Thursday, May 26, 2022

Covid-19 risk levels are high in 4 Ky. counties; medium in 21; officials discount transmission rates, high in many counties

Centers for Disease Control and Prevention has 25 Kentucky counties with elevated Covid-19 risk. 
By Melissa Patrick
Kentucky Health News

Four Kentucky counties are red on the latest Centers for Disease Control and Prevention's national Covid-19 risk map, indicating a high level of coronavirus transmission. Twenty-one Kentucky counties are yellow, indicating a medium level of transmission.

The red counties are McCracken in Western Kentucky and Greenup, Boyd and Lawrence in the northeast. McCracken was the only red county on last week's map; officials there questioned the status.

Gov. Andy Beshear referred to last week's map at a news conference a few hours before release of the new one. "We should be a little bit concerned" with having counties in red on the CDC's risk map, he said, because it the is based on hospital admissions and capacity as well as new coronavirus cases. 

In red counties, state guidelines call for wearing masks in indoor public spaces, limiting in-person gatherings, limiting the size of gatherings, and social distancing. Beshear said of the mask recommendation, "It is a wise decision to make." 

The 21 yellow counties are Ballard, Carlisle, Hickman, Graves, Livingston, Marshall, Crittenden, Lyon, Hardin, Jefferson, Anderson, Woodford, Fayette, Scott, Menifee, Morgan, Rowan, Elliott, Carter, Martin, and Pike. Last week there were 33 yellow counties in Kentucky.  

The CDC says people in yellow counties who are immunocompromised, or at high risk for severe illness from the virus, should talk to a health-care provider about whether they need to wear a mask or take other precautions.

The cluster of yellow and red counties in Eastern Kentucky border a large cluster of red and yellow counties in West Virginia. Some Southern Illinois counties are near the West Kentucky cluster.

CDC case-incidence map shows high virus transmission in many counties.

In a recent newsletter for The Washington Post, Philip Bump said it's important to look at both the CDC's weekly risk map and the community transmission map, because hospitalizations follow infections. He says the risk map, when viewed alone, presents "a much more sanguine picture of the state of the pandemic than is really the case."

The latest CDC community transmission map, based on new cases, shows a high transmission level in many Kentucky counties and those in border states.

Last week, state Public Health Commissioner Steven Stack encouraged Kentuckians to use the CDC risk map to determine the level of coronavirus risk in their communities, saying that the transmission or incidence-rate map, which reflects new cases per 100,000 people in each county, is largely used by researchers, the news media and others who are tracking the disease. "This is not the decision-making map anymore," he said.

Asked about this difference of opinion, Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, expounded on several points Stack made at that same press conference to support using the CDC map for community transmission guidance. She wrote: 

  • Both the reported incidence of Covid-19 and percent positivity have continued to increase at a slow and steady rate from very low levels in mid-April. However, although we are seeing more spread of Covid-19 in the community, this is not yet corresponding to large increases in severe disease.
  • Hospitalization trends remain both low and stable. We continue to regularly monitor hospital census data for Covid-19 patients, ICU admissions, and ventilator usage. We also monitor syndromic surveillance reports from hospital encounters and emergency department visits. All consistently show that the hospital burden of Covid-19 remains well below levels of concern.
  • Although many counties are now at “moderate” (yellow), “substantial” (orange), and even “high” (red) levels on the incidence rate map, most of these jurisdictions remain “low” (green) on the [CDC's] Covid-19 Community Levels map. The Covid-19 Community Levels [map] combine incidence with hospital admissions data to estimate the overall burden of Covid-19 in the community. These specific metrics were selected for this tool because they most accurately predicted future hospital burden of Covid-19. 
"We continue to recommend that Kentuckians use this Covid-19 Community Levels tool to stay informed on the Covid-19 impact in their communities and follow the corresponding guidance based on their local level of community burden," Dunlap said.

This week's increase in red counties comes after a week when coronavirus cases continued to escalate in Kentucky, although at a slightly slower rate than the week before. Also, the share of Kentuckians testing positive for the virus jumped to 10.52%, up from 9.35% the week before. Hospitalizations remained low, and deaths, a lagging indicator, went down. 

"We should be watching it," Beshear said. "We don't believe that currently what we're seeing is cause for concern, but we should certainly be paying attention."

Beshear said fewer people are being hospitalized with the virus because so many Kentuckians have been vaccinated, boosted or acquired natural immunity from being infected. 

He said vaccinations have declined recently, but The Post reports that Kentucky gave 3,704 doses of Covid-19 vaccine per day in the last week, an 8% increase over the week before. 

State table, adapted by Kentucky Health News
Noting that 66% of Kentuckians have received at least one dose of vaccine, he said, "This is the first day we can report to you that two-thirds of all Kentuckians have had at least one shot."

The state says 2.9 million Kentuckians have received at least one Covid-19 vaccination, or 66% of the total population; 77% of those 18 and older have received at least one shot; and 70% of those five and older have.

Other good news, Beshear said, is that the share of  Kentuckians 75 and older who have received at least one shot went up a percentage point, to 94%. This age group is the most vulnerable to the virus. 

"Remember, if you're over 50, you're eligible for that second booster," the governor said. "Please go get it."

