The best news in east Tennessee in recent weeks has been the amazing weather. The leaves have been beautiful, most days ahead are sunny, and the temperatures are peaking in the 60s most days. Normally, I would say these things at the risk of sounding like an old person with nothing better to talk about but, as we all know, outdoors is better than indoors more now than ever.
If you gather for Thanksgiving with people outside your home, consider doing so outside. And grab all of these days you can. We know the days are going to get darker, both meteorologically and metaphorically, in coming weeks. There is life outside, the sun shines and hope is coming in the months ahead. Please be safe and do not allow virus fatigue to put you or your loved ones at greater risk.
State News:
Reported test volume rebounded from its low point the day before and the number of cases reflected that fact. Tennessee reported 4,472 new cases for the day, bringing the pandemic totals to 301,901 confirmed cases and 23,300 probable cases. 279,931 cases are now considered inactive, while 17,922 Tennesseans have active cases of the illness. Reflecting the explosion of cases across the U.S., Tennessee had only the 15th highest state total for the day. The state is now averaging 4,546 new cases per day.
An additional 53 deaths were reported for the day, bringing the total number of COVID-positive Tennesseans who have died during the pandemic to 4,048. Reflecting the escalating death rates in numerous states (one was over 200 yesterday, while four crossed 100 deaths), the state only ranked 12th in reported deaths for the day. Tennessee is now averaging 41 deaths per day from COVID-19.
87 COVID-positive Tennesseans were admitted to the hospital yesterday, bringing the pandemic total to 11,342 hospitalizations in the state. Each day continues to bring new record highs in every hospital category. Two days ago (the most recent day for which accurate records are available), hospitalizations of COVID-positive Tennesseans reached 1,985.
Of these, 537 are in ICUs across the state and 240 are on ventilators. For comparison, a month earlier those numbers were 1,246, 371 and 170 respectively. Of the three categories, ICU beds are the nearest capacity, with 11% availability.
Testing rebounded, as is obvious in the number of new cases. The state reported just under 24,000 tests for the day, up from about 14,300 the day before, but still down dramatically from the 61,500 two days prior. Total tests given by the state are approaching 4.2 million.
The most alarming number reported by the state yesterday is the positivity rate of 17.12%. For a comparison, New York City Schools just closed to in-person learning as a response to a 3% positive test rate. Johns Hopkins reports a 14.0% positive test rate for the state over the last seven days.
Local News:
The Knox County Health Department is reporting 233 new cases today. The county had never crossed 200 cases in a single day until November 10, but has now crossed that number four of the last five days. It brings Knox County’s totals to 16,388 confirmed cases and 910 probable cases since the beginning of the pandemic.
14,888 people have been moved to the inactive category and 2,270 are currently considered active, the largest number since calculations were revised at the beginning of October. 83 COVID-positive Knox County residents are currently in the hospital, down from the pandemic high of 91 yesterday. 540 have been hospitalized with the illness at some point in the pandemic.
Two additional deaths were reported today, one between the ages of 45 and 64 and one over the age of 75. It brings the total deaths from the illness in the county to 140. For the month, there have now been 35 deaths, more than any other of the pandemic, and with more than a third of the November remaining.
The state is reporting Knox County’s positive test rate over the last seven days has averaged 14.9%.
With the escalating cases, hospitalizations and deaths, the Board of Health has determined they could not wait until next Wednesday to meet and have announced they will meet Friday afternoon at 5pm. The focus of the meeting, according to the agenda is to review our local situation, to examine regulations in other jurisdictions, and to discuss any options the board might have for action. It does not appear there will be a vote on actions that night, but the board is scheduled to meet again on Wednesday.
Knox County Health Department Briefing:
Dr. Buchanan began the briefing by thanking her team as they plan for distribution of the vaccine when it becomes available. She noted that the Knox County Board of Health will meet on Friday in a specially called meeting. The public can watch on CTV or youtube.
She shared the graphic below demonstrating what can happen at a Thanksgiving gathering even with a small group, given one person who is positive but has not developed symptoms, and others with medical issues or connections to other groups to whom they will potentially spread the disease.
She confirmed the above numbers. She said the numbers are “grim and not going in the right direction and it is up to us to change that.” She pleaded with everyone to do their part. Charity covered the benchmarks, which I covered yesterday. In a nutshell: Cases (red), Testing (red), Public Health (yellow), Hospital Capacity (yellow, rising), and Deaths (red). She said the total number of tests has increased, which is encouraging, but lab turnaround time is much worse.
Charity discussed community spread, pointing out there are many opportunities for spread if we are not constantly following the five core actions. It also makes it difficult to trace contacts as they number of connections grows. She said there are 341 regional cases of COVID-positive patients in the hospital at this time. She noted there have been 26 deaths over the last 14 days.
She reported the local positive test rate at 13.49% as of yesterday.
Questions:
- We’ve seen deaths and case numbers ease from the first of the week. Is that a sign of a trend? No. That involves just a couple of days and we don’t feel the trajectory is good.
- What measures will the board consider? We’re looking at what the CDC and Johns Hopkins and others to see what they say have helped stem the tide of increasing cases.
- Are you concerned about the mixed message of you and others discouraging large gatherings while UT holds in-person graduation? We have no control over UT and we hope everyone is careful in attending.
- We’re wanting to know about the vaccine plan. Plans are underway, more information will be released later.
