Friday, June 18, 2021

Kentucky ranks low in vaccinations of nursing-home employees

Centers for Medicare and Medicaid Services graph, adapted by Ky. Health News; click it to enlarge
Employees providing care at Kentucky nursing homes are among the least likely in the country to be vaccinated against the coronavirus, which has killed almost 2,500 people in those nursing homes.

The extent of the problem could be worse, because only about a third of the state's nursing homes have reported vaccination figures to the Centers for Medicare and Medicaid Services, which pays most of their costs and regulates them.

The latest update of the database, June 17, showed that 45.09 percent of the health-care employees at reporting nursing homes had been fully vaccinated for the virus. That was ninth lowest among the states.

Sherry Culp, state government's long-term-care ombudsman, told the Lexington Herald-Leader, “My concern is that having staff who are not vaccinated coming into these places every day and working in close proximity with residents could increase the incidence of Covid once again.”

Culp noted that 78% of nursing-home residents are fully vaccinated, and Herald-Leader reporter John Cheves notes that the homes had only 13 active cases in Wednesday. But he notes, "The state already saw one tragedy this year," at a nursing home in Morehead, "when an unvaccinated worker brought in the virus and infected 46 people. Three people died, including a vaccinated resident."

A study of the outbreak found that it was caused by a mutated variant of the virus. Health experts warn that unvaccinated people are breeding grounds for more variants, which can be more contagious and/or more deadly. Current vaccines seem largely effective, but the Delta variant that is 6 to 10 percent of U.S. cases and is expected to become dominant requires two doses of Pfizer vaccine to be suppressed. One dose is only 33% effective, research indicates.

Nursing homes say they don't want to require shots, for fear of losing employees at a time when the workforce is tight. They also cite "skepticism about the safety and effectiveness of the vaccine, particularly for women of child-bearing age" and the belief that they are immune to the virus because they have been exposed to it, "an assumption that is not always accurate," Cheves writes.

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the state nursing-home trade group, told Cheves, “The most successful strategies that we have seen are personal discussions with mentors, colleagues and experts to dispel fears and mistruths. Businesses are choosing to use approaches that are friendly and less forceful to manage those who are reluctant of the government. We continue to push vaccine efforts and are hopeful to see an increase among our front-line workers.”

At Cumberland Valley Manor in Burkesville, where only 23% of health-care workers are fully vaccinated, Administrator Mary Beth Shelton told Cheves, “We’re giving them the facts, we’re giving them the statistics. I’ve personally had the vaccine and I’ve had no side effects, and I talk about that.”

Shelton said the reason she hears most from employees for not getting vaccinated “is that it’s new on the market and it’s not FDA-approved yet, so they have doubts about it.” The Food and Drug Administration has approved three vaccines for emergency use and is expected to give at least one full approval this fall.

Most nursing homes are owned by chains. "Culp says she has spoken to Kentucky nursing home administrators who are privately advising their facilities’ corporate owners to consider making vaccination mandatory for employees, Cheves reports, and a federal judge in Texas has ruled that they can.

But in rural places like Burkesville, requiring vaccination is not practical, Shelton told Cheves: “I would hate to lose anybody because of that. The reality of the situation is that it’s just not doable in our setting, especially in rural areas where we fight for staff. It’s just not possible for us.”

One thing nursing homes will feel compelled to do, starting June 20, is report their vaccination data. On that date, CMS says “Failure to meet these new reporting requirements will result in a [penalty] starting at $1,000 for facilities with no previous occurrences of noncompliance.”

KET program, airing Monday night and online afterward, explores how to die a better death, with a focus on palliative care

The World Health Organization describes palliative care as
"an approach that improves the quality of life of patients and
their families facing the problems associated with life-threatening
illness, through the prevention and relief of suffering by means of
early identification and impeccable assessment and treatment of
pain and other problems, physical, psychosocial, and spiritual."
A Kentucky Educational Television program will examine some moral questions surrounding death, including how to approach medical treatment when you are at the end of your life. 

The program "Horizon: How to Die a Better Death," is presented by Dr. Kevin Fong, who explores what it means to die a better death and shows how palliative care, when done right, can help individuals achieve that goal by shifting the focus from cure to care.   

Fong talks to medical professionals and people who are near the end of their lives and explores how individuals should approach medical treatment when they are dying.

The documentary will air at at 9 p.m. ET and 8 p.m. CT Monday, June 21; and 4/3 p.m. Thursday, June 24 and Sunday, June 27 at 4/3 p.m. KET program are also available at www.ket.org.

Thursday, June 17, 2021

Some Kentuckians say ticks are worse than ever; experts can't say that, but offer ways to protect yourself from tick-borne illness

By Melissa Patrick
Kentucky Health News

Some Kentuckians are saying ticks are more plentiful than ever this year. Some states are having one of their worst tick seasons ever, but it's too soon to declare that definitively for Kentucky, largely because the state has only been doing tick surveillance for about three years. 

"In a couple more years, [we'll] have a clear understanding of how ticks and tick-borne disease dynamics are shifting and changing through time so that we can understand how to best protect the public and understand what kind of diseases are of concern and how to best control ticks," said Anna Pasternak, a graduate researcher of ticks at the University of Kentucky.

Lone Star ticks on Anna Pasternack's wrist (photo provided; click to enlarge) 
Pasternak is part of the Kentucky Tick Surveillance Program, which has been collecting information on ticks in the state since January 2019. 

That said, Kentucky provides a perfect home for ticks, with its warm, humid summer days, an abundance of  wooded, leafy areas in both rural and urban places, and plenty of hosts to feast upon, she said. And though they are most prevalent in the summer, in Kentucky, she said, "It's always tick season."

Kacy Tongate of Lebanon Junction told Alexis Mathews of Louisville's WLKY-TV in May that he thought ticks are worse than usual this year and one had given him Rocky Mountain spotted fever. 

“We can walk to the mailbox down the gravel driveway and come back with ticks on us,” said Tongate. “They fall out of the trees, they're in the grass; they just keep getting worse every year, it seems."

Pasternak said the best way to minimize your risk for tick-borne disease is prevention, which includes things like spaying your clothes, shoes, socks and hats with an insect repellent like Permethrin before heading outdoors, and doing regular tick checks throughout the day.

"The first line of defense that you have against ticks and tick-borne disease is making sure they don't get on you or your pets or children," she said. 

And if you do get bitten, she said it's important to remove the tick properly, grasping it as close to the skin as possible with a pair of tweezers and pulling it straight out with gentle, even pressure. 

She cautioned that an embedded tick will offer some resistance when you try to remove it, but it will let go after a few seconds. "You are much stronger than the tick," she said.

She said many of the home remedies used to remove ticks end up agitating them, which causes it to vomit its gut contents, which is where the disease-causing agents reside, into your bloodstream. "You don't want to speed up the disease process," she said.

Pasternak also encouraged Kentuckians to take a picture of the tick or to save it in alcohol or nail-polish remover to help your health-care provider make a diagnosis if you have symptoms of a tick-borne illness. She said this is important, since symptoms may not show up for week after the initial bite. 

Ways to protect yourself from ticks are:

  • Avoid grassy, wooded and leaf-covered areas
  • Keep grass and shrubs trimmed and cleared away
  • Walk in the center of walking trails
  • Wear light-colored clothes, which make it easier to spot ticks
  • Wear long pants tucked into boots and tuck in your shirts
  • Use tick repellent that has the repellent DEET or picaridin
  • Treat your clothes with permethrin, which repels and kills ticks
  • Do a body check along the way and at the end of each day
  • Check your pets and equipment for ticks
  • Shower within two hours of potential exposure, if possible
Pasternak said you can run a lint roller over your clothes and exposed skin to locate very small ticks. 

"The smaller ones, I think, pose a little more danger than the adults, because they are so small that a lot of people don't notice them until they've been attached for a day or two," she said. 

To kill ticks on clothing, tumble dry for 10 minutes or wash them in hot water. If clothes can't be washed in hot water, tumble dry for 90 minutes on regular heat or 60 minutes on high.

Tick species and the diseases they carry

The most common tick-borne diseases in Kentucky are Rocky Mountain spotted fever, Lyme Disease and ehrlichiosis, which causes fever and muscle aches.

