Thursday, May 28, 2020

Most of Kentucky's Federally Qualified Health Centers and Rural Health Clinic are testing for the coronavirus; anyone can get a test

By David Bolt
CEO, Kentucky Primary Care Association

The covid-19 pandemic has amplified the importance of health-care providers, networks and collaborations in our local communities. In particular, the Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) are providing essential services to help keep our local populations healthy.

David Bolt
At the Kentucky Primary Care Association our mission is to promote access to comprehensive, community-oriented primary health care services for the under-served. As part of our work, we are proud to partner with the FQHC and RHC facilities to provide resources, technical and operating assistance, and support for their innovative care delivery models. They are an essential component of a health-care system that serves all people, in every corner of our great state. These facilities provide access to high-quality care, improve health outcomes, and reduce health disparities. They also have a tremendous economic impact by creating direct jobs in more than 300 Kentucky communities.

Our FQHC and RHC partners are helping lead the way in the covid-19 pandemic response. They are collaborating with other local healthcare professionals, the Kentucky Department for Public Health, local health departments, federal experts, and other healthcare entities working to develop strategies to defeat covid-19. They are vital partners who can reach vulnerable populations in both urban and rural settings. Time and again these clinics and health centers, which operate in nearly 100 counties, step up to deliver front line care to our citizens who need it most.

Our data indicates the majority of FQHC and RHC facilities in Kentucky are involved in drive-thru testing and/or are planning their role in antibody testing. Around 60 percent of those sites are open to the general public. Anyone who wants a test can get a test. Increasing our testing capacity is paramount to gathering the data we need to make well informed decisions. Experts are also able to use the testing experience from these facilities to generate data that can be used to make future decisions about personal protective equipment distribution, supplies, packaging, and other elements involved in the testing process.

All frontline health-care workers are to be applauded for their selfless, heroic actions “on the front lines” during this pandemic. We know many heroes work at hospitals, doctors’ offices, nursing homes, with the state department for public health, at local health departments, and at other healthcare facilities. We also want to highlight the many dedicated providers, nurses, and other healthcare professionals who go to work every day at a FQHC or RHC to keep Kentuckians safe and healthy. Thank you!

To find the FQHC and/or RHC in your community go to: https://kpca.net/map/ql/health-care and search the category map.

The Kentucky Primary Care Association was founded in 1976 as a not-for-profit 501(c)(3) corporation of community health centers, rural health clinics, primary care centers and all other organizations and individuals concerned about access to health care services for the state’s under-served rural and urban populations. KPCA is charged with promoting the mutual interests of our members, with a mission to promote access to comprehensive, community-oriented primary health care services for the under-served. To lean more, visit https://kpca.net/

Wednesday, May 27, 2020

400 Kentuckians have died of covid-19; Beshear confronts the politics of masks and resistance of some local officials to testing

The governor's mansion uses green lights to memorialize the deaths of Kentuckians from covid-19.
By Melissa Patrick
Kentucky Health News

On the day when the national covid-19 death toll passed 100,000, Gov. Andy Beshear announced that with the addition of six new deaths, Kentucky's toll from the pandemic has hit 400.

"Let's all acknowledge that losing 400 people to anything, at any time, for any reason, isn't OK," Beshear said at his daily briefing. "Let's just remember that we've lost 400 Kentuckians, and this thing isn't over yet."

The governor and Health Commissioner Steven Stack spent much of their briefing saying why masks are needed, and addressing the politics of that.

"Masks have somehow become this division among people," Beshear said. "Yes, they're not comfortable; and yes, they can be hard to breathe from; and yes, they keep people from seeing your beautiful face; but they protect people."

As Stack urged all Kentuckians to wear a mask, he also encouraged those with divergent views to be respectful of each other, asking those who choose to not wear a mask to not ridicule those who do, and asking those who do wear one to protect themselves by giving a wide berth to those who don't.

"I want you to be patient and kind and tolerant of each other so that we don't have something like this -- which is a simple public-health step to try to keep people safe -- turn into strife and conflict among ourselves," he said.

Stack stressed that there is no disagreement among public-health professionals about the importance of wearing a mask to slow the spread of the disease, since we know that the virus is spread by the spit and saliva from our mouths when we talk, cough, sneeze and sing -- and that many have the virus, but no symptoms. Estimates range from one-fourth to one-half of cases.

He said some Kentuckians may not understand how bad the pandemic could have been in Kentucky if Beshear had not taken all the measures he did to slow its spread.

"I think we forget because we didn't have the same magnitude of crisis we might have had, because we didn't live in Kentucky what they lived through in New York City," Stack said. "We didn't see the horrors at the scale that they had to see in other places and I think that that's made this feel too distant and too removed from our present reality."

Beshear cautioned that as the economy reopens, it's even more important to keep our hands washed and wear a mask, reminding Kentuckians that the novel coronavirus is easily carried into long-term-care facilities, where most of Kentucky's covid-19 deaths have occurred.

"Remember, it gets into these facilities somehow. It's not just starting there," he said. "It's passed between people outside these facilities and brought in there."

Testing: Warren and Shelby counties contrasted

The governor also called for more people -- especially in Western Kentucky, where infection rates are highest -- to take advantage of the free Kroger-sponsored testing sites. He noted that there are still hundreds of empty slots available in Bowling Green and Henderson.

The day before, Beshear called on local officials in the region to encourage their constituents to get tested, revealing that some had rejected testing sites while those in Bowling Green had set a good example.

"None of this, 'We don't want testing, so we don't know there's a problem'," he said. "Our Warren County leaders haven't done that, though we've had some others that have declined testing sites. That is turning your back on your people. We've got to know the level of our problem if we are going to protect the people that are out there. That means we have testing everywhere so we make sure we  keep people safe."

Beshear said officials in Shelby County, which recently had a 50 percent increase in cases among Hispanics,"turned down a Walmart testing facility. We thought that that was interesting, but ultimately the health department and the county judge have to make decisions on that." 

Citing federal and state health officials, Beshear said, "The only way that we can reopen our economy safely is if we have significant testing, and that requires you the people of Kentucky to be willing to get tested and get tested regularly."

Asked how often a person should be tested, he said that while the Centers for Disease Control and Prevention has not issued guidelines on that yet, he advised anyone regularly in the workforce to get tested about once a month if they are not showing symptoms, and immediately if they are. 

