NASHVILLE (AP) — Tennessee is seeing a rise in COVID-19 cases in rural and urban areas, including a 93% increase among Nashville children up to 17 years old since September began, city officials said Thursday.

It's possible the increase extends to schoolchildren's families, according to Nashville health officials, because cases among those 35 to 44 years old are up 27.3%, and up 32.5% among 45- to 54-year-olds.

According to state data, Nashville has seen 2,701 confirmed cases among children ages 5 to 18, up by 161 over the past 14 days.

The increase comes just as Nashville's public schools have begun in-person classes this week, so the infections would almost entirely predate that.

Instead of stemming from in-class instruction, the infections seem to originate from extracurricular activities and social gatherings, officials said, though a few private schools have closed temporarily due to COVID-19 so far.

In terms of the rate of recent infections, however, smaller counties are being hit harder. The 10 Tennessee counties with the most new cases per 100,000 people in the past two weeks each have a population less than 40,000. Pickett County, with a population of more than 5,000 people and 87 cases in the past two weeks, has the highest rate.

State Health Commissioner Lisa Piercey said Wednesday that the COVID-19 rural death rate is double that of urban areas. And over the last month or so, the average age of someone infected in Tennessee rose by at least 10 years to 43 years old, she said.

Tennessee now has the 13th most new confirmed cases per capita in the past 14 days among all states, according to data from Johns Hopkins.

The seven-day rolling average of daily new confirmed cases in Tennessee has risen from 1,347 on Sept. 30 to 1,869 on Wednesday. The state reported more than 2,200 new cases Thursday. The seven-day rolling average of the positivity rate in Tennessee was 5.51% on Sept. 30; it grew to 7.22% as of Wednesday.

Nashville Mayor John Cooper said it's a "pivotal moment" for his city but added that he does not plan to reinstate stricter limits on businesses from earlier in the pandemic. Cooper and Piercey similarly said people need to focus on wearing masks, washing their hands and keeping a social distance.

"It's ebb and flow. We're watching it closely right now," Piercey said. "There aren't any specific new actions to take other than just a reemphasis on personal responsibility."

Nashville's increase doesn't account for any possible cases from a worship gathering that packed a big, largely unmasked crowd together outside the city's historic courthouse Sunday.

Nashville interim police Chief John Drake said Thursday that his department saw a Facebook post about the gathering beforehand and tried to contact the organizer without success. Police thought the event would be no larger than 200 people, Drake said, though it grew much larger.

Drake said an on-duty sergeant drove by the event and saw that it wasn't disorderly and decided not to notify police command staff. Drake said he had a conversation with his department's leadership earlier this week to ensure notification is always made.

"Had I been notified, we would have made the proper decision, one, to warn of social distancing, two, to wear a mask and to educate," Drake said.

Meanwhile, Tennessee's seasonally adjusted unemployment rate in September was 6.3%, down from 8.6% in August. The state unemployment rate hit a record high of 15.5% in April, as businesses around Tennessee closed or limited operations as part of the virus outbreak response.

For the week ending Saturday, the state paid more than $43 million to more than 138,000 unemployed people, state Department of Labor & Workforce Development said. In all, more than 880,000 new unemployment claims have been filed in Tennessee this year.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including life-threatening pneumonia.

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Adrian Sainz in Memphis, Tennessee contributed to this report.

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Follow AP coverage of the virus outbreak at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak.