'The only way we can take care of others is if we first take care of ourselves," UK President Eli Capilouto says in a health message

Kentucky Health News

Before he became an academic and a university administrator, Eli Cailouto was a public-health dentist. He returned to his roots in his latest campus-wide message as University of Kentucky president, promoting preventive measures as the weather cools, we spend more time inside and viruses circulate more. It's aimed at the UK campus but is generally applicable to everyone.

Dr. Eli Capilouto

By Eli Capilouto

As we continue to settle into the academic year, I encourage you to prioritize taking care of yourself.

Be healthy.

Listen to your body. Pay attention when you don’t feel well or when something doesn’t seem right — when in doubt, check it out. We have an outstanding, world-class health care system that is here to take care of you.

Get outdoors. Visit a garden, go to the park, take a walk. Exercising outdoors can help reduce stress and anxiety, improve sleep and ease your mind. The arboretum — open daily from dawn until dusk — has beautiful gardens, a two-mile paved path and a half-mile trail through its woods.

Prepare yourself. Vaccines are safe, effective and an important way to stay healthy. Employees have access to multiple pharmacies and clinics that offer flu, Covid-19, RSV and other vaccines. Flu shots are also available to UK students at University Health Service, UK retail pharmacies and various on-campus flu shot clinics. Find more information here.

The only way we can take care of others is if we first take care of ourselves.

I hope you will join me in making every effort to stay healthy this fall and winter season.

Ky. children 10-17 have nation's 2nd highest obesity rate, 19.6%; adult rate of 37.7% is 9th highest, a slight improvement from 2021

Map from Trust for America's Health State of Obesity report

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Kentucky ties with Wisconsin for the nation's ninth-highest adult obesity rate, an improvement from second-highest last year, but Kentucky children aged 10-17 still have one of the nation's highest rates, No. 2, after ranking first last year.

The 20th annual State of Obesity report from Trust for America's Health says 37.7% of Kentucky adults are obese and nearly 72% of the state's adults are either obese or overweight, tied for sixth place with Delaware. Among the state's high-school students, 19.6% of them are obese and 16.2% are overweight.

Nationally, the report says the number of obese adults continues to rise, noting that 22 states had an 2022 adult obesity rate at or above 35%, up from 19 states in 2021. A a decade ago no state had an adult obesity rate at or above 35%, the report says.

"Since TFAH’s initial report, published in 2004, the national adult obesity rate has increased by 37 percent and the national youth obesity rate increased by 42 percent," says the report. 

The national adult obesity rate is 42% and the national rate for children ages 2 to 19 is nearly 20%, according to the report.  

The good news is that from 2021 to 2022, Kentucky's adult obesity rate declined 6.4%, or 2.6 percentage points, to 37.7% from 40.3%. But that was still above the levels of 2018, 2019 and 2020.

West Virginia (41%), Louisiana (40.1%), Oklahoma (40.0%), and Mississippi (39.5%) have the highest rates of adult obesity. The District of Columbia (24.3%), Colorado (25.0%), and Hawaii (25.9%) have the lowest adult obesity rates.

“It’s critical to recognize that obesity is a multifactored disease involving much more than individual behavior,” Dr. J. Nadine Gracia, president and CEO of Trust for America's Health, said in a news release. “In order to stem the decades-long trend of increasing obesity rates we have to acknowledge that the obesity crisis is rooted in economic, health, and environmental inequities. Ensuring all people and communities have equitable opportunity and access to healthy food and physical activity is fundamental to addressing this crisis.”

Kentucky continues to struggle with all of these conditions. It ranks fifth worst for the percentage of adults with diabetes (15%) and hypertension (40.3%), and nearly 27% of its adults are physically inactive, ninth worst. 

The report shows that more adult men than adult women are obese in Kentucky: 38.7% of men and 36.7% of women, a switch from last year's report. Kentucky's adult men have the second highest obesity rate in the nation; its women rank 18th, tied with Texas.

By age, Kentucky adults between 45 and 64 have the highest obesity rate, 42%. That's followed by those 25-44 (41.2%), 65 and older (33.7%) and 18 to 24 (24.1%). 

"Solving the nation’s obesity crisis will require addressing the economic and structural factors that impact where people live and their access to employment, transportation, healthcare, affordable and healthy food, and places to be physically active," says the report, which includes policy steps to address the crisis that they say should be taken by federal, state and local officials and stakeholders. They include: 

• Fully fund the Centers for Disease Control and Prevention's proven chronic disease and obesity prevention programs so they reach every state.
• Make healthy school meals available for all students and increase access to Supplemental Nutrition Assistance Program (SNAP) and other nutrition support programs.
• Implement a mandatory front-of-package labeling system on food packaging to help consumers make informed choices.
• Close tax loopholes and eliminate business-cost deductions for advertising unhealthy food to children.
• Make physical activity and the built environment safer and more accessible for everyone, including by increasing federal education funding for health and physical education and investing in active transportation projects like pedestrian and bike paths.

Answers to questions about the updated Covid-19 vaccines

Updated Covid-19 vaccines from Pfizer/BioNTech and Moderna have rolled out to pharmacies. The Food and Drug Administration approved the mRNA vaccines for everyone 6 months and older. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 to recommend that everyone 6 months and older should get the shots, and the CDC endorsed that recommendation.

Lori Robertson and Catalina Jaramillo of FactCheck.org, a service of the Annenberg Public Policy Center at the University of Pennsylvania. Robertson and Jaramillo compiled a list of common questions and answers about the vaccines, and here's a condensed version of their report:

How are these updated shots different from the last one? All of the Pfizer/BioNTech and Moderna Covid-19 vaccines — the originals, the bivalent boosters and the latest updates — use the same mRNA technology to trigger an immune response to the spike protein of SARS-CoV-2, the virus that causes Covid-19. The spike protein is what the virus uses to enter cells.

The difference between the versions of the vaccines is in what type of spike protein they prompt the body to make. The mRNA in the 2023-2024 vaccines instructs cells to make the spike protein of omicron variant XBB.1.5. The variant became a concern at the end of last year, when the CDC projected it made up 40.5% of new CCovid-19 cases in the U.S., a figure that rose to nearly 90% by early March.

