Reopenings may not fit guidelines, but Beshear says plateau and other states' trends forecast a decline in May; public data limited

State's "epidemic curve" notes, and Kentucky Health News arrow emphasizes, that coronavirus cases with first symptoms in the last two weeks may not appear. The later the date, the more that is likely.

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky's coronavirus cases remain at a plateau, and Gov. Andy Beshear said they may not show the two-week decline that federal guidelines say should precede reopening of some businesses -- which he has scheduled to start in less than two weeks, on May 11.

Beshear's first benchmark for reopening is "14 days where cases are decreasing," but he has said that doesn't mean a decline each day. His benchmarks follow the federal guidelines, which call for "Downward trajectory of documented cases within a 14-day period" or "Downward trajectory of positive tests as a percent of total tests within a 14-day period." He gives new case numbers daily -- there were 174 yesterday -- but not the positive-test percentage.

Asked at his daily briefing Thursday if the state would see "a two-week decline" by May 11, he said, "The answer is maybe. We believe that we've been holding steady on overall numbers despite there being more testing, and that is with us now testing more people in populations such as long-term care facilities," where cases are more prevalent.

"What I believe is that by doing a very gradual and phased re-opening with strict guidelines, that we can do it safely at a time that we know where the contagion isn't increasing, that we are not on the increase," he said. "And I believe that we will see that we are on the decrease in May."

Beshear has generally scheduled reopenings for several days in May, while reserving the right to change the schedule. He indicated that his decisions are based in part on watching trends in other states.

"We have now been plateaued for about three weeks, and if we are running a couple of weeks behind other places, I think that they are seeing their numbers changing, changing gradually," he said. "Again, we wouldn't be doing it if we didn't think it was safe -- and everything is dependent on the virus."

The only time-related graph the state has on its kycovid19.ky.gov website is an epidemic curve, showing the first onset of symptoms among people who have tested positive for the virus, and it notes, "Illnesses that began within the last two weeks may not be reported," because of delays in reporting by laboratories.

The graph shows a peak of 177 cases on April 16, followed by 85, 59, 95 and 69 cases April 17-21. After that, the numbers are quite low; the virus has an incubation period as long as two weeks, so the more recent the daily number, the more likely it is to change.

Apparently referring to case numbers, Beshear said, “For about the past three weeks, we’ve been in generally the same area. That is good news when we look at something that would otherwise spread more quickly.”

But to limit the spread as normal activities resume, he said every business that plans to reopen must open in phases, allow for social distancing, make daily onsite temperature checks, enforce mask wearing, provide access to personal protection equipment, and make special accommodations for those who need it.

"These are things that allow us to start re-opening our economy, even in a time where we are facing a worldwide pandemic," he said. "These are things that keep us healthy. Let's buy into them, let's not push back on them, let's say that this is what it takes to make sure we can go back to work and not cause a spike in this virus, and that's what we ought to want to do."

He reiterated that day-care centers could not re-open and showed graphics of how doing so would greatly increase the numbers of contacts each person would have if they were allowed to, which he said greatly increases the risk of spreading the virus. Here are the graphics, in succession, also showing workplace interactions (click on them to enlarge):

Health Commissioner Steven Stack said it will not be possible to open public swimming pools in the early part of summer, and beyond that, it's too early to say. Beshear added that this includes any communal pools, such as those in apartment complexes.

"There is just almost no way you can put together a whole bunch of kids and people at a public pool and not have folks socializing and violating the social distancing rules of greater than six feet," he said.

The state's quarterly budget report shows that due to the economic impact of the pandemic, Kentucky is facing a budget shortfall of upwards of $319 million to $496 million, and a Road Fund shortfall of up to $195 million, for the fiscal year that ends June 30. Beshear said all governors have urged Congress to provide relief to both states and local governments, and he discussed "some of the numbers" Thursday with Senate Majority Leader Mitch McConnell, who first rejected "revenue replacement" for states but now seems to have opened the door to it.

Beshear said, "He said he understood, and that there were more discussions going on in Washington D.C., but he heard me out."

In other covid-19 news Thursday:

• The 174 new cases brought the state's total to 4,708. Beshear said there had been five more deaths, for a total of 240. They were of a 77-year-old man from Bath County, a 93-year-old woman from Daviess County, a 71-year-old woman from Jefferson County and a 97-year-old woman and a 66-year-old man from Grayson County.
• The counties with the highest number of new cases are Jefferson, with 27; Kenton, with 27; Warren, with 19; and Boone, with 13. 
• Two deaths were reported in the state's nursing homes, bringing that total up to 121 resident deaths and one staff death. Deaths in long-term-care facilities now account for 51 percent of the state's total. In all, 727 residents and 307 staffers in nursing homes have tested positive for the virus in 74 facilities. Click here for a list of the affected facilities with the number of residents and staffers affected in each of them.
• Rosedale Green nursing home in Covington is a covid-19 hotspot. Julia Fair of the Cincinnati Enquirer reports in detail on what health departments and St. Elizabeth Healthcare are doing to reduce coronavirus infections, including a plan to separate residents based on exposure and symptoms, increased testing, additional clinical supports, more personal protective equipment and doing a deep clean. As of Wednesday, the facility had reported 54 residents and 22 staff who had tested positive, and 14 resident deaths. 
• Beshear said everyone in the Green River Correctional Complex in Central City would be tested by Friday. The Lexington Herald-Leader reports that there have been 64 confirmed cases of the virus in the facility and two people have died from it, according to the Muhlenberg County Health Department.
• Josh Benton, deputy secretary of the Cabinet for Education and Workforce Development, said e-mails will be sent today or tomorrow to 9,000 Kentuckians who need to submit identity documents to get their unemployment benefits. He said some of the nearly 28,000 March claims that have not been processed yet have to do with employer-separation issues. 
• Beshear urged people to sign up for open slots at testing sites, and added one to the list: Jessamine County, next Tuesday through Friday. Click here for a list of all of the state's drive-through testing sites.
• The Kentucky National Guard will do a statewide flyover on Friday to honor health-care workers and essential personnel, part of a nationwide event called Operation American Resolve. It will touch Frankfort, Lexington, Pikeville, Bowling Green, Owensboro and Louisville. The Courier Journal has the schedule.
• Stack announced that Kentucky's hospitals will now use the Battelle Critical Care Decontamination System that uses "vapor phase hydrogen peroxide" to decominate N95 respirator asks for up to 20 reuses without degrading filter performance.
• Norton Healthcare specialists are researching experimental therapies to treat patients with covid-19, including medications to kill the virus or prevent it from growing; to help stop the body's immune response that results in increased damage to otherwise healthy organs; and to improve immunity; and research that looks at the benefits of "convalescent plasma" in treating covid-19 patients, according to a hospital news release.
• The release says 21 critically ill Norton patients have received convalescent plasma, which comes from a fully recovered covid-19 patient, and researchers say they are seeing "very encouraging results," with six patients having recovered and gone home. Click here to learn more about how to donate blood plasma.
• As part of a pilot program, Beshear announced that the more than 600,000 Kentuckians who participate in the Supplemental Nutrition Assistance Program, formerly called food stamps, will now be able to use their benefit cards online via Amazon and Walmart. 
• Big cities and major urban areas have seen the greatest number of coronavirus deaths, but a new Kaiser Family Foundation analysis finds the growth rate is now higher in rural areas. The report includes an interactive map that shows the per-capita number of coronavirus cases and deaths across metropolitan and non-metro counties. 
• The KFF analysis found that in the two-weeks ending April 27, non-metro counties saw a 125% increase in coronavirus cases (from 51 to 115 per 100,000 people) and a 169% increase in deaths (from 1.6 to 4.4 deaths per 100,000). Metro counties saw a 68% increase in cases (from 195 to 328 per 100,000) and a 113% increase in deaths (from 8 to 17 deaths per 100,000). 
• The Medicaid and CHIP Payment and Access Commission, a non-partisan group that analyzes policy and data makes recommendations, again told Health and Human Services Secretary Alex Azar that funds from the Coronavirus Aid Relief and Economic Security (CARES) Act are not providing sufficient help to health-care providers who serve Medicaid beneficiaries, and thus could do permanent damage to the nation's health-care safety net. Click here to see the letter. 
• Housing authorities in more than 100 Kentucky towns will get about $12.6 million from the CARES Act, says a news release from Senate Majority Leader Mitch McConnell, which lists the recipients and says the money "will be used to support prevention and preparation services for their residents, for responding to the coronavirus pandemic in public housing, and supporting the health and safety of assisted individuals and families." 
• A long list of African American faith and civil-rights leaders in Kentucky joined a statement issued by such leaders around the nation "encouraging communities to stay at home in states where stay at home orders are being lifted until there is evidence that it is safe." African Americans have been disproportionately affected by covid-19; their death rate from it in Kentucky is about double their share of population in the state. 
• The Kentucky Distillers’ Association and the Kentucky Chamber of Commerce are partnering to help business make sure they have enough hand sanitizer needed to protect Kentuckians as businesses, a chamber news release says. Click here if you are a Kentucky business in need of hand sanitizer, to find out where to get it.

