Tuesday, March 31, 2020

Worst day yet: 114 cases, 7 deaths; Beshear says Kentuckians are buying in, but cops say crowds still a problem in Louisville

Gov. Andy Beshear often compares responses of Philadelphia and St. Louis to the 1918 flu epidemic. Tuesday he added Louisville's, which was not as strong as St. Louis's but was more resilient, limiting the resurgence often seen after the initial peak. He said that shows Kentucky must remain vigilant.
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.
  • It is Kentucky's worst day of the covid-19 pandemic: 114 new cases and seven deaths, word of the seventh arriving in the midst of Gov. Andy Beshear's daily press conference.
  • "We knew this was coming, and we know there are gonna be more days where we have more than 114 new cases, and there are probably gonna be days when we have more than six new deaths," Beshear said. The latest daily projection by the University of Washington is that deaths in Kentucky will peak in mid-May, with 23 deaths a day for several days and a total of 1,161 deaths by the time they taper out on Aug. 4.
  • The seventh death was an 80-year-old in Campbell County, gender unidentified. Beshear said the others were an 88-year-old woman in Fayette County, a 74-year-old man in Bullitt County, and four in Jefferson: women aged 87 and 81, and men 74 and 66. “To my knowledge all these individuals had other factors” than covid-19, Beshear said. “This is the group that it impacts the most.”
  • “Let’s commit we do the things that it takes to makes sure we don’t have a lot of days like this,” Beshear said. “Our numbers would be significantly worse if it wasn’t for what we are doing. . . . “If you’re not going to the grocery store or going to a job, don’t travel anywhere.”
  • Health Commissioner Steven Stack said at the press conference, “If you do the things we have already asked you to do, we’re gonna be OK. . . . If you don’t do these things, there’s a lot of folks who are gonna get hurt.”
  • Beshear said in a five-minute interview on CNN that limited data indicate his steps to create social distancing have helped "flatten the curve" of the contagion, reducing the threat to Kentuckians and their health-care system. Shown a graph comparing reported cases in Kentucky and Tennessee, he said, "I believe that how aggressive we've been is working."
  • Beshear said "The people of Kentucky have bought in to what we're asking," but Louisville officials "continued to address community concerns about reports of large gatherings," the Courier Journal reports. Police Chief Steve Conrad said in a Facebook Live session that his officers spend a "great deal of time responding to situations where people are gathering" but "We cannot arrest someone for standing too close to another person — nor do we want to do that. . . . We're asking for cooperation and in some cases begging for cooperation. But at this point, we do not have the authority to make an arrest in regards to social distancing."
  • Beshear said at his press conference, “Every crowd and gathering is an opportunity for the coronavirus to spread … It's spreading in just about every crowd and very gathering. . . . If there's a crowd at any store, you don't go in.”
  • CNN interviewer John King asked Beshear to comment on President Trump's comment Monday that he hasn't heard of any problems with coronavirus testing in weeks. The overnor replied, "In Kentucky and everywhere across the country there are critical shortages of PPE and of testing kits. . . . I don't want to place blame out there; we're all fighting for these resources . . . but we've also been open and transparent about the fact that we don't have enough."

Lawmakers returning to Frankfort to pass a budget and other bills; here are some health-related measures that could pass

UPDATE: On April 1 the General Assembly passed a state budget and related bills, including one freezing health departments' pension payments at the current level. House Speaker David Osborne said more bills are likely to pass when the legislature returns April 13, including one to help rural hospitals..

By Melissa Patrick
Kentucky Health News

As lawmakers head back to Frankfort to pass a budget -- and other bills, despite Gov. Andy Beshear's repeated request that they pass only a budget and anything related to the coronavirus -- several big bills related to other aspects of health are pending, including some controversial measures.

Beshear, a Democrat, denied the request of the Republican legislative majority to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. The lawmakers plan to pass the budget and other bills Wednesday, April 1, and return April 14 to reconsider vetoed bills.

Beshear indicated at his daily press conference Tuesday that the budget would be the only bill passed. “These folks need to pass a budget and get of town,” he said. “My understanding is that now, that’s the plan.”

One big health-related bill that has been expected to pass is House Bill 32, which would tax electronic cigarettes. It has been promoted as a way to reduce teen use of the products by increasing their price and to bring state government more money -- an increased concern in light of the pandemic, which is likely to cause a recession and a drop in state revenue.

HB 32 was trimmed down in a Senate committee to place a 15 percent wholesale tax on e-cig products and a $1.50 per-pod tax on Juul-type products, which is expected to bring in $25 million a year. The original bill was estimated to bring in $50 million, and that could be trimmed down even further, as two Senate floor amendments have been filed to decrease the tax to 10%.

The original version would have put a 25% tax on e-cig products, while raising the tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigs to the list. It would have also doubled the per-unit tax on non-smokable products, but did not touch the tax on traditional cigarettes.

Health departments: Another health-related bill to watch is one that has been touted in the House as part of a three-phase approach to create a sustainable solution to local health departments' pension-driven financial woes.

House Bill 171, sponsored by Rep. Jim DuPlessis, R-Elizabethtown, would move health departments, regional universities and quasi-governmental agencies away from a "percentage of pay" pension formula to a model that requires them to pay only what they owe the system over a certain period, called "level-dollar funding." It is in the Senate State and Local Government Committee but has had two official readings, so it could pass quickly.

It could pass another way: in a House committee substitute to SB 249, with a change to include a new 30-year-amortization period for the pension debt, rather than the 27 years in HB 171. It also adds a layered, 20-year closed amortization period for any future increases or decreases in actuarially accrued liabilities after the 2019 valuation. SB 249 has received two readings in the House, and DuPlessis has said negotiations will likely be done through SB 249.

Rural hospitals: HB 387, sponsored by Rep. Danny Bentley, R-Russell, would create a revolving loan fund for financially distressed rural hospitals.

It would allow the Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available. The bill has had two readings and is in the Senate Appropriations and Revenue Committee.

Insulin costs: Another important health-related bill would cap the monthly cost of insulin for many Kentuckians at $100. HB 12, sponsored by Bentley, would require state-regulated insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." It does not include Medicaid, Medicare or self-insured government plans.

The Senate committee substitute for HB 12 would also establish an insulin assistance program. This language comes from SB 23, sponsored by Sen. Phillip Wheeler, R-Pikeville. HB 12 has had two readings and is in the Senate Rules Committee.

Abortion: At least one anti-abortion bill is likely to move; it has been awaiting final passage for some time. Senate Bill 9, sponsored by Sen. Whitney Westerfield, R-Hopkinsville, would require health-care providers to give "medically appropriate and reasonable life-saving and life-sustaining medical care and treatment" to any infant born alive, including after a failed abortion, and would make not doing so a felony. A House committee removed references to research, so it would not inhibit ongoing research.

Critics of the bill say the state already has laws to prevent this from happening and the bill does not account for palliative care needed when infants will not live, or will not have quality of life.

Another abortion bill that could pass is House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, which would expand the power of the attorney general to shut down abortion providers. The Senate Judiciary Committee added authority for Attorney General Daniel Cameron to block abortions under gubernatorial emergency orders limiting "non-urgent" medical procedures.