The free drive-thru Kroger testing next week will be Louisville, Lexington, Elizabethtown and Bowling Green; sign ups are now open. So far, at least 200,762 tests have been done in Kentucky.

Lt. Gov. Jacqueline Coleman said the Team Kentucky Fund, which is available to Kentuckian who have lost employment or have had their hours or wages cut by half or more because of the pandemic, has received more than 1,900 applications for assistance. 

The $3.2 million fund is available to all Kentuckians, but Coleman especially urged people in Breathitt, Fleming, Harlan, Knott, Knox, Lee, Leslie, Letcher, Mason and Wolfe counties to apply because they had received few applications from those counties. Click here to apply.

In other covid-19 news Wednesday: 
  • Beshear announced 127 new cases of the coroanvirus, bringing the adjusted total to 9,077. "Our numbers today continue to suggest that we are no longer in a plateau, but on a decline," he said.
  • The counties with the highest number of new cases were Jefferson, 35; Boone, 11; Ohio, 10; Fayette, 7; Shelby, 6; and Oldham, 5.
  • The latest deaths were of a 71-year-old man and a 97-year-old woman from Boone County; a 78-year-old man from Hopkins County; two men, 77 and 79, from Jefferson County; and an 88-year-old man from Oldham County.
  • Beshear said 512 people were in hospital with covid-19, and 82 of them are in intensive care. At least 3,124 people have recovered from the virus. Click here for the state's daily report.
  • In long-term care facilities, Beshear reported that 15 more residents and 16 more staff have tested positive for the virus, for a total of 1,185 and 563 respectively. He said five more residents have died of covid-19 in the last several days, bringing the death toll up to 239 resident deaths and two staff deaths, in 120 facilities. Click here for the daily long-term care facility report.
  • Beshear said the first 10 minutes of tomorrow's briefing will feature videos for young children, one about masks and one about anxiety. 

Tuesday, May 26, 2020

Coronavirus cases decline, but more nursing homes are infected, and Kentuckians' behavior and attitude worry health officials

Kentucky Health News chart shows daily cases and the trendline for the last two weeks.
As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

Amid an encouraging decline in Kentucky coronavirus cases, the number of nursing homes with cases took a big jump, and unhealthy behavior and lack of testing signups made officials worry.

The state confirmed 141 new cases Sunday, 122 Monday and 117 Tuesday, reversing last week's slight uptick and accelerating the downward trend over the last two weeks, the period that federal officials say state officials should watch as they reopen their economies.

Weekend numbers are often reduced by limited reporting, but the Lexington Herald-Leader reports the latest three-day average was 127, the lowest since April 17. The number of deaths has also declined, to only three in the last three days, raising the state toll to 394.

“These are some of the lowest daily numbers we have seen,” Gov. Andy Beshear said. “But that is fragile, and with a disease that can so easily spread we have to want and put into action our desire to continue to see that downward movement.”

The bad news is that 26 more long-term-care facilities have had at least one case of the coronavirus, bringing the total to 105, and one had a major outbreak.

Health Secretary Eric Friedlander said 39 residents and 20 employees tested positive over the weekend at Nazareth Home Clifton in Louisville, sending 37 residents to hospitals because there was not enough healthy staff to care for them. The state is providing staff support while the employees recover.

"We're going to see this probably again in Kentucky and we will have plans in place and we will respond aggressively," Friedlander said.

Health Commissioner Steven Stack said the evacuation was the state's largest to date, taking four hours and involving six local hospitals.

The 101-bed facility had requested facility-wide testing after several residents began to show symptoms of covid-19 last week, and had previously reported only one resident with the virus, Bailey Loosemore reports for the Louisville Courier-Journal. 

The state is working to test every resident and staff person at these facilities, an effort that Stack said will take several months. Friedlander said the state has done at least 11,000 tests in facilities, with a few thousand more scheduled in the next few days.

Since Friday, a total of 54 residents and 27 employees tested positive, raising those numbers to 1,170 and 547, respectively. He said there had been three new deaths "going back," for a total of 215 resident deaths, plus two staff deaths from the virus. Click here for the daily update.

So far, at least 193,576 tests have been done in Kentucky. The governor's daily news release said the testing rate in the past week was 138 per 100,000 residents, well above the recommended rate of 100 per 100,000. Click here for information on how to register for testing at more than 70 locations throughout the state.

Beshear once again implored Kentuckians to get tested, noting that the numbers at the free drive-thru sites sponsored by Kroger were disappointing, especially in Bowling Green, where only 206 signed up to be tested Tuesday, 84 on Wednesday, 39 on Thursday and 22 on Friday. The capacity at each site is typically 400 per day.

"We have a major outbreak in Warren County that our testing can help us identify and control, but you -- you've got to go in and you've got to get tested," Beshear said.

He also pointed out that the Kroger site in Henderson, near an area with many cases, had tested only 24 people Tuesday, with only 21 signed up for tomorrow and seven on Thursday.

"Folks, this is real. It is in this part of the state. We need you to take advantage of this. This is about protecting your community," he said.

In another worrisome moment, Stack showed a video of a Lexington bar/restaurant crowded with people and warned that the virus is easily spread in large gatherings, especially where people are talking loudly.

"The evidence is absolutely overwhelmingly clear that a small number of large events or a small number of a lot of people getting together with one or two infected folks spreads this thing like wildfire," he said. He later added, "I don't know what it will take for us to learn that this is not a game, that this is serious."

Beshear added that the bar was not ensuring a safe environment and said, "I wouldn't go there, and I won't go there, and you shouldn't either, because if we are not going to enforce social distancing in places, they are not safe."

Stack also talked about the importance of wearing masks to decrease the spread of the virus, though they can be a nuisance.

“This infection has taken a horrible toll on humanity, and unfortunately it will continue to take a toll until we find a vaccine and a way to prevent this," he said. "Until we find a treatment or we can cure it, we are left with old-school, old-fashioned public-health measures which we know work, but are difficult to implement because they require us to make sacrifices -- sacrifices that protect us and the people we love and care about, but also sacrifices that protect other people who rely on us."

