Knox County Board of Health Meeting, October 14, 2020: Mandates Extended

Dr. Souza acted as chair in the absence of Dr. Gotcher. Mr. Sanders joined the group from the Knox County Law office. All other members were present. The meeting began with a public forum. Members of the public, allotted three minutes each said the following (edited for the gist:

  • Kevin Hill – All of our interventions start out measured by weeks and stretch into months and the goals change. COVID deaths are down, but other deaths are up because people are afraid of going to a hospital. He said the board is following incorrect science and ignoring good science. He said the policies are causing more cases and additional harm and that hospitals are profiting from the pandemic. He said death certificates have been altered. He suggested the board move to a communist country.
  • Richard Cunningham – (Orthopedic surgeon and small business owner) He mentioned the “re-opening committee” and pointed out it was disbanded and the Board of Health entered issuing a mask mandate. He said many were shocked by the imposition by a non-elected body. He said County Commission rebuked them for good reason and they have fought public forums. He said the fact they are meeting by Zoom shows they are leading by fear. He said none of their data is reliable and that tests do not really measure COVID. He said 85% of those getting COVID wore masks.
  • Julie Grubaugh – She said her words were written by her sister, a medical professional. She thanked the Board for their work and acknowledged they try to offer a balanced response. In spite of mitigation efforts we are facing a difficult period. She said she is frustrated at how good information is swamped by incorrect information and lamented resistance to the five core actions. She implored the community to come together to confront the misinformation circulating on social media and to share good information in understandable terms.
  • Christine Cruse (?) – She said the Board has shifted objectives from flattening the curve to preventing cases. She said it primarily effects the old (80 – 82 average age) who are within weeks or months of dying. She cited experts who say we should live life as normal while protecting the vulnerable. She said the community is more concerned about the collateral damage and that people who oppose the board are not threatening it.

New Cases for Knox County and the District by Week and Month

New Cases by Age Group and week

Two others who were scheduled to address the board did not attempt to log in. Dr. Buchanan commented about the allegation of PCR inaccuracy. She said it is reliable and it can’t amplify something that isn’t present as Dr. Cunningham stated. She said it more frequently produces a false negative than a positive.

Ms. Roma asked if this was the test used across the state and country and why there would be pushback or confusion. Dr. Buchanan replied it is what is being used across the world and that she isn’t sure why there is pushback, while acknowledging that it is complicated to understand.

Dr. Matt Harris, an economist at UT, joined to give information based on the intersection of health and economics, his academic focus. He said any action seen by economists is viewed via benefits and costs. He detailed the governmental response and private sector response. He noted that economically, some sectors have boomed and others have suffered. He said that retail sales, including gardening supplies and building supplies are all up. Sales tax receipts are up by 13% in Knox County. Unemployment is up, but below the state average.

Knox County and Regional Hospitalizations by Week and Month

Hospital Census Data for the District

Concerning what to do next, it would be best to have a cost-benefit component, but that may not be possible in real time with a new virus. He noted that personal decisions resulted in 75% of the reduction in retail traffic. It exceeds the impact of mandates. He said the function of guidance is the impact it has on personal behavior.

If we loosen restrictions, he said case counts will increase and that will produce many people engaging in avoidance behavior, and the virus should be contained. He pointed out that you can do business with a mask on, but if cases are high and everyone is afraid and stays home, business will suffer. He said if mask use is made optional, it will reduce mask usage.

Dr. Buchanan gave the report, including the numbers from today, reported earlier. She reviewed the benchmarks, which were updated today and included two changes. New case numbers were moved from green to red, testing remained yellow, public health response remained green, hospital capacity remained yellow and deaths changed from yellow to green.

Projections for Hospitalizations (For Each of the Past Three Weeks)


Key Points from Dr. Shamiyeh’s Presentation

She expressed concern over the recent high hospitalization numbers and ICU numbers. She said they anticipate an increase in deaths as a result. The seven-day average for positive tests is now 9.67%. She also asked the board for help encouraging people to cooperate with investigations.

Dr. Shamiyeh gave his report (the charts pictured here are his). He started with the hospital census which he says is a large concern over the last two weeks. He reminded the board that a concern with so many infections among young people in recent weeks was whether that would “cascade” to older age groups and indicated that appears to be happening. He noted that due to reporting differences, the weekly hospital numbers, generated by the state, are not as useful as the hospital census data, which is generated locally and directly from the hospitals.