Generics are usually cheaper, but can also cost more than brand names, due to rebate deals between insurers and drug makers

By Wendell Potter

I’m not in the habit of wishing bad things to happen to anybody, but last week, when I was at the pharmacy counter, I was wishing every member of Congress would have to experience the same insanity I was experiencing. If they did, they just might do something to fix the growing crisis they helped create when they passed the so-called “Medicare Modernization Act” (MMA) in 2003.

Wendell Potter
Some background: A few days prior, I had a follow-up visit with my pulmonologist. My primary-care doctor had referred me to her some time ago when I developed a cough and laryngitis that would not go away. She prescribed a Symbicort inhaler, which despite the fact that I pay good money every month for a Medicare Part D drug plan, requires me to pay $606 out of my own pocket for a three-month supply.

During my follow-up visit, I asked her if there was a generic inhaler that would be cheaper. It turns out that there is: fluticasone propionate-salmeteroL. It isn’t a generic version of Symbicort but of a similar inhaler called Wixela Inhub. She wrote me a scrip for the generic version of the inhaler and I took it to my local Rite Aid last night.

We’ve been led to believe that generics cost us less than brand-name drugs. While it is true that the list price of generics is typically cheaper, often much cheaper, than brand-name drugs, in the illogical world of U.S. health care, you can wind up paying more out of pocket for a generic than a brand-name drug, as I found out.

You also need to know that Medicare drug plans often don’t provide any coverage for cheaper generics, thanks to secretive rebate deals, allowed if not enabled by the MMA, that insurance companies and their pharmacy benefit managers cut with drug makers. Major parts of the MMA were written by lobbyists for insurance and drug companies to ensure big profits, and those lobbyists worked overtime when the bill was being voted on to get the bill passed as they wrote it. I know this because I was at Cigna when Congress passed that bill in the middle of the night after many hours of arm-twisting by said lobbyists. One of my jobs back then was to provide Cigna’s government affairs team with talking points.

Turns out that my drug plan (marketed by WellCare, whose tagline is, “Beyond Healthcare. A Better You”) provides no coverage whatsoever for the generic inhaler my pulmonologist prescribed.

After hearing from many other folks that Medicare Part D drug plans often provide skimpy coverage for drugs they needed, I enrolled in GoodRx, which provides significant discounts for many medications. GoodRx compares drug prices and tracks down coupons that can yield significant savings. What I have come to realize is that my out-of-pocket obligation is often considerably less if I use GoodRx instead of my WellCare plan. When I was told I would have to pay the full retail price of the generic inhaler under my WellCare plan, I asked the pharmacist what the GoodRx cost would be. She told me a one-month supply of the generic would cost $102.17. I could save $20.01 per unit if I paid $286.50 for a three-month supply.
The Wixela Inhub inhaler

Just as I was about to go with the GoodRx deal, it occurred to the pharmacist to see if my plan would cover the brand-name version of the same medication. Lo and behold, WellCare does indeed cover Wixela, just not the generic. That’s undoubtedly because of the deal WellCare struck with Mylan Pharmaceutical, which makes Wixela. If I went with Wixela, I would have to pay $47 out-of-pocket for a one-month supply (but no discount for a three-month supply), which is $55.17 per unit cheaper than the GoodRx generic price.

This all took some time, as you can imagine. Meanwhile, the line behind me grew longer and longer. I cannot imagine what it is like to be a pharmacist these days.

I’m fortunate that I can afford to pay $141 for a three-month supply of Wixela, and even, albeit reluctantly, $606 for three months worth of Symbicort. Many Americans are not so fortunate. In fact, millions of us with insurance–both public, like Medicare, and private, including employer-sponsored coverage–walk away from the pharmacy counter without our often life-saving drugs because of what our insurance plans make us pay out of pocket.

Many people of course don’t have a clue that they might be able to get their medications at a lower price without using their insurance card, either through outfits like GoodRx or by using manufacturers’ coupons.

And many of us, especially those of us dealing with cancer, multiple sclerosis or other life-threatening chronic conditions, often have to spend thousands of dollars out of our own pockets before our coverage kicks in for even the drugs our insurance plans will cover. This is why so many of us with insurance get buried under mountains of debt and feel we have no alternative other than to beg for money on GoFundMe or file for bankruptcy.

Back to that so-called Medicare Modernization Act of 2003. Not only did it make the Part D drug benefit nearly impossible to figure out because of the ever-changing list of medications insurance plans will or will not cover, but it also prohibited Medicare from negotiating with drug companies for lower prices as the Veterans Administration program can do.

In Nation on the Take, the book I co-authored with Nick Penniman of Issue One, I cited the MMA as an example of how well-funded special interests are almost always able to call the shots in Washington. Here’s a paragraph from the book that provides a hint of how that industry-backed bill got across the finish line: "When asked why he thought House leaders had scheduled the vote long after most Americans had gone to bed, Rep. Dan Burton (R-Ind.), who voted against the bill, said: 'A lot of shenanigans were going on that night [that] they didn’t want on national television.' Among the shenanigans, reportedly sanctioned by House leaders: freezing C-SPAN cameras and allowing lobbyists on the House floor as the vote was being taken."

Those shenanigans have led to the financial ruin and premature death of countless Americans. But year after year, Congress has looked the other way. To change that, more than 50 organizations and businesses have come together in a coalition to demand that lawmakers take action to address what has become not only a national disgrace but a growing crisis.

