Wondering about goosebumps? Of course you are

They go by different names: goosebumps, goose pimples, goose flesh, and my personal favorite, goose bumples. The medical term is cutis anserine (cutis means skin and anser means goose). I guess the similarity in texture is just too close to goose skin to ignore. Other medical terms for goosebumps are horripilation, piloerection, or the pilomotor reflex.

Each of these terms describes a temporary change in the skin from smooth to bumpy, most commonly developing after exposure to cold.

Many people associate goosebumps with fear, or perhaps more accurately, with horror. Perhaps that’s why a popular series of children’s horror stories by R.L. Stine published in the 1990s was called Goosebumps.

Ever wonder why you get them? Do they serve a purpose? Why do they develop when we’re frightened?

What are goosebumps?

Goosebumps are the result of tiny muscles flexing in the skin, making hair follicles rise up a bit. This causes hairs to stand up. Goosebumps are an involuntary reaction: nerves from the sympathetic nervous system — the nerves that control the fight or flight response — control these skin muscles.

In the animal kingdom, a threatened animal has a similar reaction, causing fur to be puffed out a bit. This makes the animal appear bigger and more dangerous. Perhaps the most dramatic example is the porcupine, which puffs out its quills when sensing danger. This can make a threatening adversary think twice before attacking. That may explain why the sympathetic nervous system controls goosebumps — the reflex is tied into the fight or flight response.

This just in

Researchers studying mice recently linked goosebumps to the regeneration of hair and hair follicles. It seems that the nerves connected to the tiny muscles responsible for goosebumps also connect to hair follicle stem cells, which are the cells responsible for hair growth. So, in response to cold, the nerve tells the tiny muscles in the skin to contract (causing goosebumps) and the same nerve activates hair follicle stem cells for new hair growth.

What purpose do goosebumps serve?

Goosebumps may help you conserve heat when you’re exposed to cold. They may do this in several ways.

• As with larger muscles, contraction of the muscles in the skin (called arrectores pilorum) generates heat.
• The raised hair follicles cause skin pores to close.
• Hairs standing up trap a layer of air near the skin, holding onto body heat.

Each of these might be more important for furry animals than for humans. In fact, it’s not clear how important goosebumps are in humans. For example, if you couldn’t form goosebumps at all, it wouldn’t necessarily mean that you’d have problems with temperature control. Goosebumps may be one of those leftovers from our evolutionary ancestors (like the coccyx, or tailbone) that serve no important purpose.

The new discovery linking goosebumps with hair follicle stem cells might be explained as a longer-term response to cold, at least for animals with fur: they get goosebumps (or the animal equivalent) in the short run to conserve heat, and thicker fur to keep warmer in the long term.

Goosebumps: More than just being cold

Most people associate goosebumps with unpleasant situations, such as feeling particularly cold or feeling afraid. Yet there is more to it than that. The arrectores pilorum are hooked up to the sympathetic nervous system, and the sympathetic nervous system has input from many parts of the brain, including those involved with motivation, arousal, and emotion. So other stimuli may cause goosebumps, for instance:

• hearing music or seeing art that is particularly moving or completely engrosses you (which is why you might say “it gave me chills”)
• awe
• pride
• excitement
• fear.

Goosebumps and disease

Though rare, goosebumps can be a sign of a seizure disorder called temporal lobe epilepsy, a disorder of the sympathetic nervous system, or other brain disorders. They are also common during heroin or other opiate withdrawal. In fact, one explanation for the origin of the expression “quitting cold turkey” is that goose bumps that develop during withdrawal from heroin mimic cold turkey flesh.

The bottom line

You’ll see goosebumps most often when you’re cold. But don’t be surprised (or afraid or awed) if they appear at other times. They are a universal but poorly understood phenomenon, but our understanding is improving. And the recent discovery linking goosebumps with hair follicle regeneration could lead to more than just a better understanding of goosebumps; it could lead to new ways to fight baldness or improve tissue healing.