Reported cases of the diseases are relatively low in Kentucky, but Pasternak said, "There is a big issue with tick borne diseases being under-reported." 

University of Kentucky graphic; for a larger version, click on it
In Kentucky, the American dog tick and the brown dog tick can carry and transmit the bacteria that causes Rocky Mountain spotted fever. 

Signs and symptoms of RMSF are fever, headache, nausea, vomiting, stomach pain, muscle pain, lack of appetite and a spotted rash. The rash usually develops several days after the onset of a fever and can vary between splotches and smaller pinpoint dots. 

The Lone Star tick caries the bacteria that causes ehrilichiosis. 

Signs and symptoms of ehrilichiosis are fever, headache, chills, cough, malaise, muscle pain, nausea, vomiting, diarrhea, confusion and red eyes. A rash is common in children, but less so in adults. 

The Lone Star tick is also a vector for alpha-gal syndrome, known as the red-meat allergy, which is becoming increasingly more common

In Kentucky, the blacklegged tick, which is commonly called the deer tick, carries the bacteria that causes Lyme disease. 

Signs and symptoms of Lyme disease include fever, chills, headache, fatigue, muscle and joint aches and swollen lymph glands. In addition, upwards of 80% of infected persons have a distinctive "bull's eye" rash that appears at the site of the bite three to 30 days after infection. 

A Centers for Disease Control and Prevention study released in February estimated that the average number of people diagnosed with Lyme each year in the U.S. in 2010-18 was 45 percent higher than those diagnosed in 2005-10. Kentucky reported 22 cases of Lyme disease to the CDC in 2019.

Coronavirus vaccinations being delivered at an increasing rate; Beshear says state incentives are helping, not sure how much

Washington Post graphic, adapted by Ky. Health News; interactive chart and methodology are here.

By Al Cross
Kentucky Health News

Vaccination for the coronavirus is on the rise in Kentucky, as the state's seven-day rolling average of daily shots has risen to more than 16,500 after falling below 10,000 per day two weeks ago.

At his first regular non-pandemic press conference yesterday, Gov. Andy Beshear said more than 437,000 vaccinated Kentuckians had signed up for lottery-style sweepstakes drawings for three $1 million prizes and 15 postsecondary education scholarships.

Asked how much impact he thought the incentives were having, Beshear said they are having an effect, but "I admit it's hard to tell how much of an impact they're making, because we don't know how many people would be signing up otherwise."

He said he would like to see more vaccinated 12-to-17-year-olds enter the scholarship drawing than the 23,080 who have signed up. He said the state is doing better among adults that Ohio did in its first two weeks of similar incentives, but not as well as Ohio did with young people. He said his son Will, who turned 12 Tuesday, got vaccinated Wednesday.

State chart shows cumulative vaccination numbers. Click it to enlarge.
Beshear said he hoped the first of three drawings, to be held July 2, would stimulate more interest. Noting the signup numbers, he said, "Those are the best odds you're ever gonna get at winning a million dollars or getting a free ride to higher education." Sign up at Vaccine.ky.gov by July 1 for the first drawing. Signing up also makes you eligible for the later drawings.

Private groups are also offering incentives. Beshear noted that vaccinated people can get free tickets to the weekly Troubadour Concert Series at Cardome in Georgetown, sponsored by High Bridge Springs Water and Wild Health, which will be on hand to provide vaccinations.

Beshear said he is the first Kentucky governor to have a standing schedule of press conferences, to be held each Thursday at 12:30 ET.

"After 15 long months of fighting the pandemic and hosting more than 250 news conferences to keep Kentuckians to keep Kentuckians up to date, I know that making sure you have an opportunity to hear regularly from your governor or other state leaders is important. And we cannot forget we're still fighting this pandemic."

Pandemic-related issues came up in questions at the event.

Asked why he thinks the state has a significant labor shortage, Beshear said part of the reason is the extra unemployment benefits of $300 a week that most Republican governors have ended and that businesses in Kentucky have asked him to end. But that was the last reason he cited; the others were a shortage of child care and reluctance of people to take jobs that require face-to-face contact with the public at a time when less than half the population has had a vaccination.

