LOUISVILLE, Ky. - Marshall County resident Ethan Koeler said he was skeptical of the COVID-19 vaccine. Then the 29-year-old contracted the novel coronavirus and was hospitalized for two weeks with a fluid-filled chest cavity and collapsed lung.

Koeler is now urging his fellow Kentuckians to consider getting vaccinated, as part of a statewide campaign called "Take it from Me" launched by the Foundation for a Healthy Kentucky and Kentucky Medical Association. Koeler said he now believes the shot would have kept him out of the hospital.

"If I knew the vaccine would have even just taken some of the blunt away from it, I would have gotten it, because it was so horrible," said Koeler. "If the vaccine could just help a little bit that you don't have to have the symptoms that you could possibly have, I would recommend getting it. But like I said, it's still everybody's choice."

So far 62% of the state's population has rolled up their sleeves. Woodford, Franklin, Fayette, Campbell and Boone counties have the highest vaccination rates.

Residents with questions about the COVID-19 vaccine can call the statewide hotline at 1-800-722-5725.

Koeler said he's fully recovered and recently received his first shot of the COVID vaccine, because doctors say there's still a chance he could contract the virus again.

"They told me that I could definitely get it again," said Koeler. "And that if I did get it again, it would probably take me out. They did recommend very strongly that I get the vaccine after I was back recovered enough to handle it."

Dr. Neil Moser, president of the Kentucky Medical Association, said he sees cases such as Koeler's daily. He said he hopes residents will trust their doctors that the vaccine is safe, effective and necessary to help end the pandemic.

"The vaccinations," said Moser, "which have now been available for almost a year, have been given billions of times across the planet, is safe and is very, very effective at saving lives."

He added that public-health experts are working to increase vaccinations in counties lagging behind - regions seeing some of the worst hospitalization rates.

"Spencer, Louisville, Christian, Elliott, Jackson, Hart, Ballard, Hickman, Casey, and Knox actually have some of the lowest vaccination rates in the nation," said Moser, "not just in Kentucky."

As of last week, more than 1,300 people with novel coronavirus infections were hospitalized in the Commonwealth, including nearly four hundred in intensive care unit beds, according to state data.

The ruling on abortion by the U.S. Supreme Court has returned the issue to the states, fulfilling long-held goals of Republican lawmakers in Texas to ban and criminalize abortion.

With the 49-year-old Row v. Wade case overturned, a trigger law takes effect next month, banning abortions from the moment of fertilization - there is no exception for rape or incest.

Texas lawmakers were ahead of the high court, passing legislation last fall to prohibit abortions after six weeks. Aimee Arrambide, executive director of the Texas chapter of the abortion rights group Avow, said she expects half the states to follow Texas' lead.

"We've been ringing the alarm that what is happening in Texas, doesn't stay in Texas," said Arrambide. "And that the public health crisis Texans have been facing for nearly 10 months will be the reality in half the country. Our opponents are not going to stop until abortion is completely inaccessible in the country."

In his concurring opinion with the 6-3 vote, Supreme Court Justice Clarence Thomas said high court rulings that established a right to contraception, as well as gay rights should also be reconsidered.

Following the ruling, Texas GOP Gov. Greg Abbott said abolishing Roe v. Wade, "reinstated the right of states to protect innocent, unborn children."

New Mexico is now the closest state for many Texans seeking an abortion, but getting there may not be possible for low-income people who don't have the time, money or child care to travel out of state. Progress Texas Advocacy Director Diana Gomez said education is the next step.

"There are a lot of folks who don't know about the existence of abortion funds," said Gomez, "of infrastructures that are already in place to help people get abortions, and so we want to let people know about clinics in surrounding states."

In addition to Texas, 25 other states are expected to make abortion illegal, affecting the lives of 36 million people. University of Texas at Austin Associate Professor Kari White said entire regions of the country may soon be in the business of extreme criminalization.

"In a state like Texas," said White, "it's also going to criminalize a whole range of behaviors and practices for people who are trying to help someone get an abortion."

Prior to the court's ruling, a poll by Reuters showed about 71% of Americans - including majorities of Democrats and Republicans - believed pregnancy termination should be a patient-doctor decision.

Medical negligence cases in Washington and elsewhere have taken on a new shape during the pandemic, as hospital resources have been strained and the potential usefulness of certain treatments has ebbed and flowed.

Drugs like ivermectin, for instance, were touted online as a potential COVID-19 treatment but ultimately lacked scientific evidence to back up those claims.

Elizabeth Calora is a Tacoma lawyer who specializes in medical negligence cases. She said there are some legal requirements for determining if a health professional acted carelessly which have been affected by COVID.

"We need to figure out what a reasonably prudent provider should have been doing in that context," said Calora, "and it usually means talking to experts in the field and then determining if what the provider did in the moment or over the course of several visits violated that standard of care."

Calora said after that, the person has to prove that the breach is what caused the damages.

The Washington state Legislature modified evaluations of negligence cases in 2021 so that resources and staffing must be taken into account. For instance, hospitals have often lacked beds at the height of different COVID waves, a factor outside of doctors' or facilities' control.

Calora said the standard of care evolves over time. What was once an acceptable medical practice in the 1970s, for example, might not be anymore.

"But usually it happens in a much slower timeframe than what we experienced at the start of the pandemic," said Calora. "With COVID, you had physicians all over the world basically - it makes me think of throwing spaghetti on the wall to see what sticks. Everyone was trying everything they could."

Calora said the unforeseen nature of the pandemic has made it hard to bring medical negligence cases forward. However, she added that shouldn't discourage people from speaking with an attorney if they feel they or a loved one has been wronged.

"Even though things were bad," said Calora, "it doesn't give people license to practice beneath the standard of care."

Since the beginning of the pandemic, several states have passed "safe staffing" laws aimed at balancing patient-nurse ratios in hospitals. In Pennsylvania, health care advocates are calling on lawmakers to vote on legislation still stalled in committee.

Senate Bill 240, also known as the Patient Safety Act, would establish limits to the number of patients one nurse is responsible for during a shift.

Maureen May, president of the Pennsylvania Association of Staff Nurses and Allied Professionals, said it is about ensuring positive outcomes for patients.

"I want to be in a hospital bed in which I know that there are enough nurses to care for me and my family members," May asserted. "I want to be a nurse that works in a hospital and walks away from the bedside at the end of the day and know that I did everything I could to make sure my patients received the best care possible."

Many health care system administrators oppose safe-staffing legislation, saying it is costly to their bottom line. Senate Bill 240 and its companion House Bill 106, which has more than 100 co-sponsors, have been referred to each chamber's health committees and await a vote.

Sen. Maria Collett, D-Montgomery County, said the pandemic exposed the cracks in the health care system and the need for legislation such as the Patient Safety Act. She stressed it has been disappointing to see the legislation stalled by a few lawmakers, given the bipartisan support for the bill.

"If you're someone that's not going to stand with nurses, that's not going to stand with patients, then put your name on the record," Collett urged. "Vote no on this bill because the people in our communities deserve to know where we stand when it comes to protecting patient outcomes and protecting the hardworking nursing staff."

A 2017 study found patients were much more likely to survive when nurses followed a hospital-mandated patient-nurse ratio. Lower patient-to-nurse staffing ratios also have been associated with significantly lower rates of cardiac arrest, hospital-acquired pneumonia, respiratory failure and patient falls.