CHATTANOOGA, Tenn. — When Marlene José, 20, lost her mom to the coronavirus weeks after she lost her 1-year-old brother to the disease, she said, she felt like she was "split in half."
Her mother had been in the intensive care unit for a week, her lungs struggling to capture oxygen. She lost the ability to speak and breathe on her own before she succumbed on June 15.
"I told her, 'I'm here with you.' I told her, 'Soon God will get you out of this,'" José said of the last time she spoke with her mother, whom NBC News isn't naming because of her immigration status. Four days later, José's mother died alone in the hospital.
José's sad situation is one that is increasingly common in this small city in the foothills of Appalachia on Tennessee's border with Georgia. Hamilton County, where Chattanooga is located, recorded a single-day record on July 1, with 118 new cases. It has also had 16 deaths since June 1, bringing the total death count as of Sunday to 35 as the spread of the virus perpetuates the nation's greatest health emergency in more than a century.
This city, like so many others in the South, has the makings of a virus hot spot: It reopened quickly, there is little regard for masks and distancing, which studies show help mitigate the disease, and contact tracers have begun to lose threads on possible infections. Meanwhile, bars, restaurants, gyms, beauty parlors, pools and many other businesses have remained open despite a precipitous increase in coronavirus infections.
This all hits the Hispanic community particularly hard. Hamilton County Health Department data show that Hispanics have an outsize infection rate compared to other groups, likely because they are more often essential workers who live in multigenerational homes.
The infections are beginning to spread throughout Chattanooga, however, without regard to ethnicity. The reasons appear clear: Many residents seem to be carrying on as though there is no pandemic. Politicians, health experts and residents also said everything was made increasingly difficult by the perceived politicization of responding responsibly to the disease.
Meanwhile, case counts, hospitalizations and deaths continue to rise, and they could be spreading faster than recorded cases show, according to a sewage study the city of Chattanooga conducted with Biobot Analytics.
"It's been a very delicate balance between the health and welfare of our people and their economic health, as well," said Rae Bond, the executive director of the Chattanooga-Hamilton County Medical Society, who is leading the local COVID-19 task force. "I don't think any community wants to have to close the doors again and to go back to the full shutdown we had before. But at the same time, as the cases continue to expand, it becomes challenging."
Economic prosperity versus public health
Part of that changed Monday with the announcement of a mask mandate for all of Hamilton County, but there are still concerns that it could be too little, too late.
After much political infighting and frequent public disagreements, Hamilton County Mayor Jim Coppinger, a Republican, agreed to the mandate that everyone in the county wear masks or face $50 fines or 30 days in jail.
"The punitive part of this is not what we're looking for: We're looking for compliance," Coppinger said at a news conference announcing the mandate Monday. He had previously opposed the measure because he didn't consider it enforceable.
Chattanooga Mayor Andy Berke, a Democrat, had long wanted a mask mandate and a slower reopening for his city, but he lost oversight of Chattanooga's COVID-19 response at the end of April when Tennessee Gov. Bill Lee ended the state's stay-at-home order and sent residents back to work. Lee's executive order further vested Berke's power to respond to the pandemic in the county Health Department and Coppinger, who declined to comment.
The governor's office didn't respond to a request for comment.
On Friday, Lee gave the authority to mandate masks to the mayors of 89 counties, rather than order them at the state level, even as Tennessee has one of the lowest mask use rates in the country, according to a University of Washington study. Fewer than 10 percent of Tennesseans reported wearing masks regularly.
"The president who has the largest microphone in the world is not encouraging people to wear a mask," Berke said while wearing a mask inside Chattanooga's shuttered City Hall. "On the local level, it's hard to overcome that kind of messaging. So that's left us, unfortunately, with mandates as the necessary response."
Berke and Coppinger in many ways represent the politicization of masks and the response to the pandemic, as well as the challenges local and state governments face as they walk a tightrope between economic prosperity and positive health outcomes.
But Berke is concerned that with Lee's decision to reopen quickly and Coppinger's willingness to go along with the governor's reasoning, Chattanooga could soon see the virus at a level similar to New York City's and without the economic flexibility to shut down once again. Berke said that the $2.5 million the city set aside to help small businesses during the shutdown has already been spent and that owners of many shops, bars and restaurants used their life savings to reopen.
Without a bailout from the federal government for state and local governments, which is unlikely to be approved by Congress, the city's economy may not be able to survive another shutdown.
"If something like that happens again, given our decline in revenue," Berke said, referring to the drop in city tax revenue, "we don't have the same capacity or ability to support people as we did even three months ago."
Reopened but at risk?
The situation is especially frustrating for those who have been out of work and see the sudden uptick in cases as a sign that they will be unemployed even longer. While a group of people can pile into a bar without masks, live performances at theaters, where Erin Kellam worked as an electrician, still can't bring in audiences.
Kellam has been unemployed since the pandemic started, and she fears that a spike in cases could mean she won't be able to return to work any time soon. The development also comes as the CARES Act, which provides an additional $600 to state unemployment benefits, is set to run out at the end of July with little hope of being extended by Congress.
"I don't think we should have ever opened back up until we started to see that decline, and, as rapidly as we're rising now, we have to do something to start to get a decline," Kellam said. "But many of my friends and family that I have on my Facebook still believe it's a hoax."
Some argue that a city like Chattanooga, which is economically tied to hospitality and tourism, can't survive if people stay inside through the pandemic. Some businesses that have reopened insist that they are doing so safely.
Ruby Falls, a popular tourist destination on a ridge just outside the city limits, now runs at about 40 percent capacity, allowing 25 masked people to ride down an elevator into the cave at 15-minute intervals. Twenty-six stories below the ground, groups wind their way through narrow, cold, damp corridors at the direction of a tour guide as an employee watches the cave's camera feeds and tries to stop groups from crossing paths as much as possible.
The attraction sells all of its tickets online, so it knows how many people will arrive each day. It has regularly sold out since it reopened the tours on May 19, even with the recent spike in cases.
Ruby Falls CEO Hugh Morrow was an adviser for the state's reopening strategy and helped write the Tennessee Pledge, a series of guidelines that businesses can follow to safely reopen. He said that the park is continuing to operate at a loss despite the large influx of people but that being open allows it to pay staff and puts it in a prime position to reopen at full capacity if the pandemic is resolved. Morrow said visitors are getting a "tremendous value" because of the smaller tour groups.
"We feel that we're following protocols as tightly as they can be brought," he said inside Ruby Falls' closed cafe. "The analysis of our people that we do every morning when they walk in, where they've been and what they've done, is important. It's extremely important to be open and open safely and that we begin to re-create some of our tax base."
Contact tracers, however, point to large attractions like Ruby Falls as a frustrating variable as they try to follow the path of the infection through Chattanooga, and large exposure events continue to occur.
Dawn Ford, a former Hamilton County Health Department epidemiologist who led the local response to bird flu, is now a professor at the University of Tennessee at Chattanooga, where she oversees a contact tracer training program. About 100 students and professors have gone through the training and volunteer to follow cases as best they can. The local Health Department has hired eight of the trainees to do the job full time.
Ford's concerns are that most of the people they call don't want to participate and aren't taking the disease seriously — some are even openly hostile — and that the disappearance of social distancing will make their jobs impossible.
"It's getting more difficult," Ford said. "A couple of months ago, most people were agreeable. But I think as people realize that they're going to be under quarantine for 14 days if they're interviewed by the Health Department, they are becoming less and less willing to work with us."
As case counts and deaths continue to grow in Chattanooga, Berke, who has largely been sidelined in the response, said a local response won't be enough to mitigate the disease, especially in this city that shares borders with two other states that have their own protocols and rules.
"It's a global pandemic," Berke said. "A small-scale response doesn't lead to the outcomes that you want. You have to have consistent large-scale interventions to stop this virus."