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- How Memphis is continuing the fight against coronavirus, tonight on Behind the Headlines.

[intense orchestral music] I'm Eric Barnes with The Daily Memphian.

Thanks for joining us.

Today I am joined by two key members of the Memphis/Shelby County Coronavirus Task Force.

First up is Doug McGowen, Chief Operating Officer for the City of Memphis.

Doug, thanks for being here again.

Thank you, Eric, glad to be here.

- Along with Dr. Jon McCullers, an infectious disease expert who is also Dean of Clinical Affairs at UT Med School and Pediatrician-in-Chief at Le Bonheur.

Dr. McCullers, thanks for being here.

- Always happy to be on with you, Eric.

- And I'm also joined of course by Bill Dries, reporter with The Daily Memphian.

Let me, I guess I'll start with you, Dr. McCullers.

I think we are, if one is focused on coronavirus, one is focused on vaccines right now.

I think the general population, when can I get it?

Should I get it?

Is it safe?

But let's just start with the when can I get it?

And obviously, I don't think anyone anywhere is happy with the speed of the rollout, the speed at which nationwide, maybe worldwide, but just nationwide.

For you, and you've worked with the CDC before, you've obviously been in the middle of this fight, you've done infectious diseases for a long time.

If you could wave a magic wand, what would be done in the next couple of weeks to accelerate the rate of vaccinations in Memphis and Shelby County?

- Yeah, right now this is really a supply issue, and it's a supply issue from a federal standpoint in that we just haven't had enough vaccine doses made and distributed from the federal government to the states in order for it to trickle down and get into people's arms.

We're ready in Shelby County to expand our efforts to give the vaccine once we have the supply.

We have numerous organizations who are ready to step in, a lot of physician offices and other companies like that, that, as soon as we give them a vaccine, they'll start administering it to people.

It's all set up and ready to go.

We just need the supply right now.

So I think with the new Biden administration coming in and taking central control, which has really been a problem throughout the pandemic, I think we'll start to see that move a little bit.

- Would central control and the federal government, would that mean...

Right now, Shelby County gets its doses from the State.

The Trump administration pretty much delegated everything to state control, and different states have rules.

And some states allow counties to have fairly different rules.

But would you, again, if you could wave a magic wand, would you have Shelby County start to get doses directly from the federal government?

Or just change how the State is doing it?

- I think it's not so much an issue of changing the rules right now.

I think that what we've got in place works with the federal government sending it to the State and distributing it out to the counties to go.

I think that's fine.

I think it's more on the level of manufacturing the vaccine, kind of the haste at which we're doing that.

How does it get logistically from the manufacturer to the government to be distributed?

How does that distribution work?

It's that level right now where we've really been falling down because there hasn't been any central control and really any drive to get it done.

Now that there's an urgency to do it, I think there's gonna be a lot more attention paid to each step of that logistics chain, and we'll start seeing the vaccine pushed through the pipeline quicker.

- Do you, Doug...

Right now we're getting, give or take, 9,000 a week, I think, from the State.

The problem has seemed to be, as Dr. McCullers said, not capacity to give the doses, but just running out and not enough doses.

Do you have a sense of what, how many doses a week could Memphis and Shelby County handle?

When would we, when would the capacity to give doses and distribute, when would we get maxed out?

- Well, I think I'll say it like this, Eric.

In order to get essentially immunity that we need in the community, we need to administer 1.2 million doses.

That would be 600,000 people in Memphis and Shelby County.

If we wanted to do that in six months time, that means we need to do 40,000 to 50,000 immunizations per week.

Today, we're doing about 10,000, as Dr. McCullers said.

We have the wherewithal.

We have the capability here to immediately be able to do that 40,000 to 50,000 a week.

There are plenty of partners who can help.

The Health Department has a site at the Pipkin Building today.

And the together with the hospitals, they're administering those 9,000 a week.

And there's lots of folks who can help us add capacity.

There are other sites that are already being considered to be stood up.

It makes little sense to open them now without any vaccine, but we already have partners on the task force so that we can have this available all over the county.

We have a series of municipalities that are coming together to do a high volume site.

We already have some of our drive-through testing centers that could be quickly converted to high volume immunization sites.

