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Entering year three of the COVID-19 pandemic, a lot has become normalized. The nation is facing another surge of a variant that was first identified in a country 8,000 miles away. Hospitalizations are rising, testing centers are being inundated, and masks are flying off the shelves — it’s the same dance we’ve been doing since March 2020. 

But this time, Tennessee is testing the waters: Can we battle the virus outside of an emergency period? 

In the past two years alone, the state of Tennessee has accumulated so many cases of COVID-19 that even Microsoft Excel spreadsheets have met their capacity limit. And with large swaths of the population — especially globally — still without immunity, new variants will continue to circulate without seasonality. 

The Centers for Disease Control and Prevention estimates the Omicron variant went from less than 1 percent of new infections in the South to approximately 80 percent in a matter of three weeks, putting the population’s immunity and new therapies to test. This wave is notably different from past ones. Not only is Tennessee facing the new and highly contagious Omicron variant, but at the time of this writing, it will be the state’s first significant surge not under an officially designated emergency period — in the past, that designation provided flexibility and extra resources for hospitals to care for an influx of patients. 

By the time you read this, hospitals may again be overwhelmed with patients. That’s not because Omicron necessarily causes more extreme illness than other variants, but rather because its rapid rate of infection among vaccinated and unvaccinated individuals alike will widen the pool of people who could potentially become sick enough to require hospitalization. That could add a layer of demand on top of the typical wintertime prevalence of other infectious diseases.

When hospitals faced record-high hospitalizations in the summer, the state health department and major health systems banded together to operate a transfer center in Middle Tennessee, coordinating across the region’s health facilities. Without the emergency status, our hospitals are now at a sizable disadvantage. The uncertainty has health care players bracing for impact, and area hospitals have already begun suspending scheduled procedures to preserve staffing and supplies for a potential surge in patients. 

“Hospitals were able to [handle larger volumes of patients] during the Delta surge because the governor’s emergency order gave some cover to be able to do some things like they did,” says Dr. Alex Jahangir, head of the Metro Nashville Coronavirus Task Force. “The third wave now, I don’t know yet the stress it’s going to put on hospitals because, again, less people are hospitalized, but more staff are going out — and we may not have available to us now the ability to coordinate together like we did during the last surge.”

But on the other side of this next wave, says Jahangir, the pandemic in 2022 almost seems manageable. He notes that more treatment modalities coming out will keep people out of the hospital. 

“I do think this becomes more endemic as time moves on,” Jahangir says. “It is true that Omicron is less virulent than Delta was, and mutations continue as such. And it could also very well not. But assuming that it becomes less virulent each time, and we have these treatment modalities, I think what you are going to see is this become more in the background like other coronaviruses. Maybe it becomes like a flu.”

A major contributor to the pandemic becoming more manageable is greater access to a wider range of tools that can mitigate infection and illness. Highly effective vaccinations, antiviral pills, at-home testing, masks and other emerging therapeutics are shifting the responsibility to slow the spread and reduce hospitalizations to the individual, weaning off emergency-era government-sponsored services like drive-thru testing sites and mask mandates.

The Tennessee Department of Health announced in December that it would begin integrating its COVID-19 response into normal operations, which include preventative health services, routine immunizations, substance use and drug overdose monitoring and family health and wellness. The health department will continue to support COVID-19 vaccine distribution in every county in the state as a normal operational function. 

Jahangir says the Metro Public Health Department will likely begin to slim down its COVID response to the entity’s more traditional functions in the next year or so. 

“Metro Public Health Department over many decades has not been a primary health care entity,” he says. “If you have a cold, you don’t go to the Metro Public Health Department to get fixed up. Over the past two years, we have taken a public health role in helping with the pandemic and offload testing and vaccines. But at what point does that no longer become viable? With contact tracing, at what point does that become less needed in the response to this pandemic?”

“As we further transition and COVID becomes more endemic, which it will probably be, our role will probably be to give vaccines and provide testing, but not treatment. That will be on the health systems.” 

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