Sen. Ralph Alvarado, R-Winchester, has filed a floor amendment to ban abortion from being deemed an urgent procedure in the state of emergency Beshear declared for covid-19. Democratic Floor Leader Morgan McGarvey of Louisville has filed an amendment to allow abortions in the case of a nonviable fetus, rape, incest, or threat to the mother's life.

HB 451 has had only one reading in the Senate, so it could not pass Wednesday unless the Senate suspended the readings requirement, which the state constitution allows it to do. Majority Floor Leader Damon Thayer said last week that was a possibility, but he voiced skepticism of the idea because it might set a precedent that legislative leaders would like to avoid. The legislature could pass it April 14 or even April 15, the day the session must end, but Beshear could veto it without fear of a legislative override.

Another abortion bill pending is House Bill 67, sponsored by Rep. Joseph Fischer, R-Fort Thomas, which would, in effect, ban abortion in Kentucky if Roe v. Wade is overturned. It would have the constitution say, "To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion." The bill has had no readings in the Senate, but is a constitutional amendment that would go directly to the Nov. 3 ballot, not to Beshear, so it could pass if the legislature met April 15 or if it suspended the readings requirement.

Here are some other health-related bills that could pass:

HB 29, sponsored by Rep. Steve Riley, R-Glasgow, would extend temporary license for long-term care administrators to nine months, not six. It awaits House concurrence with a Senate substitute that would prohibit certification or renewal of an assisted-living community if it is owned, manged or operated by a person who has been convicted of certain crimes it would also change the appeals and renewal processes.

HB 46, sponsored by Rep. Jerry Miller, R-Louisville, would allow full-time state employees a paid leave of absence of 240 hours for donating a human organ and 40 hours for donating bone marrow. This bill is on the Senate consent calendar, which is used to pass bills en masse without debate.

HB 8, sponsored by Rep. Rob Rothenburger, R-Shelbyville, would boost Medicaid reimbursements for ambulance services by setting up a trust fund to allow them to draw a federal match. This bill is on the Senate consent calendar.

SB 30, sponsored by Sen. Stephen Meredith, R-Leitchfield, would  limit the number of managed-care organizations to three, from the current five. This bill has received a reading in the House and been returned to the Health and Family Services Committee.

SB 237, sponsored by Sen. Max Wise, R-Campbellsville, would  allow collection of tissue samples from post-mortem exams of children who have died from Sudden Infant Death Syndrome to be used for research purposes, with a parent's permission. This bill is also in the House Health and Family Services Committee, with one reading.

A more comprehensive list of health bills in the General Assembly, compiled by Kentucky Health News in a Google Doc, is available here.

Monday, March 30, 2020

Beshear bans travel to other states, orders quarantine for travelers; CDC says 29% of infections among people 20-44

Beshear said his order was based on larger case counts in most adjoining states. (Image via Herald-Leader)
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

In a state with six of its seven metropolitan areas on state borders, Gov. Andy Beshear announced an executive order instructing Kentuckians to not travel to other states. He said other states have higher numbers of covid-19 cases than Kentucky and has previously noted that some  have not established strong social- distancing mandates.

"As you can see, we have more cases in other states," he said. "That doesn't mean that they are doing a good or a bad job, what it means is your likelihood of getting infected and potentially bringing back the coronavirus may be greater in other states than ours right now. And really, you need to be home. You need to be healthy at home."

The exceptions are for work, groceries, medicine, supplies, health care, a court requirement or giving care to a loved one. "If you travel to a different state for any reason other than those exceptions," Beshear said, "you will be required to quarantine for 14 days," which can be the incubation period for the coronavirus.

Asked how his order would be enforced, Beshear said it can be done by law enforcement, judges and others, but "The reality is the only way that we are going to get people doing the right thing is because they agree to; it's because they see it as their duty and they know that their actions can harm other people; that the moment that you go across the border, whether it's to get your hair or your nails or something else done, or to go to a store that is not open in Kentucky. . . . and you have that extra contact, you can bring it back to a person in your family that is working in a nursing home."

Beshear acknowledged that Kentucky is doing a better job at social distancing than some states, but said, "We need to do better. We have to do better. I mean the lives and health of our people depend on it." He said the only places you need to travel to is "to work or the grocery store or maybe to a place that you are getting exercise -- that ought to be it."

La Tasha Buckner, the governor's chief of staff, said at Beshear's daily press conference, "We want anyone in Kentucky who has been out on spring break or for a trip to return home and self-quarantine for about 14 days, just to make sure that you haven't been exposed and don't expose other people. We want you to be healthy at home."

Beshear said he has talked with both Home Depot and Lowe's about measures that need to be taken to ensure social distancing in their stores. He also said Kentuckians must also do their part and not go into stores that are crowded.

While going over a new graphic with 10 steps to fight covid-19 at his daily press conference, Beshear reminded Kentuckians that we are in the surge of covid-19 cases so it's even more important than ever to wash your hands. "Wash your hands, wash them and wash them a lot," he said.

"The next couple of weeks folks are really, really critical," he said. "And the amount of social distancing we do and the amount of contacts that we can decrease is going to make a huge difference on what we are going to see going forward."

In other coronavirus news in Kentucky Monday:
  • The state reported 42 new covid-19 cases and two more deaths: an 88-year-old woman from Kenton County, whom Beshear called a "presumptive positive" for the virus, and a 90-year-old woman from Simpson County. Beshear said both had underlying health conditions. To date, Kentucky has at least 480 cases and 11 deaths from covid-19. 
  • Two people in a Campbell County nursing home tested positive: a resident, who is now in a hospital, and an employee. Beshear said four others in the facility are being tested.
  • Beshear estimated the total number of people tested in Kentucky is between 15,000 and 21,000. He added that the state is still working on getting better information about testing, such as reports of negative results from labs. The false-negative rate has been as high as 40 percent.
  • The governor said it would be another week or so before Kentucky decides if schools would be closed beyond April 20.
  • The state Cabinet for Health and Family Services told assisted-living facilities on March 26, "All congregate activities shall stop effective immediately and transition to virtual settings as available." One solution: hallway bingo, with residents sitting in their doorways.

Preliminary estimates of covid-19's effects on health-care system, and lives, show Ky. compares favorably with major border states

By Al Cross
Kentucky Health News

Kentucky compares favorably to its major bordering states in the first public estimates of the impact of the coronavirus on the U.S. health-care system and the number of deaths expected from the covid-19 disease caused by the virus.

However, some estimates for Kentucky have wider possible ranges than for the other states, illustrating the shortage of data that public-health experts say is needed for policymakers to make decisions.

The estimates were published Thursday by Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington. It drew in confirmed covid-19 deaths around the world through March 24, and state-by-state data on hospital capacity and use. He said he used covid-19 data "from select locations to develop a statistical model forecasting deaths and hospital utilization against capacity by state for the U.S. over the next four months."

The estimates are being revised daily, as noted below. “Every day that we get more data, we'll get better predictions,” he told The Washington Post. “We believe the data on deaths, but we don't believe the data on number of cases basically almost anywhere because of variability in testing protocols.”

Murray estimated that 585 people in Kentucky will die from covid-19, or 0.013 percent of the state's estimated 2019 population. That is lower than any of the states that have major borders with Kentucky. Indiana's percentage is the highest, 0.036%, representing  a forecast of 2,440 deaths.