• A Versailles-area winery is "putting the words of the man who told them to partially shut down to good use," John McGary reports for The Woodford Sun. Wildside Winery's first varietal is named Six Feet Petite, and bears Beshear’s familiar admonition “Y’all can’t be doing that” under an illustration of male and female silhouettes separated by a two-way arrow. Co-owner Elisha Holt told McGary that most buyers get two bottles, one to save for conversation pieces in the future. The wine "came out of the barrel last week, and Monday Holt said they’d already sold a third of it," McGary writes.
• The University of Kentucky's Chinese partners have donated 15,000 pieces of personal protective equipment to the university, says a UK news release.

Beshear starts saying what businesses can open when; analysis says Ky. shutdown saved lives; study shows promising treatment

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick and Al Cross
Kentucky Health News

Gov. Andy Beshear announced details of the first broad phase of his plan to re-open Kentucky's economy in May, while saying child care, restaurants, and businesses that require increased human contact are not yet on the list of what will be allowed to open.

"I hope everybody also sees that these are cautious steps that are going to be done with strict compliance, and I would not be suggesting these if I did not think that we could not do them safely," he said. "And if it proves that we can't do any of them safely, it is always subject to pause."

Beshear stressed that it's important that the state not open up in such a way that it causes a second spike of cases, a common occurrence in pandemics.

Beshear went over a list of 10 rules that he said will apply to every group that is planning to reopen, including such things as continuing to allow telework when possible; opening gradually, in phases; doing daily onsite temperature checks; providing access to personal protective gear if needed; maintaining and enforcing social distancing; and making special accommodations for those who need it, such as those who do not have child care or who are over 60 with underlying health conditions.

He said it's also important to have immediate testing of those who show up to work with a temperature, and systems for tracing contacts of those who test positive for the coronavirus.

The big day is May 11, when non-essential manufacturing, construction companies, and vehicle and vessel dealerships can open, Beshear said. Auto and boat dealers will be doing business differently, he said; for example, test drives will have to be done solo.

Professional services will be allowed to open, at half-staff, and pet grooming and boarding will be allowed to resume, but with no person-to-person contact.

Beshear also announced that horse racing will be allowed to open on May 11, starting at Churchill Downs -- but with no fans. "This is one of the most detailed plans that we have seen," he said.

On May 20, retail may re-open and churches may hold in-person services, both at reduced capacity. Beshear said they are working on details, and it will likely be a percentage of normal occupancy. He said they are also working with churches to make plans for things like Sunday school, and "All of this is contingent on being able to keep social distancing, on the type of cleaning that needs to occur."

On May 25, "provided the virus is where we think it will be at that stage," he said, social gatherings of 10 or fewer people will be allowed, with social distancing and masking where necessary.

"We want you to know that we think this is possible, but it is all contingent on all of us doing this right, on making sure that we don't see a spike in the virus," he said "But there is at least a light, I hope you see at the end of the tunnel where we can get together a little more."

Barbers, salons, cosmetology businesses and similar services will also be allowed to open May 25.

Beshear said restaurant openings would have to come later, and the state is working with them to figure out how to they can open safely.

He said day-care centers will also not be allowed to open this month because they increase contacts to a level that can easily spread the virus: "We go from a controlled amount of contacts to almost exponential growth."

He said gyms, movies, camp grounds, youth sports are also scheduled to open in the second phase. As for youth sports, he said he is hopeful some of these sports can resume in June or July, but "Public pools will not be in phase one or phase two." He said summer camps will not open in phase one, and it will be hard to open them in phase two.

Beshear said the "healthy at home" approach and social distancing are still keys to defeating the virus, "so healthy-at-work doesn't stop being healthy-at-home."

Reopening plans also presume that testing will continue to increase, to keep better track of the virus. Asked why Kentucky lags in testing behind other states, particularly Tennessee, Beshear said one differences is that large health-care companies that are in Tennessee are doing almost all the testing, with only 5 percent done by the state. "With us, it's over 30 percent."

He said the state hopes to see more private-sector testing, to increase the state's capacity much faster. He said the rates of infection seen in Kentucky's testing are promising and compare well to other states.

A University of Kentucky study released Wednesday estimates that without Beshear's restrictions on economic activity, the state would have had 10 times more coronavirus inflections and and 2,000 more deaths than it did through last week.

"What’s really interesting is that the study was authored by professors at the UK Institute for the Study of Free Enterprise, which is funded by the Koch Foundation and home to the same free-market philosophy that advocates reopening the economy without delay," writes Linda Blackford, who runs the opinion page of the Lexington Herald-Leader.

Study co-author Aaron Yelowitz, an economics professor, told Blackford, “What we do is we look at data and follow it where it goes. If the data told us something different, we would have written a different paper, but the data very clearly spoke to the fact that social distancing and the stay at home orders really do matter.”

Yelowitz did the study with Institute Director Charles Courtemanche, University of Louisville professor Joshua Pinkston, and graduate students Anh Le and Joseph Garuccio. They compared Kentucky's data and policies with states in the South and Midwest, covering 2,477 counties.

“These results suggest that Kentucky policymakers should be cautious when opening up the economy. Returning to partial restrictions without a broader shelter-in-place directive may not be enough to contain the spread of the virus,” Courtemanche said in a UK news release. “However, the public health benefits from strong social distancing restrictions need to continue to be weighed against the massive economic losses that disproportionately affect low-wage sectors of the economy.”

Asked about the study, Beshear said, "This is what we were seeing in our data, but I want to say it indicates that healthy-at-home gets the credit. I don't get the credit; everybody out there, every Kentuckian, gets the credit for being willing to do what it takes."

He added, "I don't know of any other state that people have come together in the way that we have seen, that have followed a set of restrictions and have stayed calm in the midst of a worldwide pandemic. . . . Now we've got to keep it going forward. That is our challenge. Making sure that as we change the restrictions a little to be healthy at work, if we can follow them just as well we can have those good results. So let's make sure that we keep that up."