Dr. Shamiyeh indicated there was a discussion among the hospitals about the meaning of shifting to red. They agreed they would only do that if they felt that the census has reached a number at which the hospitals cannot provide ordinary care. They are not at that point and emphasized that anyone who needs help should not hesitate to get the help they need from a hospital. He said staffing issues loom larger than space when talking about being able to provide care.

Dr. Shamiyeh said that most of the COVID-positive patients are admitted with difficulty breathing, they are not admitted for another reason – like a routine procedure – and then discovered to have COVID-19.

Initial Proposal of Metrics Which Might

Dr. Gregg reported for UTK. He gave the current numbers (reported earlier). Of the ROTC cluster, two tested positive, but 26 were considered close contacts. 671 students were tested last week through pooled testing and 46 were referred for further testing. 11 ultimately tested positive. Participation rates were not good and make up tests were given to 455 students, who were told they must participate. 12 of these were referred for follow-up testing.

Dr. O’Brien asked if there were incentives to students for them to be tested. He said that is being considered, but is complicated and they are looking at what other universities are doing. Dr. Hurt asked if the trend of avoiding testing is happening at other universities. He said that it is common across the SEC, the schools with which they most often communicate. Dr. Shamiyeh asked about the possibility of having all students tested before they return home for the holidays. Dr. Gregg said that the state is only going to allow them to “encourage” it.

Ms. Wagoner gave an update on the Knox County Schools, stating that there is no data this week. It will be updated on Monday. Dr. Buchanan asked if Ms. Wagoner saw resistance to testing or contact tracing due to a wish not to quarantine. She said yes.

The group discussed metrics that might be used to determine a loosening or increasing of restrictions. She said after taking to Roberta Sturm, KCHD epidemiologist, she determined each benchmark should cover a 28 day period, whereas it was 7 days before. She presented the charts you see here which show our historic data in relation to the escalation or de-escalation cutoffs. She noted that we are above the cutoffs for further action and asked the board what kind of response they would have to that fact. She said if we are going to use metrics, we should use them.

Metric for New Cases

Dr. Shamiyeh said testing volume may be a hard one to nail down and that impacts positivity rate. He added that it is difficult to add absolutes and questioned whether the cutoffs are absolutes requiring action or are they entry points for discussion. He asked whether the numbers might be made slightly more generous so they are achievable locally. Dr. Buchanan said she agreed, though the cutoffs were White House Task Force recommendations.

Dr. O’Brien said he would be comfortable with the more generous numbers and that the metrics would be guidelines, not strict calls for actions. Dr. Buchanan suggested that testing volume could be dropped as positive test rate gets at that indirectly and she voiced support for having them be guidelines, not mandates for action. Dr. Shamiyeh asked if they might not move back to seven days as a guideline if they made the numbers more generous.

Dr. O’Brien wondered if there might not to be special pushes to test. Dr. Buchanan said she doesn’t know how her staff could do it. She also noted that physicians are only testing symptomatic people as insurance will not pay otherwise. She said the Health Department has cut back on drive-through testing because it requires more staff.

Regarding the hospital metric, Dr. Shamiyeh said staffing is a concern and, for example, a cluster of cases among a nursing group could make adequate staffing levels change rapidly. He said a delay in setting the metrics would give hospital staff a chance to discuss the hospital portion. He also said he feels that there should be a component, when in yellow, indicating if the metric is rising or falling.

The issue was deferred for further discussion in two weeks.

Dr. Souza reviewed a study published this week by the CDC. The study examined the impact of mandates in Arizona. It showed the mandates worked and made an impact in generation of new cases. She noted that she got emails today regarding masks not being required at polling places and repeated that the Board is not allowed to dictate mask usage at polling places.

The group discussed the face covering mandate. Dr. Drake said she voted early today at Downtown West and everyone was wearing a mask inside and out.

