COVID-19: 6/26/2020 Update (Including Health Department Briefing)

Welcome to Friday. Weeks that seemed long to me when all this first began are now clipping by. Next week is July and we head into the heart of summer. It’s a great time to hit a trail, get out on the water or take a long bike ride. Just keep your distance this weekend, and when you can’t wear that mask. It matters.

International News:

As of this writing, there are 9,754,569 confirmed cases of COVID-19 worldwide and 492,671 deaths attributed to the disease. Yesterday, there were 179,531 new cases of COVID-19 confirmed around the world and 5,178 deaths were attributed to the disease. The number of cases represents the second highest single-day number since the beginning of the pandemic, and the highest, at just over 182,000, came six days earlier. The upward slope seems to be steepening as the numbers mount around the world.

The number of deaths is over 5,000 for the third consecutive day. There were four consecutive days over 5,000 last week and there had been no consecutive days above 5,000 for a month prior. There may be a small dip or plateauing in the curve, which is hopeful. Countries reporting the most deaths for the day were Brazil (1,180), Mexico (947) and the U.S. (649).

Even with the surge in U.S. cases (more on that later), Brazil added even more to have the most for the day at 40,673. The U.S. added 40,184, making clear that, at least for now, there is Brazil and the U.S. and everyone else is far behind. The third highest number of new cases was reported in India, with less than half that of the first two, at 18,185. In all, twenty-four different countries reported at least 1,000 new cases and a full 15 reported more than 2,000. Again, it is the most since I’ve monitored the number.

The countries continue to be clustered in the Americas, the Middle East and Southeast Asia. South Africa is of note for having, I believe, the highest rate of increase. The U.K. is the only European country to report more than one thousand cases yesterday. Of great concern is the fact that numerous countries like India, Pakistan, Mexico and Bangladesh have extremely anemic testing programs. Their true numbers cannot be represented at their current levels of testing.

To that end, India is launching an ambitious plan to send health workers to speak with, and test as needed, each of the 29,000,000 people in New Delhi. The British Government is reminding people it has the power to close beaches and seems to be threatening to do so. Work is being done to attempt to coordinate trials of potential vaccines.

National News:

As of this writing, 2,506,370 cases of COVID-19 have been reported in the U.S. since the beginning of the pandemic. 126,839 deaths have been attributed to the disease. The United States added 40,184 new cases to its totals yesterday and 649 deaths. It marked the highest single day total of cases since the beginning of the pandemic and the first time that number had crossed 40,000. The upward trajectory of the curve in new cases is beginning to resemble the curve that started the national effort to “flatten the curve” in March.

The reason for flattening the curve, then and now, is to prevent what naturally follows a rapid escalation of cases: overwhelmed hospitals and increased mortality. So far, deaths have continued to decline and hopes are for that continuation based primarily on the age of those becoming infected and the fact that the disease is less lethal to them. Some areas are reporting as many as 50% of new infections are among those in their twenties and thirties.

The new cases in the U.S. continue to be concentrated in the south and the southwest. New records are being set almost daily in places like Texas, Arizona, Florida and California, while weekly records are being set in such different places as Alabama and Mississippi. Nine states reported more than 1,000 new infections yesterday, whereas when I started tracking this number, it was around three most days. Perhaps even more troubling, four of the states ranged from 3,000 to about 6,000 yesterday.

Here are the largest numerical increases reported yesterday:  Texas (5,960), California (5,440), Florida (5,004), Arizona (3,056), Georgia (1,714), North Carolina (1,147), Alabama (1,142), South Carolina (1,125), and Mississippi (1,092). Seven of the top nine states are in the southeast. Others not far below for the day included Louisiana (#12), Tennessee (#14), and Arkansas (#15).

Whether due to increasing concern or other reasons, the White House Task Force will hold its first briefing in nearly two months today. It is unclear if the focus of the group remains “focused on getting America back to work,” or on the surge in cases. That briefing may be underway or completed by the time you read this.

In other moves, the White House yesterday filed a brief in support of a suit asking the Supreme Court to end Obamacare. If the White House and the states (including Texas) that filed the suit were to prevail, about 23,000,000 Americans currently insured by the program would lose their health insurance.

The Trump administration has also moved to de-fund testing sites in Texas (it had been previously planned, but before the current surge of cases in Texas) even though the Republican Senators and others from the states have attacked the move. The administration says this will not impact testing capability. Dr. Fauci announced  a new possible new testing strategy which might allow us to increase the volume of testing.

In the face of increasing cases, at least eight cities or states have slowed down or paused their efforts to re-open.

State and Local News:

Since the beginning of the pandemic, the State of Tennessee has reported 38,034 cases of COVID-19 and 567 deaths from the illness. Yesterday, an additional 799 cases were reported, as were 11 additional deaths. 587 recoveries were reported, yielding a net increase for the day of just over 200 cases. The current total active cases in the state now sits at 12,187.

