“The Greenprint Project is an exciting collaboration with several partners committed to making Louisville a healthier, greener city. This initiative offers a unique opportunity to reimagine and revitalize downtown Louisville,” said Aruni Bhatnagar, director, Christina Lee Brown Envirome Institute. “Using an evidence-based approach, the project will create a ‘greenprint’ designed to enhance both environmental quality and public health. The model we develop could serve as a scientific framework for greening downtowns around the world.”

This is the latest in the institute’s growing efforts to understand how the environment impacts human health and chronic disease. UofL’s New Vision of Health Campus and Trager Microforest also are participating partners.

“Downtown is the heart of our city and revitalizing our downtown benefits every Louisvillian. The Greenprint initiative shows what’s possible when government, nonprofits, businesses and community partners come together around a shared vision,” said Louisville Mayor Craig Greenberg. “By using nature as a tool to strengthen our neighborhoods and create welcoming spaces, we are making downtown safer, healthier and stronger for everyone – and setting an example that other cities across the country can follow.”

Seed funding of $1.5 million from the James Graham Brown Foundation helped catalyze the partnership, which includes leaders from city government, higher education, nonprofits and grassroots groups. The charter signing represents the formal beginning of this collective effort and signals Louisville’s intent to become a national model for revitalizing cities through nature-based solutions.

“The Greenprint initiative reflects the kind of bold, collaborative vision the James Graham Brown Foundation is proud to support,” said Mason Rummel, president and CEO of the James Graham Brown Foundation. “By aligning science and community input, this effort has the potential to transform downtown Louisville into a national model for place-based investment in public health and urban vitality.”

Greenprint projects will span beyond traditional parks to include tree canopy enhancements, pollinator-friendly landscaping, green corridors, microforests and nature-based health interventions. Together, these efforts aim to improve air quality, reduce heat islands, support biodiversity and enhance mental and physical health. Monitoring technology will be used to track environmental and health impacts of greening over time. These tools will help measure progress, inform future investments and increase transparency and public engagement.

The partnership, built on a collective impact model, focuses on measurable outcomes and long-term sustainability. While each participating project maintains its own identity, Greenprint ensures alignment through shared data and strategy that can assist with tracking impact across the downtown footprint.

Other partners include: Belvedere, LouMed, Louisville Downtown Partnership, Louisville Metro Government, Louisville Parks and Recreation, Office of Sustainability – Whole City Nature Vision, Broadway All the Way, East Market Streetscape Improvements, Reimagine 9th Street, Louisville Sports & Entertainment District/Slugger Field, Olmsted Conservancy, Parks Alliance of Louisville, TreesLouisville, VOA Care Campus and Waterfront Park.

View pictures on ��from the Aug. 20, 2025, charter signing event.

To learn more about the Greenprint initiative and explore the portfolio of projects, visit .

After more than two years of baseline research, construction and planting, the 0.65-acre Founders Square, located at Fifth Street and Muhammad Ali Boulevard, is now an inviting public space for everyone to enjoy. However, the Trager MicroForest is more than a refreshed urban park. It is a space for scientific inquiry into the impact of intense urban greening on human health and the wider urban environment.

“The vitality of downtown Louisville is inextricably linked to the vitality of the University of Louisville and the entire metropolitan community,” said UofL President Gerry Bradley. “This beautifully renewed green space will benefit not only residents and visitors to the downtown area, it also will serve as a research site for groundbreaking investigations into the connection between trees and health by UofL researchers.”

A 30-year lease with Louisville Metro Government allows the Envirome Institute to use Founders Square as an outdoor public laboratory. In the park, UofL researchers test the physiological effects of dense planting on human health and to what extent the forest�� affects temperature and humidity in the area. For Phase One of the project, the central area of the park has been densely planted with trees, shrubs and ground cover to optimize cooling and reduce urban heat.

The Trager MicroForest Project builds on the Envirome Institute’s groundbreaking Green Heart Project, which found that adding trees to a neighborhood lowered residents’ inflammation levels.

Prior to planting and construction, UofL researchers collected baseline data on how spending time in the space affects stress levels and physiological responses compared with spending time in nearby downtown areas that lack greening. In addition to human studies, the researchers are monitoring air and surface temperatures, air quality and other measures to assess the impact of densely planted trees on the environment in and around the park.

