Plans are in the works to open schools in fall, despite some superintendents' concerns that guidelines make it impossible

By Melissa Patrick
Kentucky Health News

Some Kentucky school superintendents say they wouldn't be able to re-open schools under suggested state guidelines that require social distancing on school buses, rely on children to wear masks and will disrupt the normal class structure of upper grades.

They voiced their concerns to public-health officials and the state education commissioner in an online meeting May 26, and were told that opening under the guidelines would be difficult but possible.

"I do believe we can do this. I believe it is going to be a heavy lift," Interim Education Commissioner Kevin Brown said.

Kentucky schools have been closed to in-person classes since mid-March because of the novel coronavirus. Students finished out the year at home.

Dr. Steven Stack, commissioner of public health, told the superintendents that because there will be no vaccine this year, and no treatment is likely to be widely used before school is fully underway, schools will have to rely on social distancing and other public-health measures to reduce the risk of infection.

He warned them that the virus is so contagious that without intervention, every person who has it will infect three more. He reminded them that while children who get the virus generally have mild cases of covid-19, they can pass it on to those who are more vulnerable, and even those who don't develop the disease can be contagious.

Deputy Health Commissioner Connie White said, “Children can frequently have no symptoms and spread the infection so easily, if they are wearing a mask, it helps keep the infection to them and keeps it away from others.”

Stack said, "So, the challenge we all face is substantial. I don't say these things to undermine our confidence that we will find ways to overcome them, but I do say them at least to be sobering in the sense that it is a big challenge."

He said he had seen no "real good solutions yet for these trade-offs, between bringing large numbers of children back together where they can infect each other and then take infection back home, relative to the other cost to society . . . having all these children not getting their education, perhaps falling behind and their parents unable to work as reliably because their children are not in school. . . . They are very real and very serious trade-offs.”

The guidance, among other things, includes recommendations for social distancing, not only in  classrooms, but also in the hallways and school buses; to keep the same group of students together all day, while teachers move from class to class; daily temperature checks, for those who are able to wear a mask all day; enhanced hand hygiene and surface cleaning; and for those who are sick or who have been exposed, home quarantine for at least 14 days, the incubation period for the virus.

Buses: The guidance calls for keeping students and staff six feet away from each other, even on buses, where guidance from the CDC calls for one student to a seat, with a seat between them.

"We can't transport like that, and if we don't transport, we can't have school. Is there any realistic guidance for school buses?" one superintendent asked.

Stack called this is "an enormous challenge" and said he didn't have an easy answer.

"If you put them all too close together, they end up spreading infection, and even if we tell all the children to wear masks, we see how successful we are with adults, unfortunately, and children aren't likely to be much better," he said "If anything they are likely to be less compliant."

Masks: The superintendents also asked many questions about who would and would not be required to wear a mask. Stack stressed that anyone who is not able to wear a mask would not be required to wear one, but said everyone else would need to wear one.

"The masks are likely to remain part of our future for quite a while, and I don't have any relief to offer on that," Stack said. "That's just one of the simplest and easiest things we can do to try to minimize the spread of infection."

The superintendents asked if schools would be required to provide cloth masks to students, then voiced concerns that if they did provide them, the students wouldn't bring them back from day to day.

One solution to this problem was to ask community volunteers to make masks. The Hardin County Schools website has already posted such a request, saying masks will be accepted only from provided materials, because students will only be allowed to wear colors designated for their grade level.

Hardin County students will receive masks when they get to school or when they get on the bus in the morning. Masks will be collected at the end of the day to be washed, dried and sanitized so that they can be passed out again the next day.

Classes: The state guidance also calls for grouping students in such a way that they stay together in one classroom all day, with teachers rotating in and out. This is meant to minimize the number the number of personal contacts throughout the day.

That will create a major challenge in the upper grades, where teachers are usually certified to teach in one subject area. Superintendents said finding ways to group students appropriately to accommodate a full day of classes will be difficult. Health officials urged them to be creative.

White explained the science: "If we've got a group of students that stay together, then if one of them gets sick, then we are only having to deal with looking and caring for a smaller group, as opposed to if one kid gets sick and they've been intermingling with 250 kids in the high school."

Money: White also acknowledged that telling students to stay home when they have no symptoms but have been exposed to the virus "really hits your bottom line," since state funding is based on average daily attendance.

Superintendents asked if it wouldn't be best to just go ahead and plan for nontraditional instruction, or NTI, in the fall.

