At the emergency room, the coronavirus patients arrive every day.

They are old and young, rich and poor. Some are so weak they must be carried in from cars or ambulances. A few patients stumble through the doors with so little oxygen in their blood it is a wonder that they can stand at all.

Once inside, they are met by exhausted doctors and nurses who are reusing surgical masks and gowns to conserve a limited supply. Sometimes the patients appear to be stable, then an hour later they are clinging to life on a breathing machine.

“It’s a really scary time to be an emergency department physician,” said Dr. Ali Bollinger, a physician on the front lines of the coronavirus crisis. “We are seeing COVID-positive patients every day coming through our front doors of every age, race and socioeconomic background. Some of them are extraordinarily ill – terrifyingly so.”

Bollinger, who described the Ascension-Saint Thomas emergency room where she works but does not speak on behalf the hospital group, is one of several local doctors who have publicly emphasized the ever-present threat of coronavirus in the past week.

Although new statistics and virus modeling suggest the Tennessee outbreak has been slowed by social distancing, the doctors warned this progress is fragile and the virus remains dangerous. Their message mirrors that of state and city leaders who have repeatedly urged Tennesseans to double-down on social distancing.

“There is some reason to feel hopeful, but we are so far from out of the woods,” Bollinger said. “Because there are still a lot of very very sick patients coming through our doors every single day, and that number will only go right back up if we take our foot off the gas at any point right now.”

Doctors and health officials have become worried about the public abandoning of social distancing because of two predictions of a milder coronavirus outbreak in Tennessee. First, a virus model from the University of Washington, which once forecast hospitals would be overwhelmed, has now been revised so it estimates the state has enough hospital beds to handle for the outbreak. Second, the statewide growth of new cases has dropped to its lowest point in the past week since the outbreak began.

'The storm is still there'

Dr. Isaac Thomsen, who leads Vanderbilt’s Vaccine Research Program Laboratory, said this week that signs of a smaller outbreak was “absolutely good news.” But Thomsen insisted it was far too early for Tennesseans to return to normal life.

Thomsen said state leaders should wait for a “significant, sustained decrease in cases” for at least 14 days before they consider lifting social distancing mandates.

“In the middle of a rain storm, if you go into a shelter and it’s warm and dry, you might say to yourself ‘Alright, it feels great in here. This is good. Let’s go back outside,’” Thomsen said. “But the storm is still there.”

Other doctors warned the outbreak is virtually guaranteed to be larger than the cases counted by Tennessee health officials. Many patients with mild symptoms never get tested, but they can still spread the virus if they don't isolate themselves.

Dr. Sonal Gupta, a primary care doctor who has been working via telemedicine, said she has diagnosed 20 presumptive positive cases in the past two weeks, but only three of those patients had severe enough symptoms to actually get tested.

Of the three, one was a 44-year-old long-distance runner who was previously healthy. The virus has left him so breathless that he struggles to drag himself to the bathroom, Gupta said.

Gupta stressed that one of the challenges of the coronavirus is that the best defense isn’t purely medical. While many ailments can be treated with a simple pill, a viral outbreak requires everyday people to change their behavior to protect each other.

“If you eat bacon and eggs for breakfast every morning, you affect your cholesterol, but not your neighbor’s cholesterol,” Gupta said. “If you choose to make a bad decision by not listening to your doctor, and it’s a solo decision, then that’s different."

"But this is not about just your cholesterol. This is about all of us all as a community.”

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.