The good news is that just after a few months, the Lower Out of Pockets NOW coalition is being noticed by members of Congress on both sides of the political aisle. We are determined to hold our lawmakers accountable. Some members are even talking about forming a caucus within Congress to explore solutions. You can be sure I will keep you posted at Tarbell.org.

Campaign for healthy youth behavior cites exercise, nutrition, vaccination, managing stress, monitoring chronic conditions

Centers for Disease Control and Prevention photo
By Melissa Patrick
Kentucky Health News

The Foundation for a Healthy Kentucky and the Kentucky Department of Education have launched a public-service campaign to encourage Kentucky's children and their families to use the summer months to build healthy habits for the next school year and beyond. 

"We want to encourage Kentucky students to create and engage in healthy behaviors because research shows that healthy students are better learners. They often get better grades, they attend school more and stay focused longer in the classroom," Ben Chandler, president and CEO of the foundation said at a news conference to launch the campaign. 

The effort is part of a multi-faceted education and awareness "High Five for Health" campaign that includes animated videos, social media graphics, message points and materials to be distributed at sporting events, youth organizations and various other locations. All campaign materials are available for free download at HighFiveForHealth.org.

Chandler said the campaign is designed to help parents find no-cost or low-cost activities that the whole family can do together, and activities that older children may do independently.

The campaign focuses on five key areas to promote health, including prioritizing physical activity; practicing healthy eating; monitoring chronic conditions such as asthma, obesity and diabetes; staying up to date on vaccinations; and managing stress and emotions. 

The campaign website offers tips on each of these focus areas, including ways to prioritize physical activity and how to know if children are meeting the level of aerobic activity needed to make a difference. It also offers some healthy recipes and recommendations for how many fruits and vegetables a child should eat each day. In addition, it offers suggestions for how to help your child learn how to manage stress. 

When it comes to physical activity, the Physical Activity Guidelines for Americans recommends that children and adolescents get one-hour or more of moderate-to-vigorous physical activity daily.

Many of Kentucky's youth are sedentary. The latest Youth Risk Behavior Survey taken in 2019 found that 19 percent of Kentucky's high school students said they did not participate in at least 60 minutes of physical activity on at least one day in the week before they took the survey and 81% of them said they were not physically active at least 60 minutes per day on all seven days. 

Jim Tackett, the education department's healthy-school project director, encouraged Kentucky parents and youth to have fun as they incorporate some of these new healthy behaviors into their lives, but to also be intentional about it. He also encouraged parents and youth to be open to trying new things and to celebrate small successes. 

"Good health just doesn't happen by itself," Tackett said, adding later, "Each of our behaviors takes a little time to mold or to break. So over the summer months, we're hoping that the High Five for Health campaign will help us establish some new behaviors that we can carry with us down the road." 

Asked about the relationship between high screen time and low physical activity, Tackett recognized that this is an issue, but said this particular campaign largely addresses components suggested by the Centers for Disease Control and Prevention, which funded a large portion of it. 

He said reducing screen time would not only lead to increased physical activity, but also impact the mental health piece of this campaign.

"We would definitely support trying to take a break from those electronic devices," he said. "While they are necessary in the learning process today, we would like to strike that balance if at all possible. . . . I think there is a happy medium that we need to continually talk about." 

A recent University of Southern Denmark study, published in JAMA Pediatrics, found that children in the group that had their smartphones and tablets removed for two weeks and reduced their recreational screen media use to less than three hours per week had an average of 45 minutes more daily physical activity compared to children in the control group, which did not change their usual screen habits. 

"The difference between the groups were largest on weekend days where children in the screen reduction group had an average of 73 min more physical activity compared to children in the control group," lead author Jesper Pedersen said in the news release. 

In addition to making sure your child is up to date with their recommended schedule of vaccines, the campaign also encourages parents get their children who are five an older vaccinated against the coronavirus. To support this effort, the sponsors are offering a Covid-19 vaccine clinic in Lexington. 

In partnership with the state Cabinet for Health and Family Services and other health organizations, Chandler said the foundation and the education department will host Covid-19 vaccine clinics for youth five and older on June 3-4 and June 10-11 in Lexington, weekends when the Kentucky High School Athletics Association hosts the state boys and girls track, baseball and softball tournaments. They vaccines will be available in the green lot at Kroger Field. 

About 80% of the campaign is funded by the CDC and the U.S. Department of Health and Human Services.

Wednesday, May 25, 2022

Study says one in five adult Covid-19 survivors in the U.S. may develop 'long Covid;' for those over 65, it's one in four

Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report illustration

By Melissa Patrick
Kentucky Health News

One in five adult Americans who have recovered from a Covid-19 infection have experienced a health condition that may be related to a previous infection, and that makes prevention efforts and post-Covid assessments critical, says a Centers for Disease Control and Prevention study.

Among people 65 and older, one in four were found to have a post-Covid condition. The study analyzed a database of electronic health records of nearly 2 million U.S. adults between March 2020 and November 2021, comparing those who had been infected with the coronavirus and those who were not. Of those, more than 350,000 had tested positive for the virus.

The researchers assessed the occurrence of 26 clinical conditions previously attributed to post-Covid illness.  They identified a number of post-Covid health problems involving the heart, lungs, kidneys, and vascular, musculoskeletal and neurological systems. People who develop these ongoing conditions after having Covid-19 are often said to have "long Covid," which has not been precisely defined. 

