There are a few statistics coming out of Tennessee’s battle against the coronavirus outbreak that are alarming. But, overall, there is as much good news as bad right now, as it appears the outbreak is slowing. As it does, though, few people truly grasp what “flattening the curve” is all about.
The alarming statistics: Tennessee’s case fatality rate topped 2% for the first time on Thursday, as the state announced 15 new coronavirus-related deaths. There have been a total of 4,634 confirmed cases of coronavirus in Tennessee, and 94 deaths.
Also on Thursday, the percentage of Tennesseans known to have coronavirus who have needed hospitalization topped 10% for the first time. There have been 505 people in Tennessee hospitalized at some point, which is 10.9% of known cases. This is a number that has been climbing. About a week ago, only around 9% of Tennessee’s confirmed coronavirus cases had resulted in hospitalization.
This is important because, although most people who are infected will recover with only mild symptoms or no symptoms at all, we know from what’s happened elsewhere in the U.S. and around the world that the prognosis goes down once a Covid-19 patient becomes sick enough to require hospitalization. In Tennessee, nearly 1 of 5 hospitalizations (18%) have ended in death.
Coming under control: Okay, now for the good news. For nearly a week straight, Tennessee’s number of coronavirus cases has seen only single-digit percentage growth each day.
One of the key measurement components of disease outbreaks is how long it takes cases of the infection to double. Early on, we heard a lot about exponential growth — and in mid March, the number of cases in the United States was doubling every four days. That’s no longer the case; the rate of increase has slowed down cross the U.S. as a whole. But that’s where we were at then. (In Tennessee, the number of cases was doubling every three days at that point.)
Fast-forward to the present, and it has taken nine days for the number of cases to double in Tennessee. We were at 2,239 confirmed cases on March 31, and we hit 4,634 confirmed cases yesterday, April 9. Keep in mind that testing has increased during that same time span — which, in theory, would uncover even more cases.
But that’s not all. Tennessee also hit a benchmark yesterday: A drop in the number of active cases, for the first time.
On Wednesday, the Department of Health announced that 592 people had recovered from coronavirus in Tennessee. Health officials use two ways to determine that: One, a patient is considered recovered if they’ve been confirmed asymptomatic by public health officials and they’ve completed their required time in isolation; two, a patient is considered recovered if more than 21 days has elapsed since they first tested positive.
Yesterday, the number of recovered patients jumped all the way to 921. That’s nearly 1 in 5 of Tennessee’s confirmed coronavirus cases — 19.8%, to be exact.
So the state announced that 329 patients had recovered yesterday — while also announcing 272 new cases. That means that, for the first time, the number of recovered patients was greater than the number of new patients … and the number of active cases dropped from 3,770 on Wednesday to 3,713 on Thursday.
It’s a small step, but an important milestone.
(Meanwhile, in Kentucky, there have been 79 coronavirus-related deaths and 426 hospitalizations — which means more people have died per capita, and more people have been hospitalized per capita, in Kentucky than in Tennessee. Hospitalizations: 9.5 per 100,000 in Kentucky; 7.4 per 100,000 in Tennessee. Deaths: 1.8 per 100,000 in Kentucky; 1.4 per 100,000 in Tennessee. My imagination simply doesn’t stretch far enough for me to believe that there are more than three times as many cases of coronavirus in Tennessee than in Kentucky. I’m not trying to beat a dead horse here, but Kentucky’s governor made this an issue and although many in the media repeated his claims, there’s been zero effort to put his claims to the test.)
There is still a ways to go. The outbreak in Tennessee’s two largest cities and hardest-hit areas — Nashville and Memphis — is still growing too quickly. Nashville’s total number of cases increased 6% on Thursday, and Memphis is still experiencing double-digit percentage growth. And in many parts of rural Tennessee, the virus is just now starting to take hold. My home county, Scott, has seen an increase in its case-count from three to seven in the past four days.
