Saturday, December 4, 2021

Legislature will again be asked to let local governments pass tobacco-regulation ordinances, aimed at preventing youth use

By Melissa Patrick
Kentucky Health News

Kentucky lawmakers can expect another bill to be filed in January to give local governments the ability to regulate tobacco products, touted as a another tool in the box to limit young people's use of the products, advocates said on a training webinar Wednesday. 

The Foundation for a Healthy Kentucky "Health for a Change" webinar provided education on the potential impacts of local tobacco control in anticipation of 2022 legislation that would restore local control over the marketing, sale and distribution of tobacco products. 

Sen. Paul Hornback
Republican Sen. Paul Hornback of Shelbyville said on a recorded video that he supports repealing the law, adopted in 1996 after lobbying by tobacco-product manufacturers, that stripped local communities of the power to regulate the sale, marketing and distribution of such products. 

"As a father, grandfather, lawmaker, tobacco farmer, I'm outraged at the the marketing tactics that have been used to attract our youth, leading to more than one in four Kentucky high schoolers using e- cigarettes. . . . Please join me today in support of repealing the old law and restoring local control to our communities and protecting our youth," Hornback said. 

He added, "Restoring these options does not create a mandate to pass laws, it only gives communities that are ready the opportunity to enact their own protections." Hornback announced in June that he will not run for reelection in 2022. 

Mahak Kalra, chief policy and advocacy officer for Kentucky Youth Advocates, applauded the General Assembly for its efforts to curb youth use of tobacco products: passing a statewide tobacco-free school policy, increasing tobacco taxes and raising the legal minimum age to buy tobacco products to 21.

"The commonwealth is trying to continue to build off this legislative momentum," Kalra said. "Everyone from policymakers to advocates to educators to parents need to be involved in this effort from keeping tobacco products away from our children and we hope that you alongside of your alongside your network of advocates will join us in this effort." 

Sen. Julie Raque Adams, R-Louisville, who sponsored a local-control bill in the 2021 session, said at the Kentucky Voices for Health annual meeting that it will be hard for such a bill to gain traction during a session in which the legislature must pass a state budget. "We're going to have to fight to get some airtime on that issue," she said. "We only have so much bandwidth."

Kalra said that while tobacco products are evolving, the tobacco industry's tactics to get products into the hands of youth have remained the same since the 1960s and that every effort should be made to minimize youth exposure to these products. 

"The reality is that nearly 90% of tobacco users first try a tobacco product by age 18. But if they did not start using nicotine by age 26, they are unlikely to never start," she said. 

Allison Adams, vice president for policy at the health foundation, painted a picture of youth use of tobacco in Kentucky. She said nearly 30% of high schoolers report using any tobacco product and 19.7% of middle schoolers are using some sort of tobacco product, the highest rate among the 11 states surveyed. 

Adams said that among current high school users of electronic cigarettes, 43.6% use vapes frequently (20 or more days in past 30 days) and 27.6% use them daily, indicating a strong dependence on nicotine among our youth that will ultimately result in 119,000 Kentuckians to die prematurely from tobacco use. 

Foundation for Healthy Kentucky graphic
"Time is of the essence to add more tools to our toolbox," Adams said. "We can't express enough the urgency of the issue to stop the nicotine addiction that we are experiencing and seeing in Kentucky amongst our youth."

Katherine Morrison, a youth advocate from McCracken County, said vaping is a real problem in her school and that many youth who would never consider smoking traditional cigarettes will use electronic cigarettes because of their flavors and lack of an offensive smell. 

If the 1996 law is repealed, local communities would have the option to enact ordinances to keep children from being exposed to the products, such as buffer zones for sales of vaping products near schools, requiring products to be under a counter rather than point-of-sale locations, and restricting advertising on marquees or store windows, said Shannon Smith of the American Heart Association. She said local communities would still not be able to raise taxes on tobacco or vape products. 

Prestonsburg Mayor Les Stapleton said he supports legislation that allows local control because communities know what works best for them. He said some will be more willing to enforce stricter measures than others.

Smith promoted the Nix the Next campaign, which seeks support for repealing the 1996 law. The Kentucky Youth Advocates webpage for the campaign includes information on ways to contact legislators about the issue.

Pikeville Medical Center now includes Eastern Kentucky's first hospital for children, thanks to federal grants and donors

Outpatient examination room in hospital
(Photo by Silas Walker, Lexington Herald-Leader)
Pikeville Medical Center has opened the first children's hospital in Eastern Kentucky.

The 13,400-square-foot facility, with 10 child-themed patient rooms and 13 outpatient examination rooms, is named the Drs. R.V. and Jyothi Mettu Children’s Hospital, for donors of $1.5 million to the project. Jyothi Mettu has been a pediatrician in the area for almost 30 years.

Pikeville Medical Center also received a federal-state Abandoned Mine Lands Pilot Program grant of $4.78 million and an Appalachian Regional Commission grant of $1.5 million to support the project.

PMC president and CEO Donovan Blackburn told Liz Moomey of the Lexington Herald-Leader that finding a way to serve the region’s children has long been a priority. “Our kids have to travel, it’s not right, it’s not fair,” he said. “As the largest single regional institution, we had to address that.”