Age groups aside, the study found that the most common health conditions were respiratory symptoms and musculoskeletal pain. Post-Covid patients were also twice as likely as those who had not had the virus to suffer from acute pulmonary embolism and respiratory symptoms.

In addition, the study found that post-Covid patients 65 and older were at greater risk than the younger group of developing neurological conditions and most mental-health conditions.

The study concludes that these findings are consistent with several large studies that indicating “that post-Covid incident conditions occur in 20 to 30 percent of patients.” Also, post-Covid conditions “can affect a patient’s ability to contribute to the work force and might have economic consequences for survivors and their dependents,” and “care requirements might place a strain on health services” in “communities that experience heavy Covid-19 case surges.”

Tuesday, May 24, 2022

Dr. Douglas Scutchfield, an international leader in public health and a mentor to many in Kentucky, died Monday night

F. Douglas Scutchfield, M.D.
Dr. F. Douglas Scutchfield, a public-health leader for the world, the nation and his native Kentucky, died Monday night after being hospitalized for several weeks with pneumonia.

Scutchfield recently served as chair of the accreditation committee of the Public Health Accreditation Board, which accredits local and state health departments, and spurred Kentucky to be a leader in getting its departments accredited. It was one of his latest accomplishments in a life devoted to public health.

A native of Wheelwright in Floyd County and a graduate of Hazard High School and Eastern Kentucky University, Scutchfield earned his M.D. at the University of Kentucky, where he held an endowed professorship in the College of Public Health, of which he was founding director when it was the School of Public Health. He was also a professor in the Department of Family and Community Medicine and the Martin School of Public Policy and Administration, founding director of the Center for Health Services Research and Management, and associate dean of the College of Medicine, where he chaired the Department of Preventive and Environmental Medicine. He founded the Graduate School of Public Health at San Diego State University, was a founder of the College of Community Health Science at the University of Alabama and also taught at the University of California-Irvine.

Scutchfield was an editor of many academic health journals, founding co-editor of the Journal of Appalachian Health and an editor of a new book, Appalachian Health: Culture, Challenges, and Capacity. Here's a discussion of it with the other editor, Randy Wykoff of East Tennessee State University.

Julia Costich, who succeeded Scutchfield as the UK College of Public Health's Peter P. Bosomworth Professor of Health Services Research, told Kentucky Health News, "Public health is about doing things for populations, but Scutch’s gift was relating to individuals—students, colleagues, prominent leaders—as individuals. His generous nature was tempered by a deep need for reciprocation. I think this was part of what drew him to the work of Thomas Merton, who articulated the need for human contact to bridge the spiritual gulf."

Scutchfield and Paul Evans Holbrook Jr. wrote The Letters of Thomas Merton and Victor and Carolyn Hammer: Ad Majorem Dei Gloriam (the Jesuit motto, "For the greater glory of God"), published by the University Press of Kentucky in 2015. The book helped Scutchfield earn the 2017 UK Libraries Medallion for Intellectual Achievement in 2017, which he called "a coda to my academic career." In accepting it, he said his interest in Merton and the humanities reflected a part of his philosophy of being a physician: "I am a firm believer in the importance of humanity to those of us in the health professions. We do not treat a disease; we treat a person, thus we must know the humanness of the individual in front of us, as well as the diagnosis and treatment of their disease."

Two years later, he won the top award from the American Public Health Association, the Sedgwick Memorial Medal for Distinguished Service in Public Health. He was a charter diplomat of the American Board of Family Practice, a fellow of the American College of Preventive Medicine, which he served as a regent and president. He was secretary-treasurer of the Association of Schools of Public Health and a board member of the Public Health Foundation, which presented him with the Theodore R. Ervin Award. He In 2004, he received the Balderson Lifetime Achievement Award of the National Public Health Leadership Network.

Scutchfield was a member of the American Medical Association House of Delegates and served as chair of the AMA Section Council of Preventive Medicine on several occasions. He was vice chair of the AMA’s Council on Medical Education, and represented the AMA as a member of the Accreditation Council on Graduate Medical Education, the Liaison Committee on Specialty Boards, the American Board of Medical Specialties and the Committee on Allied Health Education and Accreditation. He received AMA’s Dr. William Beaumont Award as its outstanding young physician in 1985 and its Distinguished Service Award, the highest recognition of a physician, in 2003.

Scutchfield had an international reputation and was a consultant to government and non-governmental organizations in Panama, China, Saudi Arabia, Israel and Germany, as well as the U.S. But he never forgot Wheelwright, which was one of Kentucky's biggest coal towns when he was growing up, then-Libraries Dean Terry Birdwhistell said in 2017: “As a scholar, teacher, mentor, administrator and public health advocate, he has never forgotten his Floyd County roots even as he became internationally recognized and honored.”

During the pandemic, Scutchfield worried about the damage done to his profession, said Al Cross, director of UK's Institute for Rural Journalism and Community Issues and publisher of Kentucky Health News: "At our last lunch, he and I talked about writing a 'where we go from here' essay as a bookend to the one we published on March 1, 2020: Is our political system properly serving our public-health system? The answer was no, and it got worse, and it hasn’t gotten any better. May Doug Scutchfield’s life inspire us to stand up to officials of all stripes who damage the discipline of public health and thus the health of the public."