In other coronavirus news Wednesday:

• Beshear reported 184 new coronavirus infections, with the top three counties for cases being Jefferson, with 60; Warren, 50; and Daviess, 16.
• 10 more Kentuckians have died of covid-19. They include five deaths in Jefferson County, including four men, 58, 72, 84, and 94, and a woman, 66; a 56-year-old man from Warren County; two from Grayson County, a 96-year-old man and a 101-year-old woman; a 94-year-old man from Jackson County, and a 94-year-old woman from Hopkins County.  
• Beshear announced that 29 more long-term-care residents and eight more staffers have tested positive for the virus, along with 18 new deaths. To date, there have been 693 residents and 302 staffers to test positive, 119 resident deaths, and one staff death from covid-19. Click here for a list of facilities with positive cases and deaths. 
• Kentucky nursing homes struggle to purchase personal protective equipment, such as masks and gloves, Deborah Yetter reports in detail for the Louisville Courier Journal., which published the story April 22 and in its print edition April 27. Signature HealthCare, which operates 41 nursing homes in the state, said its PPE costs have risen 200%. 
• Beshear said the four Kroger-sponsored drive-thru testing locations in Louisville, Lexington, Bowling Green and Owensboro did about 950 tests Wednesday. This week testing will run through Friday in Louisville, Lexington and Bowling Green and through Thursday in  Owensboro. Next week, Kroger will sponsor testing in Louisville, Lexington and Bowling Green, with a new site in Ashland. Beshear said signup portals are open. Click here to see all drive-through locations.
• Kentucky and Ohio are "not even close" to the amount of testing needed to safely reopen the economy, Dan Horn reports for the Cincinnati Enquirer, citing recent studies.  
• Inmates at the Green River Correctional Complex in Central City are asking judges to order their release, while some of their lawyers are accusing the warden of “cruel and unusual punishment,” Louisville's WDRB reports. The prison has about 900 inmates, two of whom have died of covid-19; Beshear said 250 have been tested, and all will be by Friday. Before the mass testing began, 43 had tested positive, as well as 28 employees.
• The Tyson Foods plant in Henderson County will shut down for cleaning, after 71 employees  tested positive for the coronavirus. The Perdue Farms plant in Ohio County also reported a number of cases, and more than 200 employees at meatpacking facilities across the state have tested positive," the Lexington Herald-Leader reports. "Kentucky has at least 26 USDA-inspected meat processors, according to the Kentucky Department of Agriculture. Fearing that meat processing plants across the country may shut down over the health concerns, President Donald Trump ordered them to remain open Tuesday."
• Beshear reiterated that he wants to resolve all of the March unemployment insurance claims by week's end. He said there are still 29,000, many with verification issues. He encouraged anyone who has not gotten their unemployment benefits to make sure they are answering their phones and checking their e-mails, including their spam or junk-mail boxes. 
• A preliminary study of the drug remdesivir shows that it can speed recovery from covid-19 and lessen its severity. "What it has proven is that drug can block this virus," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is doing the study. Dr. Sanjay Gupta said on CNN, "It's the best news in terms of a therapeutic that I think we've heard in some time." However, it made no statistical difference in the death rate.
• The Wall Street Journal reports on the race for a coronavirus vaccine, reporting that Pfizer Inc. will begin testing of its experimental vaccine in the U.S. as early as next week.
• The left-leaning Kentucky Center for Economic Policy has released a detailed report titled, "Lessons from the Great Recession: Kentucky and Other States Need More Federal Relief." Jason Bailey says the lessons are: Federal aid to states works, and should be robust and last until full recovery; without such aid, state budget cuts drag the economy further; now, such cuts can hinder the responses of Medicaid, public health, mental health, first responders and more.
• The University of Texas Health Science Center has created a covid-19 dashboard with state and global data. A news release says the site not only provides information on the number of cases and deaths, but also shows processed data instead of raw numbers.
• New provisional death statistics from the Centers for Disease Control and Prevention shows that total deaths are likely higher than the reported statistics capture, The New York Times reports.
• Costco Wholesale announced that it will require customers to wear masks as of Monday, and admit only one member per card in Kentucky, Puerto Rico and El Paso, Texas. Elsewhere, it is allowing two members per card; it did not explain the difference. It said stores would have a special hour, 9-10 a.m., for members over 60 and those with disabilities.
• "Covid-19 patients are reporting the terrible second week of symptoms they experience," The Washington Post reports. "People who seem to be handling the infection well suddenly suffer the most severe reactions in days five through 10. There is little consensus among doctors and experts about why that period seems to be so dangerous."
• The Post also reports that scientists know ways to help stop viruses from spreading on airplanes, but too late for this pandemic: "It is a problem of biology, physics and pure proximity, with airflow, dirty surfaces and close contact with other travelers all at play." 
• CNBC reports that JetBlue will require passengers to wear masks; American Airlines and Delta Air Lines will require employees to wear masks and will provide them for passengers; and United Air Lines requires masks for its flight attendants, as does Jet Blue and Frontier Airlines.

Attorney general calls bans on mass gatherings as applied to churches, and on interstate travel, unconstitutional; vows to sue

Beshear showed photos of Lillian and Leonard Press; she died of covid-19 complications Sunday.

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Al Cross
Kentucky Health News

Attorney General Daniel Cameron said in a federal-court filing that Gov. Andy Beshear's order banning interstate travel by Kentuckians is unconstitutional, then said he would sue Beshear unless the governor exempted churches from his ban on gatherings of more than 10 people.

"The constitution is my predominant concern, and when the constitution is not being respected, we have a responsibility in this office to defend it," Cameron said at a press conference called to announce his plan to challenge the ban on mass gatherings.

Asked about the Republican attorney general's moves, the Democratic governor said, "He said I had a specific order that banned church services. … No one has been singled out at all there."

Beshear's order said it included but was "not limited to, community, civic, public, leisure, faith-based, or sporting events; parades; concerts; festivals; conventions; fundraisers; and similar activities." He noted that a federal judge had already ruled that the order was constitutional because it did not single out religious activities.

That ruling came in a lawsuit by the only church that Beshear says violated his order, Maryville Baptist Church at Hillview in Bullitt County. The state asked people attending its Easter service and asked them to self-quarantine, under threat of further enforcement, but hasn't done likewise at the church's subsequent services. The state has allowed drive-in services.

Cameron said he wasn't pushing for in-person services, and that should be up to churches: “I have faith that Kentucky’s religious leaders will listen to health-care experts on when is the appropriate time and manner to resume in-person services.”

Eariler, Cameron filed a motion in a lawsuit that was started by a woman in Campbell County, which borders Ohio, against Beshear and Cameron. The woman has dropped out of the case, but two other plaintiffs remain; now Cameron wants to join them.

His attorneys wrote in the motion that “his interests coincide with those of the existing plaintiffs” and “The governor’s travel ban impermissibly violates the fundamental right of every Kentucky citizen to interstate travel. This being the attorney general’s position, he should be realigned as a plaintiff.”

Beshear said at his daily briefing, “I’m not trying to set rules that are difficult; I’m not trying to set rules that are controversial; I’m just trying to set rules that save people’s lives. . . . I’m not gonna get in a back-and-forth with anybody; I’m done with politics.”

At the end of the briefing, which dealt with gradual reopening of the state's economy, Beshear said, “Some are nervous that we’ve been closed too long; some are nervous that we’re starting to open things up. Folks, I’m trying to thread a needle, in a way, and get things just right, knowing what the consequences are. I want to make sure, though, that people can see hope, and that that hope helps you to continue to follow the guidance, and continue to live within the restrictions that we’ve had to put in place. We have come too far, we have sacrificed too much; we have flattened this curve and saved so many lives, let’s not stop now; let’s do what it takes.”