"Prior to the children’s hospital opening, a child with appendicitis or a heart murmur would likely be referred to a specialist in Lexington," Moomey notes, quoting Blackburn: “A child will be able to see its extended family for support now during an overnight stay. A child will have access to urgent care instead of having delayed care when care is needed. A child will feel like they matter during some of their scariest times because of today.”

Friday, December 3, 2021

Sen. Rand Paul's false claim that masks don't work against the coronavirus gets Four Pinocchios from The Washington Post

By Salvador Rizzo
The Washington Post

“When you talk about the peer-reviewed studies of masks, there was one done in Denmark, showed that it didn’t work. When you look at all of Sweden — 1.8 million children have not been wearing masks for the last two years, they’ve had zero covid deaths. And you say, ‘Well, have the teachers been infected?’ Well, it turns out the teachers are infected at the same rate as the rest of the public. So, they’ve had no masks for a year, year and a half. And it has worked. And that’s a whole country.” — Sen. Rand Paul (R-Ky.), in an interview on Fox News, Nov. 29, 2021

When Paul talks about “the peer-reviewed studies of masks,” he is referring to only one study, from Denmark, and he’s twisting what it says. In reality, multiple peer-reviewed studies show that wearing face coverings mitigates the spread of the coronavirus.

That’s especially true for recently infected people who don masks when they go outside the home. They may not be showing symptoms, but they are carrying a high viral load. The face covering works as a stopper, capturing many infectious airborne particles before they can reach another person.

Although Sweden has seen a very low rate of child mortality from Covid-19, Paul’s statement that no Swedish children have died of the disease also is inaccurate.

The Facts

From April to June 2020, researchers tracked 6,024 participants for a study in Denmark, which did not recommend mask-wearing in public at the time. Cafes and restaurants were closed during most of this period; public health authorities were recommending quarantine for those with the coronavirus, as well as social distancing and limiting face-to-face encounters.

The study, published in the Annals of Internal Medicine last year, found that the group wearing surgical masks was less likely to catch the virus than the unmasked group, but there was not enough evidence to reach a statistically significant conclusion.

“Our results suggest that the recommendation to wear a surgical mask when outside the home among others did not reduce, at conventional levels of statistical significance, the incidence of SARS-CoV-2 infection in mask wearers in a setting where social distancing and other public health measures were in effect, mask recommendations were not among those measures, and community use of masks was uncommon,” the researchers wrote. “Yet, the findings were inconclusive and cannot definitively exclude a 46% reduction to a 23% increase in infection of mask wearers in such a setting. It is important to emphasize that this trial did not address the effects of masks as source control or as protection in settings where social distancing and other public health measures are not in effect.”

Paul claimed on Fox News that this study showed that masks don’t work, but in fact the study says masks could reduce coronavirus cases by up to 46 percent in circumstances like Denmark’s — or increase infections by up to 23 percent. A spokeswoman for the senator referred us to the Danish study but did not respond to our questions.

“Measures to impede transmission in health care and community settings are essential,” the same study adds. “The virus is transmitted person-to-person, primarily through the mouth, nose, or eyes via respiratory droplets, aerosols, or fomites. … Face masks are a plausible means to reduce transmission of respiratory viruses by minimizing the risk that respiratory droplets will reach wearers’ nasal or oral mucosa.” (Somehow this passage did not make it into Paul’s summary of the study.)

Other studies have found that mask-wearing in the community reduces the incidence of covid-19. Paul didn’t mention them on Fox News.

“During the pandemic, the scientific evidence has increased,” according to a study this year in the Journal of the American Medical Association (JAMA). “Compelling data now demonstrate that community mask-wearing is an effective nonpharmacologic intervention to reduce the spread of this infection, especially as source control to prevent spread from infected persons, but also as protection to reduce wearers’ exposure to infection.”

In the British Medical Journal last month, a review of six scientific studies found a 53 percent reduction in covid-19 incidence from mask-wearing. It added that the “results of additional studies that assessed mask-wearing (not included in the meta-analysis because of substantial differences in the assessed outcomes) indicate a reduction in Covid-19 incidence, SARS-CoV-2 transmission, and covid-19 mortality. Specifically, a natural experiment across 200 countries showed 45.7% fewer Covid-19 related mortality in countries where mask-wearing was mandatory.”

Research published in the Proceedings of the National Academy of Sciences (PNAS) in January found “evidence in favor of widespread mask use as source control to reduce community transmission.”

“Nonmedical masks use materials that obstruct particles of the necessary size; people are most infectious in the initial period post-infection, where it is common to have few or no symptoms; nonmedical masks have been effective in reducing transmission of respiratory viruses; and places and time periods where mask usage is required or widespread have shown substantially lower community transmission,” the survey says.

The lead author, Jeremy Howard, said the Danish research Paul was referring to “showed that low-quality masks such as cloth masks do not have a very large protective effect to the wearer.”

“This was expected — respiratory particles quickly evaporate and become too small for a cloth mask to stop,” Howard said. “However, cloth masks are protective for those around an infected wearer.” Some research, he added, shows “it is far better to use higher-quality masks, or alternatively add a mask fitter.”

The first large, randomized trial to test mask efficacy in a real-world setting recently was completed in Bangladesh, where nearly 350,000 people in rural parts of the country were tracked. The study has not completed the peer-review process, but the authors report that “when surgical masks were employed, 1 in 3 symptomatic infections were avoided for individuals 60+ years old, the age group that faces the highest risk of death following infection.”

