How politics and personal choice fueled the Chattanooga region's COVID-19 crisis
By Elizabeth Fite
This is the first story in a three-part series
Since the early days of the pandemic, leaders around the world have relied on data to make decisions with important public health and economic consequences, such as when to lift social distancing restrictions, allow public gatherings or reopen businesses — some of the many measures taken to help curb the spread of COVID-19.
The coronavirus is highly contagious and spreads rapidly from person to person through respiratory droplets. It’s also a new virus, meaning it’s not well understood, there are few effective treatments and most people have no immunity through prior infection or vaccination.
COVID-19, the disease caused by the novel coronavirus, is more deadly than seasonal influenza and particularly fatal for certain high-risk individuals, such as older adults and people with underlying health conditions.
For these reasons, health officials say simple steps — maintaining safe distance from others, wearing face coverings in public, practicing good hand hygiene and avoiding large gatherings, particularly indoors — must be taken to mitigate the spread, save lives and avoid overwhelming the health care system.
However, the degree to which state and local governments should implement policies to facilitate these behaviors — and the public’s willingness to accept them — is fiercely debated and varies widely across the region and the country.
To better understand potential associations between mitigation efforts and community spread of the virus, the Chattanooga Times Free Press tracked key events and policy decisions in several area counties — Hamilton, Bradley and Marion counties in Tennessee and Whitfield, Catoosa and Walker counties in Georgia — from March through December. Those key events were then visualized alongside publicly available COVID-19 data for new daily cases, new daily hospitalizations and deaths over the same time period to create a graphic representation of each county’s “epidemic curve.”
Case data was converted to a per-100,000-resident rate to account for differences in population sizes, and a line represents the 7-day average case rate — which gives a more accurate picture of whether the curve of new cases is rising or falling, since case reports can vary widely from day to day.
These data points were chosen because when combined, they are three of the key metrics officials use to track COVID-19. The data is also made publicly available each day through both state’s departments of health, allowing for the best “apples-to-apples” comparison across counties, although Georgia does not release daily hospitalization data at the county level.
The analysis found a patchwork of regulations implemented at different times and places across the region. Combined with a dynamic pandemic — meaning cases and deaths often rise and fall in different places at different times due to many different factors — and Chattanooga’s position as a regional hub for business on the border of three states, it becomes increasingly difficult to suss out the impact of individual mitigation measures as time goes on.
Despite these limitations, this view of the data shows some instances where the presence or lack of mitigation policies may have affected transmission rates, as well as some stark differences in how the pandemic has impacted the counties.
“The initial shelter-in-place [order] seemed to stall the spread a bit, but lifting restrictions too soon without a mask mandate and allowing high-density attendance in public spaces probably escalated spread,” said Greg Heath, an epidemiologist and professor emeritus of public health at the University of Tennessee at Chattanooga.
Whitfield County, Georgia, stands out as a place that has been consistently hard-hit by COVID-19 for the size of its population.
In Whitfield County, the cumulative 14-day rate of new cases per 100,000 residents was over 500 for every day in July, November and December, showing how the summer and fall waves of the coronavirus hit the North Georgia county sooner and more aggressively than elsewhere in the region.
Since the nationwide post-Thanksgiving case surge, which makes up the most severe wave yet for all six counties, Bradley County has surpassed the others in its rate of new daily cases.
Hamilton is the only county in the region with a public face mask requirement, despite strong recommendations from the medical community and the White House COVID-19 Task Force that mask mandates were needed in all counties.
In the weeks and months after the mandate took effect in July, the county saw a marked reduction in its rate of new cases and hospitalizations. But that progress was eventually overshadowed by the fall surge, fueled initially by an uptick in rural counties without face mask requirements.
When and how to send students back to school in the fall was another controversial decision that varied widely across districts. Although outbreaks among students and teachers have occurred, in-person learning when proper precautions are in place did not appear to significantly increase community transmission.
Regional case spikes have typically followed in the weeks after national holidays, such as Memorial Day and July 4. For that reason, health officials warned the worst wave was still to come this fall, as people retreated indoors and convened for the holidays.
As projected, coronavirus cases and hospitalizations across the region increased dramatically after Thanksgiving and show no sign of slowing. Officials say high community prevalence, COVID-19 fatigue and social gatherings without precautions are the main factors contributing to the spread.
Rae Bond, chair of the area’s COVID-19 Joint Task Force, said on Tuesday that hospitals are strained but managing. But another larger, post-Christmas surge could be overwhelming.
“We need to be able to send people to the hospital if they’re having a heart attack or if they’re having a stroke or if they need an urgent surgery, and the best way for us to be able to do that is for all of us to take the steps to be safe right now,” Bond said during a news conference.
As with most health statistics, COVID-19 data comes in different forms and is not always complete. However, when used in combination with other key metrics, it helps form a piece of a puzzle that creates a clearer picture of the pandemic’s trajectory.
Confirmed case data is one of the most readily available and important metrics to understanding COVID-19, but it’s most likely an underestimate of the actual burden of disease. That’s because many people with coronavirus never get tested and access to free, convenient testing is not always readily available. Therefore, officials also rely on hospitalization and mortality data to inform decisions.
Since most people who contract the coronavirus don’t require hospital care, a rise in hospitalizations is another indication of increased community spread. This data also has limitations, though, in that the number of hospitalized COVID-19 patients represents only the most severe cases of infection. Hospital patients were often exposed to the virus several weeks before admission, so it’s a delayed metric for tracking transmission. It also omits important patient characteristics and isn’t always reported at the county level.
COVID-19 mortality data reflect the state of the outbreak several weeks prior, because it can take several weeks or more than a month for someone to succumb to the disease. Frequent lags in reporting make it even harder to draw meaningful, real-time conclusions about an outbreak.
However, Heath said that a few things are clear based on what’s happened in the United States and across the globe:
- There is considerable variability in spread, cases, hospitalizations and deaths from place to place.
- Complete shutdowns are probably not necessary if compliance with mitigation behaviors is quite high (70-100%) — masking, spatial distancing, hand washing and limiting exposure to people who are outside your household.
- Vaccination of at least 70%-80% of a population should provide adequate “herd immunity” to the extent that the virus has nowhere else to go to infect.
- Mitigation efforts must remain in full compliance throughout the deployment of the vaccine in order to stave off preventable hospitalizations and deaths.
Dr. Pablo Perez, an internal medicine physician in Whitfield County, has seen the devastating effects of COVID-19 on its citizens firsthand.
“These numbers are real,” Perez said. “The numbers are not just numbers — they’re people. They’re fathers, they’re daughters, they’re sons. The virus is not just killing elderly people, it’s killing young people and leaving some young kids without parents.”
Perez is no stranger to suffering. He has completed medical mission trips to poor countries throughout his career and treated people with horrible diseases. Until COVID-19 emerged, that kind of suffering was rare in the United States, he said.
“Here, people didn’t think that would happen to them,” he said.
Perez fears that the local outbreak will only worsen until vaccines become widely available and accepted, because local officials are not implementing mitigation measures — such as face mask mandates — or acknowledging the severity of the pandemic.
“Our officials are ignoring science,” he said. “I don’t know what type of message they want to transmit to the community, but if they keep sending the same message, which is silence, we’re going to be suffering.”
Contact Elizabeth Fite at firstname.lastname@example.org or follow her on Twitter @ecfite.