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Despite being home to 100,000 fewer people, Hamilton County has more than twice as many COVID-19 cases and more than four times as many deaths as Knox County.

As of Saturday, 2,818 Hamilton County residents had tested positive for COVID-19 since the pandemic began, compared to 1,234 Knox County residents. Also, 35 Hamilton County residents have died from the disease compared to eight in Knox County.

Officials from the Knox County health department said in an email that it's difficult to say for sure why the pandemic has affected particular areas of the state differently.

"The timing and details of local orders, community adherence to public health recommendations, along with local demographics and other factors all play a role. The significance of each in evaluating community spread, however, has not yet been thoroughly investigated," officials said. "Once the pandemic is over, many in the public health field will be researching this very topic, including our organization, as this will inform future responses and planning."

Hamilton County Health Department officials declined to answer questions as to why COVID-19 has hit the county harder than Knox County, but part could be due to Hamilton County's older population. Older adults and people with chronic conditions are more susceptible to serious illness and death due to the coronavirus.

According to U.S. Census Bureau data, the median age in Hamilton County is 39.7, whereas Knox County's median age is 37.4 years old. In the more densely populated urban areas — where COVID-19 transmission rates are higher — Chattanooga's median age is 37 years old and Knoxville's median age is 32.6 years old.

Knox County officials said many of the area's cases are associated with social gatherings and individuals not adhering to actions known to help curb the spread of the coronavirus: social distancing, wearing face coverings, proper hand hygiene and cleaning, staying home when sick or if you've been instructed to quarantine.

In other areas of the state, such as Nashville, increases in cases have also been linked to social gatherings. Nashville Mayor John Cooper ordered bars to be closed and required reduced capacity in restaurants and other businesses due to a spike in cases, especially among those between the ages of 21 and 40 ahead of the Fourth of July weekend.

Earlier this month, Hamilton County officials also linked an increase in cases to businesses reopening, though previously officials attributed many cases to spread among essential workers and businesses that had never closed.

Hamilton County Health Department administrator Becky Barnes told the Times Free Press in June that the high number of cases the county is seeing this month in residents under 40 years old was coming from spread among families, as well as from "businesses that have been open, businesses that are reopening [and] employees bringing the virus to newly opened sites."

Hamilton County is also one of the only larger metropolitan counties that does not currently have a mask mandate for public areas and businesses. Under pressure to hasten reopening, Knox County voted last week to require residents to wear face coverings in most indoor public spaces to help slow the spread of COVID-19.

Whether Hamilton County Mayor Jim Coppinger will follow suit is still up in the air.

Contact Elizabeth Fite at efite@times freepress.com or follow her on Twitter @ecfite.

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