The results for cloth masks were less conclusive. A separate study sent to us by Paul spokeswoman Kelsey Cooper — from 2015, before the coronavirus pandemic — found that cloth masks should not be recommended for health-care workers, particularly in high-risk situations, because “moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.” The findings do not apply to surgical masks or high-quality masks.

The same researchers posted an update after the coronavirus pandemic began: “Health workers are asking us if they should wear no mask at all if cloth masks are the only option. Our research does not condone health workers working unprotected. We recommend that health workers should not work during the Covid-19 pandemic without respiratory protection as a matter of work health and safety. … If health workers choose to work using cloth masks, we suggest that they have at least two and cycle them, so that each one can be washed and dried after daily use.”

How does a mask stop coronavirus particles?

Imagine an infected person who is breathing, talking, singing, exercising, coughing or sneezing in a crowded room. Several studies have found that face masks are able to capture the airborne infectious particles that can spread the coronavirus. That’s what scientists refer to as “source control,” and that’s why public health authorities recommend masks in some indoor settings along with vaccinations, social distancing and other measures.

“There is laboratory-based evidence that household masks have filtration capacity in the relevant particle size range, as well as efficacy in blocking aerosols and droplets from the wearer,” the PNAS study says. “That is, these masks help people keep their emissions to themselves. A consideration is that face masks with valves do not capture respiratory particles as efficiently, bypassing the filtration mechanism, and therefore offer less source control.”

As the JAMA study says: “Exposure is greater the closer a person is to the source of exhalations. Larger droplets fall out of the air rapidly, but small droplets and the dried particles formed from them (i.e., droplet nuclei) can remain suspended in the air. In circumstances with poor ventilation, typically indoor enclosed spaces where an infected person is present for an extended period, the concentrations of these small droplets and particles can build sufficiently to transmit infection.”

This study found that community masking reduces coronavirus transmission rates in two ways — first, by blocking the virus-laden droplets being exhaled (source control) and second, by protecting uninfected wearers, although masks were found to be less effective for this group.

“Masks form a barrier to large respiratory droplets that could land on exposed mucous membranes of the eye, nose, and mouth,” the study says. “Masks can also partially filter out small droplets and particles from inhaled air. Multiple layers of fabric and fabrics with higher thread counts improve filtration. However, the observed effectiveness of cloth masks to protect the wearer is lower than their effectiveness for source control, and the filtration capacity of cloth masks can be highly dependent on design, fit, and materials used.”

‘1.8 million children … zero covid deaths’

Paul also brought up Sweden in this interview, arguing that the country, which had no mask requirement for schools, did not see worse coronavirus transmission or mortality rates. He said zero children had died of covid-19, but the official Swedish figures show that 14 people ages 0-19 had died of the disease as of the most recent update.

study published in August in the Scandinavian Journal of Public Health found that Norway, a neighbor to Sweden that imposed stricter coronavirus lockdown measures, had lower mortality rates. “The Covid-19-associated mortality rates per 100,000 person-weeks during the first wave of the pandemic were 0.3 in Norway and 2.9 in Sweden,” it says.

“All-cause mortality in Norway was lower during the pandemic, whereas the all-cause mortality among elderly people in Sweden increased substantially,” the researchers found. “In previous years, both countries have seen a decreasing trend in all-cause mortality. It remains to be seen whether the observed excess deaths in Sweden during the pandemic may, in part, be explained by mortality displacement and whether the Covid-19 pandemic and mitigation measures are associated with other harms or benefits.”

Paul’s spokeswoman said he was referring to a letter published by a Swedish researcher in February in the New England Journal of Medicine. “Despite Sweden’s having kept schools and preschools open, we found a low incidence of severe Covid-19 among schoolchildren and children of preschool age during the SARS-CoV-2 pandemic,” it says, adding that from March to June 2020, “no child with Covid-19 died.”

That’s a few months, not the year or year and a half Paul mentioned. The letter, now outdated, was peer-reviewed by some academics and criticized by others, who said it ignored school outbreaks of Covid-19, among other issues.

The Pinocchio Test

Paul said the scientific research on wearing masks shows they don’t mitigate the spread of the coronavirus. But the only study he relies on for support was inconclusive at best.

In fact, most of the peer-reviewed research shows that wearing masks outside the home, especially surgical or high-quality masks, reduces the incidence of covid-19 cases.

The senator’s misleading talk of “peer-reviewed studies” goes far beyond the usual spin and merits Four Pinocchios.

Salvador Rizzo is a reporter for The Washington Post's "Fact Checker" column, where this was first published. The Fact Checker is a verified signatory to the International Fact-Checking Network code of principles.

Kentucky's coronavirus infection rate jumps to 16th among the states; its 22% increase in cases the last two weeks ranks ninth

New York Times map, adapted by Ky. Health News; click it to enlarge; interactive version is here.
By Al Cross
Kentucky Health News

The Thanksgiving lull is over and the pandemic is surging again in Kentucky.

The state reported 2,813 new cases of the coronavirus Friday, raising the seven-day rolling average by almost 300, to 2,039, the highest since Oct. 12. The average has been increasing steeply as fewer days from the Thanksgiving holiday period are included, and there are still more of those to come.