- Will the board of health still meet on Wednesday? It still stands but could be changed.
- Why isn’t the death rate going down given what we’ve learned? People still die from COVID and the people getting recently in Knox County have trended older.
- How long does immunity last? Do you count re-infections? We don’t count them within 90 days, we do advise continued use of the five core actions.
- Kentucky just instituted further restrictions. Should we do the same? It will be up to the board.
- What options are available for testing while Knox County H.D. isn’t providing them? There is a list on the website.
- Will private/public gathering numbers be reduced like Davidson County did today? They will discuss that as a board.
- More people seem to be wearing masks, but cases are going up. Why? We agree, more people are wearing masks. What we are seeing here and across the country is that people are gathering privately at work, home, sporting events, etc. and not wearing masks because they think it isn’t an issue. People are letting their guards down.
- With contact tracing, can you give us a sense of how tracers are being impacted? I think it will be a while before we return to green with this number of cases. We need people to cooperate and limit the number of contacts that we have to follow up on.
- How long are people waiting for test results? Four to five days is common. Please quarantine or isolate as soon as you’ve been exposed.
- If the pandemic is a marathon, where are we? We have not reached the second half. We are calling it an ultra-marathon and we are tired.
- With the spike in cases and dire words from the White House, is the community and the governor doing enough? The governor is listening to his advisors, but people are getting tired. We have to look at what works. If we all do the five core actions even at baby showers, avoiding car rides with others, don’t have lunch where you are unmasked. For lunch at work, brown bag it and sit outside. Make choices based on potential harm to others.
- Has the health department talked with UT regarding sports? They are following the numbers and following SEC guidelines.
- How often do people not cooperate with tracing? It is a daily issue.
- What percentage of spread is from asymptomatic spread? National data says 20 to 30 percent.
University of Tennessee News:
The University of Tennessee is reporting 88 active cases, up slightly from yesterday’s 79. 72 of the active cases are among students and 16 are among staff. 1,949 UT cases are considered inactive. Only 4 new cases were confirmed yesterday.
The number of students and staff in isolation and quarantine has continued to rise disproportionately to the number of new cases. This could reflect students having larger numbers of contacts than they had previously reported, or it could reflect community spread, with the quarantines and isolations resulting from contact with confirmed cases outside the UT community.
The number in quarantine or isolation has reached 526, the highest it has been since September 23. Of these, 89 are employees, 144 are residential students and 293 are non-residential students. No clusters have been reported since October 31.
Knox County (and other) Schools News:
The Knox County School System reported another new record for active cases yesterday afternoon, with 124, up from 111 the day before. Of these, 79 are students and 45 are staff members. 720 students and staff are counted as recovered from the illness.
The category that continues to be the most difficult to navigate for the schools, and for parents, is the number required to isolate and quarantine. That number has grown to a new record of 1,964, up from 1,750 the day before, and significantly more than twice the number heading into fall break.
The metrics of concern continue to be the same, with teacher attendance rated yellow and custodians and substitute availability rated red. No additional schools were placed on virtual-only learning, leaving the list the same as yesterday:
Whittle Springs Middle – November 23
Sam E. Hill Primary
(PRE-K ONLY) – November 23
Gibbs Elementary – November 30
Gibbs Middle – November 30
Regarding schools, the entire nation is struggling to determine the right move. We’re rightly concerned about the impact of virtual instruction on student learning and also on parent’s need to work. At the same time, we know that gathering promotes spread of the virus, so the concern with schools being in session relates to spread.
As a result, systems all over the country are shifting from in-person or partially in-person to virtual, Detroit, Cincinnati, and Salt Lake City among them. Governor Beshear of Kentucky has placed public and private schools on virtual learning statewide. Many states and cities have been on virtual-only since the beginning of the year. Most notably, New York City has closed schools to in-person learning as a result of the city reaching a 3% positive test threshold.
Locally, Oak Ridge Schools, which began the year with a hybrid approach involving a group of virtual-only students and in-person students, with the in-person students alternating days and attending physically only two days each week, while receiving virtual instruction the other days. Initial results found five or fewer new cases each week for the first twelve weeks.
Considering those numbers to be successful, after fall break, the system returned to five-days a week for in-person instruction starting November 2. After two weeks the system reverted to the original schedule, as cases escalated each week, culminating in 36 cases in one week. As of Monday, the 23rd, no students will physically attend until November 30.
At the same time, UNICEF, has stated they feel school closures are ineffective, while also noting the damage done to education, childhood nutrition and to family income. Indeed, most European countries, while issuing increasingly strict lockdowns and shuttering bars, restaurants, other businesses, and restricting travel, have left schools open.
At the heart of the issue is the question of whether schools increase spread. We know that gathering increases spread, but schools have become tightly controlled for mask wearing, as much physical separation as possible, and constant cleaning. The increase in numbers of school infections could simply be a result of community spread, not school spread. If schools are out, will that improve the situation because we don’t bring students together or make matters worse as they are free to mingle in the community without restriction?
An additional layer to the issue has nothing to do with where the spread is happening. If the number of students and staff either ill or in quarantine or isolation gets high enough, it isn’t practical to continue in-person instruction and virtual is the only option. With teacher attendance, presumably largely because of the virus, reaching low levels, at some point schools simply can’t function in person no matter the locus of the spread or our opinions on the matter. This may be where we are heading.