COVID-19: 4/21/2020 Update (Including today’s Health Department Briefing)

Boating, Tennessee River, Knoxville, March 27, 2020
Boating, Tennessee River, Knoxville, March 27, 2020

Today is Tuesday. Tuesday. The Day After Monday. The One Before Wednesday. Today is the 21st. Of April. Yes, March ended a while back. No, it just feels like it should be Christmas. Christmas is still two months away. Wait. Let me get my calculator and check that. The lack of anything to mark the days is mind-numbing after a while isn’t it? Try to keep oriented and keep your mind from turning into those jello shots you’ve been doing and we’ll get through this eventually.

International News:

In the twenty-four hours ending last night, there were 73,928 new cases of COVID-19 documented in the world, along with 5,366 new deaths. This reflects very little change from the previous day and continues in the range we’ve seen for some time. Some parts of the world are improving, while other parts are getting worse. Still others have improved, but are now running into trouble again.

Worldwide Cases and Deaths Through 4/20(Source:

The total world numbers as of mid-day today are 2,510,159 cases and 172,764 deaths, reflecting overnight increases of 3% and 3.3% in deaths in a twenty-four hour period. As much as we want this to end, as much as we want to believe warmer weather will stop it, the numbers, which are no doubt vastly under reported, are not consistent with these hopes, so far.

There does seem to be some improvement in rate of increase, which is the most hopeful sign. Still the graphs tell the story. Do note that while the graphs end their daily labeling along the bottom at April 12, they do include data through April 20. They are interactive on the site by moving your cursor over the line to see daily totals. You’ll find the originals here.

Trends reported in recent days, largely continue. The U.S. continues to lead the world by dramatic margins daily in new cases and deaths each day. European countries continue a steady, but uneven reduction in the numbers of new cases. That said, across Europe the newly diagnosed cases are running in the low thousands each day. The United Kingdom continues to fair worse than its neighbors in recent weeks.

Even as the rate of new cases decreases in Europe, other countries around the world appear to be doing very badly and a number are getting worse. Turkey, Russia, Iran, Brazil, India, Saudi Arabia and others continue to see escalating rates of infection though some of them have relatively small raw numbers, so far.

A real difficulty in comparisons is the disparity in testing. Russia has tested more per capita than the U.S., for example, but the other countries on this list and many others who are reporting very few cases, have done relatively little testing. India, for example, has tested only 291 people per million. This compares to the best per capita testing in the world (removing the tiny countries) in Israel, which has tested 27,763 people per million. Many other countries have tested over 20,000 per million.

Of special interest to the countries around the world considering opening up for business, is Singapore. The highly controlled city/state with a highly dense population of just under 6 million took strong early steps to test widely, identify cases and quarantine them. Otherwise, much of daily life continued and it seemed they had contained the outbreak.

But they ignored the poor immigrants to do most of low wage jobs in the country. Cases among immigrants, who were tested at a lower rate, were spreading. The country’s total numbers are still small, though pacing southeast Asia, but are increasing at an alarming 15% daily, using the approach that many countries, including the U.S. are considering the model for re-opening.

National News:

As of mid-day, today, there are 802,159 confirmed cases and 43,495 deaths from COVID-19 in the U.S. This reflects a twenty-four hour increase of 4.3% in cases and a 7.2% increase in deaths. For comparison sake, a week ago I reported an overnight increase of 5.1% in cases and 11% in deaths. There seems to be a leveling off in numbers, though the numbers remain dramatically higher than anywhere else in the world.

The most encouraging graph I’ve seen is the one below, which is encouraging only because new daily cases have seemed to level off in the upper 20,000s. The number of new cases recorded yesterday was 28,123 and the number of deaths was 1,939.

New Daily Cases in the U.S. Through April 20 (Source:

To extend the international comparisons, the United States has the most total cases and that number currently represents about four times the number in the second country (Spain) on the list. The United States has the most total deaths reported in the world at almost twice the number of the country (Italy) below us. We have given more tests (over 4,000,000) than any other country in the world.

Per capita comparisons reveal the United States has the sixth most cases in the world among relatively populous countries. It has the eighth worst death rate in the world among populous countries. In testing per capita, compared to relatively populated countries, the United States  ranks 21st.

