LOUMED Commons is a one-acre park thoughtfully designed for gathering and recreation, featuring shaded seating, native plantings and flexible areas for community programs, food trucks and events. The space enhances the district鈥檚 sense of connection and provides a welcoming place for people to enjoy the outdoors in an urban environment.
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鈥淟OUMED Commons embodies the spirit of community within our district,鈥� said Nadareca Thibeaux, executive director of LOUMED. 鈥淚t was created for the people who make LOUMED thrive, including our 18,000 health care professionals, educators and other employees, nearly 13,000 students and more than 1.5 million annual visitors. Whether someone wants to take a break, enjoy lunch outdoors or simply recharge, this park offers a place to do that.鈥�
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Louisville Metro worked closely with LOUMED and its partners to make the project possible, aligning with Greenberg鈥檚 broader vision for a more connected and livable city.
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鈥淟OUMED Commons is a symbol of the kind of city we are building together,鈥� Greenberg said. 鈥淏y transforming this block into green space, we鈥檙e creating a more connected downtown that better serves our students, health care workers, patients and neighbors alike. This project reflects our commitment to building a safer, stronger and healthier Louisville for all.鈥澨�

The project was led by LOUMED in partnership with Louisville Metro Public Works, JLL, CARMAN Landscape Architecture and Pace Contracting. LOUMED Commons was supported by city funding allocated from Governor Beshear and the Kentucky General Assembly鈥檚 investment in downtown Louisville. The $10-million allocation is helping to support multiple LOUMED projects, including LOUMED Commons. Additionally, the city is investing $1.75 million in improvements along Chestnut Street.
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LOUMED Commons is the first project completed within the study area of Greenprint, a 10-year initiative coordinated by the University of Louisville鈥檚 Christina Lee Brown Envirome Institute and the Urban Design Studio. Greenprint is a citywide framework that uses environmental data to guide where and how new green spaces can have the greatest impact on human health. It connects separate projects led by local partners, like LOUMED Commons and the upcoming Chestnut Street improvements, under a shared commitment to creating a cooler, cleaner and healthier Louisville.
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LOUMED鈥檚 anchor institutions听鈥� the University of Louisville Health Sciences Center, UofL Health, Jefferson Community and Technical College and Norton Healthcare 鈥� also continue to invest in the district. More than $560 million in education, research, health care and workforce development projects are currently underway on their downtown campuses.听
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About the Louisville Medical & 成人直播 District (LOUMED)
The Louisville Medical and 成人直播 District (LOUMED) is a 22-square-block hub where health care, education, research and community come together in downtown Louisville. Anchored by the University of Louisville, UofL Health,听Jefferson Community and Technical College and Norton Healthcare, LOUMED institutions collectively employ 18,000 people and educate 10,000 students, with a combined annual payroll exceeding $1 billion. Through partnerships and investments in public spaces, LOUMED supports the people who work, study, receive care or visit the district while contributing to Louisville鈥檚 continued growth.

For more information about LOUMED and its initiatives, visit and follow on , and .

The launched the first-of-its-kind project in 2018 in partnership with The Nature Conservancy, Washington University in St. Louis, Hyphae Design Laboratory and others to study whether and how living among more densely greened surroundings contributes to better heart health. The design of the study closely mirrors clinical trials which test whether medical treatments are effective. The team applied the treatment 鈥� the addition of large trees and shrubs 鈥� to some participants鈥� neighborhoods but not to others. They then compared residents鈥� health data to see how the addition of the trees affected their health.

鈥淭he Green Heart Louisville Project is an excellent example of how our university鈥檚 innovative and collaborative researchers are working to improve lives in our community and far beyond,鈥� UofL President Kim Schatzel said. 鈥淭rees are beautiful, but these results show that the trees around us are also beneficial to individual and community health. Through this and many other projects, the Envirome Institute is improving health at the community level, not just for individuals, but for everyone living in a neighborhood.鈥�

To understand the state of community鈥檚 health at the start of the study, researchers took blood, urine, hair and nail samples and documented health data from 745 people living in a four-square-mile area of south Louisville. The researchers also took detailed measurements of tree coverage and levels of air pollution in the area.

Following this baseline data collection, the Envirome Institute worked with The Nature Conservancy and a host of local partners and contractors to plant more than 8,000 large trees and shrubs in designated neighborhoods within the project area. Those living in the greened area were considered the treated population and the results obtained from this population were compared with residents of adjacent neighborhoods, where the project team did not plant any trees.

