While much attention has been focused on businesses and their compliance with the county’s face mask mandate, informal gatherings are driving the spread of the novel coronavirus locally, Knox County Health Department confirmed with the Board of Health on Wednesday.

The Board of Health advises following guidelines even when socializing with those most familiar to you.

The board did not take any actions at its weekly meeting, though recommendations for the school system were discussed. 

Case counts continue to surge, and today’s count will show the biggest one-day increase in COVID-19 cases since the pandemic began — in the vicinity of 190 new cases, according to Charity Menefee, the Health Department’s director of communicable and environmental disease and emergency preparedness. Over the past seven days, the Health Department has reported 702 new cases.

“This points out the virus is very active in our community and increasing at a high rate,” said Dr. Martha Buchanan, the Health Department director.

The death toll continues to rise as well, with Knox County recording its 21st fatality due to COVID-19 complications on Wednesday. “Fifty-five percent of our deaths from COVID have been reported in the past 14 days,” Buchanan said.

The board’s mandate for people to wear masks in publicly accessible buildings went into effect July 3, but its effects haven’t been seen yet and might not be for another two weeks, officials have said.

Much of the focus has been on compliance at businesses throughout Knox County. There is a Facebook group called Mask Up Knoxville in which members post about businesses where patrons and employees are, or are not, wearing masks. 

Contact tracing, however, has indicated that the spread isn’t driven by non-compliant businesses. The Health Department hasn’t traced significant clusters of cases to particular businesses.

“Where the problem comes, and I have seen this personally, is where somebody lets their guard down and they get together socially and decide to have 20 people over to the backyard and have a cookout,” said board member Dr. Patrick O’Brien. 

The Health Department’s Menefee confirmed his assertion, saying that dinner parties, baby showers and lake outings are among the activities that contribute to the spread. 

“It’s the social gatherings and getting together with people who are your friends,” she said. “It’s letting your guard down with people you’re familiar with.”

Board member Dr. James E. Shamiyeh, senior vice president and chief quality officer at University Health System, said the situation underscores the need to follow the five core actions the Health Department urges the public to take to minimize risk — wearing a mask, practicing social distancing, washing hands, cleaning surfaces and staying home when sick.

“Discipline is so important here,” he said.

The board made no changes to its mask mandate. Members discussed but ultimately did not weigh in on the Knox County Schools reopening plan, which was approved by the school board last week. 

The plan calls for the schools to open Aug. 17, with options for in-person and online instruction. Families had to make their decisions, binding for the fall semester, by Wednesday.

The board doesn’t have jurisdiction over the school system, but O’Brien came to the virtual meeting with a resolution recommending that the system amend its plan to use benchmarks to determine how to proceed with the return to school. 

His proposal was based on plans adopted by the Hamilton County and Anderson County school systems that use the number of active COVID-19 cases per 100,000 residents as a measure that would trigger a closure of in-person instruction or a return to normal teaching.

Buchanan, however, said the rate of positive cases isn’t a reliable indicator of the coronavirus spread pattern. Clusters of cases confined to a particular business or the jail, for example, would boost the numbers but not be indicative of the risk to students. 

“We don’t want to end up backing ourselves into a corner,” she said.

According to Buchanan, student absenteeism, one of the non-health metrics the school system will use, is a valuable real-time indicator of the disease burden because absences are reported daily and test results take time. It’s one of the factors used to track the flu every year, she said. 

Buchanan said she has consulted with the Hamilton County Health Department and found out it provides data but did not formulate the system. “I don’t know what the science is behind it,” she said.

Buchanan observed that the school system’s plan doesn’t define or explain the Health Department’s role and likely will be revised. She said the Health Department is in almost daily contact with the schools and has worked with the school system every year on a number of diseases and illnesses that affect students.

Lisa Wagoner, the Knox County Schools representative on the board, said the school system and the Health Department have a good relationship. “We would not do anything to jeopardize children or the staff,” she said.