The state's seven-day infection rate zoomed to 41.73 per 100,000 residents, up from 35.8 on Thursday. Friday's rate is the highest since Oct. 7. Counties with rates more than double that rate were Cumberland, 123.1; Powell, 119.1; Robertson, 108.4; Carroll, 92.7; Lawrence, 91.4; Hancock, 86.8; Harlan, 84; and McLean, 83.8.

Kentucky's infection rate ranks 16th among the states, a big jump from 21st on Thursday, according to The New York Times. Last week, it was 25th. The Times says cases in the state have risen 22% in the last 14 days, the ninth fastest increase among the states; Missouri was first, Indiana was sixth and Illinois was 10th.

The number of Covid-19 patients in Kentucky hospitals fell by 15, to 972, but illness became more serious; 284 were in intensive care, 25 more than Thursday, and 156 were on mechanical ventilation, a big jump of 24.

All but one hospital region, northeastern Kentucky, had more than 80 percent of their intensive-care beds occupied, and all but one of those was above 90%. Northern Kentucky remained at 100%. Northeastern Kentucky had the lowest ICU usage, 53%, and the highest percentage of ICU patients with Covid-19, 26.5%.

The pandemic's death toll in Kentucky rose to 11,091, as the state reported 64 more Covid-19 deaths, the sixth highest daily total of the pandemic, which is approaching the end of its 21st month. Gov. Andy Beshear said on Facebook that one of the fatalities was 39 years old.

In an interview on MSNBC's "MTP Daily," with "Meet the Press" host Chuck Todd, Beshear was asked if there is "any way" for him to regain the ability to impose mask mandates, which the legislature took from him in September. He didn't answer directly, but suggested that he won't try to reverse that.

"We know that we can lessen the spread . . . that we can keep kids in school" by wearing masks, Beshear said. "This isn't about personal popularity; it's about life versus death. . . . It's unfortunate I don't have that ability anymore."

How dangerous is Omicron?

The Omicron variant of the virus "looks ominous," says The Economist. "In genomic terms, Omicron is wildly different from any other variant seen to date. The nature of its differences suggested, in theory, that it might be better at getting into human cells than its relatives were. It might also be better at avoiding the attentions of antibodies from vaccination or an earlier infection."

Virologists long thought that a variant with both those advantages “would be a pretty dangerous thing” but unlikely; now “Omicron is exactly that,” Noubar Afeyan, a co-founder of vaccine maker Moderna, told The Economist. The British magazine concludes, "Its mutations and its apparently rapid spread added up to something potentially scary."

Ugur Sahin, head of BioNTech, with Pfizer the other maker of messenger-RNA vaccines, agrees that "the neutralizing effect of vaccine-elicited antibodies will be lower for Omicron," The Economist reports. "But he adds that it is not clear how great the reduction will be, and points out that immunological protection is not provided by antibodies alone."

Both companies are developing Omicron vaccines, but they did that for two earlier variants and never produced them because the variants fizzled. Omicron spread aggressively in South Africa, but no such surges have been seen elsewhere. "It is possible that the surge had other causes and that any variant around at the time would have spread. Or some factor which favors the variant in South Africa may be absent everywhere else."

Feeling older than you are? You may not be getting enough sleep

Shutterstock
Getting plenty of sleep is important not just for physical health but also for your own perception of your health.

A study led by the University of Exeter in England found that people who rated their sleep the worst felt older and perceived their own physical and mental aging more negatively.

Researchers surveyed 4,482 people 50 and over in an online study in which participants take regular cognitive tests and complete lifestyle questionnaires. The study aims to understand what helps people stay cognitively healthy.

Lead author Serena Sabatini said, “Our research suggests that poor sleepers feel older, and have a more negative perception of their aging. We need to study this further – one explanation could be that a more negative outlook influences both. However, it could be a sign that addressing sleep difficulties could promote a better perception of aging, which could have other health benefits.”

The research team noticed that many participants were commenting on their relationship with sleep as part of standard questionnaires within the study. Comments included: “How I feel fluctuates widely depending on my sleep. I feel great if I get six hours, so about half the time I feel younger and half the time I feel older!”

Prompted by such comments, the team offered a questionnaire looking specifically at sleep. Participants were asked whether they had experienced a list of negative age-related changes, such as poorer memory, less energy, increased dependence on the help of others, decreased motivation, and having to limit their activities. They also rated their quality of sleep. The participants completed both questionnaires twice, one year apart. The research was published in the journal Behavioral Sleep Medicine

Pineville Community Health Center gets the first loan from a new program to help Kentucky's struggling rural hospitals

Pineville Community Health Center (Photo from Pineville Sun-Cumberland Courier)
By Melissa Patrick
Kentucky Health News

Pineville Community Health Center Inc. is the first health facility in Kentucky to be approved for a loan from the Kentucky Rural Hospital Loan Program.

"I want to congratulate the leadership at the Pineville Community Health Center on this loan approval and thank them for having the foresight to quickly capitalize on this new opportunity to benefit residents in Eastern Kentucky," Gov. Andy Beshear said in a news release.

The $1 million loan at 1% interest over a five-year term was approved by the Kentucky Economic Development Finance Authority, and was provided to help with operating expenses, says the release. 

The Kentucky Rural Hospital Loan Program was established during the 2020 legislative session, but was not funded. Funding for the program was approved during the 2021 session. An analysis released early this year by the Center for Healthcare Quality and Payment Reform found that 16 of the state's 69 rural hospitals are at risk of closing. 

