Health Department Urges Compliance With Guidelines As Knox County COVID Cases Rise

Jun 28, 2020

This graph shows the trendline for new COVID-19 cases in Knox County since May 5.
Credit Knox County Health Department

As Knox County closed out a week in which 203 new COVID-19 cases were confirmed, local leaders plied a narrow path, simultaneously pointing out that the county is not currently in a worst-case scenario and urging residents and businesses to not let their guard down.

“We are concerned,” Knox County Health Department Director Martha Buchanan told reporters Friday. “The virus is still very present in our community. Observationally, we all see that not many people are wearing masks. Not everybody’s maintaining social distancing. So it’s kind of a hodgepodge across the community.”

The county recorded 223 active cases Sunday, sixteen of which were new. The week ending June 28 saw a new single-day record for new cases: 39 on Thursday. Since late May, days of double-digit new case counts have become common in Knox County. Buchanan confirmed Friday new cases are building up faster than recoveries are rolling off, a finding she called concerning.

The week has not been kind to Tennessee, either. The state recorded its highest day of cases since the pandemic began, according to the Tennessee Department of Health, and the daily average number of COVID-19 cases increased from the previous week.

“As you go about your daily life, you are at risk of contracting COVID-19 regardless of where you are or who you are,” Buchanan said, noting the virus can be spread by people who feel no obvious symptoms. “They key to this is really following the five basic principles, and doing it across the whole community and not sporadically.”

While some of the county’s active cases can be traced to small localized concentrations called clusters, they alone do not explain the recent acceleration. Spread among the general public is in progress, KCHD infectious disease specialist Charity Menefee said, concerning local public health officials. She and Buchanan again urged everyone to follow cornerstone rules that help slow COVID’s spread, including thorough hand-washing, physical distancing and wearing a mask.

The case rise “further stresses the importance to taking your health into your own hands,” Menefee said.

“There is plenty of evidence at this point to document that those five core actions we talk about help reduce the spread of this disease, and they help protect you,” Menefee said. “Following those actions is critical to help slow the spread of this disease and help protect you and your loved ones.”

While very few Knox County residents are hospitalized, the number rose from three on Tuesday to fifteen on Sunday – another record high to date. Menefee said overall hospital capacity in the Knoxville metro area remains good. Buchanan said hospitals are operating at or near typical pre-pandemic capacities, and have yet to tap into their “surge capacity” to handle severe COVID cases. The number of cases requiring hospitalization has been rising since June 19, according to state health department data. The department also said statewide hospital capacity remains good.

The increase in cases and hospitalizations raised questions about whether Knox County would re-consider its business and social guidelines to again tamp down on the virus’ spread. Buchanan and Knox County Mayor Glenn Jacobs said that decision lay solely in the hands of the county board of health. Its next scheduled meeting is Wednesday, July 1, the same day the county is set to abandon its local re-opening plan and join Gov. Lee’s “Tennessee Pledge” plan.

Jacobs, a consistent advocate for business re-openings, acknowledged the case rise but said increases were expected as people resumed social activity. He also pointed to the county’s very low COVID death count. While the Knox County still has some degree of autonomy to make locally-tailored decisions about public health, Jacobs noted county law director Bud Armstrong’s legal recommendation is that county COVID guidelines be on par with -- or even less restrictive than -- the “Tennessee Pledge” guidelines.

When the Board of Health convenes Wednesday evening, it will look at the five benchmarks KCHD says summarize “local ability to manage an increase in cases while preventing the unobstructed growth of transmission.” The benchmarks are summed up in a “traffic light” scheme – red, yellow and green – based on how data stack up against what public health officials think is manageable. As of Friday, two of the five benchmarks (the rise in new cases and community testing data) were red. The remaining three (hospital capacity, death trends and capability of KCHD to study and track the virus) were green. The next benchmark update is due to be released ahead of the meeting.

In many Tennessee counties, only Governor Bill Lee can mandate special conditions such as wearing masks or business restrictions. While the COVID task force Lee created in March is still active, the last weekly update on the state’s response was issued May 22. In the five weeks since, local officials have been pleading with residents to at least wear a mask when around other people. Adherence to the requests appears to be spotty: Information culled from a Facebook survey and plotted by social scientists at the University of Maryland showed fewer than ten percent of Tennessee residents consistently wear a mask when in public.

A mask mandate went into effect Sunday evening in Nashville-Davidson County in an attempt to help slow the virus’ spread. 350 new cases were confirmed in Nashville on Saturday. Knox County may have the same power, because its health department is locally-operated. The governor’s office says businesses can require patrons to wear masks, and deny service to those who don’t.

Knox County’s new case counts are still below the Tennessee Department of Health’s standard of 10 cases per 100,000 people. But next door, Sevier County is well over that line. Its most recent new case count is 28 per 100,000. Its recent peak was 50.65 on June 19. Some city leaders in Sevier County have expressed frustration with state officials for not providing more information about cases and trends in the county. Like most Tennessee counties, leaders in Sevier do not have the authority to deviate from “Tennessee Pledge” without specific authorization, regardless of what local COVID trends look like. A joint state/local meeting to discuss the Sevier County situation is planned for Monday, June 29.

While concern early in the pandemic focused on older people and those with pre-existing health difficulties, younger people may have been lulled into a false sense of security. Fully one-quarter of Knox County’s cases have been within people 21 to 30 years old. The same age bracket accounts for more than one-fifth of the state’s total cases.

“You may feel like you’re not at risk from this when you’re young. And you’re not seeing a lot of hospitalizations in that group,” Menefee said. “But we want you to know you can have this and not even be aware of it. We know that there’s asymptomatic spread. And you come in contact with people every day that could be at risk for having serious complications from this.”

The concentration of new cases among young people may thwart plans for college re-openings nationwide. At a Thursday meeting focused on that topic, University of Tennessee Knoxville Chancellor Donde Plowman outlined campus practices and rules coming in August – with the caveat that any of them could change depending on the course of COVID-19.