After the plantings, the research team reassessed residents鈥� health. They found that those living in the greened area had 13-20% lower levels of a biomarker of general inflammation, a measure called high-sensitivity C-reactive protein (hsCRP) than those living in the areas that did not receive any new trees or shrubs. Higher levels of hsCRP are strongly associated with a risk of cardiovascular disease and are an even stronger indicator of heart attack than cholesterol levels. Higher CRP levels also indicate a higher risk of diabetes and certain cancers.

A reduction of hsCRP by this percentage corresponds to nearly 10-15% reduction in the risk of heart attacks, cancer or dying from any disease.

鈥淭hese results from the Green Heart Louisville Project indicate that trees contribute more to our lives than beauty and shade. They can improve the health of the people living around them,鈥� said Aruni Bhatnagar, director of the Envirome Institute and UofL professor of medicine. 鈥淎lthough several previous studies have found an association between living in areas of high surrounding greenness and health, this is the first study to show that a deliberate increase in greenness in the neighborhood can improve health. With these results and additional studies that we hope to report soon, we are closer to understanding the impact of local tree cover on residents鈥� health. This finding will bolster the push to increase urban greenspaces.鈥�

As more is known about the health impacts of increased tree cover, increased greening in cities may emerge as a key method to improve public health.

鈥淢ost of us听intuitively understand that nature is good for our health. But scientific research testing, verifying and听evaluating this connection is rare,鈥� said Katharine听Hayhoe, chief scientist of The Nature Conservancy.听鈥淭hese recent findings from the Green Heart Project build the scientific case for听the powerful connections between the health of our planet and the health of all of us.鈥�

Earlier in August, the Green Heart Louisville Project was awarded an additional $4.6 million in funding from the National Institute of Environmental Health Sciences to support continued research over the next five years.

These findings were presented by Daniel Riggs, UofL assistant professor of environmental medicine, at the in Santiago, Chile on Aug. 26.

STUDY DETAILS

This study is part of the Green Heart Louisville Project, ongoing research to discover how trees and shrubs affect people鈥檚 health.

The neighborhood

The project involved a four-square-mile area of South Louisville straddling the Watterson Expressway, including the Taylor-Berry, Jacobs, Hazelwood, Oakdale, Wilder Park and Beechmont neighborhoods. The project team planted trees and shrubs in a central portion of the project area that included Wyandotte Park, which served as the treated area. They planted no trees in the outer areas of the project area. [SEE MAP]

The people

Researchers enlisted 745 people living in the project area to participate in the project鈥檚 ongoing health study. At enrollment, participants were between 25 and 75 years old, 60% female, 77% white and 50% had household income below $50,000 per year. They live in the planted intervention area as well as outside it.

Researchers collected participants鈥� blood, urine, nail and hair samples and health information before and after planting the trees and shrubs in the 鈥渢reatment鈥� area.

The trees

Between 2019 and 2022, the Green Heart Project planted 8,425 evergreen trees and shrubs of 42 different species from five different families and 630 deciduous trees. Evergreens were pine, cypress, yew, holly and magnolia. Deciduous trees were mainly dogwood, oak and serviceberry.

Project team members and BrightView Landscape maintain the trees to promote their survival, growth and sustained impact.

The data

High-sensitivity C-reactive protein (hsCRP) is a blood test that measures general inflammation in the body. After the planting, people living in the areas where trees and shrubs were added had 13-20% lower hsCRP levels compared with those living in the areas that did not receive greening from the project.

Inflammation as measured by hsCRP , including stroke, heart attack and coronary artery disease. Previous studies have shown that hsCRP increases with age. The change in hsCRP seen in individuals living in the planted areas was similar to the difference between typical levels in a 42-year-old compared with a 33-year-old.

This difference also is similar to the difference between people who exercise regularly and those who do not. Finally, the decrease in hsCRP levels with planting corresponds to a nearly 10-15% reduction in the risk of heart attacks, cancer or dying from any disease.

Funding

A $3 million grant from the National Institute of Environmental Health Sciences supported the health evaluation of community participants and an additional $4.6 million was recently awarded for continuing this research. These grants bring the total investment by the institute to more than $8 million. The Nature Conservancy provided over $8.7 million in funding to support tree planting and maintenance, project management and other key project needs. The project has had an additional $3 million in support from local donors. Recently, $4.6 million in funding was awarded from the NIEHS for continued research over the next five years.

Collaborators and community partners

Collaborators for this project include the University of Louisville, Washington University in St. Louis, , , the United States Forest Service, and other partners.

