Masks Mandated

Masks Mandated

The Knox County Board of Health votes to issue an order requiring people to wear face coverings in virtually all indoor public spaces.

by scott barker • July 2, 2020
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knox county board of health chair dr. Jack Gotcher (right) chats with board member Dr. Patrick O'Brien after Wednesday's meeting.

People entering nearly all buildings open to the public in Knox County will have to wear a face covering beginning Friday morning under an order issued Wednesday by the Knox County Board of Health.

A recent surge in COVID-19 cases in Knox County is one reason supporters gave for mandating face coverings.

With some exceptions, the order requires that all people 12 years of age or older must wear some sort of mask in an indoor public space if they are within 6 feet of another person. The order covers stores, office buildings, libraries and museums, banks, restaurants, clubs, convenience stores, theaters, and other facilities.

Dr. Patrick O’Brien, a colonel and chief medical review officer in the U.S. Air Force National Guard’s 134th Air Refueling Wing, introduced the order as a way to slow the spread of the novel coronavirus. Knox County has seen a surge in cases of COVID-19, the illness caused by the coronavirus, and the Independence Day holiday weekend begins Friday. 

“This is a holiday weekend,” O’Brien said. “I don’t want people spreading this disease and harming our community.”

The vote was 7-1 and was supported by all the medical professionals on the board, with Knox County Mayor Glenn Jacobs casting the lone dissenting vote. 

The board’s decision also ran counter to advice from the Knox County Law Department. Deputy Law Director Myers Morton vigorously argued against the measure.

O’Brien cited the recent surge in local COVID-19 cases — a 225 percent increase between June 17 and June 30 — as a reason for action. There were 271 active cases as of 11 a.m. Wednesday, and Health Department Director Dr. Martha Buchanan said at least another 30 new cases had been reported during the afternoon.

“Something needs to change,” she said, noting that her staff has found that despite repeated pleas to the public to wear masks and practice social distancing, many people are not voluntarily following the recommendations. “This board needs to act swiftly.”

Knox County joins Nashville and Memphis, which both passed their own mask requirements in recent weeks. Hamilton County, home to Chattanooga, is considering a mask mandate as well. 

O’Brien also noted that the Institute for Health Metrics and Evaluation at the University of Washington has predicted that 24,171 deaths could be avoided by Oct. 1 if 95 percent of people wore masks in public.

Another board member, Dr. James Shamiyeh, senior vice president and chief quality officer at University Health Systems, said hospitalizations are a key metric. “We really did not see many hospitalizations until the last seven days,” he said, which coincides with the rise in positive cases in Knox County.

The Health Department has determined regional hospital capacity is adequate for now, but hospitalizations tend to lag behind case increases by three to four days, according to Charity Menefee, the Health Department’s infectious and environment disease and emergency response coordinator. Knox County had reported 118 new cases in the previous three days. 

Shamiyeh said regional hospitals are revising their surge plans accordingly. “It’s the rate of rise that has caught our attention,” he said.

O’Brien said he’d talked to business owners who are concerned for the safety of their employees and customers, as well as colleagues, public officials and attorneys across the state, as he developed the order. Board members received 225 emails about the reopening.

“I don’t want our community to become like Memphis, to become like Nashville, or even Chattanooga,” O’Brien said, referring to other large Tennessee cities with much higher numbers of infections than Knoxville and Knox County.

Morton, the deputy law director, was combative with the board members he was advising throughout the meeting. He told the board that public input was irrelevant and they could only make decisions based on scientific evidence. Saying Gov. Bill Lee’s orders had referenced minimizing the impact on the healthcare system, Morton said the only metric they should consider is hospital capacity.

“You people are scientists and your decisions need to be 100 percent based on science,” he said.  “You have to have a rational basis that there’s an immediate problem with medical resources.”

Buchanan countered that there is ample medical evidence the order is needed: “We have evidence of a pandemic.”

The order applies to both individuals and to business owners. Exemptions include people with medical conditions that prevent wearing face coverings, people who are deaf or hard of hearing and the people who communicate with them, those who are eating or drinking in public establishments and people who are in houses of worship. 

State and federal government buildings are exempt, along with school buildings. Schools are under the jurisdiction of the Knox County Board of Education. The order also doesn’t apply to private homes, private vehicles in most instances and hotel rooms.

Under state law, violations of public health orders are a Class C misdemeanor, which carries penalties of up to 30 days in jail and a fine of up to $50. 

O’Brien said he doesn’t want to see anyone punished for not following the order, and Buchanan said people violate health laws all the time without going to jail or paying a fine. The Health Department typically relies on education and persuasion to get people to comply with public health laws.

Board member Dr. Marcy Souza, who is the director of veterinary health at the University of Tennessee, said having the possibility of a penalty could help with compliance. “We’re encouraging people to wear masks and they’re not doing it,” she said. “If there’s no ability to enforce this, it has no teeth.”

O’Brien said he wants the board to lift the order as soon as possible if it proves to be effective. Buchanan said after the meeting that given the two-week incubation period of COVID-19 and a typical delay in hospitalizations following positive test results, the order likely would need to be in place for about a month before its effectiveness can be determined. 

Morton argued the order was unconstitutional and could expose the county to lawsuits. “If you go forward with this without a rational basis, you could bankrupt Knox County,” he said.

Morton urged the board to not impose tighter restrictions than those contained in Gov. Bill Lee’s Tennessee Pledge economic recovery plan, which Knox County began following on Wednesday. One of Lee’s executive orders gives Knox and five other counties with independent health departments the power to make their own rules based on local conditions.

“Our legal advice is to not go beyond what the governor does, but you have the authority to go beyond what the governor does,” Morton conceded.

In the end, the board exercised that authority. After the meeting, Jacobs said he didn’t agree with the majority but hoped people would follow the directive. “I understand where the Health Board is coming from,” he said. “I wish it wasn’t mandatory.”

Jacobs, a staunch libertarian, has expressed misgivings throughout the pandemic about government restrictions on businesses and individuals. 

Other elected officials also weighed in after the vote. 

On the Knox County Sheriff’s Office website, Sheriff Tom Spangler indicated that his officers wouldn’t help enforce the order. “There are serious questions as to the constitutionality of the order made by the health board,” he posted. “My Deputies are sworn to support and defend the constitution. We will rely on the citizens of this community to protect themselves and others in the manner they find appropriate.”

In a series of tweets, Republican state Rep. Jason Zachary, who earlier this year pushed legislation that would give county mayors the sole authority to issue health orders, called the order an example of government overreach. “This is an unenforceable mandate by a board that is not accountable to anyone!” he wrote.

Knoxville Mayor Indya Kincannon, however, supported the order in Facebook posts. “I fully support a face mask mandate and am very grateful that the Health Board adopted such a measure for the entire county at their meeting tonight,” she wrote. “This is a big win for Public Health.”

O’Brien said the community needs to make decisions based on medical data. “Looking at the science and looking at the trends, it makes sense,” he said. 

O’Brien also said he hopes people wear masks and practice social distancing as the Independence Day weekend kicks off on Friday. “This holiday weekend is important for our community,” he said, “but I want us to celebrate responsibly.”