C29 D-19 - TN.gov

COVID-19Critical IndicatorsOctober 20, 2021

IntroductionAs Tennessee (TN) monitors reopening across the state, the Tennessee Department of Health (TDH) will maintainvigilance of crical COVID-19 indicators at the state and county levels to idenfy ‘problem areas’ across the stateand provide early indicaon of sustained increases in community transmission.These metrics were developed in line with the White House proposed State Gang Criteria and help officialsmonitor trends in four key areas: • Trends in COVID-19 Cases (see on page 2) • Trends in COVID-19 Symptoms (see on page 7) • Trends in COVID-19 Tesng Capabilies (see on page 8) • Trends in Healthcare System Capacity (see on page 9)

Beginning June 12th, 2020, case trends (beginning on page 2) include both confirmed and probable cases.To view the White House Gang Criteria, see hps://trumpwhitehouse.archives.gov/openingamerica/.

COVID-19 in TN at a Glance

1,270,876Total Number ofCOVID-19 Cases

1,587New COVID-19Cases Today

18,589Active COVID-19Cases Today

16,104Total Number ofCOVID-19 Deaths

Key Definitions

Below are definions important to understanding this report. In addion to these definions, each visuaizaon in thisreport will be explained in further detail in the technical notes (see page 11): • In TN, a COVID-19 case is counted in the daily case count, demographics, and outcomes, if it classified as a confirmed or probable case. Please see the COVID-19 case definion found at hps://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/COVID-Case-Definion.pdf.

• The specimen collecon date is the date someone's COVID-19 lab sample was collected. Due to lab turnaround me there may be delays between when a specimen is collected and a confirmed case is reported to the public. Unless otherwise stated, visualizaons in this report use specimen collecon date as it more accurately indicates when a paent was sick (and not when their case was reported to the public).

This report was produced by the Tennessee Department of Health on October 22, 2021.

• A confirmed case is someone who tested posive (via PCR test) for the virus that casues COVID-19 (SARS-Cov-2). • A probable case is someone who may have tested negave by PCR, tested posive by another type of test or may not have been tested at all, but has an illness consistent with COVID-19, and may have other risk factors. For example: • If a person is a close contact of a COVID-19 case and has a clinically-compable illness, this person meets the criteria to be a probable case


Trends in COVID-19 Cases in TN

Epidemic Curve of COVID-19 Cases by Specimen Collection Date1

This report was produced by the Tennessee Department of Health on October 22, 2021. PAGE 2|

The following secon will visualize the COVID-19 case trends (both confirmed and probable) in TN, including newlyreported cases, the acve number of cases, and the number of COVID-19 confirmed deaths.

The epidemic curve is based on the day the specimen was collected. Therefore, the most recent day’s data may not be complete as test results takean average of 2-5 days to be reflected in the visualizaon. To learn more about this visualizaon, please reference the technical notes.

Mar 1, 20 Jun 1, 20 Sep 1, 20 Dec 1, 20 Mar 1, 21 Jun 1, 21 Sep 1, 21 Dec 1, 21

Specimen Collection Date

0K

2K

4K

6K

8K

10K

12K

COVID-19 Cases

0K

2K

4K

6K

8K

10K

12K

Moving Average of COVID-19 Cases

Illness thatbeganduring thistime maynot yet bereported.

Illness thatbeganduring thistime maynot yet bereported.

The curve below visualizes the number of new cases each day since the beginning of the COVID-19 outbreak. The number ofcases each day are visualized in the blue bars and the moving 7-day average is visualized with the red line. On August 30th,2021, the moving 7-day average was the highest of the pandemic, averaging 8,442 new cases/day.

Mar 1, 20 May 1, 20 Jul 1, 20 Sep 1, 20 Nov 1, 20 Jan 1, 21 Mar 1, 21 May 1, 21 Jul 1, 21 Sep 1, 21 Nov 1, 21

Date

0

5

10

15

20

25

Daily % pos

Positivity Rates 5%

Positivity Rate 10%


Statewide Number and Rate of Active Cases2

Daily Percent of Positive COVID-19 Tests3


Mar 1, 20 Jun 1, 20 Sep 1, 20 Dec 1, 20 Mar 1, 21 Jun 1, 21 Sep 1, 21

Date of Public Report

0K

20K

40K

60K

80K

Active Cases

0

200

400

600

800

1000

1200

Rate of Active Cases (per 100,000 Persons)

TDH updated its definition of an active case on 9/3/2020TDH updated its definition of an active case on 9/3/2020

The chart below visualizes the number and rate of acve COVID-19 cases in TN. On September 3rd, 2020 (orange line) TDHupdated its definion of an acve case significantly lowering the number of acve cases on that day and moving forward. SinceTDH updated its definion of an acve case, the number and rate of acve cases hit a peak on September 6th, 2021 with 87,180cases.

