In its first meeting on the coronavirus pandemic, the Knox County Board of Health voted unanimously on Wednesday to drop the reopening plan developed by the Knox County Health Department and adopt the state’s approach.

The new rules and guidelines for the economic reopening take effect July 1.

The change was suggested by Dr. Martha Buchanan, the director of the Health Department, who said she would now be able to focus on the public health response to the pandemic instead of the economic aspects. 

“It makes sense to fall under the state plan, in our perspective,” Buchanan said.

The board voted to keep the Health Department’s plan in effect for two weeks to make the transition smoother.

The county Law Department, meanwhile, said the Health Department’s plan has not had the force of law since its inception and only became legally binding with Wednesday’s vote.

"There are no phases, there are no benchmarks, there's no local plan,” Myers Morton, an attorney with the Law Department, said before the voting.

The Board of Health had not weighed in on the coronavirus previously — primarily because the Health Department was unaware of the need to get the board’s approval for its reopening plans.

The county code stipulates that the Health Department director must “act in concert with, and meet all applicable policies established by, the county board of health.”

The state’s plan, called Tennessee Pledge, was developed by Gov. Bill Lee’s Economic Recovery Group, made up of public officials and private-sector representatives. 

Buchanan said the state’s plan and the county’s plan are similar, with some differences in detail. She said Knox County’s guidelines made wearing masks by employees in some businesses mandatory, while it was recommended but not mandated in the state plan. Likewise, the state plan requires restaurants to screen patrons for the coronavirus, while Knox County’s does not.

Knox County’s plan limits public gatherings to 50 people. Lee’s most recent executive order addressing large gatherings allows more than 50 people in one venue as long as they are split into “separate, otherwise permissible smaller groups” that maintain social distancing.

Buchanan said that businesses for the most part had cooperated with the county’s guidelines, which has kept the impact of the pandemic lower in Knox County than in other parts of the state. “Most of our businesses are thinking this seriously and most of our citizens are taking it seriously as well,” she said.

Buchanan said that while case numbers have gone up in Knox County in recent weeks, other metrics — hospital capacity, testing levels and contact tracing abilities — are still in the positive range.

The board’s chair, Dr. Jack E. Gotcher Jr., an oral surgeon and UT’s oral surgery program director, noted the higher case counts in other urban counties. Shelby County has twice Knox County’s population and 12 times the cumulative number of cases. Hamilton County, which has a smaller population than Knox County, has seen more than three times the number of infections. 

“It’s interesting how this disease looks different in different communities, even in the same geographic area,” Buchanan said. 

“We’re operating differently from them,” Buchanan continued, speaking of Shelby and Davidson counties, which also have independent health departments. “Their legal guidance varies from our legal guidance.”

For example, Memphis City Council on Tuesday voted to require the wearing of face masks in public. Failure to comply is a misdemeanor.

The response to the pandemic has required legal responses unprecedented in memory. The Health Department deals with outbreaks of infectious diseases all the time, but nothing on the scale of the novel coronavirus. “The pandemic is undeniably new territory for all of us,” Buchanan said. 

In a series of executive orders, Lee outlined the state’s response to the public health crisis posed by the novel coronavirus. The state Department of Health would manage the response for the 89 counties under its control. Six counties, including Knox, that have independent health departments were allowed to craft their own plans based on their unique conditions.

Buchanan, as the county’s health officer, closed bars and limited restaurant seating capacity on March 20. She issued a safer-at-home order on March 23 that shuttered nonessential businesses and limited public gatherings. 

Buchanan then issued an order allowing the first phase of a three-phased reopening to begin on May 1. On May 22, she announced Phase 2 of the reopening could begin after Memorial Day.

Knox County Law Director Bud Armstrong, however, determined that Buchanan needed to get the approval of the Board of Health for her county-wide orders. Wednesday’s meeting, held virtually via Zoom, was the first time the board considered the public health response.

The board is made up of medical professionals, plus County Mayor Glenn Jacobs and schools Superintendent Bob Thomas (Thomas sent a surrogate, Health Services Supervisor Lisa Wagoner, as the school system’s representative on Wednesday).

Board member Dr. Patrick O’Brien, a colonel in the U.S. Air Force National Guard, raised concerns that too many people were ignoring the recommendation to wear cloth face coverings in public. “I wish we had more strict mask requirements in indoor space,” he said.

Morton advised the panel that they should not impose more stringent requirements than the state to reduce the possibility of litigation. “If we don’t exceed what the governor does, we will be immune from lawsuits,” he said.

This advice seemed at odds with Lee’s explicit assurance that the six counties with their own health departments could set their own guidelines based on their local conditions.

At the suggestion of member Dr. Marcy J. Souza, public health director at the University of Tennessee’s College of Veterinary Medicine, the board voted to formally implement the county’s current plan for two weeks to give the Health Department time to make the transition to the state’s plan.

The Board of Health, which typically meets quarterly, will begin meeting every two weeks during the pandemic. “This is an issue that deserves our attention on a regular basis,” Gotcher said.