Metric for Testing

The next discussion was on the 11pm curfew for restaurants and bars. Dr. Buchanan said they have had 12 complaints and KPD has had nine. No one has been cited. There are repeated complaints about the same locations, but they are few. Most places are complying. Dr. O’Brien noted that the order was for 11pm and few restaurants stay open after that hour. Ms. Roma reminded people to call 311 if they have complaints.

Dr. Shamiyeh said that the numbers in the hospital have surprised him and he does feel the younger people who became infected spread it to older citizens who are now hospitalized. He said since he was surprised with how high the current numbers are, he’s not confident in making predictions. Dr. O’Brien said the curfew doesn’t seem to have made an impact and questioned whether spread was still primarily coming from small gatherings.

Dr. Buchanan said the clusters are typically around social gatherings, but that bar curfews or closures have helped in other locations. She pointed out that we could be worse off if we didn’t have the restriction.

A motion was made to extend the curfew for two more weeks. All present except Mayor Jacobs voted in the positive and the mandate is continued.

The group size mandate also was set to expire. Dr. Drake made a motion to extend it by two weeks. It passed with all present voting yes, with the exception of Mayor Jacobs.

They modified their schedule, as Veterans day and Thanksgiving interrupt the two in November. Dr. Shamiyeh said he would not be comfortable having more than two weeks between meetings as the data can shift quickly. Dr. Hurt agreed that three weeks is too long. She questioned whether they might meet one week after the next meeting and then resume two weeks, the 4th and 18th being the meeting dates for November. They decided to discuss it again in two weeks.

It was noted that the governor’s allowance for virtual meetings expires at the end of October and County Commission may also be considering changing the ordinance relating to the Board of Health, preventing them from meeting virtually. The County Commission is discussing two resolutions in their next meeting. One resolution would create an advisory board on health and the economy. Dr. Buchanan said she did not understand how that group would interact with boards already in place.

The other resolution would put specific language that required the Knox County Board of Health to meet in person if the County Commission does so. They would also be required to have public forum in the same way as County Commission. Councilman Kyle Ward proposed each resolution.

Dr. Hurt asked how that can be changed or why it would be changed. The Board has adopted their own set of rules. Mr. Sanders said the resolution, if passed would be a law and would supersede their rules.

Dr. Shamiyeh asked if they could use their online forum (which is open to the public to view) for discussion of metrics over the next weeks. Mr. Sanders said they likely could not based on a recent ruling that that method is only available to elected bodies, not appointed bodies.

Dr. Shamiyeh thanked the Health Department for their continued press conferences as he feels it is important to the community. He initiated a discussion of what the board would actually do if they started following the metrics. Dr. Buchanan said there have been a range of responses across the state. She noted that shut downs are effective, but the impact on the economy is drastic, but at the same time, massive hospitalizations and community fear would have the same impact, so there aren’t great answers.

On that note the meeting adjourned. The entire meeting 3 hour meeting is available below for your viewing pleasure.


  1. “[…]He said the policies are causing more cases and additional harm and that hospitals are profiting from the pandemic. He said death certificates have been altered. He suggested the board move to a communist country.”

    […] He said County Commission rebuked them for good reason and they have fought public forums. He said the fact they are meeting by Zoom shows they are leading by fear. He said none of their data is reliable and that tests do not really measure COVID. He said 85% of those getting COVID wore mask

    “[…]Dr. O’Brien wondered if there might not to be special pushes to test. Dr. Buchanan said she doesn’t know how her staff could do it. She also noted that physicians are only testing symptomatic people as insurance will not pay otherwise. She said the Health Department has cut back on drive-through testing because it requires more staff”

    […] Dr. Shamiyeh said that the numbers in the hospital have surprised him and he does feel the younger people who became infected spread it to older citizens who are now hospitalized.

    […] She noted that she got emails today regarding masks not being required at polling places and repeated that the Board is not allowed to dictate mask usage at polling places.”

    […]” Dr. Buchanan asked if Ms. Wagoner saw resistance to testing or contact tracing due to a wish not to quarantine. She said yes.

    Feelings of hopelessness as I read through some of this.

  2. Cindy R Moffett says

    Thank you for your heroic ongoing coverage of this issue and these meetings.

    • I’m concerned that you, Bob and the rest of the sycophants aren’t doing enough to inflate Alan’s ego; would you please be so considerate as to increase your flattery game?

