More testing brings COVID-19 case surge in Chattanooga; is it also a sign of danger?

Staff photo by C.B. Schmelter / Cars wait in line to get free testing offered by Cempa Community Care at the Avondale Youth and Family Development Center on Wednesday, May 20, 2020 in Chattanooga, Tenn. Cempa was offering free walk-up and drive-thru testing for COVID-19.

A group of local public health leaders sat around a picnic table at the Avondale Youth and Family Development Center on Wednesday, recapping a successful day of COVID-19 testing.

Anyone who wanted to be tested for the coronavirus - regardless of symptoms, age, job, where they lived or their immigration status - could walk up or drive through in their vehicle and get swabbed by a clinician at no cost. People didn't need to have an appointment, a doctor's referral or health insurance. If they didn't have transportation, a free shuttle would pick them up and bring them to the Avondale center parking lot.

Everyone who took advantage of the service - 380 people - could expect to find out whether they were COVID-19 positive or negative within 24 to 72 hours.

Two months ago, an event that brought this level of accessible and free testing into the community wasn't possible. Screening supplies were so scarce that only the sickest patients, those in hospitals and people who met strict travel or exposure criteria were able to get tested for the coronavirus. Test results could take weeks to return.

But the hope of bringing widespread COVID-19 testing to Hamilton County residents, including those in traditionally underserved communities, is finally a reality.

"This is just a model of what can be done if we come together and put our minds, put our resources together," said Chris Ramsey, one of the leaders at the picnic table, as Wednesday's event began to wind down and rain started spitting.

The Hamilton County Health Department would soon post the highest number of new confirmed cases in a single day - 43 - at the time, continuing a three weeks-long surge in cases.

On one hand, the county's growing number of cases is a sign of great progress.

More cases doesn't necessarily mean the outbreak is worsening, but that the region's ability to track the disease is improving. It also means that people are willing to get tested and participate in contact tracing for the good of public health. No Hamilton County resident has died from the coronavirus in over a month, and hospital capacity in the county remains stable.

Until there's a safe and effective vaccine that can protect people from coronavirus, finding out who's infected through testing and contact tracing, then isolating those individuals, is the best way to stop the spread of COVID-19, officials say.

Without expanded testing, many of those new cases could have gone undetected.

On the other hand, the rising case numbers are a stark reminder that the pandemic is far from over - even as the county and state ease restrictions, allowing more businesses to reopen and more employees to return to work.

"There seems to be a disease of denial that this is really here - it really is, and it's infectious, and it's spreading," said Mary Lambert, an advanced practice nurse and professor of epidemiology and public health policy who used to work at the U.S. Centers for Disease Control and Prevention.

Lambert is troubled by the lack of social distancing, mask wearing and hand sanitizing she sees among residents.

"COVID does not care that we're reopening. It's going to behave the same way. It's just as contagious," she said.

Ramsey, president of the Southeast Tennessee Health Consortium, which started the area's minority health fair 19 years ago, said it's hard to know how prevalent the virus is in the community.

A lot of people have been sheltered in place, protecting themselves and slowing the spread, and many people who work office jobs are still able to stay at home and work remotely. But that's not the case for many residents of Avondale, where Ramsey and Lambert both grew up and where Wednesday's testing event took place.

"Unfortunately, a lot of the people in this community, the jobs that they work, they're service industry type jobs. So, our folks are having to go back to work automatically," Ramsey said. "My understanding is that if your employer tells you to come back to work and you refuse because you feel that you're not safe, your unemployment benefits are discontinued."

Meanwhile, essential workers never had the option to stay home.

"There's been a number of cases at the chicken poultry houses, and that's just an example that people aren't protected," Ramsey said.

Lambert, co-chair and adviser for the local COVID-19 Task Force's African American working group, knows about managing disease outbreaks from her deployments at the CDC. She also understands Chattanooga and the health disparities that make controlling the pandemic difficult.

"One of the challenges with our communities of color, with communities where they are economically disadvantaged, is we know there are disparities there. Those disparities make the impact of this kind of pandemic, this kind of infectious disease process, even more impactful," Lambert said. "We do have a disproportionate representation of COVID-19 in these populations. They're already suffering from the disparities that we see in these communities. When we have something like this that happens, it layers over those disparities."

Ramsey leads the Regional Health Council's health disparities task force, which was formed last year after a new report from the health department brought to the forefront "alarming" disparities in the prevalence and mortality rates of chronic and infectious diseases among certain demographics and areas of the county.

Among some of the more troubling statistics were that black residents of Hamilton County are 2 1/2 times more likely to die from diabetes, two times more likely to die from kidney disease and 30% more likely to die from heart disease than white residents of Hamilton County. These are some of the same chronic conditions that significantly increase the risk of dying due to COVID-19.

Ramsey said Hamilton county is "playing catch up" in the minority and underserved communities. About a week ago was the first time that free, widespread, mobile testing was available - when community partners came together to conduct similar testing at the Bethlehem Center in Alton Park. More than 200 people were tested for COVID-19 that day.

"In these communities, it's very important that we bring services to them, because there are many barriers that already exist that prevent them from having access to quality health services," Ramsey said. "Sometimes people have insurance, but because of the deductibles and premiums and copays, it's not really affordable for them to utilize it. So providing this type of free service during this public health crisis is very important."

ExploreTNhealth, a website created in partnership between the Tennessee Hospital Association and its data partner, the Hospital Industry Data Institute, uses health data to illustrate health disparities in Tennessee's counties by ZIP code to better understand the factors that can influence health outcomes. That's because some experts suggest that a person's ZIP code is more predictive of their health than their genetic code.

In Hamilton County, the 37410 ZIP code, which represents Alton Park, ranks 599 out of 600 ZIP codes in Tennessee for health outcomes. The 37407 ZIP code, which represents Clifton Hills, ranks 598. The lowest ranked ZIP code in the state is in Shelby County.

Just a few miles away, the 37350 ZIP code on Lookout Mountain ranks as the top ZIP code in the state for health outcomes.

"We know where the health disparities exist by ZIP code," Ramsey said. "Rather than just having that data, it's time for us to be actionable and be intentional versus just looking at reports and producing heat maps. It's time for us to come together as a community, to combine all of our resources and efforts."

In April, Clinica Medicos was the first organization to partner with the county to address health disparities and barriers to COVID-19 care in the Latino community.

The African American community testing efforts, led by Cempa Community Care and the City of Chattanooga's Office of Multicultural Affairs, brought together community leaders, local advocates and other partners to implement the first mobile testing event held at the Bethlehem Center.

Testing needs among congregate seniors have been led through the efforts of the Chattanooga Housing Authority and the UTC School of Nursing Gerontology program in partnership with local donors of personal protective equipment, the TN National Guard and the Hamilton County Health Department. Further testing efforts are underway in the faith-based community.

Lambert said it's essential to provide continuous, widespread testing and education throughout the pandemic, especially in communities that are disproportionately affected by COVID-19 and given that people can be infected and spread the virus without showing symptoms.

"Until we have a safe and effective vaccine, which will take awhile, everyone needs to know their status, and it must be ongoing," she said. "Because negative today doesn't mean negative tomorrow."

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