But he said he is working on a "back to work bonus incentive" that he hopes to announce next week, and he said in response to another question that there is a possibility he could end the $300 weekly benefit before its federal funding expires at the end of September. The Kentucky Chamber of Commerce asked May 28 that Beshear end it by July; 30 days' notice is required to stop it.

Republicans have been hammering on the Democratic governor about the Beshear said he is "trying to thread the needle. . . . I'm the first to say that we can't have everybody looking for a job at the end of September."

Beshear said the state still has $200 million in federal relief money to help people pay rent and utilities, more than two-thirds of the $297 million it received. He said that surprises him, since so many people were financially affected by the pandemic. The money can pay 12 months of back bills and three months forward.

Daily numbers: The state reported 255 new cases of the coronavirus Thursday, lowering the seven-day rolling average to 216 cases per day, the lowest since last July 4, just before a surge in cases began. The average has dropped by more than 100 in the last week.

The daily new-case rate for the last seven days is 3.83 per 100,000. Counties with rates more than double that rate are Webster, 21 per 100,000; Perry, 20.5; Elliott, 17.1; Graves, 15.3; Hopkins, 11.5; Livingston, 10.9; Mason, 10; Fleming, 9.8; Carter, 9.1; Breathitt, 9; Union, 8.9; Bracken, 8.6; Knox, 8.3; Gallatin, 8.1; Grant, 8; and Letcher, 8.
    
The share of Kentuckians testing positive for the virus in the last seven days is 2.06 percent, about where it has been for more than a week.

Hospitalization numbers continue to decline slowly or remain fairly stable. Kentucky hospitals reported 229 Covid-19 patients Thursday, 66 of them in intensive care and 36 of those on a ventilator.

The state reported three Covid-19 deaths Thursday, bringing its toll to 7,178. Deaths are also declining; over the last 14 days, they have averaged 7.2 per day; in the last seven days, the average is 5.7 per day.

Beshear says Supreme Court ruling upholding Obamacare should end challenges to law that let his father expand Medicaid in Ky.

By Al Cross
Kentucky Health News

Gov. Andy Beshear said Thursday that the latest U.S. Supreme Court ruling upholding the Patient Protection and Affordable Care Act was the most important lawsuit in which he has been involved, and that the 7-2 decision may shut the door to further legal challenges to the 2010 federal law.

When he was attorney general, Beshear and his Democratic counterparts intervened to defend the "Obamacare" law in a Texas federal court when Donald Trump's Department of Justice did not. The judge ruled against them, in a suit by Republican attorneys general, but the Supreme Court ruled that the states did not have legal standing to sue because the hadn't shown how the law harmed them.

Beshear said, "I've been involved in a lot of lawsuits since I became attorney general or before. This is probably the most consequential. . . . I hope that this will fully and finally end attacks on a health-care system that, during a once-in-a-lifetime pandemic, was absolutely necessary in keeping people alive." 

While the decision was based on lack of standing, "I think in many ways it will preclude further suits," Beshear said. NBC News legal analyst Pete Williams agreed, saying, "It makes it pretty hard for somebody else to come along and make a similar challenge, so it's a big victory for Obamacare."

Department of Health and Human Services Secretary Xavier Becerra, who as California attorney general worked with Beshear to lead the Democrats' legal fight, noted that the decision is the third from the high court to uphold the law: "If we were playing baseball, we'd say three strikes, you're out."

A slide Beshear displayed at his press conference
Beshear said he intervened as attorney general on behalf of 1.8 million Kentuckians who have pre-existing conditions, to whom the law guarantees coverage; to keep allowing people up to age 26 to be covered by their parents' insurance; to help fight the opioid epidemic; and to preserve coverage under the expansion of Medicaid allowed under the law.

Beshear was elected in November 2019 over incumbent Republican Matt Bevin, who said he would end the Medicaid expansion unless he was allowed to add a work requirement for many beneficiaries. Federal courts blocked that.

Beshear's father, then-Gov. Steve Beshear, expanded Medicaid in 2014 to people with household incomes up to 138 percent of the federal poverty line. During the pandemic, many people who lost their jobs went on Medicaid, boosting its rolls to 1.64 million, 36.6 percent of Kentuckians. In many Appalachian counties, it covers more than half the population.