Beshear announced 12 more covid-19 deaths in Kentucky, and got emotional as he noted one outside the state: Lillian Press, 95, formerly of Lexington, who founded the Governor's Scholars summer program for promising high-school students and was the widow of Leonard Press, founding director of Kentucky Educational Television. After his death, she moved to the Seattle area to be near their son, Lowell.

“She did something that changed my life,” Beshear said, noting that he is the first governor to graduate from the program, which “changed the course of how I felt about myself and how I interacted with others.” He added, “Every person we lose is just as important but this was a friend of mine.” He said she was the first covid-19 victim he really knew.

Later, as he talked about the need to wear a mask in public, he said, “I hate to bring it back up, but if you could protect Lil, wouldn’t you wear this?”

In other covid-19 news Tuesday:

• The 12 additional deaths in Kentucky, Beshear said, were of a 69-year-old man and a 55-year-old woman in Jefferson County; a 72-year-old woman in Russell County; a 75-year-old man in Adair County; two women in Graves County, 71 and 84; two women in Campbell County, 77 and 85; and five in Kenton County; a man, 77; a woman, 92; and three 89-year-old women.
• The governor announced 202 new coronavirus cases, bringing the state's corrected total to 4,375. The counties with the most were Jefferson, with 84, and Warren, with 29.
• Beshear said three more deaths were reported in long-term-care facilities, for a total of 102. They reported 65 more residents and 10 more employees testing positive for the coronavirus, for respective totals of 674 and 294. The daily report on such facilities is at https://chfs.ky.gov/agencies/dph/covid19/LTCupdate.pdf.
• Billy Kobin of the Louisville Courier Journal breaks down what you need to know about Beshear's planned order that everyone wear masks in public by May 11.
• Beshear said the order won't be enforced against individuals, but will be against businesses. “Nobody individually is gonna get penalized for not wearing one of these, but isn’t it your duty?” he asked. “While it's asking people do so something extra, people are gonna get to do something extra too,” go to businesses that are now closed.
• The governor said he would reveal Wednesday what sorts of businesses would be allowed to open on May 11, the first of four Mondays for his phased-in approach for reopening the economy. He said guidelines for various types of businesses will be issued after consultation with their trade associations.
• Beshear said he apologized by telephone to Tpac Shakur of Lexington, whom he had cited as an example of fake unemployment claims that have contributed to delays in paying benefits. He said the man, who shares a name with a rap musician who was killed in 1996 but goes by his middle name Malik, "was very gracious."
• Some Kentucky dentists say it's still too risky to open during the pandemic, questioning whether they can keep patients, staff and themselves safe, the Courier-Journal reports.
• Stat, the medical-and science publication of The Boston Globe, reports that a new analysis shows many states are far short of covid-19 testing levels needed for safe reopening. Analysis by the Harvard Global Health Institute and Stat shows that Kentucky will need to do 2,576 covid-19 tests each day to be prepared to reopen after May 1. That's 1,772 fewer than the average number of tests done the week of April 22. Kentucky has recently ramped up its testing and to date has results for 48,799 people.
• The White House's plan for covid-19 testing involves expanding testing capacity to allow for two million test per week, reports Becker's Hospital Review The federal government aims to give states the ability to test at least 2 percent of their populations each month, an administration official told The New York Times,though the president did not use that figure and it was not in his written plan, the Times reports. Health officials told the Times that this may still not be enough.
• Two leading former federal health officials who served in recent Republican and Democratic administrations have called for a $46 billion investment in a future coronavirus aid package in order to safely reopen the economy, NPR reports. They say that funds need to be devoted for contact tracing, and then to help those who are infected or exposed to self-isolate.
• Two physicians on the front lines of caring for covid-19 patients in New York offer advice on what hospitals across the country need to be doing to prepare for an influx of such patients, specifically around staffing, testing, communications, bundling care, and discharge planning, MedPage Today reports.
• The New York Times reports that an Oxford University lab has scheduled tests of its new cornoavirus vaccine involving more than 6,000 people by the end of next month.
• A Healthcare Heroes Project is collecting stories from health-care workers and their families about their experiences during the covid-19 pandemic, Becker's Hospital Review reports.
• Doctors say older adults with covid-19 have some unusual symptoms, "complicating efforts to ensure they get timely and appropriate treatment, according to physicians," Kaiser Health News reports. "Seniors may seem 'off' — not acting like themselves ― early on after being infected by the coronavirus. They may sleep more than usual or stop eating. They may seem unusually apathetic or confused, losing orientation to their surroundings. They may become dizzy and fall. Sometimes, seniors stop speaking or simply collapse."

Beshear, heath chief lay out timeline for reopening health care and other businesses; masks to be required in public by May 11

Gov. Andy Beshear held up a mask at his Sunday briefing. (Photo by Ryan Hermens, Lexington Herald-Leader)

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear and state Health Commissioner Steven Stack announced a detailed, four-phase approach to reopen health care in the state over the next four weeks. Beshear added that plans are also underway to slowly reopen other segments of the economy on May 11, 18, 25 and June 1.

Beshear said that on each date, "We are going to gradually ease some restrictions, bring some groups or some industries back online. It gives us some time to get the right compliance from restrictions, guidelines in place industry by industry, and allow it to go in a way where we gradually work up from those that might have some of the least contacts or in an area where we already have a lot of experience on what we need to do."

The governor offered no details, except to say that by May 11, he would ask everyone to be wearing masks when venturing out to places where they might encounter other people, to "help us open things a little bit earlier. I know it's going to look strange and it is going to look very different to us, and it might be a little hard on all of us to take in, but I want to make sure that as more people are able to go back to work or to open other things as we work through May, I want to keep us as safe as possible."

UPDATE: While Beshear said he would be "asking," just before that, he said, "There's something else that we're going to end up having to require; we talked about it yesterday, and that's masks."

Beshear and Stack announced three additional phases of health-care reopenings, which began Monday with non-urgent, non-emergency and diagnostic services. Stack the services can be provided in hospital outpatient settings, health-care clinics and medical offices, physical-therapy settings, and chiropractic and optometry offices. Dental offices can get back to work if they have implemented enhanced aerosol protections.

Phase two, starting Wednesday, May 6, will allow outpatient surgeries and other invasive procedures to resume. It will require testing for the coronavirus, and acute-care hospitals will have to set aside at least 30 percent of their total beds and intensive-care beds for covid-19 patients in this phase and the next two phases.

Phase three will begin Wednesday, May 13. It will allows hospitals and health-care facilities to begin doing non-emergency surgeries and procedures, but at half of their previous patient volume.

Phase four will start May 27. At that time, health-care facilities will decide what types of procedures and volumes they are able to handle, while maintaining the bed reserve..

Stack emphasized that any surge in covid-19 cases may require these phases to be adjusted. He also said every health-care facility must maintain at least a 14-day supply of personal protective equipment procured through normal channels, and if they don't have it they cannot re-open.

"This is not intended to single out or punish anyone," Stack said. "In order for health care to safely operate it has to be able to get to the materials it needs through normal channels to safely operate. So we're going to tell you here dates that you can potentially open back up, but if you don't have the materials you need to comply with these rules then you can't open up."

Dr. Steven Stack

Stack urged Kentuckians to not become complacent and to remain vigilant in their social distancing, saying this is not the time to feel like you are safe, but to realize the as the state re-opens the economy this will actually increase your risk of exposure.

"This is exactly the time when we are at risk for the greatest harm, if people start to get lax about complying with the things we ask you to do," he said.