“The Trager MicroForest is part of the wider mission of the Envirome Institute to pursue knowledge about health,” said Aruni Bhatnagar, director of the Christina Lee Brown Institute. “This little forest will not only provide a pleasant space to spend time in downtown Louisville, but it will also help us test how dense urban planting can improve human health. The results of this experiment could inspire and inform the planting of microforests in cities worldwide.”

The microforest is considered part of UofL’s New Vision of Health Campus, located just across Fifth Street, which will include specially designed laboratory space to study sleep, nutrition and exercise, as well as offices and public spaces to investigate how environmental factors impact human health. The development of this innovative campus affirms UofL’s commitment to the vitality of Louisville’s urban core.

“We are excited for this project and hope to see further growth in the greening of downtown Louisville,” Michael Trager-Kusman said. “We believe having public spaces like these will only contribute to the growth of downtown Louisville.”

The park’s opening marks the completion of Phase One of the project. Planning and design for Phase Two of the Trager MicroForest will begin in late 2025. Learn more about .��

• 0.65-acre site
• 119 new trees
• 242 new shrubs
• 750 tons of new top soil
• 220 linear feet of new pathways
• 178 linear feet of retaining wall

of the official opening on May 13, 2025. View the .��

The campus will be��both a world-class research center and a nexus for community engagement, spawning citizen scientists and making health equity everyone’s pursuit.��It will consist of two historic buildings on West Muhammad Ali Boulevard totaling 133,000 square feet and an adjacent garden space.

The launch of the New Vision of Health Campus is made possible by a commitment from health advocate Christina Lee Brown of Louisville valued at $47 million by the university. Brown is providing $30 million over 20 years to support the����and is giving rent-free use of the buildings to the university, equating to a $17-million in-kind donation. In a special meeting earlier today, the UofL Board of Trustees approved a lease granting UofL use of the property, which is owned by Brown. The university plans to seek additional partnerships and financial support for the campus and its mission.

“We are incredibly grateful to Mrs. Brown for this generous gift of support and this special space in the heart of the city,” said Lori Stewart Gonzalez, interim president of UofL. “On this new campus, UofL researchers will increase our understanding of the many aspects of our environment that contribute to optimum health for everyone, here and beyond. It embodies our commitment to health equity.”

“To grow from our past and promote long, fulfilling lives, we shouldn’t chase any single cause. We live in a complex, interdependent world where history is our shared legacy and health is our shared aspiration,” Brown said. “By honestly recognizing our common stories, we can frame a new vision of health which unifies us. It can inspire healthier lives, healthier communities and a healthier world.”

�ճ������will include specially designed laboratories and offices for the��that will engage researchers and community members to learn how natural, cultural and personal environments impact health. Institute researchers work with community partners to discover how to build healthier cities, creating insights and models to improve health in Louisville and around the world.

The research will be directed by Aruni Bhatnagar, director of the UofL Envirome Institute, professor of medicine and chief of the UofL Division of Environmental Medicine.

“Our quest is to pursue the new vision that health is a resource that needs to be cultivated through conducive physical and environmental conditions,” Bhatnagar said. “Health is more than the absence of disease. Health is a resilience that helps individuals withstand all forms of stress. We want to move the discussion of health away from disease and instead focus on actively promoting health before disease occurs.”

The UofL Christina Lee Brown Envirome Institute was created in 2018 with a $5-million gift from Brown that charged UofL researchers to take a holistic, multidisciplinary approach to understanding how the human-environment interrelationship affects peoples’ lives and to convert that knowledge to actionable steps to promote human health. This research and the new funding announced today support the university’s grand challenge strategic research priority of “,” an initiative to lead a transformative shift in how we understand, promote and recover health through all stages of life.

Research highlights from the Envirome Institute include the��, documenting the health impacts of living among greater levels of vegetation, the��, tracking the presence and spread of COVID-19 in the community through testing of individuals and wastewater, and research to document the effects of smoking and vaping on health. Bhatnagar is co-director of the American Heart Association’s Tobacco Center for Regulatory Science, and the center’s research was employed as key evidence for ending the sale of flavored vaping products in California. The institute also houses the only NIH Superfund Research Center devoted to studying the effects of superfund chemicals on cardiovascular health, diabetes and obesity.

“This is UofL research that could transform the way we promote well-being by revealing and decoding the factors that affect it,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “We are proud to work with Christina Lee Brown and appreciate her continued support to further this important effort in advancing our health. Together, we will help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

The gift announced today is the single largest philanthropic gift in the university’s history.