Who is eligible to get an updated vaccine? Everyone 6 months of age and older is eligible for these vaccines.The FDA said those age 5 and older can get a single dose of either mRNA vaccine if at least two months have passed since the prior Covid-19 vaccine dose. Unvaccinated people can also get a single dose. Children ages 6 months through 4 years who previously were vaccinated are eligible to get one or two doses, depending on which vaccines they have received and when. Children in this age group who haven’t been vaccinated against Covid-19 can get three doses of the latest Pfizer vaccine or two doses of Moderna’s. . . . Those who are immunocompromised can also receive additional doses.

What evidence supports the use of the updated vaccines? The FDA said it approved and authorized the latest formulas of the vaccines based on its evaluation of manufacturing data and data showing the immune response to these vaccines against prevalent variants is similar to that of previous versions of the vaccines against prior variants.. . . . The FDA is using a similar approach to the annual influenza vaccines, which are tweaked each year to combat the influenza strains expected for that season. Flu vaccines are approved each year without clinical studies because the changes, compared with prior vaccines, are small and because it wouldn’t be possible to test the vaccines each year in people before the flu season.

How effective are they? We don’t have vaccine effectiveness data for the updated vaccines specifically, but data on similar, previous vaccines show they were quite effective at preventing severe disease. And the research. . . .by Moderna and Pfizer/BioNTech shows the updated version increases neutralizing antibodies against the new and emerging variants.

How safe are they? Moderna’s clinical trial for the latest vaccine showed that the percentage of participants reporting mild side effects, such as pain, swelling, headache, fatigue and muscle aches, was similar to or, in many cases, lower than the reporting rates for the prior Covid-19 vaccines. But, the safety evaluation of this formula is based on hundreds of millions of doses of Covid-19 vaccines administered over the past few years.

Are the shots still free, and where can I get one? The vaccines are no longer provided by the federal government for free, but private insurance companies, Medicare and Medicaid, and some CDC programs will cover them.

For more detailed explanations and questions, read the full article here. 

Governor declares Recovery Month, says he has 'grave concerns' about opioid-settlement spending as opioid commission meets

Gov. Andy Beshear posed with members of the recovery community on Sept. 22 in the Capitol rotunda as he proclaimed September as Recovery Month in Kentucky. (Photos by Melissa Patrick) 

By Melissa Patrick
Kentucky Health News

More than 200 people attended an event to mark National Recovery Month on Friday, Sept. 22 in the state Capitol, hearing a message that recovery is possible -- along with "grave concerns" from Gov. Andy Beshear about how the Opioid Abatement Advisory Commission may spend the millions coming to the state from lawsuit settlements with opioid makers and distributors.

Later that day, the commission approved nearly $14 million in 34 grants, but only by application numbers and amounts, saying the names of the grantees would not be announced until early October. 

The recovery event was opened by Dr. Katherine "Katie" Marks, commissioner of the Department for Behavioral Health, Developmental and Intellectual Disabilities, saying Kentucky is leading the way when it comes to access to recovery, and that by working together, recovery is possible. 

"Seven out of 10 people, of adults, who have experienced substance-use or mental health conditions . . . are in recovery; they are here with us. We are those people. It reminds us over and over that recovery is not just possible, it is probable," said Marks, who ran the state Opioid Response Effort before becoming commissioner. 

Gov. Andy Beshear

Before signing a proclamation recognizing September as Recovery Month in Kentucky, Gov. Andy Beshear touted a number of the programs in the state to help people who are in recovery or seeking recovery. He noted the addition of six more Recovery Ready Communities, bringing that number to seven.

"For the first time I can remember, we in the commonwealth have a bed for anyone ready to go into treatment," Beshear said to rousing applause. 

Beshear said that in his previous job, he sued "more opioid companies than any other attorney general in the country." He called the funds coming from settlements of those lawsuits "blood money" and said it must be spent in the "right way." 

"It is so critical that we use the hundreds of millions of dollars that we will receive in the right way to support recovery, to support treatment. And please lift your voice in the committee that is making decisions right now that I have grave concerns about," he said, referring to the opioid commission.

"When we haven't seen $10 million going into treatment, spending $40 million to support some company's private patent for a drug that the FDA will not and does not approve is not the way we ought to be spending these funds."

Beshear was referring to the proposal by the commission's chair and executive director, Bryan Hubbard, to spend $42 million of the settlement money for research to get ibogaine, a psychedelic drug that is anecdotally reported to stop withdrawal symptoms, approved for use in the United States.

Hubbard is an employee of, and the commission is housed in the office of, Attorney General Daniel Cameron, the Republican nominee for governor against Democrat Beshear in the Nov. 7 election.

The commission has held two full days of public hearings on the proposal, but has not acted on it. 

Beshear said at the Capitol event, "We ought to be spending to lift up the groups that are here, that do the hard work day in and day out, and you know what, save people one life at a time. It's important that we spend every single one of these dollars right, because I saw what these dollars can be. Sometimes just a little help, just a hand up, to the folks that are already doing the hard work can unlock the potential to do so much more."

Half of the money from the settlement is going to cities and counties. Van Ingram, head of the state Office of Drug Control Policy, encouraged counties to use their money to create more Recovery Ready Communities.

"All of your communities where you live are coming into the opioid abatement dollars. I submit to you that there's no better way to spend the money than to look at the things you're missing in your communities," Ingram said to a thundering round of applause. 

Dr. Steven Stack

Health Commissioner Steven Stack opened his remarks at the recovery event by reminding people that substance abuse is a medical problem, not a moral failure. 

"People do not choose to have substance-use disorder and all of the terrible things that go along with it," Stack said. "These chemicals are powerful. They alter brain chemistry. And they impair decision-making in ways that are not human failings; they are biological realities." 

Stack wrapped up by encouraging people seeking help to use one of the many resources available in Kentucky, including findhelpnowky.org; findrecoveryhousingnowky.org; the Kentucky Opioid Assistance and Resource Hotline at 1-800-854-6813, which is available 24/7; or the 988 suicide/crisis hotline. 

Medicaid Commissioner Lisa Lee told the story of her 55-year-old brother who died of an opioid overdose 10 years ago,. four months before Kentucky expanded Medicaid to anyone with income up to 138% of the federal poverty line. She said her brother didn't have insurance, so he didn't have access to substance-use-disorder treatment like thousands of people do now because of the expansion.

Lee encouraged he listeners to reach out to anyone they know on Medicaid and to ask them to make sure the state has their correct contact information so they don't lose coverage. Her agency has resumed its annual renewal process, following the end of pandemic rules that allowed continuous enrollment without contact for renewal.

