To better understand the psychological factors underlying this commitment to individual prevention measures, a team of psychology researchers led by Michael Cunningham at the University of Louisville surveyed several groups of people about their attitudes and responses. The studies, published in in April, revealed associations between individuals’ response to prevention measures and their belief in the credibility of science, control and coping mechanisms and political orientation.

Cunningham and colleagues at UofL, York College in Pennsylvania and FifthTheory, a digital assessment and survey solutions company in Chicago, conducted a series of three online surveys to delve deeper into the psychological determinants of COVID-19 prevention behaviors.

The first study of the series surveyed students, faculty and staff at two higher education institutions in the U.S. The researchers compared respondents’ assessments on the a measure of acceptance of responsibility and adherence to prevention measures, with additional questions to determine respondents’ belief in the credibility of science, political orientation and beliefs about the virus and the degree to which preventing an infection was within an individual’s control.

It showed that those who attributed COVID-19 safety to personal effort rather than inherent ability or outside forces, who had a progressive political orientation and who believed in the credibility of science were more likely to embrace COVID-19 prevention actions such as wearing masks, social distancing and vaccination.

The study began before the COVID-19 vaccine was available, but once the Pfizer vaccine received Emergency Use Authorization from the Food and Drug Administration in December 2020, the team added questions to the survey about willingness to take the vaccine. This gave them insight into attitudes both before and after respondents were confident a vaccine would be a reality.

“The attitudes about the pandemic may differ depending on what you think the solutions are going to be, so issues of sensitization and denial and repression may come in to play slightly differently when you think there is a solution versus when you don’t,” Cunningham said. “We were thinking a vaccine would come but we didn’t all know when it was going to hit, so when it did in December of 2020, that changed the equation quite a bit.”

After the vaccine received authorization, responses to the survey shifted slightly, showing that individuals had become less committed to personal carefulness and health-consciousness to avoid the illness and less likely to believe that becoming ill from the virus was due to fate or luck.

The second study in the series addressed work-related attitudes related to the pandemic. The researchers surveyed adults across the U.S. and found that an intention to be vaccinated corresponded to a willingness to work, less emotional distress and greater focus on customer experience.

The third study documented the personal attributes and motives of individuals who volunteered to help administer vaccines in Kentucky. Nearly 60% of those individuals were motivated by a desire to help others, whereas almost 40% said they volunteered so they could receive the vaccine themselves. Compared to the general population, the survey found the volunteers more likely to be older, to have higher levels of education, to believe in the credibility of science, vote liberal and attribute COVID-19 protection to personal effort.

The results of these studies led the researchers to propose a COVID-19 mindset hierarchy model that ranks individuals in terms of their response to pandemic. The model goes from the most basic level 1, acceptance vs. denial of COVID-19, to the most mature level 5, in which individuals become involved in community-based eradication efforts. The knowledge base incorporated in the model is useful in shaping health safety messaging going forward, not only with COVID, but with monkeypox and other plagues that have not yet emerged.

Cunningham and his team are planning additional research to further understand the psychological impact of the pandemic and related losses, to validate the COVID-19 mindset hierarchy and to examine the relation of COVID behaviors to more general health care related topics, such as support for a single-payer system.

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.

The Phase 3 trial enrolls residents and staff who live or work at facilities that have had a recently diagnosed case of COVID-19 and who now are at a high risk of exposure. The study, which included Essex Nursing and Rehabilitation Center in Louisville recently, is to evaluate the efficacy and safety of bamlanivimab for the prevention of COVID-19. The study also is exploring treatment of recently diagnosed SARS-CoV-2- and COVID-positive patients who are at high-risk of developing severe disease.

As the only Kentucky location for the Phase 3 clinical trial, UofL’s Division of Infectious Diseases worked with mobile units deployed by Lilly to the Louisville site to enroll and treat trial participants. Julio Ramirez, director of the division, leads the work, which includes follow-up monitoring for study participants at this facility and any others in Kentucky who may participate in the trial.

“We are thrilled to be partnering with NIH and Lilly for the implementation of their BLAZE-2 study in Kentucky. With nearly 30,000 residents in long-term care facilities in the state, there is an urgent need for therapeutic strategies to prevent the spread of COVID-19 in this vulnerable population. We are proud to be a part of this new type of clinical study for preventive treatment,” Ramirez said.