The death forecasts for other major adjoining states are: Illinois, 2,454 (0.019%); Ohio, 2,733 (0.023%); Tennessee, 1,551 (0.022%) and West Virginia, 460 (0.025%).

Deaths in a pandemic typically follow a bell-shaped curve. Murray estimated the peak of the curve for each state and the likeliest number of deaths on that day. Of the six states, Kentucky has the latest forecast peak date, April 29May 11, when 11 people are projected to die. Indiana is forecast to have the earliest peak among the six, 11034 deaths on April 1714.
Projections above for Kentucky, below for Tennessee; shaded areas indicate possible ranges.
To view a larger version of either image, click on it. Images have been squeezed horizontally.

Health experts talk of the need to "flatten the curve" to keep the number of cases from overwhelming the health-care system, and Kentucky appears to be doing that. Murray estimated that the state will have enough hospital beds for covid-19 patients, but his forecast is less certain when it comes to the number of intensive-care-unit beds.

His report estimates that most of the major border states will be short of ICU beds at the peak, but Kentucky probably will have enough: 448 when only 160 are likely to be needed. However, the report says the number needed could be as low as zero or as high as 2,909.

The wide possible range could stem from the relatively low number of cases and deaths reported in Kentucky through March 24.

Gov. Andy Beshear was asked at his Sunday press conference if he had a projected peak date for Kentucky. "We're working on that," he said. "It’s all based on some really limited data. … The next two weeks are critical, and we know that will impact the peak."

Kentucky Health News notified Beshear's office before the press conference that it was preparing a story on the report, offering him a chance to comment on it. He did not, at least directly.

Beshear and Health Commissioner Steven Stack said the critical measure in the next two weeks is social distancing to prevent spread of the virus. "We're at crunch time," Stack said. "Assume everybody around you has the coronavirus."

One major obstacle to dealing with the virus is the lack of testing, which could track its spread. widespread testing would identify people who have the virus but no symptoms, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN. People without symptoms can still spread the virus, and not develop symptoms until two weeks or more after becoming infected.

The University of Washington model presumes that federal guidelines for social distancing will stay in effect through May. “That’s what we believe is going to happen because nobody’s really going to want to let up,” Murray told The Washington Post. “Even if the deaths are trending down nationally, some states may still be going up.”

Murray's report estimated that as many as 162,000 Americans will die from covid-19, but that the number could be as low as 38,000. It said the likeliest number is 81,114 deaths.

"In addition to a large number of deaths from covid-19, the epidemic in the U.S. will place a load well beyond the current capacity of hospitals to manage, especially for ICU care," Murray wrote.

Coronavirus Coordinator Deborah Birx speaks as President
Trump and Dr. Anthony Fauci listen. (Washington Post / Bill O'Leary)
Murray's results closely resemble those from a model developed by federal scientists, said Deborah Birx, coordinator of the White House's coronavirus task force. “When we finished, the other group that was working in parallel, which we didn't know about, IHME and Chris Murray, ended up at the same numbers,” Birx said at President Trump's daily press conference Sunday.

Among the states bordering Kentucky, Indiana is the only one that Murray's report forecasts to be short of beds, but only it and Kentucky are predicted to have enough ICU beds.

"The estimated excess demand on hospital systems is predicated on the enactment of social distancing measures in all states that have not done so already within the next week," Murray wrote, "and maintenance of these measures throughout the epidemic, emphasizing the importance of implementing, enforcing, and maintaining these measures to mitigate hospital system overload and prevent deaths."

Sunday, March 29, 2020

Pastor and former religion reporter writes: 'Use the brain the good Lord gave you. God is real and so are pandemics.'

This column is republished with the permission of the author and the Lexington Herald-Leader, where it originally appeared. An ordained minister for more than 30 years, Paul Prather is a columnist, author and pastor of Bethesda Church near Mount Sterling, Ky. From 1988 to 1997, he was a Herald-Leader staff writer covering primarily religion.
Paul Prather
By Paul Prather
    Dozens of people from two Kentucky congregations ended up self-quarantined this past week after they ignored Gov. Andy Beshear’s plea for churches to cancel services on March 15.
    These congregations held services anyway—and it turned out that worshiping among them were people already infected with covid-19.
    A Louisiana pastor was threatened with having his future church meetings broken up by the National Guard after he defied statewide orders to not meet with groups larger than 50 people. The pastor claimed the coronavirus scare was “politically motivated.”
    In my own community this past week, as I drove around town, mainly from the drive-through window at my bank to the drive-through window at my pharmacy, trying to practice social distancing, I realized it was business as usual for a lot of residents.
    They were piling in and out of dollar stores, the post office, groceries, gas stations, pressing in cheek to jowl, seemingly without a care.
    Pandemic? What pandemic?
    We humans—all kinds of us, not just religious ones—are great for convincing ourselves facts don’t apply to us, that we’re immune, that we’re different, that we’re special.
    Why, we’ve got our own personal Big Juju working for us that nobody else has.
    So, when the governor or the president or the world’s leading healthcare scientists warn there’s a contagious disease sweeping the globe, killing people like flies in Italy and Spain and already multiplying here among us, we decide, “That doesn’t apply to me. It’s not real. If it is real, God will protect me!”
    But maybe God was protecting you by giving you those warnings, do you think?
    I’m an ordained minister of the gospel. I’m the epitome of what skeptics call a magical thinker.
    I believe in an unseen God who created the world and ultimately controls it and is active in our lives. I believe God himself abides in my heart. I believe that on occasion he even speaks to me and perhaps acts through me.
    If that’s magical thinking, count me in.
    But to me there’s no conflict between being a person of faith and being a person who pays attention to actual documentable scientific facts.
    There’s a virulent, life-threatening pandemic exploding. If you don’t avoid crowds and step up your hygiene and do all the rest, it’s going to sicken or possibly kill you. Or you’ll become a carrier who sickens or kills someone else.
    True, even if you do what you should, it may get you anyway. But at least you can improve your odds of escaping it.
    Again, it isn’t just churchgoers who live by magical thinking.
    Americans of all philosophies eat triple-cheeseburgers, chain-smoke cigarettes or tailgate in the rain at 80 miles an hour while texting.
    “Statistics don’t apply to me!” we cry. “I’m superman! I’ve been driving like a maniac for 30 years and ain’t had a wreck yet! I laugh at statistics!”
    We conclude we’re protected by the Lord, or that rabbit’s foot in our pocket, or Mommy’s hovering ghost or genetics (“Papaw smoked 80 years and it didn’t hurt him!”).
    And yes, a few people do get away with self-delusion. Papaw might have smoked like a fiend and lived to be 94.
    But you probably won’t make it to 94. Papaw was what’s called a statistical outlier. By and large, though, the averages win. They come rushing back to bludgeon you into goop.
    I have no inside knowledge and no crystal ball about this coronavirus. I’m not a prophet.
    Plain common sense tells me covid-19 will get far worse before it gets better. I’d bet money we’ll be sheltering in place very soon. If we don’t successfully slow down the virus, our hospitals—and funeral homes—will be overrun like Italy’s.
    I want to say to my friends and fellow citizens of all stripes, but especially to my fellow churchgoers: for your own sake, for all our sakes, use the brain the good Lord gave you.
    Faith and common sense don’t contradict each other; they complement each other. You can trust     God and acknowledge facts at the same time. God blesses us with facts.
    Yes, God is real. But so are pandemics.
    The Lord indeed performs miracles. I wrote a whole book about modern-day miracles. I’ve witnessed what I consider to be miracles.
    God could miraculously protect you from the coronavirus. But miracles are miracles because they’re exceedingly rare. And they’re unpredictable.
    Mostly, God works within the laws of nature. Christians and all other varieties of believers are subject to the same rules of biology and epidemiology as atheists.
    So, it’s right and good to ask the Lord to spare you from covid-19. If you’re not religious, trust your rabbit’s foot or your good genes or your Big Juju.
    But also obey public health organizations’ guidelines for protecting yourself. If the governor orders us to shelter in place, stay where you’re supposed to. Avoid groups. Wash your hands thoroughly and frequently.
    Please, in this critical time, balance magical thinking with a stern dose of reality and with loving concern for the rest of us. Just do the right thing.

