Several of Chattanooga's largest employers, a jail, food processing plants and a long-term care facility are among the top locations identified in a list of recent "COVID-19 clusters" from the Hamilton County Health Department.
By far the largest cluster of cases was at the University of Tennessee at Chattanooga, with 405 cases. The next largest cluster was at Erlanger's main hospital on East Third Street, with 103 cases, followed by Silverdale Detention Center at 72.
The health department's list was obtained by the Times Free Press through an open records request and reveals the county's largest recent coronavirus clusters, which are defined as two or more confirmed or probable cases of COVID-19 that are linked by the same location of exposure — such as a hospital, nursing home or grocery store — or exposure event — such as a party or gathering — that is not a household exposure.
Facilities on the list have had 10 or more COVID-19 cases since the beginning of the pandemic, as well as at least one new case in the past 28 days. For businesses and hospitals, the list includes employees only. For schools and long-term care facilities, the numbers include staff in addition to students and residents.
Volkswagen was fourth on the list with 70 cases, followed by the Amazon Fulfillment Center with 54 and Koch Foods with 50. CHI Memorial Hospital's main campus, Pilgrim's Pride, Standifer Place and McKee Food Corp. were next on the list.
The full document shows 28 facilities with 10 or more cases, at least one of them recent.
Eight locations are either hospitals, mental health or substance use recovery centers; six are long-term care facilities; four are food processing or packaging plants; three are educational institutions; two are correctional facilities; two are industrial facilities; two are community facilities; and one is a homeless shelter.
The Times Free Press reached out to the top 10 facilities on Monday for comment and will list other cluster sites later in the week after they have been contacted for comment.
George Heddleston, UTC's vice chancellor of communications and marketing, said the school's medical team, food service workers and housing employees have done a great job of managing the virus on campus.
UTC is ranked second highest for total COVID-19 cases among college campuses in Tennessee, according to the New York Times, trailing only the University of Tennessee in Knoxville. However, the Times's list measures total cases while UTC's dashboard also reports active cases, which included 34 as of Monday. The university in Knoxville had 95 active cases on Sunday.
Erlanger officials said in a statement that the health system "takes seriously the health and safety of our associates, patients, visitors and community.
"As one of the largest employers in Hamilton County, statistically it would be expected for a percentage of the community population with COVID-19 to work at Erlanger. We have implemented numerous safety measures such as required masking, [personal protective equipment], and working remotely where possible to help reduce the spread of COVID-19. However, community spread away from work continues to be a challenge for all employers as our associates and their families live and play throughout the region where they are exposed to others who may not follow the same practices," Erlanger officials said.
Officials said they encourage employees to participate in contact tracing with the health department in addition to reporting to the health system's own monitoring system, which tracks workers who are sick, have symptoms or a known exposure to a COVID-19 positive person without appropriate protective gear.
Officials at CHI Memorial echoed those at Erlanger.
"As a large health-care organization with 4,700 employees, the safety measures we have in place have resulted in a small number of work-related or community-related exposures. In our experience, those exposures occurred when the employee was not adhering to the safety measures designed to guard against exposure," CHI Memorial spokesperson Lisa McCluskey wrote in an email. "It is important for everyone to be aware of the absolute necessity to mask properly; (the mask should be worn at all times with the nose and mouth fully covered) to maintain a six-foot distance between others and to wash hands frequently."
The Times Free Press reached out to other organizations at the top of the cluster list, those with 38 or more COVID-19 cases. No other comments were forthcoming by deadline.
Cases on the list may not have originated at the location, but the health department identified the infected parties as being at the location during the infectious period, health department officials said. For example, employees may have contracted the virus at home or in the community but then gone to work before symptoms arose.
In June, contact tracers with UTC and the health department noted they were seeing an increase of people who were unaware they should have been in quarantine until their test results came back.
Hamilton County Health Department Administrator Becky Barnes cautioned against drawing certain conclusions from the list. The cluster list is a document for department staff to help piece together potential patterns of spread, she said.
"If all of a sudden you had 10 at one workplace, that may say that there may be transmission at work, and we could look into that particular situation," Barnes said. "But if you have one at a location, and then three weeks later you have another one, that helps us keep an eye on what's going on. But that doesn't necessarily tell you there's transmission going on at that worksite."
Barnes said she's worried publication of the list may make businesses or individuals less likely to want to cooperate with the health department's contact tracing processes — one of the few tools that can help control the spread of COVID-19 until a safe and effective vaccine is widely available.
People who test positive for the coronavirus sometimes do not want to share their whereabouts with contact tracers, making it hard to track and isolate other potentially infected people, Barnes said. Common objections to contact tracing include fear or employers instructing staff not to tell the health department where they work, she said.
"We've already had some of that occurring where positive people refuse to tell us where they work or cooperate with us at all. We don't want to compromise the progress we think we've made in our community," Barnes said.
The cluster list mirrors state and national trends for COVID-19 clusters, which typically occur where large numbers of people congregate in close quarters.
In Tennessee, the most commonly reported clusters have been in corrections facilities and nursing homes or other long-term care facilities, according to a report from the Tennessee Department of Health. Workplaces such as meat processing plants and nursing homes were linked COVID-19 cases early in the pandemic nationwide and in Chattanooga. Last month, Hamilton County-owned correctional facilities reported at least 70 inmates and personnel had tested positive for the coronavirus since April.
Barnes said that it makes sense that major employers with large numbers of essential workers — those who continued to work throughout the shutdown and who don't have the option to work remotely — would see more cases.
Erlanger Health System is the county's largest employer, with about 7,000 combined full and part-time employees, according to data from the Chattanooga Area Chamber of Commerce. McKee Food, Volkswagen and CHI Memorial are among the top-10 largest employers in the county, according to the chamber.
Several other major employers, such BlueCross BlueShield of Tennessee — the county's second largest employer — did not make the cluster list. However, unlike workers at facilities on the cluster list, most BlueCross employees have been working remotely throughout the pandemic.
Bev Fulbright, epidemiology manager for the health department, said her colleagues are seeing clusters at different events, including weddings and funerals, but those were one-time exposures. Continuous spread is more likely to occur at places where large numbers of people regularly convene in close proximity, such as the county's largest companies whose employees are not able to work from home.
Last week, the health department in Nashville released a similar cluster list. However, that list includes all clusters that have occurred since the beginning of the pandemic — not just clusters with recent cases, according to reporting in the Tennessean.
Like Hamilton County's list, many of Nashville's clusters occurred at worksites, correctional facilities and nursing homes.
Meanwhile, the Knoxville News Sentinel is suing the Tennessee Department of Health for repeatedly refusing to release data on COVID-19 clusters in the state. The state department cited federal law restricting release of medical information that identifies individuals in its refusal to release a cluster list. However, similar to the Times Free Press request for a cluster list, the News Sentinel's request sought no information that would identify individuals, according to a story in the Knoxville paper last week.
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