2,431 people have been hospitalized since the beginning of the pandemic and 45 were hospitalized yesterday. Over the past two weeks, the number of currently hospitalized COVID-19 positive patients has risen across the state from 391 to 484.

The state reported 9,230 tests were given yesterday, bringing that total to just over 727,000. The rate of positive tests, as shown in the graph above, is rising and now sits at 6.9%. This indicates community spread and the likelihood that the testing program is not finding all currently positive cases. This number should drop as testing is increased.

Locally, the Knox County Health Department reports an additional 34 cases today, five off yesterday’s record number. Only three days have exceeded 24 new cases and they have each been within the last four days, with 36 on Tuesday and 39 on Thursday in addition to today’s number. As a point of reference, last week at the Board of Health meeting in which local control was given over to the state, Dr. Buchanan indicated the Health Department expected some increase in numbers, but they become concerned when that number is over 20.

The number of active cases continues to reach new highs and currently sits at 197. There have been 67 COVID-19 positive patients hospitalized since the beginning of the pandemic and that number now sits at 12, the highest it has been at any one time. A week ago today, that number was 2.

There have been no additional deaths and the number of probable cases sits at 27. Given the increasing case numbers and an issue with testing capabilities, two of the traffic light benchmarks have been changed from green to red.

Knox County Health Department Briefing:

Dr. Buchanan chaired the meeting. She said the volume of people wanting to be tested has increased. She said next week includes a holiday July 3, so the test schedule will be slightly different. Wednesday, July 1, the Board of Health will meet from 5:00 pm to 7:00 pm. The benchmarks will now be updated on Wednesdays to give them the latest information possible. That will start this week.

She discussed the benchmarks, reiterating that the evaluation is focused on the last two weeks and whether there has been a statisitcally significant change for three consecutive days.

For the case increase benchmark, she said there have been five days this week which reflected an increase and the light will be changed to red. She said the goal is that the number of cases rolling off should keep up with those rolling on (a leveling off), but that is not currently happening.

Regarding the test result benchmark, which focus on tests given and results returned. Tests given have reduced according to state data. She said there is no delay for reporting or responding to positive results. She feels testing is in good shape, and will look better when the data is more complete. She said there are increased delays in test results, which may be due to larger volume of testing.

She said they are still able to reach out to all contacts within 24 hours (benchmark 3) and that remains green. More people are currently being brought in to help as cases increase. The fourth benchmark shows green as there are adequate beds, ICU beds and ventilators. She said there have been increases, but they feel comfortable with their capacity to respond. The numbers there, however, are trending upward. The final benchmark for deaths remains green, with no additional deaths.

She implored the community to continue following guidelines:

• Restaurant workers MAY RETURN TO WORK IF THEY ARE POSITIVE as they are considered essential. They must wear a mask and not exhibit symptoms.

*** Followup: I sent an email to the Health Department after the press conference. I wrote:

• Employees should stay home if they have tested positive for or are showing COVID-19 symptoms.
• Employees who have recently had a close contact with a person with COVID-19 should also stay home and monitor their health.

• Can’t provide more data at this time (asked about adding more hospital detail each day).
• Our local Law Director is our local expert and we will depend on them. We have not reached out to the state. The Board of Health will look at the benchmarks and will make decisions.
• Can the Health Department explain why County Commissioners are not wearing masks at meetings? That is their choice.
• The trends don’t change all that fast and we have not activated the surge capacity, so we can afford to wait until the Board of Health meets. In the meantime she urged people to follow guidelines.
• Could an emergency meeting of the Board of Health be called? Not likely, given the sunshine law requires advance notice. I do not feel we are currently in an emergency situation.
• We definitely have community spread, and that comprises most of our spread, not clusters. Many people do not know where they got it. She stressed that simple ten-minute conversations with a neighbor can result in transmitting the virus.
• Hospital data as it stands isn’t that unusual and they have not used the surge possibility.
• The data we have shows fewer tests, but there is most likely more (negatives) that isn’t been returned to the county as quickly, so they think the actual numbers are higher and that will be corrected as that data is received.
• If a child at a  summer day camp tests positive, what would be the recommendation to that camp operator? The experts working with the Health Department will contact them and advise them. Please follow their guidance. Please cooperate with contact tracing and provide the requested information.
• We are very concerned with the increases in cases. The virus is very present. Not everyone is wearing masks and maintaining social distancing guidelines and that hurts us and contributes to community spread.
• Texas and Florida are closing some businesses. Could that happen here? Governor Lee has given that power to the Board of Health and they meet next week.
• A local woman found it difficult to get tested at local hospitals because they were not showing symptoms. Is that the current guidance?
• There were workers outside the Health Department not wearing masks and they have been addressed. It is required.
• Wait times vary at the Health Department to be tested.
• Is there any evidence that protests increased positive numbers? We’ve seen no evidence of that.