With new coronavirus cases emerging, Kentucky health leaders worry about fall's advance

LOUISVILLE, Ky. — Kentucky physicians and public health experts say they are wading into uncharted territory in the battle against the deadly coronavirus as fall arrives and new infection rates surge.

As the outbreak enters its eighth month, the list of risks seems to keep climbing. Cooler weather will force people closer together indoors and raise the potential spread among family members. 

There's the onset of seasonal flu and more opportunities for people to gather over Halloween, Thanksgiving and year-end holidays. Before then, there's the temptation for families to set off on vacations during October school breaks, despite renewed warnings to limit travel. 

"The fall is going to present new challenges we've not had to deal with," said Dr. Jason Smith, University of Louisville Health's chief medical officer. 

Kentucky's COVID-19 weekly case counts have hit record levels in the last month. And for the first time since the infection emerged in Harrison County on March 6, new cases statewide exceeded 1,000 cases for two days in a row this week.

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On Thursday, the state had 910 new cases, including 146 that involved youth ages 18 and younger. There were 17 additional deaths, including a 29-year-old Clark County woman.

The numbers pushed Kentucky to 69,728 confirmed cases and 1,191 deaths. And although many people have recovered from bouts with mild infections and life-threatening illness, COVID-19 continues to sicken people in all 120 Kentucky counties.

Nationwide, the pandemic has cause more than 207,000 deaths and over 7.2 million people.

The White House, which is issuing weekly reports to states on their COVID-19 data, said Monday that Kentucky's 111 new cases per 100,000 population surpassed the national average of 93 per 100,000. That ranked it 21st highest in the country. It also put the state in its red zone — the worst status for new cases.

(Kentucky uses different metrics to measure the risks, so most of the state is a combination of orange, the second-highest level, and yellow.) 

Three counties were singled out by the White House for the highest totals over the last month: Jefferson, Fayette and Warren. Together they represented 35.7% of new cases statewide, according to the report.

Gov. Andy Beshear said his administration is watching the new numbers closely, particularly in places around the state where rising counts involve schools, colleges and long-term care facilities. But he stopped short of outlining any new steps he’d impose if the numbers keep rising.

Beshear, during his afternoon COVID-19 press conference Thursday, was asked about a number of Cincinnati-area counties along the state line that are in the red zone, noting "it is of great concern" to Kentucky health departments in the area.  

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Kentucky's experience isn't unique. New daily confirmed virus cases in the U.S. have jumped more than 15% in the past two weeks or so, and what's alarming health experts is that it's the sharpest increase since the late spring. 

Contact tracers and doctors report that Kentucky's increased numbers coincide with students' return to schools and college, youth sports, tailgating and more people spending time together in recent weeks during the wonderful weather.

Another key is a tendency for people to let their guards down, to grow lax about the precautions they've imposed on themselves, said Dr. Monalisa Tailor, president of the Greater Louisville Medical Society and an internal medicine physician who's part of a primary care practice.

She mentioned seeing a patient this week who needed a COVID-19 test after stopping in to visit a neighbor. They hadn't seen each other for months. Then the patient learned later that her neighbor had tested positive for the coronavirus, so she needed to get tested too and isolate right away, Tailor said.

That was after sticking to a strict routine to limit such exposures, the doctor said. "It seems folks are getting tired. We want to get back to this normal, and we're not there yet."

Added Dr. Chuck Anderson of Baptist Health of Louisville: "Everyone is getting fatigued," and that includes caregivers. "We are just reiterating what needs to be done to stay well," said the chief medical officer and vice president of the organization.

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A study released in late September by the federal U.S. Centers for Disease Control and Prevention underscored one of the increasingly common scenarios for how the virus is circulating more freely now. During June to August, researchers found the highest incidence of coronavirus in young adults, ages 20 to 29.

They documented evidence that showed the younger people transmitted the virus to older adults, touching off new waves of infection that wound up eventually hitting much older, vulnerable people. It was a reminder that outbreaks traced back to bars, beach trips, dormitories and parties, are hazardous not just to the 20-something patrons, but to older people they come in contact with.

Metro Louisville's contact tracing consultant, Karen Handmaker, said this week that the data gathered from people who have tested positive shows there's a lot of spread occurring among families.

Bowling Green is seeing the same thing. There are more cases within families, but the area is also seeing exposure at worksites and at colleges, Layne Blackwell, Barren River District Health Department's regional epidemiologist, said in an email.

The positive news is that hospital capacity and the availability of testing supplies is strong. And the rise in cases in Louisville hasn't correlated to an increase in hospitalizations — yet. U of L Health averaged slightly over 50 coronavirus patients in August, but in September that dropped to about 35 patients, Smith said.

Likewise, Baptist reported that beds, intensive care unit space and ventilator availability is not a problem. Just a few virus patients required ICU and ventilator support at Baptist Health Louisville, Anderson said.

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The arrival of the flu is on the minds of doctors and public health specialists, though. Many people will contract COVID-19 and mistake it for the flu, and the other way around. Patients hit with a flu bug may think it's the coronavirus and need a test because the symptoms — fever, body aches, headache and upset stomach — are the same, Smith said.

He predicts the confirmed cases will continue running high for several months as the flu complicates the fall and spring. Getting a flu vaccine "is going to be really important."

But the biggest breakthrough will come when a COVID-19 vaccine is approved and a large swath the population, Smith said, gets inoculated.

The coronavirus is never going to go away completely. Like the seasonal flu, he said, the virus will still pop up in patients, but won't spread liberally, as it has during the pandemic.

For now, if the public health community sees a huge surge in cases in the weeks ahead, Smith said, "we may need to increase restrictions" again.

Grace Schneider: 502-582-4082; gschneider@courierjournal.com; Twitter: @gesinfk. Support strong local journalism by subscribing today: courier-journal.com/graces.