As COVID-19 cases explode in Tennessee, Shelby County residents can expect new limits on socializing by early next week. What they will include is still unclear, but one likely will be limiting gatherings to 10 or fewer people.

This comes as Tennessee has rocketed into first place for spread of the disease in tracking studies done separately by The New York Times and The Financial Times.

Earlier this week, Tennessee was ranked second for new cases by the White House coronavirus task force, which offered the stern guidance that the state immediately step up its testing, reduce capacity or close indoor gathering places. 

Officials at the Shelby County Health Department have been crafting a new Health Directive for more than a week. On Thursday, Dec. 17, director Alisa Haushalter said what was expected to be a simple rewrite to clarify language now will have more teeth.

“We do know we have exponential growth. That growth is occurring because people are continuing to socialize together in their homes, in public places in more places and so on. Anything that we do is going to have to decrease the ability of people to come together and socialize,” Haushalter said.

Every avenue is being considered, she said, including national recommendations.

In Shelby County, discussions on potentially limiting gatherings involve all the mayors and members of the local COVID-19 task force, which include hospital administrators.

Health Directive 15, which went into effect Nov. 23, did not close bars and restaurants because municipal officials argued against it. On Nov. 19, the seven-day case average was 330. At 450, closure is warranted, according to tripwires the Health Department released in early August.

On Dec. 10, the seven-day new case average was 670.

With a reproduction rate of 1.06, the 6,044 people who are currently infectious in the county can be expected to create 7,138 new cases by Jan. 16, a 30-day period that includes Christmas and New Year’s. 

Those case numbers, realistically Haushalter said, may represent only one-fifth of the people who are actively infectious.

The same exponential trajectory will take place for cases announced in the coming days. For the first time Thursday, that number topped 1,000 at 1,163.

The pending interventions, Haushalter said, have to include ways to stem the tide over Christmas. Health officials say their modeling and contact tracing connects 70% of the new cases to small Thanksgiving gatherings held in people’s homes.

In the White House task force report, Tennessee has 639 new cases per 100,000 people. The national average is 451, said Dr. Bruce Randolph, health officer for Shelby County Health Department.

According to the White House task force, transmission rates this high require public officials in Tennessee to tell people 65 and older with underlying conditions that entering any indoor space where people are unmasked is an immediate health risk. Those people should have essentials delivered to their homes.

People under 40 gathering with those outside their households should assume they are infected.

“If the data that was just presented does not get folks’ attention, I’m not sure what will,” said Doug McGowen, chief operating officer for the City of Memphis.

While maps of Tennessee show exceedingly high levels of transmission, Shelby County is sixth from the bottom of the 95 counties in the state.

“So, what you are doing is working. But I want to re-emphasize that this is the time to take precautions. You shouldn’t be gathering with people outside your family,” McGowen said.

“Yes, we have crossed a grim milestone of more than 750 cases a day. The data shows that largely people are giving this to one another – people with whom they are acquainted, people whom they trust, people whom they know,” he said.

As a reminder, those gatherings include home parties, weddings and funerals – essentially, wherever people gather.

“If you are having COVID-related symptoms, do not leave your house because you assume they are just seasonal allergies,” McGowen said.

Cases in the state are higher in East Tennessee, and while she did not wish to single out a region, Haushalter said masks are not being used as widely there as they are in Shelby County. She also noted that Knox County has or will soon discontinue contact tracing, the method of identifying people who were in contact with positive cases and quickly getting them into isolation.

“We know that’s a critical component of being successful in reducing transmission,” she said.

Shelby County has enlisted the help of schools, hospitals and employers with contact tracing.

“As the cases have grown, everyone’s pitching in and helping to get people isolated or quarantined.,” Haushalter said. “That is not happening in Knox County. I would think it’s a combination of all those factors that make East Tennessee a little bit different than where we are currently in Shelby County.”