In humans, it’s possible that goosebumps will gradually disappear over the coming centuries as with other remnants of evolution, like the tailbone or wisdom teeth. Or they may serve a more important role than we currently understand and continue to puzzle us for years to come.

The post Wondering about goosebumps? Of course you are appeared first on Harvard Health Blog.

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Almost half of counties still lack syringe exchanges, including 20 of those most vulnerable to drug-related disease outbreaks

By Melissa Patrick

Kentucky Health News

Most Kentucky counties now have harm-reduction programs to fight drug abuse, but the coronavirus pandemic has slowed their expansion and complicated the work of their syringe exchanges.

Still, they've all continued to offer some level of service during the pandemic. Sixty-three counties have harm-reduction programs, and one more is in the works, but that will still leave 56 of the 120 counties without one. 

Tony Cox, director of the Bracken County Health Department, which has the newest program, encouraged those counties to be open-minded.

"Communities are hesitant, and we do understand their concerns, but I would encourage any and all communities to educate themselves, along with their policymakers and even the citizens in the community, to find out exactly what a harm reduction/syringe exchange program is really all about," he said. "It is about getting dirty needles off the street and off of our playgrounds and off of the places we go, certainly that's a huge part of it. But it is also a program that is about helping the people in our community as well that need help because they are addicted to drugs. Be open minded and get educated." 

Such programs have been able to stay open through the pandemic because the Department of Public Health designated them an essential service.

"To ensure public safety, programs adopted strategies including face coverings, moving to outside stations, creating distance in their spaces, some appointment-only programs, limiting hours/days and decreasing number of infectious-disease testing times," the department said in an e-mail.

Harm-reduction programs are designed to prevent outbreaks of HIV and hepatitis C, which are commonly spread by the needle sharing among intravenous drug users. They also provide health screenings and vaccines, and connect drug users to treatment. 

They were approved in Kentucky under a 2015 law that requires approval by the county health board, the fiscal court and the city where the exchange is to be located.

Five added since last round-up

Kentucky has 74 operational syringe exchange locations in 63 of its 120 counties. Since mid-July 2019, when Kentucky Health News did its last syringe exchange roundup, five more counties have been marked on the state Cabinet for Health and Family Services map of exchanges and the counties deemed most vulnerable to HIV and hepatitis C outbreaks.

Besides Bracken, the new counties are Christian, LaRue, Marion and Martin.

Bracken County Health Department photo on Facebook

Christian County's program is the latest to be approved, but is not yet operational. Bracken County's exchange is still marked as not yet operational on the state's map, but it started operating July 8. 

Among the 54 Kentucky counties that the U.S. Centers for Disease Control and Prevention has identified as being most vulnerable to outbreaks of HIV and hepatitis C among IV drug users, 34 have operational exchanges.

The vulnerable counties that have not approved an exchange include Bell and Clinton, which rank sixth and 11th on the national list of 220 vulnerable counties; Cumberland, Casey, Edmonson, Harlan, Johnson, Lawrence, Lewis, Menifee, Monroe, Rockcastle and Wayne, also in Appalachian Kentucky; and eight in the rest of the state: Carroll, Gallatin, Green, Breckinridge, Grayson, Green, Allen and Hickman.

Harm reduction and the pandemic

Christie Green, public health director of the Cumberland Valley District Health Department, said their program saw a brief dip in participation in March and April, and it has since increased. Early in the pandemic they only offered services every two weeks as a way to limit interactions, she said, but have since gone back to their weekly schedule. 

"As restrictions were lifted," she said. "most of our participants preferred to come every week."

Green said they also increased usage of their mobile harm-reduction unit in Clay and Jackson counties. "So, instead of bringing them into the van, which is set up kind of like a little lab on the inside, we shifted it all to outside, under a canopy with a table beside the van," she said. "If someone wants a test, then we mask them and bring them inside." 