For this trial, Lilly deploys mobile research units to a long-term care site soon after an individual has tested positive for SARS-CoV-2. The unit team enrolls residents and staff members who volunteer to participate in the trial. The one-time study drug infusion and follow-up visits are administered to study volunteers at the long-term care facility. The UofL team works with the Lilly team during the initial site infusions and will monitor participants following the infusion for up to 25 weeks.

The first deployment in Kentucky was to Essex Nursing and Rehabilitation Center, where 20 residents and staff members were enrolled in the study in November.

“Our elderly population is at a much higher risk of complications from COVID-19 and our staff and residents are happy to be participating in this study. I have personally witnessed the negative impact COVID-19 has had on nursing facilities,” said Robert Flatt, Essex administrator. “I am extremely proud to be an active participant in this collaborative study in the hopes that we will soon put an end to this pandemic.”

The virus is known to spread rapidly among staff and residents of long-term care facilities, who account for a high percentage of hospitalizations and deaths resulting from the virus.

“I am glad to be a part of this research study with the University of Louisville to help find treatment and prevention options for COVID-19. As a member of our community, I am happy to participate in the hopes of helping others. I am also excited to participate as I am a huge fan of the University of Louisville,” said Patricia L. Rollie, an Essex resident and study participant.

Antibodies are produced naturally by the immune system in response to viruses and other foreign invaders and help the body neutralize and destroy these threats. However, it takes time for the body to produce its own antibodies. Bamlanivimab is an antibody engineered from a COVID-19 survivor. Testing and previous trials have shown that manufactured antibodies can speed recovery or possibly prevent SARS-CoV-2 infection.

“COVID-19 has had a devastating impact on nursing home residents. We’re working as fast as we can to create medicines that might stop the spread of COVID-19 to these vulnerable individuals,” said Daniel Skovronsky, Eli Lilly’s chief scientific officer and president of Lilly Research Laboratories. ”BLAZE-2 is a first-of-its-kind COVID-19 trial designed to address the challenging aspects of running a clinical trial in long-term care facilities, which normally do not conduct clinical trials.”

As a result of a separate clinical trial, Lilly��has received an emergency use authorization from the FDA for bamlanivimab to treat higher-risk patients recently diagnosed with mild-to-moderate COVID-19.

Bamlanivimab targets the spike protein of the SARS-CoV-2 virus. It is designed to block viral attachment and entry into human cells, thus neutralizing the virus and potentially preventing and treating COVID-19. Bamlanivimab emerged from the collaboration between��Lilly��and AbCellera and was discovered by AbCellera and scientists at the��National Institute of Allergy and Infectious Diseases��Vaccine Research Center.

From December 10-14, project researchers tested 700 individuals in South Louisville for both active infection and antibodies, indicating previous infection, to develop a “snapshot” of the rates of infection in that area of the county. From those test results, the researchers estimate that as of these dates, nearly 11.16% of South Louisville residents have been exposed to the virus. Extending this estimate to all of Jefferson County would mean that nearly 73,636 individuals (1 in 10) have been infected with SARS-CoV-2 since the beginning of the pandemic.��

“The latest rates are the highest we have seen since we began testing in June and are higher than we had expected based on our previous testing drives,” said Aruni Bhatnagar, director of the UofL Christina Lee Brown Envirome Institute. “These rates show that the pandemic continues to grow at an accelerated rate. Indeed, it is likely to get worse before getting better.”

Key findings from the project’s latest round of testing:

• About 3.57% of those tested had an active coronavirus infection.
• Antibody testing indicates that the true rates of infection may be 1.6 times higher than reported in publicly available data.
• More than 28,000 Louisville residents may have been infected between November and December.
• About 73,000 people in Louisville likely have had a coronavirus infection at some point since the beginning of the pandemic, based on antibody testing.
• The highest rates of infection in December were found in people 18-to-34 years of age (10%), which was four times higher than those 35-to-59 years of age (2.6%).
• Women and men had similar rates of infection.
• Current rates of infection were much higher among non-whites (8.8%) than among whites (1.43%). To-date, nearly twice as many non-whites as whites have been infected by the virus.

The is a unique 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. For this round of testing, the project researchers tested individuals living in South Louisville neighborhoods that are part of Green Heart Louisville, a separate, ongoing project to test whether increasing green space in a neighborhood improves air quality and human health.

Data released for the December tests show at least 3.57% of participants from the area were currently infected by the virus, which is nearly double the rate reported for the entire County in November (2%).