Beshear, as he wrapped up talking about the Sunday protest that ended with him being hung in effigy, said as he redonned his mask, "After everything that has happened this weekend, do we still think it is too much to wear a  mask? To protect our fellow human beings? I wear it to protect my family. I think other people should wear it to protect theirs."

In other covid-19 news Tuesday: 
  • Beshear said Tuesday's deaths include an 85-year-old woman from Adair County, a 63-year-old man from Allen County and a 72-year-old woman from Jefferson County. He encouraged everyone to turn on green lights, as he and his family would at the governor's mansion, saying, "We show compassion there, not anger. We show love there, not hate."
  • Beshear said 489 patients are hospitalized with covid-19, including 78 in intensive care. He said at least 3,115 Kentuckians have recovered from the virus. Click here for the daily summary. 
  • The counties with the highest number of new cases over the last three days were Jefferson, 146; Shelby, 41; Warren, 30; Fayette, 26; Kenton, 10; and Logan, 10. 
  • In an Appalshop Twitter post Dr. James Brandom Crum, a diagnostic radiologist in Pikeville, warns coal miners with black lung or chronic lung disease about how dangerous covid-19 could be for them, and asks them to self-isolate as much as possible, wear a mask and make sure those around them are doing all they can to protect them, because they could have the virus without symptoms. "Miners, let people help you," he says. "Isolate yourself, let people go to the store for you, so you can stay away from people 'til this thing is better under control." 
  • Norton Healthcare plans to open a "first of its kind, permanent drive-thru and walk-up facility" in the fall, WDRB reports. Services will include vaccines, covid-19 testing, flu, strep, EKG and minor x-rays. 
  • The state Department of Public Advocacy, which provides public defenders, is concerned about their health and that of others in the system if courts resume in-person hearings too soon. Some courts plan to do that June 1, DPA says in a news release. It says that was not the intent of a May 15 Supreme Court order saying trial courts could on June 1 “resume hearing civil and criminal matters using available telephonic and video technology to conduct all proceedings remotely." Public defenders often represent multiple defendants in one court session.
  • ProPublica "scoured the latest research and talked to seven infectious disease and public health experts" to report on the latest information parents need to know about coronavirus as children return to day cares and camps. Beshear has said small, in-home child cares can open June 8, with some center-based programs and day camps allowed to open on June 15

Beshear says 'right-wing militia group' that hung him in effigy was 'embraced and emboldened' by GOP legislators at earlier rally

By Al Cross
Kentucky Heath News

Two days after being hung in effigy, Gov. Andy Beshear returned the fire Tuesday, using much of his daily coronavirus briefing to talk about the incident near the governor's mansion on Sunday.

He said the presence of protesters on the mansion porch after crossing barricades, “just a window pane away from where my kids play,” and the effigy hanging that followed on the Capitol grounds across the street, were “intended to use fear to get their way.” (His children, 9 and 10, were not present.)

“I will not be afraid, I will not be bullied and I will not back down, not to them and not to anybody else,” he said, reading from notes for about 10 minutes. He said it is his responsibility to lead in a dangerous time “and I know that the people out there are with me. I owe it to the people of Kentucky not to bow to terror, but to continue to do what is right.”

Beshear said the Three Percenters, "a right-wing militia group," shares the blame with unnamed but previously identified Republican legislators who spoke at an earlier Capitol rally involving the group, which “had been embraced and emboldened by elected leaders that rallied with them weeks before.”

Alluding to other Republican officials' condemnation of the incident, he said they should not “cater to these groups” and “You cannot fan the flames and then condemn the fire.” He said those who spoke at the earlier rally “have to claim responsibility, because they absolutely know what could have happened. And, they are in part responsible for what did happen.”

The effigy bore the motto "Sic semper tyrannis," Latin for "Thus ever to tyrants," which John Wilkes Booth reportedly said after fatally shooting President Abraham Lincoln. Beshear called that “a celebration of assassination on our Capitol grounds.”

Beshear said he and his wife Britainy had made a "very difficult decision" to leave "the only house my kids ever remembered" to "become the first family to live full-time in the governor's mansion for over 30 years," partly because Frankfort residents wanted them to. "One thing I never thought about and never questioned was their personal safety."

Beshear's first reference to the episode came as he gave his daily mantra: "Today maybe I need to say it as much as you do: We're gonna get through this, and we're gonna get through this together." He said he believes that because "For the most part over this Memorial Day weekend, we showed that we can continue to do the right thing."

Senate Majority Leader Mitch McConnell joined other Republicans' criticism of the episode, saying it “was completely outrageous and unacceptable. We all believe in freedom to speak in this country and the opportunity to demonstrate. But that episode, I believe on Sunday, was completely unacceptable, it’s not what Kentucky is and I hope that we will not be seeing that again.”

McConnell's Republican seatmate, Sen. Rand Paul did not respond to a request for comment, the Lexington Herald-Leader reported.

Patsy Bush, Kentucky secretary for the Three Percenters, said before Beshear's briefing that the group does not condone violence and "if she had known about it ahead of time, she would have tried to stop it," the Courier Journal reported.

Monday, May 25, 2020

Reopening when we're not quite ready to thwart covid-19 means managing risk, and there are four types, health expert writes

No state "has met the metrics to safely reopen," so the nation "needs to move to the public health strategy of harm reduction," says former Baltimore health commissioner Leana Wen. "So what does that mean in terms of choices each of us makes — what’s safe to do and what’s not?"

Wen, an emergency physician and visiting professor at George Washington University's Milken Institute School of Public Health, offers four concepts from other harm-reduction strategies: relative risk, pooled risk, cumulative risk and collective risk.

Relative risk depends mainly on three variables: proximity, activity and time. "The highest-risk scenario is if you are in close proximity with someone who is infected, in an indoor space, for an extended period of time," Wen writes, noting that gatherings where people hug, such as funerals and birthdays, can be “superspreader” events.

"You can decrease your risk by modifying one of these three variables," Wen writes. "If you want to see friends, avoid crowded bars, and instead host in your backyard or a park, where everyone can keep their distance. Use your own utensils and, to be even safer, bring your own food and drinks. Skip the hugs, kisses and handshakes. If you go to the beach, find areas where you can stay at least six feet away from others who are not in your household. Takeout food is the safest. If you really want a meal out, eating outdoors with tables farther apart will be safer than dining in a crowded indoor restaurant."