"We want everyone who is eligible to be enrolled in Medicaid and stay on the program to get the services they need," Lee said. 

Five people talked about their recovery journey, with a common message to "recover out loud." 

Alex Elswick

The first was Alex Elswick, an assistant extension professor for substance-use prevention and recovery at the University of Kentucky, who is in long-term recovery.

"I want to make sure that I do the thing that I think is most important, which is that we recover out loud," Elswick said. "That we stand up without any shame, without any fear and say 'This is who I am. This is the problem that I struggled with. This is the way that I found help, and hopefully shine the light for someone else.'" 

He also said addiction doesn't discriminate, but recovery does.

"I see it every single day," he said. "We've created an artificial division between my friends who are in recovery and my friends who still struggle with active addiction," who he later added are just as deserving of access to resources and recovery capital. 

In closing, Elswick said, " We know that addiction is a chronic disorder. And what I've learned is that means it's a chronic disorder for me also. And that means that tonight when I leave here, if God forbid I return to use, I hope that there are very many pathways there for me and not just one. I hope that your response won't be to throw me in jail. I hope that your response won't be to punish me, to demand perfection. I hope you'll give me an opportunity."

State doctors' group calls for more gun control, repeal of Second Amendment 'sanctuary' law; passes resolutions on many topics

By Melissa Patrick

Kentucky Health News

The Kentucky Medical Association called mass shooting and gun violence "a public-health crisis" and called for more gun control in one of nine resolutions on the topic at its annual convention.

Voting delegates representing the state's doctors also adopted resolutions addressing sex education, abortion care and more at their meeting Aug. 25-27 in Louisville.

Kentucky has the “14th-highest rate of gun deaths” in the nation, according to one of the resolutions.

 

KMA joined several other groups in declaring the public-health crisis, in a resolution that supports "A ban of assault (semi-automatic) weapons and killing-enhancement features, including high-capacity magazines, rapid-fire increases ('bump stocks'), silencers, and guns without serial numbers ('ghost' and 3-D printed guns)."

The resolution also calls for background checks without loopholes, waiting periods and safety training on all firearm transfers (retail, internet, gun-show purchases, lending and gifts); and extreme-risk protective orders ('red flag' laws) "to disarm persons who pose risks of gun violence to self or others."

Before the convention, Alex Acquisto of the Lexington Herald-Leader talked to KMA Executive Vice President Patrick Padgett about how KMA passes resolutions and what it means. 

Padgett said the association, by definition, is an advocacy organization to promote the well-being of patients, doctors and the community at large, and the resolutions represent the consensus of an organization that represents thousands of doctors statewide. Padgett said KMA members regularly conduct grassroots advocacy with legislators about health-related bills.

The group's rules say any KMA member can propose a policy change, which is then reviewed by a group of more than 100 doctors in KMA’s House of Delegates, which votes on resolutions in deliberations that are closed to the public. KMA is a private organization, not a public agency coveregd by the state Open Meetings Act.  

Acquisto notes that the KMA's suggested firearm legislation goes against the long-prevailing views in the General Assembly. 

Other resolutions support creation of a statewide gun-safety office to reduce firearm-related deaths;  eliminating ghost-gun loopholes; supporting legislation that promotes the implementation of "domestic violence prohibition laws;" screening during medical visits for presence of guns in the home; and research and educational campaigns about firearms, including safe storage.

"Gov. Andy Beshear, a Democrat, has called for the legislature to pass  to this end multiple times since he became governor — as far back as 2019 after two mass shootings in El Paso, Texas, and Dayton, Ohio, left dozens of people dead, and again this year, after a gunman in downtown Louisville killed five people," Acquisto reports.

Such laws are not popular "in a state that has historically championed the proliferation of and freedom to possess firearms," she adds. "Beshear’s predecessor, Republican Gov. Matt Bevin, said in 2019 that red flag laws are an 'erosion of our constitutional rights' and signed" into a law a bill repealing the requirement for a separate permit or training to carry a concealed deadly weapon.

"In 2020, a bipartisan bill to enact a red-flag law in Kentucky failed to get traction," Acquisto notes. "Earlier this year, legislators enacted a law making Kentucky a 'Second Amendment Sanctuary' state."

The legislation, which Beshear allowed to become law without his signature, says local and state officials and their employees shall not "enforce, assist in the enforcement of, or otherwise cooperate in the enforcement of a federal ban on firearms, ammunition, or firearm accessories."

One of the KMA resolutions calls for Kentucky to repeal the law, saying it and one to ban local gun laws "substantially weaken protection of our schoolchildren, citizens and police officers from mass shootings and gun violence." 

Abortion resolutions

Last year's KMA meeting, two months after the U.S. Supreme Court overturned federal abortion protections, allowing Kentucky's trigger law banning abortion except to save the life of the mother to become law, "could not reach consensus to take a bold stance in opposition to state laws restricting it," Acquisto reports. 

Five abortion-related resolutions were proposed at that meeting, and most were not adopted. This year, the KMA House of Delegates passed two of three abortion-related proposals. 

The first one "supports the protection of OB/GYN residents in Kentucky to have comprehensive education and training in obstetrics and gynecology," stating that without such training, "residents will compromise the future of OB/GYN health care and failure to incorporate abortion training in the resident curriculum will lead to a generation of physicians ill-equipped to fulfill their duty to care for patients." 

The other resolution calls for "revisions to relevant state statutes that restrict access to abortion-inducing medications for women who experience underlying medical conditions concurrently with life-threatening pregnancies."

That is aimed at 2022 House Bill 3, which "prohibits doctors from providing abortion-inducing medication to patients with certain medical histories, including if they have a history of ectopic pregnancies, are taking steroid hormones for rheumatoid arthritis, or are on a blood thinner medication for a heart condition, for example," Acquisto writes.  

The resolution says “The unintended consequences of HB 3 could adversely impact women and risk their lives during a life-threatening pregnancy.” 

A resolution to support comprehensive reproductive health care for women, including the opportunity to choose a medical or surgical abortion, was not adopted. 

