Knox County experienced a “statistically significant” increase in COVID-19 cases over the weekend, according to Knox County Health Department officials, even as residents and businesses were preparing to increase activity even more.

Health Department officials have predicted an increase in COVID-19 cases as economic activity increases.

The uptick in positive test results wasn’t unexpected — Health Department officials have been warning for weeks that case counts would rise as people began responding to lighter restrictions on business activity — and doesn’t necessarily represent a surge in cases.

But the increase came as Phase Two of the reopening began, when even more social activity is allowed that could increase the likelihood of a simultaneous surge in infections.

“We had a statistically significant increase in cases over the weekend and going into today,” Katharine Killen, deputy director of strategy for the Health Department, said during the department’s remote media briefing on Tuesday. “While this is not an outcome we want to see, as we’ve mentioned before we do expect to see an increase in new cases as our community reopens.”

Knox County is pursuing a multi-phased economic reopening plan to emerge from the restrictions imposed to stem the spread of the novel coronavirus. Phase One began at the beginning of May and was supposed to last at least 28 days, but officials decided to start Phase Two three days early because case counts and other metrics have remained favorable.

Phase Two of the county’s economic reboot began Tuesday. Under a plan announced last week by the Health Department, businesses previously closed could reopen beginning yesterday and others could expand operations under the Health Department’s guidelines. 

Over the three-day holiday weekend, however, the county saw additional cases confirmed through testing. Since COVID-19 has an incubation period of up to two weeks, those cases most likely stem from exposures in the middle of the month.

The Health Department reported 10 new cases on Tuesday, the most in one day since May 11. Over the four-day period ending Tuesday, 25 new cases were added to Knox County’s total count. The county recorded 28 new cases during the previous 10 days.

“It’s been enough time for us to see an increase in cases likely due to people being out and about more and it's not to be unexpected, but we are watching it very closely and we’ll continue to do that as we move forward,” said Charity Menefee, the Health Department’s top infectious disease and emergency response leader.

Knox County has so far escaped widespread contagion. Metro Nashville-Davidson County, for example, has seen more than 13 times the number of infections as Knox County. The increases reported over the holiday weekend haven’t changed the county’s relatively good situation.

The local increase appears to come from general community transmission and is not related to a particular business, church or special event, Menefee said. 

The Health Department has a 31-person team that investigates cases, primarily through contact tracing. Contact tracing involves questioning patients and those close to them about their interpersonal contacts to determine who else might have been exposed to the coronavirus. Contact tracers can ascertain whether new cases are clustered around one location or exhibit a more general transmission pattern.

“We are investigating one very small cluster, but it is not at all the vast majority of cases over the weekend,” Menefee said. “The vast majority of cases are not related, that we can tell at this time.”

At this point, Menefee said, the increase is not enough to issue a caution about moving forward with reopening. The Health Department follows a variety of metrics and has benchmarks to meet that guide decision-making moving forward.

In addition to tracking new cases, the Health Department assesses the amount of testing in the county, the time it takes test results to be reported, Health Department and hospital capacity to respond to new cases, and the county’s death rate.

The county meets all the benchmarks at his point to continue reopening business activity. The effect of the Phase Two guidelines, which went into effect on Tuesday, will take some time to measure.

Because of the novel coronavirus incubation period, new cases associated with the more liberal Phase Two guidelines likely won’t become apparent for two to three weeks.

“We do expect to see more cases as people get out and about more and interact more,” Menefee said.

Health Department officials continue to emphasize the importance of personal responsibility in combating the novel coronavirus. “Even in Phase One, we discussed the importance of making decisions that are right for you, your health and your family, and that continues,” Killen said.

Menefee said the Health Department would continue monitoring the data and investigating cases as they come in to determine how to proceed.

Menefee and other Health Department officials stress the importance of following five “core actions” to reduce the likelihood of transmission:  physical distancing, wearing cloth face coverings, frequent and proper handwashing, cleaning surfaces, and staying home when sick.

Photos and videos of people enjoying the holiday weekend but not following social distancing recommendations flooded both traditional and social media websites, showing that many are not following the guidelines. 

“Being outside is great, getting exercise is great, but even when you’re in these environments we still need you to practice the five core actions,” Killen said.

“It’s worrisome for us,” Menefee added, “when you see people out and about not following the guidelines, to know what the consequences of that can be.”