Wednesday, June 16, 2021

UK seeks children under 12 to be part of Covid-19 vaccine trial

The University of Kentucky is seeking children from six months through 11 years old to participate in a federally funded clinical trial of the Moderna vaccine against the coronavirus.

UK is one of 90 sites in the U.S. and 10 sites in Canada that are in the trial, which will "define an age-appropriate dose, test the vaccine’s effectiveness, and monitor any potential side effects in children, collecting information to ensure safe use," UK said in a news release.

The trial will enroll 7,050 children nationwide, in three age groups: 6-11, 2-6 and finally those 6 months to 2. UK will enroll up to 200 children to receive either two doses of the vaccine or a placebo, 28 days apart. They will be monitored for up to 14 months via phone calls, telemedicine visits and up to seven visits to the pediatric research clinic at UK HealthCare Turfland.

Participants will be compensated, and the vaccine "may protect young children from getting sick if they come into contact" with the virus, the release said. 

Parents or guardians interested in enrolling their child in the  trial can go to www.StopCOVIDKy.com, where they can answer a confidential pre-screening survey to help determine if a child qualifies and for what phase of the study. "Answering the survey does not obligate you or your child to participate," the release said. "Please note that interest in this study might exceed enrollment capacity, and it could take several weeks for the study team to contact you."

The UK study is led by Dr. George J. Fuchs III, chief of pediatric gastroenterology and vice chair of pediatric clinical affairs at Kentucky Children’s Hospital. “We are privileged for UK to be selected as a site for this important trial,” Fuchs said. “With all other age groups currently eligible for vaccination, it’s vital that we extend this to young children, which is critical to their own protection and to facilitate herd immunity in order to help bring an end to this pandemic.”

Tuesday, June 15, 2021

Ky. averaging more than 15,000 coronavirus vaccine doses per day in last seven days, more than half again as previous week

Vaccinations for the coronavirus continue to increase in Kentucky, according to data from the U.S. Centers for Disease Control and Prevention, as analyzed and displayed by The Washington Post in a chart adapted by Kentucky Health News:

Problems with the vaccination reporting system may mean that the figures for individual days are incorrect, but the weekly totals and averages appear reliable. For the interactive version of the above chart and the CDC's methodology for public reporting of vaccinations, click here. The state Department for Public Health's vaccination dashboard, with county-by-county data, is here.

Firm that has 30 addiction-treatment centers in Kentucky has its largest one on a former college campus near Springfield

Joseph Bentley got his GED degree at Crown Recovery and 
now helps others do it. (Photo by Jonathon Gregg, Spectrum News)
Addiction Recovery Care has been serving patients since on the former campus of the now-defunct Saint Catharine College just west of Springfield, now named Crown Recovery Center, since September.

But that didn't stop it from having a ribbon-cutting Monday, touted by a press release from the Gov. Andy Beshear's office saying "Gov. Beshear to Open New Recovery Center in Springfield."

Beshear said at the event, "What we see here is a chance for people to get better, a chance for them to recover, a chance for them to pull their families together, for kids to get their dads and moms back."

The company operates 30 treatment centers for substance-abuse disorder in 17 Kentucky counties and says Crown is the largest, with a capacity of 750.

Part of Crown's program helps people who haven't completed high school get their General Educational Development degree, in a partnership with Elizabethtown Community College, reports Jonathan Gregg of Spectrum News.

It started with 10 participants, including Joseph Bentley, who is now eight months into recovery and is in the program's fourth and final phase, Gregg reports. “I started to see I could really make difference in my life when I came to this facility here," Bentley told Gregg.

Sunday, June 13, 2021

Health plans' vaccination campaign moves to Eastern Kentucky; vaccinations are on the rise, perhaps due to state incentives

Ky. Health News adapted the Dept. of Public Health vaccination map (click it to enlarge; click here for live version) to show counties in the "Shots Across the Bluegrass" tour. This week's are in boldface.

At a different county health department in the heart of Eastern Kentucky each day this week, Kentucky's health-insurance companies will give away ten $100 gift cards to people who get a coronavirus vaccination.

The Kentucky Association of Health Plans, the lobbying group for companies offering health coverage in the state, said in its Friday press release that Visa gift cards would be given "while supplies last." Spokesman Tyler Glick said Sunday that each site would have 10 cards to hand out.

