At a Monday afternoon press briefing to announce new executive orders implementing a “safer at home” policy and requiring certain non-essential businesses to close, Tennessee Gov. Bill Lee said one of the reasons for Tennessee’s particularly high number of positive coronavirus cases is because the state is conducting more tests per capita than many other states.
Tennessee had 2,237 confirmed cases of coronavirus as of Tuesday, ranking it No. 15 in the nation for most overall positive cases thus far, according to a running tally by John Hopkins University. As the Volunteer State’s number of infections has risen — particularly in the greater Nashville area and in Memphis, which where the bulk of the state’s infected people live — Gov. Lee has been criticized for not doing enough to slow the spread of the COVID-19 disease.
The governor’s comments regarding how much testing the state is doing may have been a sideswipe at his Kentucky counterpart, Gov. Andy Beshear. The Kentucky governor took a sideswipe of his own at Lee last week, saying that Tennessee was not doing enough to protect its citizens from the coronavirus outbreak as he urged Kentuckians to not travel into the Volunteer State.
The Independent Herald decided to put the governor’s claim to the test by delving deeper into the data. Is Tennessee’s particularly high number of coronavirus cases at least partially due to increased testing in the Volunteer State?
We chose Florida, Georgia and Louisiana to compare Tennessee against, simply because those states have been the hardest-hit in the Southeast. The first factor looked at was how many people are being tested in each state.
• Tennessee had tested 27,360 people as of Tuesday, according to the COVID Tracking Project. That’s about 1 test for every 249 people (1:249), and about 8% of those tests are returning positive.
• Florida has tested 60,623 people. That’s about 1 test for every 351 people (1:351), and about 10.5% of those tests are returning positive.
• Georgia has tested 16,181 people. That’s about 1 test for every 649 people (1:649), and about 24% of those tests are returning positive.
• Louisiana has tested 38,967 people. That’s about 1 test for every 121 people (1:121), and about 13% of those tests are returning positive.
Based on that very limited comparison, Tennessee’s testing numbers look impressive; only Louisiana is testing more, and that’s perhaps partially due to Louisiana waging an all-out war against the spread of the virus as it faces a very real risk of its health care capacity being overwhelmed.
To broaden the comparison, we looked at the rest of the states in the Southeast:
• Alabama has tested about 1 in 673 people (1:673), with about 13% returning positive.
• Arkansas’ testing ratio is 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.
When taken at face value, Tennessee seems to have an extraordinarily high number of coronavirus cases, with 2,239 confirmed by the state’s Department of Health, as of Tuesday evening. Only the aforementioned hardest-hit states — Florida, Georgia and Louisiana — have more in the Southeast. Here is the complete list:
• Florida – 6,338 total cases
• Louisiana – 5,237
• Georgia – 3,929
• Tennessee – 2,239
• North Carolina – 1,498
• Virginia – 1,250
• Missouri – 1,327
• South Carolina – 1,083
• Alabama – 981
• Mississippi – 937
• Arkansas – 523
• Kentucky – 480
However, simply looking at the total number of cases is not a fair measurement. Tennessee has far more residents than Louisiana, for example, and far fewer than Florida. When you look at the coronavirus case count per capita across the Southeast, the numbers are even more alarming in Tennessee, where there are currently 33 confirmed cases per 100,000 people. Only Georgia (37 per 100,000) and Louisiana (an astounding 114 per 100,000) have worse outbreaks. Here is the complete list:
• Louisana – 113.8 cases per 100,000 people
• Georgia – 37.1 cases per 100,000
• Tennessee – 32.9 cases per 100,000
• Mississippi – 31.0 cases per 100,000
• Florida – 29.5 cases per 100,000
• Missouri – 22.1 cases per 100,000
• South Carolina – 21.7 cases per 100,000
• Alabama – 20.0 cases per 100,000
• Arkansas – 17.4 cases per 100,000
• Virginia – 14.7 cases per 100,000
• North Carolina – 14.3 cases per 100,000
• Kentucky – 10.7 cases per 100,000
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 that seems unequivocally clear from that data 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 conducting fewer tests per capita than anyone else in the region — with South Carolina taking the top prize by far. They also have some of the highest percentage of positive test results in the region: 19% of South Carolina’s tests are positive, 13% of Alabama’s are positive and 21% of Mississippi’s are positive. The only state with a higher percentage of positive test results is Georgia, at 24%.