And we also have our partners at the hospitals who are in the business of giving immunizations along with their clinics.

And we have our safety net clinics that are embedded in the neighborhoods.

That work is going on today.

We are all talking together about how we do this when we get more vaccine.

I could say it very simply.

Send us as much as you possibly can, and we will find a way to put it into arms.

And I don't mean this flippantly.

if they sent us hundreds of thousands of doses, we would operate 24/7 to put it in as many arms as we could.

I would love to have the problem of having too many vaccines and not enough people, but I don't have that today.

We are ready in Shelby County to accept as much as they can send us.

- And before I go to Bill, one more question.

For right now, again, we are doing, although it is just 10,000, it is 10,000 people who there's been a lot of anxiety, and understandable anxiety among people trying to get a dose.

Right now, I believe they can go to shelby.community, the website that's put together by the Shelby County Health Department for more information.

They can sign up, and you correct me where I'm wrong here, Doug.

They can sign up to be notified through the state site when they are in the category, and there's a link to that on that shelby.community site.

There's a phone number at shelby.community they can call.

Anything else, just practical information for people who think they're in the group.

'Cause right now it's healthcare workers, people over 75, and for emergency first responders.

Is that correct?

Anything else on a practical level I left out there, Doug?

- No, I think that you have it exactly right.

I think some of the frustration that people have is that different counties are at different phases.

And that's largely because we have 6,000 first responders in Memphis and Shelby County.

We have 35,000 medical staff that work here.

So that's more people than some counties have.

And so it's natural, they're going to be at a different phase than where we are.

But that's where you get the information is exactly those places you noticed.

We will do everything we can to get information out to everybody globally, to say, "Here's where you check, and here's the phase that we are in."

And that's a collaborative effort between Shelby County Health Department, the Shelby County government, and the City of Memphis to do that together.

- All right, Bill.

- Doug, as we record this, Joe Biden has been president for actually less than 24 hours.

Has there been any contact with the new administration, any preliminary contact with them, about the logistics of this at this point?

- Not at the local level.

I can't speak for what the State may have done.

We have seen the 21-page Biden COVID-19 plan.

We have begun to review that.

Again, I believe that that plan is going to be predicated on supply.

Dr. McCullers mentioned that it's...

I'm fond of saying, "No plan survives first contact with the enemy."

So you're going to have to pivot and make your plan fit the available conditions on the ground.

And that's what we're doing here.

We have lots of plans that we'll be ready to execute, but we have to understand what the conditions are.

And largely those conditions are the people who are willing to take it, the people who are not willing to take it, and the amount of supply that we have in order to put it into people's arms.

- So the contingencies include a certain amount of the population who might not want to take it?

- Sure, I think that's fair.

Every community is going to have a certain amount of people that do not want to take it.

I do think that there's some trepidation at the very beginning, which is natural because of the pace at which this was developed.

But I do think that, once we have a substantial amount of the population that has received it and has seen no ill effects, that others will follow.

I think that's a natural course of things, and it will become just another vaccine that people get on a routine basis.

There will always be people who do not want to take that, but we factored that in, Bill.

- Dr. McCullers, what happens when we have, and it sounds as if it's going to be when instead of if, when we have these vaccines that are one dose that don't necessarily require the refrigeration that the current vaccines do?

What does that do to the distribution for Shelby County?

- Well, you hope that it means more supply simply.

We're very hopeful that the Johnson and Johnson vaccine is gonna be approved in the next two or three weeks and will be available in either late February or early March.

That is a single-dose vaccine.

Its refrigeration constraints are a little bit more forgiving than the other vaccines that are out there.

And so we may be able to distribute that out into outpatient clinic settings and pharmacies and drive-throughs and other places and get it out more quickly than perhaps the Pfizer vaccine, which requires really a special refrigeration and special circumstances to be able to give it.

That'll put a lot more supply just into the US's supply chain.

And so we're hopeful that's gonna go quickly.

The AstraZeneca vaccine, which is very similar to the Johnson and Johnson, has had a few problems in its clinical trial phase.

We may not see that for a few more months, if at all here in the US.