The launch of the New Vision of Health Campus is made possible by a commitment from health advocate Christina Lee Brown of Louisville valued at $47 million by the university. Brown is providing $30 million over 20 years to support the and is giving rent-free use of the buildings to the university, equating to a $17-million in-kind donation. In a special meeting earlier today, the UofL Board of Trustees approved a lease granting UofL use of the property, which is owned by Brown. The university plans to seek additional partnerships and financial support for the campus and its mission.

“We are incredibly grateful to Mrs. Brown for this generous gift of support and this special space in the heart of the city,” said Lori Stewart Gonzalez, interim president of UofL. “On this new campus, UofL researchers will increase our understanding of the many aspects of our environment that contribute to optimum health for everyone, here and beyond. It embodies our commitment to health equity.”

“To grow from our past and promote long, fulfilling lives, we shouldn’t chase any single cause. We live in a complex, interdependent world where history is our shared legacy and health is our shared aspiration,” Brown said. “By honestly recognizing our common stories, we can frame a new vision of health which unifies us. It can inspire healthier lives, healthier communities and a healthier world.”

The will include specially designed laboratories and offices for the that will engage researchers and community members to learn how natural, cultural and personal environments impact health. Institute researchers work with community partners to discover how to build healthier cities, creating insights and models to improve health in Louisville and around the world.

The research will be directed by Aruni Bhatnagar, director of the UofL Envirome Institute, professor of medicine and chief of the UofL Division of Environmental Medicine.

“Our quest is to pursue the new vision that health is a resource that needs to be cultivated through conducive physical and environmental conditions,” Bhatnagar said. “Health is more than the absence of disease. Health is a resilience that helps individuals withstand all forms of stress. We want to move the discussion of health away from disease and instead focus on actively promoting health before disease occurs.”

The UofL Christina Lee Brown Envirome Institute was created in 2018 with a $5-million gift from Brown that charged UofL researchers to take a holistic, multidisciplinary approach to understanding how the human-environment interrelationship affects peoples’ lives and to convert that knowledge to actionable steps to promote human health. This research and the new funding announced today support the university’s grand challenge strategic research priority of “,” an initiative to lead a transformative shift in how we understand, promote and recover health through all stages of life.

Research highlights from the Envirome Institute include the , documenting the health impacts of living among greater levels of vegetation, the , tracking the presence and spread of COVID-19 in the community through testing of individuals and wastewater, and research to document the effects of smoking and vaping on health. Bhatnagar is co-director of the American Heart Association’s Tobacco Center for Regulatory Science, and the center’s research was employed as key evidence for ending the sale of flavored vaping products in California. The institute also houses the only NIH Superfund Research Center devoted to studying the effects of superfund chemicals on cardiovascular health, diabetes and obesity.

“This is UofL research that could transform the way we promote well-being by revealing and decoding the factors that affect it,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “We are proud to work with Christina Lee Brown and appreciate her continued support to further this important effort in advancing our health. Together, we will help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

The gift announced today is the single largest philanthropic gift in the university’s history.

Over the next six months, the , part of the Department of Urban and Public Affairs, will explore how the city of Louisville can serve as a living laboratory for research, education and experimentation at the Healthful City Design Studio at 429 W. Muhammad Ali Blvd. This temporary pop-up location, an addition to the current UDS location in the Portland neighborhood, offers a space in which community members can dive into issues and opportunities specific to the heart of downtown.

“This is an exciting opportunity to pull together the threads of urban planning and design, public health, equity, ecology, engineering, economics and more to focus on how these overlapping facets of the city can not only solve problems we face now, but also position our downtown and city for the future,” said UDS Director Patrick Piuma. “I believe we have the talented minds throughout our community to examine these aspects of our city, and our hope is to find ways to unlock the creativity needed to become a leader in this space.”

To kick off the pop-up, Piuma, alongside colleague and entrepreneur Sylvanus Hudson, will develop a series of events, workshops, demonstration projects and more to bring together professionals and the local community to explore how the built environment affects health and what it means to be a healthy city. The team will be joined by collaborators from other UofL departments, Louisville Metro Government, the University of Kentucky and related organizations and individuals as the direction of the initiative takes shape.

Early events and activities will be focused on outreach and education, getting people together to share ideas about what a healthy city looks like and collaborative demonstration projects to communicate the importance of cooling urban heat islands, improving air and water quality, planting trees and other vegetation, public safety, welcoming environments and the health benefits of reintroducing nature into urban environments.

