Knox County Board of Health Meeting 11/10/2020

District Hospital Census With Time Markers
Knox County and Regional New Cases by Week and Month

All members were present and were joined by David Sanders from the county law office.

Three people signed up for the public forum:

  • Sherry Garret said she was a nurse for 30 years and has done the math and that very little capacity for hospital beds, ICU and ventilators is being used by COVID-19 patients. She said the numbers are normal for this time of the year. She quoted Tucker Carlson from last night who said you must listen to people and convince them of your legitimacy. She said there are questions that have not been answered and that no one on the board had responded to any emails except Ms. Roma. She said their email system has been down and the board is not trusted.
  • Kevin Hill said they have not engaged the public in a give-and-take and only grudgingly have accepted a public forum. He said the testing coming from Dr. Buchanan isn’t correct. He referred to the testing system as a regime and said it is not useful.
  • Taylor Alex Zukowski spoke and had visuals. He urged the board to intervene on the UT campus. He said the university is incorrect in saying their numbers are better than Knox County. He said the testing program is not adequate. He pointed out that residential students – the only ones required to be tested – only represent 25% of the student body. He said their plan to “recommend” testing for students before returning to their homes contradicts the White House task force recommendation that all students be required to take a test.
New Cases by Age Demographics
Trend Comparisons in Tennessee’s Big Cities (Each Graph Uses a Different Scale)

Dr. O’Brien responded by thanking the participants. He said some people are getting responses, but that sometimes there isn’t an obvious question. Regarding Mr. Hill, he thanked him for his passion, but wanted him to understand the board is trying to do the best they can with what they must work with. He noted that masks are the best protection we have and that the board has no control over the UTK response.

Mayor Jacobs said that Knox County had done some security updates and failed to put the template back up for emailing the board and it was an error. It was fixed when it was realized.

Dr. Gotcher asked Mr. Sanders if one of the members engaged the community via email or conversation on the topic, would that be ok. He said it was fine and that they would simply not be speaking for the board.

Dr. Buchanan gave the updated report on the local situation and covered the benchmarks. She noted we set a new high for cases today. The benchmark for new cases was changed from yellow to red, as cases have increased. For testing, there were 7 red flag days in test volume and 8 in test return time and it has been changed to red. The public health capacity remained green, but she said it is becoming more difficult as cases have increased.

Knox County and Regional Hospitalizations by Week and Month
District Hospital Census With Time Markers

As noted in the earlier article, the hospitals have chosen to leave their benchmark yellow even though they have seen some numbers which are concerning. The benchmark for sustained or reducing deaths was changed from yellow to red. There have been 18 deaths in the last two weeks and 10 in the last seven days. She also noted that the positive test result rate had worsened and now stands at 14.36% average for the last seven days.

Dr. Hurt asked when we last had five red benchmarks. Dr. Buchanan said she wasn’t sure. Dr. Gotcher said he had kept a running total going back to early August and there has not been more than one red benchmark at any given time during that stretch.

Dr. Shamiyeh gave the hospital report. The charts shown here are his. He pointed out that previous peaks have lasted a week or two and the increase hasn’t proven as durable as the current one. He expressed concern that many new cases are coming in the older residents. Each city in the state continues to have high case counts which are sustained and Knox County has been over 10% positivity rate for 27 days.

His point was that hospitalizations, positive test results and other data have reached a high point and not dropped. He said he was concerned that we are normalizing the current level. He fears a spike starting at this level after Thanksgiving would be a serious issue and he’d like to see lower numbers leading into what he feels is an inevitable surge. He said hospital staffing is more of a concern than space and pointed out not all staff have the same skill set.

Anticipated Hospital Impacts


Key Points from Dr. Shamiyeh’s Hospital Presentation

Dr. Gregg gave a report from the University of Tennessee, repeating the current data I covered in yesterday’s article. There are 82 active cases, 10 new cases and 390 in isolation or quarantine. He said participation in testing has hovered around 75%. 1920 pools have been collected, 79 students referred for further testing and of these, 19 tested positive. The cluster recently reported included five positive tests and four contacts. He noted that immunizations for the flu will be required of students and staff for the spring.

Potential metrics were, once more, discussed in terms of what might result in increased community intervention or decreased intervention. In both cases per 100,000 and test positivity rate, Knox County has remained in the negative ends of each scale for a long time.

A conversation about the flu revealed that COVID-19 hospitalizations already have us at the levels we reach during a difficult flu season. The hope is that the flu season may be lighter due to the five core actions which will help with both illnesses.

The data about mask impact – that they work – was discussed. The lack of appetite for masks or other restrictions in the community was noted. The group pleaded with the public to reduce risk in every way available so that we can impact our situation. It was noted that cases also damage employers and businesses because of those who are ill and those who are quarantined.

Recession and Escalation Thresholds
Hospital Metrics for Recession and Escalation

Dr. Gotcher asked, if all goes well, when will the vaccine make an impact? Dr. Buchanan said she doesn’t think we’ll see good community penetration before late spring or summer, or even fall. She said it will help before then, but we will not have “full community penetration,” for some time.

The metrics were adopted, but it was made clear be used simply for guidance. The vote was unanimous to adopt the three metrics: Cases per 100,000, test positivity rate and hospitalization resource rate.

The mask mandate was discussed and it was continued. Dr. Buchanan said there are fewer complaints regarding the masks, though there are some about businesses that are not complying. She said there is widespread use in the county.

The curfew for restaurants and bars was also discussed. It was set to expire on Thursday. Dr. Buchanan said she spoke with Mayor Kincanan who is preparing enforcement. She said they have had repeated complaints about a couple of dozen businesses and most of the establishments consistently violating the curfew are near campus.

Positive Test Rate as a Recession or Progression Marker


New Case Escalaltion and Recession Barriers

It was noted by Ani Roma and Dr. O’Brien that the night before Thanksgiving is the biggest bar night of the year. Dr. Hurt said the most frustration she gets in emails is from bars and restaurants who are following the rules, complaining about those who are not. Dr. Hurt moved that the restaurants and bar restriction continue. Everyone, except for Mayor Jacobs, agreed to continue the restriction to the end of November.

Dr. Buchanan suggested reducing the numbers of reports in each meeting as information is generally available on websites or could be sent digitally. Dr. Shamiyeh pointed out that the meeting is an opportunity to speak to the public. No action was taken.

Dr. O’Brien said he’d had discussions with various leaders in areas in other counties. He noted the lengthy county commission meetings show that there are a number of people who want to speak and wondered if there should be an increase in time allowed or some sort of exchange in order to take some pressure off the commissioners. He also encouraged board members to have conversations with county commissioners as possible, to improve communications. No motion was made.

The meeting was adjourned. The next meeting is planned for November 25.

You can watch the entire meeting below.