Mitchell, who has known the deaths of eight of her 13 children over the years, was done taking chances with the virus stealing up the hollers along Cutshin Creek.

“That stuff’s getting so bad, I was afraid to not take it,” she said, sitting in her daughter’s car in the church parking lot. “I said, ‘Well, if all the rest of them are going to take it, I’ll take it too.’”

Kentucky is in the midst of a covid-19 wildfire sparing no part of the state; new case counts topped 4,000 a day for much of September, before easing somewhat this month. Hospital intensive care units are still at capacity in some regions, with covid patients occupying half the beds. Gov. Andy Beshear has called the situation “dire.”

Across the nation, older people have been steadfast takers of the covid vaccines: About 95% of people 65 and older have received at least one shot. But geographic variations cloud that math. Older Kentuckians in rural hamlets far from Louisville and Lexington are trailing in vaccination, with rates as low as 55% in Wayne County, on the Tennessee state line.

While seniors are still more likely to be vaccinated than younger adults in Kentucky, the simple truth of the pandemic is that older people who forgo the shots face a far greater chance of severe sickness and death. People 60 and older account for nearly 90% of the 9,184 covid-related deaths in Kentucky. Residents 80 and older account for 41% of deaths.

In Leslie County, in the foothills of the rugged Pine Mountain ridge that anchors the state’s eastern coalfields, gravel roads wind through thick forests blanketed with kudzu vines. House by house, church by church, public health workers are trying to outsmart the fantastical tales about the covid vaccines spread on Facebook and overcome the everyday hurdles of financial hardship and isolation.

“Some of our older people don’t have access to vehicles because their family works,” said Maxine Shepherd, a regional health coordinator for Leslie County and four-decade-long member of Full Gospel Church. Even for those with a car, gas is expensive, she said, and trips from secluded hollers to town are rationed out carefully.