Pooled risk "is particularly relevant for separated families that want to see one another," Wen writes. "I receive many questions from grandparents who miss their grandchildren and want to know when they can see them again. If two families have both been sheltering at home with virtually no outside interaction, there should be no concern with them being with one another. Families can come together for day-care arrangements this way if all continue to abide by strict social distancing guidelines in other aspects of their lives. The equation changes when any one individual resumes higher-risk activities — returning to work outside the home, for example."

Cumulative risk means that your risk of infection increased with every person you come into close contact with. "Many people must return to work, but they can still reduce their risk overall by not having social gatherings outside of work," Wen writes. "Choose the activities most important to you. If you must have your hair cut, don’t also go out to eat in restaurants. How much you do should also depend on your personal health. By now, we know that those most vulnerable to the severe effects of covid-19 are older people with chronic medical conditions. These individuals should aim for lower cumulative risk to best protect themselves."

Collective risk means that "The higher the rate of covid-19 in a community, the more likely any one individual you come into contact with has the virus and the riskier your interactions become," Wen writes. "This is why mask-wearing is important: If most people wear a mask, it reduces the amount of virus that we will transmit. Local and state policymakers should continue to ban large gatherings and follow the CDC guidelines for gradual reopening. They must have surveillance systems in place to detect if and when infections rise and be willing to reimpose restrictions."

National health secretary says health requires reopening

By Alex M. Azar
U.S. Secretary of Health and Human Services, for The Washington Post

President Trump’s top priority throughout the covid-19 crisis and his presidency has been protecting the health and well-being of Americans. Nothing exemplifies this leadership like our new Operation Warp Speed, which is marshaling the world’s best minds to develop and deploy a vaccine in record time.

The sacrifices Americans have made through social distancing have helped slow the spread of the virus and save lives. Moving forward, we need to confront the misconception that going back to “normal life” just means balancing the health risks of reopening against the economic costs of aggressive social distancing. Returning to normal isn’t about balancing health vs. the economy. It’s about balancing health vs. health: the health risks of covid-19 balanced against the health, social and economic costs of keeping Main Streets across the United States closed for business.

Getting this balance right isn’t simple. It will look different for every state, business and family. The Trump administration is committed to helping each state and all Americans have the information and tools they need to safely reopen.

The economic crisis brought on by the virus is a silent killer. Estimates suggest that each one percentage point increase in the unemployment rate translates into a 1 percent increase in suicide deaths and a more than 3 percent increase in opioid deaths, which means this virus-induced recession will likely cause tens of thousands of excess deaths. One study of the 1982 recession found that Americans who faced higher unemployment suffered approximately 40,000 excess deaths by age 65 — as well as more divorces and having fewer children. Shortening this economic crisis through a safe reopening could save thousands of lives.

Meanwhile, at a time of social stress, states are seeing a decline in reports of child maltreatment, which is likely going unreported because children are isolated from teachers and others who can help keep an eye on the vulnerable. On Monday, the president, first lady and vice president joined me and other administration leaders to discuss these challenges and potential solutions with governors.

The covid-19 response has also restricted access to health care. Data suggests the numbers of Americans receiving important preventive services are down significantly, with mammograms down 87 percent and colonoscopies down 90 percent.

More than 1.7 million new cancer cases are diagnosed per year in the United States. If we’re seeing an 80 percent drop in cancer cases identified, approximately, we could already have 200,000 or more undiagnosed cancer cases as a result.

According to Medicare data, breast cancer surgeries are down approximately two-thirds since January. A Centers for Disease Control and Prevention report found that vaccine administrations were down approximately 60 percent from early January to mid-March; that puts millions of American infants and children at risk for serious illnesses.

Forgoing all of these services also devastates our health-care system and the front-line heroes who have kept it running. Many health-care workers have been furloughed, and hospitals are seeing as much as 60 percent revenue declines from the cancellation of elective procedures. Hospitals in rural America operate on about a 2 percent to 3 percent profit margin, and urban hospitals have about a 5 percent to 6 percent margin. Extended disruption to our health-care system may permanently close some institutions, with lasting impacts on access to care, especially where access is a challenge already.

Pediatrician offers facts about serious syndrome that can attack children who were otherwise unaffected by the coronavirus

By Dr. Sean McTigue
University of Kentucky
There have been reports coming out of New York and other states that have been hit hard by the coronavirus about a complication experienced by children who have tested positive for COVID-19. Known as pediatric multi-system inflammatory syndrome (PMIS), doctors and the Centers for Disease Control and Prevention have made a connection between this disease and COVID-19, but there is still much to learn about it.
 Getty Images photo, distributed by University of Kentucky
Symptoms of PMIS include fever that lasts more than 24 hours along with rash and changes in skin color, swollen lymph nodes, excessive sleepiness and abdominal pain, diarrhea and vomiting. If your child shows these symptoms and has tested positive for COVID-19 or been exposed to the virus, contact your pediatrician.
PMIS closely mimics Kawasaki Disease, a rare inflammatory condition that is the leading cause of acquired heart disease in infants and children. While Kawasaki Disease can be triggered by viruses, doctors are not yet sure if these are symptoms of Kawasaki, an inflammatory response to COVID-19 or a combination of both. Both conditions cause severe swelling in the blood vessels and can lead to serious heart complications if left untreated.
COVID-19 in children and PMIS are both very rare; there have been very few cases reported in Kentucky. While doctors are still trying to understand the connection between PMIS and COVID-19, it is important to maintain social distancing and hand-washing habits to prevent the spread of the virus.
Dr. Sean McTigue is medical director for pediatric infection prevention and control at Kentucky Children’s Hospital.

Sunday, May 24, 2020

Why wear a mask when you go out in public? Because you may have the coronavirus and not know it, and it's highly contagious

President Trump wore a mask on a private tour of a Ford plant Thursday but refuses to do so in public.
By Melissa Patrick
Kentucky Health News

Wearing a mask when out in public is even more important as Kentucky reopens its economy, medical professionals advise. Many Kentuckians are skeptical.