Scott Lockard, public health director of the Kentucky River District Heath Department, which has a program in each of the seven counties in the district, said its use has held steady or better. 

"People are still thankfully coming in and getting the supplies they need, because the last thing we would have wanted to see was a big uptick in HIV or hep C right now too," he said. "Our services are being utilized more than ever."

John Moses, harm-reduction team leader at the Lexington-Fayette County Health Department, said it has seen a steady increase in participation, with record numbers in the last month.

"The good thing about our program is that we were able to continue all of our services through the syringe exchange with really minimal interruption because of covid," he said. "We simply moved our program outside and are using our mobile unit to see our clients."

Jamey Whaley, harm-reduction and peer-support specialist with the Buffalo Trace District Health Department, said that one of the biggest changes he's seen in its program since the beginning of the pandemic is a shift from methamphetamine to heroin, because limited meth supply has driven its price up.

"So I have seen more people who have gone in the direction of heroin, which is a little unsettling because of the risk of potential overdose," Whaley said. He added that he has seen some of the program's former participants relapse since the pandemic hit, and that he has added an good number of new participants. 

Whaley said Buffalo Trace shut down its program down for six weeks at the beginning of the pandemic and re-opened in mid-May. Since then, "I've been very busy, especially the last month I have really been steady." 

Only a few in the works

Logan County has received approval from its Board of Health for a syringe exchange program, but still needs the approval of the Russellville City Council and the county Fiscal Court. 

Alexis Bigham, who was the public-health educator at the Barren River District Health Department when interviewed, and now works on harm reduction in Edmonson County through the University of Kentucky, said two of the district's eight counties (Warren and Barren) have exchanges.

The agency wants Logan to be next "because we have a lot of people traveling from Logan County to here in our Warren County program." she said. But the pandemic has put that push on the back burner because everyone at the health department has been working on covid-19.

The Lincoln Trail District Health Department is based in Hardin County, but its efforts to start a program there haven't been successful. In the meantime, Marion and LaRue counties have joined adjoining Nelson County in the program, largely due to local support, said Melissa Phillips, a harm-reduction specialist.

"You really need both pieces, you need your buy-in from your policymakers, and data is usually what sells them, and knowing that there is no cost associated with it," she said. "And when you have a local champion, it makes the process so much smoother. They really do a lot of the leg work for us."

She said the need in Hardin County is supported by data on drug arrests, HIV and hepatitis C, but the pandemic has slowed the effort, largely because they aren't able to participate in face-to-face meetings with policymakers and the community, which she said is an essential part of the process.

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Pandemic calls for local leadership and trusted voices

By Al Cross

Kentucky Health News

This was originally published as a column in KyForward.com.

Norman Chaffins and Donnie Keeton probably never expected to see their name in a column about Kentucky politics. But they’re elected officials who have done the right thing when it comes to the coronavirus, and they and their kind should be exalted.

Chaffins, a Republican, is the sheriff of Grayson County, in west-central Kentucky. Keeton, a Democrat, is a magistrate in Morgan County, in Eastern Kentucky. They both got the virus, and they went above and beyond the call of duty, telling others about it.

And they think we should all be wearing masks, probably the biggest single thing we can do to thwart the virus and its covid-19 disease – but something that has become way too controversial and politicized, just like so much else about the pandemic.

After recounting his covid horrors in a Facebook post, Chaffins, 51, wrote, “I’m telling you this because I want you to wear your mask. Not because I am the sheriff, not because the governor said so, and not because the business tells you to. I want you to wear a mask because I do not want anyone to have to go through what I went through. I want you to wear a mask because I don’t want my kids or grandbabies to get sick. I want you to wear a mask because it’s just the right thing to do. It may not 100% guarantee that you won’t contract it, but wearing a mask will certainly reduce your chances. Please understand this: I am not telling you to wear a mask. We are not going to fine you or insist that you wear a mask. As your friend, I am asking you to wear a mask when you are around others and when you go out into public at least until there is a vaccine.”

