The Sum of All Fears, Part 2

On Wednesday evening, we received a message from a friend in central Italy. She was forwarding an anguished note from a friend of hers in Bergamo in that country’s Lombardy region. The note reported dire conditions there from the spread of COVID-19 infections. Italy’s hospitals and medical personnel, she said, are being overwhelmed by many thousands of citizens crowding into emergency rooms.

“The news media in the US have not captured the severity of what is happening here. If you are in Europe or the US you are weeks away from where we are today in Italy. Today the ICUs in Lombardy are at capacity – more than capacity. They have begun to put ICU units in the hallways. If the numbers do not go down, the growth rate of contagion tells us that there will be thousands of people who in a matter of a weeks will need care. What will happen when there are 100, or a 1000 people who need the hospital and only a few ICU places left?

“On Monday a doctor wrote in the paper that they have begun to have to decide who lives and who dies when the patients show up in the emergency room, like what is done in war. This will only get worse.  There are a finite number of drs, nurses, medical staff and they are getting the virus. They have also been working non-stop for days and days. What happens when the drs, nurses and medical staff are simply not able to care for the patients? …You have a chance to make a difference and stop the spread in your country. Soon you will not have a choice, so do what you can now.”

President Trump tells us the US government has finally begun to scale up to the urgency. I hope that is correct, because a true national mobilization is what we need. Our own nation is lagging behind others in coronavirus testing capacity. But we also live in a federal system where state governments have essential roles, too, and it appears there is a great unevenness among the 50 states in the their pandemic preparedness. Take Tennessee, where two connected things came to light in the past week:

1.   State officials in Nashville spoke in soothing tones, yes, but were clearly struggling to get their messages straight on how they will keep citizens and local jurisdictions sufficiently informed about the danger.

2.   More deeply, we are also seeing unfold - no longer in theory but in real time - the true effects of Tennessee’s failure over eight years to expand the Medicaid program. It’s been the legislature’s stubborn refusal that has failed to draw down available dollars, to help our hospitals and people who need more support in the face of the present pandemic.

At this moment, is it possible for our state government to be any less helpful? I can’t imagine how.

On one hand, the state’s Health Department struggles with basic coordination. First, they wouldn’t even name the counties where new cases were being discovered; two days later, under pressure, they said ‘OK, we will.’ At the same time, the legislature just seems oblivious and fixated on exactly the wrong things: Bloviating about making the Bible our official state book, and showing great enthusiasm for the very idea of abolishing the requirement of permits for people who carry guns.

And yet there are concrete things the governor and legislature can be doing now in the face of this very real, present emergency, if they but will. The most helpful would be to expand Medicaid, at long last, in order to draw down millions in available federal dollars that hospitals and hundreds of thousands of Tennessee citizens already need. More than a dozen Tennessee hospitals have closed since the General Assembly first said ‘No’ to Medicaid expansion, as proposed by the former Gov. Bill Haslam. And twenty of Tennessee’s 95 counties – where nearly one in 20 Tennesseans live – have no hospital at all, according to the Sycamore Institute. 

Our legislature could vote next week to expand Medicaid, but its majority Republican members must finally put aside old Obama-era political grudges and get proactive in the face of a true public-health crisis. Further, what about any idle facilities in the un-served counties. With ingenuity and resolve, these might be brought online quickly with proper staffing and equipment (think ventilators) to add new ER or ICU capacity for the human demand that is looming. (In New York City, as you read this, triage tents are set up outside emergency rooms, and medical staffs are being re-deployed as needed.)

The frightening fact is that Tennessee is light-years behind some other states. Ohio and Kentucky, for example, seem well ahead of Tennessee now in pandemic preparedness. Why is that?

Like it or not, that urgent warning from Italy the other night is quite relevant to Tennessee in this anxious moment, and our policymakers must do more than tell us to stay home and wash our hands. (We can take care of that ourselves, thank you.) What we need elected officials to do is step up and do what only government can, and agree that a better-funded Medicaid program ought finally to be in your toolbox and fast. We need you to do for us now what’s smart, not what’s stale and narrowly political, and put aside the tired vendettas of political Washington. This isn’t about Obama anymore. We need you to give your counties and towns the material help they need to be ready for this pandemic that is wholly unprecedented in our lifetimes.

’Soon you will not have a choice, so do what you can now.”