Halfway through another week, I hope you are all safe and doing well. After a morning of checking in with friends and family, I’m running a bit behind getting started today, so I’m going to dive right in.
International News:
Along with normal ups and downs on a seven day cycle, confirmed and reported cases of COVID-19 continue to rise. 91,840 new cases were reported yesterday and the mid-day total today is 5,727,063 who have been diagnosed since the beginning of the pandemic. 4,048 deaths due to the illness were reported yesterday and the mid-day confirmed and reported total is 353,615 dead of the illness since the beginning.
While the number of reported cases is large and continues a slow, steady rise in worldwide numbers, it is important to keep several points in mind. For one, while large, the number is tiny compared to the world’s 7.8 billion people, and is virtually irrelevant in terms of developed immunity. Even, as is almost certainly true, the “real” number of people who have had the illness is much higher, even if it was 100 times bigger, and if having the illness provides immunity (of which we are not completely certain), we would not approach the “herd immunity” numbers needed to reduce future outbreaks.
Additionally, while it could be seen as comforting that the number of cases is only slowly rising around the world, the truth is that it is diminishing in some places even as it devastates others. Many of the most vulnerable countries, in terms of living conditions and health care, have only begun to see the impact. It was the second wave of the Spanish Flu that claimed the majority of its 675,000 victims in the United States and the 50 million world-wide.
The most encouraging news, despite the fact that there is some documented under-reporting around the world, is that the death rate is subsiding. While deaths yesterday jumped from about 1,100 worldwide to over 4,000 from one day to the next, the trajectory of the daily graph is clear and encouraging. If we can keep that from reversing until we have better treatments, we will be fortunate.
Fourteen countries in the world reported more than 1,000 new cases yesterday, some much more than 1,000. While the U.S. continues to report more cases each day than any other country, Brazil, with about 60% of our population and administering about 1/3 per capita the number of tests is finding almost as many daily cases and it is increasing. Yesterday, while the U.S. reported just over 19,000 new cases, Brazil reported almost 17,000. Other countries with continuing high rates of new cases include Russia, India, Peru, Chile, Mexico, Qatar, Pakistan and Bangladesh.
One additional note, Brazil, despite very credible allegations of under-reporting deaths, reported more deaths yesterday than the United States, acknowledging 1,027 had died.
National News:
Yesterday, there were 19,049 additional cases and 774 deaths reported in the U.S. This continues a slow downward slope in the number of cases and a fairly steep downward slope in the number of daily deaths. Given that we continue to open our economy and people are in increasing contact, this is very encouraging. This marks the first time since March the U.S. has reported fewer than 1,000 deaths a day for each of three consecutive days.
Five states reported more than 1,000 cases yesterday: California, Virginia, Illinois, New York and Texas. If there is a caution to be found about the reduction in both new case and death rate, it is that the heavily populated northeastern states continue to decline rapidly, making our overall numbers go down, while less populous states are seeing increases. In addition to the two southern states in that top five, yesterday found the following southern states among the twenty highest in the country: Alabama (#6), Georgia (#8), Florida (#11), North Carolina (#16), Kentucky (#17) and Tennessee (#19).
State and Local News:
Yesterday, the state of Tennessee reported 358 new cases of COVID-19 to bring its total to 20,965. 271 additional recoveries were reported, continuing the trend of increasing numbers of active cases, with a net of 87. The total number of active numbers reported by the state is just over 7,600.
Tennessee is among a list of about a dozen or slightly more states reporting steady or significant increases in cases reported. The graph above shows that where our four day moving average (the red line) remained in the low-to-mid 200s through most of April, it has increased (with some ups and downs) since. Our current four day moving average is 393.
Five additional deaths were reported yesterday, bringing that total to 343 since the beginning of the pandemic. 15 additional people were hospitalized across the state and 7,285 tests were administered, bring the total number of tests given to 403,504. Tennessee currently ranks 12th in per capita testing among the states and D.C.
As you can see on the chart above, Tennessee continues to test at a steady rate of around 8,000 to 9,000 or so tests per day, with fluctuations above and below that. The testing rate has remained fairly steady since, meaning that the increase in cases, which has continued, cannot be accounted for simply due to increased testing.