Chaffins, a former state trooper, published 929 words on July 12. Keeton, a disabled heavy-equipment operator, kept his July 16 post simple, but in white type on a red background: “For those who don’t think covid-19 is real, it is. I tested positive. . . . Sue hasn’t got her results yet.” (His wife tested negative.)

Yes, Keeton knew people who didn’t think the virus was real, he told me: “They think it’s all about the election, or it’s going to be over after the election.”

That’s what happens when a president politicizes public health, downplays a deadly pandemic and uses Twitter to peddle conspiracy theories and quack medicine, apparently in an effort to so confuse Americans that they don’t know what to believe.

Keeton, 52, told me he voted for Trump because “It’s kind of hard to go with the national Democratic Party right now,” but he had the president’s words in mind when he told his local newspaper, the Licking Valley Courier, “It’s not a hoax and it’s probably not going away anytime soon.”

Trump implied Feb. 28 that the pandemic, or Democrats’ criticism of his response to it, was Democrats’ “new hoax” after their failed impeachment of him. He walked that back, but Keeton told me that the phrase probably gave a lot of people the wrong idea.

Trump was elected partly because a lot of Americans, especially in rural areas, thought they were being left behind and disregarded by the urban elite. Many if not most of those people have never liked elites and experts telling them what to do (remember the debates about seat belts?), and Trump appealed to their resentment.

That approach turned dangerous when Trump started contradicting public-health experts and scientists, but he was operating in a friendly environment, as the unchallenged boss of a political party that has fueled and capitalized on skepticism about science, primarily the evidence of climate change. But it is also a friendly place for skepticism about vaccines, which could be the long-term obstacle in quashing the coronavirus.

That’s why it’s more important than ever for public officials at all levels to set good examples. Chaffins told me he has tested negative for the virus, and doesn’t think government should mandate masks, but he wears one to be “a good role model.”

And in an age where social media have more sway than news media, it’s important to hear covid-19 stories from authoritative victims. Chaffins said his nurse practitioner told him his post was helpful because “a lot of people don’t know anybody who’s had this and had a bad case of it.”

In other words, stories about people you know always have greater impact. Licking Valley Courier Editor Miranda Cantrell put a note at the end of her story about Keeton asking other victims to tell their stories, because locals wonder “whether the effects are as severe as mainstream media outlets have reported.”

Yes, they can be that severe, but many don’t trust those outlets – especially after four years of “fake news” bashing from a president who has uttered more than 20,000 falsehoods. Local news media are more trusted, so they need to step up, tell these stories and help their audiences understand how to deal with the pandemic. The politicians can only go so far.

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July 26 federal report said that in most of Ky., nursing-home visits should stop, and obese, diabetics, hypertensive should stay home

Chart from White House report, adapted by Kentucky Health News; for a larger version, click on it.

By Al Cross
Kentucky Health News

The latest weekly report to states from the White House Coronavirus Task Force contains many recommendations for state and local officials that Kentucky officials have not implemented or even revealed.

For example, it recommends that the state prohibit visitation at long-term-care facilities in most Kentucky counties, those in the red and yellow danger zones as defined by the task force.

It recommends that people with obesity, diabetes and high blood pressure in those counties shelter in place, much as Gov. Andy Beshear ordered Kentuckians to do from late March to early May.

It also recommends that public officials "Ensure that all business retailers and personal services require masks," something that is not being done in much of the state, if anecdotal reports of limited mask wearing and enforcement in many businesses are indicative.

Beshear has acknowledged the need for better enforcement by businesses, and backup enforcement by health departments. "There's not been enough enforcement out there; we can admit to that," he said July 27.