Each "Vaccines for Visas" session will run from 9 a.m. to 2 p.m. ET, starting in Lee County in Monday. The project will be in Owsley County on Tuesday, Breathitt County on Wednesday, Magoffin County on Thursday and Leslie County on Friday. Appointments are encouraged, but walk-ins are welcome.

KAHP Executive Director Tom Stephens said in the release, “We’re trying to reach those that have been sitting on the fence. This promotion will be raising awareness, which is half the battle.”

Last week, the group started its a “Shots Across the Bluegrass” vaccine tour with Kentucky Sports Radio broadcasts from five Kentucky counties, including stops in London and Manchester, near this week's counties.

Counties in the area have some of the state's lowest vaccination rates. In them, the percentages of the county population that has received at least one dose of vaccine are Laurel, 29%; Clay, 26%; Owsley, 28%; Lee (which has a state prison), 39%; Breathitt, 34%; and Leslie, 35%. The statewide vaccination rate is 48%; Woodford County is tops with 63%.

The health-plan group said its members are also using "digital and radio ads, member incentives, coordinated transportation for plan members, pop-up clinics, homebound vaccination visits, text and email campaigns, yard signs, billboards, outbound calls to members prioritized by risk tier, personalized assistance from advocates with sign-ups and digital site navigation, letters, and follow-up on second dose appointments if a plan is alerted that a member has not received the second dose based on claims data."

The state is offering a lottery drawing for vaccine recipients, for three $1 million prizes for adults and 15 post-secondary education scholarships to 15 youth aged 12 to 17. Sign up at vaccine.ky.gov.

The incentives appear to be boosting vaccination numbers, as similar incentives have done in Ohio and other states. Here's the latest official data:
Chart by The Washington Post, adapted by Kentucky Health News

Local collaborations help tackle Ky.'s health problems, and can be guided by hospitals' and health departments' needs assessments

By Melissa Patrick
Kentucky Health News

Collaborations in individual communities can play a critical role when it comes to improving Kentucky's poor health outcomes, largely because those outcomes are grounded in behaviors and unmet social needs at the community level.

That was the underlying message of the June 10 webinar hosted by the Foundation for a Healthy Kentucky, "Transforming Kentucky's Public Health System: The Critical Role of Community Collaborations." 

"There's a huge need for these coalitions because our health rankings are in the toilet and they've been in the toilet for quite some time," Ben Chandler, president and CEO of the foundation, told Kentucky Health News. "So much of the poor health resides in counties where they have lots of other issues." 

Those other issues are often called "social determinants of health" and include things like housing, transportation, food insecurity, education, healthcare and employment. Researchers have said they account for 80 percent of health outcomes. 

Kentucky ranked 48th for health behaviors and 46th for health outcomes in the last America's Health Rankings report from the United Health Foundation. 

Chandler noted that while the U.S. spends twice as much money on health care as other developed nations, it has worse outcomes. 

"So what it boils down to is, we've got to spend more of our resources working on changing people's behavior," he said. "And that sort of thing, I believe can only be done through public policy and at the community level; each community has to be involved." 

Many of these coalitions already exist in Kentucky, but Chandler said there is a need for more and a need to rejuvenate some that already exist. 

The Muhlenberg County Health Coalition is an example of one that is thriving. 

Jessica Browning, chairperson for the coalition, explained that this coalition was initially created to address the findings of the 2018 community health needs assessment of Owensboro Health Muhlenberg Community Hospital's, where she is the marketing director, and includes representatives from all sectors of the community. 

Tax-exempt hospitals like Muhlenberg must do community needs assessments every three years, under the 2010 Patient Protection and Affordable Care Act, with the expectation that they use them to create plans to address the identified community health needs. Some do, and some don't, but Chandler said they are a great tool to guide community collaborations.

Browning walked through several of the collaborative's initiatives, including efforts to make information about community and health resources easily available to the county's most vulnerable residents. The coalition also offers a community resource day twice a month, has found ways to address the county's homeless and housing issues, and has secured a grant to ensure affordable transportation for people who needed rides to work, school and medical appointments.