But the J and J we think is going to be out fairly soon.

- Dr. Haushalter from the Health Department said at a briefing on a Wednesday for the County Commission that it looks like next month will be when the group starts tackling vaccinations for school children and for teachers as well.

Any insight into how that works and what that adds to the momentum of this?

- Sure, I can speak to that if you'd like.

So we have a coalition as a part of the task force.

One thing I'd like to say is I'm very proud of the community coming together.

We have partners who don't normally operate together.

But on our task force, we have all the Shelby County Schools, the charter schools, the municipal schools, the private schools from the Memphis Independent Schools, as well as the Catholic Diocese.

So we're all together.

We also have a weekly call with those schools specifically about teacher and student immunizations.

And so all of the school systems and districts are coming together.

The goal is to have one model that we can use that can be replicated among districts and school systems.

That is going right now very well with cooperation, and the Health Department is helping to inform that.

So it does give us great hope that we can get kids back into school as long as we have our school systems ready to receive and ready to have a logistics on their end executed.

When we get the vaccine, we'll be prepared when we get to that phase to immunize the teachers and the students soon to follow.

- I'll just add that the teachers are a priority, obviously, to get schools back open and operating.

These vaccines haven't been tested yet in children under 16.

So they're probably gonna be the last to get the vaccine, hopefully by the end of the summer and before the start of the next fall semester.

But right now, we can only go down to 16 with the Pfizer vaccine, and we have to get all that testing done before we can go down into school-age children below that.

- Right.

A final point before we go back to Eric, is the state, is the Lee administration aware that, when we talk about supply in Shelby County, that this includes not just people who live here but healthcare workers who work here, but may live across one of the state lines that are part of our boundaries here?

- Yes, we have a robust and regular dialogue with the State, the unified command.

And I speak at least once a week, if not twice to check in, as well as Dr. Haushalter meets with her partners with the Tennessee Department of Health.

Mayor Strickland has had a dialogue each and every week with the Lee administration.

We have made clear to them that, with the preponderance of healthcare that we provide for this entire region here, that there should be an accommodation for the number of healthcare workers.

If Methodist and Baptist and St. Jude and the VA and all of our partners at St. Francis deliver vaccines to all of their employees and fully 20% of them live outside Shelby County, that is a deleterious effect on our fair share.

We have made that clear.

We've asked for their accommodation.

They have assured us that they are factoring that into the distribution.

But we are pulling every day to get as much vaccine as we can and to make sure that we have exactly our fair share of the state of portion.

- Let me go to you, Dr. McCullers, and a question, a complicated question that different states, different localities handled in different ways, and different countries have handled it different ways, which is the holding back of the second shot.

So both of them, again, both of the vaccines, I think everyone's familiar, right now involve two shots.

I believe the original guidance from the federal government was hold back 50% of what we give you because you need that for the second shot.

On the way out, the Trump administration announced, go ahead and start giving that hold back, that reserve of second, recommended that.

Are we, Shelby County, Tennessee, where are we on that?

Are we holding back 50%?

Or are we giving, trying to give 100% of what we get on the assumption that they're manufacturing behind us and enough will come to fill in for that second shot three weeks or so down the line?

And is that the right thing to do?

- Yeah, it's an interesting question, Eric, and you can argue on both sides of it.

I think at Shelby County, our mandate has been to give the two shots to this point.

Whether that will change with some changing discussion I think is an open question right now.

The issue really is, if you have a limited supply, you want to vaccinate more people with a shot that maybe is only 50% effective with one shot, or do you want to make sure you're getting up to that 94, 95% with as many people as possible so they are effectively immune instead of only halfway immune?

That's kind of the question we're dealing with.

If there was unlimited supply, you would obviously want to give two shots to everybody and kind of go through your prioritization.

If supply is limited, then maybe you're going to lean more on let's try to get as many people who are at high risk, get that first shot into their arm as possible.

So it's a good discussion.

These vaccines, we talk about having to give it three weeks after the Pfizer or four weeks after the ModeRNA.

That's really because that's how the studies that looked at them administered it.

So that's where we have the best data.

Theoretically, there shouldn't be any problem with waiting three months or six months to give the second dose.