Scutchfield is survived by his wife, Phyllis, and his son, Alex, who is a doctor. Funeral arrangements are pending.

Women, trust your gut if you suspect a stroke; here's how to judge

Stroke is the fourth-most common cause of death in women, and rural women are particularly in danger because stroke victims must get treatment quickly to improve their odds of a good outcome, and that can be harder to find in rural areas, Madelyn Ostendorf reports for Successful Farming

When women have a stroke, they're more likely than men to experience sudden confusion as an initial symptom. Here are some other common symptoms:
  • sudden loss of limb control
  • loss of vision
  • difficulty speaking
  • drooping of one side of the face
Less common but still important signs to watch for are:
  • difficulty reading
  • double vision
  • trouble balancing
  • tingling in the limbs
To assess whether someone, including oneself, is having a stroke, remember the acronym FAST:
  • F: Face drooping. Does one side of the face droop, or is it numb? Ask the person to smile. Is the person's smile uneven?
  • A: Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
  • S: Speech difficulty. Is speech slurred?
  • T: Time to call 911.

May is not just Nurses Month; it's Kentucky Nurses Suicide Prevention Month, writers say; nurse suicide rates keep rising

OPINION by Julie Marfell, Paul Norrod and Lee Anne Walmsley
    
Nurses are the backbone of health care, supporting and protecting their patients. During the Covid-19 pandemic, nurses have soldiered through an increased workload, short staffing, fear of becoming sick or worse exposing their families to sickness and very ill patients, many of whom died with a nurse by their side and no family members. The load nurses have carried over the past two years is consistently heavy and, with no relief in sight, the backbone is feeling the strain. As nurses continue to move forward, we must find ways to lift this burden. The high price for the burden is losing nurses to suicide.

Lee Anne Walmsley, Julie Marfell and Paul Norrod 
Suicide is the 11th leading cause of death in the United States. Nurse suicide rates continue to rise with female nurses experiencing higher suicide mortality compared to other occupations. By contrast, male and female nurses are more likely to experience job problems and mental health challenges than the general population which increases the risk of suicide. In Kentucky, approximately 58 nurses have died by suicide since 2016; one is too many.

Nurses need continued support to thrive as a profession. In January, the Kentucky Board of Nursing mandated that all nurses must complete nurse suicide-prevention continuing education. The Kentucky Nurses Action Coalition, with the support of the Kentucky Nurses Association, developed an educational video and program to address suicide prevention for nurses. Visit kentucky-nurses.org for more information. This program teaches nurses how to identify signs of overwhelming stress and hopelessness in themselves and others that are risk factors for dying by suicide. It also emphasizes the importance of self-care to reduce stress and reaching out for help to carry the load and relieve some of the burden.

An increased awareness of the risk for suicide is crucial for the health of the nursing workforce. To remain strong, nurses need to support in all aspects of their work and everyday lives. This includes encouraging and providing opportunities to maintain healthy lifestyles, training in suicide prevention and removing the stigma attached to mental health illnesses. We all must develop an understanding that just like other illnesses, we can prevent mental health problems and treat them with lifestyle changes and medications.

National Nurses Month affords us the opportunity to show our appreciation for nurses and we appreciate the accolades; however, it’s important to remember to thank nurses every day, 365 days a year. If you have a friend or relative who is a nurse, check in with them, and when you ask them how they are doing. please listen. Hear what they are saying and support them. Help them get the help they need to be well. We all need to take care of nurses for without a strong backbone we cannot stand tall.

The National Suicide Prevention hotline is 1-800-273-8255. Text HOME to 741741 to speak anonymously with a crisis counselor. Kentucky Community Mental Health Centers are listed at https://dbhdid.ky.gov/crisisnos.aspx

Julie Marfell, DNP, FNP-BC, FAANP, is president of the Kentucky Nurses Action Coalition and an associate professor in the University of Kentucky College of Nursing; Paul Norrod, DrPH, M.Div., MA-C, RN, is a member of the coalition and an instructor in the College of Nursing; LeeAnne Walmsley, PhD, EdS, MSN, RN, is an assistant professor in the college.

Monday, May 23, 2022

Kentucky's coronavirus surge continued last week, but at a slower rate; vaccine for young children is being lined up for approval

Kentucky Health News graph, from state Department for Public Health data
By Melissa Patrick
Kentucky Health News

Kentucky's surge in coronavirus cases continued last week,  at a slightly slower rate than the week before. Hospitalizations from the virus remain low, and deaths, a lagging indicator, kept declining.

The state's weekly report, for the last Monday-to-Sunday reporting period, showed 8,127 new cases of the virus, an average of 1,161 cases per day. That's 26 percent more than the 920 daily cases the week before, when the state reported a 63% jump in cases. 

Of last week's new cases, 14% were in people 18 and younger. 

The share of Kentuckians testing positive for the virus in the past seven days has gone up for seven weeks in a row, when it was a low of 1.97%. This rate is now 10.52%, up from 9.35% the week before. The figures do not include results of home tests. 

The state attributed 79 more deaths to Covid-19 last week, an average of 11.3 deaths per day. The week before it was around 14 deaths per day. The state pandemic death toll is now 15,909. 