Beshear cautioned that even though new-case numbers tend to be low on Mondays because of weekend lab schedules, he was pleased to announce the state only had 87 new cases of covid-19 since Sunday, one of the lowest single-day totals the state has seen recently. He also announced five new deaths. Kentucky has identified 4,146 coronavirus infections and 213 deaths from covid-19.

"Unless we have a really large jump over the next couple of days," Beshear said, "I think we have certainly plateaued, and my hope is that, very soon, we will be headed into a decline."

Beshear concluded, "I believe that we can do this gradual re-opening with strict guidelines that we are going to need in a very safe way, but we need your buy-in on that too. We need to make sure that we are not moving too fast and that we do it the right way, but that you have confidence in the steps that we are taking."

He warned, "At any time that any of our steps causes a spike or is starting to put us in a situation that threatens our lives and our health, you can bet we will make adjustments."

In other covid-19 news Monday:

• Beshear said nine more residents and four more staff in long-term care facilities have tested positve for covid-19, and three of today's five deaths were in such facilities. Overall, there have been 619 residents and 284 staff in 68 facilities have tested positive, and 98 resident deaths and one staffer have died. The state issues a daily report on each of the affected facilities. 
• The state is providing PPE to the facilities that are "participating in our program" and the federal government is directly sending PPE, Beshear said.
• Today's deaths included a 73-year-old man from Fayette County; two women from Hopkins County, 81 and 88; a 90-year-old woman in Jefferson County; and a 62-year-old man from Jefferson County who was listed as a probable covid-19 death. 
• Beshear reported 10 new cases at Green River Correctional Complex in Central City, three inmates and seven staff. He committed Friday to test all in the complex.
• The state is preparing to hire more than 700 people across the state to help with tracing the contacts of people who test positive for the virus, Beshear said.
• The governor committed to paying this week any remaining unemployment claims filed in March, when nearly 282,000 claims were filed. He said 183,000 have been paid, and another 70,000 checks would go out Monday night, leaving about 30,000 to be paid this week. He said a new hotline will be announced tomorrow for those who filed in March, but still haven't been paid. Legislative staffers are working with the Education and Workforce Development Cabinet to reduce the backlog.
• New York Gov. Andrew Cuomo used a minute of his nationally televised daily briefing Monday to compliment Beshear for "standing up" to Senate Majority Leader Mitch McConnell and saying he was wrong on the issue of federal funding to make up revenue states have lost due to the pandemic. "It is hard for a governor, especially Andy, who is a relatively new governor, to stand up to a senior official and speak truth to power," Cuomo said as he displayed a picture of Beshear. "It takes guts, it takes courage, and you don't get that from a typical politician. It warms my heart to see an elected official who is not a typical politician."
• The White House has unveiled a blueprint to help states expand covid-19 testing and rapid response programs, USA Today reports: "The blueprint outlines the federal government's role in assisting states with access to testing platforms, increasing testing and laboratory supplies as well as enhancing sample collection." 
• Authorities have sought a court order to direct a McCreary County man to quarantine at home after being exposed to coronavirus, Bill Estep reports for the Lexington Herald-Leader. “This is no different than an individual running with a loaded gun and pointing it at people,” County Attorney Austin Price said of someone with the virus refusing to self-isolate.
• Six feet apart may not be enough social distance, say researchers at Florida Atlantic University.  A mechanically simulated cough shows that the tiny droplets emitted only take a couple of seconds to travel three feet; in about 12 seconds they reached six feet; and in about 41 seconds, nine feet, said researcher Siddhartha Verma. And after heavy coughs, the study showed the particles traveled up to 12 feet. "We found that wearing a face mask doesn’t stop the particles 100 percent, but it does slow down the cough jets," said researcher Manhar Dhanak.
• Researchers from the American Chemical Society report that a combination of cotton with natural silk or chiffon, which is a sheer fabric often used in formal gowns, can effectively filter out aerosol particles -- if the fit is good, says a news release.
• Doctors are finding cases of what they call "covid toes," which look like purple or blue lesions on a patient's feet and toes, most commonly in children and young adults, USA Today reports.  
• Why does the coronavirus kill some people and have hardly any effect on others? It could be genetic, three geneticists working on the matter write for The Washington Post: "Figuring out how genes influence responses to the virus could help the development of effective treatments or vaccines, or even point to an existing drug that could be repurposed as a covid-19 drug."
• The disease may have killed many more people than death reports indicate, four reporters write for the Post after the Yale School of Public Health analyzed the data: "In the early weeks of the coronavirus epidemic, the United States recorded an estimated 15,400 excess deaths, nearly two times as many as were publicly attributed to covid-19 at the time. . . . The excess deaths — the number beyond what would normally be expected for that time of year — occurred during March and through April 4, a time when 8,128 coronavirus deaths were reported. The excess deaths are not necessarily attributable directly to covid-19, the disease caused by the coronavirus. They could include people who died because of the epidemic but not from the disease, such as those who were afraid to seek medical treatment for unrelated illnesses, as well as some number of deaths that are part of the ordinary variation in the death rate. The count is also affected by increases or decreases in other categories of deaths, such as suicides, homicides and motor vehicle accidents." Here's the Post's graph:

Caring for your lungs, including avoiding tobacco smoke and e-cig aerosol, can help protect you from coronavirus, professors write

By Ellen Hahn and Chizimuzo T.C. Okoli
Professor & director, and associate professor, BREATHE, University of Kentucky

The novel coronavirus attacks our airways, making it difficult to breathe. It is particularly important to take special care of our lungs during the pandemic and beyond. Caring for our lungs can help us better avoid and fight this infection.

Most Kentuckians have heeded the pleas by our governor to practice social distancing, wash our hands, disinfect surfaces, and ‘stay healthy at home.’ All these activities help prevent the spread of the coronavirus. What else can we do to prevent getting and spreading this dangerous illness?

We stay ‘lung healthy’ at home by avoiding breathing tobacco smoke and aerosol, such as from vaping products, in and around our homes and cars.

Tobacco smoke and aerosol contain tiny particles that get trapped in the lungs, hurting our ability to fight off infection. Exposure to these particles happens in two ways: breathing in sidestream and mainstream smoke or aerosol.

The smoke that is released from lighting or puffing on a tobacco or vaping product is called sidestream smoke or aerosol. Mainstream smoke or aerosol is what a user inhales and then exhales into the air around them. It is possible that the virus can attach to the smoke or aerosol particles when breathing in and exhaling into the surrounding air, spreading the virus. It is really important to avoid breathing both sidestream and mainstream smoke and aerosol to stay ‘lung healthy at home’ and fight off infection.

If someone in your home smokes, uses electronic cigarettes, or vapes, there are ways to avoid exposing them and others to tobacco smoke or aerosol:

• Keep the air clean in your home by smoking or vaping at least 20 feet away from entryways, windows, and vents.
• Avoid using tobacco and vaping in the car; the smoke and aerosol can be very concentrated in this small space, even with the windows open.
• Consider that older adults, young children and those who already have breathing problems like asthma or emphysema are at greatest risk for breathing problems from smoke and aerosol exposure.

Avoiding using tobacco and electronic cigarettes inside your home and car will help everyone stay ‘lung healthy at home’. The coronavirus pandemic provides a perfect opportunity to stop using tobacco or vaping products.

We have noticed during this crisis that many Kentuckians including tobacco users want to keep their lungs healthy. There is no better time than now! Check out free help from www.smokefree.gov where you can sign up to receive text messages to quit. Call the free telephone call line: 1-800-QUIT-NOW (1-800-784-8669). There is a free mobile phone program to stop vaping: text DITCHJUUL to 88709.