Transgender health care and sex education 

Acquisto reports that last year, before most Republican-controlled states "began outlawing gender-affirming care for transgender youth, KMA adopted a policy supporting access to hormones and puberty blockers, and the preservation of the doctor-patient relationship in such settings, devoid of political tampering. According to the current policy handbook, KMA 'advocates against any prohibition of physicians or other health care providers (from) socially affirming gender identity or discussing evidence-based therapies for management of gender dysphoria with their patients and their parents.' The association also supports behavioral-health options and "non-surgical treatment provided to youth by appropriately trained and experienced health-care providers."

This year, the General Assembly passed Senate Bill 150, outlawing all forms of gender-affirming medical care for trans youth, contradicting the advice of the KMA and all oyther major U.S. medical associations.

None of this year's KMA resolutions addressed gender-affirming care, but two dealt with sex and health education in direct response to SB 150. One says "KMA supports legislation to remove age limits for health education in schools."

The other says "SB 150 . . . has raised the question of whether teaching students human health-related curriculum, including puberty and menstrual health education, is permitted in Kentucky before 6th grade." It amended KMA policy to say the group opposes the sole use of "abstinence-only education by providing information about condoms, birth control, and other means of preventing pregnancy and sexually transmitted diseases," and "supports age-appropriate anticipatory education related to menstruation and puberty for elementary school students," as well as "age-appropriate sexual education in schools to include information on sexual assault, consent communication, and dating violence prevention" and "age-appropriate sexual education in schools to include reference to non-traditional (LGBTQIA) practices for safe sex, in the interests of equality and prevention of sexually transmitted disease."

The resolution says KMA "will work with appropriate agencies, including but not limited to the public-school system, to ensure that sex education is age-appropriate, evidence-based, led by well- trained individuals, and subject to periodic evaluation and improvement." 

Other resolutions 

The House of Delegates also adopted resolutions to :

• Encourage swimming lessons for children, promotion of fences around swimming pools and direct supervision of children around water by a responsible individual, amid increased focus on an increased drowning risk of children with autism.
• Encourage caution in pediatric melatonin consumption and to promote physician-led education to caregivers regarding pediatric use of melatonin. 
• Increase skin cancer prevention, noting that "from 2016 to 2020, Kentucky was in the top 10 states with incidence rates of melanoma." 
• Support efforts to educate health care professionals and the public about the frequency and severity of eating disorders and weight stigma, and stated that it supports evidence-based treatment for eating disorders and the removal of insurance barriers designed to deny or restrict such treatment. 
• Promote efforts to decrease the rate of physicians' moral injury in Kentucky, defined as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to a variety of constraints that are beyond a physician’s control.”
• Support improvements in mental health care services for the postpartum period to improve maternal and infant health outcomes; and supports advocating for funding of programs that aid postpartum depression research.
• Support use of anti-obesity medications if they are safe, effective and have a sustained impact with lifestyle modifications; and to advocate for better access to anti-obesity medications for all patients appropriately prescribed those medications.
• Urge an increase research on the safety and efficacy of Kratom and to support increased regulation on the sale and purchase of Kratom. The resolution states that while Kratom is legal to buy, sell and own in Kentucky, "The opioid and stimulant properties of Kratom make it an option for treating opioid withdrawal, but subsequently comes with risk for abuse, addiction, and overdose." It also supported a resolution to ban over-the-counter sales of Kratom in Kentucky and that it supports increased education regarding its misuse and negative health effects.
• Encourages and support expanding representation of darker skin tones in medical education, especially in printed texts and textbooks. 

Click here for a list of the adopted resolutions and for the "Kentucky Medical Association Gun Violence and Firearm Safety Work Group Report to the 2023 KMA House of Delegates."

The pandemic is over; now Covid-19 is endemic, but is still a leading cause of death. When we will stop treating it differently?

Many resist wearing masks, but they work. (CBC photo)

As new coronavirus variants make the headlines and Covid-19 hospitalizations are are on the rise, experts told Carolyn Y. Johnson of The Washington Post that this is the new normal in a world where Covid is now considered an endemic disease. 

This, Johnson writes, is prompting people to ask when we can stop treating the novel coronavirus differently from other common respiratory diseases. 

Experts in Kentucky and elsewhere say the answer will vary, "depending on people’s individual tolerance for risk and the changing landscape of variants and boosters," Johnson reports. 

"Doctors have little to offer people who are stricken by the constellation of lingering symptoms known as long covid. Vigilance is still required to protect high-risk people, including those who are older or who have compromised immune systems." 

Covid-19 was the No. 4 cause of death in the U.S. in 2022, behind heart disease, cancer and unintentional injury. And many Americans and Kentuckians continue to suffer from "long Covid," lingering effects of the disease.

“The newer people [just diagnosed] with long Covid are really angry,” Hannah Davis, a co-founder of the Patient-Led Research Collaborative, who has long Covid, told Johnson. “Everyone’s been told the pandemic is basically over, the risk is basically over if you are vaccinated.”

All that said, public-health experts told Johnson that there is a middle ground between living in fear of the virus and ignoring its existence. And, she writes, this is especially true since we have widespread immunity, and tools such as masks, testing, treatments, updated boosters and improved ventilation. 

Also, she writes, "Many public-health experts also hope that our concept of normalcy will shift, and that habits people learned to guard against Covid — such as staying home when sick and putting on a mask in high-risk situations — will become muscle memory," done with little thinking. 

One challenge is that with the end of the public-health emergency in May, federal policies that had made Covid markedly different from other diseases — such as the government footing the bill to buy vaccines, tests and treatments for everyone — ended, Johnson notes. And with reporting requirements fading away, cases have become harder to track. Instead, experts look to other metrics, like wastewater sampling and hospitalizations, which have been rising since July. 

Scott Lockard

Johnson spoke with Scott Lockard, health director for the Kentucky River District Health Department, which serves seven counties, about the increase of Covid in Eastern Kentucky. 

Lockard said he’s seen a jump in employers calling for guidance when a worker tests positive for Covid, and noted thatg Lee County schools shut down for a few days in August because they were seeing so many absences due to respiratory illness. And the disease is even hitting Lockard's staff.

“Pretty much, my message is: If you’re in a mass gathering, you’re likely to come in contact with someone who has Covid right now in our area,” he said. “So protect yourself accordingly.”

Lockard went on to encourage eligible people get a booster shot, and he advised people to stay home when sick, and test when they have symptoms. He also acknowledged "a great reluctance" to use masks, but reminded people that they work, generally preventing severe Covid and hospitalzation.

