Chris Kenning | Louisville Courier Journal

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ELCOMB, Ky. – The two men sat on the covered porch of an aging mobile home along an Appalachian creek, a loud rain pinging off the sheet metal roof.

Joe Goans’ four children were packed inside, shut out of school by the spreading coronavirus. He hadn’t worked in two weeks, and his carpentry jobs had all canceled. One small consolation was that a yellow school bus wound each morning through the one-time coal camp with free meals for his kids.

Next to him, longtime coal miner Robbie Jonathan smoked a cigarette. He wasn’t certain if his recent health problems were black lung, but he knew he’d be in trouble if he contracted COVID-19.

“These here don’t help none,” he admitted as he took another drag.

Shaking their heads at some people failing to take the social distancing orders seriously, they agreed on one thing: The coronavirus, if it arrived in force, would cut deep in a place weakened by coal layoffs, floods and generations of poverty and poor health.

“It’s about time for Jesus to come back,” Jonathan said.

“I wish he’d hurry,” Goans responded dryly.

Along Appalachian Kentucky’s winding two-lane roads this week, where restaurants, day care centers, nail salons and bingo parlors are closed, some said they feel protected by the social distancing that naturally comes with the region’s geography of remote hills and hollows.

But on porches and in some churches, in school food lines and small-town grocery aisles stripped of toilet paper and soup, a palpable sense of foreboding pervades, reflecting what one public health expert said was Appalachia’s “perfect storm” of vulnerabilities to the virus.

Chris Kenning

While 46% of adult Kentuckians are considered at risk of serious illness if they were to get COVID-19, the disease caused by the coronavirus, few other places concentrate those health conditions that substantially raise the risks.

It's an area of higher-than-average cardiopulmonary disease, diabetes, cancer, disability and resurging black lung. Smoking rates are high, and the population is aging. Add in a rural drug epidemic that only two years ago helped fuel the nation’s largest and deadliest hepatitis A outbreak.

There’s also more limited access to care in Eastern Kentucky: longer distances to hospitals, fewer beds, fewer doctors and less nursing staff in tiny public health departments hollowed out by budget cuts. Counties such as McCreary have no hospital, much less the ventilators or testing kits now in short supply.

"It could be extremely hard-hitting" in Eastern Kentucky, said Dr. Kevin Kavanagh, a retired physician and infectious disease control advocate in Somerset, who runs a patient safety group called Health Watch USA.

Equally devastating will be the economic toll of business closures and layoffs that could last for weeks or months, despite federal help, in some of America’s poorest counties.

Harlan County, where one-third of residents live in poverty, is still reeling from last year’s collapse of coal operator Blackjewel, which left hundreds jobless and staggered the local economy, including the same restaurants now shut down.

Some spots in Appalachia also faces poor internet connectivity, which limits the ability for some to work from home. Judge-Executive Dan Mosely, whose stepson was laid off from his restaurant job, said he worries, despite a resilience borne from generations of struggle,

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“It weighs on me what people will have to deal with,” he said.

So far, limited testing hasn't confirmed any cases in Appalachian Eastern Kentucky. But public health officials believe it’s only a matter of time before some cases crop up.

Meantime, like everywhere, life has changed for everyone in far eastern Kentucky, from southeast coalfields of Harlan to the once-booming industrial northeast city of Ashland along the Ohio River.

There, church signs announced closures, the town’s Paramount Theatre marquee read “Wash your hands,” and newspapers bemoaned the sudden end of an undefeated high school basketball team’s season.

At a Kroger, there wasn't a roll of toilet paper on the shelf, and cereal, soups and meats were mostly gone. With bars closed, residents lined up inside a liquor store.

“I see we’re all sanitizing,” one woman quipped.

Inside Tri-State Travel, Chuck Rist sat at a desk piled high with papers, phone ringing from calls canceling flights and cruises.

Across the street at Fat Paddy’s restaurant, manager Jeremy Addis hauled takeout burgers to the curb, stunned from having to lay off 40 servers and bartenders.

“They’re just worried how they’re going to support themselves and their families,” he said.

Ashland in recent years has faced a large steel mill closure, recent doubts over whether a planned Braidy Industries aluminum plant will come to fruition, and the announced closure of one of its two local hospitals, Our Lady of Bellefonte, with the loss of 1,000 jobs.

“It’s extremely bad timing,” said Lynn Childers, who runs a nonprofit agency that operates a social services center.

On a recent day, she stood with a colleague discussing closures, shutdowns and panic-buying at grocery stores, which was squeezing food donations that are relied upon to feed the homeless.

“I think they’re overreacting,” her friend Tammy Mcintyre said.

“I don’t think so. It might be a late reaction,” Childers said.

Nearby, Taya Raif Snyder, who is homeless, said the local library closure meant homeless people have no place to go.

“They told us to go home and isolate, and we’re like, 'Tell us and we’ll go there,'” said Snyder, who recently battled pneumonia. “We’ve had to stay outside, and it’s freezing.”

At the Ashland-Boyd County Health Department, nurse supervisor Erin Crace was part of a team taking stock of beds and ventilators, working to halt visitors to nursing and other facilities and hoping for more test kits.

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The main thing was urging people to stay home, she said.

Two years ago, Crace and her tiny staff were in the middle of the area’s hepatitis A outbreak, which saw restaurants closed and led to hospitalizations and deaths.

Across the state, particularly in rural counties, the response, including efforts to vaccinate those at risk, was limited by a lack of funding and staff.

"We are getting a lot of people calling because they're not sure who to call for testing,” she said. “We don’t have any test kits, but we’re referring them” to private providers.

At Catlettsburg Elementary near Ashland, stay-at-home mother Michelle Williams, 35, pulled into the parking lot, grabbing bags of lunches for her children, ages 4, 5, 9 and 10, who squirmed in the back seat.

She has spent days trying to figure out how to spend the weeks, and perhaps months, her children will be out of school. Her husband’s mechanic job was about to shut down, too.

“Not knowing when things are going back to normal is rough,” she said.

To the southeast, McCreary County, tucked into the Daniel Boone National Forest and ranked as one of the poorest in the state and nation, the streets were deserted.

Sean Crabtree, who oversees the 10-county Lake Cumberland District Health Department that includes McCreary, said rural counties "have a little geographical advantage, but everyone still comes together for ball games and church,” he said.

“The double whammy is people are spreading it before they’re sick, and we don’t have a vaccine. So our biggest asset right now is the public, and the public needs to comply.”

In hospitals and clinics, he said, "we’re experiencing the same shortfalls the nation is – there are not enough personal protection equipment, not enough ventilators, not enough isolation rooms, not enough medical staff."

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To the east, past billboards for addiction treatment and disability lawyers and Dollar General stores, several strip malls were half-filled with parked cars and shoppers going in and out of shops like Rent-a-Center and GameStop.

Women sat in hair salons before they were ordered closed.

Across the region, many asked the same question: "How big of a danger will this virus become?"

“I don’t think it’ll be like a black plague or whatever. But I guess it could happen,” said James Griffitts, who was taking his 10-year-old daughter, Allie, and 2-year-old son, Cole, on an ATV ride.

In Harlan, Joyce Cheng, who owns Panda Garden and gained fame for serving out-of-work miners during last year's Blackjewel layoffs, had closed her doors but was personally delivering to the remote, sick and elderly.

By Thursday, she had decided to close, hoping to inspire more to shelter at home, cooking furiously to fill hundreds of orders, including for the local hospital.

Harlan’s small 150-bed hospital had barred visitors, along with nursing homes, but some churches had still held midweek services.

"I’m about to go and say, go home. People have to be serious. Have you read the Chinese news? It’s going to be a long time,” she said, “I think we’re going into a recession.”

That would be bad news for the town, which was already scrambling from Blackjewel’s bankruptcy that prompted miners to block a coal train to demand back wages in a protest that brought national attention.

It reflected coal production's decline in the area, and with it, good-paying jobs. In the first quarter of 2019, 3,959 miners were working in Eastern Kentucky, down from nearly 25,000 in 1990.

Some have left town after the coal bankruptcies. More recently, severe flooding left some area homes underwater.

"It’s like we’ve got a big black cloud hanging over us,” said Donna Pace, head of Harlan’s Community Action Agency. “But we’ve got a lot of people who look out for each other.”

On Wednesday night, the lights were on in an otherwise quiet downtown Harlan at the Harvest Worship Center, with about two dozen people spread out among the pews for a service.

The Rev. Roland "Bo" Lee said "people are still hurting spiritually" and wanted to gather. But he finally decided to hold services online after that night, even though he noted that crowds were still gathering at groceries and shopping outlets.

Even funeral parlors were limiting mourners, he said.

“We’ve never had anyone say 'Don’t go to church.' It’s a whole new world,” he told the congregants.

“We’re in uncharted territory.”