Beshear has gone farther than the recommendations in at least one case, limiting social gatherings to 10 people -- something the task force recommended by done only in red zones,

The latest White House report, dated July 26, was sent to state officials. It was obtained and published by The New York Times. Kentucky officials have not responded to requests for a copy of the report; one of Beshear's emergency pandemic orders gives custodians of public records 10 days to respond to requests for records instead of the usual three.

Here are the recommendations to red and yellow zones in Kentucky in the July 26 report. Most are the same for both zones; this list notes major differences.

Public Messaging
Wear a mask at all times outside the home and maintain physical distance
Limit social gatherings to 25 people or fewer (10 in red zones)
Do not go to bars or nightclubs
Use takeout, outdoor dining (indoor dining in yellow zones when strict social distancing can be maintained)
Protect anyone with serious medical conditions at home by social distancing at home and using high levels of personal hygiene (in red zones, handwashing and surface cleaning are emphasized)
Reduce your public interactions and activities to 50% of your normal activity (25% in red zones)
Public Officials
Limit gyms to 25% occupancy and close bars until percent positive rates are under 3; create outdoor dining opportunities with pedestrian areas (gyms in red zones should be closed)
Institute routine weekly testing of all workers in assisted living and long-term care facilities; require masks for all staff and prohibit visitors
Ensure that all business retailers and personal services require masks and can safely social distance Increase messaging on the risk of serious disease for individuals in all age groups with pre-existing obesity, hypertension and diabetes, and recommend to shelter in place
Work with local community groups to provide targeted, tailored messaging to communities with high case rates, and increase community-level testing
Recruit more contact tracers as community outreach workers to ensure all cases are contacted and all positive households are individually tested within 24 hours
Provide isolation facilities outside of households if positive individuals can't quarantine successfully
Testing
Move to community-led neighborhood testing and work with local community groups to increase access to testing (in red zones, increase community-level testing)
Surge testing and contact-tracing resources to neighborhoods and ZIP codes with highest case rates
Diagnostic pooling: Laboratories should use pooling of samples to increase testing access and reduce turnaround times to under 12 hours; consider pools of three to five individuals
Surveillance pooling: For family and cohabiting households, screen entire households in a single test by pooling specimens of all members into single collection device

The report also includes, for each state, four maps showing new cases, positive-test rates and the change in each from week to week. Here are Kentucky's maps from the July 26 report, comparing the week of July 18-24 with the previous week, July 11-17. For a larger version of the image, click on it.

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Limited Sunday report keeps the coronavirus in Ky. on plateau

Kentucky Health News chart; for a larger version, click on it.

By Al Cross
Kentucky Health News

Kentucky reported 463 new cases of the novel coronavirus Sunday, a little more evidence that the state has settled into another plateau, but one much higher than the one it was on a month ago.

“We appear to be seeing what we all hope is a plateau in the alarming growth of coronavirus cases in the commonwealth,” Gov. Andy Beshear said in a press release. “It shows that wearing a mask, social distancing and not traveling to virus hot spots is working. We need to see this trend continue to avoid having to make more hard choices and sacrifices.”

Beshear has also cited a decline in the percentage of Kentuckians testing positive for the virus. He did not report on testing or hospitalizations Sunday.

Reports are limited on Sundays, when fewer testing laboratories report to the state, and numbers are typically lower. But the record number of daily new cases, 979, was set on a Sunday, July 19.

Health Commissioner Steven Stack said in the news release that he was “cautiously optimistic we have blunted our steep covid-19 escalation with the mask requirement, restriction of gatherings to 10 or fewer people, bar closings and restaurant capacity restrictions. This is a prolonged challenge, though.”

The state reported two more deaths from covid-19 Sunday, a 56-year-old man from Oldham County and a 70-year-old woman from Muhlenberg County.

Counties with five or more new cases on Sunday's daily report were Jefferson, 91; Fayette, 80; Warren, 23; Kenton, 20; Pulaski, 19; Calloway, 14; Daviess, 13; Boone and Jessamine, 12 each; Oldham, nine; Graves, seven; Campbell, six; and Boyd, Casey, Franklin, Russell, Scott and Shelby, five each.