Why does it matter? When every other state in the South, with the exceptions of Georgia and Louisiana, are seeing about 7% to 9% of their tests returning positive, and Mississippi is sitting on fewer than 900 confirmed cases but 1 out of 5 of its tests are returning positive, it stands to reason that there are far more infections in Mississippi than the data reflects.
As a general rule, it could be theorized that you’ll get more positive results if you’re testing more people because you’re catching people who are asymptomatic or who are experiencing only mild, cold-like symptoms.
However, if that is true, it should also show up in the death rate. If we’re assuming that states with a higher number of infections are catching the milder cases, while states with a lower 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, lastly, we looked at the death rates for each state in the South, with the disclaimer that the numbers are not scientific death rates, but rather a simple calculation of deaths vs. confirmed cases of coronavirus. Here is the breakdown:
• Louisiana – 4.6% death rate
• 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%
We suspected before running those numbers that Louisiana and Georgia would be anomalies. Both have been hit hard by COVID-19. Mardis Gras is being blamed in Louisiana, which has one of the highest death rates in the nation. There really isn’t an explanation for Georgia, other than that the Peach State was one of the earliest sites of outbreak in the U.S., and thus its outbreak is more mature and has had longer for the numbers to build than many other states.
However, there are some interesting findings beyond those two states at the top of the list. The next two states on the list, behind Louisiana and Georgia, are Kentucky and Virginia, at 2.3% and 2.2%, respectively. Those are two states that have few confirmed cases of coronavirus, but they’re also two states that aren’t doing much testing per capita. Their testing ratio isn’t as low as South Carolina’s, Mississippi’s or Alabama’s, but it isn’t far behind, at 1:661 and 1:634. With the exception of the three aforementioned states (South Carolina, Mississippi and Alabama), the only state in the South that is conducting as few tests per capita is Georgia, with a testing ratio of 1:649. The fact that their death rates are higher lends itself to the theory that there would be more positive cases in those states if more testing were being conducted there.
Likewise, it isn’t surprising to see Mississippi and South Carolina near the top of the list as the only other states with a death rate of 2.0% or greater. The data indicates that there aren’t enough tests being conducted in those states.
At the opposite end of the list is North Carolina. All indicators are that the coronavirus outbreak simply isn’t that bad in the Tar Heel State. It has one of the better testing ratios in the region, at 1:454. Only Missouri, Florida, Tennessee and Louisiana are better. It’s rate of positive results, at 6%, is the best in the region. It has the second-lowest rate of infection per capita in the region. And its death rate is by far the lowest in the region.
And just above North Carolina is Tennessee, with the 1.0% death rate. As pointed out earlier, the theory is that if more tests are being conducted per capita, there will be a higher number of mild cases or asymptomatic cases detected, which means the rate of cases ending in death will drop.
So, as to Gov. Lee’s claim that the outbreak appears worse in Tennessee because the Volunteer State is testing more people per capita than many other states, the data confirms his statement — at least in the Southeast.
With that said, there has to be an asterisk by Tennessee’s death rate of 1.0%. That is a number that has risen substantially in the last two days. On Sunday, Tennessee’s death rate was 0.5%, before the state’s Department of Health announced 16 additional deaths on Monday and Tuesday, bringing the total to 23. If that trend continues over the next few days, Tennessee may no longer be towards the bottom of the list.
If every state reported the number of patients currently hospitalized and currently needing ICU treatment, that trend could be somewhat accurately predicted. However, not all states report the number of hospitalizations, with many of those who do reporting only cumulative hospitalizations and not current hospitalizations, and very few report the number who are critically ill.
Unfortunately, Tennessee falls among the many. While the state’s Department of Health has gradually released more information as the outbreak has progressed, it has been criticized repeatedly by advocates of open government for withholding too much information.
The bottom line: The raw numbers shows that Tennessee is among the top tier of the nation’s states in terms of the total number of coronavirus cases. However, Gov. Bill Lee says one reason for the relatively high number of cases in Tennessee is because the state is conducting more tests per capita than many other states, and the data backs up that claim.