Health officials in counties with high and low Covid-19 death rates point to vaccination rates, residents' underlying health status

Kentucky Health News map via Datawrapper, highlighting high-death-rate counties of Metcalfe, Monroe, Harlan, Perry, Lee and Robertson, and low-death-rate counties of Jefferson, Fayette, Scott and Woodford. For an earlier story with an interactive map with all counties' rates and data, click here.

By Melissa Patrick
Kentucky Health News

Health officials from Kentucky counties with some of the state's highest and lowest Covid-19 death rates both cited vaccination rates as a contributor, but the health official in the county with one of the highest death rates said the relatively low health status of the population must also be considered. 

A breakdown of Covid-19 deaths per 1,000 people in each county found that the highest county death rate is five times the lowest one. To explore that discrepancy, Kentucky Health News talked with a health official in a county with one of the highest rates, and one in a county with one of the lowest rates. 

In Woodford County, which had the fourth lowest rate, 2.09 Covid-related deaths per 1,000 residents, Public Health Director Cassie Prather said she attributed the low rate to its high Covid-19 vaccination rates, especially among residents 65 and older, who are among the most vulnerable.

"I would love to see a map overlay of the death rates and the vaccine rates," she said. Later adding, "I think the correlation is there." 

Woodford County has had one of the highest vaccination rates in the state throughout the pandemic. According to the Centers for Disease Control and Prevention Data Tracker, 78.3% of Woodford County's population has received at least one dose of the Covid-19 vaccine. Among residents 65 and older, 93.3% are fully vaccinated; 73.3% of those who are fully vaccinated have received one booster shot; and 54.6% of  those who have had the first booster have also received the second. 

Cassie Prather

Prather said getting people in Woodford County vaccinated has been a community effort that includes weekly clinics that are still running, community members volunteering to drive people to the clinics, a partnership with the emergency medical service to do home visits, and a mobile clinic that goes out twice a week to farms and people they normally wouldn't see at the health department. 

She added that city and county governments have worked diligently to keep their citizens informed, and that she and Judge-Executive James Kay still do weekly Covid-19 updates on the county government's Facebook page. "We knew how important communication would be . . . because we wanted people to be aware and to be able to make the best decisions for their family and friends," she said. 

Kay, who as judge-executive chairs the county health board, said his pandemic role has been to unite the community in an effort to fight the virus, while allowing the health department to lead the response. 

"We did a full county and community response," Kay said. "And we brought the cities and the county and the schools together to all be on the same page every day for nearly two years."

Expanding on the importance of giving the public direct, real-time information to combat misinformation, he said, "We created a level of trust. When we told them information; they knew it was true."  

Adjoining Scott County's Covid-19 death rate was just .007 per 1,000 higher than Woodford's. Crystal Miller, public health director of the regional health department that serves the county, told Mike Scogin of the Georgetown News-Graphic that the community's response to the pandemic was critical to keeping Covid-19 under control. 

“It was all hands on deck,” Miller told Scogin. “All our community partners bought in and everyone contributed. From elected leaders to businesses and industries, the hospital, schools and the newspaper, everyone wanted to do the right thing. A big portion was community support. The calls we received at the health department were, ‘How can we keep people safe?’”

Miller also said Scott County has one of the state's highest vaccination, which saved lives. The CDC says 65.2% of the county's population has received at least one dose of Covid-19 vaccine. 

“We did not get a lot of pushback," Miller said. "I know that was not the case in other communities, where people refused to even wear masks."

Metcalfe County, in south-central Kentucky, had the sixth highest Covid-19 death rate, 7.348 per 1,000 residents. It is served by the Barren River District Health Department, where Public Health Director Matt Jones said he thinks the rate stems from multiple factors.

Jones cited the county's poor health outcomes, gauged by life expectancy and measures of quality of life; and health factors, such as access to physicians, tobacco use, children living in poverty, and other environmental factors that contribute to or detract from the local population's health. 

"Those health outcomes, those health factors, they were already at play," he said. "And I think that is one of the leading reasons why we had higher mortality rates in Metcalfe County and the other six counties that you listed."

Counties with death rates higher than Metcalfe were Lee, 7.565; Perry, 7.803; Monroe, 8.075; Harlan, 8.574; and Robertson, the state's smallest county, 10.436 deaths per 1,000 residents.

Comparing just Metcalfe and Woodford counties' 2022 County Health Rankings, Metcalfe ranked 71st for health outcomes and 89th for health factors and Woodford County ranked eighth for health outcomes and third for health factors. 

Eight of the top 10 counties with the lowest Covid-19 death rates in Kentucky ranked in the top 11 counties for health outcomes, and included the top six counties for health factors.

"ZIP code matters," Jones said. 

Among the seven counties with the highest Covid-19 death rates, all ranked 69th or lower for health outcomes, and four ranked in the bottom 11. All seven ranked 64th or lower in health factors, with three in the bottom six. 

Jones also pointed to the discrepancies in health-care access between rural and urban counties as a possible reason for Metcalfe County's higher Covid-19 death rate.

He noted that Warren County, which has a population of nearly 133,000, and Metcalfe, with around 10,000, have very similar vaccination rates, 45.7% and 45.3%, respectively, with at least one dose, but Warren's death rate was less than half Metcalfe's, 3.02 deaths per 1,000 residents. 

Warren, with its fast-growing county seat of Bowling Green, has many more health resources than Metcalfe County, including two hospitals, while Metcalfe County has no hospital and a shortage medical providers, Jones noted.  

Asked about the county's lower vaccination rates, he said, "I think vaccinations did play a role, especially as it relates to moderate and severe cases. But I do think those health outcomes and the other indices played a major role in the overall outcomes of Covid." 

Among Metcalfe County seniors, 62.7% are fully vaccinated; 67.8% of those have received one booster shot; and 36% of that group have taken the second shot, according to the CDC.  

Jones said the eight counties in his health district have taken a multifaceted approach to the pandemic that has evolved as their needs have evolved. Beyond providing testing and Covid-19 vaccination clinics, the local departments participated in work groups with community leaders to keep them informed and used social media, local newspapers and radio stations to keep the public informed.