Q&A with Dr. Alex Jahangir of Vaderbilt Medical Center: ‘It really was a big private-public partnership’

As chair of the Metro Coronavirus Task Force in Nashville, you led the city’s COVID-19 response. How did the strategy to address the pandemic come together?

COVID first came to Nashville on a Saturday, March 7. And very quickly, all of us realized that this was going to be a much bigger deal than perhaps we had thought. So during that very first week, I, along with the mayor’s office and the health department, brought together a lot of players, including the three tertiary healthcare systems: Vanderbilt University Medical Center, Ascension St. Thomas and HCA TriStar.

Each of the systems individually had a response plan, but we brought together the leaders of those three medical centers, along with Meharry Medical College, a historically Black medical college; Nashville General Hospital; and not-for-profit organizations, such as the Red Cross, nursing homes and other groups focusing on our less-served communities. We brought everyone together on that Wednesday to try to figure out a coordinated response. And from there, we built a lot of infrastructure—first around testing—that I think has really helped our community.

How was the testing infrastructure set up, and how did it focus on addressing underserved populations?

With the three health systems, as well as Meharry and Nashville General, we pulled out this big map of the city of Nashville, and we looked at areas that were underserved in healthcare. Nashville has some areas that have a lot of providers and healthcare systems, and some areas that don’t—predominantly North Nashville, which has a large portion of the African-American community, and southeast Nashville, where there is a lot of our immigrant population.

We decided that we were going to really focus on testing in those areas. We decided we were going to do drive-thru testing that has walk-up capabilities. We decided what information to get from people to make it efficient and effective, but also glean the information that we needed to track demographic data.

What was most beneficial was each healthcare system—all fierce and healthy competitors of each other—donated their staff and their time to help us initially staff these resources. So we had staffing, we had a plan and we had the facilities. The final piece of the equation was that we were able to have a great partnership with the state of Tennessee, and the state health department, which provided the funding for each test. They allowed us to work with private lab companies to get the tests run, which is not a cheap task. Partners such as Nissan Stadium, where the Tennessee Titans play, gave us their facility for months to be able to run the testing centers. So it really was a big private-public partnership, with both the city and the state being the public side.

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I think another partnership that’s really hard to overstate was that with Meharry Medical College. Can you talk about how critical that was to the city’s response?

Meharry is a historically Black medical college in Nashville. It is led by Dr. James Hildreth, who is probably one of the most world-renowned infectious disease doctors, and we had him right in our backyard. Really early on in the pandemic, one of the first people I reached out to was Dr. Hildreth to see if he would help guide me and our city.

Meharry provided expert advice and—after the first six weeks, when hospitals started reopening—the staff for our testing sites. And that continues to this day, as they have also become vaccination sites.

I think the key here is Meharry and Dr. Hildreth allowed us to have credibility and expertise so that those who were most at risk received the vaccine. What I’m really proud of is by June 2021—three or four months into our vaccination efforts—53% of our African-American population over the age of 55 were vaccinated and 58% of our white population over that age were vaccinated. Very deliberately communicating, placing testing and vaccination centers in these communities and having a trusted partner in Meharry Medical College to deliver the messaging and the vaccines allowed us to have that successful response.

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The broader community response was meant to keep case numbers at a level hospitals would be able to manage. Can you tell us what it was like in Nashville’s hospitals during the worst surges? What challenges were they facing? And how did you work to solve them?

I remember Dec. 31, 2020, was probably the peak, when we still didn’t have vaccinations, and about a third of our region’s hospital beds were at full capacity. I remember having to turn down referrals from as far away as Virginia. We realized we needed to come up with an innovative way to help our people in the city, because we didn’t want people from Middle Tennessee to have to travel to Virginia to get their care.

We created a coordinated transfer center in Middle Tennessee. We set up a system in which the three tertiary health centers would take transfers from any unaffiliated hospital or free-standing emergency department in our region. Hospitals that were unable to successfully transfer patients, whether it was for COVID or for something else, could call our Middle Tennessee regional transfer center.

We had 838 requests for transfers in three months. Nearly 700 of those people were able to be transferred to a higher level of care in Middle Tennessee. I think about the lives that we saved and the administrative burden that was taken away from patients, hospitals and healthcare providers, because they didn’t have to sit on the phone and call 20 or 30 different places. It’s a model that is very successful, and I really think it has saved lives. It was only able to happen because we had three really innovative strong leaders and we had a state health department that allowed us the legal coverage to be able to do it.

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