      • KnoxvilleUrbanGuy says

        Mr GB0203, I appreciate your concern that my ego may be inadequately inflated. 🙂 Some people come here to read what I write and they appreciate the work I do, while others come here to read what I write on the chance they can catch me making an error or favoring one side over the other. It’s the nature of the business.

        • I take no issue with people appreciating your efforts to provide Knoxville daily COVID-19 updates and BoH briefings, and I myself typically prefer your recaps and compilations to other resources, but I’m sure you can admit (albeit not publicly) that the comparisons to Batman and use of words like “heroic” in this context are a touch extreme.

          • KnoxvilleUrbanGuy says

            I just get the sentiment: some people appreciate what I do. It has, at times, been quite exhausting and difficult to balance with the downtown news people expect. I don’t need praise, but I appreciate support, as I think we all do. People choose their own way to say it. I would never say those words about myself.

    • Dean Schultz says

      Professional opinions should be welcomed and addressed, not frowned.

      Especially those from Dr. Harris “economist” and Dr.Cunningham. Both of which offered great thoughts and ways to improve.

  3. Play nice people. Let’s be the kind of people our parents raised us to be. Negative and snarky only makes the person spewing it look bad. If you don’t like the forum, don’t read it. Your choice.

  4. Tamara Shepherd says

    As always, thanks for your detailed coverage of the Board’s meetings, KnoxUrbanGuy. Vastly superior to all other local coverage!

  5. The comments by Dr. Buchanan feigning mystification regarding the push back to the PCR test is either an example of an outright lies or complete incompetence on the matter and in either case merits her immediate removal from office. In August during public comment I raised this issue and quoted from a lengthy article published in April in which a close associate of Kary Mullis, the the inventor of the PCR process, detailed how this research technique is being abused and that the medical health establishment is only able to perform this fraud because Dr. Mullis passed away in Aug. of 2019. Prior to his death Mullis was a vocal critic of using his research tool of manufacturing genetic material as a diagnostic tool. Dr. Buchanan has spoken of this method as a gold standard test, I find it laughable to refer to a protical as gold standard which is currently only used under provisional approval from the FDA. This method is not approved for testing in any other virus and still is not fully approved in the case of Covid19. Currently because this method is being used under provisional approval that means that labs can not deviate from the recommendations from the FDA. The FDA suggests a minimum of 40 cycles of amplification for the use of the process as a Covid 19 test. However most experts on this process suggest that at 40 cycles or more the false positives go up exponentially. The reason the medical establishment can’t use more traditional methods is because they have yet to have followed long standing protocol and isolated and purified a sample of the complete virus. If you search this issue you will find loads of papers claiming to have isolated the virus but when these teams were pressed to confirm if they purified that sample each one admitted this traditionally required step had not been achieved. I have sent the article I quoted on these matters to the entire Board of Health and asked about this issue in that email. Since that article was published the NY Times has also published an article highlighting that it has been documented that 90% of tests in NY were most likely false positives based on the fact that the process stimulates genetic material into replicating itself until enough material is present to perform meaningful research on it. This means that virus fragments not capable of infecting a person can be exponentially multiplied until they seem to be present in a significant quantity. The test is not looking for a complete virus but a fragment of code and the lab literature itself states that other corona viruses can cause a positive result. If I, someone who does not work in public health has taken the time to learn and understand this information what is the likelihood Dr. Buchanan is aware of this information? As I said if she isn’t then it is simply evidence of her incompetence. Furthermore if you want evidence of the level of censorship going on with this matter I have an experiment for you to try. We have turned the word “Google” into a verb for searching a matter on the internet. That means that the public perception of Google as a search engine is that it is superior to all others in its ability to effective find relevant information on the matter being searched. However when you search a quote from the article I referenced above and have linked below, Google does not present the article or any pages that reference the article. When I performed the same search on Duckduckgo the first link was to a page that extensively quoted the article and provided a link to it. Go randomly copy any quote from any article unrelated to covid 19 and see how effective Google is at finding that article vs. this matter.

    Quote searched:
    Kary did not invent a test. He invented a very powerful manufacturing technique that is being abused. What are the best applications for PCR? Not medical diagnostics. He knew that and he always said that.” When asked his opinion of the PCR as a Covid test, Crowe stated.

