The number of new confirmed COVID-19 cases reported in Tennessee has fallen again despite experts' assertions that neither the state nor the country has seen the peak of the pandemic. 

For three days in a row, state officials have reported fewer new cases than the day before: 134 on Sunday, 110 on Monday and only 52 on Tuesday. In a well-flowing system, those number would signal that the pandemic is slowing down.

But a national shortage of supplies and backups at laboratories mean that data is quite incomplete, rendering state and local government officials using the metric as a factor in their policy decisions unable to know the scope of COVID-19's spread and slowing their ability to make appropriate decisions. This is not isolated to Tennessee: Department of Health Commissioner Lisa Piercey said in a press briefing Tuesday that dynamic is affecting all states in some measure.

On Wednesday morning — when Nashville reported only four new cases in a span of 24 hours — Metro Coronavirus Task Force chair Alex Jahangir said, “I believe this is a function of the results coming in and does not signify a downturn.” 

Earlier this week, Jahangir predicted that the peak of COVID-19 cases won’t arrive in Nashville for weeks to come. In other words: The illness around us likely continues to grow but our ability to track new cases has almost come to a stand-still.

Metro leaders have built and staffed assessment sites — key to screening and testing potential COVID-19 patients — across Nashville but have been delayed as they wait for face masks, gloves, testing swabs and more. Jahangir said the city is waiting to build up enough supplies to protect clinicians and administer tests for two weeks but they’ve already been waiting for almost a week and still don’t know when the needed supplies will arrive. As soon as they do, Jahangir added, the sites will open to the public. 

State health officials told the Post on Tuesday they do not know how many assessment centers, including 35 mobile sites set to be opened by the National Guard, have been unable to open because of supply chain gaps. In an email Tuesday, a TDH spokesperson said:

“As mentioned during [Tuesday's] media briefing with Governor Lee, the national supply chain shortage is impacting all states. As far as assessment sites being impacted, you will need to contact those locations that are listed on the COVID-19 page.”

The lack of assessment centers is particularly dangerous in parts of the state where it's unclear if there are COVID-19 cases. Most of Tennessee’s rural counties have reported low case volumes, mainly due to lack of testing resources as compared to Davidson County, leaving it unclear to researchers whether the virus has actually spread. In the daily White House Coronavirus Task Force briefing on Tuesday night, National Institute of Allergy and Infectious Diseases director Anthony Fauci underlined the significance of collecting data in these areas to inform urgent policy decisions surrounding social distancing.

“We need to know what is going on in those areas of the country where there isn’t an obvious outbreak,” Fauci said. “Is there something underneath the surface that says, ‘Wait a minute, you better be careful!’ and really clamp down or what looks that you don’t really have to be as harsh as you are in other areas. It is looking to information that up to this point we haven’t had.”

The Department of Health has reported that its state lab and commercial players have completed 1,031 and 10,113  COVID-19 tests, respectively. Vanderbilt University Medical Center has reported more than 5,000 of the latter number — with 2,800 tests more in the queue as of Tuesday night — through the system's designated assessment centers across Middle Tennessee. Local Ascension Health facilities have been able to test only 638 individuals and TriStar Health System facilities have declined to release the data. VUMC and Ascension both confirmed they are not experiencing shortages in test kits. 

Based on those numbers alone, Middle Tennessee makes up more than half of the state’s testing volume. 

A lab logjam also is delaying case reporting. VUMC has an in-house lab to process the tests administered by its screening facilities, unlike HCA or Ascension who are sending their samples to the state’s public lab and national operators such as LabCorp and Quest. But as testing capacity grows and protective equipment and supplies are used up across the nation, a number of labs are seeing a backlog of tests such as the 2,800 in the VUMC system. Officials are seeking other options — including sending samples to alternative labs — but the shortage may also be affecting those facilities.

VUMC spokesman John Howser said the backlog means wait times for results can be as long as 72 hours. The Tennessee State Public Health Lab is currently reporting an average wait time of one to two days for results. State officials could not confirm whether they are experiencing a similar strain in processing the tests.

Those turnaround time estimates may be generous: Williamson Medical Center leaders, who send their samples to both public and national labs, last week in a press release said patients may have to wait up to 10 days to receive results. These delays look to make the state's data — already insufficient and lagging on-the-ground developments — even more spotty and policy decisions less informed.

Gillum Ferguson, spokesman for Gov. Bill Lee, said testing data is still a factor being considered in the administration’s policy decisions, albeit with a general understanding of its inability to fully inform Lee and his team of COVID-19’s spread. Feguson noted that, along with other methods such as contact tracing, the data still helps identify emerging trends across the state. 

“A lot of factors go into that, and I would say the number of tests and the number of positives are two important variables that go into every calculation,” he told the Post Tuesday night. “On the one hand, it’s great to have this data. But at the same time, we have 667 confirmed cases [... W]e know there are more out there. Is it perfect? No, because we know there are more and more people. But the more we test, the better our data set is, so we are definitely using that as one of the variables.”

Gov. Bill Lee earlier this week announced the formation of a unified command to address the supply chain crisis and expand access to testing across the state. Lee on Tuesday also directed 250 volunteer soldiers and airmen to support the state's response effort; 150 of them will provide medical assistance at the 35 mobile assessment sites.

This post originally appeared in our sister publication, the Nashville Post. 

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