The project researchers with the , directed by Kenneth Palmer, also tested samples from the participants for antibodies against the virus and found a 1.6-fold increase in the number of individuals who previously had been exposed to the virus. Study researchers estimate that by December 14, about 73,000 individuals had been infected by the virus rather than the 48,228 known cases documented so far. These data also suggest that approximately 15,000 individuals became infected between November and December.

“Reasons for the increase in the rates of infection are not clear, but may relate to a drop in temperature,” Bhatnagar said. “From our previous work we know that . However, part of the reason may also be fewer precautions by young people and increased travel during the Thanksgiving holiday.”

Bhatnagar said he expects infection levels to continue to rise due to colder weather temperatures.

“Our models suggest that infection rates likely will continue increasing at least until the end of December and that things are likely to get much worse in the coming months as temperatures dip even further,” he said. “We are entering the most dangerous and deadly phase of the pandemic and we have to maintain high vigilance for at least the next two months until the temperatures begin to rise again or a large number of individuals are vaccinated.”

“In what may be a glimmer of hope, we have seen a consistently increasing awareness of the importance of repeated COVID-19 testing among the residents of Jefferson County, especially the South Louisville area where there was a robust push for testing and awareness by the local community members,” said Alok Amraotkar, a postdoctoral research fellow in the Envirome Institute who conducted the study. “We will keep building on these relationships with the community to curb the spread of COVID-19 virus.”

In an effort to obtain a uniform sample of residents, investigators at the Brown Envirome Institute mailed 20,000 letters to households across the study area. The invitations were sent to individuals selected using addresses derived from��U.S. Census Bureau tract boundaries. In addition, any adult resident of the area was invited to participate through news, emails and social media messages.

Nearly 1,000 individuals were tested, 700 of whom live in the Green Heart Louisville study area. The testing took place at community drive-up or walk up locations. Participants were tested both for the presence of the virus via nasal swabs, indicating current infection, and for antibodies against the virus in their blood, indicating a previous infection. Samples for the virus were tested by Bluewater Diagnostic Laboratory and antibodies were measured at UofL’s Regional Biocontainment Laboratory by the .

Wastewater monitoring results reinforce findings

The Co-Immunity Project also has been monitoring the presence of SARS-CoV-2 in Louisville wastewater in collaboration with MSD since June. During this round of community testing, daily wastewater samples were gathered from seven manhole locations within the study area. All locations revealed daily presence of the virus at levels consistent with those found across Louisville in this time period. These levels are 10 times higher than area levels just six weeks ago.

The researchers are planning to conduct a fourth round of randomized coronavirus testing in Jefferson County January 22-28.

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, the Jewish Heritage Fund for Excellence and others.

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.

Jon Klein, vice dean for research at the UofL School of Medicine, is a participant in the Pfizer trial.

“While we must wait for the safety data, the news from Pfizer this morning about the effectiveness of their COVID-19 vaccine exceeds all expectations. From my own perspective as a participant in the trial, the two-injection vaccine was not a bad experience and my own adverse effects were mild,” Klein said.��

While he is encouraged by the very high effectiveness of the potential vaccine shown in this this early report, he cautions that the data have not been published and the study has not been peer reviewed. Klein expects the data will be made public within the next 7 to 14 days.

“Today’s news will not change the course of the pandemic over the next 12 weeks, which could be some of the worst we have seen,” Klein said. “It is still up to the public to limit activities, wear masks and continue diligent hand washing, to keep the numbers in check for the next several months.”

Klein has also been participating in the fight against COVID-19 as a medical professional. At the invitation of Louisville Mayor Greg Fischer, Klein has provided medical information to the community in the mayor’s regularly scheduled livestreams each week.

“My advocacy efforts have focused on explaining science and public health to the public during the COVID-19 pandemic. Since March, I have appeared weekly with Mayor Fischer on his Facebook Live video broadcast where I answer questions about all aspects of COVID-19,” Klein said.

He is also a weekly guest on WLCL-FM and WBCE-AM radio.

“While these are ESPN sports radio stations, the hosts have taken the lead in bringing COVID-19 information to the Kentucky-Indiana audience,” he said.����

Since warmer weather is known to decrease the transmission of other coronaviruses, researchers at the University of Louisville’s , 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.

“Although this is typical and expected behavior for most members of the coronavirus family, SARS-CoV-2’s 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,” 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%.

“Of 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,” 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.