On 5/3/2021, TDH shied to a more reliable system-generated date, the date the COVID-19 case was added to the surveillance system. Because of thischange, this visualizaon has had a minor shi in the number of new cases reported for each day and therefore, the daily percent of posive COVID-19 tests.

On October 20, 2021, therewere 18,589 active COVID-19cases in TN. The rate of activecases was 272.2 per 100,000

persons.

The chart below visualizes the daily percent of posive COVID-19 tests. For today, October 20, 2021, the dailyposivity rate was 7.8% and the posivity rate for the last 7 days was 9.3%.

7.8%


Positive Tests per 100,000 Person by Public Health Region (over last 7 days)4


46.4▼

66.9▼

121.9▼

85.3▼

79.1▼

96.9▼

79.5▼

52.1▼

70.1▼ 84.4

▼49.0▼

68.0▼

84.3▼

The map below shows the number of new posive tests in the last 7 days per 100,000 persons. The arrow indicators representthe trend (up or down) as compared to the week prior. For the week of October 20, 2021, the highest rate of posive tests wasseen in the Blountville-Sullivan Metro. Addionally, all of the 13 public health regions saw a decrease in the number of posivecases compared to the week prior.

46.4 121.9

Positive Tests by Region

TN Region AY.1-Delta AY.2-Delta B.1.617.2 -Delta

Blountville-Sullivan Region

Chattanooga-Hamilton Region

East Tennessee Region

Jackson-Madison Region

Knoxville-Knox Region

Memphis-Shelby Region

Mid-Cumberland Region

Nashville-Davidson Region

Northeast Region

South-Central Region

Southeast Region

Upper-Cumberland Region

West Tennessee Region

Grand Total 10,750

1,709

895

245

329

661

792

1,245

3,301

355

159

798

197

64

20

0

0

0

1

10

2

3

4

0

0

0

0

0

5

2

0

0

0

0

0

2

0

0

0

1

0

0

Below is a table summarizing COVID-19 variant cases reported to the Tennessee Department of Health. Because sequencing isnot performed by all laboratories, these data are a convenience sample and not indicave of the true prevalence of variants.To learn more about COVID-19 variants, please see the SARS-CoV-2 Variant Classificaons and Definions published by theCDC: hps://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html

Variants of Concern

TN SARS-CoV-2 Variant Case Summary5

Addional data on variant proporons naonally and by state are avaiable from the CDC at:hps://covid.cdc.gov/covid-data-tracker/#variant-proporons


Vaccine Breakthrough Cases in TN6


CDC defines COVID-19 Vaccine Breakthrough Cases as a U.S. resident with SARS-CoV-2 RNA or angen detected on a respiratoryspecimen collected ≥14 days aer compleng the primary series of an FDA-authorized COVID-19 vaccine. To learn more aboutbreakthrough cases across the US and how they are being reported to the CDC:hps://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html

TN Region

B.1.1.7-Alpha

VBM

B.1.351-Beta

VBM

B.1.427-Epsilon

VBM

B.1.429-Epsilon

VBM

B.1.525-Eta

VBM

B.1.526-Iota

VBM

B.1.617.1 -Kappa

VBM

B.1.621-Mu

VBM

P.1-Gamma

VBM

P.2-Zeta

VBM

Chattanooga-Hamilton Region

East Tennessee Region

Jackson-Madison RegionKnoxville-Knox Region

Memphis-Shelby Region

Mid-Cumberland Region

Nashville-Davidson Region

Northeast Region

South-Central RegionSoutheast Region

Upper-Cumberland Region

West Tennessee Region

Grand Total 4,294

344320

168

132

321

356

604

1,66449

16

237

83

22

70

0

1

5

1

1

41

0

2

0

54

01

7

0

2

0

3

290

0

9

3

55

33

5

4

0

10

12

140

0

2

2

7

00

0

0

1

0

5

00

1

0

0

111

1010

0

4

8

20

24

251

1

7

1

277

6310

1

8

10

32

27

866

8

24

2

37

21

0

0

3

3

2

81

0

17

0

143

1126

3

0

12

11

15

394

1

21

0

16

01

0

0

0

0

0

61

0

8

0

TN SARS-CoV-2 Variant Case Summary Continued5Below is a table summarizing the COVID-19 variants of interest cases and variants being monitored cases reported to the Tennessee Department of Health.