You'll have the same effect immunologically.

You'll just have that gap in time where you're only partially protected.

So the ability to do it is there, but it becomes more of an ethical and policy issue that really is based on where you're projecting the supply to be.

- Go ahead, Doug.

- I was just gonna add some, a fine point to that, what Dr. McCullers said.

So let me do the public health immunization where we receive the ModeRNA vaccine, approximately 9,500 of those.

Began administering those on the 28th of December.

And the direction was, put every single vaccine that you have of the ModeRNA in people's arms.

And that's what we did, put 9,500 vaccines into people's arms and trusted the supply chain would catch up.

And so the good news is that we received that second dose, and those will begin being administered, as Dr. Haushalter talked, later this month or the first week of February.

So all 9,500 of the second doses of ModeRNA have shown up, and they will be going into arms.

- And am I right, just again, so we get also some practical information, people who got a first shot who maybe are a little in the dark about when they get their second shot, they can go to shelby.community?

Or they follow up with the group, the hospital that gave it to them?

What do they do if you're looking for your second shot?

- Yes, you would go to shelby.community, and we will also be pushing out communications to everyone.

The start date of the second dose for those public immunizations is still being worked out because we need to add some additional capacity in order to do that.

So information to come very shortly.

- And I'll stay with you, Doug.

When the first public sort of drive-through sites were open, there was some, and some of this may still be, I've heard anecdotally some of this is still happening, where there are set criteria for people to get shots, but people showed up who thought they...

I'm not accusing anyone doing anything wrong.

I know a couple of people who did this when it was supposed to just be healthcare workers and emergency responders, they had heard that over 75 could get it.

They got in line, they got a shot.

And a number of them told me they felt very guilty, like they'd done something wrong.

But my understanding is that you all have tried to err on the side of give the shot versus being hard and fast about the criteria.

Is that a fair characterization?

And is that still the philosophy you all have going forward?

- Well, I think that's a fair philosophy.

We're threading the needle at the very beginning.

And it was tough work because there was, if you recall, we have the lens to look backwards now and say, "Here's how it should have been done."

But at the time, you recall the guidance was changing almost on a daily basis until, right up until the point where we got that vaccine here.

And so for the first week or two, we were pretty generous, put the shots in the arms.

Now I think it's a more clear and stable phasing of this.

And so they are being sticklers now for people only in phase come.

So we did have about a two-week kind of grace period there, if you will, to get the word out, wait for that guidance to stabilize.

And now we're trying to stick by the phases to the best of our ability.

But the idea is, we should never let a shot go to waste.

That's for sure.

- Right, and I was going to go to you Dr. McCullers.

You hear these stories, and everything's very anecdotal at this point.

But you hear stories of some hospitals in some areas, I haven't heard it in Memphis, where they've had to throw doses away 'cause, again, it's once you open it, once it gets from frozen to cool, it's got a very short shelf life.

And part of the criticism, right or wrong, was that certain states or communities had such strict guidelines that they couldn't find anybody to meet the criteria, and they were throwing doses away.

So have you heard of that happening in Shelby County, Dr. McCullers?

And do you agree with this notion of, look, err on the side of giving it, even if somebody doesn't isn't 100% within one of the criteria bands?

- No, yeah, exactly as Doug said.

We've had the attitude that we're not gonna throw anything away.

We're gonna get as many doses in arms as we can.

And we've had this come up, when UT was giving out their doses, we have a certain limited supply.

You thaw it.

It has to be given within a certain amount of time.

We schedule people for all of those doses that we have available, but we had no shows.

We had people that didn't show up to get their dose.

And now you're left with, okay, what do we do with this vaccine?

And they call me up.

I said, "Well, give it "to all the volunteers that were there.

Give it to any of our security officers who were there."

We'll send down some people who are kind of in the next priority list.

Make sure you don't waste a single dose of this.

And that's what we did, and that's really been the attitude.

- We have that in the city as well, Eric.

In the city and the county, we have backup lists for all our first responders and critical infrastructure folks who said, on a moment's notice, drop everything and run over to make sure we don't waste a dose.

But that's our attitudes, that we don't waste any.

- I think both of you have my cell number, by the way.

