More than one in five new COVID-19 cases in Shelby County – 22% – are among health care workers who may be passing the disease to each other when they let their guard down outside patient rooms.

The transmission is most likely among nurses and nursing aides in hospitals (46%), with long-term care facilities (34%) second, according to data the Shelby County Health Department is getting from deeper contact-tracing interviews it has being doing since mid-September.

“A lot of the transmission risk seems to be associated with what we say is peer-to-peer transmission,” said David Sweat, Health Department deputy director.

“So, while doing patient care, they are wearing their PPE and following PPE guidance. But then they get in the breakroom or a staff meeting, they take their masks off, they are more relaxed.”

Health care workers represent 16% of employment in the metro area.

The three largest health care occupations reporting positive were nurse, (26%) nurse’s aide (14%) and clerical support (9%).

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By drilling down into the data, the Health Department hopes to establish patterns of where and how the disease is being transmitted in Shelby County.

“We see that among recent employed cases, working in the health care sector is over-represented, especially among nurses and nurses’ aides. That information should serve as a reminder to people working in those settings that they need to be vigilant and follow best practices all the time,” Sweat said.

“But we did not say that 22% of cases got infected because they work in health care. It isn’t possible to draw that specific of a conclusion.”

The industry with the next highest rate of infection is warehousing and manufacturing at 14%. Third, 12%, is education, followed by retail (9%), restaurants (5%) and bars (1%).

“This is really important work we are doing because it is an opportunity for us to shed light on things other people may not be asking about,” Sweat said. “We are going to continue to look at this in our data. Every week, we will be adding to this analysis.”

Christ Community Health Services, which has 10 clinics in Memphis and one in Jackson, Tennessee, expects to begin testing every employee once a week, says CEO Shantelle Leatherwood.

“We’re starting to see an increase in the cases among our employees to about one a day,” she said. “That was just reported to me yesterday. I would say it probably started in the last week. And of course, it correlates with the increases that we are seeing in the county.

“We are also seeing an increase in the demand for testing. It’s a slight increase, not a large increase in the demand for testing.”

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The Health Department’s workplace statistics come from 704 contact tracing interviews it did in October with specific questions to determine what people did in the two to 14 days between exposure and when they started showing symptoms.

Of the two-thirds (67%) who were employed, more worked in health care than any other single industry.

“We know nurses and health aides have the most intimate contact with patients, but they also happen to be a larger percentage of your workforce in those places,” Sweat said.

“We know some of the main connections they had were in the breakroom or they went to lunch together,” he said.

Eighty percent of the people who reported working in health care were employed in hospitals or nursing homes. Fourteen percent reported working in clinics; 5% said they worked in dental clinics.

Dr. William Schaffner, infectious disease expert at Vanderbilt University Medical Center, suspects that nurses and nurses’ aides in Memphis represent populations disproportionately affected by COVID-19, as they do in Nashville, he said, and therefore are part of the story of what the disease looks like in most cities.

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In Shelby County, the age group with the largest number of infections is 25-34. Women account for 20,417 cases, compared to men at 16,515. More than half of the cases (58%) are among African Americans.

“In day-to-day practice, it is very hard to trace back definitively,” Schaffner said. “First of all, the virus is out there so commonly. Second, it can come from people who are without symptoms, and it’s very contagious.”

Dr. Stephen Threlkeld, an infectious disease expert treating COVID-19 patients at Baptist Hospital-Memphis, says the key thing “is to assume that anyone who is within six feet of you has the virus.”

“Health care workers are like people in the community, just like everybody else. They’ve gotten tired and so forth, and they are probably more likely to be tested,” he said, noting that more frequent testing could produce more positive cases.

“All that said, I do think the bigger danger to us in our community, whether you are inside a health care facility or not, is being around someone that you are not suspecting is infected.”

In the same interviews with the Health Department, recent positive individuals (46%) indicated they were socializing in small groups while they were infectious.

“It’s the biggest single behavior that is driving the spread of COVID everywhere,” Sweat said.

“We get together. I know you; you know me. We’ve been friends a long time, and we hang out regularly. At Kroger, we have our masks on. At home, it’s ‘Let’s go sit in the living room, take our masks off and be together.

“And then you have transmission,” Sweat said.

That is the stage of the pandemic now. Because transmission is so widespread, the disease is coming from more places at a time when hospitalizations are already up. Flu season is upon the nation, and the holiday season begins with Thanksgiving in three weeks.

Deborah Birx, the White House coronavirus coordinator, delivered a warning Monday, Nov. 2, in a private memo that was leaked, saying the nation is now entering “the most concerning and most deadly phase of this pandemic.”

“This is not about lockdowns — it hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”

Tuesday, more than 90,000 cases were reported in the U.S. Wednesday, the daily number ticked past 100,000. The seven-day average has surpassed 86,000.

“These have doubled over just a couple of months,” Threlkeld said. “And though we have not reached the breaking point any where in the Mid-South area, or any place that is really making maximum news on the coasts, there are places in the Midwest that are in very difficult situations right now.”

The challenge as the cold season approaches is not being around people who have the disease, he said.

“It’s going to be that you don’t believe your cousin Bob will give you this virus. And so, you let your guard down when he comes to visit.”