The line through the graph is a seven-day moving average showing the rate of positivity. Most guidance suggests the goal would be to increase testing until this is below 5%, which the state of Tennessee accomplished in early May. However, the number of those testing positive has risen slowly since then and now sits at 4.6%, just below a point of concern.
In state/local news, the University of Tennessee announced its plans for fall semester, which include having students report in early August, continue classes through Labor Day and, eliminating fall break, conclude the semester before Thanksgiving. This is similar to plans adopted in other parts of the country, with the goal of reducing the likelihood of spread resulting from students dispersing to their hometowns and returning again repeatedly.
Locally, I’ve had some interesting conversations on social media. This issue is so politicized that even a small word can ignite a firestorm (or tempest in a teapot). I had two words which garnered big reactions in yesterday’s article. I said I was “shocked” when I first heard that 100,000 Americans might die. Apparently some people didn’t believe me.
I also said that yesterday’s uptick in cases in Knox County was “significant,” which made its own waves. That, as it turns out, wasn’t my word, but that of the health department and used in the context of statistically significant because it moved the new case totals by more than one standard deviation. It was roundly ridiculed given our overall amazingly and wonderfully low numbers.
Today’s numbers indicate that yesterday’s were not an anomaly, however you characterize them. Today the health department reported fourteen additional cases to follow yesterday’s 10. While the numbers are small, compared to many less fortunate locales, it marks the first time since the beginning of the pandemic that Knox County has reported two consecutive days of double digit increases. There had only been six such days prior to these two since this began.
This brings the total cases to 366 since the start of the pandemic and raises the number of active cases to 48 in the county. There continue to be two people hospitalized and the total who have died remains at five. The health department reports 10 additional probable cases.
Knox County Health Department Briefing:
Dr. Buchanan led today’s briefing. She expressed thanks to the environmental safety team and 311, as well as others answering questions from the public. She confirmed the above numbers.
She said that, in addition to yesterday’s increase, today’s increase is also a statistically significant increase. She said each day would warrant a “red” light, correcting information given yesterday that it would be equivalent to a “yellow” light on their metrics and said that would be three days in a row. They are bringing additional team members in to help with contact tracing as there are more contacts to follow.
She said the metrics on the website will be adjusted, if needed, on Friday, as previously planned. She noted that while they are responding to the increase, it was important to remember that an increase was expected given the loosening guidelines A few of the cases are related to two small clusters.
Questions:
- Another day of a jump in cases – when do we look at going back to phase one? It is one benchmark we use. We’ll use case increases, testing, deaths and more. We’ll also look at the context of the increase. Our case count has been so low that it doesn’t take much to be statistically significant. It is a reminder that we all need to wear masks, wash hands, stay home if sick, clean surfaces and maintain social distancing.
- If a customer scans with a higher temperature, but says they have a condition that produces that, should businesses let them in? That is up to the business.
- Who is eligible for testing at this time? The health department will test anyone who wants it, as well as people who are symptomatic or connected with someone who is symptomatic. Appointments are made for drive-through testing (today and Friday). They are now collecting insurance information to recoup some of the expense that the county is assuming. It remains free to the public. Providers may have their own guidelines for who they will test.
- When will it be safe for people to visit nursing homes? It will be a while. The state is in the process of testing all residents before they open, in order to set a baseline.
- Are the clusters related to businesses, families or neighborhoods? Some are businesses. Everyone is cooperating and helping us find those who have been exposed.
- Does phase two mean that quarantines are over? No. Quarantines are for sick or exposed people and that will continue. The quarantine period is 14 days from exposure. Exiting earlier than that could expose others.
- Should people be concerned about shopping at a store where there have been cases or clusters? People should simply follow basic guidelines for safety (listed above).
- How do you enforce the quarantine on individuals? They simply do it. We check on them every day. We can force the issue, but people generally are cooperative. We haven’t had to follow legal procedures with anyone during this pandemic.
- I recently had contact with someone who had a negative test before contact with me, but a positive test afterward. Should I get an anti-body test? Antibody tests are not generally useful.
- Can you explain where the new guidance came from regarding 12 feet distance for exercise or singing and performing? It came from the task force because of data that says droplets are more forcefully released.
- What should I say to people who respond negatively to me when I wear a mask? We are asking that if you are wearing or not wearing a mask, to please be compassionate to those who make a different choice. We think masks will help us not go backwards.