“Although COVID-19 is an infectious disease that will have non-temperature dependent transmission, our research indicates that it also may have a seasonal component,” Bhatnagar said. “This means that this winter could bring a serious surge on top of the regular transmission.”

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.

From June 10-19, researchers conducting Phase II of the tested members of the Louisville community for both the presence of the novel coronavirus in the participants’ nasal passages and for antibodies against the virus in their blood. Samples were collected at five community drive-up locations across Louisville by UofL Health and researchers from the . Samples were analyzed by UofL’s Center for Predictive Medicine for Biodefense and Emerging Infectious Disease in its Regional Biocontainment Laboratory.

To obtain a representative sample for the study, households in Jefferson County were organized into geographic regions based on U.S. Census Bureau tract boundaries. Households within each region were sent invitations to participate in proportion to the population of that region. Within the regions, areas that had higher concentrations of non-white residents were sampled at a higher rate to increase their representation.

Invitations were mailed to a total of 18,232 addresses. Based on the ages and sexes of all adults in the household as provided by those responding to the invitation, one adult from each household was asked to provide a sample.

The researchers tested 509 people who responded to the mailed invitations. An additional 1,728 community members booked appointments on their own and were tested after hearing about the study in the news or on social media. Many individuals who were invited to participate did not book an appointment.��

Of the 2,237 individuals who were tested, 10% were non-white. The ages of tested individuals was as follows:

• 21% between 18-34
• 40% between 35-59
• 40% age 60 or older

Residential locations of the 2,237 participants are shown in Map 1 (below). Overall, nearly 0.4% of the population of Jefferson County was sampled.

Analysis of the study data found that at least 0.05% of the participants had an active infection during the time of the study and approximately 4% (5.1 to 3.2%) of people had detectable levels of antibodies in their blood, indicating they had been exposed to the virus earlier in the year.

“These results allow us, for the first time, to more accurately estimate the spread of coronavirus within our community. If we extrapolate the results from this study to the general population, it would suggest that as many as 20,000 people may have been exposed to the virus – many more than the 3,813 cases reported in the city by the end of June,” said Aruni Bhatnagar, director of the Brown Envirome Institute.

This difference may be due to the fact that people did not have symptoms and were not aware they were infected.

“We were told by several participants that they believed they had COVID-19 before testing was widely available. Nonetheless, our preliminary data suggest that the estimated number of people who have had COVID-19 may be 4 to 6 times higher than those who have tested positive to-date,” said Rachel Keith,assistant professor of environmental medicine at UofL who conducted the study. “This suggests that the virus is much more widespread in our community than previously estimated. I believe this indicates a need for continued and widespread testing, including antibody testing, which plays an important role in understanding the spread of disease.”

“The random sampling of the population also allows us to calculate the true mortality associated with COVID-19,” Bhatnagar said. “Previous estimates of COVID-19-related mortality have varied from 0.5 to 15%. However, given that the city had reported 209 deaths by the end of June, our results suggest that the rate of mortality associated with the virus, at least in Kentucky, may be 1.3%. This is significantly higher than the 0.65% rate suggested by the CDC. Our research suggests that many who are infected with the virus nationwide have not been tested and that there is urgent need to continue random testing so that we can calculate the most accurate mortality rate.”

The study data also provide an estimate of the spread of the infection in Louisville.

“Because participants were drawn from all parts of the city, we could estimate which areas have had the highest rates of infection,” Keith said. “Although we are still analyzing all our data, our early results show that the highest cluster of individuals exposed to the virus is in Western Louisville. (See Map 2, below). We found that the prevalence of exposure was twice as high in non-white participants as in white participants. Most (54%) of those who tested positive for the antibody were between the ages of 35-59 years old,” she said.

The researchers cautioned that because so little is known about SARS-CoV-2 and because the rates of community infection and exposure are changing rapidly, the results of this survey are applicable only to the period of June 10-19.

“Although many individuals had detectable levels, the amount of antibodies in blood varied greatly among the participants,” said Kenneth Palmer, director of the CPM. “As a result, we are not sure to what extent they are protected from re-infection. Indeed, some of our early results show that the levels of antibodies decline rapidly within a month. Therefore, we are planning to re-measure individuals who had antibodies in their blood to see if those levels are maintained over time and, if so, for how long.”

Currently, the researchers are repeating the antibody test in those health care workers who were found to have anti-SARS-CoV-2 antibodies during . They also plan to repeat community-wide testing in Jefferson County in September.