Kentucky's Covid-19 hospital numbers remain low. They reported 264 Covid-19 patients Monday, down 76 from 340 the week earlier, 23 intensive-care unit patients and six patients on mechanical ventilation.

The report shows that nearly 75% of the state's ICU beds are occupied, with the  Northern Kentucky hospital region using 100% of its ICU beds. Only 1.4% of the patients have Covid-19. 

The statewide incidence rate is 23.84 cases per 100,000 people, up from 19.64 cases per 100,000 people last week. Eighteen Kentucky counties have rates above that amount, but Jefferson County is the only one with more than double that rate, at 55.7 cases per 100,000 people. Not one county has a zero case rate. 

The New York Times ranks Kentucky's infection rate 27th among states and Washington, D.C., with a 132% increase in cases in the last 14 days. 

"The United States is currently averaging more than 100,000 known cases per day for the first time since February. Cases are rising in nearly every state, and since many cases go uncounted in official reports, the true toll is likely even higher than these figures suggest," the Times reports.

Pfizer-BioNTech has said that an early analysis shows three doses of their coronavirus vaccine was 80% effective in preventing symptomatic infections in children 5 months to 4 years old. 

“Our Covid-19 vaccine has been studied in thousands of children and adolescents, and we are pleased that our formulation for the youngest children, which we carefully selected to be one-tenth of the dose strength for adults, was well tolerated and produced a strong immune response,” Albert Bourla, chairman and CEO of Pfizer, said in a news release.

The Washington Post reports that the U.S. Food and Drug Administration has said its outside experts will meet June 14 and 15 to discuss the Moderna and Pfizer-BioNTech pediatric vaccines.

The Pfizer-BioNTech vaccine is already approved for those 5 and older, although less than one-fourth of Kentucky's younger children have received it, according to the state report that shows only 23% of Kentucky children between the ages of 5 and 11 having received at least one dose of the vaccine. 

White House officials are also warning that the US is at risk of rationing Covid supplies without additional funding. 

"The White House is planning for “dire” contingencies that could include rationing supplies of vaccines and treatments this fall if Congress doesn’t approve more money for fighting Covid-19," Zeke Miller reports for the Associated Press

Dr. Ashish Jha, the White House coronavirus coordinator, has warned that "without more money, vaccines will be harder to come by, tests will once again be scarce, and the therapeutics that are helping the country weather the current omicron-driven surge in cases without a commensurate increase in deaths could be sold overseas before Americans can access them," Miller writes.

Campaign to promote student health this summer to launch Wed.

CDC photo
The Foundation for a Healthy Kentucky and the Kentucky Department of Education is launching a statewide summer wellness campaign to promote five habits to promote student health during the summer. 

"With Memorial Day weekend upon us, marking the unofficial start of summer, this initiative encourages kids to prioritize physical activity, practice healthy eating, monitor chronic conditions, stay up to date on vaccines and manage stress and emotions," says a news release.

 The virtual  event will be held Wednesday, May 25, from 10:30 to 11 a.m. ET. 

Speakers will include Ben Chandler, president and CEO of the foundation; Jim Tackett, KDE healthy schools project director; and high-school students who will talk about their personal healthy routines.

The release says the campaign is needed because one in five children 3 to 17 have a mental, emotional, or developmental disorder and more than 80 percent of the world’s adolescent population is physically inactive.

"Healthy children are better learners and summer is a great time to form healthy habits that will help kids succeed in school," the release says.

The campaign is part of the foundation's "High Five for Health" campaign and is funded by the Department of Education.

Sunday, May 22, 2022

UK program helps pregnant women overcome opioid-use disorder

Gabi Espinosa and Ashlee Vogelsang at the Polk-Dalton Clinic
(University of Kentucky photo by Mark Cornelison)
By Dani Jaffe
University of Kentucky

For expectant mothers, the top priority is to do everything in their power to ensure their baby arrives healthy. For some women, this task is harder than it sounds. In Kentucky, 20 out of every 1,000 babies are born to a mother who is using opioids — the third-highest rate in the country.

Two women who have been through this experience are Ashlee Vogelsang and Gabi Espinosa. Both underwent treatment in UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program, housed within UK’s Polk-Dalton Clinic. This program is designed to help pregnant people who are living with substance-use disorders.

Vogelsang lived with opioid use disorder for 13 years. The final time she got in trouble with the law for using drugs was also the moment she found out she was pregnant. She was given no other choice but to seek treatment at The Chrysalis House and enter PATHways for prenatal care — a program that helped save her life.

She was first put into PATHways for traditional treatment and was referred for additional support from its Birth and Recovery Integrating Group Holistic Treatment program. BRIGHT is a woman-centered group treatment program led by a midwife, which meets every Friday for treatment and counseling with a therapist, nursing support and peer support staff.

Her first moments in BRIGHT were filled with fear and anxiety for what was to come, but that soon faded when she realized that she did not have to go through it by herself – a whole staff, support group and midwife were there to help her.

“You don’t know what to expect. But when you come in and have a group of women who all are going through the same thing you are, that just kind of takes away all the fear,” Vogelsang recalled. “It gives you that feeling of not being alone. We’re all there. We’re all pregnant. We’re all trying to recover. You can commiserate with other people, and it just gives you that feeling that it’s going to be OK.”