Johnson writes, "Even as health experts urge people to stay calm but alert, many argue that we need to continue to treat Covid differently from seasonal flu or the common cold for a few reasons." But others told her that we still don't know what to expect from the virus so it's important to remain cautions. Added to that concern, one expert told Johnson that as we become more complacent about Covid-19, we may have lost "our barometer" for knowing when to worry.

At the time Johnson wrote the article, the White House had not announced that it was relaunching its free Covid-19 test program, allowing every household to order up to four free tests through the mail. Orders can be placed at COVIDTests.gov starting Sept. 25. The tests will be delivered without charge.

Federal government relaunches free, at-home Covid-19 tests, to be available Monday, Sept. 25, for up to 4 tests per household

CDC photo

Kentucky Health News

The Biden administration announced Wednesday that it is providing $600 million to make new at-home tests for Covid-19 and relaunch the program that allows Americans to order up to four free tests per household through the mail.  

The Department of Health and Human Services says in a news release that orders can be placed at COVIDTests.gov starting Sept. 25. The tests will be delivered for free by mail.

"These tests will detect the currently circulating COVID-19 variants, are intended for use through the end of 2023, and will include clear instructions on how to verify extended expiration dates," says the release.

The funding will go to 12 manufacturers in seven states that will produce 200 million new over-the-counter Covid-19 tests. 

“Manufacturing Covid-19 tests in the United States strengthens our preparedness for the upcoming fall and winter seasons, reduces our reliance on other countries, and provides good jobs to hardworking Americans,” Assistant Secretary for Preparedness and Response Dawn O’Connell said in the release. The Administration for Strategic Preparedness and Response's "investments in these domestic manufacturers will increase availability of tests in the future.”

HHS Secretary Xavier Becerra added that this investment will address "vulnerabilities in the U.S. supply chain by reducing our reliance on overseas manufacturing" and will "help mitigate the spread of the virus." 

The initiative follows four previous rounds of free tests where federal officials and the U.S. Postal Service provided more than 755 million tests for free to homes nationwide.

Covid-19 cases and hospitalizations have been on the rise in Kentucky and the U.S. since July, though the numbers are far below where they were during the peak of the pandemic.

Kentucky had 54 Covid hospital admissions per 100,000 residents in the last seven days and 10 reported deaths during the week of Sept. 3 to Sept. 9, according to The New York Times Covid-19 tracker, which uses Centers for Disease Control and Prevention data. 

O'Connell told Will Weissert of The Associated Press that home testing remains a key way to slow the spread of new cases. 

“Whether or not people are done with it, we know the virus is there, we know that it’s circulating. We know, if past is prologue, it’ll circulate to a higher degree and spread, and cases will go up in the fall and winter seasons,” O’Connell said. “Anticipating that that would be true again, or something similar, we want to make sure the American people have these tools.”

O’Connell told Weissert that the website is scheduled to receive orders through the holidays, but could stay open longer if there is an increase in cases. "At this point, our focus is getting through the holidays and making sure folks can take a test if they’re going to see Grandma for Thanksgiving," she said. 

Weissert reports, "It is also meant to complement ongoing federal efforts to provide free Covid tests to long-term care facilities, schools, low-income senior housing, uninsured individuals and underserved communities which are already distributing 4 million per week and have distributed 500 million tests to date, the department said."

WellCare of Kentucky, a manager of Medicaid, honors nine Kentucky health heroes with Community Health Champion awards

Front row, from left: Matt and Jennifer Westwood, Chelsea Ryann’s Festival of Hope; Christy Hinton, River Valley Behavioral Health; Faith Fountain, Ramey-Estep/Re-group; Sonja Grey, Exploited Children’s Help Organization; Stacy Kuhn, Farmstead, Inc. Back row, from left: Katina Hayden (overall winner), Catholic Charities of Owensboro; Dustin Bowman, Frankfort Police Department; Tiffany Riley, Kentucky Care; Corey Ewing, WellCare plan president; Dr. Key Douthitt, Breathitt County Long-Term Recovery.

Kentucky Health News

WellCare of Kentucky, one of the companies that manages Medicaid coverage for the state, honored nine people as "community health champions" for their efforts to improve the physical and mental well-being of Kentuckians.

 

Gov. Andy Beshear spoke at the Wednesday event, recognizing the health-care professionals who work to improve the quality of life in Kentucky’s communities through service, volunteerism and advocacy.

"All of this year’s nominees are integral partners in supporting the well-being of Kentuckians, and I am proud to be a part of this ceremony honoring their efforts," said Beshear. "Thank you to WellCare of Kentucky for continuing to recognize those who go above and beyond in helping their neighbors."

The statewide award was presented to Katina Hayden, director of case management of Catholic Charities of Owensboro.

Hayden's nomination by her peers said she played a crucial role in managing recovery efforts from the tornados that ripped across Western Kentucky in July, and helped the most marginalized Kentuckians recover from the natural disaster, a nws relese said. Hayden provided assistance to more than 4,000 survivors through her tireless work, helping to provide hope to 14 counties.

“Katina represents exactly the type of service, commitment, and passion that we want to support in Kentucky,” WellCare Plan President Corey Ewing said. “We know that people like her help make Kentucky communities healthier.”

The 2023 Regional Community Health Champions, by Medicaid region, are: 

Region 1: Tiffany Riley, Kentucky Care community health worker, for her "remarkable" impact on the lives of homeless individuals with physical and mental health problems. She was also recognized for her work as a lead facilitator at Western Kentucky Situation Table, connecting people at risk with essential resources. "Thanks to her valiant efforts, countless individuals who often slip through the cracks have been provided medical, dental, vision, and behavioral health services," says the release.

Region 2: Christy Hinton, River Valley Behavioral Health 988 mental-health first responder, for putting in up to 70 hours a week, and her volunteering for New Beginnings and her local church. "But her commitment does not stop there. Hinton goes above and beyond for everyone she meets, always having a smile on her face," says the release. 

Region 3: Sonja Grey, Exploited Children’s Help Organization, for her dedication to preventing and reducing child abuse through education, advocacy and support services in Louisville. It also says she actively partners with non-profit organizations, schools, and youth-serving organizations while serving in multiple leadership roles, with more than 15 years of experience in leading nonprofit organizations and for-profit businesses "Grey is extensively involved in the community, serving on multiple task forces and advisory councils for organizations like Kosair for Kids-FaceIt Movement campaign and Jefferson County Public Schools," says the release.