Beshear pleads for social distancing as Kentuckians flock to stores and recreation; Trump extends guidelines to April 30

Chart illustrates the spread of contagion with and without social distancing.
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

By Al Cross
Kentucky Health News

It's yet to be proven that warm weather will be bad for the coronavirus, but it's becoming clear that it can be bad for fighting it. Gov. Andy Beshear warned at his daily conference Sunday that he may have to close places of outdoor recreation and home-improvement stores if they can't enforce the social distancing that health experts say is needed to limit spread of the virus.

"I know it was a beautiful weekend, but we can’t, if we’re gonna keep these open, have large groups of people, and a large group can be six of you very close together. We can’t allow any crowds in Kentucky right now," Beshear said.

"Where social distancing is not being followed, we’re gonna have to close golf courses and other places like it. . . . If two dozen if you are standing around the practice putting green, then you’ve frustrated everything you’ve done throughout the entire week. I know it’s beautiful outside, but folks, this is real."

Warm weather also fills home-improvement stores, which Beshear has allowed to remain open as essential, life-sustaining businesses. He said there have been reports, "mainly from home-improvement stores, that we’re gonna have to look into, and we’re gonna have to have calls with those that run those facilities. We’re gonna have to ask that either those stores find a way to enforce social distancing, or we’re gonna have to see how essential they are."

The governor said that under his social-distancing order, "If there are that many people in the store, you’ve gotta close the front door until the store thins out. This is an absolute requirement that ought to be met."

He said shoppers also have a responsibility to avoid crowded stores and be careful about getting close to others: "You ought to treat yourself as if you have the coronavirus, and you ought to treat them as somebody whose spouse works in a nursing home."
Beshear said keeping away from other people “is against everything that we feel, every way that we’re raised, pretty much every way our society is put together, but . . . I want everybody to start thinking about the fact that if they don’t follow the guidelines, then doing what they just think is social can result in real harm to another Kentuckian."

He acknowledged, "We’re never gonna be able to enforce our way into the type of behavior we need to protect people. Instead, we're gonna have to have to encourage people. . . . As the days get nicer and the weekends are incredibly pleasant, I need you to be incredibly strong."

Other news about the coronavirus and its covid-19 disease included:
  • President Trump said the federal government's social-distancing guidelines, which were set March 16 and were set to expire Tuesday, will be extended to April 30.
  • Dr. Scott Gottleib, who ran the Food and Drug Administration for Trump, said the guidelines should not be eased "until you see sustained reduction in the number of cases for 14 days."
  • Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, estimated that it “would be a matter of weeks” before the guidelines could be relaxed. He also said testing speed must improve to provide better data for decisions.

Methamphetamine returns to Appalachian Kentucky, in a more deadly form, and it's causing fear and division in communities

Dakota Scott, with her two-week-old daughter, fights meth addiction at Karen’s Place Maternity Center in Ashland, a facility for women in addiction recovery (Photo by Hilary Swift for The New York Times)
Timothy Williams of The New York Times reports from Louisa: "Home deliveries from the local food bank now require a police escort. A shop owner has started to carry her gun to work. And the local constable, who rarely had to pull his weapon in the past, has drawn it a dozen times over the past year. All because people hooked on methamphetamine have threatened them. . . . A very public push to end opioid abuse has unwittingly ushered in the return of crystal meth."

Officials have warned for a year or more that meth was making a comeback even as the opioid epidemic continued in Appalachia. It returned in "a powerful new form," Williams notes, and that "has brought a sharply different set of problems . . . If pain pills left residents struggling to help many family members deal with the risk of overdose, methamphetamine has bred fear and division."

Referring to homeless meth users, Louisa Mayor Harold Slone told the Times, “Half the people want to take them to the river and tie something around their neck. We hadn’t seen that level of anger before.” State police told Williams that in some places, about three-fourths of arrests are related to meth crimes — "mostly shoplifting, burglary or assault, but occasionally attempted murder."

Much as a crackdown early in the last decade on prescription opioids led to a surge in heroin, the latest crackdown and increased awareness of the epidemic has "unwittingly accelerated the switch to methamphetamine," Williams writes.

"Opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute. A powerful Mexican organized crime syndicate, the Sinaloa drug cartel, has sought to fill the vacuum by targeting Appalachia, federal drug officials say. . . . The new Mexican variant is often mixed with cocaine, and increasingly, with fentanyl. Law-enforcement officials said cartels mix in those ingredients because fentanyl is inexpensive to produce, enhances the effects of meth and appears to cause faster addiction. Meth users around Louisa sometimes add their own dangerous ingredients, including wasp repellent, which users say produces a more intense high."

Saturday, March 28, 2020

Beshear signs more than 35 bills amid pandemic, many related to health care; physician assistants get limited prescribing power

By Melissa Patrick
Kentucky Health News

The Kentucky legislature continues to pass bills despite Gov. Andy Beshear's plea that it just pass a budget and anything related to the coronavirus, due to the social distancing needed to thwart it. He announced Saturday that he had signed more than 35 bills into law, many of them related to health.

“While all of us should be focused on responding to the coronavirus as the number of cases grows in Kentucky, I will continue to evaluate the dozens of bills lawmakers are passing and sign those I believe will benefit the people of the commonwealth,” he said in a news release. “While all of these issues could be addressed after we defeat the coronavirus, my staff and I will continue to look out for the best interests of all Kentuckians in deciding which bills should become law.”

Beshear, a Democrat, earlier rebuffed the request of Republican legislative leaders to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. They plan to pass the budget and other bills April 1, and return April 14 to reconsider vetoed bills; he has vetoed two.

Here are some of the health-related bills Beshear signed:

Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, requires the state to hire a single pharmacy benefit manager to manage Kentucky Medicaid's $1.7 billion-a-year prescription drug business. This bill is designed to address many of the billing practices between pharmacy benefit managers and pharmacists, which pharmacists have long said are so unfair that they are putting some of them out of business.

House Bill 135, sponsored by Rep. Steve Sheldon, R-Bowling Green, gives physician assistants "modified prescriptive authority" for controlled substances in Schedules III, IV and V after they've practiced a year. Sheldon said all other states allow prescriptive authority for PAs and Kentucky will become the sixth state to place restrictions on them for Schedule II drugs, which includes a long list of narcotics used for pain management as well as several psycho-stimulants that are used treat attention deficit hyperactivity disorder, or ADHD.

