‘It’s skyrocketing.’ Here’s what health officials say is causing KY’s COVID-19 surge.
A family barbecue. A graduation pool party. A small-town parade. A beach vacation. A church service without masks. Health department directors across Kentucky say activities like these, collective indicators that people are letting their guard down on COVID-19, are contributing to the state’s rise in cases.
“Things are open, [people] have been locked down for three months and they want to live their lives thinking they can’t get it,” said Alicia Thompson, an infection control nurse at the Graves County Health Department. Community spread in the last two weeks has caused infections to balloon in this Western Kentucky county of just over 37,000.
Over the past week, Graves County has seen a an 18 percent increase in cases, which now total 387, according to Gov. Andy Beshear. Based on population, that’s the seventh-highest increase per capita in the state.
New cases in Kentucky have exceeded 400 for nine out of the last 14 days, topping out on Sunday at 979 — a single-day record. And while larger cities like Lexington and Louisville often boast the highest raw numbers of new cases day to day, it’s the smaller communities across the state where growth rates are exploding.
Beshear on Monday placed restrictions on two activities he said are causing prolific spread: travel and backyard barbecues. He signed an executive order limiting the size of social gatherings to 10 people, and his office is now advising anyone who travels to a state where the infection rate is 15 percent or higher to quarantine for two weeks. Those states include Florida, South Carolina, Georgia, Alabama, Mississippi, Texas, Arizona, Nevada and Idaho.
While outbreaks in congregate settings such as nursing homes continue to be reliable hotspots, it’s the patchwork of small-to-medium sized interactions between people, including outdoor cookouts, that are largely to blame for Kentucky’s surge, according to eight health department directors across more than 30 counties.
“A lot of our cases are attributable to people just being more interactive,” Buffalo Trace District Department Director Allison Adams said of Mason and Robertson counties.
Matt Hunt, director of the Barren River District Health Department for Warren, Barren, Butler, Edmonson, Hart, Logan, Metcalfe and Simpson counties, said aside from the outbreaks in nursing homes, this pattern of community spread fits with what’s happening in his region, where the average age of those who’ve tested positive is 38.
“The 20- and 30-year-olds are driving that increase for us,” he said, through “just the mingling of small groups.”
This may not be a surprise, many said, but it should serve as a reminder: even small groups of people can propagate aggressive spread of the virus. Health directors were quick to remind Kentuckians that their choices to socialize are not made in isolation. Just as wearing a mask is a personal choice but a public benefit, true mitigation of this infectious disease requires buy-in from the bulk of a community, they said.
‘Playing with life and death’
In recent weeks, Kentucky has started to see what happens when that buy-in wanes, especially in less densely populated areas.
Scott Lockard, director of the Kentucky River District Health Department for Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe counties, wonders if Kentucky’s early success at keeping its infection rates at bay is now working against it. The state’s health care system has so avoided being hobbled by unmanageable case loads or deaths, making it easy for some to dismiss the still-present dangers of the virus.
“That’s the thing about prevention: you don’t realize how well your preventative efforts are working because nothing is happening and people get complacent and think, ‘Oh, this is not as bad as it’s been made out to be,’ so they start getting together again,” he said.
That’s what’s happening in the Lake Cumberland District, which includes Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor and Wayne counties.
“We’ve been having 20 to 30 new cases a day the last few days. Our growth rate is 1.05, which means the total case count is projected to double every two weeks. That is a crazy pace,” District Director Shawn Crabtree said last week. “That means we’re adding new cases more than we are releasing recovered cases.”
New cases in Bell County, on the border with Virginia and Tennessee, are increasing at a similar pace. In the last week, the number of new infections has grown by 40 percent percent, which is a seven-day increase of 46 cases. That’s the fifth highest increase per capita statewide.
Casey County, in Crabtree’s district, has one of the highest active case rates per population, partly due to an outbreak at one of its nursing homes. Over the last seven days, the case rate has grown by 110 percent — the second-highest per capita increase. Twenty-six percent of the district’s active cases are tied to nursing homes, but 21 percent are related to travel, mostly to Florida and Tennessee, which Crabtree’s district borders.
Many of the travel-related cases are family clusters, he said. “There’s a way these things work — you may have caught it while you were traveling, and then, before you got sick, you may have gone to work and then to church,” unknowingly dishing out doses of the virus to a lot of people.
Graves County Health Department contact tracers pieced together a similar scenario late last month, director Noel Coplen said.