Region 4: Stacy Kuhn, Farmstead Inc., for her work as a volunteer providing pro bono equine-assisted psychotherapy to veterans. "Kuhn, a trauma survivor, holds multiple licenses in counseling. Her unique qualifications and personal journey make her the perfect advocate for our veterans," says the release.

Region 5: Dustin Bowman, Frankfort Police Department, for his work in addressing substance abuse treatment and prevention, and understanding that arresting people is not a long-term solution. "Bowman is involved in school activities, substance abuse prevention initiatives, and organizations addressing homelessness and affordable housing. Chief Bowman has secured grants for collaborative efforts between law enforcement and service organizations," says the release.

Region 6: Matt and Jennifer Westwood, Chelsea Ryan Festival of Hope, for their efforts to spread awareness about mental health, having "turned their pain into purpose," the release says. "After their daughter's tragic suicide, they dedicated themselves to helping the students at Lloyd Memorial High School. Through their fall festival, Chelsea Ryann Festival of Hope, they not only raised funds but also spread awareness about mental health. It is a joyful event where the community comes together, and mental health resources are readily available. Every year, they raise an average of $10,000, which helps the counselors bring in outside help for students in need." 

Region 7: Faith Fountain, Ramey-Estep/Re-group, for her work to better people's lives. She joined the organization as a youth support specialist in 2012 and has worked with more than 200 young people. "Faith is a passionate advocate for diversity and inclusion within the community. She serves on several community action boards, working to ensure equitable representation and opportunities for all. Faith initiated programs such as free ordainment ceremonies, fostering inclusivity and supporting individuals from various backgrounds," says the release.

Region 8: Dr. Key Douthitt, Breathitt County Long-Term Recovery Team, for his work as the medical director of the North Fork Valley Community Health Center, where he played a pivotal role in in helping rural communities during the flood of 2022. According to the release, "He organized door-to-door medical teams to hit the hardest affected areas across Breathitt, Knott, Perry and Letcher counties. He coordinated 13 teams and administered over 2,500 tetanus vaccines. Dr. Douthitt also established a hotline for flood-related medical needs. Furthermore, he also helped replace lost medications for those in shelters at Wolfe and Perry counties."

Now is the time to get vaccinated or re-vaccinated for Covid-19, as the weather cools and people spend more time indoors

University of Kentucky photo

By Vince Venditto
University of Kentucky

As the weather gets colder and gatherings move indoors, vaccines remain the safest and most effective way to protect ourselves from Covid-19.

On Sept. 11, the Food and Drug Administration approved the updated mRNA Covid-19 booster vaccines to align with the currently circulating variants. The vaccines are recommended for everyone six months and older to protect against the serious outcomes of Covid-19.

Vaccines are free to most people in the U.S. who have health insurance, and available for free to everyone through local health centers, or participating pharmacies. Here are questions and answers :

Is COVID-19 still with us? The virus that causes Covid-19 is still circulating, causing increased rates of hospitalization in several counties in our region. Nationally, there was about an 8% increase in hospitalizations and 5% increase in deaths last week. As the weather gets colder and more people gather indoors, it is likely that the infection rate and hospitalizations will continue to increase. It is important to remain mindful of yourself and others for the potential risk of infection with SARS-CoV-2, flu, and RSV (respiratory synctial virus).

Isn’t the virus getting weaker and not making us as sick? It is true that there are lower rates of hospitalization and death from the virus, compared to the peak of the pandemic, but this is due mostly to the immune response after vaccination and infection. New variants of the virus continue to emerge with changes that sometimes lead to increased risk of infection, increased severity, or ability to avoid our immune system. Vaccination remains the safest method to protect ourselves from severe disease.

Do we still need vaccines? Vaccination is the second most important public-health intervention, only behind clean drinking water. The vaccines are designed to improve our immune response to fight a potential infection, and the new vaccines are designed to provide improved immunity against the virus that is currently circulating, which aligns with how the flu vaccines are developed each year. As the virus continues to change, new vaccines become necessary to target the virus that we are most likely going to be exposed to.

What’s different with the new vaccine? The new mRNA vaccines are based on the XBB.1.5 variant and closely related to other currently circulating variants. While previous vaccines and boosters were effective at inducing robust immunity, the new vaccines align better with the variants that are currently circulating to provide an additional boost to our immune system. The other change to this vaccine is that it is monovalent – meaning there is only one variant included. The prior booster consisted of two variants and the new vaccines provide a more focused immune response on what is currently circulating. Currently, only the updated mRNA vaccines from Pfizer and Moderna have been approved and an alternative vaccine from Novavax is currently under review by the FDA.

When should I get the vaccine? It is recommended that Covid-19, flu, and RSV vaccines be obtained in the fall, around late September and early October. All three vaccines can be given during the same visit or spaced out over three different visits. The biggest benefit of getting all three at the same time is convenience.

Vince Venditto, Ph.D., is an assistant professor of pharmaceutical sciences in the University of Kentucky College of Pharmacy.

90% of for-profit nursing homes would need more staff to meet proposed rules; 60% of others would, KFF Health News estimates

KFF Health News graph; individual estimates for staffing by RNs and aides are in the story.

Kentucky Health News

For-profit nursing homes would have to hire more staff to meet proposed federal rules than other nursing homes would, according to an analysis by KFF Health News, a service of the Kaiser Family Foundation.

"90% of for-profit facilities would need to hire additional nursing staff, compared with 60% of non-profit and government facilities," says the analysis by Alice Burns, Priya Chidambaram, Tricia Neuman and Robin Rudowitz.

In Kentucky, about two-thirds of nursing homes are for profit, and only 21% of all homes meet the proposed standard, which is about the same as the national figure of 19%, KFF Health News estimates.

The Centers for Medicare and Medicaid Services has proposed that nursing homes employ registared nurses for at least 0.55 hours per resident per day, and nurses' aides for at least 2.45 hours per resident per day. The rule would also require facilities to have an RN working at all times.

"CMS is seeking comment on several alternatives to the proposed rule, one of which would require facilities to comply with requirements that were adjusted to reflect the health and frailty of nursing facility residents," KFF Health News notes. "Assuming this alternative was implemented using CMS’ existing approach for adjusting staff hours for resident health and frailty, virtually all facilities would need to hire new staff to meet the requirements."

