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Our Health and Economy

Our Health

Tennessee’s first case of COVID-19 was reported on March 4, 2020. Over the subsequent weeks, case numbers increased rapidly. On April 2, Governor Lee signed a Safer at Home order to implement statewide restrictions on non-essential business and travel in order to “flatten the curve” and quickly slow the spread of disease. This order gave Tennessee and its healthcare system enough time to increase testing, plan for additional healthcare facility capacity and secure enough personal protective equipment (PPE) to protect our healthcare workers.

In the weeks since the Safer at Home order, Tennessee has made notable progress on slowing the spread of disease and improving Tennessee’s readiness.

As Tennessee monitors reopening across the state, the Tennessee Department of Health (TDH) will maintain vigilance of critical COVID-19 indicators at both the state and county levels. These indicators will help identify ‘problem areas’ across the state and provide early indication of sustained increases in community transmission.

The following metrics, developed in line with the White House State Gating Criteria, help officials monitor trends in four key areas:

  • Trends in COVID-19 Cases
  • Trends in COVID-19 Symptoms
  • Trends in COVID-19 Testing Capabilities
  • Trends in Healthcare System Capacity

Disease Monitoring

The curve of illness is flattening. Despite an initial rapid rise in cases in late March, Tennessee saw a plateau and then steady decline in the number of average daily number of new cases reported for the first three weeks of April, at which time the decision was made to reopen sectors of the economy. The declining rate of positive tests has also been encouraging. While the daily percentage of positive COVID-19 tests fluctuates, thecumulative percent of positive tests showed a gradual decline from April 10th to April 30th.  

Positive Test Rates Since Safer at Home


Tennessee Meets White House Criteria for Cases to Reopen


Syndromic data monitoring of influenza-like illness and COVID-19 like illness have steadily declined since mid-March and late March respectively.

Syndromic Surveillance1


Coronavirus-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 by the 2019 novel Coronavirus. The visits counted within these criteria will contain a percentage of illness caused by conditions other than novel coronavirus infection. The visits counted within these criteria will contain a percentage of illness caused by conditions other than novel coronavirus infection.2

Influenza-Like Illness (ILI)

Is defined by terms, free text, or discharge diagnoses that are likely to be related to illness caused by seasonal in-fluenza. The visits counted within these criteria will contain a percentage of illnesses caused by conditions other than influenza infection.3

Increase in Testing

Tennessee has dramatically increased testing capacity, with rapid deployment of large volume and fast turnaround testing when cases are identified in high-risk populations, including those in long-term care facilities and state prisons. Testing is readily available throughout the state, with residents having access to testing via health care providers, local health departments and drive-thru testing stations. Testing for expanded symptomatology has also been implemented to better ascertain the true volume of disease.

In April 2020, Tennessee’s State Public Health Laboratory, and the private labs working in partnership with the Tennessee Department of Health, performed more than 161,000 COVID-19 tests statewide. From a national perspective, Tennessee has exceeded the federal benchmark indicating states should be able to test at least 2% of their populations monthly to make informed decisions regarding re-starting and re-opening their economies. From the middle of April to the end of the month, daily testing doubled from approximately 4,000 tests per day to 8,000 tests per day.

On April 15, 2020, Gov. Lee directed his Unified-Command Group (UCG) to rapidly expand Tennessee’s COVID-19 testing capacity to inform re-opening decisions. The state committed to testing all prison inmates and staff, as well as all nursing home patients and staff. In addition to testing these high-risk populations, the state greatly expanded testing for all people in Tennessee. In addition to expanded daily testing, the State launched 15 drive- thru testing sites the weekend of April 18-19 across the state with Tennessee National Guard and TDH. Over three consecutive weekends, drive-thru efforts tested more than 23,000 Tennesseans and expanded testing to include asymptomatic individuals. Testing continues to be available in greater capacity across the state. Now, any Tennessean who desires can get a test free-of-charge, five-days-a-week at all counties in the state.

Increase in Healthcare Capacity

The most compelling reason to close public spaces was to slow the rise of cases and hospitalizations to avoid overwhelming hospital capacity. This objective has been achieved. Careful monitoring of hospital bed usage shows current capacity to treat COVID-19 and non-COVID-19 patients. The UCG has been working with hospitals, providers and regional planning groups to increase the capacity of current facilities to “surge” if and when it is needed, and to plan for additional clinical alternative care sites.

When it comes to serving COVID-19 patients in Tennessee, our first priority is utilizing our existing healthcare resources. UCG is working closely with Regional Healthcare Coordinators (RHCs) in eight regional coalitions, along with individual hospital facilities and stakeholders such as the Tennessee Hospital Association (THA) to improve regional resource monitoring and allocation through the collaborative use of real-time utilization data. During the initial COVID-19 surge in cases, elective procedures and admissions were halted to preserve hospital space and personal protective equipment (PPE). Hospitals and facilities across the spectrum of care now have improved capacity to resume non-urgent procedures and admissions.

