Kentucky is in the midst of a third surge in COVID-19 cases as public health experts warn that without precautions, the worst could be yet to come.

Case counts are higher than in the summer’s wave of infection while hospitalizations and intensive care unit admissions are higher than at any previous point in the pandemic.

And on Wednesday, Gov. Andy Beshear reported the second-highest daily total — 1,487 cases — coupled with the second-highest number of deaths — 21. 

For these reasons, coupled with rapidly rising rates of infection around the country and the onset of colder temperatures, Beshear said Wednesday he believes the Commonwealth is staring down a “grim” future.

“National Health experts [are] saying this could be the ugliest fall and winter of our lifetimes, which they’re predicting significant loss of life,” Beshear said. “So let’s do the right thing. Let’s realize our sacrifice is small and the benefit is huge.”

Kentucky By The Numbers

Cases of COVID-19 are on the rise around the country, particularly across the Midwest and rural West. For example, North Dakota’s weekly average ranked the worst in the country at 98 cases for every 100,000 residents as of Wednesday, according to the U.S. Centers for Disease Control and Prevention

Kentucky, alternatively, has 25.1 cases per 100,000 residents, which is still enough that it falls within the category of “uncontrolled spread,” according to White House recommendations. 

Hospitalizations, which typically lag behind cases, have also reached new heights. The governor reported 794 hospitalizations Wednesday, beating an August record of 717 cases. 

A White House report indicates much of the spread appears to be happening at family gatherings, Beshear said. 

Kentucky Department for Public Health

In the last two months, the White House discovered a single Kentucky wedding connected to 44 cases and a college party connected to 63 cases. Other clusters were associated with funerals, bingo halls, yard sales and family gatherings, Beshear said. 

The White House recommendations actually suggest no gatherings at all in counties facing accelerated spread (10-25 cases per 100,000), or uncontrolled spread (25+ per 100,000), like Jefferson County. 

Kentucky restrictions continue to allow groups of up to 10 people to gather, though Beshear said people should seriously consider the prudence of holding any gatherings right now. 

“And what we need in the very least is for people to be a lot more cognizant of the danger of these gatherings,” Beshear said. 

Changes In Treatment 

In several critical ways, Kentucky’s hospitals are better prepared for a new surge in cases compared to the early days of the pandemic.

University of Louisville Hospital Chief Medical Officer Dr. Jason Smith said testing has improved significantly, hospitals have larger stockpiles of protective equipment, and medical experts have better strategies for treating sick patients. 

“We know more about this disease than we knew about the disease even three or four months ago,” Smith said. “And so from that standpoint we are in a better position to take care of the patients that come through the front door.”

Still, doctors in the University of Louisville Hospital system are treating the highest number of COVID-19 patients they’ve seen since July — 57 patients as of Wednesday, and Smith anticipates that number will increase for at least the rest of the week. 

U of L Hospital staff have also seen an increase in the number of families testing positive for the virus, including multiple generations within those families. Smith thinks it’s likely that the latest surge in infections is related to pandemic fatigue: more gatherings and fewer masks. 

And he warns the current rate of infection positions the state poorly as it heads into flu season. 

“We are starting at a much higher baseline than I would have hoped or anticipated,” Smith said. “What will happen moving forward, I can’t say. My guess is we will see an increase in COVID cases.”

Even as Kentucky hospitals are better positioned to manage cases of COVID-19, they continue to grapple with financial hardship. 

Hospital Financial Woes

The state’s hospitals are facing more than $1 billion in losses by the end of the year due to COVID-19, said Kentucky Hospital Association President Nancy Galvagni in testimony before an interim legislative committee Wednesday.

“Hospitals both large and small, urban and rural, independent or part of the system, have been hit and hit very hard,” Galvagni said.

While federal relief provided “a tourniquet” to stem an expected loss of $2.6 billion, it hasn’t been enough to make the state’s hospitals whole, she said. 

Delays in treatment, lower emergency room use and smaller payouts from Medicare and Medicaid have all significantly impacted hospital revenues, she said.  

Even with the losses, Galvagni said hospitals continue to excel at managing their capacities and preventing health care providers from being overrun by COVID-19 patients. 

Correction: A previous version of this story incorrectly listed the number of COVID-related deaths on Wednesday. 

Ryan Van Velzer is WFPL's Energy and Environment Reporter.