Nursing homes say some of them might have to go out of business because they already have big problems finding enough nurses and nurses' aides. To address that concern, the rules would be phased in, with some differences for rural and urban nursing facilities.

The first phase, starting 60 days after publication of the final rule, would require facilities to "assess the needs of each resident, include input from nursing facility staff and residents’ families or legal representatives, and develop a plan to meet required staffing levels given residents’ needs," KFF notes.

Two years after publication, urban nursing homes would need round-the-clock RNs. For rural nursing homes, that would occur three years after publication. After that, the rules for number of nursing hours per resident day would kick in.

The proposed rule would allow nursing hoems to have less staffing if they are "at least 20 miles from the nearest nursing facility, or in an area with workforce unavailability (defined as having a provider to population ratio that is at least 20% lower than the national average)," KFF notes. "Nursing facilities would also have to demonstrate good faith efforts to hire and retain staff and a financial commitment to staffing by reporting the total amount of money spent on direct care staff." They could not get such exemptions "if they had any staffing-related violations" or had been designated as a Special Focus Facility "with a history of serious quality issues."

KFF explains, "Nearly half of facilities meet the RN requirement (52%) but only 28% meet the nurse aide requirement. . . . When looking at ownership of facilities that meet the RN requirement, a larger share of non-profit facilities would meet the 0.55 standard than for-profit and government facilities (75%, 44%, and 61%, respectively). When looking at nurse aides, about half of non-profit and government facilities meet the minimum staffing levels, compared with only 20% of for-profit facilities."

However, "If the proposed staffing levels were enforced after accounting for resident health and frailty, virtually no nursing facilities would meet the requirements in the proposed rule," KFF estimates.

And what about the workforce shortage? "As of June 2023, employment levels were still more than 11% below pre-pandemic levels for workers in skilled nursing care facilities and 3% below pre-pandemic levels for workers in elderly care facilities," KFF reports. "Although fewer facilities would need to hire new RNs, those that do may find it difficult to compete with hospitals, many of which are also trying to increase the number of RNs they employ. To the extent that many nursing facilities receive hardship exemptions on account of workforce shortages, the effects of the proposed rule on minimum staffing levels will be muted."

CMS estimates that the proposed rules would cost nursing homes $40 billion in the first 10 years after the final rule takes effect. "Such costs are likely to be passed on to public and private payers for nursing facility services, including residents and their family members who paid $45 billion in out-of-pocket costs for care in nursing homes" and other long-term care in 2020. "Medicaid spent nearly $53 billion in that year, about twice the amount ($26 billion) that traditional Medicare spent on skilled nursing facilities in 2020, and although Medicaid financing is shared by the state and federal governments, all states except for Vermont must meet balanced budget requirements."

Changing positions, Cameron says he would sign legislation to add rape and incest exceptions to Ky.'s near-total ban on abortion

By McKenna Horsley
Kentucky Lantern

Republican gubernatorial nominee Daniel Cameron said Monday that he would sign legislation allowing exceptions to Kentucky’s near-total abortion ban in cases of rape and incest — a departure from his past statements about the law.

“If our legislature was to bring legislation before me that provided exceptions for rape and incest, I would sign that legislation. There’s no question about that,” Cameron said on the "Tony & Dwight" show on WHAS Radio.

Daniel Cameron (File photo)

It’s the first time Cameron, Kentucky’s attorney general, has publicly expressed support for adding any exceptions to the abortion ban.

During a Republican primary debate in Louisville, Cameron was among candidates who signaled support for the law that bans abortions up to six weeks of pregnancy. Another law bans all abortions except in cases of threat to the woman's life. The laws took effect last summer when the U.S. Supreme Court overturned its 1973 Roe v. Wade decision that created a constitutional right to abortion.

The attorney general’s website says: “General Cameron is a fearless advocate for the unborn because every life is worth protecting. Inside the courtroom and outside of it, Daniel Cameron is the tip of the spear in the fight to preserve a pro-life Kentucky.”

A spokesperson for the Beshear campaign, Alex Floyd, issued this statement: “Throughout his time in office, even before this campaign began, Daniel Cameron has made it clear that he supports Kentucky’s extreme abortion ban with no exceptions for survivors of rape or incest. He has repeated that position in public statements, questionnaires, press interviews, and debates. As attorney general, Cameron repeatedly defended this extreme law with its lack of exceptions in front of multiple courts, including the Kentucky Supreme Court. Either recent polling numbers have changed Cameron’s core beliefs, or he is lying to Kentuckians now that he is seven weeks from an election.”

Also on the radio show, Cameron pushed back at a Behsear attack ad that faults Cameron’s previous stance on abortion. The TV spot features a Jefferson County prosecutor who claims Cameron believes nine-year-old rape victims “should be forced to give birth.” Cameron said the ad was part of a “smear campaign.”

Nine was the age of the two youngest abortion recipients in Kentucky in 2021 and 2022. In 2021 in Kentucky, 34 girls ages 15 or younger received abortions,

Beshear generally favors abortion rights but says the ban should have exceptions for pregnancies resulting from rape and incest. In a December interview with the Kentucky Lantern, he said the Republican-dominated General Assembly had “given rapists more rights than their victims.”

Republican  Rep. Jason Nemes of Louisville filed a bill in the last legislative session to put rape and incest exceptions in the law. The bill was never assigned to a committee in the House, where he is majority whip, or assistant floor leader.

A spokesperson for the Beshear campaign said of Cameron’s latest comments.“Either recent polling numbers have changed Cameron’s core beliefs, or he is lying to Kentuckians now that he is seven weeks from an election.”

The WHAS interview also touched on Cameron's response to a Northern Kentucky Right to Life questionnaire earlier this year, to which he said “yes” to all questions including: “Will you actively support (and if in a position to do so, sponsor and vote for) legislation which prohibits all use of local, state, federal, and/or Medicare or Medicaid funds for abortion (including chemical abortions, such as RU-486, or the so-called “morning after pill,” Norplant, Depo Provera, or the so-called “standard birth control pill”)?”

Cameron said on the radio he supports birth control and contraception and wrote off the idea of him not supporting either as “completely absurd.”