“The pandemic has revealed the importance of the built environment on health and how valuable safe and healthy places are in promoting public health and resilience,” said Aruni Bhatnagar, director of the Christina Lee Brown Envirome Institute.

The goal of the effort will be to create a unique urban laboratory for innovation where UofL becomes a stronger partner with the community, public officials and others to develop novel solutions to the challenges our city faces. This initiative is an offshoot of the Downtown Revitalization Team’s Action Plan that calls for making downtown more vibrant, clean, safe and welcoming.

“It is critical for Louisville to invest in its natural and built environments to improve residents’ health, as well as be a competitive city in the 21^st Century,” said Jeff O’Brien, co-chief of Louisville Forward. “We can design our cities to prepare us for the changing climate and improve our health, all while making the city a more vibrant and equitable place.”

The UDS initiative will draw on past programs such as the Sustainable City Series’ public forums that raised awareness of sustainable practices and has led to place-making projects such as and .

The Healthful City Design Studio opens Monday, Nov. 8.

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Between Aug. 25 and Sept. 1, investigators from the tested nearly 3,000 Jefferson County residents for the to detect the presence of the virus in participants’ nasal swabs by the polymerase chain reaction (PCR) method and for the presence of antibodies against the virus in their blood.

The results showed that approximately 1.1% of all the participants tested positive for active coronavirus infections. Among vaccinated participants only 0.7% had an active infection, while nearly 5% of unvaccinated participants were actively infected. This number would roughly correspond to 7,260 active infections in the county, a nearly tenfold increase in infection rates over the rates measured in April, despite a sharp increase in vaccinated residents, as shown in Figure 1.

As in previous testing rounds, the team also tested for antibodies in participants. They found that independent of their vaccination status, in both the sampled and volunteer groups, nearly 16% of the participants had natural infection antibodies against the virus suggesting that they must have been infected by the virus in the recent past. These data indicate that in the last few months, at least 100,000 adults in Jefferson County have had COVID-19.

“These results highlight the steep rise in coronavirus infections in our community and provide a startling snapshot of the current state of the pandemic,” said Aruni Bhatnagar, director of the Envirome Institute. “Our estimates suggest that the number of infected individuals may be twice as high as that indicated in public records.

“Our work shows the vaccine is working as intended. Our population was almost 90% vaccinated, much higher than the 64% of fully vaccinated county residents. In the entire cohort, vaccinated people were over 12 times less likely to be infected compared with unvaccinated people. Though in our volunteer group, 65% of the active infections were in fully vaccinated individuals who had received the vaccine earlier this year. Most reported no or mild allergy-like symptoms and did not recognize that it may be a COVID infection thus did not think they needed to get tested.”

The study also provided estimates of where in Jefferson County the infections are most prevalent. To identify infection rates in different areas, the researchers classified the participants into neighborhood zones, as shown in Figure 2.

The highest rate of active infection was found in Zone 3A, or far southwestern Jefferson County. The highest rate of those recently having had an infection was found in Zone 3B, central southern Jefferson County, as shown in Figure 3.

Participants from Zone 3B also reported lower rates of vaccination, although vaccination rates were lowest in Zone 1B in western Jefferson County, as shown in Figure 4.

“Even though nearly 90% of the participants in the entire study population were vaccinated, we had areas that reported as low as 60% vaccination, and the persistence of infection in some geographical areas seems to be related to lower rates of reported vaccination,” said Rachel Keith, associate professor of environmental medicine at UofL who conducted the study. “Our results show that much work remains to be done and that knowing that rates of infection are high in their community may be an added incentive for some individuals to get vaccinated.

“Additionally, knowing that fully vaccinated individuals may still get an active infection allows those individuals to take additional precautions such as masking or testing which helps keep the community safe, including any young or immunocompromised friends and families who may need extra protection.”

“The vaccine is very effective. Nearly 96% of vaccinated individuals had detectable levels of antibodies against the virus in their blood. However, in a small number of people (less than 0.6%) the levels of antibodies were undetectable in our assay, even though these individuals were fully vaccinated,” Keith said. “The lack of a measurable response in some individuals even after vaccination may be due to their health and immune status. We are analyzing our results to find out more about why some rare individuals do not develop high antibody levels in response to vaccination.”

