Coronavirus Spread in Tennessee, Despite State Paying for Covid-19 Testing – The New York Times

There are some obvious explanations for Tennessee’s travails. The state was among the first to reopen its economy, and many people abandoned social distancing and masks. A country music star, Chase Rice, performed in late June in front of 1,000 people — most not wearing masks — at an outdoor venue in eastern Tennessee and was eventually shamed into delivering what critics called a nonapology

Young people jammed into Nashville’s famed honky-tonks and bars; Dr. Jahangir said the biggest growth in cases in the city was among people ages 25 to 34. In a city whose economy thrives on music and drinking, tensions have erupted between businesspeople and public health officials.

One of the city’s best-known establishments — Kid Rock’s Big Ass Honky Tonk & Rock ’N’ Roll Steakhouse — lost its permit to serve beer for five days after opening its bar in violation of a city public health emergency order that limited alcohol to tables and booths. Photographs on social media showed a packed house of maskless patrons standing shoulder to shoulder. On Monday, Kid Rock’s was among several bars whose owners sought a temporary restraining order against city and state health officials.

“We did well, but then stuff started opening up, and there’s not national leadership. I don’t care if you quote me on that, because I’m tired of being P.C. about that,” Dr. Jahangir said, referring to political correctness. “There’s not national leadership, and there’s a lot of pressure to open up the economy.”

Public health experts say they saw this coming and have been warning for months that the country was too focused on testing and not enough on other measures, like contact tracing, that must be paired with it.

“I feel like we’ve got attention deficit disorder — we can only focus on one thing: a travel ban, stay at home, testing,” Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention, recently told reporters. “None of those things are going to work in isolation.”

Dr. Osterholm said he, too, had been trying to send the message that “the testing, testing and testing mantra was not going to save us, or even materially change the course of the pandemic.” He said he saw offering tests to anyone, regardless of symptoms, as a waste of precious resources.

In May, he and his colleagues published an article calling for a national blue-ribbon panel to devise a “smart testing” strategy.

But the Trump administration has resisted a national testing strategy, insisting that it be left to the states. And Mr. Trump’s mixed messages about testing are only complicating matters. His claim in April that the United States had “tested more than every country combined” was rated “‘pants on fire’ wrong” by Kaiser Health News.

Now, the president has taken to blaming the rising caseloads on an increase in testing — an assertion that is also false, given that the percentage of tests coming back positive is also rising. The sharp increase in confirmed infections has created more demand for testing, leaving some governors back where they started: scrambling for scarce supplies.

“Although we have greatly expanded the amount of testing we have done in the United States, the virus has outpaced those efforts,” said Dr. Jennifer Nuzzo, the lead epidemiologist for Johns Hopkins University’s Covid-19 Testing Insights Initiative.

Throughout the spring, administration officials and public health experts said states needed to ramp up testing and contact tracing to reopen. But very few were doing enough to stay on top of potential outbreaks. Tennessee’s expansive approach stood out, according to a report in May by Kaiser Health News, which wrote that it was ”rare for a community to encourage such broad symptom-free testing.”

Building capacity took time. The state’s health commissioner, Dr. Lisa Piercey, said in an interview that she initially relied on national laboratory vendors, who were slow, before turning to private labs based in Tennessee.

It was a win-win situation, she said: By guaranteeing payment, the state created a ready market for the local laboratories, which were able to purchase new equipment, scale up and deliver test results quickly. Facing outbreaks in prisons and nursing homes, the state also did targeted testing.

Tennessee’s governor “made two very important decisions that I wish could have been a national model,” said Dr. James E.K. Hildreth, the president of Meharry Medical College in Nashville. “He made testing available to anyone who wanted a test, and he also decided to test nursing homes and prisons.”

But not everyone has such high praise. Dr. William Schaffner, a professor of preventive medicine and infectious disease Vanderbilt University in Nashville, said he gave the governor a B+ for his management of the pandemic. While Mr. Lee had “modeled wearing masks,” Dr. Schaffner said, the governor opened the economy “earlier than the medical community wanted, and so that knocks him down a little bit.”

Mr. Lee, a businessman who had never held public office before becoming governor, said the decision to offer free testing grew partly out of his Christian faith; he did faith-based nonprofit work in Haiti, Mexico and Africa, which gave him an appreciation for those confronting disease. Dr. Piercey said they had prayed about it.

“Our key success factor is you will never pay for a test,” she said in late May, when daily confirmed infections were declining and the positivity rate was about 5 percent. “We couldn’t think of a better way to use our resources than on widespread testing.”