Rebecca Dutch, chair, UK Department
of Molecular and Cellular Biochemistry
(UK Photo by Mark Cornelison)
"It is actually, primarily, so that if you happen to have the virus and you don't know it -- which happens very frequently now -- you're not breathing it out, coughing it out on other people," said Rebecca Dutch of the University of Kentucky, who has spent more than 30 years studying viruses.

"Every person we add into our interactions is someone we might either get it from or pass it to, or take it home to our families," Dutch said. "Remember that the risk is still there, so think carefully about whether what you are doing is something that is a good idea."

Dutch is a professor and the chair of the Department of Molecular and Cellular Biochemistry at UK, and leader of the Covid-19 Unified Research Experts (CURE) Alliance team, which advises on covid-19 patient care and clinical trials at the university.

She said the novel coronavirus has a relatively high infection rate, with each infected person causing three more infections if there are no restrictions on activities and contacts. Emergency restrictions imposed by Gov. Andy Beshear have reduced Kentucky's infection rate to 0.87, according to a model created by the co-founders of Instagram, which displays each state's rate at rt.live. A rate of less than 1 means the virus should eventually stop spreading.

It will be important to watch this number as the state has fewer restrictions and more contacts; Beshear has refused to say how the infection rate drives his decisions, but New York Gov. Mario Cuomo has said a rate of 1.1 or above would be a trigger for him to reimpose restrictions.

As he allowed opening of Kentucky's stores and restaurants, and social gatherings of 10 or fewer people, Beshear used the rhyme "Hands, face and space" to summarize the medical advice: Keep your hands washed; don't touch people not in your immediate family; wear a mask in close quarters; avoid touching your face; keep six feet of separation; and to entertain outside, if at all possible.

"All of these are mechanisms just to try to stop as much spread as we can," said Dutch. "So that is why the governor is now asking people to mask."

The official message also came with a warning that some Kentuckians may have become complacent about their risk of getting the virus. "Some may conclude that the danger is not still there, and I’ve got to urge you, the danger is still there. If we take our eye off the ball . . . we could find ourselves in late June paying very dearly for our actions today," Health Commissioner Steven Stack warned May 22.

The most controversial piece of advice is to wear a mask, so Beshear is asking Kentuckians to say on social media posts why they wear one, and to talk to others about it.

"Some people have objected to masks, and the challenging part about that is you can object to a mask on your own personal health, but it is not your own personal health that it is going to impact," Beshear said May 19. "It is other people's health, so it is more about your willingness to protect other people if you are wearing or not wearing one."

The governor regularly points out that masks are recommended by the White House and the Centers for Disease Control and Prevention. At one point he said they shouldn't be a partisan issue.

Kaiser Family Foundation Poll released May 22 found that Democrats are about twice as likely as Republicans to say they wear a mask every time they leave their house: 70% and 37%, respectively. Majorities of each party said they wear a mask "most of the time."

Kaiser Family Foundation chart; click on it to enlarge. More data and poll questions are here
The poll also found that while 72% of Americans think President Trump should wear a mask when meeting with others, only about half of Republicans, 48%, agree. The report says that the partisan difference in largely driven by Republican men.

A pushback on several levels

Trump says he doesn't need to wear a mask because he is tested daily for the virus, but critics say he is missing an opportunity to set an example that would save lives. Thursday, he refused to wear a mask in front of news cameras while touring a Ford plant in Michigan, saying "I didn't want to give the press the pleasure of seeing it." He wore a mask when news cameras weren't around, but someone on the tour took a picture of him and it was widely circulated.

Senate Majority Leader Mitch McConnell regularly wears a mask, bit U.S. Sen. Rand Paul, an ophthalmologist, says he won't wear one because he has had the disease and is immune. However, experts warn that this hasn't been proven, and there have been reports of people testing positive weeks after they have recovered, and that it is uncertain if they are contagious or not.

Fourth District U.S. Rep. Thomas Massie weighed in on Twitter yesterday, saying "There is no authority in the Constitution that authorizes the government to stick a needle in you against your will, force you to wear a mask, or track your daily movements. Anyone who says you have to right to avoid those things fundamentally misunderstands the 9th" Amendment, which says the Constitution's language "shall not be construed to deny or disparage others retained by the people."

Lexington Herald-Leader photo
And in a move that got national notice, a Manchester convenience store posted a sign banning masks. Alvin's responded to complaints by saying it was a "joke," the Lexington Herald-Leader reported. Later, it clarified the statement in a Facebook post, saying it would not turn away mask-wearing customers and "It's your choice to wear one or not, not our government's choice for us." Newsweek reports that the sign has since been taken down.

Earlier, Chris Kenning and Sarah Ladd of the Louisville Courier Journal took a look at who was or wasn't wearing masks around Kentucky and found a low percentage of compliance in one of the hardest-hit parts of the state.

Mason Barnes, Judge-Executive of Simpson County, just south of Warren County, which continues to have one of the state's highest infection rates, told the CJ, "I'd say 70 percent to 80 percent of the people are not wearing masks when they're out and about."

Beshear has said Kentuckians will not be cited or arrested for not wearing a mask in public.

So, why should you wear a mask?

The simple answer is because the virus is primarily spread by tiny droplets from infected people, not just coughing and sneezing, but from talking and breathing. A mask can stop the spread of those droplets, especially from people who have the virus but don't know that they do.

Stack, the health commissioner, said May 18 that about 25 percent of people with the virus have no symptoms. Later in the week, the Centers for Disease Control and Prevention estimated the number at 35 percent.

UK HealthCare photo
Dutch, the UK virologist, pointed out that people can be very infectious just before they get symptoms.

She said, "When people can spread it before they know they are sick, we actually have to take extra precautions because we all have to think, 'Oh, I might have this, what do I need to do to protect people when I go out?'"

More than 40% of Kentucky adults are at higher risk of serious illness if infected with the virus because they have heart disease, chronic obstructive pulmonary disease, uncontrolled asthma, diabetes or a body mass index of 40 or more, indicating morbid obesity, according to the Kaiser Family Foundation. It did not include people with another risk factor, cancer, in which Kentucky is a national leader.

The value of wearing a mask is illustrated by a new study, published in The Proceedings of the National Academy of Sciences. It shows how normal speaking can launch thousands of droplets that can remain suspended in the air for eight to 14 minutes, allowing them to be inhaled by others. "There is a substantial probability that normal speaking causes airborne virus transmission in confined environments," the study report says.

