Monday, August 15, 2022

Kids' back-to-school stress: Talk it out, take it slow, get back into a routine, use available resources, Children's Hospital doctor says

By Dr. Amy Lynn Meadows
University of Kentucky 

Children have coped with a lot of change over the past several years. It’s important to recognize that change, even good change, can sometimes be challenging for kids. As we work on establishing post-pandemic equilibrium, we must be sensitive to those who may be having a harder time with the transitions.

Mental health experts are still seeing higher rates of anxiety and mood issues in children and adolescents compared with pre-pandemic rates. Depression and anxiety in children may not look exactly like it does in adults — they may be more likely to isolate themselves or act out.

Here are few tips to help your child during this time of transition:

Talk it out. The most important thing is to be open and communicate about emotions with kids. Talk with kids regularly, like at dinner or at bedtime, and ask specific and deeper questions. Don’t be afraid to ask kids questions. We all have a role to play in normalizing mental health, but we can start by having open discussions about mental health, stress and self-care with our kids.

Take it slow. Parents sometimes jump into problem-solving mode when we really should just slow down and acknowledge that it can be normal to be stressed or anxious. Grown-ups can validate the emotion, be open about talking about it, and help kids to come up with their own solutions instead of us trying to solve it for them.

Get back into a routine. One of the biggest challenges is getting kids back in a good routine. Mental and physical health are closely related, so we talk about a few cornerstones. Make sure that kids have had their checkups and are physically healthy, pay attention to regular sleep (including a set bedtime and wake-up time each day), limit screen time (including putting phones away), and encourage kids to have some gentle movement each day — walking, playing, stretching.

Take advantage of available resources. Pediatricians and primary care providers can be a great resource for screening and information. Online, I always encourage families to seek reputable resources, including the Resource Centers through the American Academy of Child and Adolescent Psychiatry.

If your child’s stress or anxiety is interfering with his or her life (for example, school, ability to enjoy friends or family or their activities), reach out to your child’s doctor, school counselor or find a mental health professional for an evaluation.

If you, your child, or someone you know are thinking about suicide or self-harm, call or text 988, the national Suicide and Crisis Lifeline, or go to the nearest hospital emergency room.

Amy Lynn Meadows, M.D., is director of the Division of Child and Adolescent Psychiatry at Kentucky Children’s Hospital.

Broad symposium on rural-health issues to be held at UK Aug. 26

Health-care practitioners and people interested in rural health policy are invited to attend a wide-ranging symposium on rural health issues Friday, Aug. 26, at the University of Kentucky.

UK's Rural and Underserved Health Research Center is hosting the symposium, which will be held from 10 a.m. to noon ET in Room 411 of the Charles T. Wethington Building, near the UK hospital and adjacent to Kentucky Clinic. Admission is free; parking will be available in the connected hospital garage on Limestone Street.

Researchers affiliated with the center will discuss some of their recent findings, including screening in primary care for colorectal cancer, in which Kentucky ranks first in the nation; dispensing of naloxone, the drug that blocks drug overdoses in progress; prevalence and monitoring of diabetes, which is more common in Kentucky than most states; and "Addressing Social Determinants of Health in Family Medicine Practices," from Dr. Lars E. Peterson, a UK professor and vice president of the American Board of Family Medicine.

Following the presentations, national and regional experts will have an open discussion of rural-health issues. The panelists will be Dr. Andrew Bazemore, ABFM senior vice president for research and policy; Veronica Judy Cecil, deputy commissioner of Kentucky's Medicaid program; Mary Charlton, associate professor and director of the Iowa Cancer Registry at the University of Iowa; Dr. Gilbert Liu, medical director of The Ohio Colleges of Medicine Government Resource Center; Alan Morgan, CEO of the National Rural Health Association; and Tim Putnam, former president and CEO of Margaret Mary Health in Batesville, Ind.

Possible topics for the panel discussion include the impact of Inflation Reduction Act, the impact of flooding in Eastern Kentucky, possible changes in federal definitions of rural, metropolitan and micropolitan; and the future work of the federally funded center.

Sunday, August 14, 2022

CJ visits Illinois abortion clinic; Bristol clinic closer to much of Ky.

With almost all abortions illegal in Kentucky, at least for the time being, and largely unavailable in most other bordering states, Sarah Ladd of The Courier Journal went to the abortion clinic in Granite City, Ill., to describe how it has become a medical magnet for women from 19 states.

"On the day Roe v. Wade fell, hundreds of people called the Hope Clinic," Ladd reports. "Front-desk employees of the Granite City abortion clinic usually field no more than 200 calls a day. But when the U.S. Supreme Court overturned the federal right to abortion on that day in June, more than 600 people called the office seeking help. For many in the surrounding region, the Land of Lincoln suddenly became the only place to legally access abortion, following a series of state "trigger" laws banning or severely limiting the procedure."

Supporters post signs at the Tennessee Clinic, above, and the
new Virginia clinic. (Photo by Sam Whitehead, Kaiser Health News)
But Granite City isn't the only abortion magnet within a few hours' drive of most Kentuckians. Sam Whitehead of Kaiser Health News reports that a doctor at Bristol Regional Women's Center in Bristol, Tenn., got an out-of-state abortion provider to open Bristol Women's Health a mile away in Bristol, Va., because of the change in the law. Tennessee's ban on abortions after six weeks of pregnancy takes effect Aug. 25.