SB 56, sponsored by Sen. Ralph Alvarado, R-Winchester, brings Kentucky law in line with the new federal law raising the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21. It also removes status offenses for youth who "purchase, use or possess" tobacco products, which are often called PUP laws. The bill allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications. The bill had an emergency clause so it became law upon Beshear's signature.

SB 42, sponsored by Sen. Denise Harper Angel, D-Louisville, requires any student identification badge issued to a public middle- or high-school student to contain the contact information for national crisis hotlines specializing in domestic violence, sexual assault and suicide. This contact information must also be on all IDs issued by public or private postsecondary education establishments. This information must be included on the IDs beginning Aug. 1.

SB 60, sponsored by Sen. Jimmy Higdon, R-Lebanon, adds spinal muscular atrophy, also referred to as SMA, to the list of  required tests run on infants for heritable disorders. Early diagnosis of this genetic disease helps babies receive treatment when it is most effective. Including SMA, Kentucky will now do 60 newborn screenings. Alvarado said at the bill's Jan. 29 committee hearing that this condition affects five or six Kentucky babies each year. 

SB 82, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes the Kentucky Eating Disorder Council to oversee development and implementation of eating-disorder awareness, education and prevention programs. It will also identify strategies for improving access to adequate diagnosis and treatment services. and make recommendations on legislative and regulatory changes. Adams said 900,000 Kentuckians, including nearly 30,000 children, have been diagnosed with an eating disorder but the state has no residential, partial-hospitalization or acute-care programs.

SB 134, sponsored by Sen. David Givens, R-Greensburg, establishes the Optometry Scholarship Program with a trust fund supplied by state appropriations (determined with each biennial budget) gifts, grants, and federal funds. A minimum of one-third of the amount appropriated for scholarships must go to eligible students at an in-state institution -- a boon to the University of Pikeville's Kentucky College of Optometry, the state's only optometry school.

SB 125, sponsored by Sen. Tom Buford, R-Nicholasville, allows the Kentucky Board of Medical Licensure to determine the allowable scope of practice for athletic trainers in Kentucky, particularly related to their training. This bill has been in the works for about 10 years.

HB 153, sponsored by Rep. Kim Moser, R-Taylor-Mill, establishes a mental-health first-aid training program to show people how to best meet the needs of someone in a mental-health or substance-use crisis. Funding will come through a trust supplied by state and federal appropriations, grants and private donations. Advocates' hope is that this training will become as common as CPR.

Beshear had already signed several other health-related bills into law, including:

HB 129, sponsored by Moser, will overhaul the state public-health system, including how health departments are funded and how they prioritize their resources.  It is called the public health transformation bill. It was fully funded in the House budget but falls about $9.4 million short in the Senate's proposal, according to Randy Gooch, director of the Jessamine County Public Health Department. HB 129 is part of a three-phase approach submitted in the state House to create a sustainable solution to local health departments' pension-driven financial crisis.

SB 122, sponsored by Adams, modifies Tim's Law of 2017, which allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized at least twice in the previous year. SB 122 would make that two years. The goal of Tim's Law is to stop the revolving door of these individuals in and out of jails and state psychiatric hospitals, allowing more participants. The law is named for Tim Morton of Lexington, who was hospitalized involuntarily 37 times by his mother because it was the only way she could get him the psychatric treatment he needed. He died in 2014.

HB 99, sponsored by House Speaker David Osborne, R-Prospect, authorizing a $35 million state loan to the University of Louisville to support its recent acquisition of Jewish Hospital and other Louisville health-care facilities.

House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. A House-passed bill to make marijuana legal medicine in Kentucky has gotten nowhere in the Senate. 

As big surge in covid-19 cases begins, along with warm weather, Beshear warns gatherings will kill Kentuckians; vows enforcement

Gov. Andy Beshear spoke in his daily press conference as information sources were displayed.
By Al Cross
Kentucky Health News

As he reported a big surge in daily cases of the covid-19 disease caused by the coronavirus, and reports of gatherings that could spread it, Gov. Andy Beshear gave perhaps his most extended oration about the need for Kentuckians to restrict their activities to keep the virus from spreading.

"I know the personal emotions that this coronavirus is causing. It makes us anxious, afraid, uncertain, sad and isolated; but I hope you know that I think right now we are more connected than ever, even if we have to be physically apart," Beshear said near the start of his daily press conference.

"Our safety depends on us caring about each other, more now than ever before in my lifetime," he said. "It requires us being a commonwealth for the common good, putting the health of our people above our self-interests. In fact, it is a calling for us to hear, and a clear truth for us to believe, that our individual actions as we move through this impact the safety and the health of others."

Then Beshear alluded to politics, a subject he has tried to avoid in his public comments during the crisis.

"You know, when I was elected last November, I felt we were as fractured and as separated of a commonwealth and as a country as I have ever seen, and I believe now we are more united than I have ever seen, and I believe now that we are more united than I have ever seen," he said.

He added later, "Every single one of us have to live up to our duty as a member of the commonwealth and as a patriotic American, to protect those around us; more than ever we are connected to each other; our actions matter."

Noting a gathering of hundreds of young people in Louisville Friday night, and funerals open to more than immediate families, he said, "If hundreds of people come together, several people are going to die because of it; that is what we are facing. We’re getting reports of funerals that are not limiting the number of people. That loved one that’s passed on would not want their funeral to be a reason that someone else has passed on."

Beshear has issued an emergency order banning "all mass gatherings," but violations of that appear to have increased with warm weather. "There are going to be people out there asking you to break up if you are in these groups," he said. "If you come together in a large group, probably multiple people are going to die because of it."

The state reported 92 more cases of covid-19 Saturday, by far the largest in any one day. The previous high, 54, was the day before. "We are seeing at least the start of our surge, and we know know more than ever that we have to engage in social distancing and we have to do our duty as a Kentuckian and an American. Those things that divided us three months ago don’t matter."

Kentucky reports 92 new cases, by far the most yet in one day; 'We are seeing at least the start of our surge,' Beshear says

The state Capitol and Executive Mansion are lit green on nights after a covid-19 death is reported in Kentucky. One was reported Saturday after the daily press conference. (Alex Slitz, Lexington Herald-Leader)
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.
  • Kentucky reported 92 new cases of covid-19 Saturday, by far the most in any one day, including a Lexington 1-year-old. The previous high, 54, was Friday. "We are seeing at least the start of our surge, and we know now more than ever that we have to engage in social distancing, and we have to do our duty as a Kentuckian and as an American," Gov. Andy Beshear said. "Those things that divided us three months ago don’t matter." For more of his remarks, click here.
  • Beshear reported no deaths at his 5 p.m. press conference, but shortly afterward, he reported that a 66-year-old woman in Kenton County had died of covid-19. "Please turn on your green lights to show compassion for the family and as a show of our resilience," he said on his Facebook page. The death was the ninth in the state, which has 394 reported cases.
  • Beshear said Fayette and Jefferson counties both had 23 new cases. Numbers depend on test results, but a new hotspot may be Hopkins County (Madisonville), which reported 10 new cases and has already had a covid-19 death, a 77-year-old man with underlying medical conditions. Daviess County (Owensboro) had five new cases Saturday.