COVID-19 Outcome Breakthrough Cases

Cases 62,118

Hospitalized Cases* 1,366

Deceased Cases** 558

* Hospitalizaons: Hospitalizaon data is reported from case interviews or via Tennessee Hospital Associaon data. Please note, TDH currentlyconducts more robust acve surveillance for hospitalized COVID-19 cases that are vaccinated than for those that are unvaccinated; therefore the datafor hospitalizaons among the unvaccinated may be more incomplete. We are working to improve the completeness of our hospitalizaon data.

** Deaths: Deaths where COVID-19 is a cause or contribung factor listed on the death cerficate. Other cases may sll be under invesgaon.

Symptoms Breakthrough Cases

Yes

No

Unknown 47,946

1,599

12,573

Month Dates Included % of Cases Unvaccinated% of COVID Hospitalizations

Unvaccinated*% of COVID DeathsUnvaccinated**

May 5/2/2021 - 5/29/2021 96% (13,993/14,518) 95% (848/890)June 5/30/2021 - 7/3/2021 93% (6,019/6,503) 88% (392/446)July 7/4/2021 - 7/31/2021 86% (28,305/33,001) 87% (918/1,051)August 8/1/2021 - 8/28/2021 86% (137,150/158,577) 86% (2,226/2,575)September 8/29/2021 - 10/2/2021 84% (143,440/170,001) 87% (2,944/3,400)May- September5/2/2021 - 10/2/2021 86% (328,907/382,600) 88% (7,328/8,362)

97% (228/236)96% (152/159)88% (184/208)83% (723/869)85% (1,527/1,790)86% (2,814/3,262)

Overall Metrics: Symptoms:

Percentage of Unvaccinated vs. Vaccinated for Cases, Hospitalizations, and Deaths:


7 Day Rolling Average of COVID-19 Cases by Vaccination Status

7 Day Rolling Average of COVID-19 Hospitalizations by Vaccination Status


The plot below shows the 7 day rolling average rate of COVID-19 cases (per 1,000,000 persons) by vaccinaon status.

January February March April May June July August September October

0

50

100

150

200

Fully VaccinatedNot Fully Vaccinated

Illness thatbegan at thistime may notyet bereported.

Illness thatbegan at thistime may notyet bereported.

January February March April May June July August September OctoberNovember

0

10

20

30

Fully VaccinatedNot Fully Vaccinated

Hospitalizations thatbegan at this time maynot yet be reported.

Hospitalizations thatbegan at this time maynot yet be reported.

The plot below shows the 7 day rolling average rate of COVID-19 hospitalizaons (per 1,000,000 persons) by vaccinaon status.

7 Day Rolling Average of COVID-19 Deaths by Vaccination StatusThe plot below shows the 7 day rolling average rate of COVID-19 deaths (per 1,000,000 persons) by vaccinaon status.

January February March April May June July August September October

0

5

10

15

Fully Vaccinated

Not Fully Vaccinated

Deaths thatbegan at this timemay not yet bereported.

Deaths thatbegan at this timemay not yet bereported.


7 Day Running Average of New Cases in Metropolitan Public Health Regions7

7 Day Running Average of New Cases in Rural Public Health Regions7


The plot above illustrates the 7 day running average of new COVID-19 cases (based on the date of public report) for the sixmetropolitan public health regions. The Nashville/Davidson and Memphis/Shelby metropolitan areas have consistently reportedhigher counts of COVID-19 cases compared to the other four metropolitan areas since the outbreak began.

The plot above illustrates the 7 day running average of new COVID-19 cases (based on the date of public report) for the sevenrural public health regions.


