Knox County Board of Health Meeting (10/28/2020)

health Department


All members were present and were joined by David Sanders from the Knox County Law Department, Chancellor Plowman from UTK and Dr. Katie Cahill from the UTK Howard Baker Center.

Dr. Cahill started the meeting by discussing the Pulse Survey conducted by the center and compiled at their website. (It sounds as if it may have some detailed information that some readers of this blog have requested.) The survey, which she presented, is available on the website. Major points from the survey included the following:

  • 6 surveys have been given over the pandemic era (the sixth isn’t yet on the website, this data is from September)
  • A majority of Tennesseans are very concerned or extremely concerned about the pandemic.
  • 85% wear masks and 88% believe masks work.
  • About half or most concerned about health and half more concerned about economic impacts.
  • 70% are concerned that easing restrictions will increase cases.
  • 69% want employers to require employees to wear face coverings.
  • About 10% to 20% report not wearing masks when participating in a range of activities.
  • 78% support a local mask requirement, 15% are not in support and about 7% said they are not sure.
  • 20% said they will not be ready to resume many activities until caseloads are steadily dropping.
  • 15% said they will not return until there is a vaccine.
  • 10% said they will not return until there is a treatment.
  • 33% say they will definitely get a vaccine, 16% said they would definitely not get the vaccine. Support has dropped.

Dr. Cahill said the CDC is the dominant source that people trust for information about the virus, whereas the media is near or at the bottom.

Knox County and Regional Hospitalizations by Week and Month
Knox County Cases by Week and By Age Group

Dr. Buchanan reported the local data and benchmark information relayed in the previous article on this website. Test volume is not as high as the Health Department would like. She expressed concern about the increasing hospitalizations and ICU and ventilator use. Positivity rate is 9.9%, which is down from two weeks ago. The White House task force has moved Knox County from yellow to red in the last two weeks.

Dr. Shamiyeh gave the hospital report, and many of the charts seen here are his. He said while the hospitals are on a yellow rating, they agree they are worsening. He made a point that new hospitalizations are being driven the over 51 age group, which is a concern.

Metro Comparisons by Week (Scales are Different – Intended to Demonstrate Trends in Each Metro Area)
District Hospital Census

Dr. Plowman gave the current UTK stats. She noted that no transmissions have been traced to classrooms or the workplace. Off campus students are being encouraged to participate in the testing program if they are coming onto campus. She said students are complying with mask use. She thinks parties are still happening, but that they have changed to more safe practices. Dr. Shamiyeh questioned how there could be more positive pools than positive students.

Ms. Wagoner reported on the schools and repeated the data included in the previous article. She noted that teachers can teach from quarantine via Zoom.

Current Hospital Impacts Regionally
Anticipated Hospital Impacts

The unlikelihood of being able to de-escalate soon was discussed, as well as resistance to escalating mandates. Dr. Buchanan observed that many places that have loosened restrictions have seen increases in cases and have had to backtrack. She indicated we may be waiting until a vaccine is in place to have all restrictions removed. The group discussed that imposition of additional mandates will be exceedingly difficult.

It was noted that outside of Knox County mask usage is much lower. A consensus was apparent that hard cut offs with metrics would be difficult to maintain. The need for education of larger groups was expressed. It was pointed out that fewer than 150 were watching the meeting.

Growth of Hospitalizations in Masked vs. Unmasked Areas (Mandates)
Mask Mandates vs. No Mandate Case Comparisons

Dr. Buchanan noted that County Mayors can institute mask mandates and that if the counties around us did so, it might spare our hospitals being overrun. She admitted that,

I’ll be honest, when I look at our numbers, the pure public health in me says we need to be shutting things down. The practical side of me that has lived and practiced in this county a long time knows that that is not going to be tolerated. More closures are not going to be tolerated by the community, and that is an important piece. There’s an economic impact to closures and a social impact. There is already a lot of tension, frustration, and fatigue. I don’t see our role as adding to that. I think it is going to have to impact a lot more people’s lives . . . a majority do support the mask mandate.

She said she did not think it would be helpful to expand mandates at this time and would likely make the resistance increase. She noted that the mask mandate will need to stay, and that data supports it.

Key Data Points from Dr. Shamiyeh’s Hospital Report
What to Expect in Coming Months

The group then discussed metrics for possible escalation (increasing mandates) and de-escalation (reducing mandates). Dr. Buchanan said her epidemiologist and one from UT worked on the metrics. It was noted that we are over the escalation marks even as we are having the discussion. Ultimately, the group stuck with the metrics the Knox County Health Department has used all along, but would clarify when yellow reflected an improving or worsening situation.

The current restrictions were discussed. Dr. Buchanan share data showing that case rates are lower in the locations with mask mandates. Ms. Roma emphasized the earlier report that most people support a mask mandate. Dr. Buchanan said there had been few complaints about the 11pm curfew for restaurants and bars.

With outliers, the group feels the majority of bar and restaurant owners are being supportive. Dr. Gotcher pointed out that indications are reductions in business is largely due to people being wary of going out. Dr. Buchanan said the Vanderbilt study also supported that. The restrictions on group size gatherings were also discussed.

Behavior Impacts
Local vs. State Level Policies

The restrictions (other than the mask mandate) were set to expire at the end of the month. The 11pm closure for bars and restaurants was extended. The Mayor voted against extension. The gathering size mandate will be allowed to sunset, though the Tennessee Pledge has essentially the restrictions (6 feet spacing). The group agreed to solicit a psychologist to talk about the mental health impacts of the pandemic, though not at the next meeting due to the public forum.

Regarding education, Dr. O’Brien suggested meetings with County Commission or board members being willing to be interviewed by the media. Dr. Buchanan asked if the new community leader group, of which he is a part, would be willing to help with public education. Mayor Jacobs said he does not think that is their role, but that they would be happy to talk with the Board. Dr. Shamiyeh said the hospital group will have a public service announcement soon.

Dr. Hurt raised the question of how much County Commission can alter the role of the Board of Health. She asked what it would mean that the public forum would be conducted in the same manner as the Commission. Mr. Sanders said there would be no enforcement of the ordinance, but they should follow it and he felt what they intended was for the public to have the opportunity to speak more often and more people allowed to speak.

The governor extended the capacity of the group to continue meeting virtually through the end of the year. The next meeting will be November 10 (a Tuesday) and the next will be be the day before Thanksgiving.

The entire 3 1/2-hour meeting is available for viewing below: