Even before it enlisted the help of the National Guard to offer drive-thru testing clinics on weekends, Tennessee had emerged as a regional leader in coronavirus testing.

But since those weekend clinics started, the Volunteer State has widened its lead, and has the numbers to make an argument for leading the South when it comes to its coronavirus response.

The state has tested nearly 18,000 people at those drive-thru testing sites — which are open to anyone, regardless of symptoms, and free — the past two weekends. Those numbers have contributed to the total of almost 170,000 coronavirus tests that have been performed in Tennessee.

As a result, Tennessee is one of only three states in the Southeast that has tested more than 2,000 people per 100,000 population since the coronavirus outbreak began. Only Louisiana, which has tested 3,404 per 100,000, has tested more than Tennessee’s 2,479 per 100,000.

It is a number that off-sets the total number of coronavirus cases in Tennessee. At first glance, the Volunteer State is one of the hardest-hit states in the region when it comes to Covid-19 illness — one of just four states with more than 10,000 cases. And while Tennessee’s 10,366 cases pales in comparison to the more than 25,000 cases that have been confirmed in Georgia and Louisiana, and the more than 33,000 in Florida, the Volunteer State has far more confirmed cases than some other states in the South — such as Arkansas, which has just over 3,000 cases, and Kentucky, which has fewer than 4,500.

But despite what appears to be an excessive number of coronavirus cases, the rate at which Tennessee’s tests are returning positive is less than any other state in the South — underscoring the number of tests that are being conducted here.

As of Wednesday, Tennessee’s tests were returning positive just 6.2% of the time. No other state in the South was returning fewer than 7% of its tests positive.

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Across the region, states that have ramped up testing have seen the percentage of positive cases drop. Mississippi was once returning nearly 1 in every 4 of its tests positive. As the state has significantly boosted the number of tests it is performing, however, the rate at which tests are returning positive has dropped to just under 10%. But, as a consequence, the state has gone from having relatively few cases of coronavirus to having more cases per capita than Tennessee; its 219 cases per 100,000 people is among the most of any state in the South.

Like Mississippi, Alabama and South Carolina have seen the rate at which their tests are returning positive decline as they have begun testing more people. In Alabama, only 8.5% of tests are now returning positive; that percentage was well into the double-digits at one point. In South Carolina, the percentage of tests returning positive is still hovering near 11%, but South Carolina is still performing relatively few tests; the 1,063 tests per 100,000 population that have been performed there is the lowest per capita testing amount in the Southeast.

Tennessee has been no exception. While the Volunteer State has never had a positive rate of greater than 9% on the tests it has conducted, the percentage has dropped as the number of tests being conducted has ramped up. Over the past week, since Tennessee began testing more people, fewer than 5% of the tests have returned positive.

On the other end of the scale, the two states where the outbreak has been particularly bad — Georgia and Louisiana — are still seeing nearly 1 in 5 tests return positive. In each state, the rate that tests are returning positive hovers at around 18%.

Those numbers seem to suggest that while Louisiana — which has had nearly 28,000 confirmed cases of coronavirus so far, or a whopping 601 per 100,000 people — is testing more people per capita than any state in the South, including Tennessee, it still isn’t testing a sufficient amount of people to truly paint an accurate picture of the outbreak there.

There are other indications that Tennessee is leading the South in testing, as well. As of Wednesday, the coronavirus case fatality rate in Tennessee was 1.9%. That’s the second-lowest in the South, trailing only Arkansas, which has a case fatality rate of 1.8%.

The case fatality rate is a measurement of deaths against confirmed cases of the virus.

Based on studies in controlled environments — such as the Diamond Princess cruise ship — experts figure that the actual death rate of coronavirus is about 1%. But just about every U.S. state has case fatality rates that are well above that. Experts say that’s because no state truly knows how many of its citizens have coronavirus. A significant number of coronavirus patients are proving to be asymptomatic — a fact that was underscored last week, when the TN Dept. of Corrections found nearly 600 infected inmates at a state prison in Bledsoe County. Most of those inmates who tested positive had never shown coronavirus symptoms.

As a result of so many of those infected with the virus being asymptomatic or otherwise going undetected, case fatality rates are higher than the virus’s actual death rate. In theory, the more tests that are being performed, the more of those mild or silent cases that will be detected, thereby lowering the case fatality rate.

That seems to be underscored in Tennessee, where the unusually high amount of testing that is being performed coincides with an unusually low case fatality rate.

On the other end of the spectrum, Kentucky, which has few known cases of coronavirus but has been criticized for a lack of testing, has a high case fatality rate — with 5.1% of its known cases of the virus ending in death. The only state in the South with a higher death rate is Louisiana, at 6.7%.

Louisiana’s high death rate, coupled with its positive test rate of 17.7%, continues to underscore that the state isn’t testing enough people.

Finally, a sign that Tennessee is closer to discovering its real number of coronavirus cases than other states in the region: Not only is the Volunteer State’s case fatality rate lower than any state in the South with the exception of Arkansas, but the percentage of patients requiring hospitalizations is lower in Tennessee than anywhere else.

As of Wednesday, 9.8% of diagnosed coronavirus patients in Tennessee had required hospitalization since the outbreak began. No other state in the South had a hospitalization rate of less than 12%. (Louisiana and North Carolina do not offer a cumulative total of hospitalized patients. However, the current number of hospitalizations in each state represent nearly 6% of the total number of coronavirus cases since the outbreak began, indicating that each state’s cumulative hospitalizations is far ahead of Tennessee’s.)

The next closest state to Tennessee was Arkansas, where 12.2% of patients have required hospitalization.

In general, states that perform fewer tests have a higher percentage of patients who have required hospitalization — an indication that a lot of the milder cases of the virus are going undiscovered in those states.

In Kentucky, for example, which has tested fewer people per capita than just about any Southern state, a whopping 30% of patients — 3 out of every 10 — who have been diagnosed have required hospitalization. In Virginia, one of the few states to test fewer people than Kentucky, nearly 1 in 4 patients have required hospitalization. In Georgia, which is also testing relatively few people with nearly 1 in 5 tests returning positive, nearly 20% of patients, or 1 in 5, are requiring hospitalization. In South Carolina and Mississippi, the other two states, along with Kentucky and Virginia, that have tested very few patients, greater than 17% of patients are requiring hospitalization.



Go Deeper: New hospitalizations are on the rise in Tennessee