0

200

400

600

800

7 Day Average of New Cases

Blountville/Sullivan CountyChattanooga/Hamilton CountyJackson/Madison CountyKnoxville/Knox CountyMemphis/Shelby CountyNashville/Davidson County


0

500

1000

1500

7 Day Average of New Cases

East Tennessee RegionMid-Cumberland RegionNortheast RegionSouth Central RegionSoutheast RegionUpper Cumberland RegionWest Region


Number of Deaths per Day (by date of death)8


On October 20, 2021, the total number of confirmed COVID-19 deaths was 16,104 (12,801 confirmed and 3,303 probable).Below are the number of COVID-19 deaths by the date of death. The red line represents the 4 day running average number ofdeaths.

Mar 1, 20 Jun 1, 20 Sep 1, 20 Dec 1, 20 Mar 1, 21 Jun 1, 21 Sep 1, 21 Dec 1, 21

Date of Death

0

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Deaths

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4-Day Moving Average Number of Deaths

Deaths thatoccurredduring thistime maynot yet bereported toTDH.

Deaths thatoccurredduring thistime maynot yet bereported toTDH.

Case Fatality Rate:1.3%

(16,104/1,270,876)

30-Day Case Fatality Rate:1.6%

(990/62,535)


COVID-19 Active Cluster Monitoring Table9

COVID-19 Confirmed Clusters by Week10


The table below shows the number acve COVID-19 clusters that are currently being monitored by region and cluster type. Tolearn more cluster and cluster types, please reference the endnotes on page 14.

For more informaon on the metro and regional health departments, please click here or see page 15.

Facility Type CHR ETR JMR KKR MCR MSR NDR NER SCR SER SUL UCR WTR Total

Assisted Care Living Facility

Bar

Community

Correctional

Homeless Shelter

Industrial

Nursing Home

Other facility

Other Healthcare

Restaurant

Total 406

3

4

39

120

21

2

30

163

2

22

31

3

16

1

6

3

2

24

1

1

14

3

2

3

9

1

2

4

2

19

11

1

6

1

5

4

1

10

3

2

5

39

2

6

8

2

3

15

2

1

14

4

3

1

1

4

1

39

4

24

2

4

4

1

113

9

10

2

1

85

6

29

3

3

2

8

1

12

39

2

22

5

7

3

35

1

3

2

3

1

24

1

The visualizaon below shows the number of new clusters idenfied in Tennessee each week.

Jun 14, 20 Aug 9, 20 Oct 4, 20 Nov 29, 20 Jan 24, 21 Mar 21, 21 May 16, 21 Jul 11, 21 Sep 5, 21 Oct 31, 21

Week

0

20

40

60

80

100

120

140

Number of New Clusters Identified

25142632

4743

84

120131

96103

83

55

25157910510

21202629

47444035

16

41294338

22284140

4732

69676352

10596100

74869885

103104

73

91888783

65

119

100

120

88

113111

133

110122

102

83

655760

44

27


Trends in COVID-19 Symptoms in TN

Syndromic Surveillance (Emergency Room) Data11


The following secon will visualize the trends in COVID-19 symptoms based on data collected through TN’s syndromicsurveillance system, ESSENCE. ESSENCE tracks paent chief complaints and discharge diagnoses from 95 emergencydepartments across the state. The data are typically received from parcipang EDs within 24 hours of a paentencounter. These data are used to get pre-diagnosc esmates of health condions (like COVID-19) being reportedfrom emergency departments.

Nov 10, 19Jan 26, 20Apr 12, 20Jun 28, 20Sep 13, 20Nov 29, 20Feb 14, 21May 2, 21 Jul 18, 21 Oct 3, 21

Week Starting Date

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Percentage of All Emergency Department Visits

5.0%

1.8%

Coronavirus-like Illness

Influenza-like Illness

Cornavirus like illness (CLI) is defined as symptom terms, free text, or discharge diagnoses specified by CDC that are likely to be related to illness caused bythe 2019 novel Coronavirus. The visits counted within these criteria will contain a percentage illnesses caused by condions other than novel coronavirusinfecon. The visits counted within these criteria will contain a percentage illnesses caused by condions other than novel corona virus infecon. Theseresults should be considered preliminary in nature and are not all confirmed diagnoses of disease.

Influenza like illness (ILI) is defined by terms, free text, or discharge diagnoses that are likely to be related to illness caused by seasonal influenza. The visitscounted within these criteria will contain a percentage illnesses caused by condions other than influenza infecon. These results should be consideredpreliminary in nature and are not all confirmed diagnoses of disease.


