In March 2021, hundreds of boxes of the Johnson & Johnson vaccine are unloaded at the Worldport Hub in Louisville. (Photo by Sarah Ladd)

On March 6, 2020, a Kentuckian in Lexington tested positive for the novel coronavirus, COVID-19, and Gov. Andy Beshear declared a state of emergency.

The United States had been under a public health emergency for more than a month by then.

Five days after Kentucky’s first confirmed case, the World Health Organization said COVID-19 was officially a pandemic.

The NCAA canceled March Madness? rather than “contribute to spread” of the virus. The Metropolitan Museum of Art and the Museum of Modern Art shuttered temporarily. NASCAR suspended racing.

We had entered a time like nothing Americans had experienced since the flu epidemic of 1918. In other words, it was “uncharted territory,” said Dr. Paul McKinney, the University of Louisville’s interim dean and a professor in the School of Public Health and Information Sciences, in a September interview with the Lantern.?

Over the next three years, around 2 million COVID-19 tests came back positive in Kentucky. More than 19,000 Kentuckians died.?

Beshear issued more orders, including restricting mass gatherings, closing schools and releasing some medically at-risk prisoners.?

Now some Republicans are urging Kentuckians to make Beshear a one-term governor based on his handling of the COVID-19 pandemic.

“Andy Beshear has failed us,” says an ad by Republican nominee and state Attorney General Daniel Cameron. “He locked our schools and unlocked our jails. We can do better.”

A pro-Cameron PAC is running ads accusing? a “criminal coddling governor” of having unleashed dangerous criminals on Kentuckians.?

To help voters navigate the criticisms, the Lantern is looking at the pandemic, a time of economic upheaval, rapidly-changing guidance and rampant misinformation.

‘Flying blind’

At the beginning, the response to COVID-19 was “a blunt instrument,” said UofL’s McKinney, “because what could we do at that point?”??

“We had no antiviral medications to use, we didn’t have a vaccine,” he said. “We didn’t have adequate testing; we didn’t have enough (personal protective equipment) to go around. All we had was basically the ability to trace contacts of people who were exposed and to … implement social distancing.”?

Tim Veno, CEO of an organization of nursing homes and assisted living facilities in Kentucky, agreed.

“We were pretty well flying blind,” he said. “We had no test or any way to determine who may or may not have had COVID.”?

Until the science caught up, social mitigation was the only option.?

In March 2020, Beshear, who had been governor three months, issued a variety of recommendations and orders based on guidance from federal public health authorities, meant to slow the virus’ spread.

Almost as quickly Attorney General Cameron began challenging some of the orders in court.

Not all of Beshear’s orders were restrictive. He streamlined the process for out-of-state nurses to work in Kentucky, suspended evictions and expanded unemployment benefits eligibility.?

The unemployment system was quickly overwhelmed by the influx of applications, and people waited months for help. Meanwhile, Louisville’s WDRB reported that Lt. Gov. Jacqueline Coleman texted the head of the Office of Unemployment Insurance to get attention on her hair dresser’s application, as well as that of a “friend of a friend.” The administration maintained that there wasn’t an abuse of power.

Beshear also began holding daily, virtual news conferences, broadcast across the state, to share information about the virus. Health experts praised this move, but it rankled some of his political opponents.

And, he encouraged Kentuckians to light their homes green in memory of those lost to COVID-19.

Spring 2020: A ‘somber’ experience?

When Beshear recommended that schools close for a few weeks, Louisville high school freshman Spandana Pavuluri, now 18, remembers thinking the time would be “just like an extended spring break.” Two weeks to catch up on homework, nothing more.

Before the end of? March, though, the virus closed all public school buildings in the U.S., according to Education Week.

The extended remote learning and loss of social connections in a pivotal time of her life “hit me like a truck,” Pavuluri said, describing the time as “somber.”

Her bedroom, where she did school, became a “place of … stress,” not relaxation.

The “really social person” was suddenly very alone, a sentiment reflected back to her from other students in research she helped conduct with the Kentucky Student Voice Team.