Friday, March 27, 2020

3 more Ky. deaths from covid-19, first day with more than one; Trump invokes Defense Production Act to get more ventilators; Beshear says don't travel to Tennessee unless you must

Concepts by Jason and Brooke Ison and @tizbitz, design by @SinclairArt for KyforKy.com
As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.
  • Gov. Andy Beshear announced two more deaths in Kentucky from covid-19, marking the first time two have been reported in one day. He said it would happen again, and more than once. The deaths were in Fayette and Hopkins counties.
  • UPDATE: Louisville Mayor Greg Fischer announced a covid-19 death in Louisville, bringing to eight the total deaths in the state from the illness.
  • Beshear told Kentuckians who live on the Tennessee border to not go there because Tennessee has not implemented the same aggressive steps to reduce the spread of the coronavirus that he has implemented in Kentucky, increasing the risk of bringing the virus into the state. "If you are a Kentuckians living on that border, I need you to not go to Tennessee for anything other than work or helping a loved one, or maybe the grocery if it is closer," he said.
  • He specifically urged residents of Christian, Logan and Todd counties to not cross the border, since the Tennessee counties that border those counties have some of the highest covid-19 rates in Tennessee. "Folks, don't travel," Beshear said. "We need you to be healthy at home." 
  • Asked what he would say to Tennessee Gov Bill Lee, he said: "I would ask him to close restaurants and bars to in-person traffic. I would ask him to close forward-facing businesses, just like we have. . . . I'm not here trying to criticize his leadership. I'm just here trying to protect my people. I just want to make sure that all of our surrounding neighbors are doing everything that they can because it gives us an extra level of protection.. . . We will be better protected as a state if our neighbors are also doing the same thing." 
  • Beshear didn't rule out closing the Tennessee border. "I think that we consider different options every single day," he said. "I'm not there yet." But the Commerce Clause of the U.S. Constitution may prevent that.

Massie, long an outlier, is a House pariah after forcing members to gather, against public-health advice, to pass virus-relief bill

Rep. Thomas Massie spoke Friday. (Associated Press photo)
By Al Cross
Kentucky Health News

Thomas Massie, the congressman from Kentucky's Fourth District, has long been at the limits of elective politics at the national level. He is more Libertarian than Republican, but his strong stands against the tax-and-spend mentality of the federal government harken back to Republicans of old, such as the late Sen. Robert Taft of Cincinnati, just across the Ohio River from the most populous part of his district.

Now that the Republican Party has been taken over by Donald Trump and seems not to care about the nearly $24 trillion national debt and the budget deficits that build it, Massie is even more an outlier. And he made that even more so Friday, by demanding a roll-call vote on the $2 trillion coronavirus relief bill, forcing his colleagues to attend against public-health advice. Then Trump said he should be thrown out of the party.

Trump said on Twitter, “Looks like a third rate Grandstander named @RepThomasMassie, a Congressman from, unfortunately, a truly GREAT state, Kentucky, wants to vote against the new Save Our Workers Bill in Congress.” Trump tweeted early Friday. "Workers [and] small businesses need money now in order to survive. Virus wasn’t their fault. It is 'HELL' dealing with the Dems, had to give up some stupid things in order to get the 'big picture' done. 90% GREAT! WIN BACK HOUSE, but throw Massie out of Republican Party!”

House members were in their districts, and many didn't want to return to Washington to vote, to avoid the risks of travel and gatherings; most are "older or with a pre-existing health condition," The New York Times noted. "Many were privately terrified of the health risks of traveling." So, House leaders planned to pass the bill without a roll-call vote. But Massie, 49, drove his Tesla seven hours from Lewis County to Washington to object.

“Mister Speaker, I came here to make sure our republic doesn't die by unanimous consent in an empty chamber, and I request a recorded vote,” he said on the floor. “I object on the basis that a quorum is not present and make a point of order that a quorum is present.”

House staff had counted the members, the presiding officer ruled that a quorum of 216 was present, Massie's request for a roll call didn't get a required second, and the bill passed by an unrecorded voice vote, with many members in the House gallery to keep from sitting close to each other. Trump signed it later in the day.

But Massie had an impact, because he had refused to say that he would not object, and that caused many of his colleagues to make unwanted trips to the Capitol, enough for a quorum, the Times reported. They were "infuriated and terrified as they put their health on the line amid a rapidly spreading pandemic to grudgingly board empty flights or drive back to the Capitol,” the Times said.

That didn't seem to bother Massie. “The Constitution requires that a quorum of members be present to conduct business in the House. Right now, millions of essential, working-class Americans are still required to go to work during this pandemic,” he said in a long statement before his request. “Is it too much to ask that the House do its job, just like the Senate did?”

The Times reported, “Massie has never been one of the more beloved members of the House, but on Friday, he became in short order its most reviled representative, bringing together Democrats and Republicans — who had spent days fighting bitterly over the economic aid bill — around shared contempt for one man.”

Massie even put Trump on the same page with former Secretary of State John Kerry, who was a U.S. senator when he was the Democratic nominee for president in 2004 and was a target of Massie last year. He quipped that "Massie “has tested positive for being an asshole,” and should “be quarantined to prevent the spread of his massive stupidity.” Trump retweeted, “Never knew John Kerry had such a good sense of humor!” Very impressed!”

But Massie has been re-elected three times, and has his admirers. "His unwillingness to bend on even the smallest issue has charmed a slew of powerful conservative groups, including the Club for Growth and FreedomWorks," the Times notes. "His closest friends on Capitol Hill are Representative Justin Amash, the Republican turned independent from Michigan who is also a frequent invoker of constitutional principle, and Sen. Rand Paul."

The Washington Post interviewed Massie and reported that he "disclaimed responsibility for forcing members back to Washington," arguing that House leaders, including top Republican Kevin McCarthy, "should have adhered to the letter of the Constitution and chamber rules." He told the paper, “I am wholly rejecting the notion that I am the culpable one because I am insisting on the rules. Why aren’t you indicting Kevin McCarthy for conspiracy to circumvent the Constitution?”

"Only a few fellow lawmakers expressed support for Massie afterward," the Post reports.

Massie has a June 23 primary foe, Northern Kentucky lawyer Todd McMurtry, who says the incumbent hasn't voted with Trump enough. He issued a statement accusing Massie of “putting his own selfish agenda before the needs of our healthcare providers, small businesses, and hard working Americans” and called him “an embarrassment to Kentucky and the Republican Party.” The Post reported, "One influential group, the Republican Jewish Coalition, announced Friday it would endorse McMurtry."

Legislature passes bill to support state response to covid-19; includes many suspensions and changes in health-care rules

Rep. Patti Minter, D-Bowling Green, wears a mask as she uses her phone on the House floor during a recess. At right is Rep. Chris Fugate, R-Chavies. (Kentucky Health News photos by Melissa Patrick)
By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill supporting and enhancing Gov. Andy Beshear's executive orders to address the coronavirus pandemic passed without dissent in both chambers of the legislature Thursday, with a caution that more measures will likely be needed.

"Things evolve as we know day to day on this issue, and I'm sure there will be more needs," Sen. Ralph Alvarado, R-Winchester, said in describing the bill. Senate President Robert Stivers told Kentucky Health News that this is likely the first step of many to address this issue, and Senate Democratic Leader Morgan McGarvey of Louisville, said,  "This a good bill and it's a good start."