Bristol, Va., is closer than Granite City to the geographic center of Kentucky, Lebanon; and to the state's center of population, which is near Willisburg, 20 miles north-northeast of Lebanon. According to Google Maps, they're 4 hours and 40 minutes and 4:45 from Bristol, respectively.

A Memphis-based abortion provider is planning to open a clinic this month in Carbondale, Ill., which is three and a half hours from Louisville, about 20 minutes less drive time than Granite City. When the clinic opens, Lebanon will be about the same distance from it as from the Bristol clinic. 

Bristol is two hours from Middlesboro, on Kentucky's southeastern corner; 2:10 from Pikeville; three hours from Corbin; and 3:40 from Somerset.

The owner of the Bristol clinic is Diane Dervis, who owned the Mississippi clinic that lost the Supreme Court case, Dobbs vs. Jackson Women's Health Organization. "Derzis said a doctor at the Bristol Regional Women’s Center reached out to her with the idea for the Virginia clinic," Whitehead reports.

"Derzis said the Tennessee and Virginia clinics are separate, distinct operations. . . . She said she’s working to offer abortions to people across the Southeast who have lost access as states restrict the procedure. She opened Las Cruces Women’s Health Organization in southern New Mexico in late July after closing her clinic more than 1,000 miles away in Jackson."

Like almost any abortion clinic, the one in Bristol has already drawn protesters. "On a recent weekday morning, a handful stood on the sidewalks around the clinic holding large anti-abortion signs," Whitehead reports. "On the clinic property, a group of volunteers who call themselves the Pink Defenders had put up pro-abortion rights signs and hung large sheets in various shades of pink and purple around the clinic parking lot."

In Granite City, longtime anti-abortion protesters Daniel and Angela Michael drive from 40 minutes away "several times a week in a purple RV that advertises 'Mobile Medical Unit' and 'Real Hope … Real Help'," Ladd reports. "They run an organization called Small Victories, which provides things such as ultrasounds, formula and diapers to people. 

The Michaels "criticized protesters who name-call and berate patients headed into the clinic as hypocritical," Ladd writes: “They always scream and yell at people and talk them out of abortion, but they won't help them after that,” Daniel said, his voice breaking as he spoke.

"Both he and Angela feel like a lot of crisis pregnancy organizations make it too difficult for people to get assistance, such as requiring classes in exchange for supplies." The Michaels "estimate they’ve turned more than 6,000 potential patients away from the clinic. Two of the couple’s 13 children were adopted from people who had initially come to the clinic for abortions, Daniel said. . . . The couple raises about $100,000 annually and uses the money to drive to the clinic, as well as provide supplies for mothers through the first year after birth, Daniel said."

Saturday, August 13, 2022

As overdoses among Blacks in Kentucky more than double, UK researchers explore their relations with drug-treatment providers

By Amanda Nelson
University of Kentucky

Black adults share about their experiences in drug treatment in a new University of Kentucky study published in the Journal of Substance Abuse Treatment.

Until now, few studies have included the voices of Black people and their experiences with treatment providers. Study authors hope it will inform changes to promote successful recovery and healing.

The study was conducted among 39 African Americans in Kentucky, where opioid-related deaths recently more than doubled among Blacks. All the interviewees had used opioids within the past six months.

Researchers found three primary themes influenced interviewees’ perceptions about treatment for substance-use disorder, centering on:
  • Readiness for change, influenced by whether the treatment was mandated by an external entity such as the legal/justice system, or individuals were able to decide for themselves they were ready for help;
  • Characteristics of their treatment provider (race, gender, the provider’s personal substance-use history, as well as their ability to build rapport, maintain confidentiality, and seem motivated to help);
  • Relational support from people in the interviewees’ lives, such as partners and family members.
Danielle Stevens-Watkins (UK photo by Mark Cornelison)
Exploring factors likely to impact the experiences of Black adults in treatment is an important step to being able to culturally adapt treatment strategies and integrate approaches that will have more meaningful effects among this underserved population, said Danelle Stevens-Watkins, professor of counseling psychology in the UK College of Education Department of Educational, School and Counseling Psychology and UK’s associate vice president for research in diversity and inclusion.

The paper is the first to be published from a $3.2 million National Institute on Drug Abuse project led by Stevens-Watkins, now in its second year. The project will include interviews with 800 African Americans who misuse prescription and illicit opioids, filling a need for data on this under-served group.

Readiness for change

Research conducted among primarily white participants has found that time in substance-use treatment tended to increase readiness to change, regardless of whether it was mandated by the legal system. But that was not true among African Americans in the study.

“The men and women in our study reported less success in their experiences with treatment when it was mandated, versus something they sought out because they wanted it for themselves,” said Candice Hargons, associate professor of counseling psychology and interim chair of the Department of Educational, School and Counseling Psychology.

Possible reasons that participants felt this way about mandated treatment were tied to the culture and climate of mandated-treatment settings.

The study authors suggest that assessing Blacks for readiness and motivation is important, especially when treatment is mandated. They said helping them reduce feelings of loss of control in treatment could increase desire to engage in the process. This could be accomplished, for instance, through developing a collaborative experience, where clients have a role in defining their needs.