On top of school closures, in April 2020, Beshear halted elective surgeries so medical staff and supplies could be fully employed in addressing COVID-19. He closed Natural Bridge and Cumberland Falls state resort parks and suspended overnight stays at state parks.?

When several individuals sued the state challenging Beshear’s restrictions on interstate travel, Cameron officially took their side. A federal judge in a different case ruled that?parts of the travel order were unconstitutional. Beshear lifted it before Memorial Day.

The state shut down visits to nursing homes except in end of life situations. Leaders feared that visitors would bring COVID-19 to the most vulnerable.?

“That, of course, was devastating to some families,” said Veno, president and CEO of LeadingAge Kentucky.

“After that, we mobilized very quickly in setting up remote communication, iPads and other connected devices so that we could immediately, at least, at the very minimum, allow residents and families to talk via the internet,” Veno said. “Those were all very difficult decisions to make.”?

Despite “some political blowback” from those moves, Veno said, “in my view, that action saved lives.”?

On churches: Did the governor go too far??

After mass gatherings were suspended, some churches kept holding in-person services. That was despite a?religious revival in Hopkins County being linked to at least 28 cases of the virus and two deaths.

One congregation in Bullitt County gathered on Easter Sunday despite the order. The pastor found nails in the parking lot before the service. And attendees found notices placed by state troopers on their windshields telling them to quarantine.

Maryville Baptist Church in Bullitt County and Tabernacle Baptist Church in Nicholasville sued Beshear. Attorney General Cameron joined both of their lawsuits.

Two U.S. district judges ruled that Beshear’s ban on religious gatherings was unconstitutional and that the churches could hold in-person services while observing precautions against spreading the virus. But the 6th Circuit U.S. Court of Appeals disagreed, allowing the restriction on in-person services to stand. The appeals court did block Beshear’s ban on drive-in services.

By then Beshear had agreed to allow places of worship to gather. But many chose to wait. The Rev. Kent Gilbert, pastor of historic Union Church in Berea, told the Lexington Herald-Leader at the time, “No pastor wants to race back to church to do more funerals.”

Todd Gray, the executive director of the Kentucky Baptist Convention, told the Lantern that the denomination’s pastors and church leaders “made their own decisions” about protecting congregants. They “sought to be good citizens working in cooperation with recommendations from the Centers for Disease Control and from Frankfort,” he said.

The theological belief that Christians must gather together also factored into some congregations coming back to in person services “as quickly as possible,” said Gray.

He also feels the state unfairly targeted churches during this time.

“While most Kentucky Baptist churches sought to cooperate with the governor’s recommendations as much as they could,” Gray said, “most, if not all, believed the governor went too far when he specifically targeted churches while some businesses such as liquor stores remained open.”

Politicizing a pandemic

In May 2020, angered over mass shutdowns, protesters opposed to COVID-19 restrictions hanged Beshear in effigy outside the State Capitol and marched to the Governor’s Mansion demanding he resign.?

Attached to the effigy was a sign with the words “sic semper tyrannis,” which means “thus always to tyrants.” John Wilkes Booth famously said this after shooting President Abraham Lincoln in 1865.?

Republicans and Democrats alike decried those actions. Secretary of State Michael Adams, a Republican, tweeted at the time that the “words of John Wilkes Booth have no place in the Party of Lincoln.”?

There were other protests of the shutdowns and social distancing and masking measures. Misinformation was rampant, including a claim that the pandemic itself was a hoax.?

The politicization of the pandemic made it harder for health care workers to do their jobs, they said.

“It was extremely difficult for hospitals,” said Deborah Campbell, the vice president for clinical strategy and transformation at the Kentucky Hospital Association.?

In early 2021, when vaccines became available, Kentucky gave first priority to health care workers and staff in long-term care and assisted-living facilities followed by those over 70, first responders, K-12 school personnel and child care workers.?

Many, including some health care workers, refused vaccination against the virus.

Once vaccines were mandated by the Center for Medicare and Medicaid Services, those who refused the shots could no longer work in hospitals, Campbell said.?