Using the data from more than 7,000 individuals tested over the past year, the team is trying to identify personal and environmental characteristics that increase the risk for coronavirus infection and how vaccination reduces this risk.

For this round of testing, the team collected samples at 13 locations across Jefferson County. Active coronavirus infections were analyzed by Bluewater Labs and antibodies against the virus were assayed at at the .

To randomly sample people from all parts of the city and to include proportional number of individuals of different age and race/ethnicity, researchers at UofL partnered with Westat to mail approximately 30,000 letters asking people to participate in the study. Nearly 1,000 people who responded to this invitation were tested and an additional 1,886 booked their own appointments after hearing about the study in the news or on social media.

This study was supported in part by a contract with the Centers for Disease Control and Prevention.

In the first study, UofL researchers Aruni Bhatnagar, professor of medicine and director of the Envirome Institute, Ray Yeager and Daniel Riggs, with Carver Coleman and Arden Pope of Brigham Young University and others, analyzed retrospective data from more than 5.5 million cancer patients and survivors from 2003 to 2016. They found that cancer patients in greener counties lived longer than those in counties with less greenness. The protective effects of greenness against cancer mortality were seen with both males and females and individuals of all ages, but were more pronounced at urban locations. Individuals with cancers that were highly survivable – such as breast, prostate and skin cancer – benefitted more from greenness than those with cancers with low survival rates such as brain, esophageal, liver, lung and pancreatic cancer. ����

The study, “,” published in the journal Environment International, evaluated associations between greenness and fine particulate matter in the air on causes of death in a large group of cancer patients and survivors in the United States.

“This is the largest study of the relationship between greenness and cancer mortality, and it provides clear evidence that living in green areas is beneficial to cancer patients,” said Bhatnagar “However, we do not yet understand why greenness protects against cancer mortality. Much more remains to be done to see whether greenness benefits cancer patients by lowering mental stress and anxiety or by reducing the levels of air pollutants or whether some other mechanisms are at play.”

The study also found that cardiopulmonary disease, but not cancer, was associated with higher levels of fine particulate air pollution. Mortality from cardiopulmonary causes – stroke, heart attack or COPD – was not affected by county greenness, except in rural locations.����

Greenness and depression

A second study, led by Kandi Walker and Joy Hart, professors in the UofL Department of Communication, Bhatnagar and other researchers in the Envirome Institute, found that people’s satisfaction with levels of greenness in their neighborhood was associated with lower levels of self-reported depressive symptoms. ��

The researchers surveyed participants about their perceptions of greenness in their neighborhoods and their mental health symptoms and found that those who were more satisfied with the greenness surrounding their homes also reported lower depression symptoms on a health survey, the Patient Health Questionnaire-9.

The 44.5% of survey participants who reported they were satisfied with the level of greenness in their neighborhood collectively scored better on the health questionnaire for depression.

“Given the pervasiveness of depression in the U.S. population, any changes that can reduce depression are essential, particularly those that can affect a large number of people,” Hart said. “The findings of this study suggest that greening interventions that focus on greenness satisfaction may be a strategy to reduce depression in urban populations.”

The study, “,” was published in July in the journal Population Medicine.

South Louisville study participants needed

Participants in the greening satisfaction study were part of the Health, Environment and Action in Louisville (HEAL) study of the Great Heart Project, which is an ongoing assessment of the effects of neighborhood greenness on individual health. Additional participants are needed for the HEAL Study by the end of September. More information is available on the website.

“Together, these studies add weight to the importance of trees, shrubs and other vegetation in urban areas in benefitting and nurturing human health. Accumulation of such evidence strengthens the case that increasing greenness in urban locations can decrease the high rates of non-communicable diseases in cities,” Bhatnagar said. “And since greenness improves health in general, it may also be effective against infectious disease.”

UofL detected the variant, a Brazilian strain known as P.1, early in April in a wastewater sample from western Jefferson County. Once researchers received the results, they alerted the Louisville Metro Department of Health and Wellness as well as the state, which confirmed a positive case in the same zip codes with different testing methods a week later.

“The ability to detect viruses early, such as in this case, gives officials more time to take precautions and contain their spread,” said Aruni Bhatnagar, professor of medicine and director of , which leads the wastewater research. “With pandemics, every second counts. In as little as one week, the virus can spread significantly, and then it becomes much harder to contain. This work gives us more time and an opportunity for targeted testing.”

