COVID-19: 4/15/2020 Update (Including Today’s Health Department Briefing)

View from the Bedroom, Foggy Bottom Flats, Foggy Bottom Road, Knoxville, March 2020
View from the Bedroom, Foggy Bottom Flats, Foggy Bottom Road, Knoxville, March 2020

It’s been about a month since the COVID-19 pandemic began to strongly assert itself into our daily routines. For those weeks, it’s been a mind-numbing combination of being frozen-in-time and witnessing a rapidly evolving situation. Many people are struggling to maintain basic necessities like food and shelter. We’re told this is the week many of us should begin receiving support from the government. I hope each of you are holding up well in difficult times. Here’s hoping we can safely share a drink or a meal together in the not-so-distant future.

International News:

While numerical markers make an emotional impact more than they truly signify a true shift, it is worth noting that global diagnosed cases of COVID-19 surpassed the 2,000,000 point yesterday. While it took just under two-and-one-half months to go from the first known infection to the 1,000,000th, the second million took less than a month-and-a-half.

The rate seems to have stabilized at about 70,000 to 90,000 new cases per day. Yesterday’s increase was 74,012 new cases. The caveat there has to be that we are testing at a much more rapid pace today than a month ago, so perhaps the numbers there reflect some combination of more comprehensive testing and an increase in spread that may be less than that implied by a straight reading of the numbers.

There are currently 2,028,069 diagnosed and acknowledged cases in the world and 129,181 deaths reported. These numbers represent twenty-four hour increases of about 3.7% in new cases and 4.7% in deaths. This rate of new cases would have us reaching 3,000,000 cases by right around May 5, or about 20 days.

While numbers of new cases remain high across much of Europe, they are much lower than was previously the case, with 24-hour infection rates rising at less than 5%. France seems to be behind other mainland countries in reducing the spread, though their numbers are also improving. The United Kingdom continues to have rates exceeding 5%. Brazil and, particularly, Russia seem to be struggling. Russia’s new infection rates are well over 10% daily. They have mounted a large testing program, testing just more than the U.S. on a per capita basis.

Europe was hit with the outbreak before the U.S. and, therefore, is slightly ahead of us in discussing reopening and actually beginning to do it. Some schools are reopening and shops are reopening with limitations. There is no European Union policy, but rather a country-by-country approach, which has some concerned because borders are largely open. Here’s a good look at their situation, which may have implications for us in the coming weeks.

View Inside a Windowpane, Henley Street, Knoxville, December 2019

National News:

The worst news is that yesterday was, by far, the deadliest day in the United States since we began tracking the virus. 2,407 people died, surpassing last Friday’s record of just over 2,000. Again, this number packs a large emotional punch, but it must be kept in mind that the peak number of deaths will trail the peak number of cases by some days. Let us hope that is the worst of the daily death tolls.

The currently reported national numbers are 618,325 confirmed cases and 26,290 deaths. These numbers reflect twenty-four hour increases of 4.6% and just under 10% respectively. The rate of new cases is up slightly from yesterday.

The national conversation is increasingly focused on when to re-open and what conditions must be met for that to make sense. President Trump made references to twenty states or more that have not been hit as hard and may be able to reopen. Both he and a number of governors seem to be targeting the beginning of May as a time to begin shifting back toward more openness. The Washington Post took a look at what we need to reopen and what the early stages might look like.

Another concern and disappointment regarding previous assumptions is that there appears to be evidence that not everyone who has had the virus has sufficient immunities to fight off a second round. It’s unclear at this time if the virus is re-emerging in this (relatively small) group or if they are responding to a new exposure.

State and Local News:

The latest numbers from Tennessee confirm 5,823 cases and 124 deaths. This reflects twenty-four hour increases of 3.8% and 13.8%. The rate of new cases seems to be leveling off. Governor Lee has extended his Stay at Home orders, but he appears to be looking at May as a time to begin reopening and an announcement on schools is apparently imminent. Re-opening schools this academic year continues to be a source of great discussion and not a little disagreement nationally.

Locally, the Knox County Health Department is reporting 172 total cases and 4 deaths. This is an increase of two cases and no deaths over the last twenty-four hours and is another indication that measures taken so far have worked. 21 people have been hospitalized. County Mayor Jacobs has made it clear that he wants us to open sooner, rather than later, while Knoxville Mayor Kincannon has been more cautious. Dr. Buchanan with the Knox County Health Department has, by all appearances, provided great help to each of the Mayors as they make their respective decisions.

Knox County Health Department Briefing:

Dr. Buchanan started today’s briefing with an expression of gratitude to the the Knoxville Center for the Deaf who have provided sign language interpretation to the briefings. She also expressed gratitude to the epidemiologists on staff who are doing major work with follow-ups to confirmed cases and their contacts.

She continued to stress staying at home, washing hands, maintaining distance and more. She said the fact that people are limiting contacts, when new cases emerge, there are only four or five contacts for them to reach out to, which makes the load manageable. She pointed out that this number will increase as we begin to open back up.

Acknowledging that people without symptoms can spread the virus, she noted that they spread it at a much slower pace because they are not sneezing and coughing. Discussing the “heat map,” on the Health Department’s website, she noted that it is not intended to provide a false sense of safety in a place with lower infection rates. The map shows infections by zip code across the county.

From the questions:

  • Should workers or customers at businesses be required to wear masks? She said the recommendation is simply an encouragement at this time when people can’t maintain social distancing.
  • What metric will be used to make recommendations on opening? Total cases and active cases will be critical, but she said there must be increased testing. She said all providers need to be testing an the support in supplies and lab capacity has to be able to handle re-opening. This allows us to determine quickly if we should back off as we begin opening.
  • Laboratory tests are required in order to make a diagnosis. Doctors cannot diagnose in the absence of a test. (New York has added numbers based on counts kept of probable cases, that move has not been vetted for Tennessee.)
  • Regarding Mayor Jacob’s plan, she said she supports a phased re-opening and everyone is working on that. She noted that Nashville and Memphis, for example, look very different from our local situation.
  • Asked if grocery bags brought from home are a greater risk, she said anything that can reduce risk is important. Introducing bags from outside could be putting employees at greater risk for exposure as they use those bags.
  • Asked what she will do if Mayor Jacobs asked her to open the economy before she feels we are ready, what would she do, she says they are working together and she will give honest advice.
  • She said there is no way to predict a peak on the limited data. She said the “doubling rate,” is extending, which is a good thing.
  • Asked if testing capacity has been increased to 90 per day as projected, she said not yet, but they are working toward that.
  • She acknowledged that some deaths among people never tested could have an underlying cause of COVID-19. The medical examiner, she said, is looking at that postmortem.
  • She said we will have to have things back to normal before a vaccine is widely available. She said that availability will likely be “months if not a year away.” She said as we get back toward normal we will have to continue to do the other practices currently encouraged.
  • Asked about models that show Tennessee’s peak to range from the next 48 hours to mid-June, she said they are looking at all the models and there is not enough data at this time to say certainly and we may not know until after we begin going down.