“It was terribly painful. It was painful for the staff, it was painful for the hospital leadership,” Campbell said.?

But in the end, Campbell said, precautions did save lives. They also kept hospitals running better than if no mitigation measures had been in place.?

“Having less sick people means more staff were not sick and able to take care of patients in the hospital, which means they got better care, which means they did better,” she said.

Still, health care workers often bore the brunt of people’s anger.?

Some hospital visitors and even patients treated health care workers in a “demoralizing” way, said Campbell.?

They spit on and cursed them.?

“People were threatened. Workplace violence increased in our hospitals, particularly around visitation, and any personal freedom restrictions,” Campbell said. “Those visitation restrictions were heart wrenching. But at some point … I think it was pretty clear it was the right thing to do.”?

Veno with LeadingAge said that in his 20 years working in health care, “I’ve never seen this kind of public reaction, anti-vaccination reaction as I saw with COVID.”?

All of this helped feed burnout and exacerbated an already worsening medical workforce crisis.?

On the economy

About 18% of Kentucky’s businesses had to close because of a government mandate during 2020, according to the United States Bureau of Labor Statistics.?

That’s similar to the percentage nationwide, which was about 19%.

The state designated workers as “essential” and “nonessential” to determine who could stay open with more flexibility. Grocery store workers, for example, were deemed essential. Jewelry and clothing stores were “non-essential.”?

The designations remain a sore spot for some. Cameron has said he wants to make Beshear “not essential” come Election Day.

The Kentucky Center for Economic Policy reported in May that the state lost 294,900 jobs in just the first two months of the pandemic. Businesses permanently closed left and right. Thousands across the country shuttered.

“In the three years since, Kentucky has experienced a remarkable recovery,” Kentucky Policy said. It reported Kentucky had 53,800 more jobs than before COVID-19 hit the state.?

Cameron said in October that, had he been governor at the time, he would not have closed small businesses and health spaces like chiropractor’s offices. He criticized what he called “inconsistency” in Beshear’s decisions.?

“There are a lot of small businesses right now that have not been able to recover,” Cameron said. “Several of them closed their doors for good.”

Prisons: a ‘public health failure’?

Among other steps to stifle COVID-19’s spread, Beshear closed restaurants to in-person traffic, suspended out-of-state travel for state employees and stopped prison visits.?

Beshear commuted the sentences of 1,870 inmates who were medically vulnerable and who had not been convicted of violent or sexual offenses.

Cameron and his allies have criticized Beshear’s pre-release vetting. They’ve cited data from the Administrative Office of the Courts that shows about half of 1,700 commutation recipients were charged with another crime by July 2023.

Republican state Rep. Kevin Bratcher of Louisville asked for the numbers to be updated from a 2021 report. At an Oct. 13 campaign event for media, Cameron, Bratcher and state Rep. Jason Nemes released the new numbers and blasted?Beshear’s “shortsighted decision” on prisoner releases.

The Courier Journal?of Louisville and the?Lexington Herald-Leader have reported, though, that many of those re-offenders would have been free to commit their alleged subsequent crimes because their original prison sentences would have expired by then anyway.

Prison Policy Initiative, a Massachusetts-based national nonprofit that researches criminalization in the United States, reported in April that Kentucky’s overall incarceration population decreased 13% from January 2020 to December 2021.

The national average was 15% over the same time.?

Wanda Bertram, a communications strategist with Prison Policy Initiative,? says the real mistake by Kentucky and most states was not releasing more prisoners — despite warnings that prisons would become “hotbeds for coronavirus spread” and? “endanger not just people who are inside and people who are working inside but also the entire community that surrounds the prison.”

Kentucky, like most states, continued to imprison people for technical violations of probation and parole, Bertram said.

“We actually did prove that mass incarceration probably added at least half a million COVID cases nationwide in the summer of 2020 alone,” said Bertram.

In 2021, Prison Policy gave states letter grades based on their treatment of incarcerated populations during the pandemic.

Kentucky, along with many others, received an “F.”