While the interviewees understood that personal investment in the treatment process was necessary for recovery, some may have overestimated that wanting it for yourself was the predominant driver in the recovery journey, the study authors wrote.

“Many of the people who talked to us for this study felt someone can simply ‘will’ themselves into recovery,” said postdoctoral fellow Brittany Miller-Roenigk. “Having a personal investment in the process is important, but you also must consider the biological aspects of recovery and the ways treatment helps to address those. It really takes both a readiness for change and a supportive therapeutic environment along the way.” 

Provider characteristics

The study’s look into the lived experiences of Black men and women who use opioids also highlighted how provider characteristics can largely influence the treatment process. Many expressed a difficulty in trusting others, complicated by a lack of racial similarity with providers.

“There is a great need to recruit more Black therapists,” said Natalie Malone, Ph.D. student in counseling psychology. “Many of the participants in this study had never or rarely encountered a provider of color. Several talked about needing to feel the therapist will understand them when talking about experiences of racism, discrimination and microaggressions.”

A few said that race did not matter, if the provider had the ability to build rapport, avoid a judgmental tone and maintain confidentiality.

While most participants felt they could best express themselves to a race-matched provider, opinions were mixed on participants’ preference for providers who had experienced addiction. Some felt providers who were in recovery could better understand them. A few said they preferred providers who had never experienced addiction because they did not trust their providers’ sobriety, meaning it would be difficult to confide in someone that may have questionable time clean from substances.

Study participants also discussed differences in quality between mandated programs, compared to treatment programs available through insurance or direct payment. Some thought treatment facilities more likely to have Black patients had therapists with less education and training than those serving predominantly white patients. Participants also suggested that providers in mandated programs may have been facing burnout and lacked investment in the treatment process, too.

Relational support

Partners and family members were primary sources of support networks among the individuals in the study. Partners undergoing treatment simultaneously were most likely to provide support. Nobody in the study said their partners were a barrier to treatment.

For those with family members aware of their drug use, several identified their family as a primary source of support. Some family members were unsupportive of treatment due to their own personal substance use.

The researchers found a third theme they refer to as “absent support,” which had a negative impact but not a negative intent. This happened among participants’ families that spend time together socially but have a culture of not becoming involved in the personal affairs of others. Absent support was most often related to maintaining privacy, which is consistent in the literature among African Americans, the authors said.

When possible, the study authors suggest integrating peers, family members or partners into treatment may be a useful resource for reducing opioid use among African Americans.

The study authors are sharing these initial findings to highlight aspects of treatment that could be addressed to most likely influence success.

“It is important to take a deeper look into the lived experience of Black men and women who use opioids so that researchers, clinicians and those who influence programs that support recovery and healing have a better understanding of the factors that can make a true difference in their success,” said Destin Mizelle, a Ph.D. student in counseling psychology.

This is a critical time for Black individuals who use opioids, said Jovonna Atkinson, a master's-degree student in the College of Social Work.

Stevens-Watkins noted, “Overdose-related deaths are on the rise and Black men and women are more likely to face similar and sometimes harsher consequences than their white counterparts, including higher likelihood for criminal convictions, longer incarcerations, higher unemployment rates and increased mental health risks. The more data we can gather to inform culturally-tailored interventions, the greater chance we have to reduce the adverse social, legal and fatal consequences associated with opioid use among Black populations.”

Friday, August 12, 2022

UK HealthCare and St. Elizabeth Edgewood-Covington Hospitals tie for best Ky. hospitals in U.S. News & World Report rankings

By Melissa Patrick
Kentucky Health News

Six Kentucky hospitals have been named among the nation's "Best Regional Hospitals" in the annual ranking by U.S. News & World Report magazine. 

The No. 1 hospitals in Kentucky are the University of Kentucky hospital and St. Elizabeth Edgewood-Covington Hospitals, followed by Baptist Health Lexington, Baptist Health Louisville, Louisville's Norton Hospitals , and U of L Health-Jewish Hospital.

To make the list, a hospital must:

  • Offer a full range of services;
  • Rank nationally in one of 11 measured specialties, or have seven or more high-performance rankings for procedures and conditions; and
  • Have at least three more "high performing" than "below average" rankings for procedures and conditions.

The report offers an overview of 123 Kentucky hospitals with a breakdown of each of the measured categories, according to the services a hospital provides. 

UK HealthCare, for the seventh straight year, is No. 1 with its Albert B. Chandler Hospital. It ranked in the top 50 hospitals nationally for cancer care for the sixth straight year, ranking 33rd. Its Markey Cancer Center is Kentucky's only National Cancer Institute-designated cancer center, and one of 71 in the nation.

“In Kentucky, we have the highest rates of cancer in the country, and this issue is especially pronounced in Eastern Kentucky and Appalachia,” Dr. Mark Evers, director of UK's Markey Cancer Center, said in a news release. “Nowhere in the country is it more important for people to have access to complex and compassionate cancer care. This ranking is a testament to the hard work of Markey’s health care providers and staff, who are committed to ensuring that no patient has to travel outside the state for the care they need.”

