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: