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COVID-19 trends in Tennessee and the United States over 40 weeks

Biometrics & Biostatistics International Journal
Todd R. Ashworth, MS,1 Sheryl Strasser, PhD,2 Billy Brooks, DrPH,1 Shimin Zheng, PhD1

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Coronavirus disease 2019 (COVID-19) occurred and spread in Spring 2020 in the United States. The study of early COVID-19 incidence rates distribution and trends between the State of Tennessee in comparison with US rates can offer important insights into public health system surveillance and epidemic control measures. Objective: The purpose of this study is to evaluate weekly trends in the COVID-19 crude incidence rates experienced in the first 40 weeks of the pandemic in the US and Tennessee in 2020 using Joinpoint Regression Trend Analysis Software and provide the important insights into public health system surveillance and epidemic control measures. Methods: Joinpoint regression modeling was used to evaluate weekly COVID-19 incidence rates experienced in the first 40 weeks of the pandemic. COVID-19 incidence rates over 40 weeks between the State of Tennessee and the United States were compared using data obtained from the Johns Hopkins University & Medicine Coronavirus Research Center. Results: Evaluation of weekly trends comparing the crude incidence rates within Tennessee versus the United States reveal that there were significant historical shifts that occurred over time. The initial two months of the pandemic, the incidence rate in Tennessee was below the national rate before catching up in week 8. Beyond week 9, Tennessee rates remained above the national average through week 40. A sustained decrease in the rate, was observed from approximately week 18 through week 26. Conclusions: Joinpoint regression analysis results offer important investigative insights into public health surveillance and epidemic control interventions. Our findings show that Tennessee COVID-19 case rates were below national rates for the first 8 weeks of the pandemic and in the 30 weeks that followed, the incident rate in Tenseness rose and remained above the national rate. There as a notable 8-week decrease in COVID-19 cases occurring between approximately week 18 and 26, which offers a critical window of insight into public health and ecological influences that may be attributed to this decline. While overall trends between Tennessee and the overall were similar over the course of the pandemic, Tennessee rates remained higher over the longer duration. Investigation into extraneous factors that may have contributed to the steady rise, and period of decline, are important to support intervention strategies that may have effectively curbed coronavirus spread, as well as into factors that may have catalyzed the collective 32 weeks associated with increased incidence rates across the State.  


joinpoint regression, COVID-19, incidence rates, pandemic, trends