Staying healthy at home is the best way to prevent getting or spreading the new coronavirus. Let’s stay ‘lung healthy’ at home by avoiding tobacco smoke and aerosol for ourselves and those we love. Caring for our lungs is especially crucial now as our airways and lungs are directly impacted by what we breathe. Since tobacco smoke and aerosol impair our ability to fight infection, what better way to prevent getting or spreading the virus by staying ‘lung healthy’ at home?

With kids at home, now's a good time to get them to quit using electronic cigarettes; state has programs designed for teenagers

A message from "This is Quitting"

Adolescents and teenagers are spending much more time at home while schools are closed, so this seems like a good time for parents and caregivers to help those who use electronic cigarettes to quit that habit.

Kentucky offers two free programs specifically targeted to teens:

"This is Quitting" is for people 13 to 24 and provides coaching by text message.

"My Life My Quit" is a free, confidential quitline for Kentuckians under 18, available from 7 a.m. to 1 a.m. ET seven days a week. To learn more, call 855-891-9989; text START MY QUIT to 855-891-9989; or visit the MyLIfeMyQuit website.

Signs that a teenager may be using e-cigarettes include: increased secrecy, unwillingness to stay at home, desire for spicy or salty foods, disappearing money, increased thirst, increased irritability or mood changes.

46 rural hospitals in Ky. to share $3.88 million from CARES Act

Forty-six rural hospitals in Kentucky will share almost $3.9 million from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, according to Senate Majority Leader Mitch McConnell.

The Center of Excellence in Rural Health, part of the University of Kentucky, will distribute $3,878,582 from the U.S. Department of Health and Human Services’ Health Resources and Services Administration.

“I’ll continue working to help provide resources and supplies to these healthcare heroes on the front lines,” McConnell said in a release, which said "The CARES Act funding allows hospitals maximum flexibility in how they respond to covid-19 within their communities, including for testing and laboratory services as well as the purchase of personal protective equipment to minimize covid-19 exposure."

The money “comes at a crucial time in assisting our rural hospitals and the communities they serve in providing access to care and helping in the fight to defeat the COVID-19 pandemic,” said Dr. Fran Feltner, director of the Center of Excellence in Rural Health.

Ernie Scott, director of the Kentucky Office for Rural Health, said in the release, “The covid-19 pandemic has caused a widespread disruption to our health system. While preparing for and fighting the coronavirus, our hospitals have had to discontinue outpatient care and elective procedures. As a result of that lost revenue, many hospitals have been faced with the reality of having to temporarily furlough staff. Through it all, though, these hospitals have remained open all day, every day. And, their staff has continued to place the medical needs of community members above all else.”

KORH will oversee the administration of federal funds to these rural hospitals:
1. AdventHealth Manchester
2. ARH Our Lady of the Way Hospital in Martin
3. Barbourville ARH Hospital
4. Bluegrass Community Hospital in Versailles
5. Bourbon Community Hospital in Paris
6. Breckinridge Memorial Hospital in Hardinsburg
7. Caldwell Medical Center in Princeton
8. Carroll County Memorial Hospital in Carrollton
9. Casey County Hospital in Liberty
10. Crittenden Health Systems in Marion
11. Cumberland County Hospital in Burkesville
12. Ephraim McDowell Fort Logan Hospital in Stanford
13. Ephraim McDowell James B. Haggin Hospital in Harrodsburg
14. Flaget Memorial Hospital in Bardstown
15. Fleming County Hospital in Flemingsburg
16. Harrison Memorial Hospital in Cynthiana
17. Jane Todd Crawford Hospital in Greensburg
18. Kentucky River Medical Center in Jackson
19. Livingston Hospital & Healthcare Services in Salem
20. Logan Memorial Hospital in Russellville
21. Marshall County Hospital in Benton
22. Mary Breckinridge ARH Hospital in Hyden
23. McDowell ARH Hospital
24. Mercy Health-Marcum & Wallace Memorial Hospital in Irvine
25. Methodist Health in Morganfield
26. Middlesboro ARH Hospital
27. Monroe County Medical Center in Tompkinsville
28. Morgan County ARH Hospital in West Liberty
29. Ohio County Healthcare in Hartford
30. Owensboro Health Muhlenberg Community Hospital in Greenville
31. Paul B. Hall Regional Medical in Paintsville
32. Pineville Community Health Center
33. Rockcastle Regional Hospital and Respiratory Care Center in Mt. Vernon
34. Russell County Hospital in Russell Springs
35. St. Elizabeth Grant in Williamstown
36. Saint Joseph Berea
37. Saint Joseph Mount Sterling
38. The Medical Center at Albany
39. The Medical Center at Caverna
40. The Medical Center at Franklin
41. The Medical Center at Scottsville
42. Three Rivers Medical Center in Louisa
43. T.J. Health Columbia
44. Trigg County Hospital in Cadiz
45. Twin Lakes Regional Medical Center in Leitchfield
46. Wayne County Hospital in Monticello

46% of Ky. covid-19 deaths in long-term-care facilities, higher than other states; protective gear, testing and staffing are concerns

Long-term-care facilities have largely confined residents to
rooms to protect them from the virus, but they play games
via hallways. (Photo via The News Courier, Athens, Ala.)

By Melissa Patrick
Kentucky Health News

With 46 percent of Kentucky's covid-19 deaths occurring in long-term-care facilities, up from 32% just a week ago, nursing homes continue to be a tinderbox for the coronavirus. That has prompted state officials to ramp up testing and to create a Long-Term Care Task Force charged with finding ways to slow down the spread of the virus inside these facilities.

Gov. Andy Beshear said the state has increased testing for the virus in these facilities, and more resources than ever are available for them to fight it, but he cautioned that as he begins to reopen the state's economy, it will be even more important to protect some of Kentucky's most vulnerable people.

"As we make these new decisions, as we try to ease restrictions, we've got to make sure that we don't increase the exposure," he said at his Sunday briefing. "Listen, this is what has happened in these facilities when we've had everything shut down . . . So, we've got to be really careful when we start expanding our opportunities that we're not allowing additional access to these facilities."

As of Sunday, Kentucky reported that 610 residents and 280 employees in 60 long-term-care facilities had tested positive for the virus. Ninety-five residents and one employee have died of covid-19. In Kentucky overall, there have been 4,074 confirmed cases and 208 deaths.

In several of Kentucky's surrounding states, long-term-care facilities account for a smaller share of covid-19 deaths, the Kaiser Family Foundation reports: Tennessee had 37 deaths, or 22% of its total; Illinois had 284, or 18%; and Virginia had 78, or 22%. West Virginia, Missouri, Indiana and Ohio are not among the 23 states that have reported their long-term-care deaths yet.

The overall rate among those states is 27%. LTCs accounted for over half of covid-19 deaths in six states: Delaware, Massachusetts, Oregon, Pennsylvania, Colorado and Utah. The Centers for Medicare and Medicaid Services told all nursing homes April 19 to report cases to the Centers for Disease Control and Prevention, but the data is not yet available.

Kentucky's higher rate could partly result from differences in how states define a covid-19 death. In Kentucky, any person who dies having tested positive is counted, regardless of other conditions. Some states have narrower definitions.

The dangers are very real for residents of nursing homes, personal-care homes, family-care homes and assisted-living facilities, given their group living conditions and their many underlying health conditions.

The challenges for protecting them include finding ways to isolate, in buildings that often have few single rooms, those who have been infected; and ways to protect staff who care for this most vulnerable population – especially when basic supplies, like gowns, masks, and gloves, otherwise known as personal protective equipment, is so scarce.

