Hamilton County Mayor Jim Coppinger has strongly advocated for wearing masks in the past few months, giving his podium to local doctors at news conferences to underline the importance of face coverings in stopping the spread of COVID-19 and keeping the economy open.
On Wednesday, Coppinger again emphasized that science supports masks as Hamilton County, and the surrounding region, is in the midst of a surge in new cases.
"In no circumstances should you be without a mask when you're attending functions, or without social distancing," he said.
Yet, the fruits of Chattanooga's location, sitting on the border with two states and surrounded by rural areas, in other ways pushes against the public health interventions the county is undertaking to stop the coronavirus.
Wearing a mask stops the spread of respiratory droplets that are released when someone speaks or laughs and may contain the virus. Masks become more effective at stopping the spread when they are widely used.
Hamilton County, which has a mask mandate, is surrounded by counties that do not require their residents to wear masks. Many residents travel across state and county borders for work or other activities.
Gov. Bill Lee maintains leaving mask mandates up to individual county mayors is the best strategy to address the virus, though he said Wednesday county mayors "ought to consider" imposing the requirement. The governor has pointed to individual responsibility in his approach to the pandemic.
"It is important that we each recognize what's happening around us and take the responsibility and make the decisions that are important for all Tennesseans to make to help protect ourselves and our neighbors in the mindset of a growing pandemic in our state," he said.
Health experts like Dr. William Schaffner, a Vanderbilt University infectious diseases expert, said this kind of piecemeal approach is putting communities at unnecessary risk.
"Certainly the experience now is very, very clear: You need large geographic areas all doing the same thing," Schaffner said. "Having one community do one thing, having one community doing another, is not a coherent public health, epidemiologically sound approach in an attempt to control the spread of this virus. You have to have large areas doing the same thing."
The call for a cohesive approach comes as the state, and the nation, face record-level increases in new cases. As of Friday, Hamilton County reported at least 100 new infections every day for the past nine days. Hospitalizations in the state in the past week surpassed records set months earlier during the summertime surge.
The Chattanooga metro area and Hamilton County moved into the "red zone" for the virus in the past week because of the increase in cases, according to an Oct. 25 report from the White House COVID-19 Task Force. Bradley and Coffee counties were also included on the White House's list of "red zone" counties in Tennessee.
"All indicators of community spread are increasing, including percent of nursing homes with positive staff members and residents, and community spread is increasing hospital admissions, leading to potential resource constraints," the report reads.
Meanwhile, the falling temperatures mixed with coronavirus fatigue, as well as the approaching holidays, risks further spread of the virus and, likely in the weeks to come, a spike in deaths.
The COVID-19 pandemic hit rural areas particularly hard in the past two months while areas like Chattanooga saw a flattening of new cases. Places like Grundy, Bledsoe and Marion counties saw sharp spikes in cases after months of relatively few known infections.
A study released Tuesday by Vanderbilt University showed that while cases and hospitalizations are rising across the state, the hardest-hit areas of Tennessee continue to be those without public face mask requirements. As of Friday, 58 of the 87 hospitalizations reported by the Hamilton County Health Department were people living outside of Hamilton County.
In the past week, Grundy County, Tennessee; DeKalb County, Alabama; and Whitfield County, Georgia, were among the regional counties hardest hit by the virus, according to an analysis by the Times Free Press.
Georgia counties are allowed to impose their own mask mandates under Gov. Brian Kemp's executive order. During the summer, Whitfield County residents protested a potential mandate, with some calling such a requirement tyrannical. Some residents heckled the director of the North Georgia Health District during an August news conference at which the director talked about the importance of masks. The county does not have a mandate in place.
Marion County reported the sixth highest increase in new cases per 10,000 residents in the past week, according to an analysis by the Times Free Press. Last week, the Walmart superstore in Kimball closed temporarily after numerous employees reportedly tested positive. The county, which borders Hamilton County to the west, does not require masks.