At a news conference, Beshear praised Rep. Danny Bentley, R-Russell, who sponsored the legislation to create the loan program and encouraged other eligible hospitals to apply for the program. The Pineville facility was long called Pineville Community Hospital, then briefly Southeastern Kentucky Medical Center, and became Pineville Community Health Center as it went through bankruptcy in 2018-19. 

Slide from Gov. Andy Beshear's press conference
The $20 million program, which started in September, provides struggling rural hospitals with low-interest loans of $25,000 to $1 million. The loans are available in counties with fewer than 50,000 people and can be used to maintain or increase staff, to maintain or upgrade their facilities or to provide more services. 

"The only way to achieve our goal of ensuring a brighter future for every Kentuckian is to make sure every Kentuckian has access to quality and affordable health care," Beshear said at the news conference. "This program is a major step towards achieving that goal." 

HD Cannington, interim chief executive officer of Pineville Community Health Center, said the funds will be used to reopen its intensive-care unit, which will allow critical-care patients get care closer to home. 

In 2019, a Tennessee-based bank bought the hospital and changed its name. In August 2020, the Pineville Community Health Center Association, a non-profit organization formed by the hospital board, took over complete ownership of the hospital and its property, the Pineville Sun-Courier reports.

Thursday, December 2, 2021

As positive-test rate zooms above 9% and hospital cases surge, Beshear urges more vaccinations, boosters and caution

Ky. Dept. for Public Health graph, adapted and updated by Ky. Health News; click on it to enlarge.
By Melissa Patrick and Al Cross
Kentucky Health News

The share of Kentuckians testing positive for the coronavirus in the last seven days zoomed above 9 percent Thursday, and most other measures of the pandemic in Kentucky kept rising.

"I think what this says is we are in an escalation again; at the moment we don't know how long it would last," Gov. Andy Beshear said as he gave in his first detailed pandemic report in 10 days. He said hospitalizations are up 11% in the last week, and "We need to watch that carefully." Later in the day, the state's daily report showed the seven-day increase had shot up to 20%.

The report showed 2,841 new cases of the virus, raising the seven-day average by more than 100, to 1,747. That's about where it was before the Thanksgiving holidays, which brought lags in testing and reporting. In the last three days, 8,711 cases were added, the most for any three-day period in two months.

A more reliable measure at this point is the positive-test rate. On Thursday the seven-day rolling average was 9.2%, more than half a percentage point above Wednesday's average of 8.56%. Ten days ago, it was below 7%. 

Beshear said it's too early to know what's causing the escalation, but it could be driven by behaviors, colder weather, holiday gatherings or waning immunity among people who have been vaccinated against. He said he knows "a number of folks" who got a mild case of Covid-19 because they didn't get a booster.

"If we want to prevent escalations as we move forward. . . we not only have to get more people vaccinated," he said. "We not only have to continue testing so we can isolate when we get it, but we absolutely have to get as many people boosted with that booster shot as possible."

So far, 2.7 million Kentuckians have received at least one dose of a Covid-19 vaccine, or 53% of the total population; 2.3 million are fully vaccinated (53%) and 581,442 have gotten a Covid-19 booster (13%). The state's vaccination dashboard now shows the rate for each of these categories. 

The daily number of Kentuckians getting booster shots is much larger than those getting their first shot. Beshear said the latest "day over day" number of those getting their first dose is 4,865, and 12,631 for the booster. 

Beshear said the importance of getting a booster is indicated by the rate of cases, hospitalizations and deaths among those who are not vaccinated. He said that between March 1 and Dec. 1, 82.6% of cases, 84.6% of hospitalizations and 82.7% of deaths in Kentucky were among people not vaccinated or partially vaccinated.

Another impetus for shots is the new Omicron variant of the virus. Health Commissioner Steven Stack said no cases have yet been found in Kentucky, but “It’s not a matter of if, it’s a matter of when.” He added, “Our future is not outside our control. . . . Please go get that booster; it’ll help keep you safe.”

Stack said there is still much to learn about Omicron's transmissibility, severity, immunity and treatments. He said its many mutations may make it more potent, and could also limit the effectiveness of monoclonal antibodies, a Covid-19 treatment for which Beshear said demand is growing.

Asked what can be done to encourage more vaccination, Beshear talked about boosters, not initial shots, but put the fight in stark terms: “We’re fighting death. Our battle right now is against death. This virus wants to kill as many of us as humanly possible . . . Every variant we see encourages more people to get vaccinated, but that’s not the way to ultimately win the battle.”

Stack was asked about "herd immunity," in which so many are vaccinated that the unvaccinated are protected too. He uses another name for it: "I think community immunity is still a possibility. It’s just that the longer we have large percents of the population unvaccinated, the longer this lingers and the more the problem kind of festers."

Beshear spread responsibility: “The way I would kind of translate that is we’re only finally gonna defeat Covid as one world, and it’s still gonna take some time until we can get enough vaccines to the entire world.” He said the goal in the U.S. should be to get “as protected as we can be until we reach that point.”

Stack said that also means wearing a mask in indoor public settings; getting tested if you have symptoms; and staying home if you are sick. 

Beshear said neither his office nor the state Department for Public Health track masking policies in Kentucky schools, but "Going mask-optional is a recipe for disaster for spreading the virus and for missing out on days of school." He said his two children's schools require masks and have missed only one day. 