The researchers said in a letter to The New England Journal of Medicine that the same experiment, using scattered laser light, found that use of a cloth face mask blocked nearly all droplets emitted when talking. They posted a video, the last part if it in slow motion, to show their finding.


The latest study to confirm the effectiveness of cloth masks was published May 22 in the peer-reviewed journal Annals of Internal Medicine.

Science supporting mask wearing is so strong that more than 100 prominent health experts have asked governors to require them. They write that the research "strongly suggests that requiring fabric mask use in public places could be amongst the most powerful tools to stop the community spread of covid-19."

So why did the CDC recommend not wearing a mask two months ago? The Mayo Clinic says face masks were not recommended at the start of the pandemic because experts didn't know the extent to which people with covid-19 could spread the virus before symptoms appear, nor was it known that some people have covid-19 but don't have symptoms.

The CDC now recommends the use of reusable cloth masks so that surgical masks and N95 respirator masks, which continue to be in short supply, can be saved for health-care workers.

The CDC guidance says cloth masks should: fit snugly but comfortably against the side of the face; be secured with ties or ear loops; include multiple layers of fabric; allow breathing without restriction; and be able to be laundered and machine-dried without damage or change to shape. It also cautions that they should not be placed on children under age 2, anyone who has trouble breathing, or anyone who would have trouble removing the mask without help. The Mayo Clinic recommends that cloth face coverings be washed after every day of use.

Beshear's "healthy at work" rules require businesses to have employees to wear a cloth mask, unless it is a health or safety hazard to do so, or if they are working alone or in an enclosed space, or if they are working in an area that allows for appropriate social distancing. The order also encourages customers to wear masks, and allows businesses to refuse to serve customers not wearing them.

Dutch urged caution as the state reopens its economy, saying that the "long road ahead of us" will require all of us to make smart choices if we are to slow the spread of this virus, like continuing to practice social distancing and wearing a mask.

"I think it is really critical that people understand that as we are reopening the economy, we've done a good job of slowing down the rate of infections, but the virus is not gone," she said.

She added later, "The best we can do is anything that can just slow down how often people spread this virus from them to someone else, and that's how we win. Hopefully we will do well. We will see."

Protesters hang Beshear in effigy, sparking bipartisan rebukes

Photo by Sarah Ladd, Courier Journal, via Twitter
Protesters hung Gov. Andy Beshear in effigy from a tree across from the governor's mansion and took their demonstration to its front porch, prompting objections from Kentucky politicians of both parties Sunday.

The event started as a Second Amendment rally "but turned into a protest of coronavirus restrictions and Beshear’s administration," reports Sarah Ladd of the Louisville Courier Journal. "As the rally wound down, organizers led the remaining crowd to the governor’s mansion to attempt to hand deliver a request for Beshear to resign. . . . No one came to the door. A few Kentucky state troopers got out of their cars to observe but did not attempt to stop the crowd. It’s not clear if Beshear was at home at the time. The crowd returned to the capitol, at which time an effigy of Beshear was hung from a tree outside the Capitol while 'God Bless the U.S.A.' played over the loudspeaker."

The effigy bore a sign saying "Sic semper tyrannis," Latin for "Thus ever to tyrants," the state motto of Virginia and the words John Wilkes Booth reportedly said after assassinating President Abraham Lincoln in 1865. "After hanging for a short time while people snapped photos," Ladd reports, "it was cut to the ground." But it brought objections from some protesters, and from politicians of both parties.

"I condemn it wholeheartedly," Secretary of State Michael Adams, a Republican, said on Twitter. "The words of John Wilkes Booth have no place in the Party of Lincoln."

State Senate Minority Leader Morgan McGarvey, D-Louisville, called on Republican leaders to "join me in condemning violent threats against any elected official."

Sen. Whitney Westerfield, R-Hopkinsville, who narrowly lost the 2015 attorney general's race to Beshear and has been one of his most frequent critics, replied, "Agreed, @MorganMcGarvey. This awfulness has no place in civil society."

Senate Majority Leader Damon Thayer, R-Georgetown, tweeted, "These actions are reprehensible. I absolutely condemn violence and threats of violence. If you want to protest, do it peacefully and respectfully."

Saturday, May 23, 2020

No deaths from covid-19 in Ky. for the first time in 1½ months

Kentucky Heath News chart shows that cases trended up this week, but the two-week trendline, a key federal metric used to guide states in reopening their economies, is down.
As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

“For only the second time in about a month and a half, we have zero new deaths to report,” Gov. Andy Beshear said in his daily coronavirus update, delivered by press release, not in person.

Beshear reported 148 more cases of the coronavirus, for an adjusted total of 8,571. At least 3,102 Kentuckians have recovered from the virus. For additional information, including lists of positive cases and deaths, as well as breakdowns of coronavirus infections by county, race and ethnicity, click here. The list does not include a breakdown of today's new cases.

While a key federal metric for states reopening their economies, a two-week trendline, is down in Kentucky, the state's cases have trended upward this week as Beshear has allowed all retail establishments to reopen, restaurants to reopen at limited capacity, and gatherings of 10 or fewer people, a step he advance to include Memorial Day weekend.

“I am urging Kentuckians to please be safe this weekend,” Beshear said in the press release. “As we recover, we are depending on Kentuckians to take the steps necessary to protect one another this weekend and every day and weekend moving forward.”

About 200 demonstrators gathered on the steps of the state Capitol to call for removal or reduction of restrictions imposed by Beshear. Few masks were in evidence as people stood within six feet of each other, and Republican U.S. Senate candidate Wesley Morgan went around shaking hands.

Four would-be protesters had sought an injunction from a federal judge to block any state enforcement at the event, but District Judge Gregory Van Tatenhove said no Thursday evening, noting that the Beshear administration said the rally could proceed, and the four men hadn't shown that they had suffered harm, the Courier Journal reports.

