Kentucky Gov. Andy Beshear made coronavirus personal late last month, when he decided to single out Tennessee for its response to the pandemic. As the Bluegrass State reaches a grim milestone — with 200 dead from Covid-19 illness as of Friday — one can’t help wondering whether Beshear regrets going after his neighbors to the South.
Beshear didn’t mention his Tennessee counterpart, Bill Lee, by name back on March 27, but he didn’t have to. It was obvious where his shot was aimed.
“We have taken very aggressive steps to try to stop or limit the spread of the coronavirus to try to protect our people,” Beshear said. “But our neighbors from the south, in many instances, are not. If you are a Kentuckian living on that border, I need you to not go to Tennessee for anything other than work or helping a loved one or maybe the grocery, if it is there closer. If you ultimately go down over that border and go to a restaurant or something that’s not open in Kentucky, what you do is you bring the coronavirus back here in Kentucky.”
In Kentucky, where Beshear’s favorability rating is sky-high and residents adoringly refer to him as “Andy,” the governor’s remarks have been defended as merely an effort to warn residents of the Bluegrass to not travel out of state rather than a side-swipe at Lee and Tennessee.
But Beshear’s comments were … well, weird. They were weird at the time and even moreso in hindsight.
It was hard to pinpoint Beshear’s motive. He’s a Democrat and Lee is a Republican … but Ohio and Indiana each have Republican governors, and Beshear didn’t single them out — even though each of those states were experiencing far worser outbreaks of Covid-19 illness than Tennessee.
Yet, therein lies the caveat that made Beshear’s motive suspect: Yes, Tennessee had — and has — far more confirmed cases of coronavirus than Kentucky, but the Volunteer State’s Covid-19 outbreak pales in comparison to Kentucky’s northern neighbors.
Anyway, fast-forward one month, and Beshear’s comments aren’t standing up very well to the tests of time.
Tennessee still has far more cases of coronavirus than Kentucky — 8,726 vs. 3,779, as of Friday — but one simple truth, glossed over by many in the media who have reported on the TN vs. KY Covid-19 controversy, remains:
Tennessee is still testing far more people than Kentucky.
As of Friday, Tennessee had tested 131,298 people. Kentucky had tested 44,962.
So let’s put the numbers into perspective … again.
When the population difference between the two states is accounted for, Tennessee still has more coronavirus cases than Kentucky, but the difference between the two isn’t quite as stark. With 6.8 million residents, Tennessee has 1,312 cases per 1 million people. With 4.5 million residents, Kentucky has 851 cases per 1 million people.
Why? Simple: It’s all about the testing.
As of Friday, Tennessee had conducted 19,741 tests per 1 million people. Kentucky had conducted 10,126 tests per 1 million people.
In other words, Tennessee is testing almost twice as many people per capita as Kentucky. And given everything we know about coronavirus — which is proving asymptomatic in a significant number of people — it’s crystal-clear: the more you test, the more cases you’re going to find.
Nowhere has that been clearer than the last three days. As of Tuesday, everything pointed to the coronavirus outbreak slowing dramatically in Tennessee. Lee announced that restaurants and retail stores will reopen next week, and said he will not extend the state’s “stay-at-home” order beyond April 30.
Then, suddenly, new cases began to spike. In three days, Tennessee has had more than 1,300 new cases. Friday saw the most new cases in a single day — 460 — since the outbreak began.
But most of the reason for that spike is the testing of every inmate — more than 2,000 in all — at a state prison in Bledsoe County. As of Thursday, more than 12% of the inmates had tested positive with still more than 1,000 tests pending. In three days, the number of positive coronavirus cases in Bledsoe County jumped from 10 to over 500.
And most of those cases — the state hasn’t said exactly how many, but a majority — were asymptomatic.
So, Tennessee tests a lot of people … and finds a lot of illness, even if it isn’t severe illness — or, in some cases, isn’t really illness at all.
For that, Lee has caught a lot of flack. Even though Tennessee’s executive orders on things like staying at home and closing non-essential businesses trailed Kentucky’s by days instead of weeks, critics pointed to the difference in total coronavirus cases in the two states and hailed Kentucky’s approach while condemning Tennessee’s.