Community organizations and resident involvement are vital to the success of this ongoing work to learn the health effects of urban greening. The team is grateful to the residents participating in the health study and those who have allowed tree planting on their property.

Watch a video about the research:

More:

View pictures from the Aug. 27 research results announcement on .

Watch the full Aug. 27 research results announcement on .

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.

鈥淭his 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,鈥� said UDS Director Patrick Piuma. 鈥淚 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.鈥�

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.

鈥淭he 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,鈥� 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鈥檚 Action Plan that calls for making downtown more vibrant, clean, safe and welcoming.

鈥�It is critical for Louisville to invest in its natural and built environments to improve residents鈥� health, as well as be a competitive city in the 21^st Century,鈥� said Jeff O鈥橞rien, co-chief of Louisville Forward. 鈥淲e 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.鈥�

The UDS initiative will draw on past programs such as the Sustainable City Series鈥� 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鈥� 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.

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

鈥淥ur 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.鈥�

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.

鈥淓ven 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,鈥� said Rachel Keith, associate professor of environmental medicine at UofL who conducted the study. 鈥淥ur 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.

鈥淎dditionally, 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.鈥�

鈥淭he 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,鈥� Keith said. 鈥淭he 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.鈥�

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 鈥� such as breast, prostate and skin cancer 鈥� benefitted more from greenness than those with cancers with low survival rates such as brain, esophageal, liver, lung and pancreatic cancer. 听听

The study, 鈥�,鈥� 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.

鈥淭his 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,鈥� said Bhatnagar 鈥淗owever, 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.鈥�

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

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鈥檚 satisfaction with levels of greenness in their neighborhood was associated with lower levels of self-reported depressive symptoms. 听

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.

鈥淕iven 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,鈥� Hart said. 鈥淭he findings of this study suggest that greening interventions that focus on greenness satisfaction may be a strategy to reduce depression in urban populations.鈥�

The study, 鈥�,鈥� 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.

鈥淭ogether, 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,鈥� Bhatnagar said. 鈥淎nd since greenness improves health in general, it may also be effective against infectious disease.鈥�

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.

鈥淭he ability to detect viruses early, such as in this case, gives officials more time to take precautions and contain their spread,鈥� said Aruni Bhatnagar, professor of medicine and director of , which leads the wastewater research. 鈥淲ith 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.鈥�

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 鈥� from identifying whether disease exists in a neighborhood to estimating how prevalent it is there.

Bhatnagar said understanding that connection could 鈥渞evolutionize the way we track and contain pandemics, and not just COVID-19.鈥�

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.

鈥淭his is cutting-edge work 鈥� and the fact that it鈥檚 being done right here in Louisville 鈥� right here at UofL 鈥� places us at the forefront of public health innovation,鈥� said Louisville Mayor Greg Fischer. 鈥淚t shows we鈥檙e doing the work to keep our city and cities around the world safe.鈥�

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.

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

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.

鈥淭his could revolutionize the way we track and contain pandemics, and not just COVID-19,鈥� said Aruni Bhatnagar, professor of medicine. 鈥淚t gives us an invaluable tool that could offer a clearer view of where and how the virus spreads.鈥�

Researchers at UofL鈥檚 , 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鈥檚 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.

鈥淭he 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,鈥� said Ted Smith, associate professor of medicine and a lead on the wastewater epidemiology project. 鈥淎dditionally, 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.鈥�

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.

鈥淭his is critically important work in our fight against COVID-19,鈥� said Kevin Gardner, UofL鈥檚 executive vice president for research and innovation. 鈥淥ur 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.鈥�

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鈥檚 Co-Immunity Project.

鈥淥ur country has responded to this terrible pandemic with innovation and discovery and Kentucky continues to play a major role in beating this virus. I鈥檇 like to congratulate Dr. Bhatnagar and UofL鈥檚 entire Co-Immunity Project on their groundbreaking study,鈥� McConnell said in a statement. 鈥淎fter 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.听As UPS and other Louisville employers are sending safe and effective vaccinations around the country, I鈥檓 proud top researchers right here at UofL are pushing the boundaries of knowledge in detection and prevention.鈥�

In February, the researchers asked adults living in Jefferson County their perceptions about the coronavirus vaccine in order to identify potential barriers to vaccine uptake and to better understand vaccine hesitancy. Letters were mailed to 35,999 households across all geographic sectors of the county inviting the recipients to take part in the survey as well as to make an appointment for free testing for COVID-19, also part of the Co-Immunity Project.