Trends in COVID-19 Testing Capabilities

Laboratory Testing & Turnaround Time12


The following secon will visualize the COVID-19 tesng trends in TN, including laboratory tesng turnaround meand the rates of tesng across the state.

Below is the number of COVID-19 laboratory tests conducted in TN over the last year as well as the average laboratoryturnaround me by month.

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2.2 2.4 2.6

Average Turnaround Time in Days (# of Labs)

NOVEMBER 2020

DECEMBER 2020

JANUARY 2021

FEBRUARY 2021

MARCH 2021

APRIL 2021

MAY 2021

JUNE 2021

JULY 2021

AUGUST 2021

OCTOBER 2021

SEPTEMBER 2021

1.37 Days (1,098,166 Labs)

1.82 Days (980,934 Labs)

1.18 Days (831,268 Labs)

1.02 Days (508,232 Labs)

0.89 Days (494,668 Labs)

0.83 Days (434,482 Labs)

0.79 Days (309,991 Labs)

0.79 Days (203,535 Labs)

0.76 Days (245,115 Labs)

1.13 Days (830,351 Labs)

0.87 Days (324,973 Labs)

1.06 Days (836,044 Labs)


Trends in COVID-19 Hospital Capacity

Number/Rate of COVID-19 Hospitalized Patients13


The following secon will visualize trends in hospital capacity, including the number of COVID-19 posive paentscurrently admied, hospital bed ulizaon, and bed/venlator availability. All of the visualizaons below werecreated using data from the TN Healthcare Resource Tracking System (HRTS), a tool developed by TDH that manageshealthcare facility bed, service and asset availability. These data are reported by hospitals across TN daily.

May 1, 20 Jul 1, 20 Sep 1, 20 Nov 1, 20 Jan 1, 21 Mar 1, 21 May 1, 21 Jul 1, 21 Sep 1, 21 Nov 1, 21

0

5

10

15

20

25

30

# of reporting patients per hospital

0

500

1000

1500

2000

2500

3000

3500

4000

Patients

446

1,348

InpaentICUVenlated

Below is the number of COVID-19 paents currently hospitalized (dark blue), and of those hospitalized who are in the ICU (green) andare using venlators (light blue). The grey bar represents the number of paents per reporng hospital, a rate that can help us beerinterpret changes in COVID-19 hospitalizaons (as not all hospitals report each day).

The total number of COVID-19 posive paents hospitalized across TN on October 21, 2021 was 1,348. There are 446 COVID-19paents currently in the ICU and 301 ulizing venlators. The number of admied paents per hospital reporng was 10.61 (with 114hospitals reporng).


Hospital Utilization and Confirmed COVID Hospitalizations in TN13

Quick Glance at Hospital Bed & Ventilator Availability13


Below is a brief snapshot of the currently available floor beds, ICU beds and venlators across TN.

Jul 1, 20 Oct 1, 20 Jan 1, 21 Apr 1, 21 Jul 1, 21 Oct 1, 21

0K

2K

4K

6K

8K

10K

12K

Floor Beds in Use

9,409

902

Total Bed Capacity: 12,344

COVID Hospitalizations

Non-COVID Hospitalizations

This visual illustrates the total number ofhospital beds (adult floor beds) occupied bynon-COVID-19 (light blue) and confirmedCOVID-19 paents (darker blue) since July 15th,2020.

Addionally, please note the following:• On December 18, 2020 this visualizaon waschanged to compare the number of hospitalbeds (adult floor beds) occupied bynon-COVID-19 paents and confirmed COVID-19paents (excluding COVID-19 paents using ICUbeds) across TN.

• On October 21, 2021, 9.6% (902/9,409) offloor bed hospitalizaons in Tennessee wereCOVID-19 paents.

Available Adult Ventilators Available Floor Beds Available ICU Beds

10%1,253/12,187

68%1,363/1,990

9%194/2,206


Technical Notes


1. Epidemic Curve for COVID-19 Cases by Specimen Collecon Date (page 2)

The visualizaon on page 2 shows the daily new COVID-19 cases (blue bars) and 7-day moving average of new cases (red line). A sevenday moving average is the average of one data point and the six preceding data points. Looking at the moving average helps tounderstand trends and account for fluctuaons in the data.