At an extended family get-together, where masks weren’t worn and six feet of distance wasn’t maintained, an asymptomatic family member who hadn’t yet tested positive infected at least 10 relatives. They then fanned out in the community, many returning to in-office work spaces they shared with other people.
At least one of the newly-infected relatives carried the virus to work, where they again weren’t diligent about following the state’s guidelines on social distancing, forcing their co-workers to also self-quarantine and for the small office to temporarily close, Coplen said.
Had members of that family worn masks and stayed apart, it’s likely “there might have been [fewer] infected people,” he said.
Crabtree understands. His district tries to meticulously chart the origins of their spread, but “it’s not mutually exclusive.”
Virus spread at houses of worship, for instance, accounts for 14 percent of his district’s positive cases, while 18 percent of people who test positive contracted the virus from local businesses and 3 percent come from restaurants. But, “one person could be tied to more than one area. You could be tied to travel and church if you are positive during both of those activities,” Crabtree said.
This hopscotch spread happened in Hazard earlier this month, in Lockard’s district.
The Kentucky River District has more than 200 confirmed cases, many of which are tied to known hotspots, including Myrtle Beach, South Carolina, and Panama City Beach and Daytona Beach in Florida. Cases in Perry County, alone, have increased by 25 percent over the last week, partly due to a local outbreak.
Earlier this month, a virus cluster bloomed after the Hazard High School football team spent time training in the team’s weight room, sharing machines and breathed air. Local contact tracers believe the first player who later tested positive likely caught the virus from others who had recently traveled out of state for a beach vacation. As of Monday, at least 18 players, three coaches and 17 other friends and family had tested positive.
“Even though young people typically do not have as near a tough health outcome from contracting COVID-19, they are great carriers,” Lockard said.
Unfortunately, in some cases, young people are carrying it to others who aren’t as capable of fending off those serious outcomes, he said. Though cases have been steadily rising for a little more than two weeks, not enough time has passed for Kentucky to bear witness to a spiking mortality rate, which lags a few weeks behind a spike in infections.
People with underlying health conditions are most likely to die from the virus. That’s what’s worrying Lockard in Eastern Kentucky, where much of the population is at-risk.
“When it hits us full force, which I still do not think it has hit us like it’s going to hit us here in Eastern Kentucky, we’re going to see some very negative impacts on some very medically fragile people,” he said. “We’re playing with life and death here.”
‘It’s skyrocketing’
Most health directors interviewed for this story said they noticed an uptick in residents wearing facial coverings after Beshear signed an executive order earlier this month mandating masks be worn in virtually all public places.
Roanya Rice, director of the North Central District Health Department for Henry, Shelby, Spencer and Trimble counties, said she’s seen more compliance in her communities, thanks to that order, which “drove it home” for many people, she said.
Hunt agreed: “Masking has increased significantly since [last] Friday, which is a good thing.”
But the uptick in compliance doesn’t mean full compliance. Far from it, in some cases. “It seems like we’ve got half that take it seriously and half that don’t. Half that believe it’s a hoax or is being inflated,” Crabtree has observed in his Southern Kentucky district.
Early on in the pandemic, the blunting of his district’s infection curve correlated with many of Beshear’s executive orders, he said. That began to shift as the economy started to reopen and more reliance was placed on individuals and businesses to enforce mask-wearing and social-distancing protocols.
But his district has a “steeper curve now than we did at the beginning. Now that people are out and about, it’s skyrocketing.”
It’s troubling, some said, to expect necessary and sustained levels of compliance across the state without those formal orders and guidelines.
Last week, state Attorney General Daniel Cameron filed a motion in Boone County Circuit Court to overturn each of the governor’s executive orders instituted to slow the spread of the virus, as well as block Beshear from issuing and enforcing any future orders.
Boone County Circuit Court Judge Richard A. Brueggemann planned to uphold the motion on Friday before the Kentucky Supreme Court blocked that lower court effort, citing the need for “clear and consistent statewide public health policy” amid a “public health emergency.”
Even though the commonwealth has remained an outlier in this region for successfully slowing the virus’ progression, that position is tenuous and, public health officials said, it’s undoubtedly changing.
“We’re naive if we think that what’s happening in Texas, Florida and Arizona won’t happen in Kentucky,” Crabtree said. “If something doesn’t change, that’s where we’re headed. The growth rate is too fast for it not to get there.”
This story was originally published July 21, 2020 at 10:18 AM.
