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A sign requiring mask for fans sits in a cup holder during an NFL football game on Sunday, Nov. 29, 2020, in Indianapolis. (AP Photo/Zach Bolinger)

NASHVILLE — Tennessee ranked first in the nation early this week for highest per-capita rate of new COVID-19 infections per 100,000 people over a seven-day period, a distinction that eased on Tuesday, when the Volunteer State fell to second place, according to the U.S. Centers for Disease Control and Prevention.

The seven-day rolling average rate of new infections for Tennessee stood at 117.9 cases per 100,000 as of Tuesday. Only Oklahoma had more — 125.5 cases per 100,000, according to the CDC's website.

Regardless, critics charged Tuesday that Tennessee Republican Gov. Bill Lee should be moving more aggressively.

"For the sake of love of God, @GovBillLee, are you planning on doing anything here? Anything at all?" tweeted Tennessee Senate Minority Leader Jeff Yarbro, D-Nashville. "The entire state is a hot spot."

The situation "can't be blamed on national or regional trends," Yarbro said. "The current outbreak is clearly worse in the jurisdiction for which you are the governor. Lead!"

Critics, including health care providers and experts, have been calling on Lee to impose a statewide mask mandate for months. The governor has refused but has allowed local county health boards to impose mask requirements, even as some of his fellow Republicans in the Legislature say that leeway for local jurisdictions goes against ideals of freedom in the state.

Lee spokesman Gillum Ferguson said Tuesday, "We are in an incredibly serious moment in the pandemic in Tennessee, and it's incumbent upon individuals to really examine how they can make responsible choices, that they must make responsible choices during this time."

That includes continuing to wear a mask, washing hands and keeping distance, Ferguson added, calling all those actions "critically important."

The state right now is also focusing on providing access to testing, working with hospitals to boost their capacity and readying the state for distribution of the new Pfizer vaccine, Ferguson added.

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Staff Photo by Angela Lewis Foster / Tennessee State Democratic Caucus Sen. Jeff Yarbro talks with editors and reporters Thursday, August 13, 2015, at the Chattanooga Times Free Press.

Dr. Melissa McPheeters, a Vanderbilt University research professor and epidemiologist, said the increasing positivity rate "when there is adequate testing is a sign of increasing cases and spread of the virus. We should definitely be concerned about it."

Moreover, she said, a high positivity rate "also means we are unlikely to be actually observing all of the cases, so there are likely many more cases that may be going unrecognized and therefore contributing to more spread. Statewide our positivity rate is over 18%, and [the World Health Organization] states that a positivity rate needs to be below 5% to suggest the virus is under control. The high positivity rate is especially concerning given that Tennesseans do have access to free, asymptomatic testing."

McPheeters said in that context, the high positivity rate "means that we are experiencing substantial community spread. With cases and the positivity rate where they are, it's clear the house is on fire and we're still lighting matches."

In one of a series of tweets, Dr. James Parnell, president of the Tennessee chapter of the American Academy of Emergency Medicine, wrote that the hospital where he works no longer has available beds. "When trying to transfer, was just offered a bed in the neighboring state. It's pouring for sure. @GovBillLee - please help us help our state. #MaskUp @ProtectMycare."

Urgent. Today. Wear a mask. Need a mask mandate. We are losing this battle in Tennessee and vaccines can’t reverse in...

Posted by Senator Bill Frist, M.D. on Tuesday, December 15, 2020

Noting that Lee and state health officials have set aside Tennessee's first shipment of nearly 1,000 Pfizer vaccines as backup, Parnell later tweeted, "Please allow those 975 vaccines in your office in your Twitter photo op to be for front line workers. Even a single dose is more effective than a dose in a box."

The governor and officials say the first batch is needed as emergency backup for the expected 56,000 more doses in coming days. The Pfizer vaccine requires special freezing precautions to avoid spoiling. Lee administration officials say soon-to-be arriving Moderna vaccines need to be kept refrigerated but don't need the special freezing that the Pfizer vaccine requires.

Dr. John Graves, a Vanderbilt associate professor of health policy, said Tennesseans "absolutely should be concerned at the current state of the pandemic. We have the highest reported cases per population worldwide right now, and the number hospitalized continues to rise."

His reference to the state having the highest reported cases per population was based on a report posted Monday by Eric Topol, founder of the Scripps Research institute in La Jolla, California.

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Gov. Bill Lee speaks during the Tennessee Higher Education Commission session of the state budget hearings Tuesday, Nov. 10, 2020, in Nashville, Tenn. Lee said Tuesday he's looking to include "meaningful" teacher pay raises in next year's budget despite facing financial crunches brought on by the COVID-19 pandemic. (AP Photo/Mark Humphrey)

Topol tweeted out two charts showing Tennessee and Ohio as the only places in the world with infection rates hitting 1,000 per million.

"Where is the highest place in the world now for new cases per population? Tennessee," Topol tweeted.

Another Twitter user complained that it was cruel to point out high points in a state's experience with the virus. Topol replied, "You know what's cruel? States that are not taking action to protect their residents who are getting sick, hospitalized, #longcovid, and some are dying. In fact, the people in the states affected appreciate any & all pressure on their government officials to do something. Goodbye."

Topol's tweet highlighted a map posted Monday on CovidExitStrategy.org as well as a Financial Times chart based on data compiled by the Covid Tracking Project.

"The pandemic is stressing the health care system and exhausting front-line providers, and this has implications for everyone who needs care, not just COVID patients," Graves said.

Contact Andy Sher at asher@timesfreepress.com or 615-255-0550. Follow on Twitter @AndySher1.

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