    Article quoted:

    • Sealion Harpooner says

      Word salad.

      Glad you took a break from peddling over-priced Patagonia to type that up but I’ll err on the side of a duly certified, appointed, confirmed, and professionally-accountable board of health over whatever brainworm blog you linked.

      • Downtown Worker says

        Kevin, I did your test and got the same results you implied I would. Although I am also suspicious of Google results, I found this, which implies the quote was taken out of context:

        Sealion, ad-hominem attacks never work. They’re counter-productive to your argument.

        • Sealion Harpooner says

          Point taken, but this isn’t a debate or 11th grade English, friendo.

          That implies good faith and equal logical footing on both sides. There’s no changing minds on this, the only thing that will work is public ridicule. Short of ostracism that is.

          I’m just taking old Kev at his word:

        • Kevin Hill says

          I appreciate you taking the time to investigate the matter for yourself. I disagree that my comments on Google were ad hominem in nature. I included that statement because I was shocked at my inability to find the article that I for months had no difficulty finding on Google. I accepted the initial difficulty as resulting from the fact that the article was months old. What caused me to be so disappointed in Google was that in searching a direct quote it didn’t find the article knowing that this has worked in the past I can only explain this failure as evidence of the attempt at censorship on an alternative scientific viewpoint. Now to the fact check you mentioned. Allow me to give some context that reveals how manipulative that supposed fact check is. Yes the specific quote they are fact checking didn’t come from the inventor but that is only half the story. The real question is did Mullis say similar things? And the answer is yes. In a research paper linked below Mullis certainly did regarding the inappropriate application of PCR in the HIV/Aids research world as a diagnostic test. So rather than be honest and point this out the Fact Checker simply point out the quote is improperly attributed to Mullis but they don’t go on to point out that Mullis did in fact say similar things. There are videos I have watched of Mullis saying similar things in a simpler form than in a peer reviewed scientific paper but alas I don’t have the links to those discussions. If I find them then I will share them later.

        • Sorry I misread your comments and realized that fact. Your Ad Hominem comment was aimed at Sealion not my comments about Google. I missed that in my first read. I hope however the context I shared on the supposed fact check was helpful nonetheless.

      • Kevin Hill says

        I don’t see the need for rude behavior in attempting to argue the merits of a discussion. That aside allow me to point out I linked to a publication by a well respected journalist who personally interviewed the inventor of PCR on multiple occassions and has published articles in scientific periodicals. However allow me to share with you a publication Mullis coauthored and is catalogued on the NIH website in which Mullis himself explains how PCR should not be used as a diagnostic tool for identifying HIV.

      • Also with a name like Sealion Harpooner I can understand why you would not be a fan of such an environmentally conscious company as Patagonia. But to each his own. While you are out destroying endangered animals I will persist in the ancient tradition of self education through broadly reading so that I can independently evaluate truth claims by those who simply want me to recognize them as an authority because they have a title.

        • Sealion Harpooner says

          (Think I’ve properly adjusted the tone in this one, Alan, thanks for reconsideration):

          Welcome to internet: where everything is literal.

          Also, “environmentally-conscious” corporation is a bit of an oxymoron. “Their carbon footprint is less than the Deepwater Horizon spill. Let’s call them eco-activists!” It’s a cliché at this point but there is no ethical consumption under capitalism.

          That said: there are plenty of places to purchase Patagonia products for those want to, I’d advocate that East Tennessee-based consumers look at very public (and very incorrect) comments when making a decision about who to purchase from.

          That “civil” debate is going to be rare when the other side is advocating to prolong a pandemic and an economic crisis. While at the same time being exceedingly wrong on science and Supreme Court precedent.

          • The quickest way to turn around an “economic crisis,” believe it or not, would be for the overwhelming majority of us unaffected by the virus to move on with our lives and immediately lift these silly restrictions on local businesses.

          • Sealion Harpooner says

            GBO203 proving once again that they have no idea what they are talking about.

            The loss of business is due to consumer confidence not mandates:


            The economy won’t rebound in certain sectors until consumer confidence is restored. Spending will lag even when confidence rises as it always does in a recovery, straight from McKinsey:


            Key takeaways from their research for those who don’t want to do a deep dive:

            Only 22% will “return to normal” when gov’t restrictions are lifted.

