A bustling home improvement store, boutiques full of eager shoppers, a church softball dugout crowded with adolescents and their family members — these are the kinds of scenes playing out all across Chattanooga this weekend that make experts' stomachs churn.
Doctors say far too few Chattanoogans are wearing face masks to mitigate the spread of COVID-19, which is more contagious than influenza and actively spreading throughout the region at a time when businesses, parks and other activities are reopening.
Meanwhile, hundreds of people have convened each night in weekslong protests where local police did not wear face masks or shields, and summer concert series that have historically drawn between 1,000 and 2,000 people are scheduled to resume in July.
"Whenever we have congregate activities, there's a risk," said Dr. Bill Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. "I don't think we will have a burst of transmission every place there was a demonstration, but I'm sure that there were people there who were transmitting the virus, and all of this is happening in the context of society opening up generally."
Hamilton County Mayor Jim Coppinger — who has the ultimate authority on how the county and its municipalities regulate businesses and other public spaces — further relaxed social distancing measures Friday by allowing exercise facilities to increase customer capacity and reopen locker rooms, as well as close-contact business to perform beard shaving, trimming and facials.
But doctors aren't calling on him to reclose businesses, they're pleading for residents to listen to the science instead of their emotions and practice what's known to stop the spread of COVID-19 — keep your distance, wash your hands, don't touch your face and wear a mask.
"I feel that we have missed the boat letting people go back out," said Dr. David Bruce of One-to-One Health. "We should let our people out. We should have let them out earlier, but I think we should've been guided that we highly recommend that you wear masks, and our restaurants and large volume stores need to [require that customers] wear masks."
Schaffner agrees. He said the fastest way to normalize wearing masks would be requiring people to wear them.
"If every business not only masked all their employees, but put a sign at the door that said, 'In respect to every employee here, you must wear a mask,' that would change things largely overnight," Schaffner said. "If you couldn't get into the supermarket without a mask, pretty soon we'd have everyone wearing a mask."
Coppinger said he doesn't plan on requiring businesses to implement mask-wearing policies.
"It would be much easier and better for businesses to be the ones to enforce that," he said, acknowledging that masks do make a difference and are one of the few tools to combat the virus.
"The good thing about living in this country is you get to make personal choices, and what I would say is people are making some poor choices by not protecting themselves and others," Coppinger said. "Honestly, I am disappointed that I don't see more masks. I'm disappointed that I don't see more social distancing."
Mask wearing is important because respiratory droplets can harbor infectious virus particles, and the coronavirus can be transmitted by people who show no symptoms.
Coughing and sneezing expel more droplets than talking, but the risk of coming into contact with virus particles increases with time spent around an infected individual and in close quarters with poor air circulation. The acts of singing and yelling can also expel a significant amount of infected droplets.
That's why some of the most infamous super-spreader events, when many people are infected by one person, have occurred in densely populated meat packing plants, at parties, bars, weddings, funerals, and business conferences where lots of face-to-face networking takes place.
Bruce and his wife, Dr. Lisa Smith, are both surgeons in Chattanooga. When COVID-19 hit and hospitals paused elective surgeries to prepare for a coronavirus patient surge, the two found themselves with some extra time on their hands and looking for ways to help out.
Now, in addition to their regular jobs, they're medical directors for the "Back to the Workplace" program at One-to-One Health, an on-site workplace health care provider founded by Chattanooga internist Dr. Keith Helton.
In light of COVID-19, the company has expanded to teaching businesses best practices to mitigate the spread of the virus and implement the U.S. Centers for Disease Control and Prevention guidelines for returning to work.
Smith said they're "trying to help people in town to get their hands around what it's like to not get infected," but one of the biggest challenges is convincing companies that all employees need to be wearing face masks.
"When I approached this whole back-to-work process, I said, 'I can keep our patients from getting wound infections in surgery. Why can't we take that mindset and give it to people who want to go back to work?' You're not going to eliminate spread, but the majority of people can and need to be following best practices," said Smith, a pediatric surgeon at University Surgical Associates who specializes in chest wall reconstruction — a complex surgery that requires meticulous infection control.
Bruce, an orthopedic surgeon and co-director of the Erlanger sports medicine program, said it's hard for the general public to get used to wearing masks.
"It's easy for Lisa and me, because we live in masks," Bruce said, adding that people who don't wear masks are largely basing their decisions on opinion and emotion rather than looking critically at the scientific literature.
Compounding the problem is that in the beginning the CDC said masks weren't necessary, he said. Although that recommendation changed in early April, people are reluctant to accept the current protocols.
"I can't blame the guy at Lowe's who's loading lumber without a mask. It's really because, in my opinion, the CDC is walking the data back," Bruce said. "As of January, I was with the CDC — there's no reason to wear masks out in public. But as things started to evolve, we learned this transmission wasn't fomites — hand rails, keyboards — turns out, it's way more airborne than we ever thought it was."
Schaffner said while it's true that the CDC changed its stance, people are wrong to use that as an excuse not to wear a mask now.
"The CDC said at the beginning, 'This is a new virus in a new population. We're going to be telling you the best recommendations that we have right now.' That's what happens with all new infectious diseases," Schaffner said. "The more you learn, the more you adapt."
Smith said she's been pushing for a public service announcement campaign to get the community to focus on the issue.
"We can't affect the world necessarily, but we can help our community by getting our community on board with the best public health," she said. "We're not New York, but we can learn from them. We're not Italy, but we can learn from them.
"I'm going to wash my hands, wear my mask and press on. We've got to get Tennessee back to work, and it's totally possible," Smith said.
Tennessee and many parts of America have been largely spared from the high levels of sickness and death seen in some big cities.
Unless businesses and other decision-makers implement stricter mask policies, Schaffner said Tennesseans may wind up learning the hard way.
"As this virus gets out into rural areas — and it will — it will strike friends, it will strike members of your family," he said. "That's the other thing that will bring home the importance of wearing masks and these guidelines."
Contact Elizabeth Fite at firstname.lastname@example.org.