’s the best hope to get rid of this virus?” he asked them.

“Vaccination,” they replied.

Then Berthaud followed up: “So raise your hand if you would like to take the vaccine?”

Some hands shot up, but not all.

“I ain’t going to be the first one, now,” said Lanette Hayes.

Another woman, Katrina Thompson, said she does eventually want to get a shot for protection against the coronavirus. She explained she’s especially worried about all the residents of her apartment building who don’t seem to be doing the basics of covering their coughs.

“The word ‘vaccination’ don’t scare me,” she said. “The word ‘trial’ do.”

Participation in clinical trials among Black people is low, according to Food and Drug Administration statistics. Still, including them in coronavirus vaccine trials has been a stated priority for the pharmaceutical companies involved, since African American communities, along with those of Latinos, have suffered disproportionately from the pandemic.

The ongoing trials are moving at a pace that is unprecedented for medical research, with the Trump administration’s vaccine acceleration effort dubbed “Operation Warp Speed.” Yet recruiting minority participants requires sensitivity to a mistrust borne of past and current medical mistreatment. Trust-building cannot be rushed.

So far, participation by minority volunteers in coronavirus trials has increased only slightly compared with typically low levels for other clinical trials — and targeted outreach efforts to recruit more minorities have been slow to launch.

Some of that outreach is taking place at historically Black colleges and universities, which are trusted institutions for many Black Americans. At Meharry Medical College in Nashville, Tenn., researchers have set up in-person meetings with patients they already know.

Deep reservations

Black Americans have reason to be suspicious — stemming beyond the well-known Tuskegee experiments, in which Black men with syphilis were deceived and mistreated as part of an experiment that went on for decades. Many Black Americans report ongoing mistreatment by medical providers today.

Berthaud is recruiting patients for a clinical trial site he will oversee in Nashville, and he would like more than 300 people of color to enroll. Berthaud, who is Black and from Haiti, appeals to his patients’ sense of duty.

“If you don’t have enough people like you in those vaccine trials, you will not know if it works for you,” he told them. “You will not know.”

For most of the current coronavirus vaccine trials, recruitment mainly takes place online — which often results in mostly white people enrolling.

That’s why Meharry researchers are wooing Black patients with a personal invitation. They’re not recruiting for the phase 3 trials underway now. Meharry’s first trial, for a vaccine candidate by Novavax, doesn’t launch until October.

Other pharmaceutical companies are nearly done recruiting. Moderna said it chose nearly 100 trial sites for their “representative demography.” But the country’s four historically Black medical schools are not among the sites.

The company did not respond to requests for comment but publicizes demographic statistics about the clinical volunteers every week. While somewhat more inclusive than the typical clinical trial, it still is not a good representation of the diversity of the U.S.

For the coronavirus vaccine in particular, the National Institutes of Health has suggested minorities should be overrepresented in testing — perhaps at rates that are double their percentage of the U.S. population.

“We say we want to have everybody included, but really the effort for the vaccinations — in a sense — [is] starting the same way they’ve always been,” said Dr. Dominic Mack, of Morehouse School of Medicine in Atlanta.

Dr. Vladimir Berthaud and Dr. Rajbir Singh recruit patients for a COVID-19 vaccine trial at Meharry Medical College in Nashville, Tennessee.Blake FarmerWPLN

Taking time to build relationships

Mack is working with the NIH to make sure people of color are included in COVID-19 research. He said there are no shortcuts if medical research is going to reflect the diversity of the U.S. It takes time to build trust and meaningful relationships with people who have endured a history of abuse or neglect by medical providers, and exclusion from biomedical research and decision-making.

“Now, that being said, the only thing we can do is what we’re doing,” he said — by which he means respectful, unrushed outreach and dialogue.

The primary effort, called the COVID-19 Prevention Network, taps into four existing clinical trial networks designed to advance HIV research. Those networks are based in Seattle, Atlanta, Los Angeles and Durham, N.C.

One project will be led by the Rev. Edwin Sanders II of the Metropolitan Interdenominational Church in Nashville. It will involve seven “faith ambassadors” and 30 “clergy consultants” in the African American community working to dispel myths and increase trust in the clinical trial process. But Sanders cautioned this is not about a hard sell.

“I think they’re increasingly small, but there are some ways in which that there’s reason for the concern that people bring with them,” he says.

It’s not his job to preach trial participation from the pulpit, he said.

“We are not out beating the drum,” Sanders said. “I am not going to do anything more than make sure people are able to make an informed choice.”

The danger in lunging for big diversity goals is that it could spark a backlash, meaning minorities might be even less willing to participate, said associate professor Rachel Hardeman, who studies health equity at the University of Minnesota. It’s important that the doctors doing the asking look like the people they’re appealing to, she said.

