Coronavirus is getting much worse. Tennessee's strategy remains the same.
Correction: This story has been edited to correct Tennessee's statewide weekly positivity rate as of Wednesday. It was 14%.
As the coronavirus pandemic surges, Tennessee leaders are continuing a mild-mannered approach to the virus by encouraging masks wearing and social distancing by all but requiring it of no one.
State officials publicly committed to this strategy months ago and have not flinched in the face of an outbreak escalating at an accelerating rate. Infections, hospitalizations and deaths spiked to record levels this week and show no signs of slowing. On Wednesday, the state reported a daily positivity rate of 17.1% — the highest ever.
That alarming statistic came one day after Gov. Bill Lee reiterated his opposition to a statewide mask mandate or simple restrictions for bars, stores or other businesses. Lee recommends county mayors enact mask mandates but will not do so himself.
"I've said throughout this pandemic there is nothing off the table, but for now what we believe is the strategy we are taking is actually working," Lee said. "It may well be working better than a statewide mask mandate would work."
The governor also said he won't add regulations requiring businesses to limit customers or sanitize shared spaces because new research suggests most infections occur not in businesses but smaller "personal gatherings." Lee said a moment later he wouldn't regulate gatherings either.
Tennessee remains in a shrinking minority of states that haven't mandated the use of masks. Only 14 states – all of which are led by Republican governors – do not require masks or face coverings statewide, according to reporting from Axios. The newest mandates come from North Dakota and Iowa, where governors resisted calls to action for months before changing course in the past week.
Lee faces similar pressure in Tennessee but hasn’t budged. Instead of requiring masks statewide, the governor passed that the decision to the state's mayors, insisting mandates would be more effective if they came from local officials.
Most mayors have not used this authority, and a majority of the state does not fall under a mandate. This is especially true in rural areas, where the virus is now spreading fastest and rates of both hospitalization and death are higher.
INVESTIGATION:COVID-19 crept from cluster to cluster, weaving a web over Nashville
While Lee empowered local mayors to issue mask mandates, he did not give them the authority to require businesses to slow the spread of the virus. Business restrictions, like customer caps or mandatory sanitation policies, only exist in a few Tennessee cities where mayors have more authority to act independent of the governor.
Statewide, Lee merely issued "The Tennessee Pledge," a set of optional guidelines for businesses. Across nearly all of Tennessee, the vast majority all businesses are not required to make any changes to their operations to slow the virus.
Calls for Lee to take more deliberate action ramped up as the pandemic worsens.
The Tennessee Education Association, the state’s largest teachers union, challenged Lee to enact a statewide mandate Tuesday. Two prominent doctors, Dr. David Aronoff of Vanderbilt and Dr. Aaron Milstone of Williamson Medical Center, published a MedPage Today editorial calling on state leaders to “do all they can to reduce transmission risk, including new mandates on social distancing and masking.”
Four more doctors followed up on Wednesday with a video plea urging Lee to issue a statewide mandate. Three of the doctors said they would spend Thanksgiving treating COVID-19 patients in their respective hospitals.
“Governor Lee, you aren't responsible for COVID, but you are responsible for leading us through this crisis,” said Dr. Katrina Green, a Nashville emergency room physician, in the video.
“As a front-line physician, I implore you to listen to the health experts and make the tough decisions. I understand that making masks mandatory is a tough and likely unpopular decision, but it's the right decision and one that will save lives. You will see this if you visit the hospitals and see firsthand how your current strategy is not working. We desperately need your help.”
New peaks for COVID-19 infections, deaths and hospitalizations
Lee’s pandemic strategy, which pushes but does not shove, hasn't contained the virus.
The pandemic rocketed to new heights in the past month, surpassing all previous records for the spread of the virus. The state recorded nearly 8,000 new infections on Monday, shattering the prior daily record by more than 30%, and the average number of new infections per day climbed above 4,500 this week for the first time ever.
Tennessee is reporting more than 45 coronavirus deaths per day. More than 2,000 people are hospitalized with the virus. The average test positivity rate is 14%. All three of these stats peaked this week at the highest they have ever been.
Most likely, the virus will only get worse from here. While the early results from some vaccine trials are promising, the vaccines won’t be widely available until after a winter season that worries most public health experts. Cold weather will push millions of Americans indoors, where transmission is more likely, and holiday gatherings have the potential to become nationwide superspreader events unlike any other.
“The fact that we have a vaccine coming means we should double down and hang in there because help is on the way,” said Dr. Anthony Fauci, the nation’s leading infectious disease expert, during a CNN interview this week. “It should motivate us to do even better with public health measures.”
Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at firstname.lastname@example.org. Follow him on Twitter at @brettkelman.