The evaluation of the UK hospital includes data from Kentucky Children's Hospital and Good Samaritan Hospital. The hospital system was also nationally ranked as high performing in two adult specialties: gastroenterology and gastrointestinal surgery and geriatrics and two children's specialties: pediatric cardiology and heart surgery and pediatric orthopedics. 

Ten common adult procedures and treatments for conditions at UK HealthCare also received a high-performing designation: chronic obstructive pulmonary disease, colon cancer surgery, heart attack, heart bypass surgery, heart failure, kidney failure, lung cancer surgery, ovarian cancer surgery, pneumonia, and stroke.

St. Elizabeth Edgewood-Covington Hospitals, which tied for No. 1 with UK, ranked high performing in 14 procedures and conditions, including: COPD, colon cancer surgery, lung cancer surgery, abdominal aortic aneurysm repair, heart attack, heart failure, diabetes, kidney failure, back surgery (spinal fusion), stroke, hip fracture, hip replacement, knee replacement, and pneumonia.

Baptist Health Lexington, which tied for No. 3 with Baptist Health Louisville, ranked high performing in 11 procedures and conditions: COPD, colon cancer surgery, uterine cancer surgery, abdominal aortic aneurysm repair, heart attack, heart failure, kidney failure, back surgery (spinal fusion), stroke, hip fracture and hip replacement. This hospital received one below-average mark, for transcatheter aortic valve replacement. 

Baptist Health Louisville ranked high performing in 10 procedures and conditions: COPD, colon cancer surgery, abdominal aortic aneurysm repair, heart attack, aortic valve surgery, heart bypass surgery, diabetes, stroke, hip replacement and knee replacement.

Norton Hospitals (Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Healthcare Pavilion and Norton Women's and Children's Hospital) ranked No. 5 in Kentucky and No. 2 in Louisville. It ranked high performing in nine procedures and conditions: COPD, heart attack, heart failure, diabetes, kidney failure, stroke, maternity care for uncomplicated pregnancies, hip replacement and knee replacement. It ranked below average for uterine cancer surgery. 

UofL Health-Jewish Hospital, which also included data from UofL Health-Frazier Rehabilitation Institute, ranked No. 6 in Kentucky and No. 3 in Louisville. It ranked high performing in seven procedures and conditions: COPD, heart attack, heart failure, diabetes, kidney failure, stroke and knee replacement. This hospital ranked below average for back surgery (spinal fusion) and hip fracture.  

The 33rd annual rankings compared hospitals in 15 specialties and 20 common procedures and conditions. This year, the survey added new cancer ratings: ovarian cancer surgery, prostate cancer surgery and uterine cancer surgery.

Of the 4,500-plus hospitals evaluated, only 164 were nationally ranked in at least one specialty, compared to 175 last year, and 493 were ranked among the Best Regional Hospitals in a state or metro area, compared to 531 last year. 

While it is not included in the rankings, the U.S. News report includes an updated health equity measure  for each hospital that features measures of racial disparities in unplanned readmission, a measure of how much charity care each hospital provides, and a measure of how well low-income patients are represented among the patients each hospital serves.

Click here for a list of frequently asked questions about how the magazine ranks the hospitals. 

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot, followed by Cedars-Sinai Medical Center in Los Angeles, NYU Langone Hospitals in New York and Cleveland Clinic.

Loved ones say actor killed himself after losing all in flood, showing need for mental-health services for region's homeless

Tony Calhoun (Showhouse Productions)
A Kentucky actor and screenwriter killed himself after losing everything he owned in last month's flash floods, his fiancée said, and "His friends and family hope the incident emphasizes the need for mental health services as part of Eastern Kentucky’s recovery," reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

Tony Calhoun, 39, "killed himself Monday morning, said Calhoun’s fiancée, Edith Heather Lisk. . . . Gov. Andy Beshear is counting Calhoun as the 39th death in the state flood toll. Calhoun’s parents, Betty and Lowell Thomas Calhoun, said that if even one person could be helped by talking about Calhoun’s death, it will be worth them telling his story."

Calhoun's mother said he lost first-edition comic books and "memorabilia that he had collected since he was 5 years old, but he was proud that he had not broken down in tears," the Herald-Leader reports. "What happened on Monday, she said, 'was his way of breaking down'."

Mental-health professionals are needed to tell hundreds of people made homeless by the flooding “that they don’t need to give up on life, that they can start over,” Betty Calhoun said. Breathitt County Coroner Hargis Epperson said Calhoun’s death is being investigated as a suicide.

Panel to study mental-health issues in criminal-justice system

Chief Justice Minton, Justice Lambert, Gov. Beshear
The Supreme Court of Kentucky has created a commission to investigate mental-health issues in the state's criminal-justice system. Its membership has not been announced, but it will be chaired by Justice Debra Hembree Lambert.

“I’m excited to focus on mental health and substance-use cases, but this will also be the first time there will be an all-hands-on-board effort to assess and improve the way the court handles intellectual disabilities,” Lambert said in a news release. “No group this broad and with this many resources has ever come together to tackle all three of these important issues.”

The Kentucky Judicial Commission on Mental Health "will potentially have a great deal of latitude," report John Cheves and Aaron Mudd of the Lexington Herald-Leader. "According to Lambert, the body will examine where the court system touches cases involving mental health, substance use and intellectual disabilities, she said in the news release. The commission will also be empowered to make recommended changes where appropriate," including training for judges, other court personnel, law-enforcement officers, mental-health providers and community advocates, she said.