But in Knoxville and Chattanooga, the other two metro areas, both of them behind Nashville and Memphis on the outbreak timeline, the outbreak appears to be growing more slowly. Knoxville’s total number of cases increased just under 10% in two days between Tuesday and Thursday; Chattanooga’s increased less than 5% across those same two days.
Meanwhile, in Sumner County — which has been slammed by coronavirus — the increase in the total number of cases was just 3% on Thursday. And, in Williamson County, ground zero of the outbreak in Tennessee after the first infection was reported there, there was only one new case reported on Thursday.
Understand that I’m typing this at just after noon on Friday, April 10. In less than three hours, the state’s next data dump will occur. And there is always the threat of wild day-to-day swings in the data, which wound render moot much of what I’m saying here.
But, for now, we’re on the right trajectory in Tennessee.
Flattening the curve means it’s with us for a while: I’ve heard a lot of people in recent days say something like this: “If everybody will just stay at home and do what they’re supposed to do, this will go away and we can all get back to normal much quicker.”
I’m pretty sure I’ve been guilty of making similar statements a time or two. But that’s not what “flattening the curve” is about. Flattening the curve actually means this is a longer, drawn-out ordeal. To visualize this, think back to all those “flatten-the-curve” graphs we saw when this outbreak began:
The red mountain is intended to represent what happens with no efforts to mitigate the spread of the virus — no social distancing, no business closures, no stay-at-home orders, etc. The blue bump is intended to represent what happens once those mitigation measures are put into place.
If you do nothing, the virus comes on quickly, everyone gets sick at once, and the health care system gets overwhelmed — similar to what happened in Italy and Spain, and what almost happened in New York City. If you successfully flatten the curve, the virus comes on more slowly, not everyone gets sick at once, and the health care system isn’t overwhelmed.
That’s the whole point of flattening the curve: Not overwhelming the health care system. The cost of flattening the curve is a prolonged outbreak. As the graphic shows, the blue bump is going on long after the red mountain has disappeared. The whole point of flattening the curve isn’t to accelerate the end of the outbreak; by its very nature, flattening the curve prolongs the outbreak. With no mitigation measures, everyone gets sick at once, the disease peaks, and then it’s over as quickly as it began. With mitigation measures, the peak takes a lot longer to come, then there’s a plateau, and then there’s a slow downward trend in the number of cases.
I think it’s important that we make that distinction because a lot of people think the point of everyone staying at home right now is so we can get back to normal more quickly … when, in reality, the point of everyone staying at home right now is so we don’t overwhelm our health care system and so fewer people die from this virus. And, of course, it’s also to try to protect the vulnerable populations that each of us have contact with on a daily basis.
I point out that distinction because a lot of people will look at Tennessee’s positive trends and think, “Good … we’ll get back to normal soon.” I’m not sure that’s the case. I’m not an elected official or a health care expert, so that’s not my call. But, as all the health care experts have cautioned, there can be no true “normal” again until there’s a vaccine in place — and we’re still at least a year away from widespread availability of a vaccine. In the meantime, the hope is that we can start to relax our social distancing measures and businesses can start to open back up. But those same health care experts are also cautioning that until we have widespread testing and contact tracking protocols in place, we can’t do that without risking another wave of sickness and deaths.
Nobody is more ready for a return to normalcy than me. I’m just not sure it’s realistic to think that happens anytime soon. Perhaps a best-case scenario at this point is that warm weather knocks this thing back for a while before it comes on again with colder weather (a la the flu), which gives us a reprieve of a few months to move closer to a vaccine, which researchers are working feverishly to produce. But even if the number of new cases drops to near zero with this summer’s warmer weather, I suspect we’re in a place where we won’t be able to completely lay down our guard.
But, for now, we know the Trump administration’s social distancing guidelines are in place through April 30. That’s another three weeks. In this battle, three weeks is an absolute eternity. Let’s see how the month of April unfolds, and hope for the best.