Are probable cases included in the Epidemic Curve?Probable cases are included in the epidemic curve in this report. For the probable cases where specimen collecon date is not available,the date the paent's illness or symptoms began is used.

Can I recreate this with TDH publicly available data?Not exactly. The public downloadable datasets (Daily Case Informaon) present COVID-19 case counts based on the day they werepublicly reported, not specimen collecon date. However, using the column New_Cases one can create a similar visualizaon. Theprimary difference between the visualizaon using the public dataset method and the one in this report would be that the trends seenin this report should align with trends seen roughly 2-5 days later in the public dataset visualizaon. Again, this would be because of the2-5 day lag between specimen collecon date and public report date.

2. Statewide Number and Rate of Acve Cases (page 3)

The visualizaon on page 3 shows the number (light blue bars) and rate (dark blue line) of acve cases each day in TN.

How does TDH count recovered COVID-19 Cases?The number of acve COVID-19 cases are determined by: total number of cases - inacve/recovered cases. TDH considers a case“inacve/recovered” when: 1) they are at least 14 days beyond their symptom onset date, or are at least 14 days beyond the first testconfirming illness if asymptomac, and 2) are not deceased.

How is the rate of acve cases calculated?The acve rate is the total number of individuals who acvely have COVID-19 in TN divided by the state populaon, see examplecalculaon and interpretaon below. The populaon of the state is from the 2018 projected populaon esmate for Tennessee.

Can I recreate this with TDH publicly available data?Yes. Using the public downloadable datasets (Daily Case Informaon) you can use the column Total_Acve to get the daily number ofacve cases and the instrucons above to calculate the rate. If you want to understand how TDH calculates "Total Acve" you cancalculate it yourself by subtracng the number of recovered cases (Total_Recovered) and the number of cases who have died(Total_Deaths) from the total number of cases (Total_Cases).

3. Daily Percent of Posive COVID-19 tests (page 3)

The visualizaon on page 3 shows the daily posivity rate (blue line) as well as two thresholds that indicate if the posivity rate wasabove either 5% or 10%.

How is the daily percent of posive tests calculated?The daily percent of posive tests is calculated by taking the number of new posive tests for that day divided by the total number ofnew tests for that day. These numbers are publicly available in the downloadable data- Daily Case Info. While the number of new testsconducted that day can be found in the column New_Tests, the new posive number of tests can be calculated by subtracngyesterdays total Pos_Tests from today's total Pos_Test.

Can I recreate this with TDH publicly available data?Yes. Using the public downloadable datasets (Daily Case Informaon) and the instrucons above one is able to recreate thevisualizaon.



5.TN SARS-CoV-2 Variant Case Summary (pages 4 and 5)

The tables on pages 4 and 5 summarizes the COVID-19 variant cases idenfied in TN. To learn more about the variants and theirclassificaons please see hps://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html#Concern.

What are the variant classificaons and definons?Variants of Concern (VOC)(page 4)- a VOC is a variant for which there is evidence of an increase in transmissibility, more severe disease,significiant reducon in neutralizaonby anbodies generated during a previous infecon or vaccinaon, reduced effecvness oftreatments or vaccines, or diagnosc detecon.

4. Posive Tests per 100,000 Persons by Public Health Region (Over the last 7 Days) (page 4)

The regional level map shows the number of new posive tests per 100,000 persons by public health region in the last 7 days. Thearrows indicate trends (up or down) of the new posive tests rate compared to the week prior.

How is the number of posive tests per 100,000 persons calculated in the map?These rates are calculated by the taking the number of new posive tests for the region divided by the region's populaon. This is thenmulplied by 100,000 to have the number per 100,000 persons.

Are the number of cases the same as the number of posive tests?No, not necessarily. The number of posive tests is the total number of PCR-posive laboratory results that have been reported to TDH,while the number of cases are individual people who are either confirmed or probable COVID-19 cases. Individuals are only countedonce in this number, no maer how many posive tests they might have had. Therefore, if an individual tested posive mulple mes ina given week in the same area they would be counted mulple mes in this map (but would only be counted once in the case counts)

Can I recreate this with TDH publicly available data?Yes. The numbers required to create the calculaon explained above are publicly available in the County New dataset but only at thecounty level. In order to recreate this visualizaon one will need to group the counes (and county populaons) by their public healthregion (can be found at hps://www.tn.gov/content/dam/tn/health/program-areas/oral-health/dental-regional-metro-areas.jpg).