Leveraging partnerships with community and public health stakeholders, state hospital capacity is ready to expand up to 40% beyond its usual capacity in the event of a COVID-19 related surge in hospital admissions. UCG, TEMA, and TDH leadership monitor numbers closely, while hospitals continue to provide daily reporting metrics throughout this pandemic. Improvements in hospital reporting and stakeholder collaboration ensures that Tennessee’s healthcare resources are coordinated efficiently at the local level, that our rural communities and vulnerable populations are well-supported, and that our state’s healthcare system is equipped and prepared to respond to a surge in COVID-19 patients. If the surge capacity of existing hospitals is exceeded, Tennessee is preparing alternate care sites for low-acuity COVID-positive patients in our most populous counties.

Contact Tracing Program

TDH is working to promptly identify Tennesseans who are ill with COVID-19 as well as their close contacts through case interviews and contact tracing. Contact tracing allows public health officials to identify individuals who have been exposed and are at higher risk of becoming infected with COVID-19, and provide anticipatory guidance and education around required quarantine measures, symptom monitoring and access to testing. These core public health activities are performed by local health department professionals, supported by state public health staff. Daily active monitoring of cases and contacts (i.e., making contact with a case or contact daily to check on their health status and provide any support or guidance needed) is performed by both state and local public health staff. TDH has rapidly expanded its contact tracing workforce through both internal resources and external contracts and is currently able to identify and monitor all cases and contacts. Statewide and regional trends are closely monitored in order to rapidly increase capacity for additional case interviews and contact tracing should case numbers increase.

Increase in PPE Availability

Tennessee has been working closely with businesses across the state and beyond to identify possible sources of masks, gloves and other forms of PPE. The UCG has

streamlined requests for PPE through regional emergency management coordinators and TEMA. PPE has been purchased to supplement routine supply channels for health care workers and first responders. Meanwhile, supply chains have also stabilized to meet the needs of health care workers and first responders, and Tennessee has partnered with facilities to better conserve PPE supplies. While PPE availability has increased, it is still not plentiful, and Tennessee has collaborated with partners on PPE decontamination systems and will support local procurement efforts.


1Syndromic data is reported by 85% of TN Eds.

2These results should be considered preliminary in nature and are not all confirmed diagnoses of disease.

3These results should be considered preliminary in nature and are not all confirmed diagnoses of disease.


Our Economy

As the direct threat to Tennesseans’ health has been mitigated, the threat to their livelihoods has increased. We know economic health promotes physical and mental well- being. A substantial body of research from the U.S. and abroad consistently demonstrates a strong association between unemployment and poorer health outcomes.1 Tennesseans have experienced devastating job losses across all 95 counties and diverse industry sectors.

466K - TN Unemployment Claims

As a result of COVID-19 mitigation, Tennesseans filed 465,951 unemployment claims with the Department of Labor and Workforce Development between March 1 and May 2, 2020.2

15% - TN Workers Filed Unemployment

While these challenges started first for many of the Tennesseans who work in entertainment, recreation, and accommodation, they have now spread to impact almost every industry and every county across Tennessee3

$870M - Net Sales Lost by TN Retailers in March

Some industries were impacted more dramatically than others including: a $408 million decline in restaurant sales, a $177 million decline in hotel and accommodation sales, a $218 million decline in motor vehicle related sales, and a $64 million decline in entertainment and recreation sales year over year. April losses will be significantly greater.4

50% - Professional Licensure Decline

New business applications are down 53% in April 2020. Additionally, the number of licensed professionals and businesses declined by 13% compared to the same time last year.5

$5B - TN GDP Lost in 2020

Tennessee Gross Domestic Product is projected to decline $5 billion during 2020 as a result of closures and joblessness related to the pandemic, assuming businesses begin to reopen on May 1, 2020.6


1Hergenrather, K. C., Zeglin, R. J., Mcguire-Kuletz, M., & Rhodes, S. D. (2015). Employment as a Social Determinant of Health: A Systematic Review of Longitudinal Studies Exploring the Relationship Between Employment Status and Physical Health. Rehabilitation Research, Policy, and Education, 29(1), 2–26.

2Tennessee Department of Labor and Workforce Development.

3Tennessee Department of Labor and Workforce Development.

4Tennessee Department of Revenue. Sales and Use tax estimates do not reflect activities in the personal services sector, and other sectors that are not subject to the tax. Any inferences from these estimates should consider those sectors not represented.

5Tennessee Department of Commerce & Insurance. Compares professional business licensure applications for April 2019 and April 2020.

6Economic impact analysis prepared by the Nashville Area Chamber of Commerce Research Center using REMI dynamic modeling software. Fixed (2012) $.