Chief Justice John Minton, who named Lambert chair, said Kentucky is the latest state to tackle "the growing mental-health crisis in the justice system."

But Cheves and Mudd write, "This is not the first time the commonwealth has tried to address severe mental illness in the people caught up in the state’s justice system. So far, its efforts haven’t been all that successful." They note that "Tim's Law," which lets district judges order seriously mentally-ill people into outpatient treatment, apparently has been used only once, in Jefferson County.

The commission is scheduled to have its first meeting Sept. 22. It apparently will have some members from the executive branch of state government, since the Supreme Court announcement was accompanied by a photo of Minton, Lambert and Gov. Andy Beshear.

Flooding and recovery cause concerns about health and safety

WEKU-FM photo by Stu Johnson
"Maintaining good physical and mental health is top of mind for health officials in flood-devastated Eastern Kentucky," reports Samantha Morrill of WEKU-FM. "Tetanus and hepatitis are major concerns after a flooding event."

So says Scott Lockard, public health director at the Kentucky River District Health Department. He told Morrill that the agency has been administering vaccinations in the community and going door to door.

“We have partners, and we've done this ourselves, to get on ATVs and side by sides and go up hollers in our communities and people who have not been able to get out and get the care, they need to make sure that they're getting vaccinations and getting, you know, the services that they need right there at their homes,” Lockard said.

He added that volunteers need to take care of their general health. Part of that includes properly treating cuts and scrapes: “They're in the water or the mud, you know, there's just a coating of mud on everything. We have to make sure that individuals are very mindful of treating wounds effectively, don't let these places become infected.”

The mud that coats nearly everything the flooding touched carries contaminants that can cause illness, Lockard said. The mud and debris are hazards for falls, and people should use protective equipment like rubber boots and gloves.

Lockard also said maintaining good mental health is also a concern. "A social worker by training, Lockard said setting boundaries and knowing when to ask for help are important tools," Morrill reports.

Thursday, August 11, 2022

CDC eases some Covid-19 guidelines, says 89 Ky. counties are at high risk of Covid-19; state's infection rate is highest in U.S.

CDC map estimates ranges of risk for contracting Covid-19.
By Melissa Patrick
Kentucky Health News

As the Centers for Disease Control and Prevention loosened some of its Covid-19 recommendations, even more Kentucky counties moved into the high-risk category for coronavirus transmission on the CDC's weekly risk map.

And The New York Times reports that Kentucky has the highest infection rate among the states.

The number of Kentucky counties in the high-risk category, orange on the CDC map, increased to 89, from 80 in last Thursday's report. The number of yellow counties, indicating a medium risk of Covid-19, dropped to 20, down from 31.    

The good news is that for the second week in a row, the state still has green counties on the map, indicating a low risk of Covid-19 transmission. The number of low-risk counties increased by two, to 11: Fulton, Calloway, Simpson, Logan, Butler, Edmonson, Green, Taylor, LaRue, Fleming and Bracken. 

In the high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed. If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC's new guidance says people who are exposed to the virus no longer need to quarantine at home, regardless of vaccination status, although they should wear a high-quality mask for 10 days and get tested on day five. It also not longer recommends routine surveillance testing for people without symptoms and says contact-tracing is only necessary in health care settings or high-risk congregate settings. 

With schools starting, the CDC made several changes in its recommendations for schools, no longer mentioning its "test-to-stay" option and no longer recommending routine testing, unless it is in response to high-risk activities during high Covid-19 community transmission or in response to an outbreak. 

Masks continue to be recommended only in areas where community transmission is high, or if a person is at high risk of severe illness. The CDC publishes maps showing the level of community transmission in each county; all Kentucky counties but four (Hickman, Lyon, Todd and Metcalfe) have high levels. 

One CDC recommendation that remains the same is that people with Covid-19 should isolate for at least five days as long as they are without a fever for 24 hours without the use of fever-reducing medication and all other symptoms have improved. They should then wear a mask through day 10, or test negative twice over 48 hours before they stop wearing a mask. 

Beshear's view: At his weekly news conference, Gov. Andy Beshear said that with the state's weekly coronavirus cases going up and down, the hope is that we are heading toward a plateau. He said cases increasing for a while and then going down is what some experts see going forward. 

Beshear noted that hospitalizations continue to go up and while they are still relatively low, he said, "That's still a lot of people in the hospital, folks, so make sure you get vaccinated . . . Make sure you get boosted as well and if you are over 50, get that second booster."  

He added, "Everybody now has all the information on how Covid spreads, what you can do to stop it. Please try to make the best decisions for you knowing that at this point, we all know how this thing works and how we can protect ourselves." 

The data shows that the pandemic is clearly not over, even though 31.7% of Kentuckians think it is, and 53% of them say it is over for them, according to a Foundation for a Healthy Kentucky poll taken June 4-July 13. 

Asked what can be done to persuade Kentuckians that the pandemic is not over,  Beshear said Kentuckians are tired of it, and of wearing masks, then said the most important thing we can do is to get more people vaccinated and boosted. He also said Kentucky will keep sharing pandemic information with Kentuckians even as other states quit. 