At opioid panel's final hearing, Ben Chandler leads endorsers of funding research into psychedelic drug as treatment for addiction

By Melissa Patrick
Kentucky Health News

Twenty-three people spoke in favor of funding the development of an opioid-use disorder treatment using the psychedelic drug ibogaine with some of the state's opoid-settlement money at the Kentucky Opioid Abatement Advisory Commission's second and final public hearing on Friday, Sept. 15.

Ben Chandler (File photo)

Foundation for a Healthy Kentucky President and CEO Ben Chandler, a former Kentucky attorney general and five-term congressman, opened the meeting by saying that he had seen this problem from almost every angle.

Chandler spoke of a first cousin's addiction to opioids and other drugs and at least 15 failed attempts at recovery, having gone to "about every rehab center that you could go into of any note in this country." At age 30, the cousin "put a bullet to his head" and died. "He was like a brother to me."

Then his real remaining brother, Matthew Chandler, died of a fentanyl overdose in January. Ben Chandler said his brother sought illegal opioids to manage his pain because he wasn't able to legally obtain the pain medications he thought he needed, and he had been addicted to opioids for "probably 15 years." 

Chandler also talked about the surge of Oxycontin in Eastern Kentucky in the late 1990s, when he was attorney general, and his efforts to combat it, then about his time in Congress and the "enormous sums of money" spent to address this problem.  

"The bottom line to me is, despite the best efforts of so many people working on this problem for so many years -- and I mean that, they work their tails off, and they care deeply -- we have been unable, in my judgment, to solve this problem," he said. "It continues to be intractable, and we need as many tools as we can get.

"And I believe that a drug like ibogaine, from what I have read, it has the potential to make the difference that we need to have made, or at least a big difference. It's a tool that we can give the people who are working in the trenches, which will give them the opportunity, maybe, to break this cycle of addiction and actually save quite a number of lives. And I endorse anything that we can do to get that done." 

Most speakers and Opioid Abatement Advisory Commission staffers
at the Sept. 15 public hearing to discuss the psychedelic drug ibogaine
gathered for a group photo after the meeting. (Photo by Melissa Patrick)

Chandler said the proposed $42 million to fund this proposal, about 5 percent of the settlements with opioid makers and distributors, "is a drop in the bucket, compared to what has been spent over the years to try to deal with this problem. And spent quite frankly, to a large extent, unsuccessfully. We have successes, but we have a whole lot of failures. And I've seen those failures in my family, both my cousin and my brother, in and out of facilities, strong efforts to try to break the chain of addiction, both of them no longer with us." 

Ibogaine is illegal in the U.S. but has been anecdotally reported to stop the withdrawal symptoms of opioid dependence. The $42 million expenditure, to help get ibogaine federal approval in the next six years, was proposed by Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor. 

Dr. Joseph Barsuglia, a clinical psychologist and ibogaine researcher who also provided a long list of professional connections to ibogaine, talked about the first time he witnessed an opioid detoxification with ibogaine in 2015. 

"I could not believe my eyes," he said. "To witness a patient with the most severe and chronic addiction you can imagine on death's doorstep undergo a 48-hour process and come out calm, connected, with a new radiance in their eyes and really wanting to live -- this is a miracle in the truest sense. With ibogaine, this is not a rare occurrence, this is the norm."

Barsuglia said ibogaine works for opioid-use disorder because it "rapidly alleviates opioid withdrawal and cravings and promotes lasting sobriety in a manner that is superior to opioid-maintenance therapies," and because "It induces dreamlike visions that increase insight into the causes of one's addiction, which can lead to durable psychological change." 

He said studies show that "ibogaine simultaneously targets addiction and craving to multiple substances, including alcohol, methamphetamines, cocaine and nicotine -- not just opioid use disorder," which is important because over half of opioid-use disorder patients are addicted to multiple substances.

Also, he said ibogaine is "fast acting and has durable outcomes." He said it takes 12 months to break opioid dependence with methadone and 12 hours with ibogaine. He added, "It reduces anxiety, improves mood, does not require ongoing burden on the medical system and has little potential for abuse."

The major objection to legalizing ibogaine are its risks to the heart. Barsuglia said that can be mitigated under a carefully controlled environment.

"I believe funding ibogaine research for opioid use disorder is perhaps one of the most obvious and necessary decisions that can be made in the history of addiction medicine," he said. 

Several speakers gave personal testimonies about their experience with ibogaine, with a recurring message that it not only healed them physically, but also spiritually.

Paria Zandi, a licensed marriage and family therapist in California, said she describes her life as two distinct chapters, "pre-ibogaine and post-ibogaine," and has been free of her opioid addiction for 10 years. 

"Through an intense 24-hour treatment, I emerged feeling reborn," she said. "Not only did I escape the clutches of the physical withdrawal symptoms and cravings, but I also began to relive some of the traumas in my life and gained a newfound perspective. I saw myself as someone of immeasurable worth, and a child of God. I experienced a profound sense of aliveness and connectedness that had eluded me until that moment." 

Zandi added that ibogaine is not a "cure-all" and if it is ever approved will need to be combined with social services, support systems and education. "We urgently need innovative approaches to addiction treatment, such as ibogaine," she said. 

Navy SEAL veteran and ibogaine patient Tommy Aceto told the commisison, "It wasn't just a medicinal treatment. It was a deep dive into my subconscious, self-forgiveness and most importantly, self-love."

Reed Madison, a parent of an ibogaine patient, said of his son, "The reason he went to an ibogaine clinic is because ibogaine offered him a solution for addiction interruption without withdrawals. . . . So I feel incredibly lucky that I learned about ibogaine at the time to help give my son a way out of his addiction problem before it was too late. I think there's a pretty good chance he may not be alive today had ibogaine not been available to him." 

In closing, retired Marine Corps Lt. Gen. Martin Steele, CEO of Reason for Hope and the president of the Veterans Mental Health Leadership Coalition, called on the commission to vote unanimously to fund the ibogaine initiative. 

"Our nation owes its citizens a viable alternative to something that's not working. You have it here in Kentucky, you have this moment in history, this moment in time," he said. "To conclude, I implore each and every member of the commission to support this initiative. A unanimous vote will send a message that will resonate loudly, nationwide."

Asked what was next, Hubbard told Kentucky Health News, "I think every commission member needs to take a little while to think over everything that they have heard. It's a tremendous amount of information to absorb that's been presented between May 31 and now we sit here on Sept. 15. And I think after some due diligence individually and collectively at some point, within some months, we'll be ready to put a vote on the agenda."