We are going to start today by going over the numbers,and then talk about Tennessee and opening up. Finally, we have some news, including a likely coming meat shortage.

For those of you reading outside of Tennessee we still recommend sticking with us if you want to understand the arguments for and against opening up that are already present in your own state.

Nationally, the new cases curve trends more flat than down. Even with the average it is worth taking Monday with a grain of salt, as the people behind The COVID Tracking Project report that a weekend bump seems to follow on Tuesday.

Source: Data from The COVID Tracking Project; Chart by JM Addington

Tennessee remains mostly flat for awhile, this will be important later. Also, Tennessee reports more cases on both Tuesdays and Wednesdays than on Mondays, so tomorrow may go up.

Source: Data from The COVID Tracking Project; Chart by JM Addington

The nine-county area also shows about the same growth. In the past we’ve shown 21 days worth of days, today we are going to expand that to 45.

Source: Data from the New York Times; Chart by JM Addington

Knox County is up 1 case per day, for 4 straight days.

Source: Knox County Health Department

Opening Up, Part 3

Today Governor Lee announced that he was going to let the stay-at-home executive orders expire April 30th, open up state parks on April 24th, allow some businesses that are shut down to open April 27th and most of the rest by May 1st. In the past he’s shied away from specific dates and allowed himself some room to maneuver in the future, there was not much of that today.

The stay-at-home order is statewide but the counties with their own health departments (Knox, Madison, Hamilton, Shelby and Sullivan) can still issue their own guidance or orders, as Knox County did in late March.

Over the weekend Tennessee had 19 drive through testing facilities, conducting over 11,200 tests. Governor Lee said, “This surge of tests accounts for the largest number of tests conducted in our state over a two day period.”

Friday, we spent some time going the rationale behind opening up, a post we stand behind 100%. And the thrust of that post, we believe, remains true, that the shutdowns were intended to keep the healthcare system operating within capacity, a metric we are clearly currently at.

There are still challenges ahead in Tennessee as we look to re-open. Tennessee meets one, maybe two, of the four guidelines issued to states on re-opening (#3 and maybe #4):

States should consider initiating the reopening process when (1) the number of new
cases has declined for at least 14 days; (2) rapid diagnostic testing capacity is sufficient
to test, at minimum, all people with COVID-19 symptoms, including mild cases, as well
as close contacts and those in essential roles; (3) the healthcare system is able to safely
care for all patients, including providing appropriate personal protective equipment for
healthcare workers; and (4) there is sufficient public health capacity to conduct contact
tracing for all new cases and their close contacts.

First, Dr. Buchannan said during the Knox County Health Department briefing that test turn-around times have been four to five days and that will increase with the surge of tests. We assume that lag is statewide, meaning that the test results we got back today are from tests done a week ago, and, likely, COVID-19 exposure that happened two weeks ago. (From exposure, 3-5 days to develop symptoms and seek out a test, 5-7 days to get a test result = 8-12 days from time of exposure to test result).

Thinking about it another way, many of today’s new cases in Tennessee we won’t know about until early May.

“Tests need to come back quickly… you need the results almost immediately.” – Dr. Hildreth, president of Meharry Medical College

People are contagious 2-3 days before showing symptoms. So, if it takes 4+ days to get a result back that is a lot of time to be infecting others.

Think of it like this, let’s say Wednesday (exposure+0) I come over to work on your computer. We’re in close contact long enough time for a virus to pass between us. Over the weekend I begin feeling ill and go to a drive-through testing center Saturday (exposure+3). I think it’s probably just allergies, I stay at home post-test but don’t call everyone I’ve been around. Thursday (exposure+8) I get the COVID-19 test result back and I’m positive.

You’ve been exposed for so long you’re probably already getting tested yourself. But what about everyone you’ve been around? I was around you when I didn’t even know I was sick, and now you’re around others before you knew you were sick. The cycle continues. 

The second major challenge is what we’re not lowering the number of new cases per day. April 20th, today, we are at about the same level of new cases per day as we were at April 8th. Dr. Pearcy of Tennessee Department of Health interprets this as good news, 17 days of single digit percentage increases. It’s not, however, the decline in new cases we’d hope to see by now.

April 13th, when Lee announced that Tennessee would re-open in May, new cases were the same as today. Internally we assumed that state had access to data showing declines that we did not. And maybe they do. However, a clear decline isn’t something we are able to present here.

However, our positivity rate (about 6%), the percentage of tests that are positive compared to total tests, is also stubbornly high, although much better than the US as a whole (about 20%). Scott Gottleib, one of the MDs behind the White House’s opening plan, tweeted today about the issue and indicated that a rate closer to 1-2% was what we should be aiming for. Anything less than that means we are under capacity on testing.

Source: Data from The COVID Tracking Project; Chart by JM Addington

Finally, East Tennessee is in a different world than Middle and West Tennessee. We’re cautiously optimistic on the state as a whole, but cases on the east side of the state are incredibly low:

Source: TN Department of Health

At JM Addington we’ll be continuing to primarily work from home for a while, but we’re happy to see businesses here open, slowly and carefully.

Meat Shortages & Negative Oil Prices

100 workers at a Tennessee Tyson chicken plant tested positive for COVID-19, Tyson is being pressured to close a pork plant in Waterloo, IA, a South Dakota pork plant closed last week, and another pork plant closed today in Minnesota [edit: and a beef plant in MI with 60 cases]. We expect that the pork shortage will spill over to beef, and then poultry.

A specific type of oil (WTI) contract for a specific date (May) ended in the negative today. A few things to note:

It is still historic.

Three of the world’s leading public health experts are speaking a free webinar on Wednesday. Dr. Osterholm, in particular, is a fantastic down to earth speaker. You have to register to attend.

Hong Kong had no new cases yesterday. (For comparison, population close to all of TN inside Nashville’s footprint.)

Knox County has material for about 800 tests today and tomorrow. After that, we’ll see.

At Friday’s Knox County Health Department Briefing a new drive through testing site in Knox County offering free tests was announced at the Knox County Engineering and Public Works building. M-F, 8-3.

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