6. Vaccine Breakthrough Cases in TN (page 5)

The table on page 5 shows some demographic, hospitalizaon, and death metrics for the COVID-19 vaccine breakthrough casesidenfied in TN. Please note the 'Overall Metrics' secon was updated on 9/17. This update removed the denominator and percentagedata as they were not accurate representaons of the proporons of breakthrough cases. To learn more about breakthrough cases andhow they are reported see hps://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html.

What is a breakthrough case?CDC defines COVID-19 Breakthrough Cases as a U.S. resident with SARS-CoV-2 RNA or angen detected on a respiratory specimencollected ≥14 days aer compleng the primary series of an FDA-authorized COVID-19 vaccine. All cases meeng this definion throughApril 30th are reported. As of May 1st, CDC asked that only cases with severe outcomes (hospitalizaon or death) be reported.

Can I recreate this with TDH publicly available data?No, vaccine breakthrough informaon is not publicly available.<Blank>

Variants of Interest (VOI)(page 5)- a VOI is a variant with specific genec markers that have been associated with changes toreceptor binding, reduced neutralizaon by anbodies generated against previous infecon or vaccinaon, or predictedincrease in transmissibility or disease severity.

Variants Being Monitored (VBM)(page 5)-include variants for which there are data indicang a potenal or clear impact onmedical countermeasures.

Can I recreate this with TDH publicly available data?No. The count of variant cases is not currently available in the TDH provided public data sets.



8.7 Day Running Average of New Cases in Metropolitan and Rural Public Health Regions (see page 7)

The visualizaons on page 6 show the 7 day running average of new COVID-19 cases for all of the metropolitan and rural public healthregions. These new case counts are based on their public report date and not specimen collecon date. A 7 day moving average is theaverage of one data point and the six preceding data points. Looking at the moving average helps to understand trends and account forfluctuaons in the data.

Can I recreate this with TDH publicly available data?Yes, using the downloadable dataset- County New and the column New_Case, one is able to see the daily counts at the county level.These counts can added together to create the daily new case counts for each public health region. The 7 day average of new cases canbe then calculated by totaling the daily new case counts (by region) for today and the previous 6 days and then dividing by 7.

9. Number of Deaths per Day (by date of death) (page 8)

The visualizaons on page 7 show the number of COVID-19 deaths by date of death (blue bars) and the 4-day moving average of thenumber of deaths. A four day moving average is the average of one data point and the three preceding data points. Looking at themoving average helps to understand trends and account for fluctuaons in the data.

What is a probable death?A probable COVID-19 death is if a person dies and the health care provider that signed their death cerficate determined that COVID-19disease was their cause of death or a significant condion contribung to death, then the person meets the probable case criteria andwould be considered a probable death.

Is date of the death the same day it is publicly reported?No, similarly to specimen collecon date, the date of death frequently occurs 2-5 days before the death is reported to the public due tolag me in reporng. Therefore, the most recent day's data may not be complete.

How can I calculate the Case Fatality Rate? What about the 30-Day Case Fatality Rate?A case fatality rate is calculated by taking the total number of COVID-19 deaths divided by the total number of COVID-19 cases. A 30-daycase fatality rate would only look at the total number of deaths and number of cases for the last 30 days. Both of these rates can beproduced using the publicly downloadable datasets (Daily Case Informaon).

Can I recreate this with TDH publicly available data?Not exactly. The public downloadable datasets-Daily Case Informaon presents COVID-19 deaths based on the day they were publiclyreported, not the date of death. However, using the New_Deaths column one can create a similar visualizaon. The primary differencebetween the visualizaon using the public dataset method and the one in this report would be the trends seen in this report shouldalign with trends seen roughly 2-5 days later with the public dataset visualizaon. Again, this would be because of the 2-5 day lagbetween date of death and public report date.

7. 7 Day Rolling Average of COVID-19 Cases, Hospitalizaons, and Deaths by Vaccinaon Status (page 6)

The visualizaons on page 6 show COVID-19 cases, hospitalizaons, and deaths based on if the individual was vaccinated or not.