On the national level, the response coordinator of the White House Corinavirus Task Force warned that the virus is now widespread across the nation. She said, "To everybody who lives in a rural area, you are not immune or protected from this virus."

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New coronavirus case numbers and 7-day average drop below 600; positive-test rate declines for third day but remains above 5%

Kentucky Health News chart

By Al Cross
Kentucky Health News

Kentucky's coronavirus numbers were almost all improved Saturday.

The number of new cases, 572, was more than 200 less than Friday's fourth-highest figure of 778. The latest report lowered the seven-day rolling average to of daily new cases to 571. The three-day average dropped from 685 to 670.

The number of Kentuckians hospitalized with covid-19 increased slightly, to 602 from Friday's total of 597, but the number in intensive care dropped substantially, to 128 from 150.

The strongest trend line at the moment is the percentage of Kentuckians who have tested positive for the virus in the last seven days: 5.22 percent, the third straight day of decline from a recent high of 5.81% on Wednesday.

Since July 24, the rate has been above 5 percent, which the White House Coronavirus Task Force says is a "danger zone." That and the surge of cases in July prompted Gov. Andy Beshear to close bars, tighten restaurants' indoor capacity and advise school districts not to start in-person classes until the third week of August.

In a news release, Beshear urged obedience of the mask mandate he issued July 9, days after the July surge began. "Facial coverings work," he said. "They are our best chance of saving lives and protecting the health of our people, ensuring our economy can stay open, and getting our kids back in school."

Health Commissioner Steven Stack reminded Kentuckians of another order, one that depends more on public cooperation because it is harder to enforce.

“Gatherings should be limited to 10 or fewer guests, especially informal ones going on in backyards, parks, lakes and similar settings,” Stack said. “The commonly more personal, informal social behavior in these situations is a big risk. If you and your guests are not keeping at least a six-foot social distance and if you’re not wearing masks, this spreads the disease. It places the people you care about most at risk and it endangers others if they spread the disease throughout the community.”

Stack added, “I don’t want to sound like an alarmist, but a big part of this is about the decisions made and behaviors practiced by every one of us as individuals. Public gatherings and social activities can be tinderboxes for covid-19 transmission. Until we get a vaccine or cure to neutralize this threat, we all must continue practicing social distancing and wearing masks.”

The state's covid-19 death toll rose to 740 with five more fatalities, including three men in Oldham County, aged 55, 61 and 67. The others were an 81-year-old man from Jefferson County and an 84-year-old woman from Simpson County. Beshear's office did not immediately respond to a question asking if the Oldham County deaths were connected to the three state correctional facilities in thatg county, at least one of which has had an outbreak of covid-19.

Most county fairs in Kentucky appear to have been canceled, but the Oldham County Fair is planning to open Tuesday, despite advice to the contrary from the county health department, the Louisville Courier Journal reports. The fair plans to screen attendees and require masks, but County Judge-Executive David Vogele voiced doubt about the fair's ability to enforce mask wearing and keep up with necessary cleaning of surfaces over five days. The fair has the same midway as the state fair, Kissel Entertainment.

Counties with more than five new cases Saturday were Jefferson, 152; Fayette, 43; Warren, 32; Kenton, 28; Campbell, 23; Boone, 22; Whitley, 19; Jessamine, 14; Bullitt, 11; Daviess and Madison, 10 each; Barren, 9; Fulton, Graves, Hopkins Perry, Pike and Scott, 7 each; and Hardin, Knox and Laurel, 6 each.

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As cases surge in southeastern Ky., public-health and local officials join forces to combat it and tamp down the politics

Like much of the nation, stopping the spread of the novel coronavirus in Appalachia isn't just a public-health effort, but also involves convincing its citizens that it isn't a political issue, Chris Kenning reports for the Louisville Courier Journal. 