鈥淲e wanted to better understand which residents had access to the vaccine as well as their attitudes toward the vaccine,鈥� said Aruni Bhatnagar, Ph.D., director of the . 鈥淭his information would help us improve equity in vaccine availability as well as help us understand the reasons behind vaccine hesitancy in our community. So, we incorporated the survey opportunity into our outreach for random community testing for the virus.鈥�

The survey included questions about whether the person had been vaccinated, where they received most of their information about the vaccine and where they would prefer to be vaccinated. They also had an option to indicate they would not get vaccinated. They also were asked what would make them more likely to be vaccinated and what influenced those who were hesitant to vaccination.

Participants completed the questionnaire on a website that also offered them the opportunity to schedule an appointment for COVID-19 infection and antibody testing. Most of the 1,296 survey participants were age 60 or over (44%), female (61%) and white (84%) and 90.2% reported being unvaccinated.

An overwhelming majority of participants (91%) indicated they would choose to be vaccinated, with slightly lower rates among minority participants. Vaccine-hesitant participants suggested that more evidence of safety and effectiveness or their health provider鈥檚 recommendation would increase their likelihood of getting vaccinated. Although vaccines are provided for free, concerns about cost were seen in more than half the participants.

While most vaccine-hesitant participants expressed concern about side effects and safety, followed by not 鈥渢ested on enough people who are like me,鈥� minority participants expressed these concerns at higher rates and many vaccine participants from all races had concerns about the timeline of vaccine development. Other concerns were related to the efficacy of the vaccines, vaccines in general and government mistrust.

About 3% of white and 8% of minority participants indicated they would never choose vaccination. Minority participants reported they were more likely to choose vaccination with celebrity endorsement, offerings by faith organizations and vaccination requirements. White participants were more likely to choose vaccination if their family and friends or elected officials were vaccinated and with evidence of efficacy.

Most participants would prefer to be vaccinated by their health care provider, followed by a mobile or walk-in clinic, a pharmacy or a hospital. Other sites, such as community organizations, community recreation centers, workplaces or schools were of interest to one-fourth or less of participants. Minority participants were less interested in vaccination at work, pharmacies, libraries and mobile or walk-up clinics and more interested in being vaccinated at food distribution centers or by their health care provider.

Compared with white participants, minority participants were less likely to report knowing how to find out their vaccine eligibility or sign up for a vaccination.

While they acknowledge limitations to the study due to the fact that it was delivered along with the testing invitation and that it required a computer and internet access to complete, the researchers believe analysis of the results will be helpful in increasing access and acceptance of vaccines among different populations.

鈥淥btaining information on how to get a vaccine continues to be burdensome and solutions to this problem will help with more equitable vaccine distribution,鈥� said Rachel Keith, Ph.D., assistant professor in the UofL Department of Medicine and a lead investigator in the Co-Immunity Project.

Since warmer weather is known to decrease the transmission of other coronaviruses, researchers at the University of Louisville鈥檚 , the Johns Hopkins University School of Medicine and the U.S. Department of Defense Joint Artificial Intelligence Center theorized that atmospheric temperature also would affect transmission of SARS-CoV-2. To find out, they compared temperature data and logged cases of COVID-19 in 50 countries in the Northern Hemisphere between Jan. 22 and April 6.

The data showed that as temperatures rose, the rate of increase in new cases of COVID-19 decreased.

鈥淎lthough this is typical and expected behavior for most members of the coronavirus family, SARS-CoV-2鈥檚 rapid spread and lethality have been atypical and unexpected. The confirmation of the SARS-CoV-2 temperature sensitivity has important implications for anticipating the course of the current pandemic,鈥� said Adam Kaplin, of Johns Hopkins, an author of the study.

The researchers compared daily low temperature and relative humidity data with logged COVID-19 cases in the 50 Northern Hemisphere countries. The data showed that between 30 and 100 degrees Fahrenheit, for every 1 degree Fahrenheit increase in temperature, COVID-19 cases declined by 1%, and for every 1 degree decrease in temperature, cases would be predicted to rise by 3.7%.

鈥淥f course, the effect of temperature on the rate of transmission is altered by social interventions like distancing, as well as time spent indoors and other factors. A combination of these factors ultimately will determine the spread of COVID-19,鈥� said Aruni Bhatnagar, co-author and director of the Brown Envirome Institute.