UofL researchers began testing wastewater last year as part of the , a groundbreaking partnership to track COVID-19 in Louisville Metro.

The Louisville/Jefferson County Metropolitan Sewer District has sent weekly samples from 12 sites representing multiple neighborhoods and five wastewater treatment facilities that aggregate the entire county.

Those samples are taken to the , where pharmacology and toxicology assistant professor Josh Fuqua and his team process the samples and isolate viral RNA, and to the UofL Genomics and Bioinformatics Core facilities, where computer science and engineering professor Eric Rouchka analyzes the virus sequences to detect variants.

UofL recently announced the expansion of this work, backed by an . That expansion goes one step further than previous work — from identifying whether disease exists in a neighborhood to estimating how prevalent it is there.

Bhatnagar said understanding that connection could “revolutionize the way we track and contain pandemics, and not just COVID-19.”

Rather than rely solely on direct testing, such as with nasal swabs, wastewater testing can give health departments another tool to gauge the severity of community infection and to identify areas where the infection is prevalent. The tool also is faster, more efficient and less invasive.

“This is cutting-edge work – and the fact that it’s being done right here in Louisville – right here at UofL – places us at the forefront of public health innovation,” said Louisville Mayor Greg Fischer. “It shows we’re doing the work to keep our city and cities around the world safe.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with 91% of Jefferson County residents in a recent poll saying they would like to be vaccinated.

“This is one more example of how UofL has led the charge in finding new and innovative ways to detect, contain and fight COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Developing these new, more efficient tools for tracking pandemics, such as wastewater monitoring, is a big step in advancing health for our community and beyond.”

The Co-Immunity Project needs 2,000 residents to undergo random testing for COVID-19 infection and antibodies the week of May 17-23 as part of this ongoing research. To learn more, , call 833-313-0502 or email covidsupport@louisville.edu.

UofL researchers already are testing wastewater to determine whether coronavirus infection exists in different neighborhoods around Jefferson County. This new work goes one step further, with the goal of estimating how many people within those neighborhoods are infected. If virus levels are high in the wastewater, it may be a signal of widespread infection in the community.

“This could revolutionize the way we track and contain pandemics, and not just COVID-19,” said Aruni Bhatnagar, professor of medicine. “It gives us an invaluable tool that could offer a clearer view of where and how the virus spreads.”

Researchers at UofL’s , where Bhatnagar is director, began testing wastewater last year as part of the Co-Immunity Project, a groundbreaking partnership with the to track COVID-19 in Metro Louisville.

As part of that effort, the from 12 sites representing multiple neighborhoods and five water quality treatment centers that aggregate the entire county to the UofL Center for Predictive Medicine for virus analysis.

In this new work, MSD and other community partners will continue collecting wastewater samples over the next six months. After analysis, UofL will also send the results to the CDC’s National Wastewater Surveillance System, which will help inform efforts across the U.S.

As with previous rounds of COVID-19 testing conducted through the Co-Immunity Project, researchers will recruit participants by sending letters to selected households across Jefferson County. They hope to continue to enroll a few thousand people every month and will compare their COVID-19 infection and antibody results with wastewater samples from the same area, with the goal of finding how they correlate.

“The aim of the project is to figure out whether we can estimate how many people in a given area are infected by simply testing the community wastewater,” said Ted Smith, associate professor of medicine and a lead on the wastewater epidemiology project. “Additionally, this is a passive and comparatively low-cost way to monitor community infection and has the additional benefit of being inclusive of all communities in our city and is a promising step to ensuring public health equity.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with in a recent poll saying they would like to be vaccinated.

“This is critically important work in our fight against COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Our hope is that by working with the CDC, we can develop these new, more efficient tools for tracking pandemics and take a big step in advancing health for all of our community.”

Last year, U.S. Senator Mitch McConnell (R-KY), then-Senate majority leader, negotiated and championed five historic and completely bipartisan COVID-19 rescue packages. In addition to supporting workers and propping up the economy, these relief bills also allocated for COVID-19 testing. McConnell personally called then-U.S. Secretary of Health and Human Services Alex Azar to request that the CDC direct a portion of that funding to UofL’s Co-Immunity Project.

“Our country has responded to this terrible pandemic with innovation and discovery and Kentucky continues to play a major role in beating this virus. I’d like to congratulate Dr. Bhatnagar and UofL’s entire Co-Immunity Project on their groundbreaking study,” McConnell said in a statement. “After hearing about their work, I took this project to the highest levels of the federal government to help accelerate their research with additional federal funding.��As UPS and other Louisville employers are sending safe and effective vaccinations around the country, I’m proud top researchers right here at UofL are pushing the boundaries of knowledge in detection and prevention.”

