Priming the Economic Pump

Priming the Economic Pump

Gov. Bill Lee announces his phased restart of Tennessee’s economy will begin next week as testing ramps up across the state.

by scott barker • April 21, 2020
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Knox County Health Department staff prepare to open a drive-through COVID-19 testing center at the Knox County Engineering and Public Works Building in North Knoxville on Monday. (Knox County Health Department photo.)

Some Tennessee businesses shuttered by coronavirus restrictions will be able to open as early as next Monday under Gov. Bill Lee’s plan to gradually reopen the state’s economy.

Knox County is one of six counties in the state that will develop its own plan to lift restrictions on businesses.

Lee announced yesterday he would allow his “Safer at Home” executive order to expire April 30, though social distancing guidelines will remain in place. 

“For the good of our state, social distancing must continue, but our economic shutdown cannot,” Lee said.

The state will regulate the reboot in 89 of the state’s 95 counties; the other six, including Knox County, are responsible for drafting their own reopening blueprints. The governor also said state parks would begin reopening on Friday.

Lee’s decision comes as the national debate over when and how to reopen the economy intensifies. In what seemed part of a national effort among conservative activists, protesters gathered in Knoxville and other Tennessee cities on Sunday demanding an immediate reopening of all businesses in the state.

Public health researchers, on the other hand, have said that expanded testing should be a prerequisite for reopening sectors of the economy idled by restrictions due to the novel coronavirus pandemic. 

The Knox County Health Department has expanded its testing efforts and on Monday opened a drive-through center at the Knox County Engineering and Public Works Building in North Knoxville where people could get tested for free without an appointment.

Public health officials say the state’s coronavirus outbreak measurements are trending in the right direction, though increased economic and social activity will lead to more cases.

Rebooting Business

The coronavirus pandemic and the public health response have left the state’s economy reeling. Nearly 250,000 people in Tennessee applied for unemployment benefits between March 15 and April 4. Of those, about 52,000 worked in the 16-county region that includes Knox County.

Lee has stressed his desire to reopen the economy when the COVID-19 situation stabilized. On Monday, he cited improving health measures and increased testing as reasons to move forward.

“The numbers are in the right place and headed in the right direction,” Lee said.

The statewide reopening plan will apply to the 89 counties with satellite offices of the state Health Department. That’s all of the rural counties and most of the suburban ones, including the eight counties bordering Knox County.

Lee said details of the reopening plan, including which businesses that were closed under his order will be allowed to resume operations and under what restrictions, will be released in the coming days.

“Our Economic Recovery Group is working with industry leaders around the clock so that some businesses can open as soon as Monday, April 27,” he said. “These businesses will open according to specific guidance that we will provide in accordance with state and national experts in both medicine and business.”

Restrictions on group gatherings and other social distancing requirements will stay in place, meaning that many businesses will have to alter their traditional processes.

The other six counties — Knox, Shelby, Davidson, Hamilton, Sullivan and Madison — operate their own independent health departments and will develop their own plans. Knoxville Mayor Indya Kincannon and the mayors of Memphis, Nashville and Chattanooga have formed a task force to develop plans for the state’s four largest cities.

“We want to be supportive and cooperative in working with them to develop their own plans,” Lee said. “I’m not extending the order past the end of April, but we’re working directly with our major metropolitan areas to ensure that they are in a position to safely reopen as soon and as safely as possible.”

The city and the county have sometimes taken slightly different approaches to the pandemic, with Knoxville Mayor Indya Kincannon quicker to impose social and business restrictions than Knox County Mayor Glenn Jacobs.  Although both are currently under the state order, those differences could re-emerge as reopening begins.

Kincannon, who can keep stricter measures in place in the city if the county loosens restrictions, has said her decisions will be based on statistics from the Knox County Health Department. She has said she’d like to see two weeks of sustained reductions in cases before she would consider allowing nonessential businesses to open. The majority of businesses in Knox County are inside Knoxville city limits.

The number of new infections has slowed in recent days — over the past week the average daily increase is a shade under four cases, and only four new cases were reported over the weekend. The number of active cases has fallen to 28, the first time since April 12 it’s been below 30.

“Recent trends in Knoxville indicate that our social distancing efforts are working,” Kincannon said in a response to Lee’s announcement. “If the numbers continue to show this 'flattening of the curve,' I support reopening our economy, lifting restrictions in a gradual way, based on data, not dates.”

Jacobs, on the other hand, is ready to move forward and said he’s glad Lee wants to begin opening businesses next week. He said he’s ready to work on finalizing a plan.