About a week ago, Larinda Simmons posted a sign on the door of the jewelry store she owns with her husband in Jasper. The sign, written with black marker and posted in one of the door's diamond-shaped windows, reads, "Masks required. Thank you."
Simmons said she put up the notice after the spike in cases in Marion County. She washes her hands after every piece of jewelry she touches or repairs, she said.
Simmons runs the store herself these days, three days a week, while her husband is recovering at home from a scheduled surgery this spring. He was in the hospital and a recovery center for months, she said.
"I need to put that up because I really don't want to take it home to my husband. I don't want him to go back to the hospital," Simmons said.
David Jackson, Marion County mayor, said more people in the area are wearing masks now than a few months ago. He is encouraging people to wash their hands and stay home if they are sick, something he recently received complaints about, he said.
The county mayor agreed with infectious disease researchers like Schaffner who say there needs to be regional cohesion in addressing the virus.
"We're sitting here on the Alabama state line and the Georgia state line. If Georgia has a mask mandate and [if] Marion County has a mask mandate but if Sequatchie and Grundy and the surrounding counties do not, what good would it do?" Jackson said.
However, Jackson has not joined neighboring Hamilton County in implementing a countywide requirement to wear a mask.
"We think that encouraging people to do it works better than you got to do it," Jackson said, adding that counties in nearby Alabama, which has a statewide mask mandate, are seeing spikes in COVID-19, too.
A mask mandate does not guarantee that people will follow it, and the Northeast Alabama counties border multiple counties in Tennessee and Georgia that do not require masks, likely creating spread across state lines as people travel to work, shop and visit friends or family.
This is why Schaffner said the best approach to stopping the spread of COVID-19 is to think regionally, even if that means working across state lines to create a unified response.
The recent Vanderbilt report makes clear instituting a mask mandate does not immediately change the spread of the virus. A flattening of the curve from widespread mask use could take several weeks and has to be used along with other mitigation efforts, like limiting contact with people, social distancing and hand hygiene.
Using cell phone data, the Vanderbilt study reported drops in mobility in Tennessee's 89 non-metro counties tracked with case surges more closely than statewide restrictions on gathering places, offering some hope that people were taking steps to keep themselves safe. The researchers found people traveled to restaurants and bars less frequently when the first case was announced in Tennessee in March before Gov. Lee implemented a "safer at home" order.
Mobility then increased during the summer until cases surged in July and August, during which people traveled less to restaurants and bars. The researchers said mobility is again declining as cases and hospitalizations spiked in October.
"It is very clear that the best way to manage the economic fallout is to definitively manage the virus using proven strategies that can break chains of transmission," the study reads.
Schaffner said that while this data on mobility is promising, it does not replace a coordinated public health approach.
"That has to do with personal protection, one at a time," he said. "But if we're trying to do this on the basis of the entire population, you have to take a public health approach. You can't just leave it up to individual decisions."
Battling COVID-19 takes a community effort because one person's decisions can affect someone else's health, Schaffner said. The disease specialist likened the need to wear masks to the social agreement to stop at a red light and go on a green one. A decision to not follow these laws is a personal one, but doing so puts others at risk.
"We have to all decide to stop on the red and only go on the green," Schaffner said. "We have to do this all together, otherwise we hazard us all. And that's exactly what's happening throughout most of the country and those rural counties throughout the state."
While even wearing a mask has been critiqued as a political gesture, Schaffner emphasized the practice will keep people from getting sick and save lives. Widespread mask use is a key part in containing the virus, he said, which means getting groups of counties and even states on board.
"The state's leaders need to get their brains around the notion that the entire state has to do the same thing," he said. " Our leaders have gotten very good medical advice. It's come from the medical societies, infectious disease specialists, the public health community. It's all in harmony. We should all have a mask mandate. There isn't any doubt."
Contact Wyatt Massey at email@example.com or 423-757-6249. Follow him on Twitter @news4mass.
Hamilton, other Tennessee counties have special procedures to allow voters with COVID-19 issues safely vote