The Bell County Health Department's Leighann Baker brings groceries
to Alan Smith, who is quarantined. (Photo by Pat McDonogh, Courier Journal)

Kenning went to Bell and Harlan counties, which recently recorded some of Kentucky's highest per-capita average daily case increases. 

"Bell went from 20 cases to more than 200 in two weeks. Harlan saw 85 in a single week, twice as many as it had over four months. Bell, Clay, Knox and Harlan counties combined, for example, saw deaths more than triple to 18 in the month ending July 30," he reports. 

“We were one of the last counties to see any cases," Trissa Wilder, nurse supervisor for the Bell County Health Department, told Kenning. "We got lax, feeling that we were safe and secure” because of Central Appalachia’s geographic isolation.

Officials across several Kentucky Appalachian counties told Kenning that the virus first spread from "Carolina beach trips, Fourth of July parties, weddings, football practices, a four-day church revival — and even an illegal Clay County cockfight," he reports.

Health officials have voiced concern that covid-19 will have a disproportionate impact on Appalachia because it has fewer hospitals and intensive-care beds, high rates of poverty and conditions such as diabetes and heart and lung disease that make people more vulnerable to the virus.

"All that has meant special challenges for health departments hollowed out by budget cuts, such as those in Bell County, which battle distance, poverty, spotty cellphone coverage, neglected health, difficulty getting some residents to testing and distrust amid the growing politicization of public health," Kenning reports. 

In addition to their ongoing daily work to keep a community safe, public health departments have been stretched even thinner as they have increased their their contact-tracing efforts to identify those who have been infected, then tracking down everyone they have come into contact with and asking them to self-quarantine. 

The state has provided some relief on this front by expanding the number of tracers with federal coroanavirus money, "even as the effort's effectiveness wanes as cases increase," Kenning reports. The state says it recently added 455 tracers to the 431 who were already doing this job, and so far, the tracing is keeping up with the demand.

That added help is critical, Kenning reports, since the number of public-health workers in Kentucky has fallen 34% since 2012, according to the Kentucky Center for Economic Policy. 

"We’ve got a small health department, and we did get a little overwhelmed," Harlan County Judge-Executive Albey Brock told Kenning. "Contact tracing is no joke. It’s laborious. They keep daily communication. If we have 104 active cases, they each have to be called every day. That’s on top of having to track down people they've had contact with, getting them a letter, let them know to quarantine. 

 "And then you run into the knuckleheads who don't want to stay quarantined because they’re not positive . . . Some of them don’t want to cooperate." 

And then there's the politics. Kenning writes from the Bell County seat of Pineville, "The area remains a conservative place, where every elected official but one constable is Republican. When cases were slow to materialize, some found it easy to dismiss alarms over the coronavirus as a Democratic plot to make President Donald Trump look bad or infringe on rights by requiring masks, local residents and officials said." 

In Harlan, about 30 miles up the Cumberland River from Pineville, Brock, a Republican, told Kenning that he has attempted to depoliticize the pandemic by sending public-health messages via social media and radio and having stern talks. 

“We’ve tried real hard locally to stamp that down. If you want to fight with Trump or Biden, have at it. Just wear a mask,” he said, adding jokingly, “Some believe we never walked on the moon, so I can’t help them.” 

Since Gov. Andy Beshear mandated masks and Walmart required face coverings, mask use has “gone up dramatically,” which has been “a pleasant surprise,” Ben Barnett, Bell County’s Emergency Management director, told Kenning.

Christie Green, public health director for the Cumberland Valley District Health Department. which overs Clay, Jackson and Rockcastle counties, told Kenning that contact tracing has thwarted the spread of the virus in several cases. "But she's still fighting distrust of public health fueled by national politics." She said, "People don’t know what to trust or believe. . . . How do you parse out all the soundbites you get?"

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