In other covid-19 news Saturday:
  • The "How Covid-19 Spreads" webpage of the U.S. Centers for Disease Control and Prevention no longer says that the coronavirus spreads easily from contaminated surfaces. A CDC spokeswoman told The Washington Post that the agency made the change after that the revisions were the result of “usability testing” and an internal review. The webpage still says,  “It may be possible that a person can get covid-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus.”
  • President Trump’s move to block travel from Europe in March "triggered chaos and a surge of passengers from the outbreak’s center" before the ban went into effect, the Post reports, noting that "Harrowing scenes of interminable lines and unmasked faces crammed in confined spaces spread across social media." Trump banned travel from China in February, but allowed 48,000 Americans to return, and "Members of the administration’s coronavirus task force were even presented with charts showing that the number of flights arriving from Europe dwarfed the influx from China," the Post reports.

Friday, May 22, 2020

Beshear says virus is declining in Kentucky, but he and health chief warn that might not continue 'if we take our eye off the ball'

Johns Hopkins University chart shows how Kentucky testing is up and positive results are down.
By Al Cross
Kentucky Health News

Gov. Andy Beshear declared for the first time Friday that the coronavirus is declining in Kentucky, but he and his health commissioner warned of a possible resurgence as the Memorial Day weekend began with small gatherings allowed and restaurants opening on a limited basis.

“We now think that we have not just plateaued, but we are actually in a decline in overall numbers of cases, especially when you look at the amount of testing that we’re doing,” Beshear said as he announced 141 new coronavirus cases and five more deaths from covid-19, bringing the state's toll to 391.

“We have proven that when we have adversity like we have had, we are resilient, we take care of each other,” Beshear said at the start of his daily briefing. Looking ahead to the Memorial Day weekend, he said, “It’s about being able to more things that we have done in a while and to make sure we do them responsibly. . . . How we're able to keep our cases down depends on how we do this weekend, and every weekend thereafter.”

Health Commissioner Steven Stack praised Kentuckians for their sacrifice, then issued much more comprehensive warnings.

“This is a time that gets dangerous for us; people get complacent. We can have the tendency to reach the wrong conclusions sometimes,” he said. “The reason we’re not having a much serious crisis right now … is because of what you have done … staying healthy at home these last couple of months.”

Then he warned, “Because we’re not in that trouble some may conclude that the danger is not still there, and I’ve got to urge you, the danger is still there. If we take our eye off the ball . . . we could find ourselves in late June paying very dearly for our actions today.”

Beshear, replying to a question about Memorial Day, said “My chief concern is that we’re so excited to see each other we’ll forget all the rules.”

Primary election: Secretary of State Michael Adams and State Board of Elections Executive Director Jared Dearing appeared at the briefing to urge people planning to vote in the rescheduled June 23 primary to do it by absentee ballot, to avoid long lines at polls, which will be as few as one per county.

GoVoteKy.com, a site for absentee-ballot applications, will be open until midnight June 15. Dearing said it takes about two minutes to apply. Adams said voters can also call, email or fax their county clerk, but the clerks are overrun, "so the best way to be a respectful citizen is to go to the website."

Ballots and postage-paid envelopes will be mailed to applicants, who must mail or otherwise return them by June 23. The deadline to register to vote for the primary, or correct registration information, is 4 p.m. Tuesday, May 26.

Beshear said, "This might be the easiest that it ever is to vote. . . . I would love to see us have a better primary response through this than we normally see" in a primary, when about one in six voters usually cast ballots.

Unemployment: Deputy Workforce Secretary Joshua Benton said 14,000 claims from March and  38,000 from April remain unresolved. He said more reviewers and adjudicators and being hired, and the most experienced adjudicators are being assigned to the March cases.

Benton said the kcc.ky.gov website has been changed to allow employers to submit return-to-work dates for employees, which will stop their unemployment benefits, and to add a dialog box to "streamline email . . . A lot of people are emailing a lot of different staff."

Beshear, asked if people who are told to quarantine themselves because they have had contact with an infected person, didn't answer directly. “We’d contact their employer because their employer should not want them coming back in sick,” he said. “Every business ought to realize that at that point its dangerous for that person to come in.”

In other covid-19 news Friday:
  • Beshear said the five deaths were of an 88-year-old Jefferson County man, a 97-year-old Jefferson County woman, a 74-year-old Barren County man, an 88-year-old Hopkins County woman and a 72-year-old Shelby County woman.
  • He said the fatalities have been 77.6 percent white, 18.7% African American, 2% Asian American, and 1.3% multiracial; and 3% Hispanic and 97% non-Hispanic.
  • Counties with five or more new cases were Jefferson and Warren, 28 each; Kenton, 16; Boone, 11; Fayette, nine; Woodford, six; and Logan and Shelby, five each.
  • Beshear said the state more than 171,338 coronavirus tests have been conducted in Kentucky, and "I still think that number is low," because some negative results are not reported.
  • Asked how the state is reporting viral tests, which determine if someone has the virus, and antibody tests, which see if they've had it but are less accurate, Stack said positive results from antibody tests are counted as probable cases; that number stood at 121 Friday, part of a total case number of 8,426 -- 3,069 of whom have recovered.
  • Beshear's chief of staff, LaTasha Buckner, said the state Capitol would reopen to groups of 10 or fewer visitors, by appointment, on Wednesday, May 27. She said they would be asked, but not required, to wear masks.
  • Beshear said a private funeral for former first lady Phyllis George, with about 40 people, would be held in the Capitol rotunda on Monday and livestreamed on KET.org. He complimented her children, Lincoln and Pamela Brown, saying they saw "the difficulty in having the same types of services we have had in the past," presumably a public lying in state with visitation.
  • The governor said that on June 29, when he tentatively plans to allow gatherings of 50 or fewer people, he might allow opening of small, "community type" swimming pools "where there is the ability to limit folks to 50 and to enforce the social distancing." He said that would depend on "where the virus is."

Thursday, May 21, 2020

Child-care reopenings set; tentative date announced for larger gatherings and bars; Beshear says 'We may be in true reduction'

Kentucky Health News chart shows two-week trendline slightly down, more than Wednesday.
By Al Cross
Kentucky Health News

Small child-care centers in Kentucky will be allowed to reopen June 8, and larger ones with limited capacities June 15, removing much of a major obstacle to getting unemployed Kentuckians back to work in the covid-19 pandemic.

Gov. Andy Beshear announced several other openings at his Thursday briefing, including a tentative date of June 29 for bars and gatherings of 50 or fewer. Gatherings of 10 or fewer will be allowed starting Friday.