He said that at this point in the pandemic, Kentuckians need to recognize that they will just need to change their behaviors, like wearing masks, for a few weeks at a time, instead of forever. 

Beshear spoke as the CDC was relaxing its guidance, while sharing a similar message as the governor. 

“We’re in a stronger place today as a nation, with more tools—like vaccination, boosters, and treatments—to protect ourselves and our communities, from severe illness from Covid-19,” CDC epidemiologist Greta Massetti said in a news release. “We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation. This guidance acknowledges that the pandemic is not over, but also helps us move to a point where Covid-19 no longer severely disrupts our daily lives.”

UK health workers in flooded areas work to provide care

By Hillary Smith
University of Kentucky

HAZARD, Ky. — More than a week into recovery and relief efforts following the devastating floods in Eastern Kentucky, Dr. Key Douthitt sums up the experience with two words: “I’m exhausted.”

But what he and his community are going through is not so simple. Douthitt is the medical director for UK HealthCare’s North Fork Valley Clinic in hard-hit Perry County.

He considers himself one of the lucky ones.

“My wife told me this morning, think how exhausted you would be if you didn’t have a home, you didn’t have electricity, you didn’t have a car,” he said. “So at the end of the day, whatever I’m going through is small in comparison to what a lot of our neighbors are.”

A mobile dental unit donated by Ronald McDonald House was converted to
a basic-care unit for wound care and vaccinations. (UK photo by Hilary Brown)
Two weeks ago, parts of several communities were virtually wiped away by the floodwaters, with some homes being swept off their foundations and carried away. In Eastern Kentucky, it’s common for generations of families to put their homes on the same strip of land. For those who had the misfortune of being along the path of the historic flooding, pieces of their families’ homes and many of their belongings are now scattered along creek banks and even up in trees, showing just how high the water rose. Anything left behind, including the insides of homes, are now caked in layers of mud.

Along with family keepsakes, electronics, clothes and food, many residents are also left without crucial items like lifesaving medications, identification and insurance cards, glasses, dentures, walkers, canes and more.

Several homes that were spared have been without electricity for days, which is problematic, especially for those who rely on things like oxygen and CPAP machines. Getting generators to those homes is a top priority. Health care workers are working tirelessly to try to meet the growing list of needs in their communities and know that these needs are dire — and will only continue to grow.

UK HealthCare operates two clinics in the flooded areas. The North Fork Valley Clinic in Hazard is still operational; however, the June Buchanan Clinic in Hindman experienced significant flooding.

“When we see someone who is down, we are going to pick them up and try and pull them back up as best we can,” said Douthitt. “So we're used to hard times here but we're also used to coming together as a community.”

With support from UK’s Center of Excellence in Rural Health in Hazard and volunteers, the staff from the two clinics have spent the past several days out in the community offering aid. They have been a shining example of what a community health care worker is.

“In a lot of these communities, we find people that either can’t or don’t want to leave what is left of their homes. They are worried about looting, and it is where they are comfortable,” said Douthitt. “They won’t come to us; we know we are going to have to go to them. And after all they have been through, that’s the least we can do.”

While crews have worked tirelessly to clear main roads throughout the mountains, the reality is that dozens of bridges, culverts and small roads remain impassable — or have even been wiped from existence.

“Unless you are from this area, you don’t really know what rural means … especially flooded rural,” said Pam Cornett, who is working out of one of UK HealthCare’s mobile clinics. Cornett, a Letcher County native, typically works as a dental hygienist in the dental mobile units but is using her skills and expertise to help with wound care and vaccinations for flood survivors.

Rescue teams have needed to get creative in finding ways to provide help for some of these hard-to-reach areas. CERH Director Fran Feltner noted that one of their mobile teams were unable to reach someone in need even on an ATV — so they instead got to the person and delivered necessary supplies by horseback.

“Our rural Kentucky mountains are beautiful places to live, a place we call home, a place where family, friends and neighbors lend a helping hand or shoulder to lean on in times of disaster,” said Feltner. She says as their teams are out working to access those impacted by the floods, they are often joined by neighbors who also want to help by providing extra hands, an ATV or their own horse.

“That is what we do here. You go out into these communities, and you just see the absolute devastation,” said Douthitt. “We were out the other day and came across a man who was all cut up. It was because he was out looking for his wife’s body. When you see that stuff, you just know we need to do everything we can for these people.”

UK's two dental units operated out of its Hazard clinic have been converted for basic wound care and tetanus vaccinations. As one lady rolls up her sleeve to receive her shot, she quietly tells the team member, “We lost everything.”

Her husband is also there, being inspected for a puncture wound on his foot. The family, including an 84-year-old, had waded through water up to their necks to get to safety.

“Everyone is kind of bewildered and overwhelmed,” Cornett said. “One gentleman told me that he doesn’t know where to even start.”

As they travel, the mobile clinics are also handing out backpacks with a day or two supply of hygiene items and food that have been collected and organized by the Center for Excellence in Rural Health.

“I’m trying to stay focused on the medical needs knowing we have people working hard to get the other supplies out,” said Douthitt. “Together, we are going to make sure the whole person is taken care of.”

The team members in the mobile care units are also helping connect those in need with the appropriate contacts and services.