The Purchase Area Health Connections coalition in has also created a searchable database of resources in Kentucky's far west to make it easier for citizens to find the resources they need. 

Kaitlyn Krolikowski, network director of the coalition, said two of its largest initiatives are an opioid task force and a transitional care team of community health workers who work to reduce hospital readmission rates. CHWs are not health-care providers but educate people about care and help them get it.

The Purchase coalition's website shows that it also works on issues around childhood obesity, diabetes, mental health and more.

Krolikowski said the coalition formed when community members realized it would make the best use of their resources if everyone worked toward the findings of a regional community health needs assessment. She said the coalition's first meeting served as a "catalyst moment" to create different partnerships. 

Community collaborations have also been important to the state's local health departments, especially as it moves to a new model of operation, dubbed Public Health Transformation. 

Public Health Transformation was launched in 2019 and became law in 2020. Among other things, it establishes four "core public health" services that must be provided, those required by law or regulation. It also requires departments to do community health assessments, which many already do, to determine local health priorities beyond the core requirements. Those local priorities are funded separately. 

Jan Chamness, the state's Public Health Transformation project leader and director of the Division for Women's Health, said the transformation depends on strengthening partnerships in a community and allows health departments to collaborate with community partners to achieve their local priorities. 

For example, she said some departments have turned their women's health services and school health programs over to federally qualified health centers, clinics that get federal funds for meeting federal rules.

Public Health Transformation came about because of the fiscal instability of the health departments and because their services had evolved to not reflect their community needs, Chamness said. 

"What we're doing is not really working that well and so we really need to transform public health to be more responsive," she said.

Local businesses can play a big role in getting rural customers and neighbors vaccinated for Covid-19; organizations offer help

Map by The Daily Yonder, adapted by Kentucky Health News
"A return to regular, small-town living will require a continuous effort to get residents vaccinated for Covid-19, according to the head of the Rural America Chamber of Commerce," Adilia Watson reports for The Daily Yonder. But do employers know how crucial they are to making that happen?

“A lot of business leaders, small business owners . .. see this as a critical issue,” Sherri Powell, the Rural Chamber’s executive director, said during the recent online National Rural Business Summit, which "explored outreach tools that business leaders, public health officials, and elected officials can use to share information in rural communities about Covid-19 vaccination," Watson reports.

Employers are important sources of information for their employees, and they can cut through medical and public-health terminology to “describe what science says in an accessible way,” said Maria Elena Castro, a health equity program analyst with the Oregon Health Authority

"As part of the online summit, the National Rural Health Association released a toolkit for communicating about vaccination in rural areas," Watson notes. The Health Action Alliance, which sponsored the event, has a checklist for rural employers who want to do more to educate workers and community members about coronavirus vaccination.

Without herd immunity, estimated at 70 to 80 percent of a population, “We will never get back to normal, even as small towns,” Powell said. “We can’t gather at the local baseball team’s games, or we can’t head into summer camp. These things are just not going to happen in a safe way until we take this seriously and get the shots.”

Saturday, June 12, 2021

Virus that was suppressed by pandemic measures resurges in Ky. and the South; main threat is to younger kids, vulnerable adults

The Centers for Disease Control and Prevention is advising people in Kentucky and states to the south to look out for a respiratory illness that is spreading in the region.

The disease is inter-seasonal respiratory syncytial virus.  RSV cases have been reported in Kentucky, Tennessee, Arkansas, Oklahoma, New Mexico, Texas, Louisiana, Alabama, Florida, Georgia, Mississippi and the Carolinas.

"Infants, young children, and older adults with chronic medical conditions are at risk of severe disease from RSV infection," the CDC said in an official health advisory Thursday. "Each year in the United States, RSV leads to on average approximately 58,000 hospitalizations with 100 to 500 deaths among children younger than 5 years old and 177,000 hospitalizations with 14,000 deaths among adults aged 65 years or older."

RSV was suppressed last winter, due to precautions taken to thwart the coronavirus, so "older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months," the CDC warns. "In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or apnea with or without fever."

Older children may have runny nose and decreased appetite, followed by cough, often followed by sneezing, fever, and sometimes wheezing, CDC says. Symptoms in adults are much like those caused by common cold viruses, and there is no specific treatment other than management of symptoms.