Beshear announced 135 new cases of the coronavirus, tipping further down the two-week trendline that is a key federal metric for reopening state economies. "We may be more than just plateaued," he said. "We may be in true reduction."

Cabinet for Health and Family Services Secretary Eric Friedlander said the child-care move made Thursday "a day of really good news for many people. . . . Child care is one of the areas that we know is critical to opening the economy."

Beshear has allowed people who are receiving unemployment benefits to keep getting them and not return to their jobs if they cannot find child care. He acknowledged that the limits on larger facilities will limit their capacity, but said that until a coronavirus vaccine is developed "our world . . . has to be based on reduced contacts."

The child-care centers allowed to open June 8 are those in homes, serving 10 or fewer children, "more in a family style atmosphere," Friedlander said.

The larger providers opening June 15 will have limited capacity because they must have 10 or fewer children in a room, and those groups must stay together all day, along with staff members. The groups must have staggered play times, and the centers must do temperature and wellness checks on everyone, and have centralized pickup and drop-off points with social distancing.

Friedlander said family events will not be allowed "for now," and there will be no field trips. Adults at the centers will be required to wear masks, and children under 5 will not be required to do so. "It’s a judgment call, [based] on a child’s developmental ability," he said. The state's guidelines say centers "may recommend to the parents of children over 5 that their child wear a mask, and provide information about the benefits of masking."

The state has continued to pay child-care providers, almost $62 million in the last two months, based on previous payments, to keep them in business, Friedlander said: "We can't afford to lose them."

Friedlander also announced additional food benefits for children who will no longer get meals at school this summer, using $163 million in federal relief funds. He said $313.50 per month will go to families on the Supplemental Nutrition Assistance Program (once called food stamps), Temporary Assistance to Needy Families and Medicaid.

He urged people who qualify for the programs, but are not enrolled in them, to apply beginning June 23 at benefind.ky.gov or at 855-306-8959. "Don’t feel like this is selfish, or something you shouldn’t do," he said, noting that the money will help grocers, farmers and "the rest of the food system."

Other openings: Beshear announced that auctions will be allowed starting June 1, and horse shows on June 8. On June 29, he plans to allow opening of bars, with social distancing, and gatherings of 50 or fewer people. But he said that isn't certain.

"It all depends on how good we do at being healthy at work," his catchphrase for the current phase of reopenings. He said he made the announcement because "We want to give those people dates to see and work toward. It relieves a lot of anxiety." He said his top priority is to "make healthy-at-work successful; my number-two goal is to get kids back in school this fall."

Health Commissioner Steven Stack, who said last week that he was worried that Kentuckians don't appreciate the danger posed by the virus, again alluded to the possibility that reopenings will be delayed or scaled back if cases start going up: "If we take our eye off the ball, we’re gonna find we have the problem in June and July that we have avoided."

Beshear said gatherings of up to 50 will facilitate weddings, which should still keep "groups of family units" together and practice social distancing. "The six feet’s gonna be really important," he said. "It's gonna require some creativity." He said the five weeks between now and then will allow Kentucky to learn best practices from other states.

Beshear said the 50-or-fewer rule could also provide "an opportunity to do something" with swimming pools. He said he hasn't allowed them to open because of the likelihood that social-distancing rules would be violated "outside the pool."

He said June 29 might also provide an opportunity to reopen indoor recreation facilities, which are "taking us a little longer" to figure out, due to capacity questions, differences among facilities, and the number of things that can be touched.

Asked about reopening gyms, he indicated that will take longer. "We can't go back right now to everything the way we used to do it," he said. Then he complimented retailers "for being really thoughtful" with their reopenings this week and said he thought restaurants would do likewise when they are allowed to open at one-third capacity plus outside seating on Friday.

And what about more personal activities, such as hug between friends this weekend? "We’re realistic," he said. "We know that people have missed each other . . . Limit your contact as much as you can."

In other covid-19 news Thursday:
  • The new-case number of 135, which brought the adjusted total to 8,286, was "one of the smallest in a while," Beshear said. He reported 122 new cases on Sunday, but Sundays and Mondays tend to be low due to limited lab activity on weekends; aside from that, Thursday's number was the lowest since the 105 reported on Monday, May 11.
  • Counties with more than five new cases were Jefferson, 23; Kenton, 18; Warren, 15; Boone and Grayson, nine each; and Fayette and Logan, seven each.
  • Beshear reported 10 more deaths, bringing the three-day total to 40 and the overall total to 386. Death numbers have gone up lately as new-case numbers have trended down; Stack said the average length of a fatal case of covid-19, from onset of symptoms to death, is 13 days.
  • The new fatalities were two Warren County women, both 56; an Adair County woman, 73; a Grayson County man, 62; a Jackson County woman, 93; a Jefferson County woman, 69; a Jefferson County man, 78; an Oldham County man, 81; and Oldham County woman, 86; and a Simpson County man, 72.
  • Six of the deaths were in long-term-care facilities, bringing their death toll to 207, including two staff members. State testing found cases in 39 more residents and 27 more employees, for respective totals of 1061 and 488. "All across the country we’re finding out there’s a lot of asymptomatic staff members," who can spread the virus without knowing it, Beshear said.
  • Asked if his administration had done enough, early enough, for nursing homes, which account for most covid-19 deaths, Beshear said "I believe we did everything in our power with the resources we had. We did done of the first visitor bans in the country," and other steps. He said there are things he would have done differently, having learned from experience, but said he had made "made the very best decisions based on the data in front of us and what we’ve known at the time."
  • The governor said he plans to issue guidance for youth sports Friday, so organizers and parents will have time to plan for the June 15 opening.
  • Asked if hospitals are falsely identifying patients as covid-19 so they can get more money from Medicare and Medicaid, Stack said "I have no sense that's occurring" and Friedlander said he was "very confident" that it is not, partly because such records are subject to federal audits.
  • Beshear, asked about Senate Majority Leader Mitch McConnell's opposition to continuing extra unemployment benefits, which some conservatives think discourage returns to work, Beshear said "I think we’re gonna have plenty of people ready to go back to work. What I want to make sure is that people who need help are getting help. … I am not for cutting the benefits at this time."