Between Nov. 9 and 16, researchers at the tested samples from 2,800 individuals representing all parts of Jefferson County for both active infection and antibodies, indicating previous infection. From those test results, project researchers estimate that during these dates, 1 in 50 Louisville residents were infected and that the rates of infection were nearly five times higher than the publicly reported number of cases, estimated at 0.4% of the population.

“At this rate, as many as 13,000 Louisville residents likely are infected today, many of them asymptomatic and who unwittingly may be spreading the virus,” said Aruni Bhatnagar, director of the institute. “These rates are startling and should make every person living in Louisville re-evaluate their personal precautions to avoid coronavirus, especially as we approach the holidays.”

Other key findings from the project’s latest round of testing:

• Antibody testing indicates a 150% increase in antibody presence compared to documented cases.
• Nearly 13,000 Louisville residents likely were infected between September and November.
• About 45,000 people in Louisville likely have had a coronavirus infection at some point since the beginning of the pandemic based on antibody testing.
• Shively and Northeastern Jefferson County currently show the highest rates of infection in the city.

Benefits of representative sampling

The is a series of studies to estimate the true prevalence of SARS-CoV-2, the virus causing COVID-19, in Jefferson County. This phase of the project involves testing a representative sample of individuals from different areas in the city in proportion to the age and race of the population of the area. Researchers say this approach provides a more reliable estimate of the breadth and spread of coronavirus infection in different parts of the city than testing only those who have reason to believe they may have the virus. The team tested its first community sample in June, a second in September and the most recent in November.

In addition to the 2% infection rate among randomized participants, individuals who participated without an invitation showed a 3.3% rate of infection. This is higher than the random sampling because individuals self-selecting for testing are more likely to have been exposed to the virus.

“Most of the individuals we identified as having coronavirus infection did not have overt symptoms, which indicates that a large number of cases are likely to remain undetected,” said Rachel Keith, assistant professor of environmental medicine at UofL, who conducted the study. “We do not know for sure, but it seems likely that the recent increase in infections may be in part due to asymptomatic individuals.”

The project also tested for antibodies against the virus and found a one-and-a-half-fold increase in the number of individuals who previously had been exposed to the virus. Study researchers estimate that by Nov. 20, more than 45,000 individuals had been infected by the virus, rather than the 20,500 known cases documented so far. These data also suggest that approximately 15,000 individuals became infected between September and November.

��

“One reason for the recent increase in coronavirus infection may be the recent drop in temperature,” Bhatnagar said. “ shows that low temperatures promote the spread of the virus. Hence, we were expecting the rates of infection to rise in winter, but this increase is much more than we thought.

“Unfortunately, things are likely to get much worse in the coming months as temperatures dip even further. Therefore, we urgently need collective action, maybe just for a few months more. An effective vaccine is on the horizon so it seems that there is clear hope ahead that might hearten us to make the necessary sacrifices for a little longer.”

In an effort to obtain a uniform sample of city residents, investigators at the institute mailed 30,000 letters to households across Louisville for the November round of testing. The invitations were sent to individuals selected using addresses derived from��U.S. Census Bureau tract boundaries in proportion to the total population in each geographic area.

In addition, any adult resident of Jefferson County was invited to participate through news and social media messages.

A total of 2,800 individuals were tested, 1,091 in response to the invitations and an additional 1,709 who booked their own appointments. The testing took place at 10 community drive-up or walk-up locations. Participants were tested both for the presence of the virus in participants’ nasal swabs and for antibodies against the virus in their blood, indicating a previous infection. Samples were analyzed at UofL’s Regional Biocontainment Laboratory (RBL) by assistant professor Krystal Hamorsky, and Amanda Lasnik, at the Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases.

The random sampling of different neighborhoods also allowed the team to identify areas with higher prevalence of infection. Although infections were spread throughout the county, the highest rates were in the Shively area as well as northeastern Jefferson County.

The researchers are planning to conduct a fourth round of randomized coronavirus testing in Jefferson County Dec. 9-14.

This study was supported in part by the City of Louisville, the James Graham Brown Foundation, the Owsley Brown Family Foundation, Foundation for a Healthy Kentucky and others.