Asked if he wished he still had the authority to require masks, which the legislature took from him in September, he said, "Yes, I wish I had more authority to fight this virus. With cases increasing certainly I would have required school systems to have universal masking. I think it's a no-brainer and I think the science shows that it's a no-brainer." He said "test to stay" programs don't work without masking.

UPDATE: Three Catholic high schools in Louisville (Assumption, St. Xavier and Sacred Heart Academy) are going mask-optional on Monday, the Courier Journal reports: "The Archdiocese of Louisville has left masking protocols for high schools up to school leadership. . . . Assumption is recommending that unvaccinated individuals still wear a mask."

More daily numbers: The state's seven-day infection rate rose to 35.8 daily cases per 100,000 residents, 8.3% higher than the day before. Counties with rates more than double the statewide rate were Cumberland, 110.2; Robertson, 101.7; Powell, 94.8; Carroll, 88.7; Harlan, 77.4; and Lawrence, 76.5.

The state's infection rate, which had been at or around 25th among the states, rose to 21st in the ranking by The New York Times. Its 19% increase in cases over the last two weeks ranks eighth.

Kentucky hospitals reported 987 Covid-19 patients, 39 more than Wednesday and 20.3% more than a week earlier, with 259 in intensive care (up 10) and 132 on mechanical ventilation (up 9). 

Eight of the state's hospital-readiness regions were using more than 80% of their intensive-care beds, with Northern Kentucky at 100% and Barren River (the Bowling Green-Glasgow area) at 97%.

The state reported 40 more Covid-19 deaths, raising Kentucky's pandemic toll to 11,027. Nationally, the disease is killing about 2,000 people per day.

Appalachian Regional Healthcare buys Paul B. Hall Regional Medical Center, to be renamed Paintsville ARH Hospital

Mountaintop Media photo

Appalachian Regional Healthcare has finalized its purchase of the Paul B. Hall Regional Medical Center in Paintsville and its associated clinic operations in Johnson and Magoffin counties, making it the 14th member of the ARH system. 

The hospital will be renamed Paintsville ARH Hospital

"We are excited to welcome the nearly 250 team members at Paintsville into the ARH family and look forward to expanding ARH services in the Big Sandy region,” ARH President and CEO Hollie Phillips said in a news release. “As a member of the ARH system, the hospital will benefit from the collective stability and strength of our multi-hospital system while continuing to provide the exceptional level of care for which it has consistently been recognized over the years.”

Rocky Massey, who has served as community CEO for ARH hospitals in West Virginia, will be the interim community CEO for the 72-bed acute-care hospital. 

Wednesday, December 1, 2021

As first U.S. Omicron case is found, Beshear says Delta remains 'deadly and highly contagious' in Ky.; over 3,000 new cases today

Ky. Health News chart (click to enlarge); case numbers are from initial, unadjusted daily reports. 
By Melissa Patrick
Kentucky Health News

Kentucky saw another day of increasing coronavirus cases, a positive-test rate that is accelerating, and a daily infection rate that is higher than it was before Thanksgiving, all on the day that the first case of the Omicron virus variant has been identified in the United States. 

"I know that we're all nervous waiting for more information on the on the Omicron variant," Gov. Andy Beshear said in a Facebook post. "But today I want to talk about how concerned we ought to be about our escalating number of cases here in the Commonwealth of the Delta variant, which is proved to be deadly and highly contagious. Today, for the first time in over two months, we have over 3,000 new cases. This is not the direction we want to go."

Kentucky reported 3,312 new cases Wednesday, the most in one day since Oct. 1, when the seven-day rolling average was 3,076. Today's average is 1,636. Of today's new cases, 25.5% are in people 18 and younger. 

Beshear encouraged Kentuckians to get vaccinated or to get a booster "as quickly as possible" and to wear a mask when indoors and away from home. 

Kentucky Health News graph; click it to enlarge.
The percentage of Kentuckians testing positive for the virus went up again, at a steeper rate, to 8.56%. 

Kentucky hospitals reported 948 Covid-19 patients, 18 more than Tuesday; 249 of them in intensive care, down 17; and 123 on mechanical ventilation (up one).

Eight of the state's 10 hospital regions are using at least 80% of their intensive-care beds, with five of them over 90%. 

The state's seven-day infection rate is 33.05 daily cases per 100,000 residents. Counties with rates more than double that rate were Carroll, 96.8; Powell, 91.3; Cumberland, 73.4; Lawrence, 72.7; Harlan, 70.9; Monroe, 68.4; Estill, 67.9; and Robertson, 67.8. 

The number of counties in red on the state infection map, for counties with rates over 25 per 100,000, considered a high level of transmission, rose to 85 Wednesday, from 73 on Tuesday. The orange zone (more than 10 to 25 daily cases) has 32 counties. Three are in yellow (up to 10 cases).

The state reported 44 more Covid-19 deaths Wednesday, raising the pandemic death toll to 10,987. Over the last seven days the state has reported an average of 27 deaths per day; the 14-day average is 35.

Health officials on Wednesday detected the first U.S. case of Covid-19 linked to the Omicron variant, The Washington Post reports. The case was identified in a fully vaccinated San Francisco resident who recently returned from South Africa, wasn't yet eligible for a booster shot, and has mild symptoms.

“The individual is self-quarantining and all close contacts have been contacted and all close contacts thus far have tested negative,” Anthony S. Fauci, President Biden’s chief medical adviser and longtime director of the National Institute of Allergy and Infectious Diseases, said Wednesday.

