Time for Leadership in the Governor’s Office

Dr. Bob Rosen Retired Emergency Physician

I am Dr. Bob Rosen. I moved to Tennessee 4 years ago after a 40-year career as an emergency physician. My daughter, who lives and works in Nashville, is also an emergency physician and my son-in-law is a pulmonologist and critical care physician here in town. I practiced emergency medicine through the eras of AIDS, ebola, and H1N1. And I see COVID19 through my family’s eyes every day.

I am gravely concerned that we have begun to see exponential growth in new coronavirus cases here in Tennessee, much like what New York and New Jersey experienced in March and April, and like what Houston is experiencing now. I am sounding the alarm because I don’t want Tennessee to be the next Florida or Texas, and I don’t want Nashville to be the next Houston.

Forecasting the impact of this exponential growth is not complicated. In the last few weeks, the number of new cases per day in Tennessee has gone from being a few hundred a day to around 2,000 a day. I’m afraid that in ten days or so the number of patients requiring hospitalization will start to rise dramatically. And 10 days to 2 weeks after that, the death count from coronavirus will begin to rise. If we don’t change anything, all those numbers will just keep going up.

It would be great if we had an effective vaccine, and it would be great if we had effective treatments for this virus. BUT WE DON’T. At the moment, we have only a few tools to limit the spread of the coronavirus. And it would be great if the public understood clearly what those tools are, and if they did those things on their own. BUT THAT’S NOT THE CASE. There is a fire raging, and before we do anything else, we need to tamp down the inferno. This is a time for leaders to be heard, and to take bold steps. It’s a time for leadership.

Here are a few immediate steps that I believe are necessary:

We need a mandatory mask requirement. Masks protect us all, and when someone doesn’t wear one, it threatens the lives of others. Refusing to wear a mask in public when that refusal threatens others is not an expression of freedom or liberty – it is an expression of selfishness. It is dangerous. It’s like driving while intoxicated. And it is profoundly disrespectful to frontline workers.

We need to mandate that every business immediately take steps to assure appropriate distancing and to require masks. We are past suggesting or encouraging or recommending. A business that allows people to get close to each other for any substantial amount of time increases the amount of coronavirus in the community, and ultimately harms and kills other people.

Businesses where distancing may be difficult or impossible (bars come to mind) may need to temporarily close. Even if a bar patron walks into a bar intending to maintain his distance, once he’s had a drink or two, that intention may dissolve. And the sharp rise in coronavirus cases among young people suggests that bars may be driving much of the current rise in cases.

We need to mandate limitations on any activities that cause groups of people to gather. The best limit might be 5, might be 10, and might well be somewhat higher for outdoor activities, since being outdoors poses a lower risk of virus transmission.

We need for leadership to be vocal and almost constantly visible, with clear, unambiguous, fact-based messaging about steps we the public need to take, until the number of daily new cases has dropped to a low level (many experts suggest 1/100,000 population, or about 70 daily cases in Tennessee) and continues to drop. This leadership needs to start at the top – in the Governor’s office.

Finally, we must understand that only a uniform coordinated response is likely to be effective. If we let the virus spread anywhere, it will, in time, spread everywhere. And while it may make sense for local leaders to be temporarily MORE aggressive when a hot spot develops in their communities, it does not make sense to allow communities to be LESS aggressive.

In summary, I believe we need
• leadership to provide clear, frequent, coordinated, and consistent messaging;
• mandatory masks;
• mandatory distancing in businesses;
• mandatory limitations on groups.

Once we get the overall level of coronavirus down to a more manageable level, more traditional public health measures such as testing and contact tracing will become important. But first, we need to put out the fire. If not, I fear we are in for a difficult time.