Nashville for Rational COVID Policy

Roadmap for A Smart Nashville

Transparency

Nashville hasn't been very transparent when it comes to the data they provide. Here is additional information that would be beneficial:

• Total hospital bed capacity. We know COVID+ hospitalization numbers, but Nashville does not report hospital bed capacity that allows calculation of their % of available beds. Additionally, we contend that the percentage of beds taken by COVID+ patients is a better measure of hospital resource usage than the percentage of all beds taken, which is routinely high under normal operations. Memphis provides this data in regular updates from the Mayor's office; we would like Nashville to do the same.
• Unclear / Conflicting Metrics. The New Cases per 100k Residents metric for reopening is consistently inflated from numbers that we can independently verify. Take a look at this spreadsheet for a breakdown of the Metro daily announced numbers, the state numbers from Tennessee Department of Health for Davidson County and the Metro Reopening Metrics. With these numbers being critical to our path to reopening, the least we can ask for is that Metro calculates them correctly.
  
  
  Note: On September 2nd, we wrote an article criticizing the opaque and discrepant calculation of the 7-Day Positive Test Rate, which was at odds not only with the TN Department of Health's calculation, but also with Metro's own data. On September 3rd, Metro changed the way this metric is being calculated to bring it more in line with the state and with our understanding of the meaning of the metric. We appreciate this change.
  
• Depersonalized contact tracing data for transmissions. If policies are being made based on where cases are transmitted, the public should have access to that data.

Accountability

On April 23, Mayor John Cooper announced the city's "Roadmap for Reopening," a 14-page plan that, in his words, would be "data-driven." However, the data used by the city to determine whether movements to different reopening phases under the plan has changed repeatedly, without a public discussion or accountability.

• New metrics added on August 6. Under the plan (which can be found here), there are several measures tracked by the city to determine when the next Phase can begin. There were 6 such metrics from the time that the plan was announced in April, until August 6. On that date, Nashville met the criteria to move to Phase 3 under those 6 metrics - but instead, the city added two NEW metrics, "7 Day Positive Test Rate" and "New Cases Per 100K Residents," the latter of which was deemed "unsatisfactory" to move to Phase 3. Adding metrics to achieve a desired outcome is the opposite of "data-driven," and prohibits planning on the part of business owners and employees.
• Arbitrary "Modified Phase 2" rules. Rather than sticking to the plan - which would have involved movement to "Phase 3" on August 10, to include permitted gatherings of up to 100 people, bars/restaurants open at 50% capacity, and all other businesses open at full capacity with minor restrictions - Mayor Cooper announced on August 13 that the city would exchange one set of "modified Phase 2" rules for another, allowing bars to open with a maximum capacity of 25. Subsequent changes have insisted on bearing the "Phase 2" moniker, with variations each week in what can open and what restrictions are in place, including the crown jewel of hypocrisy: Extending the bar and restaurant curfew for one night only to accommodate patrons for a Titans football game. Completely arbitrary, not data-driven.
• Limited dialogue with the public. Nashville does not have public hearings or meetings to discuss the reopening strategy and the detrimental impacts of business closures and restrictions with the general public. This open dialogue is essential to good governance; Nashvillians should feel as though their voices are heard and that the effects of public policy on their lives are considered.

Hospital Bed Ratio

Among the metrics tracked by Nashville to determine reopening are measures of hospital capacity, both in terms of "floor beds" as well as "ICU beds." However, these metrics track TOTAL capacity of the hospitals, regardless of the share of hospital census which is COVID+.

What the city's "Reopening Response" page does not provide is the number of COVID+ patients currently in hospital. This information can be found from the Metro Public Health Department dashboard, which shows 115 COVID hospitalizations (as of September 15).

Here are our best estimates for COVID and non-COVID hospitalizations over time, as compared to total system capacity: A Smart Nashville Covid Dashboard

This shows that there are several times more empty beds in area hospitals than there are beds being taken by COVID patients. There is also no discernible strain on the health care system by COVID at this time. Hospital capacity criteria used in the city's reopening guidelines should be reconfigured to reflect a more reasonable measure of hospital system stress.

Test Positivity Rate

As mentioned above, Nashville for Rational COVID Policy appreciates the change made on September 3 to bring this calculation more in line with conventional standards and with the state Department of Health.

You can see more detail on Nashville's test positivity rate from the state and from Metro over time at our dashboard here: A Smart Nashville Covid Dashboard