Although more-populated Hamilton County has seen a recent surge in new COVID-19 cases - representing the majority of the region's new cases overall - new coronavirus cases are increasing at a significantly faster rate in some of the region's more rural counties when taking population size into account.
In the past week, DeKalb County, Alabama, averaged 7.12 new COVID-19 cases a day per 10,000 residents, followed by Whitfield County, Georgia, which averaged 6.3 new cases a day per 10,000 residents.
By comparison, Hamilton County averaged 2.8 new cases per 10,000 residents in the same time frame.
Other regional counties experiencing a more rapid increase in new cases include Jackson County, Alabama, at 4.61 new cases per 10,000; Gordon County, Georgia, at 3.22 new cases per 10,000 and Rhea County, Tennessee, at 2.97 per 10,000.
Officials say hospitalizations are perhaps a more important indicator of a worsening outbreak than case counts, since most people with COVID-19 don't require hospitalization and new cases are dependent on testing.
On Thursday, the Hamilton County Health Department reported 114 hospitalizations (including cases pending confirmation) due to COVID-19 on Thursday - a record high that was driven entirely by patients coming from outlying counties in the region surrounding Chattanooga. The number of Hamilton County residents in the hospital with coronavirus remained at 37 both Wednesday and Thursday.
It's unclear how many of those cases are pending or confirmed, but local hospital officials said that they have experienced an increase in patients from throughout the region, although they're managing well and are prepared should the increase in patients continue.
Ashley Mathews, director of operations and development at DeKalb Regional Medical Center, said in an email that the hospital is currently treating five coronavirus patients.
"As expected, we have begun caring for patients testing positive for coronavirus as cases have increased in our community. At present, the number of positive cases in our hospital remains low at five hospitalized patients. As we've shared previously, the number of hospitalized patients can fluctuate, and this number may change in the coming days," she said.
"COVID-19 in DeKalb County is a fluid situation. Our patient volumes and acuity levels change by the hour. We are closely monitoring staffing and equipment levels as volumes change during this time. We have created additional capacity if a patient surge occurs at the hospital," Mathews said.
Dr. Karen Landers, health officer at the Alabama Department of Public Health, said in an email that DeKalb County now is classified as "very high risk" for COVID-19, according to the state's risk indicator dashboard. She said the county's case surge is driven largely by outbreaks in several long-term care facilities as well as widespread community transmission.
Dr. Don Williamson, CEO of the Alabama Hospital Association, said during a Facebook Live video this week that he is "extremely concerned" about the state's current COVID-19 outbreak but even more concerned about the future.
"We are now over the last seven days clipping along at 1,100 admissions per day," Williamson said. "We have a very, very short window to get this under control, and if we don't, I think we will reap the consequences of that both in terms of hospitalizations, deaths and disruption to our routine lifestyle for a long time to come."
Alabama on Thursday began requiring face masks in public statewide as health officials try to quell the surge of new coronavirus cases that are filling up hospitals.
Jennifer King, a spokeswoman for the North Georgia Health District, said in an email that "Whitfield County is experiencing a remarkably high rate of COVID-19 transmission in comparison to most other Georgia counties."
"It is very concerning," King said. "Convincing the public that they can have an impact on slowing the spread of this disease has been a challenge for health officials. By neglecting to follow simple precautionary recommendations such as wearing a mask in public, maintaining a social distance of at least six feet, avoiding large crowds and frequently washing their hands or using a hand sanitizer, many people are needlessly spreading the virus."
Although COVID-19 spreads faster in densely populated, urban settings, rural communities are also vulnerable to the disease. In general, rural areas have older populations, are less healthy and have less access to medical facilities.
In epidemiology, to calculate a county's incidence rate for a disease, the number of new cases - the numerator - is divided by the number of people in the population - the denominator - and then multiplied by 10,000 to make the rate comparable with other counties.
Rates put health data in the perspective of the size of the population, so they can be used to compare disease frequency in different locations, at different times or among different groups.
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