"Staffing, PPE and testing are the common themes of everybody who is really concerned about what do we do next if this goes south on us," said Keith Knapp, the state official and former long-term-care administrator who acts as convener of the task force.

One task-force member is Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington. She said there are about 315 Kentucky nursing homes, with about 28,000 residents, and about 206 personal-care and family-care homes, with about 7,400 residents.

Personal protective equipment

PPE is needed to not only protect vulnerable residents, but to also protect staff, and nursing homes were running short of these supplies long before the pandemic hit, said Betty Shiels, director of Kentucky Emergency Preparedness for Aging and Long Term Care, a public-private coalition.

“They were running short on PPE because they were using so much of it up because they were being hard hit by the flu," she said.

Dr. Muhammad Babar with PPE donated by the
Association of Physicians of Pakistani descent
in North America (Image from governor's briefing)

In an interview, Dr. Muhammad Babar, a geriatrician and independent physician who is on the task force, called the PPE shortages in these facilities "big" and spoke to some of the challenges around procuring it.

"That really limited our facilities, which are still struggling with PPE," he said. "The cost has increased tremendously, and as we all know our states are competing with each other."

Babar is regional hub medical director for Signature HealthCare, which has 42 nursing homes in Kentucky, more than any other operator; the medical director of four of them in Louisville, an assistant clinical professor at the University of Louisville, and the founder of Doctors for Healthy Communities Inc. and Muslim Americans for Compassion.

Beshear speaks almost daily about the challenges of procuring enough PPE for health-care providers in the state, and often pleads for donations, which can be made at any of the 16 state police posts, or can be arranged by calling 1-833-GIVE-PPE or going to givePPE.ky.gov.

Adding to the challenge, the federal government requires the state to make daily reports of its PPE stock in order to be eligible to make a request for additional PPE, and that requires daily reporting from all of the state's health-care providers, including long-term-care facilities.

Shiels, who is also on the task force, said the facilities have been doing everything they can to follow the CDC guidelines, given the PPE supplies that were made available from the strategic national stockpile, which are now depleted. She recognized that long-term care facilities took second priority to hospitals for PPE supplies, but said that was largely because hospitals have higher acuity patients.

Since then, she said, PPE has been "trickling in" and nursing facilities are doing the best they can with what they have available. “I'd say there is varying available supply of PPE for nursing homes right now," she said.

Culp encouraged facilities to keep reaching out to public health for PPE because "this is an evolving situation."

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the long-term-care industry's trade group, said her association's main focus has been to secure PPE and testing for members and residents. “It's not been easy,” she said, “and I wouldn't say we've had a great deal of success.”

Testing

Testing capacity is finally picking up in Kentucky, but Johnson said it is still "iffy" and "I do know that we were not prioritized for testing, either." She said the association's stance is that testing needs to be a priority in these facilities.

"In order to protect our residents, we have to prioritize testing for skilled nursing facilities – all residents, all staff, all the time – to ensure that we know what is going on in that building," she said. "You can be asymptomatic and still be shedding the virus."

Acting Health Secretary Eric Friedlander said last week that the health cabinet has been testing all residents of some facilities, starting with those that need the most help, and that it is working with all facilities that have a positive case.

Beshear said Sunday that nursing homes are classified by red, yellow and green categories, based on several factors, and the state is testing the red group first.

He said for a nursing home to qualify for testing by the state, it must "be working with our Department of Public Health, it's got to collaborate on its established process on how it deals with potential infection and its response, and it's got to comply with a facility plan we put out there of best practices."

He added, "I don't want to sugar-coat it, the coronavirus is deadly in these settings. It's why we cut all visitors at a time when people maybe didn't understand why we were doing it, and so this is a setting where it is a matter of life and death, and we are doing the best we can in a very difficult circumstance with a virus that comes for those that are already vulnerable."

Health officials have called for "sentinel surveillance," which involves rigorous, frequent testing to find hidden carriers of the virus, isolate them limit its spread.

Staffing

Staffing has been an issue for nursing homes for decades. They have successfully lobbied against laws or regulations to require certain staffing levels. Johnson said her members have trouble finding and keeping staff because unemployment rates have been low and they have a non-competitive wage scale because of low payments from Medicaid, the program that pays the bill for most residents.

“I think this covid-19 pandemic has allowed us to really highlight the fact that our skilled nursing facilities simply need more support," she said. "We need support from our policymakers in government. We need support from our communities. We need support from the media."

Culp noted that while the federal CMS agency normally keeps a tally of staffing at these facilities, it has removed this requirement during the pandemic. "That really concerns me, that when this is all over, we will not have a good picture of how the short staffing may have played into this," she said.

CMS has a site, https://www.medicare.gov/nursinghomecompare/search.html, that ranks nursing homes on staffing, health inspections and quality of care. A tabulation of deficiencies in Kentucky nursing homes during the three years through mid-2019 is available from the nonprofit investigative newsroom ProPublica at https://projects.propublica.org/nursing-homes/state/KY.

The state has several measures to help facilities with staffing issues, including the Medical Reserve Corps, which can be used to improve emergency response capabilities and the creation of a rapid response team of providers who can be deployed as needed. Knapp said the state is also working on a "strike force" of health-care professionals to help facilities deal with immediate crises.

An advertisement in the The Messenger newspaper in Madisonville shows that the state is paying registered nurses $65 an hour, licensed practical nurses $50 an hour, and certified nursing assistants $32.50 an hour to work for the state's covid-19 crisis teams for seven days on and seven days off in long-term care facilities.

The state has temporarily waived certain training requirements for nursing aides, who provide most of the hands-on care for residents, to allow for temporary covid-19 personal-care attendants. These new hires would not be allowed to provide care for residents in covid-19 isolation areas.

The state has also partnered with Norton Healthcare to set up a 24-hour hotline staffed by health-care professionals to help long-term-care facilities manage complex infection-control issues and see if they need more support.

"Mostly they need to know that someone is out there willing to help, willing to support," Friedlander said last week. "And we've found that on many calls, that is what is most needed."

Many who work with nursing-home employees are quick to point out their dedication to their jobs. "There are a lot of dedicated people who are working in long-term care," Culp said.

"They are good people," Babar said. "They represent our society. They do their best every day in this broken healthcare system. They are doing a good job."

Johnson said, "This group of people are the most dedicated. They are just hard workers who really want to do the right thing, with very little support."

Visitation restrictions will remain in place

As restrictions are eased elsewhere in the coming months, Beshear has said, “Visitation is going to be extremely, extremely restricted” at long-term-care facilities, a decision that both Babar and Johnson support.

“I think we still need to make the sacrifices of not visiting our loved ones in the facilities, we need to protect them from the outside world and that visitation should be the last thing allowed,” Babar said.

He praised Inspector General Adam Mather's decision to restrict visitation in long-term-care facilities, saying it saved lives.

"We were one of the very first states to stop visitation in our facilities, because of his leadership," Babar said. "He has done a marvelous job because of the base of his knowledge."

Prior to becoming inspector general, Mather was regional operations vice president for Signature, and some criticized his appointment because of his ties to the industry.

Johnson, whose mother is in a nursing home, said, "I haven’t seen Mom since the beginning of March, but I fully support that decision by both the federal and state government. We have to keep these elders safe. It is hard; it's been hard on my family, but hopefully we'll get through this and we'll keep our elders safe at the same time.”

Culp said most of her calls right now are about the visitation restrictions and a need to know if their loved ones facility has been infected with the coronavirus.

The state recently started posting a daily update on Kentucky facilities that have coronavirus cases, listing the number of residents and staff testing positive and the number of covid-19 deaths. It is at https://chfs.ky.gov/agencies/dph/covid19/LTCupdate.pdf.