"Since the new variant was first reported in southern Africa last week, it has been identified in at least 20 countries spanning the globe, and officials had expected it to appear in the United States as international travelers passed through airports and returned from trips abroad," the Post reports. 

Fauci also "advised Americans to resume wearing masks in indoor group settings, including at restaurants when not eating or drinking, and to get boosted as soon as possible for adults who are six months out from their last vaccine dose," the Lexington Herald-Leader reports.

The head of the firm that developed the first effective vaccine against the virus told The Economist, “I am personally not scared about the situation. We expected such a variant to come.” Ugur Sahin is chief executive of BioNTech, the German firm that produced the vaccine with America’s Pfizer.

"Sahin’s relative optimism contrasts with the foreboding tone struck by a rival vaccine-maker, Moderna, whose chief executive, St├ęphane Bancel, told the Financial Times this week that there would be a 'material drop' in vaccine effectiveness," The Economist reports. "Both men acknowledge that the world remains very ignorant about Omicron. But Mr. Sahin balances that with reassurance. He explains that even if Omicron overcomes the antibody response, the first layer of direct protection against the virus, it is known that the immune system can fall back on the second layer, which involves T-cells. These attack infected cells to stop the virus reproducing. Mr. Sahin also sought to ease concerns that the vaccinated population will get very ill if infected with Omicron, though he cannot allay them altogether. He says his 'scientific expectation' is that vaccinated people with boosters should fall only mildly or moderately ill if they catch Omicron."

Why we must listen to science and get vaccinated for Covid-19

By Kevin Kavanagh

Recently Medicare announced a 14.5% increase in Part B premiums, primarily driven by rising health-care costs and utilization during the pandemic.

Our inability to abide by sound public-health advice has restricted urgent care for many with life-threatening illnesses and placed an overwhelming strain on our health-care system – a strain that may far outlast the end of the pandemic, perpetuated by the continued medical requirements and costs of those afflicted with long Covid.  

Kevin Kavanagh, M.D.
I am not sure why our citizens continue to listen to those who have stated the pandemic was a hoax and medical personnel were diagnosing cases for money. Some of these same leaders also predicted the attainment of herd immunity after each Covid-19 surge. 

Many in our society rely on social media for their health-care advice. Unfortunately, this has turned out to be as effective as reading emails in your spam folder. A grain of truth is taken and then distorted to reach dangerous conclusions. Regrettably, many of our leaders are also fanning this fire.

In response to new data, our scientific leaders changed guidance regarding the wearing of masks in July 2020, but over a year later far too many leaders on the fringe have not updated their advice. They still discourage the use of masks, even high-grade N95 masks.

The newest disinformation is the belief that vaccines do not slow the spread of Covid-19, which can be traced back to a study by the United Kingdom’s National Health Service. This research did observe a marked decline in protection against transmission over a three-month period after full vaccination. However, several of the conclusions negate the dire misinterpretation: Those who were vaccinated were less likely to be infected in the first place; they transmitted the virus for a shorter period of time; and their contacts were less likely to contract the disease. Also, the Pfizer mRNA vaccine performed much better than the Oxford/AstraZeneca vaccine used in the U.K., and 66% of the transmissions were within the household where daily and prolonged contact often took place. The study concluded that “Vaccination reduces transmission of Delta.”

Anti-vaxxers have also been eager to point out the recent Covid-19 surge in Maine and Vermont.  These are some of the most highly vaccinated states, with 72% of the entire population fully vaccinated as of Nov. 22. But even at this level of vaccination, the virus can still spread. The surge in these northern states is primarily due to the advancing cold weather promoting the congregation of unvaccinated individuals in poorly ventilated indoor settings.

Association or correlation does not mean causation. Almost all buildings need to upgrade their ventilation system. This should be one of our highest priorities to implement with Covid-19 relief funds.  

The emergence of the Omicron variant has sent shockwaves throughout the world with fears of even a more transmissible and possible immune-escape variant. Most experts feel the current vaccines will offer a degree of protection, but having the highest possible immune response is of utmost importance.  

The take-home message is obvious: Become vaccinated, and when indicated, obtain a booster (if you had a previous infection, view vaccination as the needed booster). A recent study found that vaccination increased immunity over 30-fold in those with a previous infection, and boosters increased immunity 25-fold in those who have been vaccinated.

Vaccinations reduce both the spread and severity of Covid-19. But even if you are vaccinated, you still need to wear a mask in public indoor settings.

Many around the world are envious of the Covid-19 resources available in the United States and perplexed why we do not fully utilize them. For the safety of our loved ones, let’s become vaccinated, wear masks and utilize home testing.  All of these modalities are inexpensive and readily available.

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA, which focuses on infection control. A longer version of this was published in the Louisville Courier Journal.

Tuesday, November 30, 2021

As Kentucky's pandemic numbers catch up with the holiday weekend, they jump; state's positive-test rate is now 8.31%

State Dept. for Public Health map, adapted by Kentucky Health News; for a larger version, click on it.

By Melissa Patrick

Kentucky Health News

Kentucky's coronavirus metrics took another jump Tuesday, with new cases and the share of Kentuckians testing positive up, and the fallout from that reflected in hospitalizations and deaths. 

