Comparatively harder-hit: Data over full pandemic show higher mortality, hospitalization rates regionally

Local Coronavirus Coverage

The population-adjusted COVID hospitalization rate in Northeast Tennessee the past two months is more than double the statewide average.

JOHNSON CITY, Tenn. (WJHL) – With 2020 in the books, a data analysis shows COVID-19 death and hospitalization rates are disproportionately higher in the News Channel 11 viewing area than Tennessee and Virginia as a whole.

Even though the region avoided much impact until mid-summer while other parts of Tennessee and Virginia were hit earlier, the 15-county viewing area caught up and surpassed those respective states in the measures that affect families most.

When the year ended, Northeast Tennessee’s COVID cases per 100,000 population was 12 percent lower than the state’s figure. Its death rate, though, was 28 percent higher.

ETSU Health’s Chief Medical Officer, Dr. Sheri Holmes, said that’s because regardless of how much testing is being done, the true rate of cases and the overall age and health of a population tend to rule the mortality numbers.

“The hospitalizations and deaths … tease themselves out over time,” Holmes said. “When you look at your total percentage as far as the number of occurrences per hundred thousand, those numbers in context with the rest of the nation are very frightening.”

The News Channel viewing area on both sides of the state line has higher death rates than both states as a whole and the country.

When the year ended, Northeast Tennessee had the highest rate of deaths per 100,000 population — 128 — compared with Southwest Virginia, Tennessee, Virginia and the entire United States.

Southwest Virginia’s 109 deaths per 100,000 was the second-highest. It was followed by the national rate — almost certainly skewed upward by the higher mortality rate that occurred in the spring.

Tennessee’s rate is just below the national rate while Virginia’s is far lower. Both states also had pockets of high case rates and higher death rates early in the pandemic, particularly Virginia.

Northeast Tennessee’s deaths per 100,000 would rank it 11th among the states.

Case rates a tale of two states

The disparity between Tennessee and Virginia’s COVID case rates is stark. The Volunteer state has battled a nation-leading surge over the past several weeks and now ranks sixth in cases per 100,000 over the course of the pandemic.

Virginia’s rate is less than half Tennessee’s. The commonwealth, which has pursued stricter measures such as a statewide mask mandate, ranks 44th in cases per 100,000.

Regionally, though, the gap between the two states is much narrower. Northeast Tennessee’s case rate is actually lower than Tennessee’s while Southwest Virginia’s rate is a third higher than the statewide average.

That closer gap has prompted several thinly veiled criticisms of Tennessee’s approach to mask mandates and other restrictions. Mt. Rogers Health District Director Dr. Karen Shelton has been outspoken, talking of Southwest Virginians’ frequent travel across the state line to work and shop.

Gov. Ralph Northam also referenced the difference as a possible explanation for the elevated numbers in this area.

Within the past month, a spike in Southwest Virginia’s case rates has driven those averages closer to the ones in Northeast Tennessee. During the same period Southwest Virginia has seen its daily new hospitalizations climb toward a peak even as Northeast Tennessee’s rate has declined some.

Combining the numbers yields mortality rate

Using data for cases per 100,000 and deaths per 100,000 can yield the mortality rate — deaths per 100,000 cases.

That figure shows a very big disparity between Northeast Tennessee and the state as a whole. The 1.71% mortality rate in the region is 47% higher than the state’s rate of 1.16%.

Virginia’s got a significantly higher mortality rate than Tennessee, at 1.42%, but Southwest Virginia’s 1.99% rate is 40% higher than the statewide average.

The U.S. mortality rate has almost certainly dropped since the first wave of deaths in the spring, but it still stands at almost the same level as Northeast Tennessee’s — 1.72%.

Hospitalization gap widening in Tennessee

Tennessee’s hospitalization data is more easily accessible than Virginia’s. What it shows is that Northeast Tennesseans are being hospitalized at higher rates over the entirety of the pandemic, and that the gap is even more pronounced in the past two months.

Even with the lower case rate, Northeast Tennessee has seen 268 people hospitalized per 100,000 population since March. That’s 26% above the state rate of 213.

But a look at the last couple months bears out Dr. Holmes’ concerns. More than half the region’s hospitalizations have occurred since Nov. 1, while fewer than a third of Tennessee’s have overall during that time.

As a result, the hospitalization rate over the past two months is 2.4 times the state’s rate.

East Tennessee State University College of Public Health Director Randy Wykoff said the disparities aren’t surprising.

The gap’s causes include the region’s average age and the higher incidences of serious disease — often called “co-morbidities.” Northeast Tennessee’s average age is 43.6 while Tennessee’s overall is 38.8, Wykoff said.

In addition, more than one in five Northeast Tennesseans is over 65 compared to one in six people statewide.

“Old age is one of the major risk factors from COVID, so even given the same number of cases we would expect more hospitalizations and deaths,” Wykoff said.

When it comes to chronic disease, Northeast Tennessee’s heart disease death rate was about a third higher than the state’s and its cancer death rate was one fourth higher. Those figures are from 2018.

Overall, the region had a death rate 17 percent higher than the state prior to COVID, Wykoff said.

“I think this is all consistent with, we are a high-risk population in terms of age, in terms of chronic disease, unfortunately,” Wykoff said.

While it’s early, one number stands out in Northeast Tennessee’s favor. Through mid-week, the region’s counties were among the most successful in getting people vaccinated, adjusting for population.

Data supplied by the Tennessee Department of Health show that roughly 8,000 vaccinations had been delivered through Dec. 29.

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