“I met a man yesterday who lost his prosthetic leg in the flood, so we are working to get him set up and get that replaced,” said Cornett. “Basically, we’re trying to get anything they need in order to get back to some sort or normalcy.”

While these health care heroes work tirelessly to help their community, they are also living the experience as an Eastern Kentuckian.

“We have staff trying to come and concentrate on providing medical care to people when the whole time they're thinking, ‘I need to be doing X, Y or Z for my family. My family needs me right now,’” said Douthitt. “And it's a lot. That's a lot to put on people.”

Next, the hope is to have the June Buchanan Clinic cleaned up and operational soon.

“We are just going to get through this one day at a time, one moment at a time,” said Douthitt. “Eventually we will be able to look back and say, ‘Look how we picked ourselves back up.’”

The region is far more complex than many understand. From its hills to its valleys, the area is rich in tradition and pride. Those are all things that the floodwaters could not wash away.

“I’m very proud to be from this area,” said Cornett. “We have some really good people, really strong people. We will bounce back. It might take years, but we will bounce back.”

In the aftermath of the floods, there are many moving parts and a constantly changing list of needs, some which could mean the difference between life and death. It can be overwhelming at times, which is why the health care workers try to keep the focus on what really matters — the strength in their community and unwavering support from strangers — all while taking it one step at a time.

“When you say to someone, ‘Hey, I know you aren’t from here, but can you get on an ATV and run this up to the next holler over and they say, Yes!’ It just warms your heart,” said Douthitt. “To see people come together for a common goal, it just shows at the end of the day we are all on this same earth, and we're just going to pitch together to do the best we can.”

Tuesday, August 9, 2022

53% in statewide poll say the pandemic is over for them; 1/3 are unvaccinated; 1/3 of those say they could be moved to get a shot

By Melissa Patrick
Kentucky Health News

Even as the share of Kentuckians testing positive for the coronavirus continues to rise, about a third of the state's adults believe the pandemic is over, and more than half believe it is over as it pertains to their own lives, according to a Foundation for a Healthy Kentucky poll taken June 4 through July 13.

What this means is that Kentuckians are back to living their normal everyday lives, despite the ongoing pandemic, foundation president and CEO Ben Chandler said at a news conference Tuesday. 

Centers for Disease Control and Prevention maps; click to enlarge.
"We have to remember to stay vigilant against the virus," Chandler said. "Research shows the best way to avoid severe illness and death is to stay up to date with vaccines and boosters. Other ways to keep on guard include staying home if you feel sick, and testing, wearing a mask in a big crowd and getting healthier by doing things like eating nutritious foods." 

One dose provides very little protection, experts say.

The poll found that 65.4% of Kentucky adults said they believed the pandemic was not yet over in Kentucky, 31.7 % said it was over and 3% said they didn't know. But when asked if the pandemic was over as it pertains to their own lives, 53.3% said it was, 44.7% said it was not, and 2% said they didn't know. 

In both cases, the share who said the pandemic was over was higher among men and younger age groups.

The pandemic is clearly not over. The state's latest weekly report showed a 6.8% increase in coronavirus cases last week, with 2,236 new cases per day. The positive-test rate, which does not include home tests, rose to 18.41%; hospitalizations increased; and 67 more deaths were attributed to the virus, the largest weekly total since 79 were reported in mid-May. Kentucky has the second highest infection rate in the nation, according to The New York Times. 

Good news and bad news

Chandler said the good news from this poll is that when unvaccinated Kentucky adults were asked if they would get a vaccination, about one-third of them appeared open to the possibility. 

Opinions of the unvaccinated; click on graph to enlarge it.
The bad news is that poll found that the number of unvaccinated Kentuckians who say they "definitely will not" get vaccinated is going up. The poll found that 63.5% of the unvaxed said they definitely will not, compared to 46.6% in August 2021 and 19% in February 2021. 

On the other hand, the poll found that 2.1% said they would get a shot as soon as possible; 18.7% said they were waiting to see how the vaccines worked for other people; and 15.6% said they would only get a shot if it was required for school, work or other activities. 

"We think these responses are encouraging," said Chandler. "This shows there are still movable people and we should continue educational efforts to increase confidence in the safety and efficacy of the vaccine and boosters." The reportedly persuadable unvaccinated are about 12% of the state population.

Chandler said focus groups, small-group discussions about current topics, have found Kentuckians want to discuss vaccination with their doctors and it's not too late to have those conversations. 

"We've been able to drill down on this point with some of our recent focus groups, and feel there's an opportunity to educate people about the risks from getting Covid-19, including severe illness and 'long Covid' symptoms, compared to the risks of side effects and benefits of the Covid-19 vaccines and boosters," he said. 

According to the state Department for Public Health, 34% of Kentuckians have not received a Covid-19 vaccine. That amounts to 1.5 million. If 36% of this unvaccinated group are still open to getting a shot, as Chandler suggests, that means about 550,000 Kentuckians could still be convinced to get it.

The poll found an increase in those who believe getting a Covid-19 vaccine is a personal choice and fewer saw it as a "part of everyone's responsibility to protect the health of the community." In February 2021, Kentuckians were split nearly equally on this issue, but the most recent poll shows 62.7%, believe it is a personal choice.