As the total numbers mount and the new numbers stabilize, states are making plans to re-open. Some are doing so much more aggressively than others and the trends are breaking along political lines, with Republican governors, particularly in states with Republican legislatures, leading the charge to re-open. Florida, South Carolina and Tennessee are among those planning to re-open soon. Georgia is taking it to a new level.

Governor Kemp of Georgia was among the last governors in the U.S. to close businesses and has already reopened beaches. He never closed parks and expressed his displeasure at closing churches. The state has not met the benchmarks set by the federal government for reopening, but the governor says they are going to expand testing and the numbers are encouraging. The move is extremely controversial. Businesses allowed to reopen include gyms, hair salons bowling alleys and more, all of which are allowed to open beginning this Friday, April 24.

State and Local News:

Tennessee is reporting 7,238 total cases and 152 deaths. This reflects increases from yesterday of 168 cases (2.4%) and 4 deaths (2.7%). These numbers compare to significantly higher numbers last week. (Specifics are obscured due to reporting changes that happened a week ago.)

These encouraging numbers, along with a national move among Republican governors to reopen sooner rather than later, have prompted Governor Lee to say he will not extend the Stay at Home Order past April 30, the day it is set to expire. Schools will remain closed and urban counties in the state, which have larger raw numbers, will be allowed to chart their own course.

Locally, the Knox County Health Department is reporting 196 cases, an increase of 3 cases over yesterday, and no increase in deaths. The increases have continued to be in the low single-digits for days and there have been no new deaths reported in several days. There are 27 known active cases in the county, though as testing expands, the Health Department has said to expect that number to increase.

Knox County Health Department Briefing:

Dr. Buchanan, once again, provided today’s information in the previously unscheduled briefing. She said that starting today, in response to requests, the briefings would return to a daily time table. She acknowledged Governor Lee’s announcement regarding the loosening of restrictions across the state.

She said locally we are working on a data-driven plan to reopen, while acknowledging that demand for testing has out-stripped supply. She said hospitals are planning together in the event of any possible surge. She said contact tracing efforts will be increased. She said it requires more people.

She said we have not observed a spike in cases, thanks to the community changing behaviors to limit the spread. She said local data does support a phased re-opening. She said details would be forthcoming, but that it would not mean returning to pre-virus behaviors. She said business openings will be phased carefully. She said the reopening of the economy would only work if we all work together.

She said there are 195 cases currently diagnosed in Knox County which is one off from the number on the website. She said drive-through testing is suspended for tomorrow due to overwhelming demand. When it re-opens on Thursday guidelines will be stricter. She noted some people are being tested more than once and asked that that not happen.


  • The rate of increases has slowed across the state, while it has stayed steady here. She said that slowing rate across the state is why the governor made his move and she made the point that closing businesses isn’t a long-term plan.
  • She said locally the decision has been made to follow the governor’s guidelines to phase in openings.
  • What data would cause a reversal in the plan? She said they would have to look at the data regarding transmission.
  • In the local plan there will be guidance for specific industries and it will be slow. Social distancing, hand-washing and more will continue to be encouraged.
  • Do you expect a spike if we open back up? She said they do not want a return to normal. They want people to continue restricting trips, wearing face masks, etc. We have to, at some point, open up. We will see an increase in cases and we’ll watch that.
  • We do not plan to extend Stay at Home any further at this time.
  • Will the urban task force recommendations be considered? Yes, but we do what works for us, locally.
  • Other metrics to be considered beyond rates include monitoring similar symptoms in doctor visits, hospitalizations and deaths.
  • Asked about people who are afraid to go back to work, she said that is understandable and people have to make decisions while the health department will work with employers to make the return as safe as possible. She alluded to parents who have to stay home with their children.
  • How many people doing contact tracing? 30 to 40, but we have plans to expand this team by bringing employees back who are currently furloughed.
  • She does not know the total number of tests done in the county.
  • Parks open this Friday and Governor Lee said some business could be open earlier, she said that may be true in Knox County, as well.
  • Concerns were expressed for a flood of unauthorized openings once the first ones start. She said this will be monitored.
  • The plan is that the city and county will coordinate for consistency.
  • Churches cannot resume meeting at this time.