“It’s racial concordance,” she explained. “It offers this feeling of, ‘You know who I am, you know where I come from, you have my best interests at heart.’”

Historically Black medical institutions in the U.S. are uniquely positioned to do this work. While they haven’t been on the leading edge of recruitment for vaccine trials, they intend to play an important part. The president of Meharry Medical College, Dr. James Hildreth, is an infectious disease researcher. But instead of overseeing the trial site being hosted on his campus, Hildreth has a more modest goal in mind: He plans to participate as a patient, and urge others to join him.

“I think my role is more important in advocating for people to be involved in vaccine studies than to be one of the leaders of the study,” he said.

So at Meharry, Berthaud is the principal investigator. As lunch wraps up in the crowded conference room, he has managed to win over some holdouts.

“Where is the line?” asked Robert Smith. “Where do we sign?”

Smith, with his young grandson in tow, didn’t raise his hand at first when asked if he’d take the vaccine. But after listening to Berthaud, Smith agreed to participate in the clinical trial — for no other reason than the trust he has in Berthaud, his longtime physician.

“He’s not only my doctor; he’s proven that he cares about me,” Smith said.

Persuading tens of thousands of Black Americans to sign up will be difficult. But researchers hope their outreach efforts will at least result in more minorities agreeing to take an approved vaccine when available.

Nashville has seen an uptick in the transmission rate and percentage of people testing positive for the coronavirus, and health officials say outbreaks at prisons located in Davidson County are partially to blame.

Mass testing at Tennessee prisons has recently uncovered several-hundred new cases at three facilities here in Nashville.

Coronavirus task force chair Alex Jahangir says the outbreaks have accounted for a large portion of local cases this month, including about 40% of new cases during Labor Day weekend, alone.

“So, we need to keep a close watch over the next few days to see if these numbers stabilize and start trending in the right direction,” he says.

Nashville prisons have reported far fewer coronavirus cases than correctional facilities in other parts of the state. In some prisons, more than 1,000 people have tested positive. The largest outbreak in a Nashville correctional has infected fewer than 200 prisoners.

However, some of the smaller clusters have been more deadly. Five people have died at the Lois M. DeBerry Special Needs Facility, which houses some of the state’s sickest prisoners.

Coronavirus cases started slowly building over the course of the summer, and about 130 people have tested positive in total. More than 80 have since recovered.

At the Debra K. Johnson Rehabilitation Center, which houses most of the state’s female prisoners, nearly 200 people have the virus and one has died. But just a few miles down the road at at the Riverbend Maximum Security Institution in West Nashville, no deaths have been reported, and only 73 men have tested positive since the start of the pandemic.

Samantha Max is a Report for America corps member.

Metro Nashville Public Schools has set the dates for Nashville students to begin returning to the classroom in mid-October, and the district is giving families three more days to decide whether to attend in person or remain virtual.

Director Adrienne Battle told teachers in an email on Sunday that she wants pre-K through second graders to have in-person classes the second week of October. Third and fourth graders would return to campus the next week, then fifth and six graders, followed by seventh and eighth.

High school students, however, aren’t expected to be back on campus until January. Battle said the district’s oldest students wouldn’t return before second semester, partially due to scheduling challenges, but also because they’re most likely to spread the virus.

“We would love to have our high schoolers back in our classrooms as soon as possible, but waiting until the start of the second semester is not only the safest option but also the least disruptive to the learning progress of our students,” Hunters Lane High School Principal Sue Kessler said in a press release. “My fellow principals and I appreciate the thoughtful and safety-driven approach to returning to schools presented by Dr. Battle.”

Proposed Schedule For Return To In-Person Learning:

• Tuesday, Oct. 13: pre-K through second grade (half days on Oct. 13 and 14)
• Tuesday, Oct. 20: third and fourth grade
• Tuesday, Oct. 27: fifth and six grade
• Wednesday, Nov. 4: seventh and eighth grade
• Thursday, Jan. 7: ninth through twelfth grade

This timeline is not set in stone, though. Battle says the post-fall break return to the classroom will happen only if Nashville continues to make progress with its COVID-19 numbers.

“I believe this phase-in schedule can result in a safe and thoughtful return to school for students,” Battle said. “In order to make this happen, we need all community members to do their part to stop the spread of COVID-19 by wearing masks and social distancing whenever possible.”

Some students are expected back in the classroom even sooner. Special education students will have the option to attend in-person classes by Sept. 23. About 700 will be learning face-to-face by the end of the month.

But, even once school buildings open, all families will still have the option to keep their kids at home for virtual learning. Parents now have until this Friday to fill out a survey letting administrators know whether they plan to send their children to school.

Samantha Max is a Report for America corps member. Damon Mitchell contributed reporting.

So far, Hispanic Nashvillians have received 2% of the city’s pandemic assistance money that’s designated for rent, mortgage and utility assistance.

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