            46% will when individual stores and businesses CONTINUE advanced safety measures. (Much like the 75% of Tennesseans in the UT CORE-19 survey, see Q38c:

            And 32% won’t resume until there is an effective vaccine or treatment. Meaning the consumer spending component of GDP will be down by 1/3rd on a national level and 1/3rd of local spending will be down no matter what our local board of health does.

            That’s 78% of households.

            We’re also currently experiencing another K-recovery a la 2008. Tech and online services are already over pre-crisis levels, service industries are down across the board and won’t return until mitigation tactics coincide with an effective vaccine that is widely distributed.

            We’re looking at summer 2021 (Q3ish) at the earliest for an end to the waves of the pandemic (it’s moving through rural states atm and will return for a second round in urban centers this winter before starting all over again) and Q4 of next year before we get some type of U-shaped recovery in consumer spending.

            Of course all of this is thrown into doubt the second the stock bubble bursts, as banks have been hoarding QE and PPP funds and reinvesting it in the market rather than issuing more loans at this point.

          • Though your business acumen and general understanding of economics are questionable at best, which makes it ever-so-rich to watch you post links discussing concepts that you clearly don’t comprehend, I would expect even the lowliest of PSCC dropouts to recognize that mandates negatively affect consumer confidence/unquestionably curtail one’s ability to spend money. Rest assured, all of the economic “woes” about which you are worried will begin to dissipate once we stop pretending that this virus is even remotely concerning for the vast majority of the county/state/nation.

          • Sealion Harpooner says

            Here I am using widely-accepted, orthodox economic indicators and you still can’t dispute them.

            Most economists consider CCI widely accurate alongside PMI, and even business leaders use it to project future growth in demand.

            What would you like to use? A historic 33% decrease in GDP during Q2, the worst single-quarter drop since records were kept. Minding that consumer spending equates to 70% of GDP (Y=C+G+I+NX, since you’ve likely forgotten).


            Would you like to use U6 Unemployment as it accounts for marginally attached and under-employed individuals? It was 12.8 during the latest September jobs report. Keep in mind nothing factors in discouraged workers and we’ve seen tens of millions drop out of the labor force in recent months: the real reason these rates are falling.

            Here’s a hint: if you don’t have income (let alone disposable income) you can’t spend it.


            Would you like to use labor force participation rate?


            Would you like to use the change in consumer loans as tracked by the Fed? Down $100 billion since March:


            Tell me which leading indicator to cherry-pick for you that will back up your claims.

            Nothing exists in a vacuum, but the fact is at least 75%~ of consumers don’t trust businesses or consumer spaces to maintain their health and safety at the same levels they did pre-COVID.

            If you lifted mandates tomorrow, again, according to the multi-billion dollar, blood-thirsty, supply-side, corporate hatchet-job, “consulting” firm McKinsey (who are paid exorbitant amounts to get things like this right), only 22% of consumers would return to business-as-normal.

            I’ll even give you an extra 8% to bump it up to an even 30% with an end to certain mandates on a local level. How do you account for the remaining 70%?

            Or is this another supply-sider, “if you build it (read: lessen safety precautions), they will come” field of dreams?

  6. Don’t let them get to you Alan. Those that speak the truth and leave it on the table are always first in line for abuse from the propagandists. This whole situation just keeps getting weirder and weirder. Keep up the good work. I don’t give a damn about your ego, but I care about your coverage of this issue, and it’s by far, the best in town.

  7. Oh good lord, how did you sit through this?? The county commission wants to establish a health and economic advisory group?! Say what?

  8. Heather Johnson says

    I greatly appreciate your coverage of the Health Department meetings as I would much rather read your article than listen to hours of a meeting. It sounds agonizing. Thank you for simply reporting what was discussed, with an attempt not to slant, but just to present. Please keep doing what you are doing and try to ignore the people who are just plain mean.

    • I wanted to echo your words, being someone who could have been maligned by a slanted coverage I want to also give my words of appreciation for the coverage. What makes this coverage excellent is the fact that as a reader I have no idea of the author’s opinions on the issues raised are. The comments and points made by differing person have been accurately summarized and reported!

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