In the United States, sharp spikes in COVID-19 have been seen over the summer, but the researchers noted that based on the data they analyzed, cooler summer temperatures may have resulted in an even higher number of cases.

鈥淎lthough COVID-19 is an infectious disease that will have non-temperature dependent transmission, our research indicates that it also may have a seasonal component,鈥� Bhatnagar said. 鈥淭his means that this winter could bring a serious surge on top of the regular transmission.鈥�

The research, published as a preprint on MedRxiv, also indicates that the correlation between temperature and transmission was much greater than the association between temperature and recovery or death from COVID-19.

As part of community testing for Phase II of the , MSD is providing samples from eight sites in its vast network of pipes and five treatment facilities which are sent weekly to UofL and research collaborators at Arizona State University for virus analysis.

The laboratory at ASU will use RT-PCR tests, a technique for detecting genetic material of the virus, to count copies of SARS-CoV-2 virus RNA in the wastewater and sewage sludge samples. The researchers believe the presence of this RNA sequence is an indicator of the level of infection with the virus in a given community.

To support this work and other aspects of the Co-Immunity Project, a groundbreaking collaboration to track and curb COVID-19, UofL has received a new $1 million gift from the Owsley Brown II Family Foundation.

鈥淭raditionally, science has had difficulty addressing the interdependent nature of people and their environment or factoring in the many forms of human health, including environmental health and the water we all depend on. The Envirome Institute was founded to fill that void,鈥� Christina Lee Brown said. 鈥淭he challenges of this pandemic have made the need to learn how to make decisions through all forms of health all too clear, and I’m so proud the team here is at the national forefront of the response. The Co-Immunity Project, especially now with this singular partnership with MSD, puts Louisville and Kentucky at the cutting edge nationally in terms of virus monitoring.鈥�

This research is part of the Co-Immunity Project鈥檚 Phase II, last week, which also includes testing 2,400 individuals for SARS-CoV-2 infection and antibodies. By concurrently testing individuals and wastewater from different parts of Jefferson County, the researchers hope to develop a 鈥渧irus radar鈥� to track the spread of the virus in the county. The 鈥渧irus radar鈥� could be used to identify hot spots of viral infections and even as an early warning sign of future outbreaks in an area. This information could be used to guide public health actions and social restrictions to reduce future surges.

鈥淢SD has a team of skilled professionals who are already taking samples as part of our operations and regulatory requirements. It was a natural extension to offer help to the researchers at the University of Louisville for this important COVID-19 research,鈥� said MSD Executive Director Tony Parrott.

MSD wastewater operators and lab staff already have personal protective equipment and follow best practice guidelines from the Occupational Safety and Health Administration and the Centers for Disease Control and Prevention in their daily work.听These measures also protect the safety of MSD employees who obtain the samples for this research.

The reports that to date, there have been no cases in the U.S. or elsewhere in the developed world of infection of a wastewater employee with the COVID-19 virus as a result of treatment operations.听

UofL has offered additional MSD employee testing as part of this research collaboration. MSD employee time for supporting this project is funded by the Co-Immunity Project. The project is part of Metro Louisville鈥檚 COVID-19 testing framework that includes extensive testing and contact tracing to contain COVID-19 in the city.

鈥淭his collaboration builds off years of research partnership with MSD and our collaborators at Arizona State University,鈥� said Ted Smith, director of the Center for Healthy Air, Water and Soil in the UofL Christina Lee Brown Envirome Institute. 鈥淲e hope to learn quickly how coronavirus detection in our wastewater can be a useful input to Louisville鈥檚 overall COVID-19 test and containment effort.鈥�

This type of testing has been demonstrated to be a reliable indicator of infection in entire communities. Recently, Yale University published showing that the amount of virus in daily samples taken between March 19 and May 1 was a seven-day leading indicator of positive clinical tests for COVID-19 in the New Haven, Connecticut, population of 200,000.

鈥淲e are incredibly grateful to the Owsley Brown II Family Foundation for funding the important work of the Co-Immunity Project,鈥� said Aruni Bhatnagar, director of the UofL Envirome Institute. 鈥淭his research, combined with the other components of the project, may provide new ways of understanding this emerging area of epidemiology and guide Louisville and other communities in responding effectively to COVID-19, and perhaps other infectious diseases as well.鈥�

The Co-Immunity Project is a collaboration of the UofL Christina Lee Brown Envirome Institute, the Louisville Healthcare CEO Council and three health systems in Louisville 鈥� Baptist Health, Norton Healthcare and UofL Health.