“Our case trend line has remained flat over the past week and our recoveries are increasing,” Jacobs said. “Hospitals in our region are just over 50 percent occupied, and thanks to the efforts of our local health departments, hospitals and TEMA, we are well positioned to accommodate an increase in COVID-19 patients should there be an unexpected increase in the trend line.”

 Expanding Testing

Early Monday afternoon, the line of cars outside the county’s drive-through testing site stretched for a block north on Wray Street between the entrance to the site and Oklahoma Avenue.

Public health workers in the parking lot used nasal swabs to obtain samples from drivers and passengers to be tested for COVID-19, the illness caused by the novel coronavirus. By the end of the day, nearly 400 people — more than twice the number the Health Department expected — had provided samples to be shipped to labs for processing. Another 400 people should get tested today. 

“While we are thrilled with that response, we do not have an unlimited supply, so we have to make some tweaks in our schedule going forward in the week,” Health Department Director Martha Buchanan said. 

At Monday’s County Commission work session, she emphasized that while the testing is open to anyone, the Health Department wants to focus on people with COVID-19 symptoms or a reason to think they've been exposed to the coronavirus. 

"We are testing everybody, but I'll be honest, due to our limited supplies — and not just our limited supplies, the whole medical community is challenged with the testing supplies —  we would really prefer that people who have symptoms and people who are healthcare workers who have had an exposure, we prefer to test those,” Buchanan said. “We're not turning anybody away,  but if you're not symptomatic, maybe wait and see."

Buchanan cautioned against people getting tested just for peace of mind.  "If they're negative today, they could be positive in two days,” she said, “I think people believe that if I got tested today, then I'm done, I'm good.  So they come in and get tested, and they don't have to worry about getting COVID-19. And that's just not true."

She also repeated her warnings that expanded testing would result in a spike in COVID-19 cases. “It’s going to increase the number of positives that we see,” she said.

Over the weekend, the state Health Department tested 11,230 people at sites in 29 counties across Tennessee, most of them in rural or suburban areas, the largest number tested in a two-day period in the state. Expanded testing will continue for the next two weekends, April 25-26 and May 2-3, at other locations.

Comprehensive testing is seen as one of the keys to gauging whether it’s safe to reopen nonessential businesses. 

The more people we get tested, the more we can see what the burden of disease in our community,” Buchanan told commissioners. “It also allows us to isolate those folks, connect with their contacts and protect the community.”

The Harvard Global Health Institute estimates that testing needs to be conducted at a daily rate of 152 per 100,000 residents for a safe economic reopening. Tennessee would need to triple the number of tests administered each day to reach that mark. As of April 15, the state’s daily testing rate was 51 per 100,000 residents.  

Only Rhode Island is testing residents at or above the recommended rate. Tennessee is testing at a faster clip than all its neighboring states except Mississippi.

Tennessee is doing well by another metric used by the Harvard researchers and public health organizations — the rate of positive tests among all tests conducted. A high positive rate indicates that health officials haven’t tested a lot of people who have the disease, Ashish Jha, the director of the Harvard Global Health Institute, told the New York Times

“You want to drive the positive rate down, because the fundamental element of keeping our economy open is making sure you’re identifying as many infected people as possible and isolating them,” Jha said.

Tennessee has tested 100,689 people, with 7.238 receiving positive results. The state’s 7.2 percent rate is lower than the World Health Organization’s 10 percent target recommendation and the nationwide rate of about 20 percent.

Other Metrics

Testing isn’t the only measurement officials are using. Lee and state Health Commissioner Lisa Pearcey said other statistics show the state is beginning to manage COVID-19. 

Monday marked the 17th consecutive day of single-digit percentage increases in cases on a day-over-day basis. Pirecey said daily percentage increases have dropped from the mid-teens to 2.3 percent on Monday. 

“For the first time, the number of recovered cases exceeds the number of active cases,” Piercey said. “What this means is that there are more people that have gotten over the disease than are getting infected. That’s very encouraging. That means our social distancing measures have worked and so we need to keep them up.”

Piercey said one of the most important metrics is the reproduction rate, which tells officials how quickly the infection is spreading. “Ideally, you want that to fall below 1.o. When we first started, we were at the 2 to 3 range, 2.6 or so, and the last estimate was 1.3, maybe even a little bit lower.”

Lee said state officials will work with local health departments to monitor case loads after the reopening and will have plans to address hotspots of infection that could pop up. 

In addition to an increase in cases due to expanded testing, Buchanan said more spreading of COVID-19 will be inevitable after restrictions are eased. "Once we start reopening our community, we know we'll see an increase in cases, just because people are going to mix and mingle, and we're going to have more contact," she said.