There were 39 confirmed cases of the novel coronavirus in the state of Tennessee when Jackson Mayor Scott Conger declared a local state of emergency March 16. There were no cases in West Tennessee outside of Memphis.

As of April 2 — just 17 days later — there are 2,683 cases across Tennessee, and the virus can be found in all but four West Tennessee counties. Madison County alone has 13 confirmed cases and two hospitalizations, but projections by the Institute for Health Metrics and Evaluation (IHME) and statements from President Donald Trump's administration are hinting the worst is yet to come.

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The projection estimates 3,259 Tennesseans will die from coronavirus; 24 have already died. An estimate says by April 9 the number of hospitalizations for coronavirus will match the number of available hospital beds in the state.

If just a fraction of the 500,000 people within West Tennessee Healthcare's region of care are confirmed positive for coronavirus in the next 20 days, and the current Tennessee hospitalization rate continues, every West Tennessee Healthcare hospital bed would be filled. Additionally, there would not be enough ventilators for sick patients.

"That's when we get into a situation like Italy," Conger said. "They had to look at life expectancy and started making some tough choices on who received life-saving equipment."

What is the model saying

IHME projects Tennessee to reach its peak number of cases by mid to late April. It estimates 14,945 hospital beds are needed for severely sick COVID-19 patients; the state only has about half that currently available.

"We have not reached our peak yet and the data is sobering," Amy Garner, communications director for West Tennessee Healthcare, said. "People need to continue to stay home and be diligent."

The situation is more complicated in rural West Tennessee, which has been plagued with hospital closures.

There are no hospitals in Haywood, Crockett, Chester and McNairy counties. West Tennessee Healthcare owns various smaller satellite hospitals in Benton, Hardeman, Weakley, Gibson and Dyer counties and recently purchased a hospital in northern Madison County.

All these counties' patients are then fed into West Tennessee Healthcare's main campus, Jackson-Madison County General Hospital, meaning roughly 500,000 people will potentially rely on one hospital with six smaller locations that aren't necessarily equipped.

West Tennessee Healthcare reports having around 1,200 beds throughout its seven locations. But roughly half those beds are being used by current patients suffering from other life-threatening ailments.

The hospital system has made efforts reduce its patient population by eliminating all elective procedures. Thanks to these reductions Jackson-Madison County General Hospital reported having roughly 350 available beds and 57 of the hospital system's 90 ventilators.

The IHME projected that 0.02% of state will be hospitalized by April 19, which projecting out evenly means that 1,104 could be hospitalized in West Tennessee.

"The bottom line is we expect these numbers are going to increase so people have got to stay home so we can flatten the curve," Madison County Mayor Jimmy Harris said.

Contact tracing could become overwhelming

Many infectious diseases with slow spread can be kept under control by tracing an infected person's contacts and whereabouts. Contact tracing has been used to track COVID-19, but Madison County health officials worry it will soon be too difficult to trace.

"We are still contact tracing, but eventually it'll be so overwhelming that it will be hard to do," Kim Tedford, executive director at Jackson-Madison County Regional Health Department, said. "The cases we are seeing today are from the actions people took two weeks ago."

Coronavirus is presumed to be most contagious when symptoms like dry cough and fever are present, however health officials' largest concern is those who may be asymptomatic and still spreading the disease around.

"Think about everyone you have been in contact with in the last 14 days," Conger said. "Now think about if you were responsible for giving those people COVID-19.

"How would you feel if you were responsible for putting someone's family in the hospital? That's how we have to think."

Age groups at risk have also changed; originally it was thought that the elderly were most susceptible.

"It's varied from what we were originally told," Conger added. "A 43-year-old Chester County man, who was thought to be in relatively good health, has been on a ventilator because of it."

Social distancing measures in place

Jackson was ahead of other West Tennessee cities when Conger closed various non-essential businesses March 22. The surrounding counties were slower to take action, instead waiting for direction from Gov. Bill Lee, who didn't call businesses to close statewide until March 30.

Conger and Harris have both ordered safer at home initiatives; Gov. Lee has yet to declare the initiative, instead urging people to stay home.

The imbalance between city and state initiatives creates a potential risk for Jackson. According to Conger the city has a population under 100,000 but serves up to 500,000 thanks to its restaurants, shopping and employment opportunities. Due to the connectivity between Jackson and its outlying counties, only time will tell if its efforts were effective.

"Gov. Lee's order at least creates a some consistency," Conger said.

Conger and Harris have also issued executive actions banning gatherings of 10 or more people, including church services. Conger closed Jackson parks after requests for social distancing were ignored. Harris closed the county courthouse because people kept coming in.

Together the two have issued six executive orders that have done everything short of fining people for non-essential travel.

"You have to stay home," Conger said. "This thing spreads from person to person and it's only going to get bigger. It's time to stay home and social distance to make sure we are taking care of each other."

Reach Adam Friedman by email at afriedman@jacksonsun.com, by phone at 731-431-8517 or follow him on Twitter @friedmanadam5.