NASHVILLE (AP) — As health experts ring alarm bells at surging virus case numbers, Tennessee is just one of 14 states poised to head into the holiday season without a statewide mask mandate.

Gov. Bill Lee also has vowed he will not impose business restrictions nor issue guidance on how families should gather for next week's Thanksgiving holiday amid the ongoing pandemic. The Republican has remained steadfast that he's open to all options to battling COVID-19, reiterating for weeks that he hasn't ruled anything out.

However, Lee has thus far refused to adopt recommendations like other GOP governors — most recently in hard-hit states like Iowa, North Dakota and Utah — who have begrudgingly implemented some sort of limited mask requirement in the face of skyrocketing virus numbers. Lee, instead, has left the mask requirement question up to Tennessee's counties.

Lee's administration has also spent months encouraging Tennesseans to take "personal responsibility" in their actions to prevent the spread of the virus. When asked what happens if people don't heed that advice, Lee has maintained that personal responsibility is the only path to curbing the spread of the novel coronavirus.

Additionally, Lee has extended hours at various free virus testing sites ahead of Thanksgiving and directed National Guard personnel to help assist the expanded services in the more populous counties of Davidson, Knoxville and Hamilton.

"(For) now, what we believe is the strategy we are taking is actually working," Lee said during this week's virus news briefing. "It may well be working better than a statewide mask mandate would work."

"Let me just say, we're not going to mandate how a family gathers at Thanksgiving. I want to be real clear about that," Lee added. "But what we will do is encourage Tennesseans to think hard about that."

At the same time, while Lee announced this week he wouldn't attend his annual large Thanksgiving family dinner, the Republican did confirm that he held a campaign fundraiser at his farm and will attend an indoor House GOP retreat later this week.

According to a recent study from Vanderbilt University School of Medicine, 63% of Tennesseans are currently required to wear masks, 31% never were under a mask requirement and 6% only faced one during the summer months.

That report also found that Tennessee counties without a mask mandate are on average seeing COVID-19 death rates double or more compared with those that instituted mandates.

Meanwhile, over the past two weeks, the rolling average number of daily new cases has increased by about 2,340, an increase of 112%.

Notably, on Monday, Tennessee reported nearly 8,000 new cases of COVID-19 — smashing previous records of a single-day increase in virus case numbers. In the hospitals, COVID-19 patients currently account for 20% of the state's inpatient beds and 30% of ICU beds.

In western Tennessee, The Jackson Sun newspaper reported that a key hospital in Madison County — which serves as the health care hub for the region — was no longer accepting patient transfers due to a rise in coronavirus patients.

Calling it a "sobering day," West Tennessee Healthcare CEO James Ross said the hospital typically accepts 50 to 60 ambulance transfers outside of the county per day.

As of Wednesday, the hospital had reported 573 patients, approaching its maximum 642-bed capacity. More than 100 patients are being treated for COVID-19.

"Week over week increases in hospitalizations, reported limited bed availability, and increasing deaths correlate with Halloween and related activities," a White House coronavirus task force report dated Sunday warned. "With Thanksgiving and upcoming holidays, Tennesseans must understand the COVID-19 situation statewide."

Tennessee has seen just over 4,000 COVID-19 related deaths to date, according to researchers from Johns Hopkins University in Baltimore. That death count is the 19th highest in the country overall and the 27th highest per capita at 59.0 deaths per 100,000 people.

Prominent doctors at Nashville's Vanderbilt University of Medical College have called for federal and statewide mask mandates. Tennessee's largest teacher union has unsuccessfully pleaded with the governor and education officials for at least a mask mandate inside schools as more districts move to virtual learning.

While most people who contract the coronavirus recover after suffering only mild to moderate symptoms, it can be deadly for older patients and those with other health problems.

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Follow Kimberlee Kruesi on Twitter at https://twitter.com/kkruesi.

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Follow AP's pandemic coverage at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak.