Pandemic

A pandemic is an epidemic disease that spreads over multiple countries or continents, typically infecting a large portion of the population. In the BRADD region, pandemic events (such as the recent COVID-19 crisis) have demonstrated how a highly transmissible pathogen can overwhelm local health systems, disrupt daily life, and cascade into economic, social, and infrastructure stress. While pandemics are rarer than seasonal outbreaks, their magnitude and scope mean they must be factored into hazard mitigation planning. Recognizing pandemics as a regionally relevant hazard helps local jurisdictions anticipate surge demands, strengthen public health capacities, and coordinate resiliency for cross-sector dependencies.

Description Extent, Past Events, & Location Probability Impact Vulnerability Summary Analysis

What is a Pandemic?

The World Health Organization (WHO) describes a pandemic as the “worldwide spread of a new disease”. Often, there is little to no immunity within a community to this new or re-emergent disease, so transmission and contraction is significant. While a general definition of ‘pandemic’ exists, the term is often misapplied. However, there are characteristics of disease and disease spread that allow public health practitioners to identify a pandemic and begin a response.

Characteristics of Pandemics

David Morens, Gregory Folkers, and Anthony Fauci published a paper in a 2009 volume of The Journal of Infectious Diseases describing the eight characteristics of a pandemic. They note that pandemic is often used by the media to describe disease spread which does not rise to the level of being classified by scientists and public health officials as pandemic. These are the eight characteristics that are common in diseases that are officially classified as pandemics:

  1. Wide Geographic Extension: Pandemics impact a wide geographic area, often being classified as transregional, interregional, or global.
  2. Disease Movement: The spread of a pandemic disease can be traced from place to place.
  3. High Attack Rates & Explosiveness: Refers to the number of cases of a particular illness reported within a short time frame. Diseases with slow rates of transmission are rarely classified as a pandemic, as was seen in the 1999 spread of the West Nile virus from the Middle East to both Russia and the Western Hemisphere.
  4. Minimal Population Immunity: While pandemics have occurred in partly immune populations, limited population immunity has created ideal conditions for pandemic disease to develop and spread.
  5. Novelty: The term ‘pandemic’ is often applied to new diseases, or new variants of known diseases. However, this does not preclude repeatedly
  6. Infectiousness:  Pandemic diseases generally have a high level of infectiousness. While the term has been applied to non-infectious health issues, such as cigarette smoking, this term is often used in less scientific settings.
  7. Contagiousness: Most diseases classified as ‘pandemic’ are transferred from person-to-person.
  8. Severity: Pandemic typically describes diseases that are severe or fatal, such as SARS, HIV/AIDS, and the Black Death. Measuring Magnitude

In the event of a pandemic, the WHO and the U.S. Center for Disease Control and Prevention (CDC) direct response efforts. Depending on the severity of the outbreak, local or national public health agencies may also respond. The World Health Organization breaks pandemic alerting into five phases:

  • Phase 1: No viruses circulating among animals have been reported to cause infections in humans
  • Phase 2: Animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
  • Phase 3: An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances
  • Phase 4: Characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic.
  • Phase 5: Characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Extent

The extent of a pandemic depends on the pathogen’s transmissibility (often captured by the basic reproduction number, R₀), incubation period, asymptomatic spread potential, and mutation rate. In severe pandemics, infection may reach across all communities in the region, with multiple waves lasting months to years. Hospitals, clinics, labs, and public health systems may be stretched, supply chains disrupted, and many sectors operate under constrained conditions. A pandemic’s severity may also be amplified by the emergence of variants or changes in virulence, potentially leading to unexpectedly high morbidity or mortality. In the BRADD region, a future pandemic might vary from a moderate influenza-type strain to a more virulent respiratory pathogen with multi-system impacts.

Past Events

The BRADD region and the broader U.S. have been impacted by several pandemics and widespread infectious events in recent history. Seasonal influenza pandemics (e.g. 1918, 1957, 1968, 2009 H1N1) have illustrated how novel strains can rapidly spread beyond borders. More recently, the COVID-19 pandemic (beginning in late 2019) had pronounced effects on public health, hospitalization rates, mortality, economic activity, and social functioning across Kentucky and the U.S. Even within the region, local hospital admissions, deaths, long COVID cases, workforce shortages, and disruptions to education and commerce are testimonies to the local imprint. The experience of COVID-19 provides a contemporary benchmark for planning, response, and recovery.

Historical examples of pandemic demonstrate that while a pandemic may be devastating to a community from a life safety and economic standpoint, the threat was often downplayed and ignored. 

Spanish Influenza 1918-1919: The 1918 Spanish Influenza pandemic was initially disregarded as having a significant impact as influenza was thought of as a minor illness that incapacitated the sick for a relatively short period of time before they eventually recovered. However, as the Spanish Influenza rose to pandemic level, it redefined the public’s perception of the virus. A historian at the time noted that at a military encampment in southern Ohio, soldiers would arrive healthy and within twenty-four hours would be dead from the flu.

The virus spread globally along trade routes and shipping lines. Residents of North American, Europe, Africa, Asia, Brazil, and the South Pacific were particularly affected by the illness, which in-total infected 1/5 of the global population. In contrast to the majority of flu strains, the Spanish Influenza primarily affected young, healthy adults between the ages of 20 and 40. The mortality rate was 2.5%, an astounding figure given that flu outbreaks typically have a rate of 0.1%. By the end of the pandemic, the virus had claimed 20 million lives worldwide and 675,000 in the United States.

Asian Flu 1956-1958: The New York Times first broke the news of the Asian Flu in 1957 when they published a story of a flu virus that had infected 250,000 in Hong Kong. Months after this story was published, the disease had spread to the United States. Unlike Spanish Influenza, the Asian Flu was most commonly reported in the vulnerable populations, such as the elderly and individuals with heart and lung conditions. People with rheumatic heart disease and women in their third trimester of pregnancy were uniquely impacted. Infection for this pandemic came in two parts—the first in the late summer of 1957 and the second in the winter of 1958. The death toll for the Asian Flu widely varies, with sources reporting between 1 and 4 million deaths worldwide and approximately 69,800 in the United States.

Hong Kong Flu 1968-1969: The Hong Kong Flu is the mildest of all pandemics of the 20th century, a fact that is often explained by its similarity to the Asian Flu which increased immunity to the 1968 strain and the fact that it hit the United States in late December when most students were on break, reducing opportunities for spread. As with the Asian Flu, the vulnerable populations, particularly the elderly, were most at risk. By the end of the pandemic in 1969, it had claimed 33,800 lives in the US.

H1N1 2009-2010: This pandemic first appeared in the United States in the spring of 2009. By June, H1N1 had infected 18,000 people in the US. The virus primarily affected the populations most typically affected by the flu: children and infants, pregnant women, the elderly, and individuals with prior-existing health conditions. Due to advancements in medical research and technology, the overall impact of the pandemic was curbed. A vaccine was introduced in the fall of 2009. Approximately 80 million people were vaccinated worldwide. By the time the pandemic was declared over in the spring of 2010, between 43-89 million people had been infected and between 8,870 and 18,300 people had died.

COVID-19 2020-2022: The most recent pandemic first appeared in the United States in the spring of 2020. By July 2020, COVID-19 had infected over 200,000 people worldwide. The virus initially primarily affected the elderly, and individuals with prior-existing health conditions, however as spread increased so did the populations at-risk. A vaccine was approved for use against the virus in December of 2020, with hopes that the pandemic will be declared over in 2021.

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The probability of another pandemic occurring in the future is moderate to high. While not every contagious agent will become pandemic, globalization, human mobility, zoonotic spillover risk (e.g. from wildlife or livestock), and pathogen evolution increase the chances. New influenza strains, novel coronaviruses, or other unforeseen agents may emerge. Advances in surveillance, vaccination, and early warning may reduce risk, but the inherent unpredictability of viral evolution and human–animal interface make pandemics more likely than rare catastrophic hazards. For the BRADD region, this means that infectious disease threats warrant continuous monitoring, planning assumptions, and readiness for surge response.

The COVID-19 pandemic demonstrated how a global health crisis can create far-reaching impacts across every aspect of life in the BRADD region. Hospitals in Bowling Green, Glasgow, and Franklin faced sustained patient surges, requiring expansion of ICU capacity and coordination across county health departments to manage testing and vaccination distribution. Schools across all ten counties transitioned to remote learning, affecting student performance and family routines, while local industries—from automotive suppliers to small businesses—faced workforce shortages and temporary shutdowns. Community events, tourism, and downtown commerce slowed dramatically, particularly in areas like Cave City and Scottsville that rely on visitor traffic. Even as infection rates declined, long-term effects such as workforce turnover, learning loss, and increased behavioral health needs have continued to shape the region’s recovery. These experiences highlight how a pandemic can simultaneously test the built, natural, and social environments—and underscore the importance of preparedness, adaptability, and coordinated regional response.

Pandemics can subtly but significantly stress and alter the built environment, though direct physical damage is rare. Healthcare facilities, clinics, and laboratories often face capacity overloads, pushing infrastructure beyond design limits. Buildings and spaces may require retrofits or operational changes—such as enhanced ventilation, spacing of occupancy, physical barriers, and modified traffic flows—to reduce transmission risk. Office layouts, schools, and public buildings often shift toward hybrid or reduced occupancy models, potentially leaving portions of infrastructure underutilized or undermaintained. Work-from-home practices and remote operations can lead to vacant commercial real estate, deferred building maintenance, and financial strain on facility owners. In aggregate, these changes can reshape building use, maintenance demands, and lifecycle planning in the region.
David Morens, Gregory Folkers, and Anthony Fauci published a paper in a 2009 volume of The Journal of Infectious Diseases describing the eight characteristics of a pandemic. They note that pandemic is often used by the media to describe disease spread which does not rise to the level of being classified by scientists and public health officials as pandemic. These are the eight characteristics that are common in diseases that are officially classified as pandemics:

1. Wide Geographic Extension
Pandemics impact a wide geographic area, often being classified as transregional, interregional, or global.

2. Disease Movement
The spread of a pandemic disease can be traced from place to place.

3. High Attack Rates & Explosiveness
Refers to the number of cases of a particular illness reported within a short time frame. Diseases with slow rates of transmission are rarely classified as a pandemic, as was seen in the 1999 spread of the West Nile virus from the Middle East to both Russia and the Western Hemisphere.

4. Minimal Population Immunity
While pandemics have occurred in partly immune populations, limited population immunity has created ideal conditions for pandemic disease to develop and spread.

5. Novelty
The term ‘pandemic’ is often applied to new diseases, or new variants of known diseases. However, this does not preclude repeatedly

6. Infectiousness
Pandemic diseases generally have a high level of infectiousness. While the term has been applied to non-infectious health issues, such as cigarette smoking, this term is often used in less scientific settings.

7. Contagiousness
Most diseases classified as ‘pandemic’ are transferred from person-to-person.

8. Severity
Pandemic typically describes diseases that are severe or fatal, such as SARS, HIV/AIDS, and the Black Death. Measuring Magnitude

In the event of a pandemic, the WHO and the U.S. Center for Disease Control and Prevention (CDC) direct response efforts. Depending on the severity of the outbreak, local or national public health agencies may also respond. The World Health Organization breaks pandemic alerting into five phases:

  • Phase 1: No viruses circulating among animals have been reported to cause infections in humans
  • Phase 2: Animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
  • Phase 3: An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances
  • Phase 4: Characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic.
    • While pandemics primarily affect human systems, their effects can cascade into the natural environment. Reduced human mobility and industrial activity during pandemic peaks sometimes lead to short-term improvements in air and water quality, reduced emissions, and lowered pollution levels. However, outbreak responses can generate higher volumes of medical waste (e.g. personal protective equipment, disposable testing kits, packaging) and lead to increased chemical disinfectant use, which, if not handled properly, may affect water, soil, and wildlife. Surveillance efforts such as wastewater monitoring integrate environmental sampling as a public health tool. The interconnectedness of human health and ecosystems underscores that pandemic management must consider environmental stewardship, especially in waste handling and resource use.
Pandemics have profound and enduring impacts on the social environment. They disrupt daily routines, force social distancing and isolation, and strain mental health across populations. School closures, shifts to remote work, and cancellation of gatherings reduce social cohesion and weaken communal support systems. Economic stress, unemployment, and service interruptions disproportionately affect vulnerable populations, exacerbating inequities. Trust in institutions—public health agencies, governments, and health systems—is challenged, as is the spread of misinformation or stigma. Recovery often requires rebuilding social networks, restoring community engagement, and addressing long-term psychological and social resilience. Spanish Influenza 1918-1919
Historical examples of pandemic demonstrate that while a pandemic may be devastating to a community from a life safety and economic standpoint, the threat was often downplayed and ignored. The 1918 Spanish Influenza pandemic was initially disregarded as having a significant impact because influenza was thought of as a minor illness that incapacitated the sick for a relatively short period of time before they eventually recovered. However, as the Spanish Influenza rose to pandemic level, it redefined the public’s perception of the virus. A historian at the time noted that at a military encampment in southern Ohio, soldiers would arrive healthy and within twenty-four hours would be dead from the flu.

The virus spread globally along trade routes and shipping lines. Residents of North American, Europe, Africa, Asia, Brazil, and the South Pacific were particularly affected by the illness, which in-total infected 1/5 of the global population. In contrast to the majority of flu strains, the Spanish Influenza primarily affected young, healthy adults between the ages of 20 and 40. The mortality rate was 2.5%, an astounding figure given that flu outbreaks typically have a rate of 0.1%. By the end of the pandemic, the virus had claimed 20 million lives worldwide and 675,000 in the United States.

Asian Flu 1956-1958
The New York Times first broke the news of the Asian Flu in 1957 when they published a story of a flu virus that had infected 250,000 in Hong Kong. Months after this story was published, the disease had spread to the United States. Unlike Spanish Influenza, the Asian Flu was most commonly reported in the vulnerable populations, such as the elderly and individuals with heart and lung conditions. People with rheumatic heart disease and women in their third trimester of pregnancy were uniquely impacted. Infection for this pandemic came in two parts—the first in the late summer of 1957 and the second in the winter of 1958. The death toll for the Asian Flu widely varies, with sources reporting between 1 and 4 million deaths worldwide and approximately 69,800 in the United States.

Hong Kong Flu 1968-1969
The Hong Kong Flu is the mildest of all pandemics of the 20th century, a fact that is often explained by its similarity to the Asian Flu which increased immunity to the 1968 strain and the fact that it hit the United States in late December when most students were on break, reducing opportunities for spread. As with the Asian Flu, the vulnerable populations, particularly the elderly, were most at risk. By the end of the pandemic in 1969, it had claimed 33,800 lives in the US.

H1N1 2009-2010
This pandemic first appeared in the United States in the spring of 2009. By June, H1N1 had infected 18,000 people in the US. The virus primarily affected the populations most typically affected by the flu: children and infants, pregnant women, the elderly, and individuals with prior-existing health conditions. Due to advancements in medical research and technology, the overall impact of the pandemic was curbed. A vaccine was introduced in the fall of 2009. Approximately 80 million people were vaccinated worldwide. By the time the pandemic was declared over in the spring of 2010, between 43-89 million people had been infected and between 8,870 and 18,300 people had died.

COVID-19 2020-present
The most recent pandemic first appeared in the United States in the spring of 2020. By July 2020, COVID-19 had infected over 200,000 people worldwide. The virus initially primarily affected the elderly, and individuals with prior-existing health conditions, however as spread increased so did the populations at-risk. A vaccine was approved for use against the virus in December of 2020, with hopes that the pandemic will be declared over in 2021.
The 2016 Global Risk Report published by the World Economic Forum has proposed that climate change could be a causal factor in future pandemics. This finding is further explored in a 2016 report produced by Johns Hopkins University’s School of Advanced International Studies, Pandemics in a Changing Climate – Evolving Risk & Global Response. The report explains that vector ecology indicates the potential for climate change to create the conditions for future pandemics. Changes in temperature, precipitation, and pH levels due to climate change will impact the quantity and quality of ecological services, such as food, water, and soil. Ecosystem shifts can impact the migratory patterns, habitats, population, and survivability of certain animal and insect populations. Such changes may increase human-animal or human-insect contact, increasing the likelihood of transmission. For example, as hot summer months extend tick and mosquito populations, both culprits in transmission of epidemic-causing viruses, can survive longer and have more opportunities to infect humans. Climate change may have more direct impacts on humans by making certain populations, particularly in developing countries, more susceptible to illness by creating food and water security crises.

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Vulnerability to pandemics across the BRADD region is shaped by differences in population density, healthcare capacity, demographics, mobility, and public health infrastructure. More urbanized counties with hospitals, universities, congregate settings, and high connectivity may face greater exposure and transmission potential, but often also possess more robust medical resources. Rural counties may be somewhat shielded by lower density, yet face challenges of limited access to care, delayed diagnosis, and lower surge capacity. Counties with older populations, comorbidities, or socioeconomic vulnerabilities may suffer disproportionate impacts. Integrated regional planning, equitable resource allocation, and cross-county coordination are critical to reducing vulnerability for all.

Pandemic Vulnerability Analysis by County

Allen County’s vulnerability in a pandemic is moderate. Scottsville and its surrounding rural communities may experience strain on limited medical and clinical services if case loads surge. Travel distances to larger hospitals may delay care, especially for severe cases. The county’s lower density may slow transmission, but health resource constraints and limited surge capacity remain a concern.
Barren County is relatively more vulnerable due to its population centers, connectivity, and local health facilities. The Glasgow area’s hospitals and clinics would likely absorb significant caseloads, but may become stressed during peaks. The movement of people in and out of the county, business centers, and congregate settings (schools, workplaces) increase exposure potential.
Butler County’s predominantly rural character affords some buffer, but it maintains vulnerability due to limited healthcare infrastructure and lower redundancy. An influx of cases beyond local capacity may require transfer of patients and support from neighboring counties. Delay in testing or resource delivery could degrade outcomes.
Edmonson County is vulnerable because of tourism traffic (Mammoth Cave National Park) and influxes of visitors, which heighten exposure potential. The local health infrastructure is limited and may not sustain large surges. Coordination with park services and cross-county backup is critical during pandemic waves.
Hart County’s vulnerability is intermediate. Tourist sites, highway access, and visitor traffic may introduce pathogen transmission. The dispersed rural layout may slow spread initially but also delay detection and response. The county’s medical and public health capacity could face stress in sustained pandemic conditions.
Logan County is moderately vulnerable. The presence of medical clinics and hospitals offers some resilience, but increased demand may overwhelm capacity during significant pandemic waves. Populations with chronic diseases may face more severe outcomes. Intercounty movement increases transmission risk.
Metcalfe County’s vulnerability is lower in terms of exposure given its small size, but infrastructure limitations raise risk. The county may rely heavily on adjacent counties for advanced care, diagnostic labs, and public health resources. Delays in detection and logistical support are key vulnerabilities.
Monroe County’s vulnerability is shaped by rural challenges, cross-border mobility, and limited direct health resources. In a pandemic, Tompkinsville might suffer case surges beyond capacity, and remote areas may struggle with access to testing, medical care, or public health services. Mutual aid and regional support will be vital.
Simpson County’s proximity to larger traffic corridors (I-65) and commuting flows increases vulnerability. The county may receive spillover of cases from more populous areas, and local medical infrastructure may be taxed. Existing regional health networks will play a critical role in response support.
Warren County is the most vulnerable within BRADD in many respects. Bowling Green’s urban density, presence of Western Kentucky University, multiple hospitals, and numerous institutions constitute both exposure points and capacity centers. The county likely will absorb many of the region’s surge cases. The relatively stronger health infrastructure provides advantages, but pandemics of high scale may stress its limits.