Studies show that being surrounded by a support system of other expecting mothers and a midwife for woman-centered care can make a world of a difference. In fact, midwifery care has been shown to decrease intervention when in labor, improve patient satisfaction and reduce preterm labor rates.

While Vogelsang had no choice but to enter the program, when she was in recovery and found out she was pregnant again, she instantly knew that she wanted to re-enter BRIGHT, this time on her own terms.

“I came back willingly for my second pregnancy in recovery because I know how much I gained the first time,” she said. “I was excited to be there because I knew there would be girls like my friend Gabi that were new to this, and I’d be able to help them through the process because I had already been through this once.”

Today, because of her hard work, dedication and the support she received through PATHways, Vogelsang is a stay-at-home mom, homeschooling her two teenage children and caring for her two little ones, all while furthering her own education at UK.

“I wouldn’t be where I am today, almost four years sober, if it wasn’t for the PATHways group believing in me every step of the way,” she said. “I lived with these people. We all came in different parts, but we came as one person. We all were there for the same end goal. They’re like sisters now.”

And in the future, she would not hesitate to go back again, as she attributes much of her success to the women that helped her through both pregnancies.

“I just love the women at PATHways,” said Ashlee. “And I promise, when I do find myself ready to have another baby, PATHways is where you will find me.”

Gabi Espinosa and her fiancé dreamed of having a family but first wanted to seek treatment and stability. They started on the right track, found themselves in a better home and began treatment on Suboxone, one of three effective medications used to treat opioid-use disorder. But when Gabi found out they were expecting, she knew that she wanted some additional support to help her through the pregnancy. That is how she found PATHways and BRIGHT.

One of the best things about the BRIGHT program for Espinosa is the sense of security it gave her during her pregnancy.

“Going into the BRIGHT program, I was able to see certain people all the time and it stayed consistent. Having to see a whole bunch of different people and doctors can be nerve-wracking, and I don’t feel like that’s very good when you’re in recovery,” she said. “It gives you that trust and lessens your uncertainty because you’re next to women who are all going through the same thing.”

A common misconception about medication for opioid-use disorder is that it’s simply “replacing one drug for another.” OUD is a disease of the brain, not a lack of willpower, and withdrawal from opioids can cause debilitating side effects. Medications for opioid use disorder act on opioid receptors in the brain to both reduce cravings and the effects of illicitly used opioids – in other words, if a person uses opioids while on medication, the euphoria or “high” that usually comes with using the drug will be blocked. Studies show that the vast majority of people who attempt to stop using opioids “cold turkey” or stop medication treatment after a few weeks or months are very likely to relapse.

For pregnant women, having continual access to their medication is a key elements to the program’s success. To date, there have been no overdose deaths in women who are active in the program and using medication.

In the BRIGHT program, the use of a midwife to provide woman-centered care can also help with another hurdle: overcoming the stigma that pregnant women with substance use disorders face with mislabeling and misinformation about them as people, and as mothers.

“I was always worried about how people would see you being in recovery or being on Suboxone while you’re pregnant,” Espinosa said. “But I had all of them to support me, and people don’t look at you the way you think they might. You’re doing what you’re supposed to do for the sake of your child, and you’re a person just like everyone else.”

And like Vogelsang, Espinosa found the group environment BRIGHT provides to be very helpful in overcoming some of her greatest fears during pregnancy.

“I was terrified about how it would go at the hospital. But I wasn’t as terrified when I got to the program, because all the other girls were there with me and I was able to see them have their babies and everything was completely fine,” said Gabi. “That’s what helped put my mind at ease.”

Their partnership between UK, its College of Nursing, and the state Cabinet for Health and Family Services has helped provide treatment to hundreds of other mothers like Espinosa and Vogelsang.

Espinosa said she has looked up to many of the other strong mothers in her program. Seeing them have success and overcome struggles helped her through the most challenging times she faced, and now she hopes to be an inspiration to others as well.

“Now, my fiancĂ© and I are in a beautiful two-bedroom apartment with our baby girl, and we look forward to expanding our family,” she said. “It’s crazy to see how far you’ve come. I know someone is probably looking up to me and it’s hard to believe that sometimes. If I could say one thing to the other women entering the clinic, I would say never give up, and never feel like you’re alone. There are so many people here to back you up. You can do this.”

If you or someone you know is pregnant and dealing with substance use disorder, contact the Polk-Dalton Clinic at (859) 218-6165 to make an appointment for prenatal care.

Carter County student goes to hospital with adverse vape reaction

A Carter County ambulance (Carter County Times photo)
An ambulance took a student from East Carter High School in Grayson to Kings Daughters Medical Center in Ashland Thursday after the student had an adverse reaction to an electronic cigarette, Carter County school officials said. They said the student was being treated for non-life threatening symptoms, and school administrators and law enforcement were investigating the incident while students were being asked to stay in their classrooms, the Lexington Herald-Leader reported.

The student lost consciousness but "didn't appear to suffer any lasting harm," reports Jeremy Wells of the Carter County Times, paraphrasing Supt. Paul Green. He told the Times that vaping “is a huge issue, not just for Carter County Schools, but schools all across the state. . . . What they don’t understand is that while there are perhaps some of these  aren’t as harmful as others – though they’re all harmful – but a lot of times kids don’t know what’s in these.”

