Hamilton County sees growth in COVID-19 cases, attributes it to more testing

More mild cases are caught by screening, officials say. 'A slow simmer could be manageable,' expert says

Staff photo by Troy Stolt / Chattanooga-Hamilton County Health Department Administrator of Health Services Becky Barnes speaks during a press conference in the Golley Auditorium at the Chattanooga-Hamilton County Health Department on Monday, May 18, 2020 in Chattanooga, Tenn.

The Hamilton County Health Department announced 28 new COVID-19 cases Tuesday, continuing a recent spike in cases and bringing the county's total to 404.

Tuesday's data continues the trend over the past two weeks with daily new case totals rising. Over the past seven days, Hamilton County has averaged 19 new cases a day, more than six times what it was at the beginning of the month and higher than at any point during the pandemic.

Local leaders say they're not concerned, that an increase in community testing is pushing the numbers up. They say they have ample hospital capacity to take care of a surge in patients if needed.

The number of coronavirus-related deaths in the county remains at 13, unchanged since April 18.

For the past week, Hamilton County averaged 19 new COVID-19 cases a day - largely fueled by sharp increases in cases among the county's Hispanic community, which represents 6% of the population and 49% of the county's total confirmed coronavirus cases. Due to underlying health issues, higher density housing and disproportionate levels of poverty, some communities are more at risk of contracting or dying from the virus. These conditions can make community members less likely to be to keep social distance or isolate themselves if they do become sick.

People hospitalized with COVID-19 in Hamilton County, which could include patients from outside the county, is also at its highest level since the pandemic began - hovering in the upper teens over the last five days. On Tuesday, 18 people were hospitalized with COVID-19 and an additional 12 people were under investigation for possible infection.

Becky Barnes, Hamilton County Health Department administrator, said expanded testing efforts are detecting more people with mild COVID-19 infections.

In the past - when testing was more limited - if a family member tested positive for COVID-19, Barnes said the rest of the family would self-quarantine. Family members and other contacts were typically only tested if they were showing symptoms. Now, anyone who's known to come into contact with an infected person often gets tested, which is revealing more positive cases in people who don't appear sick.

"We know there is asymptomatic spread, so we are doing more testing of the whole family, so we will see more positives," Barnes said during a press conference on Monday.

Hamilton County Mayor Jim Coppinger said on Tuesday that while there's always a concern about coronavirus cases, the spike in new cases did not warrant reinstating a stay-at-home order, because most of the new cases are among essential employees who worked throughout the shutdown.

He also said that data is important but needs to be put into context. For example, hospital data includes patients from across the region and not just Hamilton County residents, because Chattanooga is a medical hub for outlying counties, and most of the new cases are mild.

"That's not to say we don't have people who are seriously ill, but we don't have our heads in the sand," Coppinger said.

Hamilton County is responsible for the majority of the COVID-19 case increases in a nine-county region in Southeast Tennessee that includes Bledsoe, Bradley, Grundy, Hamilton, McMinn, Meigs, Polk, Rhea and Sequatchie.

Despite representing 58% of the population in the nine-county region, Hamilton County was responsible for 78% of the new cases in the past week (149 of 190).

While Hamilton County cases trended up over the past week, Tenneesse's four other major counties - Davidson, Knox, Rutherford and Shelby - saw the average number of new cases each day level off or drop over the same time period. However, these counties, with the exception of Knox, have a higher total case count and higher average daily case increase than Hamilton County.

The county is conducting significantly more tests than it was previously.

Since the pandemic began, Hamilton County has conducted 8,935 COVID-19 tests, according to data from the Hamilton County Health Department, which may include negative results from outside of Hamilton County and tests not yet reported to the Tennessee Department of Health.

The current level of testing equates to testing 24.29 people out of every 1,000 residents based on a population of 367,804. A month ago, the county had conducted 1,751 tests, or 4.76 tests per 1,000 residents.

Melissa McPheeters, a health policy research professor at Vanderbilt University Medical Center, said more widespread testing can certainly contribute to an influx of new cases and make an outbreak appear worse than it is, which is why it's important to look at other data in addition to the number of new cases.

"Lots more mild cases - for example among younger people without comorbidities - might not stress the health system or lead to bad outcomes. So it is important to look at average numbers of cases over a week, percent of those tested who test positive, health care capacity and other factors and put those together to make decisions," McPheeters said in an email. "It is also important to understand whether the public health capacity is in place to manage the rate of new cases - a lot is possible with a strong test/track/isolate approach."

Rae Bond, chairwoman of the local COVID-19 Task Force, said during a press briefing on Tuesday that Hamilton County hospitals are ramping up preoperative testing before some medical procedures, which has resulted in additional positive cases that likely would have gone undetected.

Bond said the contact tracing is showing that largely the new clusters of cases are related to people who continued to work throughout the pandemic and are not necessarily associated with businesses that just reopened. She said as time goes by, the possible effects of community spread due to relaxed social distancing and businesses reopening will become more apparent. She said it wouldn't be surprising for the virus to spread as a result.

"How to reopen and when to reopen is a very complex question, and I will be chatting with the medical society board tonight about that very topic," Bond said, adding that there is a high level of monitoring of the data trends by local hospitals, the health department and local government.

McPheeters said when following case data, it's important to look at both case increases and rate of increase.

"It's easy to tip into the exponential growth phase of a viral pandemic, which could overwhelm a health system, but a slow simmer could be manageable," she said. "Given that we did not suppress transmission in the United States for an extended period of time, it is likely that there will be some increase. The key is to mount a strong response."

Contact Elizabeth Fite at efite@timesfreepress.com.

Contact Wyatt Massey at wmassey@timesfreepress.com or 423-757-6249. Follow him on Twitter @news4mass.