“Beshear’s commutations of 1,800 incarcerated people is a bright spot in what, otherwise, I would consider to be a complete public health failure when it comes to protecting incarcerated people and the communities that surround prisons,” Bertram said.

Kentucky had the nation’s third highest rate of COVID infections and deaths among prisoners from March 2020 to June 2021, according to the Marshall Project, which collaborated with the Associated Press to keep track. The numbers are an undercount because inconsistent testing caused infections to go undiagnosed, especially early on, according to the report.

During the 15 months, Kentucky recorded:

• 7,909 cases — a rate of 6,503 cases per 10,000 prisoners, lower than only Michigan and Arkansas.
• 48 deaths — or 39 deaths per 10,000 prisoners, lower than only Nevada and New Mexico.

Ultimately, eight state prison staff in Kentucky died of COVID-19, the Department of Corrections said earlier this month.

Learning loss

By the start of the 2020-21 academic year, four states had ordered schools to open in person, but in Kentucky most schools continued remote learning.

In November, a deadly “third wave” struck and Beshear announced that public and private K-12 schools would close.??

Danville Christian Academy and Cameron challenged the school closing order and won before U.S. District Judge Gregory Van Tatenhove. But the Sixth Circuit U.S Court of Appeals upheld Beshear’s order, saying it treated all schools, religious or otherwise, the same.?

The appeals court took note of one of Beshear’s justifications: “Kentucky leads the nation in children living with relatives other than their parents — including grandparents and great-grandparents, who are especially vulnerable” to the virus.?

The? U.S. Supreme Court refused to hear the case.

By early 2021, a year into the pandemic, ?most Kentucky schools had returned to in-person.?

Some research suggests school closures helped keep COVID-19 transmission lower than if the doors had stayed open, but children suffered from the disruption in their education.

In 2021, Harvard Medical School researchers found that while most children who contracted COVID-19 were themselves mildly symptomatic or without symptoms at all, they could still carry the virus on to others.

Many children suffered learning loss during remote and hybrid classes in 2020 and 2021 across the country, according to a 2022 study out of Harvard University’s Center for Education Policy Research.?

In Kentucky, reading and math proficiency dropped during the pandemic when comparing 2018-2019 assessments with 2021-2022 data.?

At the time of that October report, Education Commissioner Jason Glass said in a statement that “the COVID-19 pandemic has had a profound impact on our students and our schools as they continue to recover from the interrupted learning that occurred over the past two years.”?

Cameron has said that should he be elected governor, he will institute a “Catch Up” plan featuring tutoring programs to bring kids up to speed.

Looking back, Pavuluri, a first-year student at Vanderbilt University studying public policy, says that despite the disruptions in her education, school closures and other restrictions were worth it.

Because her mom is a geriatrician who works with older adults, she felt more empathy toward people at higher risk.

“So for me, that was always in my mind and COVID was something I feel like I took pretty seriously,” she said. “I didn’t necessarily have someone very … immunocompromised in my family. (But) I think I really … empathize with the students who do.”

“There was obviously … negatives to the experience,” she added, “but I think just the massive negative would have been to … lose someone.”

How did Kentucky compare to other states?

Kentucky is famously one of the sickest states — ranked third most unhealthy by Becker’s Hospital Review in January ahead of only West Virginia and Mississippi.?

“Everyone had a reason to expect that we would be absolutely devastated” by COVID, said UofL’s McKinney.

Kentuckians suffer high rates of heart disease, diabetes and cancer. And the state’s population is shifting older. All these factors mean a lot of Kentuckians went into the pandemic with at least one “comorbidity” — a pre-existing condition putting them at higher risk for COVID-19 complications and potentially death.?

“Among our neighbor states, we were much more vulnerable than almost all of them,” said McKinney.

And yet CDC mortality data, which only includes 2020 and 2021, shows Kentucky’s death rate was lower than Tennessee’s and West Virginia’s though higher than Indiana, Ohio and Virginia.?

McKinney credits measures “implemented by the leadership and state” for saving Kentucky lives.