Just putting it out there that I think you both have my cell number.

Dr. McCullers, this may or may not be a fair question to you.

We talked about manufacturing and that being from y'all's point of view the biggest impediment right now.

How quickly do you expect the two double doses, the currently approved vaccines, how quickly can they ramp up production to meet?

We need some 30, 40, 50,000 a week if we're gonna hit get this done within the year.

What's the estimate for production being where it needs to be?

- Well, it depends on how much you believe what the companies tell you.

They're saying they can get to that hundreds of millions of doses, 100 million, 200 million doses by the summer, and that the pace will accelerate as they go.

Whether you believe that or not, I think there's gonna be substantial capacity and substantial supply coming out.

It really is amazing.

If we look back even 5 or 10 years and look at something like influenza vaccine, you could not have done this sort of manufacturing push.

You could not have created this sort of a supply chain so quickly.

We've come forward a lot in terms of the technology.

And then these new vaccines, these mRNA vaccines, are just so much easier to do than kind of old school vaccines like influenza, which you have to grow in chicken eggs, which means you need eggs, right?

And there's a limited supply of those, and it takes time to do it.

Now with these more molecular-based approaches, you really can scale it very rapidly and create many, many more doses because there aren't these limitations in the supply chain like with the flu vaccine.

- All right, let me go to Bill.

- Doug, we haven't talked in a while about the alternate care facility at 495 Union Avenue.

And we should point out that that is a state call in terms of activating it.

But the last we heard was that we couldn't, we didn't necessarily have the staffing for it, to activate it.

Is that accurate?

And are we still at that point?

- That's a good question, Bill.

That became a very hot topic.

Obviously we've been prepared for this for quite some time as the hospitalizations and ICU hospitalizations went up.

Our approach was always to put as many people in our hospital systems as we could.

That's the best place for anyone to be because that alternate care site really is kind of just a fancy field hospital.

It's got lots of beds and clean conditions and positive pressure, but it really just has oxygen.

So our approach was to put as many folks in the hospital as we could before we had to use that.

I'm very proud of our hospital systems.

They were managing their patient loads on a day to day, minute to minute basis.

We were on the phone multiple times a day figuring out how we can manage that patient load, how we can bring on some additional staff, and doing some innovative practices there, where they were expanding their ability and their scope of practice so that they could actually take on more patients.

We had not reached the point yet where we needed to activate because we did still have some capacity in our hospital systems.

There were specific hospitals that were very, very pressurized.

And so we did some work throughout the system to make sure that we didn't over pressurize those specific facilities.

We're at a point now where the pressure's off a little bit.

There are some facilities that are very focused.

But when we did reach that peak, we were able to galvanize enough support so that, if we did have to open that, we would be able to find staff to do so.

People answered the call for the Medical Reserve Corps and with the intention of working at that alternate care site.

It's gonna take 200 to 300 to 400 people to run that.

And we had a substantial amount of volunteers.

We weren't there yet.

I just want to be clear on that.

But we do still have that in reserve should we get a second wave here, and I think we're all prepared to activate that if we needed to, as you said, when the State says it's time to do so.

- The numbers, the latest numbers are pretty good.

But I take it it's still too early to say that we are over the hump in terms of another surge?

- I'm not even gonna begin to forecast what happens in the surge.

There's science to this.

And it's all predicated on how people behave.

If we let our guard down and everybody takes their masks off and we just go about our business, we'll be right back where we were, especially if we get this new strain, which is much more infectious.

We can very quickly be in a worse position than we were just a few years, a few weeks ago, excuse me.

So there's cautious optimism that, if we continue to do what we're doing, we'll be in good shape.

But this is no time to let the guard down.

We have to stay extra vigilant, put more shots in arms.

And my viewpoint is that, by late summer here, things will be much different.

And we'll be glad that we stayed the course this spring.

- All right, we're gonna give you the last word there.

I will say that weeks do feel like years right now.

So I forgive your slip there.

Thank you both for being here, but that is all the time we have this week.

Remember, you can get past episodes of the show at wkno.org, or download the full podcast of the show from The Daily Memphian site or wherever you get your podcasts.

We'll see you next week.

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