What Does The Number Of COVID-19 Active Cases Really Tell Us? - And Response

Tuesday, July 28, 2020

As I write this article this afternoon, like many concerned citizens, I am waiting for the Hamilton County Health Department to release the latest numbers relating to COVID-19. The big stat everybody and most parents are fixated on are the number of active cases. This number is the stat that will tell us in what phase school will open this August, but what does it really mean?

I have asked many people and for the most part no one seems to understand its meaning. When this pandemic first started we were all taken aback and no one in the medical field was sure what we could expect. There was an incredible fear and if you caught the virus your prognosis was unclear.  Therefore, once we started testing people in March we needed to follow up with them a second time to see what occurred because their course was unknown.

As a result we reported the number of active cases. Active cases are calculated by taking the total number of positive cases (after you have a swab placed in your nose and you are told it is positive) and subtracting out the number of people that have recovered. How do we know if a patient has recovered? The Health Department has to either retest them or call them to see if they are then asymptomatic. After this then they are considered recovered. So once you test positive you are considered active until the Health Department declares you recovered.

Fast forward to today from March. The course of COVID-19 in 99.7 percent of people 60 and younger that have tested positive here in Hamilton County is for the patient to recover, and in my opinion will only improve.

Therefore, why are we looking at the number of active cases to gauge our ability to open our economy and schools? If there is an increase in positive cases, won’t we see an equal increase in
recovered cases in the next 7-10 days? (which is the usual course of the disease). As a result we will see a volatile increase and decrease of active cases because there is a lag in time for the Health Department to follow up and record that the patient has in fact recovered.

Why are the majority of positive cases recovering? As our economy opens up, the number of positive cases will increase, but I can only imagine the vulnerable are staying put so they aren’t being exposed and more healthy people are being exposed to the virus and are simply improving on their own. An additional factor is that the hospitalized positive cases are receiving improved care as doctors and nurses have learned to treat COVID-19 in so many improved ways. As a result the majority are being discharged home after a stay in the hospital. 

To open our schools and economy safely and maximally we need a number that tells us how severe the virus is and how much it is spreading. I simply don’t see how useful using active cases  is in providing us with this information. It might have been useful early on since little was known about the virus, but we are starting to see a consistent course for this disease, so its usefulness as the key gauge to determine what phase school opens up is in question.

The opening of school is so critical to learning and the success of our children. Here in Hamilton County we made tremendous progress last year that we cannot afford to lose. I strongly feel that we need to wrestle with the numbers relating to COVID-19 and gain a true insight into what they really mean so we can all feel confident in our decision to open school this fall. Numbers are important, but their meaning is what we need to focus on. Sure, there is an increase in positive cases, but if 99.7 percent recover does this really matter? Hospitalizations may increase, but if most are being discharged back home then that would be important to convey. 

COVID-19 is to be respected, but not feared. All we have to do is wear a mask, social distance, wash our hands, and stay home if we feel sick. This will limit the spread of the virus. 

I encourage the Hamilton County Task Force on Reopening of Schools to continually meet and revisit the criteria that will be used to reopen schools. We are constantly learning more and more about this virus. New treatments are being developed and public attitudes toward mask wearing is improving. Anecdotally, many institutions here in Hamilton County have already opened up with great success. Hospitals and EMS have been able to meet the needs of sick patients with COVID-19 while keeping staff safe. I will admit that I was scared in April when I walked into a patient’s room for the first time that had COVID-19. Nevertheless, I was inspired by others who took that same step before me. There is a sense of duty that we need to be listening to and not the irrationality of fear.

I have been impressed with the requirements of masks, sanitation, and social distancing that the school board is requiring. Couple that with temperature testing and parents taking an oath not to send sick children to school, and classrooms are going to be a safe place to be. I encourage teachers that encounter disruptive students that don’t adhere to guidelines to send them home so
they can learn remotely.

Hopefully we can come together as a county and truly understand the data regarding COVID-19 so we can move forward rationally and open schools as much as possible safely and consistently so families can plan their lives with minimal disruption. We have a duty to inform and not sensationalize. The public has a duty to wear a mask and keep the vulnerable safe. While initially there may be some anxiety, I am confident once school starts, normalcy will quickly return.

Louie Meier, MD
Emergency Medicine Physician

* * *

Thank you to Dr. Meier’s thoughts on this very basic question that no one is asking.  The bottom line is that the Hamilton County Task Forces used a single number to determine whether or not 40,000 young, healthy students have one day in an actual classroom this year.  The threshold that they set was painfully low and much too conservative.  With all the experience and brainpower that the Task Force included, they could have at least used a combination of statistics and developed a matrix to determine the various phases.  Do active cases include many people who do not reside in our county or even the State of Tennessee?  Also, don’t underestimate the onslaught of positive testing that is only weeks away when thousands of healthy asymptomatic college students are tested prior to returning to campus.    


Dr. Meier brings up some very good questions and many of the same questions that a non-medical professional like me have pondered for weeks now.  This is not a difficult question, but no one on any level to include local media or the TFP seem to want to ask or consider.  I love the general idea that the virus is to be respected, but not feared.  This very basic concept would go a long way in every aspect of society right now.  The virus is here, it’s not going away soon, we know a lot more about it, and it’s not a death sentence to every person who gets it.  As Tennesseans and Americans, we need to power through this pandemic in a responsible and courageous way.  We also have to accept that the virus will continue to spread and that we have to learn to deal with that reality every day for the foreseeable future.   


Not opening schools will be the single most detrimental thing about this whole saga.  Along with 40,000 kids comes about 80,000 parents who are losing their patience, their minds, and their jobs.  For those most vulnerable and disadvantaged children, their plight will only get worse.  Of those 40,000 kids, there are a significant number of them who don’t have a mommy and/or daddy at home to help them with their glossary words and math assignments.  They will learn nothing, continue to fall behind, and will be left with a lot of spare time on their hands to roam the streets and get sucked in to gangs and abuse.  This will be a huge hit to poor and minority children in our community and teachers, HCDE leaders, school commissioners, and the “Task Force” all know this.  Revisit the phased approach now based on what we know going into August 2020 and try to do the hard thing which these days is to do something instead of the easy route of doing nothing. 


Robert Maner

East Ridge

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