On Thursday, the number of Tennesseans who have died of Covid-19 illness surpassed 500. It’s a relatively small number; there are a handful of states across America with fewer coronavirus-related deaths, but only one of them — Arkansas, with 171 deaths attributed to the virus — border Tennessee.
By comparison to the Volunteer State, there have been more than 24,600 coronavirus deaths in New York, nearly 13,000 in New Jersey and almost 8,000 in Massachusetts. Illinois, Pennsylvania, Michigan and California are other states with more than 5,000 deaths attributed to the virus. In Florida, there have been just over 3,000 deaths. In Georgia, more than 2,600. Even in Kentucky, which has had less than half as many diagnosed cases of coronavirus as Tennessee, there have been more than 500 deaths related to the virus.
Not surprisingly, most of Tennessee’s deaths related to the coronavirus have occurred in the greater Nashville area and in Memphis — the two areas hardest-hit by the pandemic. Shelby County accounts for 158 deaths by itself, while the Nashville metropolitan area of Davidson, Williamson, Rutherford, Wilson and Sumner counties accounts for 200 of the state’s deaths.
Elsewhere in the state, deaths and population largely go hand-in-hand. There have been 22 deaths related to coronavirus in Hamilton County, 15 in McMinn County, nine in Robertson County and six in Putnam County.
But coronavirus deaths in Tennessee — as in other states — follow parallels beyond population. Nursing home outbreaks are by far the largest sources for coronavirus deaths. While the virus causes very mild — or no — symptoms in a majority of people, the elderly and those with underlying medical conditions are exceptions. Nursing home residents often fall into both categories: older people who also have chronic illnesses. It’s why nursing homes have essentially been on lockdowns since the pandemic reached the United States.
Nursing home deaths
In Tennessee, Gov. Bill Lee began allowing nursing homes to phase in modified visitation on June 15. Locally, Huntsville Health & Rehabilitation planned to take advantage of the governor’s relaxed orders, then reconsidered as the state’s active coronavirus cases trended upward.
“The health and welfare of our residents and staff are paramount and since the governor’s plan is not mandatory or required and each facility can choose whether to allow limited visitation, we have decided to use our medical judgment and delay the phasing in of visitation,” the facility said in a statement on June 15.
Carla Buttram, a corporate administrator with Plainview Healthcare Partners, the Northeast-based parent company of Huntsville Health & Rehab, said that while the company’s facilities in Tennessee have been coronavirus-free, other long-term care facilities in the state have not been as fortunate.
“We have been able to keep residents safe and employees safe with no cases,” Buttram said. “We will phase visitation back in but want to do it at the right time. Unfortunately, cases have spiked again. We know all want to see and visit but the safety of residents and staff are our first priority.”
Tennessee’s numbers spell out just how dangerous coronavirus can be inside long-term care facilities. About 1 in 4 of the state’s coronavirus deaths — 132 in all — have occurred among nursing home residents. And in areas where coronavirus deaths seem to have bucked population trends, its usually related to outbreaks in nursing homes.
In Sumner County, for example, there have been a total of 49 Covid-19 deaths — the third-highest of any county in Tennessee, behind only Memphis and Nashville. The Gallatin Center for Rehabilitation & Healing is also home to the state’s worst coronavirus outbreak inside an assisted living facility. Ninety-nine of the facility’s 155 patients were sickened, and 23 died. Dozens of staff members also tested positive.
McMinn County, too, has been victimized. There have been 15 deaths there, the sixth-most of any county in Tennessee and by far the most of any rural county. All but one of those deaths were linked to the Life Care Center of Athens, where 82 of 97 residents were sickened. As in Gallatin, dozens of staff members at the nursing home were also infected.
Other serious nursing home outbreaks have occurred in Memphis, where 22 deaths were reported at Quince Nursing & Rehabilitation Center, and in Murfreesboro, where 15 people died at Boulevard Terrance Health & Rehabilitation.
Even in nursing homes, an outbreak of Covid-19 isn’t a death sentence for residents. Of 716 that have tested positive for the illness, far more have recovered — 388 — than have died. In fact, more than 80% of cases have not resulted in death.
For reasons that medical experts still don’t fully understand, black people are more susceptible to coronavirus than people of other races. That helps explain why Shelby County — at 158 deaths — has a far higher number of fatalities than any other Tennessee county. There have been 16.3 Covid-19 deaths per 100,000 people there, compared to 13.5 per 100,000 in Davidson County, 5.9 per 100,000 in Chattanooga and just 1.1 per 100,000 in Knox County.
Memphis has the largest black population of any of the state’s metropolitan areas; 52% of Shelby County’s residents were black as of the 2010 census.
The case fatality ratio is also higher in Memphis than in other parts of the state. Two percent of known coronavirus cases in Shelby County have ended in death, compared to just 1.3% in Nashville and 1.1% in Chattanooga.
Beyond nursing homes, an examination of counties with higher Covid-19 deaths reveals outbreaks of the virus in susceptible populations. For example, there have been five fatalities in tiny Trousdale County — pop. 7,816 — to the east of Nashville. Those five deaths pale in comparison to the 153 in Shelby County, but they make Trousdale County’s death ratio 64 per 100,000 people — by far the highest in the state. The reason? An outbreak at the Trousdale Turner state prison in Hartsville. There, more than half of the prison’s 2,600 inmates tested positive for the virus. And while the vast majority — greater than 90% — were asymptomatic, three died.
Surprisingly low numbers
In other parts of the state, there have been relatively few coronavirus-related deaths. One county that immediately jumps out is Knox, where there have been just five deaths related to the virus. But there have been no major outbreaks of the virus in controlled environments — such as nursing homes or detention facilities — in Knoxville. So while 57 people have been hospitalized with coronavirus in Knox County, the five deaths equates to less than 9% of the hospitalizations — a far smaller number than the statewide average, where nearly 1 in 4 people who have been hospitalized with Covid-19 illness have died.
While there have been well-documented cases of younger victims dying of coronavirus — and health care professionals warn that anyone with existing medical conditions such as diabetes, high blood pressure and heart disease are at risk, regardless of age — the link between age and coronavirus mortality is undeniable.
In Tennessee, people over the age of 80 make up just 2% of the state’s more than 32,000 diagnosed cases of coronavirus, but 1 in every 3 people who have died have been over the age of 80. More than 8 out of 10 Covid-19 deaths in Tennessee have been over the age of 60. Most of them have suffered from chronic illnesses in addition to coronavirus.
Tennessee has had three pediatric deaths linked to the virus, while four people in their 20s have died. The numbers start to climb after that, and more than two dozen residents of the state in their 40s have died. That number doubles for people in their 50s.
Still, the death rate for people under the age of 30 is far less than 0.1%. That’s important because the overall coronavirus death rate in Tennessee is 1.6%. After the age of 30, the death rate begins to climb somewhat. It’s just above 0.2% for people in their 30s, but still less than 0.5% for people in their 40s. It doesn’t climb above 1% until people in their 50s. After that, it climbs rapidly: 4% for people in their 60s, greater than 12% for people in their 70s and greater than 20% for people in their 80s.
The good news is that older people in Tennessee are far less likely to contract coronavirus than their younger counterparts — perhaps because they’re more likely to heed health officials’ warnings and take precautions to avoid exposure to the virus. There have been only 800 cases of the virus in people over the age of 80, compared to 7,000 among people in their 20s — which remains the hardest-hit age group in terms of total infections. In fact, nearly half of Tennessee’s coronavirus diagnoses have been people in their 20s and 30s.