The state reported 2,558 new cases, bringing its seven-day rolling average to 1,469 per day. Tuesday's number was likely inflated due to delays in testing and reporting over the holiday, but that said, it is the highest one-day new-case number since Oct. 7. Of today's new cases, 25% are in people 18 and younger. 

The share of Kentuckians testing positive in the past seven days went up again, to 8.31%, maintaining a a steeper rate of climb that began last week. 

The state's seven-day infection rate is 29.41 daily cases per 100,000 residents, up from 27.84 on Monday. Counties with rates more than double that rate were Carroll, 73.9; Powell, 69.4; Cumberland, 64.8; Harlan, 61.5; and Robertson, 61. Seventy-three of the state's 120 counties have more than 25 cases per 100,000 residents, labeled a high level of transmission and showing red on the state infection map.

Hospital numbers also jumped. Kentucky hospitals reported 930 Covid-19 patients, an increase of 71 from Monday. That was the largest one-day rise since Sept. 8; both days followed holiday weekends in which hospital admissions may have been delayed. (Hospital numbers are recorded at midnight.)

The number of Covid-19 patients in intensive care grew by 25, to 266; and those on mechanical ventilation went up 11, to 122.

Eight of the sate's 10 hospital readiness regions are using at least 80% of their intensive-care beds, with two over 90%: Northern Kentucky (96.25%) and Barren River (95.35%). 

The state reported 30 more Covid-19 deaths Tuesday, bringing the pandemic death toll to 10,943. 

The Hopkinsville Art Guild memorialized seven people who have died from Covid-19 with portraits, each of them with a connection to Western Kentucky and most of them from the Hopkinsville area, Jennifer P. Brown reports for the Hoptown Chronicle. 

Other pandemic news Tuesday: 

U.S. District Judge Gregory F. Van Tatenhove of Lexington issued a preliminary injunction Tuesday effectively blocking implementation of President Biden's Covid-19 vaccine mandate for federal government contractors and subcontractors, Austin Horn reports for the Lexington Herald-Leader. The order came in response to a challenge from Attorney General Daniel Cameron, who joined other state attorneys general in the challenge. 

Van Tatenhove "said that the question before him was a narrow one: whether or not Biden had the authority to impose vaccines on the employees of federal contractors and subcontractors," Horn wrote, quoting the judge: “In all likelihood, the answer to that question is no.”

An independent advisory committee to the U.S. Food and Drug Administration narrowly endorsed the first antiviral pill developed by Merck & Co. for Covid-19, called molnupiravir. The vote was 13-10, with some members voicing concerns over the drug's potential impact on people of childbearing age and concerns over whether the drug could drive mutations of the virus, The Hill reports.

Merick said the drug, which is administered as a five-day treatment, showed a 30% reduction in hospitalizations and deaths, based on data from 1,433 patients, The Hill reports.

Aleria Companies and bankrupt Trinity HealthShare told to pay $4.7 million in Lexington class-action lawsuit that is still going on

"A purported health care cost-sharing company . . . has lost a class-action lawsuit resulting in a nearly $4.7 million judgment" in U.S. District Court at Lexington, reports Jeremy Chisenhall of the Lexington Herald-Leader

After representatives of The Aliera Companies "failed to appear in court multiple times, according to records, Senior Judge Joseph M. Hood "declared that the company should have been subjected to Kentucky insurance laws because their claims of selling health care sharing ministry plans were inadequate," Chisenhall reports. "Members in health care sharing ministries share medical expenses among themselves. Health-care sharing ministry plans aren’t subject to the same regulations as insurance, but they have to meet strict requirements. Aliera didn’t meet those requirements, Hood ruled."

Jay Prather, one of the plaintiffs' attorneys, said “Aliera and its partners have taken advantage of hundreds of Kentuckians, many of whom trusted the company because it professed Christian beliefs. “Aliera’s customers sought affordable healthcare coverage to protect their families in times of need. But when those times of need came, Aliera was more likely to shut the door in the face of its own customers. This ruling by Judge Hood is the first step in helping those families recover what they have lost.”

"Aliera created, marketed, sold and administered health care plans for Unity HealthShare and Trinity HealthShare, companies that were purported to be health-care sharing ministries, according to the lawsuit. Unity HealthShare later rebranded itself as OneShare Health, according to court records," Chisenhall reports. "Hood sided with the victims that purchased a plan while Aleria was partnered with Trinity. Assuming each policyholder would elect to receive the higher payout of those two options, Hood reached an aggregate judgment of $4.7 million, according to court records. Trinity has since filed for bankruptcy, according to court records."

The lawsuit continues because Hood's ruling applies only to policies sold through Trinity. Attorneys for the plaintiffs said Aleria sold plans to "hundreds, if not thousands, of Kentucky residents" and kept 84 percent of their payments. Conversely, insurance companies are required to pay out 80% of the premiums they received, but the law doesn't apply to health care cost-sharing companies.

Aleria denies that it was a health care cost-sharing company. It said in a court filing, “It is a for-profit entity that contracted with Unity and then Trinity (through its subsidiaries) to market memberships in their sharing programs and to create processes to facilitate member-to-member sharing of medical expenses. Aliera has created a system that is designed to afford members the ability to consent to their contributions being shared on a real-time, case-by-case basis with other members as their needs arise. But, as previously noted, all members are informed that their requests for sharing payments may not be met — there are no payment guarantees or indemnification.”