Wells reports, "That became an issue on Thursday when the students who had the vape got rid of it, fearing punishment, and medical personnel had to wait on toxicology reports to determine what the student was in fact reacting to."

Green said, “The first thing they [the first responders] want to know is what was in it. Because they don’t know how to treat a student, or anybody, if they don’t know what they’ve actually consumed or inhaled. So, it’s a scary situation where we’re glad that today didn’t end in anything worse, but we want to make sure we continue to work hard with everybody to prevent this from happening in the future. . . . We’re still trying to find out exactly what caused that adverse reaction.”

The school district issued a statement saying, “The safety of our students is of the utmost importance across the district. We ask that parents and guardians discuss the dangers of vaping with their children.”

Saturday, May 21, 2022

Appalachian counties continue to dominate lowest level of County Health Rankings in Ky.; most counties moved at least 10 notches

By Melissa Patrick
Kentucky Health News

The annual County Health Rankings & Roadmaps report, showing how the health status of every county in the United States compares to that of every other county in the state, has been released.

Many Kentucky counties showed little change, but 76 of the state's 120 counties shifted up or down by at least 10 notches in the rankings, which essentially measure of how long and how well we live. 

The rankings measure health outcomes, gauged by life expectancy and measures of quality of life; and health factors, such as access to physicians and areas to exercise, tobacco use, children living in poverty, violent crime, long commutes and other environmental factors. The report is issued by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

The rankings are meant to be viewed more as a general categorization of a county's health status, rather than making specific comparisons with counties that are relatively close in the rankings. Because the differences in rankings for most counties are so small that they are statistically insignificant, the researchers have placed counties in four groups of 30 counties each, called quartiles (each with one-fourth of the total of 120 counties). 

The bottom quartile for both health outcomes and health actors in Kentucky continues to be made up of almost entirely Appalachian counties. The exceptions for health outcomes are Carroll County, between Louisville and Cincinnati, and Fulton County, at the state's western tip. The relatively poor county is the only non-Appalachian county in the bottom quartile for health factors. 

In health outcomes, Fulton County moved down 17 spots from last year's report to rank 116th. Owsley County ranks 117th, followed by Perry County, which dropped 22 spots from last year's ranking, and Wolfe and Breathitt counties. The last four counties form a cluster.

Oldham and Boone, two of Kentucky's wealthiest counties, continue to be the top two in health outcomes, as they have been since 2011. No. 3, Scott County, has ranked between fifth and eighth since 2011. Campbell County in Northern Kentucky ranked fourth for the second year in a row and Calloway County, home of Murray, ranked fifth after moving up 19 notches from last year's rankings. 

Oldham and Boone are also the top two counties for health factors, and have been since 2015. They have been in the top five since 2011. Woodford, Campbell and Fayette counties are ranked third, fourth and fifth, respectively, for the second year in a row. 

The bottom five counties for health factors are Breathitt, Lee, Clay, Harlan and McCreary, all in Appalachian Kentucky.

Some big changes in health outcomes

Altogether, 26 Kentucky counties improved more than 10 notches in health outcomes from last year, and 13 of them improved by more than 20 places; 27 of them dropped more than 10, and 12 of those dropped by more than 20. 

Edmonson County improved the most for health outcomes, with a 50-notch jump up to No. 31 and the second quartile. However, its No. 81 rank last year was not typical for the county, which had been in the second quartile for health outcomes most years since 2011, so its latest rank is a return to form.

Several counties showed big improvements that moved them into the first quartile for health outcomes. Graves County improved 29 notches, to No. 28 from No. 57; Carlisle moved up to 20th from 45th; and Livingston moved up to 26th from 46th. 

Breckinridge County also saw a 37-notch gain (to 35th from 72nd) in outcomes that moved it into the second quartile.

Because the rankings are relative, county to county, they tend to have about as many drops as gains. Bracken County saw the greatest drop in health outcomes, 46 notches, to 81st from 35th. Clark County had the second greatest drop for outcomes (30th to 70th), moving from the first quartile to the third.   

Two Appalachian coalfield counties also saw big drops in outcomes, which moved them into the bottom quartile. Johnson fell to 96th from 71st, and Whitley dropped to 100th from 67th.  

Some big changes in health factors

Twelve Kentucky counties improved more than 10 notches for health factors, with three improving by more than 20. Eleven counties fell more than 10 notches; only one moved down by more than 20.

Livingston and Crittenden counties showed the most improvement for health factors. The adjoining counties in West Kentucky each moved up 24 slots into the second quartile. Livingston moved to 46th from 70th and Crittenden moved to 54th from 78th.  

Allen County's 17-notch improvement in health factors moved it into the 55th from 72nd, and into the second quartile. Simpson County moved into the first quartile by rising to 29th from 39th.  

McLean County had by far the biggest drop in health factors, falling 24 notches to 80th from 56th, which moved it down to the third quartile. Gallatin County fell to 65th from 53rd and Montgomery County fell to 62nd from 46th, both moving to the third quartile. Henry County dropped to 38th from 25th, moving it to the second quartile.

The report challenges Kentucky counties to take this data and turn it into action. Evidence-based resources to do that can be found in the "Take Action To Improve Health" section of its website. Here are the rankings (click image to enlarge):