As the number of confirmed coronavirus cases increases in Tennessee, state officials stood behind a decision to no longer release county-level data — a move critics said was a step backward that will generate confusion.

But after facing a backlash of criticism, the state once again reversed course, opting to release county-level information about coronavirus cases.

The back-and-forth began last week, when the state announced its first case of the coronavirus, or COVID-19. Department of Health Commissioner Lisa Piercey said the 44-year-old man was a Williamson County resident.

“While we typically do not disclose county-level data on patients, given the recent severe weather impacts on some counties in Middle Tennessee, we are sharing that this patient is a resident of Williamson County," Piercey said.

Piercey said the state was "committed to transparency."

But since then, state government has clamped down on what and how often information is released. Since Friday, three spokespeople for the Tennessee Department of Health have stopped answering The Tennessean's questions about the coronavirus and insisted that all information will be released through occasional news conferences or a daily update on the agency website.

The stance was reiterated Tuesday morning when agency spokeswoman Elizabeth Hart said the agency would release no information about the virus outside of a 2 p.m. post on its website and Facebook and Twitter.

When a fourth case of coronavirus was announced in Tennessee on Monday, state officials indicated they would reverse course and stop releasing county-specific data going forward.

Shelley Walker, a spokeswoman for the health department, said the agency would only identify the grand division of each new case, which is how the agency has approached other public health concerns, like vaping-linked lung illness.

But late Tuesday, after facing criticism over the public release of county-level data, Walker said the agency would once again provide such information.

Health department cites patient privacy concerns

During a Monday afternoon meeting of a recently formed task force, Piercey explained the decision about ending the release of county-level data, citing privacy issues.

“Patient privacy is very important to us," she said. "While it might be easy to blend in a very large community with several hundred thousand people, when we have counties that are very small and rural, the risk of reidentification is very high.”

The decision was quickly met with criticism.

Chaz Molder, the mayor of Columbia, called for the state to release additional data on social media, saying citizens "deserve to know — for their own safety."

An online petition was quickly started calling for the information to be released.

Senate Minority Leader Jeff Yarbro, D-Nashville, said Tuesday that state officials need to err on the side of transparency.

"There is grave uncertainty stemming from communication difficulties with the federal government and the state should be endeavoring to build trust in every decision it makes," he said. "Unless there is a compelling public health rationale, this decision should be reversed."

Yarbro called the decision to withhold county-level data an "unforced error."

Health departments in other states across the country that have seen confirmed cases of the coronavirus have released a wide range of information.

In Florida and Colorado, the public can find how many tests have been performed, including whether they were positive, negative or pending, in addition to county level data — including whether the person infected had a history of international travel. In Washington, which has seen some the most cases of coronavirus in the United States, the states share county-level data that also includes the age and sex of patients.

► Newsletter: Stay safe and informed with updates on the spread of the coronavirus.

In recent days, the Tennessee Department of Health's website has contained little and at-times outdated information. During the task force's Monday meeting, the agency's website was displayed on a television. At the time, the website said the state had just three cases, despite a fourth being announced earlier in the day. Piercey said starting Tuesday afternoon, the department will have a daily live update with the latest developments on their website.

When the agency's website update went live at 2 p.m. it contained no additional information about coronavirus in Tennessee beyond confirming the state had a seventh case.

"To be an outlier in providing less information than other states and other countries is ridiculous," Yarbro said.

Open-records advocates: Less information means more confusion

Deborah Fisher, executive director of the Tennessee Coalition for Open Government, said sharing county-level information with the public provides assurances.

"That doesn't create hysteria, that actually creates a little bit more calm because you feel like you're getting the facts from your government," she said.

By withholding the information, Fisher said it would generate rumor and confusion among the public.

One example of such confusion came Tuesday morning, when Williamson County schools announced they were canceling school. The move came after a Brentwood parent told the district they had tested positive for coronavirus, according to the school district. It was not immediately clear whether the parent was one of the state's first four cases of coronavirus or if they were a new case yet to be announced by the state.

Confusion continued when the Department of Health said hours after the school closure Tennessee had two more cases of coronavirus.

Fisher rejected the notion that releasing county-level data was necessary to protect citizens, noting Pickett County, the state's smallest county, has 5,000 residents.

"If I lived in a rural county, I would want to know if there was a confirmed case in my county," she said.

Fisher said given the state's limited resources, providing the public more information could create a system where residents call in tips akin to the Crime Stoppers hotline.

"The state doesn't have to release the name of an individual," she said. "This isn't China where the state tries to control every piece of information out there."

Early Tuesday evening, the Department of Health sent out another email, saying it intends to once again release the counties of residence for confirmed cases of coronavirus. The updates, however, will not include age or gender, said Piercey, the commissioner, who cited a need to balance transparency with patient privacy.

Several other states have continued to release both gender and age of patients who have tested positive.

"While the department's standard protocol for outbreaks is to announce information by region, we understand COVID-19 is an evolving situation presenting unique concerns for our communities," Piercey said.

The department's latest data indicated four of the seven confirmed cases were in Williamson County. Shelby, Davidson and Sullivan counties had one confirmed case as well.

Brett Kelman contributed to this report.

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Reach Joel Ebert at jebert@tennessean.com or 615-772-1681 and on Twitter @joelebert29.