But the data demands that the narrative be re-examined. If Kentucky is testing too few people, and as a result finding relatively few cases of coronavirus, while Tennessee is testing significantly more people, and as a result finding more cases, how on earth is Beshear’s approach to combating the virus a better approach than Lee’s? After all, virtually every infectious diseases expert on Planet Earth has said that the key to putting our best foot forward against this pandemic is more testing and more data … testing, testing, testing.
What we’re now discovering is that a lot of us have been exposed to and infected by the novel coronavirus without even knowing it — unless we’re tested. And there is a much higher likelihood — almost 2 to 1, based on population — that you’ve been tested if you live in Tennessee than if you live in Kentucky.
That’s not to say that Kentucky isn’t conducting testing in its prisons and other places just like Tennessee is. But Beshear’s state simply isn’t testing enough people.
It’s the only way you can describe the disparity in the number of cases between the two states. It’s unconscionable to think that the Covid-19 illness is really that much more severe in Kentucky, where 5.3% of everyone known to have been infected by the virus have died, than in Tennessee, where only 1.9% of those known to be infected by the virus have died. The health metrics between the two states are very similar — almost identical. Things like diabetes and high blood pressure, two of the most significant risk factors for serious Covid-19 illness, afflict nearly the same amount of the Tennessee population as the Kentucky population. The age demographics are also very similar between the two states.
So why has Kentucky, with fewer than 4,000 known cases of coronavirus, had over 1,100 people hospitalized (including 303 right now — with just over half of those in ICU), while Tennessee, with nearly 9,000 cases, has had just over 800 people hospitalized?
To put those numbers into perspective, the hospitalization rate in Tennessee — based on known infections — is running about 9%. It’s likely nowhere near that high, but we likely won’t know exactly how many people are developing serious illness from coronavirus until antibody testing becomes widespread.
In Kentucky, though, a whopping 30% have been hospitalized. That’s not a misprint: 3 out of every 10 people who have been infected with coronavirus in Kentucky have required hospitalization, according to the state’s data.
Can we just say that not only is it doubtful that 3 out of every 10 people who’ve had coronavirus in Kentucky have become seriously ill, but that it’s nonsense to think that’s true?
So what gives? If you said “testing,” you’re right! I’ve said it before and I’lll say it again: Coronavirus isn’t really impacting people that much more severely in Kentucky than in Tennessee. The death rate isn’t more than twice as high in Kentucky than in Tennessee, and the hospitalization rate isn’t more than three times as high in Kentucky than in Tennessee … it’s just that there are far more than 3,779 people in Kentucky who’ve had coronavirus.
There’s another way to say the same thing: Why are 8.4% of Kentucky’s tests returning positive for coronavirus while only 6.6% of Tennessee’s tests returning positive? Simple. Tennessee is testing much more broadly than Kentucky.
For all the praise heaped on Beshear for his “quick action,” and all the criticism directed at Lee for his “slow action,” the data spells out one thing perfectly clear: If Kentucky were testing on the same level as Tennessee, Kentucky would have more coronavirus cases per capita than Tennessee.
If you need more proof, look to Mississippi. When this TN vs. KY fight first began, and Lee responded to Beshear’s statements — without mentioning Beshear or Kentucky specifically — by saying that Tennessee had more cases of coronavirus because it was testing more, the Independent Herald put the governor’s claims to the test. It was pointed out that Mississippi — which was testing fewer people than anyone else in the South, with the exceptions of South Carolina and Alabama — wasn’t testing enough people. At the time, 21% of Mississippi’s tests were returning positive, but the state had only a fraction of the cases that Tennessee had (937 to 2,239 at the time).
Fast-forward one month, and Mississippi has significantly beefed up its testing. In fact, Mississippi has tested nearly as many people per capita as Tennessee — and Tennessee continues to rank second in the South, behind only Louisiana. What has Mississippi found? Well, first of all, it has far more cases per capita than Tennessee now — 1,800 cases per 1 million people vs. 1,300 per 1 million. And, secondly, the percentage of its tests returning positive has dropped to under 10%. That’s what happens when you test more people: You find more cases, and you return a higher percentage of negative tests.
So, in a fight where testing, testing, testing has been the drum beat from medical experts, it remains bizarre that Gov. Andy Beshear has been hailed as a coronavirus hero while Gov. Bill Lee has been criticized for his response. From here, it seems that Lee has likely done a much better job of combatting coronavirus than he was given credit for from the start. And it also seems that Beshear was way too quick won the trigger when he decided to make the coronavirus fight personal.