Senate Bill 150, generally called the "Covid-19 relief bill," was gutted of its original language about surprise medical billing and amended to offer relief on several fronts for covid-19 response.

The bill has several health-care provisions, including one to make it easier for providers to serve patients through telehealth, including one to allow out-of-state providers to practice telehealth in Kentucky.

It also clarifies language on what is considered emergent or urgent care, stating that a health-care procedure can be performed it it meets this criteria. It also allows services like physical therapy, occupational therapy, or alcohol- and drug-abuse treatment to be administered if they are ordered by a physician licensed in Kentucky.

Those provisions are in response to Beshear's order for medical facilities and providers to cease all elective procedures as a way to keep hospital beds available and preserve personal protective equipment.

The bill also has provisions aimed at expanding the state's health-care workforce.

For example, it allows the state Board of Medical Licensure, the Board of Emergency Medical Services and the Board of Nursing to waive or modify licensure or certification requirements for health-care providers who are licensed or certified in other states to provide those services in Kentucky.

It also relaxes the scope of practice requirements to allow health-care providers to practice in all settings of care; allows physicians to supervise a larger number of other providers and to do it by telephone; allows rapid certification, licensing, re-certification or re-licensing of providers; allows medical students to care for patients under a provider's supervision; and allows reactivation of licenses for inactive and retired health-care providers so that they may render service.

The bill also provides immunity for health-care providers who render care in good faith to covid-19 patients during the state of emergency, as well as immunity for Kentucky businesses acting in good faith to make or provide personal protective equipment or personal-hygiene supplies related to covid-19, and that don't make or provide such products.

A time of crisis

The bill passed on a day that Kentucky reported 50 new cases of covid-19, its largest one-day increase so far, for a total of 248. It also came at a time that Beshear warns the public daily that the next few weeks are expected to get worse.

“The next two to possibly three weeks is gonna be absolutely critical in our battle against the coronavirus,” Beshear said at his daily press conference March 25, repeating the point several times.

Rep. Terri Branham Clark, D-Catlettsburg, also wore a mask.
The bill also has provisions to help those who have lost their jobs or have had their hours decreased because of covid-19. It waives the seven-day waiting period for unemployment benefits, extends benefits to those who are self-employed, and allows those who were not let go, but simply had their hours cut back, to also apply.

"The number of workers who filed for unemployment jumped to 48,847 from 2,785 the week before, according to non-seasonally adjusted figures from the Labor Department," Alfred Miller reported March 26 for the Louisville Courier Journal.

Among other provisions, the bill also extends the state deadline for filing income taxes to be the same as the new federal deadline, July 15, and removes all penalties and interest that could result from such extensions; permits restaurants with a license to sell alcoholic beverages in conjunction with takeout food orders; authorizes funds to support the state's covid-19 hotline; and extends the length of time government entities have to respond to an open-records request to 10 days, from three.

The bill also:
  • Allows the governor to direct the suspension or waiving of the collection of licensing fees, renewal fees, application fees, and other administrative requirements where they are required by the state. Licensees may continue working without interruptions, and shall be granted at least 30 days after the expiration of the state of emergency to pay any fees or complete any administrative obligation before any action is taken.
  • Allows a public agency to delay on-site inspections during the emergency. Public agencies may conduct their meetings by live audio or live video teleconference, with information on how the public and media can access the meeting.
  • Suspends deadlines related to land use, planning and zoning, and deadlines for code enforcement proceedings and hearings.
  • Allows taxing districts to suspend or otherwise extend applicable deadlines.
  • Suspends the rule that a notary certify a signature after face to contact, if they can communicate via a video teleconference in real time.
  • Requires Beshear to declare when the state of emergency has ceased, and if he has not done so by the first day of the next regular legislative session, the General Assembly may make that determination.
The report from the House-Senate conference committee that wrote the bill points out that its actions "are not statements of approval or disapproval relative to any executive order or action," but are necessary to support Beshear's actions during the state of emergency because the General Assembly is  responsible for creating or modifying law and for creating policy.

Asked as the bill was nearing passage what he needed from it, Beshear said, "I need maximum flexibility. We are living this battle and we are fighting it day by day. I need the maximum amount of financial flexibility. I need the maximum amount of flexibility if we have to take more restrictive steps. We need the flexibility to be able to move very fast to work with local governments … and local law enforcement when needed."

The bill has an emergency clause, which means it will become law as soon as Beshear signs it.

Thursday, March 26, 2020

Beshear rejects Trump idea of scaling distancing by county risk; hospitals cut staff in 'lull'; Ky. board limits drugs Trump promoted

As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.
  • Kentucky confirmed 50 more cases of covid-19 Thursday, raising its total to 248. That was the “single largest increase in a day, though it is not escalating as quickly as in other states,” Gov. Andy Beshear said in announcing the figures.
  • Asked what percentage of the state's population will get the coronavirus, Beshear said he had not seen any projection, but it will "depends on how much we reduce contacts" between people. "I believe that we are doing better than other states" at that and managing health-care resources, he said.
  • Beshear said he has had "a better week than last week" in his efforts to procure personal protective equipment that is needed to expand testing and withstand the surge of covid-19 cases in hospitals. He said he has spent more than $8 million on PPE, and "I’m gonna spend what it takes."
  • President Trump said the federal government will publish new guidelines, based on testing data, for state and local officials to decide "about maintaining, increasing or relaxing social distancing and other mitigation measures," including criteria "to help classify counties with respect to continued risks posed by the virus," as high, medium or low risk.
  • Asked about that, Beshear said, “A county line is something we put on a map; it’s not real.” Noting that he had voiced concern a few minutes earlier about Kentuckians traveling to states with less strict measures, he said, “We’re gonna make sure that the entire state is operating under the very same game plan.” Later, he said returns of test results can take as much as a week.
  • Asked if Trump should use the Defense Procurement Act to force and control production of PPE, Beshear didn't answer directly, saying "I’m working with businesses here in the state."
  • He declined to say just how much PPE the state had, saying that giving detailed numbers “would give a competitive advantage to others . . . We are procuring in different ways that we ever have before . . . We still don’t have what we need for a sustained surge.”
  • “Our first responders do not have enough personal protective equipment,” so they and health-care workers will get top priority for drive-through testing that will begin next week, along with "people in most vulnerable groups" who show symptoms," Beshear said.
  • A third Kentuckian was quarantined at home after testing positive for the virus and refusing to self-isolate. She was the first person in her county to test positive. County Attorney Austin Price "said McCreary County doesn’t have enough police to post a guard outside the woman’s house, but that people in the community are likely to report it quickly if she doesn’t stay in," reports Bill Estep of the Lexington Herald-Leader.
  • With warm weather arriving, Beshear said he has asked local officials to “very closely monitor the park areas and public congregation areas, and if people aren’t observing social distancing, to shut them down.” He said large gatherings in state parks would not be permitted. “Everyone needs to treat themselves like they could be a carrier of it,” he said.
  • St. Claire HealthCare in Morehead is furloughing staff “not directly involved in the delivery of care or participating in the covid-19 response,” about a fourth of its employees. It's an example of the squeeze that many Kentucky hospitals are going through after stopping elective procedures in anticipation of a surge of patients. State Sen. Stephen Meredith, R-Leitchfield, said that city's Twin Lakes Regional Medical Center, which he once ran, is laying off workers.
  • A state Senate committee approved a bill that it revised to allow Republican Attorney General Daniel Cameron to stop abortions in Kentucky during the pandemic, Louisville's WFPL reports. Democratic Gov. Andy Beshear's order banning elective medical procedures apparently does not apply to abortions.
  • How does a coronavirus test work? It starts with a cotton swab 10 inches up your nose, writes Daniel Desrochers of the Herald-Leader, in a story about tests at the University of Kentucky. Thursday, UK started drive-through tests for symptomatic “frontline employees” and those who provide patient care.
  • "Reports of doctors stockpiling medicine that may treat the covid-19 disease led the Kentucky Board of Pharmacy on Wednesday to adopt new measures restricting when pharmacists can dispense the drugs," including a written diagnosis, WFPL reports. "The drugs are not yet proven to treat the virus, according to the U.S. Food and Drug Administration. Despite that, President Donald Trump has promoted several of them as treatments, and there’s been a nationwide run on the medications. . . . The board wanted to prevent any abuse and ensure supplies remain for people who rely on the drugs to treat other conditions including lupus, rheumatoid arthritis, malaria and HIV."
  • Refuting reports that ibuprofen (leading brand name Advil) could worsen the severity of covid-19, the World Health Organization said it "does not recommend against the use of ibuprofen," based on current information. Frank Romanelli, associate dean of the UK College of Pharmacy, said in a UK news release, "There is no direct data to support the original negative claims that were circulated," the reports have prompted data gathering "so that, in time, more evidence-based recommendations can be made."
  • Medicine used to control blood pressure could make covid-19 symptoms worse. Angiotensin converting enzyme inhibitors, generally called ACE inhibitors, "may be a primary driver of the severe symptoms" of the disease caused by the coronavirus, Dr. Kevin Kavanagh of Health Watch USA writes in Infection Control Today, citing recent research. ACE inhibitors increase a protein that the virus "uses to attack the lungs," Kavanagh notes.
  • "A Lexington-based company that uses three-dimensional scanning for industrial pipelines has started helping UK HealthCare make custom and much-needed masks using 3-D printing, the Herald-Leader reports.