A study published in April in the international medical journal The Lancet took into account age and health when comparing states. It found that Kentucky’s death rate was lower than the national average when adjusted for comorbidities.

Kentucky’s unadjusted COVID-19 death rate from January 2020 through July 2022 was 472 deaths for every 100,000 residents, higher than the national average. After adjusting for age and comorbidities, however, the rate was 341 deaths per 100,000 population, lower than the national rate of 372.?

The state with the lowest adjusted death rate was Hawaii (147 per 100,000 residents). The highest was Arizona (581 per 100,000).

In April 2020, University of Kentucky professors in the Gatton College of Business and Economics released research estimating the state would have been much worse off had social distancing measures not been implemented early on.?

UK did not make those researchers available to the Lantern for this story. At the time they estimated Kentucky would have had 45,000 cases by April 25, 2020, had the state not closed communal businesses like gyms and restaurants. Instead, the state had around?4,000.?

The researchers also estimated that, a month into the pandemic, those actions saved about 2,000 lives.?

A more comprehensive study from The Royal Society in London examined the effectiveness of non-pharmaceutical interventions (NPIs) like social distancing and mask wearing during COVID-19 across the globe.?

The August 2023 report found that social strategies like mask wearing and physical distancing helped reduce virus spread.?However, scientists found that this was most true when powerful variants like Delta and Omicron, which were particularly good at evading protective barriers, weren’t spreading.?

“Could they have … relaxed restrictions more rapidly? Could they have … let us get to a normal life faster? That’s a tough call,” said McKinney. “You have to play it a little bit by ear. And, again, you’re trying to probably err on the side of protection of human life.”?

“Everything’s clearer in hindsight,” he added.??

“I think that the leadership of both the commissioner of public health (Dr. Steven Stack) and the governor, who worked closely together in implementing policy, the primary concern was preservation of lives,” McKinney said.?

“Freedom of the population is very important. But if you’re dead, you can’t be free,” he said. “So if you preserve life first, and then… worry about how tight the controls have to be later. I think that was the general plan: to be as tight as possible to hopefully stop the progress of the virus.”?

Lessons for the future?

Kentucky’s response to COVID-19 wasn’t perfect, experts say, and there is much the state can learn from it for the future.?

For example, Kentucky needs more vigorous respiratory virus surveillance, automated data reporting and well-maintained stockpiles of personal protective equipment.?

The ability to produce vaccines quickly will ease government reliance on social mitigation measures as well,?McKinney said.?

Kentucky — and the nation — will need to guard against complacency, McKinney said. Although “hopefully” there won’t be another pandemic in the near future, “there’s no guarantee.”

Kentucky also must rebuild its health care workforce. The pandemic “taxed” health care workers “beyond belief,” said Veno with LeadingAge. And the staffing challenges this caused continue.?

KSVT’s Pavuluri said leaders must keep in mind that students need social connections, mentorship and relationships. Many lacked that during NTI learning and will need it for the next public health crisis, she said.

And, even though the emergency years of the COVID-19 have ended, “staffing remains a huge problem,” said Campbell with the state hospital association.

“We are incredibly concerned as hospitals and the hospital association about trying to increase the pipeline and retain the staff that we have,” she said.?

Before the pandemic hit, she said, there was already a concerning trajectory of an aging nursing workforce. “Then we had COVID, which caused burnout.”?

Looking to the future, climate change is a concern.

“Warming of the climate will affect…a lot of disease transmission,” McKinney said. “If winter weather that wipes out the mosquito population every year did not do so, and they survived and thrived and carried something like malaria … throughout that time, it would be … a big concern, obviously, for the nation.”?

COVID-19 is shifting more into an annual flu-like nuisance, public health experts have said. People will still get sick, but the science is there to manage large waves.

For now, many facilities are still using universal precautions–like wearing personal protective equipment–during outbreaks. They also use screening tools to keep the spread low.?

“Make no mistake about it,” Veno with LeadingAge said. “We’re still dealing with COVID, and we’re going to be dealing with COVID for quite some time.”?

Jamie Lucke and McKenna Horsley contributed to this story.?