This study was supported in part by the James Graham Brown Foundation. 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 – Baptist Health, Norton Healthcare and UofL Health.

The treatment, a new formulation of Aviptadil (RLF-100), produced by Pennsylvania-based NeuroRx and Relief Therapeutics Holding, SA, of Geneva, works by combating “cytokine storm,” an unchecked overreaction of the body’s immune response. These storms can cause severe lung inflammation and stiffening that make it difficult, if not impossible, for patients to breathe on their own.

“We want to mitigate these storms,” said the clinical trial lead, Dr. Rainer Lenhardt,�� associate professor of anesthesiology and critical care in the “We’re doing anything we can to improve outcomes.”

COVID-19 is primarily a respiratory disease and about 80% of cases are mild to moderate, . But in severe and critical cases, the lungs can swell and fill with fluid as the body tries to fight off the infection. This severe respiratory failure is a major cause of COVID-19-related death.

“These patients are terribly ill,” said Forest W. Arnold, an investigator on the clinical trial and an associate professor in the UofL Division of Infectious Diseases. “And because this virus is so novel, options for treatment are just now being developed. This gives us another option.”

In this Phase 2b/3 trial, UofL and other sites will treat at least 144 patients. To be eligible, participants must be patients at receiving intubation and mechanical ventilation due to COVID-19-induced severe respiratory failure. Phase 2 and Phase 3 trials determine effectiveness and monitor for adverse reactions. A list of other ongoing clinical trials at UofL is available .

The drug has previously been used for other indications, but in this formulation, it acts as an anti-inflammatory agent. The formulation is believed to protect alveolar type-2 cells in the lungs which are essential to oxygen exchange and are thought to be a major target of the SARS-CoV-2 virus.

In Phase 1 trials, designed to assess safety and dosage, seven of eight patients with acute respiratory distress caused by sepsis were taken off breathing machines after receiving the drug and six eventually left the hospital.

“Our No. 1 goal is to provide a potentially life-saving therapy to critically ill patients with COVID-19. The FDA has granted fast-track designation for RLF-100 underscoring the urgent need for new treatment options,” said Jonathan Javitt, CEO and chairman of NeuroRx. “We are excited to work with UofL and leverage its clinical research and infectious disease expertise to advance research in COVID-19.

Since the coronavirus pandemic began, UofL has taken a leadership role in investigating and developing innovative ways to prevent, diagnose and treat the virus. Researchers are working to block coronavirus from infecting human cells, launching groundbreaking initiatives for testing, building robots that can sanitize high-risk areas and more. If you are interested in supporting this or other COVID-19 research at UofL, contact Lisa Warner at lisa.warner@louisville.edu or visit .��

The second round of the COVID-19 Kentucky Equine Business Impact Survey will close July 13. .

The previous survey, conducted in May, showed that the pandemic resulted in Kentucky’s equine businesses cutting costs and postponing capital improvement projects. However, the survey indicated that the vast majority of respondents did not have to lay off employees.

Since the last survey, horse racing has resumed in Kentucky, although without spectators, and historical horse racing facilities have reopened with limited capacity. The second round of the COVID-19 Kentucky Equine Business Impact Survey will capture how this is affecting the equine businesses across the state. Churchill Downs announced last week that the Kentucky Oaks and Kentucky Derby, scheduled for Sept. 4 and Sept. 5, will occur with a limited number of spectators.

Survey participants will not be identified in the published results.

“Since we completed our first survey in May, the state has lifted some of the restrictions on the horse industry, which should provide a boost to equine business across the state,” said Elisabeth Jensen, KEEP’s executive vice president who oversees the daily operations of the organization. “However, we have yet to see the impact of how the pandemic is affecting horse sales and what that means for Kentucky’s equine economy. We hope that this second round of our survey can, when combined with the data from our May survey, paint a clearer picture of the challenges the industry will face.”

“The UofL Equine Industry Program educates and trains the next generation of leaders for Kentucky’s signature industry,” said Sean Beirne, director of the UofL Equine Industry Program in the . “The COVID-19 Kentucky Equine Business Impact Survey provides us with an incredible up-to-the-moment view of the challenges that the industry will face in the coming years. In addition to helping inform policymakers on the status of the industry, we can also use this data to prepare our students for the challenges of the industry they will be entering.”

The is a not-for-profit grassroots organization created in 2004 to preserve, promote and protect Kentucky’s multi-breed horse industry.