What are the definions for fully vaccinated and not fully vaccinated?Fully Vaccinated: Completed a vaccinaon series (2 doses of Pfizer/Moderna or 1 dose of Janssen)

Not Fully Vaccinated: Not vaccinated or parally completed a vaccine series.

Can I recreate this with TDH publicly available data?No, COVID-19 cases, hospitalizaons, and deaths are not available in the public data sets by vaccinaon status.



BusinessesShopping faciliesSports/fitness faciliesOther facilies clusters include facilies such as camps.Other Healthcare clusters include provider types such as:Mental health instuonsPharmaciesHome health agenciesDenst offices

Metro/Regional Health Department Abbreviaons:

CHRETRJMRKKRMCRMSRNDRNERSCRSERSULUCRWTR West Tennessee Regional Health Department

Upper Cumberland Regional Health DepartmentSullivan County Health DepartmentSoutheast Regional Health DepartmentSouth Central Regional Health DepartmentNortheast Regional Health DepartmentNashville Davidson County Health Department

Mid Cumberland Regional Health DepartmentMemphis Shelby County Health Department

Knoxville Knox County Health DepartmentJackson Madison County Health DepartmentEast Tennessee Regional Health DepartmentChaanooga Hamilton County Health Department

Can I recreate this with TDH publicly available data?No, cluster informaon is not publicly available.

10. COVID-19 Acve Cluster Monitoring Table (page 9)

The table on page 8 displays the number of acve COVID-19 clusters that are currently being monitored by region andcluster type.

What the definion of a COVID-19 Cluster?A COVID-19 cluster is two (2) or more confirmed cases (with posive lab results) of COVID-19 that are linked by the samelocaon of exposure (for example a hospital, nursing home, grocery store, correcons facility, etc.) or exposure event (forexample a work party, vacaon, etc.) that is not a household exposure. In TN, the most commonly reported clusters havebeen in correcons facilies and nursing homes.

Cluster Types Quick Definions-Community clusters include those associated with: First RespondersReligious/spiritual organizaonsDaycares, educaonal se ngsApartment complexes



12. Syndromic Surveillance (Emergency Room) Data (page 10)

The visualizaons on page 9 shows the percent of all emergency room visits in that are reporng both Cornavirus like Illness (CLI) andInfluenza like Illness (ILI) in TN. This dashboard can also be found online here.

Can I recreate this with TDH publicly available data?Yes and no. While ESSENCE data is not included in the publicly available datasets, the dashboard above does provide the weekly percentof ILI and CLI symptoms in the tool ps. Therefore, one could recreate the visualizaon if desired.

Can I recreate this with TDH publicly available data?Yes and no, while lab turnaround me is not publicly reported, the lab tesng volume can determined using the New_Tests column ofthe Daily Case Informaon public dataset.

13. Lab Tesng & Turnaround Time (page 11)

The visualizaon on page 10 shows the volume of COVID-19 lab tesng and average turnaround me for the months of March throughOctober (so far) in 2020.

Can I recreate this with TDH publicly available data?Yes and no, while lab turnaround me is not publicly reported, the lab tesng volume can be determined using the New_Tests columnof the Daily Case Informaon public dataset. This dataset can be found athps://www.tn.gov/health/cedep/ncov/data/downloadable-datasets.html.

14. HRTS-Reported Hospitalizaons & Bed Capacity (page 12 and 13)

The visualizaons see on pages 11 and 12 shows TN's hospital capacity through acve hospitalizaons, current bed ulizaon, and bedavailability.

Can I recreate this with TDH publicly available data?No, HRTS data is not publically available.

To access all the downloadable datasets menoned in the technical notes, please see:hps://www.tn.gov/health/cedep/ncov/data/downloadable-datasets.html

11. COVID-19 Confirmed Clusters by Week (page 9)

The visualizaon on page 8 shows the new clusters idenfied in Tennessee each week.

What the definion of a COVID-19 Cluster?A COVID-19 cluster is two (2) or more confirmed cases (with posive lab results) of COVID-19 that are linked by the same locaonof exposure (for example a hospital, nursing home, grocery store, correcons facility, etc.) or exposure event (for example a workparty, vacaon, etc.) that is not a household exposure. In TN, the most commonly reported clusters have been in correconsfacilies and nursing homes.

Can I recreate this with TDH publicly available data?No, cluster informaon is not publicly available.

Documents

C29 D-19 - TN.gov