It wasn’t unexpected, but the coronavirus outbreak is now beginning to rage in Tennessee.
The Volunteer State has had one of the nation’s highest state-by-state confirmed case counts for a while, but the number is now starting to really accelerate, and the outbreak is manifesting itself in other ways.
There were 405 new cases of coronavirus reported by the Tennessee Department of Health on Tuesday. That’s the largest 24-hour increase thus far, and it represents a 22% increase in the total number of confirmed cases in a single day from Monday to Tuesday.
Additionally, Tennessee reported 10 new coronavirus-related deaths on Tuesday. That’s up 10 from Monday, and 16 from Sunday. I’ve written that, for whatever reason, the virus doesn’t seem to be hitting all that hard in Tennessee, but that we have to be cautious with that sort of statement because the deaths are going to lag behind the diagnoses … and now they seem to be catching up somewhat.
Tennessee’s total number of deaths vs. confirmed cases is just about 1% so far, so it’s still well ahead of the national average and what we’re seeing in states like Louisiana and Georgia. Looking at the numbers, one would have to anticipate that we’re going to see that percentage continue to rise.
Tennessee Gov. Bill Lee said during his press briefing on Monday that one reason for Tennessee’s high coronavirus case count is because the state is doing more testing per capita than some states are doing. I suspect that was a sideswipe at Kentucky Gov. Andy Beshear, who has made his own sideswipes at Lee and Tennessee in recent days. And, with regards to Kentucky, Lee is absolutely right. More on that in a moment.
But I wanted to know how Tennessee’s testing stacks up to a few other Southern states that seem to be hit particularly hard. I chose Florida, Georgia and Louisiana for comparisons.
Tennessee has tested 27,360 people as of Tuesday. That’s about 1 test for every 249 people, and about 8% are returning positive.
Louisiana has tested 38,967 people. That’s about 1 test for every 121 people, and about 13% are returning positive.
Georgia has tested 16,181 people. That’s about 1 test for every 649 people, and about 24% are returning positive.
Florida has tested 60,623 people. That’s about 1 test for every 351 people, and about 10.5% are returning positive.
Based on that very limited comparison, Lee is absolutely right. Curious to know if it expands to the rest of the region, I decided to look at the rest of the states bordering Tennessee:
Alabama’s testing ratio is about 1:673, with about 13% returning positive. Arkansas’ testing ratio is about 1:463, with about 8% returning positive. Kentucky’s testing ratio is about 1:661, with about 7% returning positive. Mississippi’s testing ratio is about 1:671, with about 21% returning positive. Missouri’s testing ratio is about 1:383, with about 8% returning positive. North Carolina’s testing ratio is about 1:454, with about 6% returning positive. South Carolina’s testing ratio is about 1:895, with about 19% returning positive. Virginia’s testing ratio is about 1:634, with about 9% returning positive.
Here are the number of confirmed coronavirus cases in each of those states:
Alabama – 981
Arkansas – 523
Florida – 6,338
Georgia – 3,929
Kentucky – 480
Louisiana – 5,237
Mississippi – 937
Missouri – 1,327
North Carolina – 1,498
South Carolina – 1,083
Virginia – 1,250
When you look at Tennessee’s coronavirus case count of 2,239 in relation to the rest of the Southeast, it looks pretty alarming. Especially when you break it down to infections per capita:
Louisiana – 113.8 cases per 100,000 people
Georgia – 37.1 cases per 100,000 people
Tennessee – 32.9 cases per 100,000 people
Mississippi – 31 cases per 100,000 people
Florida – 29.5 cases per 100,000 people
Missouri – 22.1 cases per 100,000 people
South Carolina – 21.7 cases per 100,000 people
Alabama – 20.0 cases per 100,000 people
Arkansas – 17.4 cases per 100,000 people
Virginia – 14.7 cases per 100,000 people
North Carolina – 14.3 cases per 100,000 people
Kentucky – 10.7 cases per 100,000 people
So, at first glance, Tennessee’s outbreak is the third-worst in the South, trailing only Louisiana and Georgia — two states that have been hit particularly hard. However, Tennessee is also testing more people than anyone else in the South, with the exception of Louisiana.