Confidence in the vaccines is dropping

The poll also found that among the unvaccinated, confidence in the vaccines' efficacy has lessened since the emergence of the Delta and Omicron variants and subvariants, with 76.4% of unvaccinated Kentucky adults doubting effectiveness of the vaccines, up from 65.7% in August 2021. 

Opinions of the unvaccinated; click on graph to enlarge it.
The most recent poll found that of the 76.4% of unvaccinated adults who doubted effectiveness of the vaccines, 45.6% said the vaccines are "not effective at all," 30.8% said they are "a little effective," 20.7% said they are moderately effective, 2.1% said they are very effective ad 0.8% said they didn't know.  

In August 2021, 43.8% of this group said the vaccines were "not effective at all" and 21.9% said they were only "a little effective." 

The poll also found real concern among Kentucky adults about the effectiveness of the vaccines and boosters against future strains of the coronavirus. Among the unvaccinated, 52.4% said a vaccine would not be "effective at all" against new strains, marginally higher than in August 2021. 

Among fully vaccinated adults, 75.7% said they felt booster shots would be "moderately effective" or "very effective" in protecting them, but only 63.8% said the booster shots would have the same levels of protection against new strains of the virus.

Chandler said this lack of confidence in the vaccines, especially when it comes to protecting against new variants, is one reason that it is hard to get unvaccinated Kentuckians vaccinated.

He said the foundation will use these insights to inform vaccine outreach and educational efforts. "We hope the information encourages health-care workers to continue talking with patients about the vaccine and boosters discussing those risks and benefits and dispelling misinformation," he said.  

The poll, which was funded by the foundation, was conducted by the University of Cincinnati Institute for Policy Research. It surveyed a random sample of 814 Kentucky adults via landline and cell phones and has a margin of error of plus or minus 3.4 percentage points. 

Experts at hearing sought by Sen. Rand Paul say gain-of-function virus research should be subject to more government oversight

Academic and drug-industry experts told a U.S. Senate subcommittee Aug. 3 that more government oversight is needed for gain-of-function research, "which is used to better understand which pathogens have the potential to become a pandemic," Jessica Karins reports for Inside Health Policy.

Sen. Rand Paul (Photo by Jabin
Botsford, The Washington Post)
Sen. Rand Paul of Kentucky pushed for the hearing by the emerging threats subcommittee of the Senate Homeland Security Committee. The top Republican on the subcommittee, he has said gain-of-function research funded by the National Institutes of Health could have caused the Covid-19 pandemic.

However, most witnesses at Wednesday’s hearing "maintained that SARS-CoV-2, the virus that causes Covid-19, came from nature and not a lab," Kairns reports. Still, they said Congress should work to strengthen reviews of research proposals at the NIH and the Agency for International Development. "They also asserted that such research should be overseen by a single, independent federal agency that does not fund or conduct research."

"Gain-of-function research . . . seeks to enhance the transmissibility or other qualities of a pathogen," Karins explains. "It is usually employed with the intention of better understanding pandemics and to possibly identify agents that could cause a pandemic in the future. Some types of gain-of-function research pose concerns about safety and security because they could enhance an agent’s ability to pass to humans and cause an epidemic. . . . Central to the controversy over the origins of Covid-19 is whether gain-of-function research was conducted and funded by NIH at the Wuhan Institute of Virology, located near the area where Covid-19 was first identified."

Most experts say the virus came from animals in a street market in Wuhan, but they have not been able to pinpoint how or when. Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, has said NIH did not fund gain-of-function research in Wuhan, but Paul said at the hearing, “I maintain that the techniques that the NIH funded in Wuhan may have, or could have, been used to create Covid-19. The American people deserve to know how this pandemic started, and whether the NIH-funded research that could have caused this pandemic.”

Paul has said that if Republicans take control of the Senate, he will chair a committee and conduct an investigation of the matter. His wife, Kelley Paul, said in campaigning for him in West Kentucky last weekend, "He will subpoena every last document of Dr. Fauci's and get to the bottom of what happened." 

Sen. Paul said at the hearing that regardless of the source of Covid-19, it’s important to increase government oversight of gain-of-function research because of its risks, and witnesses agreed that it "should be subject to a much greater degree of oversight, adding that it provides little benefit compared to its risks," Karins reports.

Kevin Esvelt, assistant professor of media arts and sciences at the Massachusetts Institute of Technology Media Lab, said scientists disagree on whether the Wuhan experiments were gain-of-function. "Nevertheless, he said, scientists should continue to regard research involving pandemic-capable pathogens as particularly risky, and there should be additional security measures in place when conducting such research," because such research is more likely to cause a pandemic than prevent one, because pathogens being studied through such research can leak from the lab, Karins reports.

In addition to lab leaks, publication of some research information could allow a rogue nations, organizations or individuals to create a pathogen, said Richard Ebright, laboratory director of the Waksman Institute of Microbiology at Rutgers University. He said gain-of-function research is a very small part of virology and is unnecessary because it does not contribute to the development of vaccines and medications.

"Steven Quay, CEO of Atossa Therapeutics, agreed that gain-of-function research does not help prevent pandemics, but he believes efforts to fully ban gain-of-function research would go too far," Karins reports. "Quay recommended such research be reviewed by a structure similar to that of institutional review boards that review experimentation involving human subjects."