Brown said schools need to have a playbook that includes both in-person instruction and NTI, as well as a hybrid approach that uses both, and recognize that the playbook probably won't be executed exactly as planned. He said it must allow schools to pivot quickly and efficiently from one scenario to the next.

He said schools would be allowed NTI days in the fall, through Gov. Andy Beshear's emergency powers, and “Even if we did not do it through that authority, I am confident that the General Assembly would have gone back and made that retroactive when they meet in January.”

After superintendents repeated their concerns about reopening under the guidelines, Stack said, "I wish I had more reassurance . . . but the challenges are significant, and it doesn't mean we won't let school open up; and it may mean we have to accept that when school opens up. that there are more kids together than we would prefer because the counterbalancing trade-offs of having them fall further behind in education, of having parents who can't be at work, that those things are so substantial that we have to try to figure out a way to navigate the trade-offs. I think it is premature for us to reach the conclusion that we can't have school yet in the fall."

Politicians' views and legal issues

Beshear often says at his daily briefings that his two main goals in dealing with the virus are to open the economy and to reopen schools this fall.

"I want to get our kids back to school. We know that distance learning isn't the same, we know that our kids fall behind when they do it, we know as parents how hard it is to step in," he said at his May 15 briefing. That was the same day the  Kentucky Department of Education released its 16-page document, meant to serve as a starting point for schools and districts as they work toward reopening.

Resumption of school is a broadly accepted goal. U.S. Senate Majority Leader Mitch McConnell said in a recent visit to Owensboro that most people are comfortable with getting back to normal, and that one of the most important aspects in doing so would be having children return to school, Katie Pickens reports for the The Owensboro Times.

“K-12 and college-age kids need to be back in school,” McConnell said. “There are consequences for being cooped up at home. You’ve seen the results of these studies indicating suicide is up, spousal abuse is up, child abuse is up. There are health-related consequences as well. So, clearly, that needs to come to an end.”

McConnell has also called for schools to be legally protected from lawsuits that could arise due to resuming classes amid the pandemic, Newsweek reports.

Asked if school districts are setting themselves up for a lawsuit since each would have a separate plan for opening, Commissioner Brown reminded the superintendents that districts are sued regularly, with or without covid-19, and when they are sued for negligence, the standard defense is reasonableness.

Schools advised to be creative but observant 

White told the superintendents that the guidance is based in science, but as the Centers for Disease Control and Prevention says, "You have to look at feasibility, accessibility, and you have to tailor that to your particular community. The closer you can get to these, the less likely there will be issues." She encouraged the superintendents to be creative

"We don't have a covid police," White said. "Nobody is going to be coming with a six-foot measure and measuring and citing people We feel like that if we give you the information you need, then you are going to come up with those creative situations to make the best possible things happen for your students."

Brown said local schools are obliged to follow state guidelines: "Everyone needs to act in good faith. Local school districts are state actors; even though they are locally controlled, they are arms of the state. And I think we all want to act in good faith, and we don't want to have a situation where these practices are not followed."

Pike County Supt. Reed Adkins told the Appalachian News-Express, “We plan to follow all of the state’s guidelines to protect our students, but we haven’t received enough guidance yet to make a decision on reopening.”

Adkins "said the situation is still changing and there are many questions that have been left unanswered, which has caused him to hesitate," Nicole Ziege reports. Adkins told her, “The health and safety of our students is our top priority.

Virus cases are elevated for 2nd straight day in Ky., but Beshear attributes pattern to heavy testing in long-term-care facilities

Anonymous cell-phone tracking gauges mobility as the economy reopens. Selected counties' numbers are shown; all are available on an interactive map from The Washington Post, with a story; click here.

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

Kentucky Health News chart shows two-week trendline of cases is up.

Coronavirus cases remained elevated for the second straight day, but Gov. Andy Beshear said the number was driven by long-term care facilities, where the state is in the process of testing all residents and employees.

Beshear reported 247 new cases Saturday, following 283 on Friday after almost two weeks with no day higher than 166. “We have been reviewing the data from yesterday, and nearly half of the new cases were from long-term care, accounting for more than 37 percent,” he said in a press release. “Another 9% of cases were from congregate care settings, mainly the federal prison in Lexington.”

He said Saturday’s data were still being reviewed, but he said the pattern to see if the pattern “is largely a result of our expansive testing initiative in long-term care facilities.” Such facilities have accounted for about 58% of Kentucky's covid-19 deaths.