    Read more here: https://www.kentucky.com/news/coronavirus/article241456926.html#storylink=cpy
  • Ronald McDonald House Charities of the Bluegrass has temporarily suspended acceptance of additional families and its mobile program, but is working with Kentucky Children’s Hospital to re-purpose some space to "provide a place of respite for health-care professionals who are tirelessly working the frontlines of this pandemic," it said.
  • The Kentucky business community "is stepping up to answer the call to be a good neighbor and are showing leadership in an incredibly trying time," writes Ashli Watts, president and CEO of the Kentucky Chamber of Commerce. The chamber has created a “one-stop-shop” for businesses at kychamber.com/coronavirus, with daily updates and latest information.
  • Kentucky Voices for Health has published an explainer chart describing public-assistance programs available to help Kentuckians weather the economic downturn caused by the pandemic, incorporating recent policy changes. It has also published a list of frequently asked questions, with answers, that can be used for talking about covid-19. "It includes basic facts about the virus and touches on transmission, who's at risk, prevention, testing, when to seek care, social distancing, flattening the curve, the economic impact, available resources, and how people can help in their communities," the group says.

Republican senators move legislation that would let GOP attorney general block abortions during Beshear's pandemic emergency

Attorney General Daniel Cameron
Kentucky Health News

Reacting to Democratic Gov. Andy Beshear's order that apparently lets abortions continue during the covid-19 pandemic, Republican legislators have adopted a countermeasure.

A Senate amendment to House Bill 451 Thursday would allow Republican Attorney General Daniel Cameron to close abortion clinics during the pandemic. The House-passed version of the bill would have simply allowed the attorney general to enforce abortion regulations.

The revised version would give Cameron power to enforce gubernatorial emergency orders “relating to elective medical procedures, including but not limited to abortion.” Beshear issued an order banning "non-urgent, in-person" medical procedures during the pandemic, "citing the need to conserve medical resources," notes Louisville's WFPL.

The revisions included an emergency clause, so if the legislature passes the bill, presumably over a veto by Beshear, it could create the first open conflict between him and Cameron, who succeeded him in the office. (Beshear and Cameron are scheduled to appear on a coronavirus "tele-town hall" sponsored by AARP Monday morning from 10:20 to 11:20 Eastern Time.)

Gov. Andy Beshear
Asked about the bill, Beshear said, “This is the coronavirus we’re facing, and every day that we focus on anything else – I know that this is an issue that’s really important to people in numerous ways, but every day we get together and we pass bills on other things, and every day we shift our focus, and every day we focus on something that can stir people up at a time we need them to be calm, I just don’t think we are doing the right thing.”

He added, “Now is not the time for any traditional battles that might have happened between various parties, we push aside every bill that might upset or concern people, we pass a budget, we pass any other bill that helps us with the coronavirus, and we go home.”

Beshear's order said the state Cabinet for Health and Family Services would rely on the judgment of "licensed health-care professionals" in deciding whether a medical procedure should be allowed. Generally, medical professional groups do not consider abortion an elective procedure, and Kentucky law bans abortions after 20 weeks, creating urgency in some cases.

Kate Miller, advocacy director for ACLU of Kentucky, told WFPL that women seeking abortions would be in a “desperate situation” if the attorney general shut down the state’s two providers, both in Louisville. “People are in desperate situations right now and the government should never have the power to force someone to stay pregnant against their will.”

Ed Harpring, pro-life coordinator for the Catholic Archdiocese of Louisville, told the Courier Journal this week that abortion providers should suspend services during the coronavirus emergency. "It seems like they are getting a pass," he said.

Sen. Ralph Alvarado, R-Winchester, filed a floor amendment that would prohibit an abortion provider from deeming abortion to be an urgent procedure allowed under the emergency order. Democratic Floor Leader Morgan McGarvey of Louisville filed a floor amendment that would allow abortion during the emergency in case of rape, incest, a nonviable fetus or a threat to the life or health of the mother.

Republicans have supermajorities in both houses of the General Assembly, but Beshear and others have said they need to avoid controversial legislation and limit their business to the state budget and legislation related to the pandemic, so prospects for the bill's passage are unclear.

If passed by the Senate, it would return to the House for approval of the change, and House Speaker David Osborne said Thursday that the House would not pass any anti-abortion bills that day. He said an abortion bill might come to a House vote on one of the other two or three days that the legislature plans to meet before it must adjourn April 15, but “We are dealing with things that we have to get done right now, and those are going to take priority.”

Republican officials in other states have moved to limit abortions during the pandemic. "Anti-abortion groups have asked the federal government to urge abortion providers to 'cease operations' and donate medical equipment to the coronavirus response, Ryland Barton of WFPL reports.

Asked if Cameron thinks abortions are elective procedures, his office did not answer directly, telling Barton that the bill “clarifies the law in these areas.” Cameron "campaigned heavily on the abortion issue, taking up the defense of Kentucky’s anti-abortion laws that have been challenged in federal court," Barton notes.