Staff photo by Troy Stolt / Barista Tarig Idris wears a mask as he works at the register at Mad Priest's Broad Street location on Friday, Oct. 2, 2020 in Chattanooga, Tenn.

All of Tennessee is experiencing a COVID-19 case and hospitalization surge, and the hardest-hit areas continue to be those without public face mask requirements, according to a report from Vanderbilt University researchers released on Tuesday.

"We've seen a statewide increase in hospitalizations since early October, indicating that masking alone is not sufficient to curb further spread of the virus," John Graves, associate professor of health policy at Vanderbilt University School of Medicine, said in a news release. "But it's very clear that areas where masking requirements have remained in place have seen much lower growth in COVID-19 hospitalizations."

Several Tennessee hospitals were forced to either scale back or stop elective surgeries this week as a result of the surge, including Ballad Health's hospitals in Kingsport, Bristol and Johnson City.

"To our communities, we plead with you to stay home, social distance, wash your hands and wear masks in public. It is up to all of us to ensure that our hospitals don't become overwhelmed so we can continue to provide the best possible care to all patients," Ballad Health said in a tweet on Monday.

Also on Monday, Maury Regional Medical Center in Columbia suspended all elective procedures that require an overnight stay after the hospital set a record of 50 patients hospitalized with COVID-19 last week, according to an announcement on the hospital's website.

"The time has long passed for our community to take this virus seriously. We are seeing the impact of our community letting down their guard and we must make every effort to mitigate the spread of this virus so that it does not further tax health care providers across Middle Tennessee and the entire state," Maury Regional Health CEO Alan Watson said in the online statement.

He attributed the patient spike in part to recent fall breaks, saying that the hospital has consistently seen patient spikes after holidays.

In Hamilton County, COVID-19 Joint Task Force Chair Rae Bond said at a news briefing Tuesday that local hospitals are also experiencing a surge, due largely to an influx of patients from outlying counties without mask mandates. However, she said Hamilton County hospitals are not to the point of needing to suspend elective procedures.

"We urge people, regardless of where you live, to wear a mask. The fact is COVID is now prevalent in every community in our region," Bond said. " We want the hospitals to be able to continue to stay open for elective surgeries and procedures, because there are health risks if we have to close down because the hospitals are overwhelmed with COVID."

She also said halting elective procedures comes with its own set of negative health consequences. Even though some procedures can be put on hold, that doesn't mean they should be postponed.

"Absolutely nobody wants that to happen again," Bond said. "Being able to continue to care for people in our community and people from the surrounding communities — that is our goal We need our hospitals to be open, we need them to be able to care for everybody who's in need of care, and the best way we can do that is to wear masks, wash our hands and stay six feet away from other people and avoid large gatherings."

Gov. Bill Lee has consistently said that he will not impose a statewide mask mandate and instead leave that decision up to county mayors.

Vanderbilt's report found that 54% of Tennesseans now live in counties with mask mandates, while the remaining 46% either live in counties that lifted mask requirements after the summer or never required face masks in public.

In the Chattanooga region, only Hamilton County has a public face mask requirement.

Last week, statewide hospitalizations and new coronavirus cases reached their highest points since the pandemic began. While patient numbers appear slightly lower this week, that could be in part because fewer health systems are reporting their patient data to the Tennessee Department of Health.

On Tuesday, Tennessee reported 1,223 hospitalized COVID-19 patients, including 368 patients in intensive care.

The Hamilton County Health Department on Tuesday reported 133 new cases of COVID-19, the seventh straight day of at least 100 new cases, and one additional Hamilton County resident death for a total of 110 since the beginning of the pandemic.

At the same time, the health department reported 90 hospitalizations on Tuesday, 37 of which were Hamilton County residents. Twenty-one of those patients were in intensive care.

Hamilton County's total hospitalization number represents a more than 50% increase in the past two weeks.

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