So what does that mean? One thing we can say, unequivocally, is that South Carolina, Alabama and Mississippi aren’t testing enough people. Their testing ratios are 1:895, 1:673 and 1:671, respectively. Those three states are testing fewer people per capita than anyone else in the region — with South Carolina taking top prize by far. And, guess what? They also have the highest percentage of positive test results in the region: 19% for South Carolina, 13% for Alabama and 21% for Mississippi. When every other state in the South is only seeing about 7%-9% of their tests return positive, and Mississippi is sitting on fewer than 900 confirmed cases but 1 out of every 5 cases is returning positive, it stands to reason that there are far more infections in Mississippi than the data reflects.
The same can be said for every state that isn’t testing a lot of people, including Kentucky.
As a general rule, it stands to reason that if you’re testing more people, you’ll get more positive tests because you’ll catch more people who are asymptomatic or who are experiencing only mild, cold-like symptoms. However, if that’s true, it should show up in the death rate. If we’re assuming that states with a high number of infections are catching more of the milder cases, while states with a low number of infections are only catching the more serious cases, there should be a higher percentage of confirmed cases ending in death in those states with fewer positive results. So let’s look at the percentages of confirmed cases ending in death for each of those states:
Louisiana – 4.6%
Georgia – 2.8%
Kentucky – 2.3%
Virginia – 2.2%
Mississippi – 2.1%
South Carolina – 2.0%
Arkansas – 1.5%
Alabama – 1.3%
Florida – 1.2%
Missouri – 1.1%
Tennessee – 1.0%
North Carolina – 0.5%
I knew before running those numbers that Louisiana and Georgia would be anomalies. Both have been hard-hit by COVID-19. Mardis Gras is being blamed in Louisiana, which has one of the highest death rates in the nation. But there really hasn’t been an explanation for Georgia.
However, there are some interesting findings beyond those two states at the top of the list. Mississippi and South Carolina — two states that we’ve already established aren’t testing enough people — are among the four remaining states with death rates in excess of 2%.
Kentucky and Virginia are at the top of the list. Those are two states that have few confirmed cases of coronavirus, but two states that also aren’t doing much testing. They’re testing per capita isn’t as low as South Carolina’s, Mississippi’s, or Alabama’s, but it isn’t far behind. The fact that their death rates are higher lends itself to the idea that there would be more positive cases in those states if more testing was being conducted.
At the other end of the list, it seems that the coronavirus is truly sparing North Carolina thus far. All of the indicators there are low. It has one of the better testing ratios per capita in the region, it has the lowest percentage of tests returning positive, at 6%, and it has the second-lowest rate of infection per capita in the region.
And just above North Carolina is Tennessee, with a 1.0% death rate. Again, that lends itself to the idea that Tennessee has more cases in part because it’s testing more people, catching more of the milder cases that aren’t being discovered in other states.
There has to be an asterisk by this number, however. Tennessee’s death rate has risen substantially in the last two days. As of Sunday, Tennessee’s death rate was just 0.5%, but the state has reported 16 deaths in the past two days. If that trend continues over the next few days, Tennessee will no longer be near the bottom of the list. If every state reported the number of patients currently hospitalized and currently needing ICU treatment, that could be somewhat accurately predicted. However, not all states report current or cumulative hospitalizations, and very few report those who are critically ill in the ICU.
Meanwhile, the coronavirus is beginning to grow substantially in the Knoxville area. As of Tuesday, there were 66 confirmed cases in Knox County. Prior to now, the worst outbreaks had been in the greater Nashville area and in Memphis. But Knoxville is now catching up rather quickly, and smoldering outbreaks are beginning to show in rural areas, as well.