Hamilton County's growing number of new COVID-19 cases turned heads this past week, landing Chattanooga in the top five on The New York Times' list of communities with the highest average daily growth rate in the nation.
The week was capped off on Friday by the largest single-day increase in cases and the most coronavirus-related hospitalizations to date, 29, including the most critically ill COVID-19 patients ever in intensive care at Hamilton County's hospitals, 17.
The situation prompted an alert from the Hamilton County Health Department, calling on citizens to treat themselves and everyone around them as if they have the coronavirus.
"We can't stress enough that this virus is very active in our community," health department administrator Becky Barnes said in a news release on Friday, emphasizing that people with any inkling they may be infected should isolate themselves and not go to work - where much of the transmission is taking place before being brought home to entire households.
Hamilton County Mayor Jim Coppinger has the ultimate authority on how Hamilton County, and the cities within it, regulate businesses and other public spaces.
However, last week he said the data - particularly the number of coronavirus-related hospitalizations - didn't warrant him reinstituting the kinds of stricter "stay at home" orders that locked down the economy in April.
Friday's record number of cases and hospitalizations might raise the question of whether he should.
Jonathan Helm, a professor at the Indiana University Kelley School of Business, doesn't think so.
Helm is the academic lead for COVID-19 modeling at Indiana University Health System, which has more than 2,700 patient beds and a staff of 30,000. He's also a member of that state's COVID-19 Task Force. His expertise is health care operations and decision technologies, and he's held operations management and supply chain roles at GE Healthcare and the Mayo Clinic.
Helm uses a form of artificial intelligence called machine learning and optimization algorithms to understand what disease transmission looks like in different regions and then collect data to illustrate possible scenarios for the pandemic's trajectory. Hospital leaders use the models to make informed decisions, such as when to resume or scale back elective procedures to make room for a COVID-19 patient surge.
"Shelter in place helps, because it stops super-spreading events - basketball games, concerts, things like that - which could infect tons of people at once," Helm said. "Opening things up doesn't necessarily make things worse, as long as people continue to practice good hygiene and social distancing."
But that doesn't mean Helm isn't worried. He fears for people who are more vulnerable than he is, such as his parents and in-laws. It would be "extremely dangerous" if they were to become infected, he said. He wants people to take it seriously and have more respect for others. Protecting ourselves is also about protecting those around us, he said.
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As of Saturday, 999 Hamilton County residents had tested positive for the coronavirus that causes COVID-19 since the first local case was confirmed on March 13. At least 446 of those people have recovered, but more than half of those cases are active. Fifteen residents have died due to coronavirus infection.
Helm has a vested interest in Hamilton County because his cousin lives in Apison. He first looked at disease transmission in the area about two months ago. Back then, transmission was going down and the disease curve was flattening, he said.
On Thursday, his cousin asked if he could check on things again given the surge in new cases. Helm looked up Hamilton County on Columbia University's disease tracker.
"As soon as I looked at that, I thought to myself, 'Uh oh, something bad is going on here,'" he said.
(READ MORE: The priest who was Chattanooga's first COVID-19 case speaks about why he went public, why his church is still closed and why he still wears a mask)
Public health officials have emphasized since stay-at-home orders were put in place to curtail the spread of the pandemic that lifting social distancing restrictions too soon could result in a patient surge that would force another lockdown.
As phased reopening began, they said businesses and individuals needed to religiously practice the measures known to stop the spread of the virus in order to mitigate further economic damage and save lives - social distancing, isolation, wearing face masks and vigorous and frequent hand washing.
Helm said reopening businesses will increase the number of COVID-19 cases somewhat as people begin socially mixing, but in Indiana that started happening before the shelter-in-place orders were lifted.
"The weather got nice and people got sick of being inside and sheltering in place, so they went out and they went hiking, and we started having barbecues and things like that. So, a lot of it is human behavior," he said.
"Sheltering in place is something that works to stop it initially, but even if we had kept sheltering, we might even see it keep going up, because people don't want to do it anymore - they get weary of it or just think, 'well you know, it's been like this for so long, and things are probably OK,'" Helm said. "It's gonna come down to social distancing. We're not going to be able to withstand the economic impact of another shutdown."
Marianne Wanamaker, an economics professor at the University of Tennessee, said that while controlling the virus is important, it's not the only aspect to consider.
"The bridge support to survive a second shutdown just isn't there," Wanamaker said
She said relief funds won't be available to businesses that used them already, and many people used all their savings to survive the first round of closures. Even in the best-case scenario that avoids another shutdown, Wanamaker said, economic models suggest it will take months if not years to return to full employment.
"We reopened under the assumption that we can handle the virus load as it is, and if the signal from public health officials is this is getting out of control, that's going to change spending behavior again," she said. "At this point, the virus matters, but a lot of other stuff really matters."
Melissa McPheeters, a health policy researcher at Vanderbilt University Medical Center, said that the good news is our understanding of COVID-19 has vastly improved since the initial stay-at-home orders were put in place.
"We have learned that there may be substantial asymptomatic transmission, but we have also learned that wearing masks, for example, can really help us prevent transmission," McPheeters said in an email. "We can use that mechanism to help keep our numbers down as we re-engage with our economy."
Hospitals also have learned more about how to prepare for and care for COVID-19 patients, and officials have more knowledge and ability to implement other policies to control a resurgence.
"There is an increasing body of scientific data that demonstrates that a comprehensive testing program, with good contact tracing and isolation, can nip a smoldering outbreak in the bud and can be targeted where needed. The catch is that we have to have a strong program in place and be ready to act very quickly," McPheeters said, adding that in the coming months it will be critical to demonstrate that officials are able to react when and if that happens, both statewide and locally.
"Hamilton County is one of the areas we are watching as they have had an uptick in cases associated with increased testing," she said. "Now is the time to implement that widespread test, trace, isolate system."
Wanamaker said businesses have a role to play by mandating employees wear masks, which helps curb the spread and goes a long way toward reassuring customers that it's safe to shop somewhere.
Punishing businesses that don't practice safe infection control would be a challenge, because it would require enforcement. However, Wanamaker said there are still policies that public health officials could implement to help, such as issuing certificates for businesses that properly adhere to the reopening guidelines.
"Tell us who's doing things right," she said. "That removes a lot of uncertainty for people wondering if they go to a restaurant is it going to be safe."
Helm's model projects the best-case scenario for Hamilton County to be a late June peak with around 65 new cases a day. The moderate scenario has Hamilton County peaking around early July with about 80 new cases a day, and a worst-case scenario peak of around 200 new cases a day in late July - which will occur if people return to 75% of normal activity in terms of social mixing, he said.
"That would be like what we were seeing in Indianapolis, back when it was really bad," he said.
Helm follows many other researchers' models and COVID-19 predictions, and while no one model should provide the sole basis for decision making, some of them are truly frightening, he said. But the shutdown mentality isn't sustainable, especially since the pandemic isn't going away, at least not any time soon.
He said the better scenarios can happen if people are conscientious - no big parties, extreme caution in public and staying home when infected. Individual behavior matters more now than forced shutdowns, Helm said.
"I wear a mask when I go to the grocery store, and I don't do it because I'm scared. I do it to be respectful of everyone else," he said.
"It does not seem like it's going away anytime soon, and I know they've had some more outbreaks in China," Helm said. "It should hopefully change our way of living, if we're going to limit the amount of deaths from this pandemic."
Contact Elizabeth Fite at email@example.com.