Infection Control

Shiels, who does emergency preparedness training for nursing homes, said they are fully prepared to control infections, because that's what they do everyday. She said the challenge with covid-19 is that it is so contagious and PPE is in short supply. "Everybody has been doing the very best they can under extreme circumstances," she said.

Inspectors have stopped routine visits to nursing homes during the pandemic, with a short list of reasons for investigation, including serious allegations and targeted infection control.

The Long-term Care Task Force's guidance is posted on the state's covid-19 website, kycovid19.ky.gov. It recommends that residents be screened for fever and respiratory symptoms at least daily, including daily use of blood-oxygen meters, since "long-term care residents with confirmed covid-19 infections may be less likely to show signs of fever and respiratory signs, and symptoms may be subtle." Research has shown many people infected with the virus have low oxygen levels without recognizing it or any other symptoms.

"There are a lot of moving parts to this," said Knapp, a newcomer to state government. Speaking later about the efforts of the health cabinet, he said, "This Team Kentucky thing, it's more than a slogan, it permeates the place."

As he and Beshear take the first small steps to reopen the state, Health Commissioner Stack asks for 'patience and tolerance'

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Al Cross
Kentucky Health News

As Kentucky takes small steps toward reopening businesses, starting gingerly with much of health care, you can almost see top officials crossing their fingers.

“As hard it was to say no to so many things, it will be challenging to say ‘yes, but’ to a lot more things,” Health Commissioner Steven Stack said at Gov. Andy Beshear's daily briefing, recalling the early days of the crisis.

“We would probably prefer to wait even longer before lifting any restrictions but we’re trying to balance competing societal needs – people’s need to get back to work, people’s need to perform other important functions in society, people’s need to pursue their lives – with the need to also keep people safe. So as we work through this, I ask everyone’s patience and everyone’s tolerance . . . ”

Stack and Beshear both said they, and their counterparts in other states, are doing something that's ever been done.

“None of us have ever had to reopen an economy during a worldwide pandemic before, Beshear said. “Some of the time, our decisions are not going to be fully consistent with others … What we're trying to do is do it safely. . . . I'm gonna make the best decisions I can, treating your family like they were my family.”

Beshear and Stack said health care is the logical business area to start opening first because it is best equipped to control infection, it can provide a gauge for reopening other areas, and people are in need of medical attention and showing up at emergency rooms in worse shape than usual.

Stack at the April 19 briefing

Beshear said Saturday that dentists wouldn't open Monday because rules for them had not been agreed on. Stack said Sunday he had received "a very well thought-out proposal" from dental groups and, "We will use this in coming up with more detailed requirements. . . . You should use this as a guiding place to start your preparations. . . . Don’t open until you’re ready to comply."

Stack said Beshear's order detailing the rules for health-care providers wouldn't be issued until Monday, probably in the afternoon. “We’ve got things backward a little bit,” he said, but are responding to “societal demands.”

Stack, an emergency-room doctor who has been president of the American Medical Association, said he wanted to make clear that the first phase of reopening health care will not include elective surgeries or invasive procedures. Those are the chief moneymakers for hospitals, which have been pressing for a green light to restart them.

Senate Majority Leader Mitch McConnell said in a Wednesday interview, broadcast Sunday, that hospitals "need to be able to engage in elective surgery" and said of Beshear, "Hopefully, he’ll take a look at the regions of Kentucky that are less impacted and begin to let them begin to open up." Beshear said Saturday that there could come a time when reopenings could be done regionally, but “It’ll still have to have a lot of thought.”

Beshear said Sunday that Kentucky's houses of worship are doing better than those in any other state at complying with his social-distancing orders, which unlike some states allow drive-in services. “It’s one of the reasons we have flattened the curve,” he said, “and it’s one of the reasons I believe we get to our new normal faster than other places.”

Beshear concluded his briefing by saying “I feel hopeful, because we are in a better place today, a far better place, than any thing, any model, any expectation, I was ever given. . . . We need you to stick with us and stay strong.”

In other covid-19 news Sunday:

• Beshear announced 202 new coronavirus cases in Kentucky, for a corrected total 4,074. "As we increase our testing we are gonna see more cases," he said. Counties reporting 10 or more new cases were Warren, 35; Jefferson, 28; Grayson, 16; Muhlenberg, Boone, 11; and Hopkins, 10.
• The governor announced the state's lowest daily death toll "in a while," three. All were 88 years old; two were in Adair County and one was in Jackson County; both have had major covid-19 outbreaks in nursing homes.
• Beshear said long-term-care facilities had the fewest additional cases "in a number of days, partly due to reporting" that can be spotty on weekends: eight residents and seven staff. The state's daily report is at https://chfs.ky.gov/agencies/dph/covid19/LTCupdate.pdf.
• “Social distancing will be with us through the summer to really ensure that we protect one another as we move through these phases,” Dr. Deborah Birx, coordinator of the White House Coronavirus Task Force, said on NBC's "Meet the Press." She was answering a question about Vice President Pence's notion that the pandemic would be "largely behind us" by Memorial Day.
• McConnell made another suggestion on "Newsmakers" on Lexington's WKYT-TV, citing the leading federal experts: "As we open up, people need to listen to Dr. [Anthony] Fauci and Dr. Birx and practice social distancing and don’t be stigmatized by wearing a mask. It doesn't necessarily mean you’re sick; it means you're concerned about others."
• Beshear displayed a mask and said wearing the devices will be "incredibly important" in preventing a resurgence of covid-19.
• The Democratic governor said he had not spoken with the Republican leader since McConnell suggested Wednesday that states could take bankruptcy and wouldn't be getting federal aid to solve employee-pension problems that existed before the pandemic. “I have not had a personal conversation with Senator McConnell,” he said. “I need to.”
• House Speaker Nancy Pelosi vowed on CNN, "We will have state and local [aid], and we will have it in a very significant way."
• Dr. Scott Gottlieb, former head of the Food and Drug Administration under President Trump, said on Twitter, "We're not out of the woods in U.S. on #covid. While there are signs of slowing in some areas, and nationally we may have hit a plateau, we're still recording more than 30,000 infections a day. The trip down the epidemic curve will be far more gradually than the trip up. . . . Our mitigation steps were not as stringent as China's, they were leakier, and our epidemic was far more pervasive across our country. We're likely to see a much slower decline in new cases spread across weeks not days. While there are signs of U.S. improvement, it'll be slow. We all want this to be over. And things are mostly trending in right direction. But we're still very much in the thick of the epidemic. What we do over next few weeks will determine if we can get this wave more firmly behind us, or whether covid remains a combustible threat."
• "There are two faces of public opinion surrounding covid-19," Jan Hilliard writes for the Northern Kentucky Tribune. "One face represents the roughly 75 percent of the public who support science, believe that covid-19 requires widespread caution, and trusts the government’s response. This is the face of science and reason. The other face represents 25% of the public who does not believe the scientific facts about covid-19 and are suspicious of government’s motives in responding to the virus. This is the face of denial and conspiracy."
• T.A. Frank offers five "surprising facts" about the virus for Vanity Fair: "Singing looks like a big danger," according to a study and anecdotal evidence; "Children aren't significant spreaders," at least in relative terms; the similar virus SARS "had its own once-promising drug combo, reminiscent of hydroxychloroquine today; "If your mask has a valve, it’s dangerous to others;" and "You have to work hard to catch it outside," according to "one impressive Chinese study," still in review. But wait: "There’s a Belgian study on the potential hazards of 'exposure to slipstream droplets' left by runners."