Beshear reported 13 additional deaths, raising the state's toll to 431. Eight were in Jefferson County: men aged 64, 66 and 94; and women aged 67, 84, 86, 90 and 93. The others were a 72-year-old man from Nelson County, an 88-year-old woman from Gallatin County, a 81-year-old man from Metcalfe County, a 69-year-old man from Taylor County, and a 70-year-old man from Hopkins County. 

As usual, he asked Kentuckians to light their homes, places of business and places of worship green, symbolizing compassion for the victims, and added, “In light of the events of the last couple days, compassion is something we need to have on full display.”

Beshear said more than 65,800 tests were reported this week, believed to be the most in one week. The state has confirmed 9,704 residents with the coronavirus, at least 3,232 of whom have recovered.

The state has additional information, including updated lists of positive cases and deaths, as well as breakdowns of coronavirus infections by county, race and ethnicity, here.

Rebidding of Medicaid managed-care contracts gets same result: Anthem and Passport to be out on Jan. 1; Passport plans protest

By Al Cross
Kentucky Health News

Hundreds of thousands of Kentuckians on Medicaid will have a new managed-care organizations to deal with when the new year rolls around, because two of the five MCOs serving the state were not among the five winners this week of state contracts for 2021.

Medicaid members of Anthem Health Plans and Passport Health Plan will have to choose from subsidiaries of the five insurers that won the bidding: Aetna, Humana, UnitedHealthcare, WellCare and Molina Healthcare, which apparently hopes to supplant Passport as Louisville's favored MCO. Passport was scored seventh among seven bidders, and Anthem placed sixth.

The two losers and the five winners were the same chosen by the administration of Republican Matt Bevin 11 days before he left the governor's office in December. Democratic Gov. Andy Beshear canceled the contracts and sought new bids, noting the timing, the vote against the contracts by a legislative advisory committee and Bevin's previous criticism of Passport.

Health Secretary Eric Friedlander said terms of the contracts were revised to increase oversight, quality control and transparency. But in the end, the result for the 1.4 million Kentuckians on Medicaid was the same.

"I wasn't a part of it whatsoever," Beshear said Friday. "It's done objectively, and it's done under the law." He noted that the bid scoresheets are posted online. The contracts total almost $8 billion.

Beshear said Anthem "does a really good job" with the state employee health plan, and said Passport "has provided great service and "been an important community member." It is the only not-for-profit MCO in Kentucky and is based in Louisville, where most of its members live. It was created in 1997 as a pilot project to control Medicaid costs in the Louisville area at the state's request.

Passport was building a new headquarters in western Louisville. Beshear indicated that Molina wants to take over the project; he said one company had said it was committed to creating 1,100 jobs in a headquarters in Louisville, and indicated later that the company was Molina, which is based in Long Beach, Calif., and has 3.4 million members.

Evolent Health, which recently bought most of Passport, said they would protest the contract decision, saying that "disrupting insurance coverage and continuity of care during an unprecedented public health crisis could have on some of the most vulnerable members of Passport's community."

The University of Louisville, which once owned 70 percent of Passport, had 19 percent after the sale. Other local owners include University of Louisville Physicians, the Jewish Heritage Fund for Excellence and Norton Healthcare.

Virus cases spike; Beshear says too early to draw conclusions; Butler, county with highest infection rate, reports 6 deaths in 1 day

Kentucky Health News chart shows how the spike in cases turned the two-week trendline almost flat.

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 and Melissa Patrick
Kentucky Health News

Coronavirus cases in Kentucky spiked Friday, to levels not seen in two weeks, but Gov. Andy Beshear said it's too early to reach conclusions from that.

The state reported 283 new cases, more than double the average of the last two weeks, but the governor said "I don't want to suggest that it means something either way."

He said the jump may have been created by testing laboratories finally catching up from delays of the Memorial Day weekend. He said the average for the last four days was 158, which "is still a decline, and a significant decline from two weeks ago."

Beshear said the counties with more than five new cases were Jefferson, 62; Fayette, 41; Warren, 31; Gallatin, 18; Kenton, 17; Shelby, 16; Boone, 12; Logan, 11; Campbell, 10; and Allen and Franklin, seven each. Beshear said the Fayette cases appear to be driven by an outbreak at the federal prison there. The day's numbers brought the state's total to 9,464, at least 3,231 of whom have recovered.

The governor reported nine more deaths from covid-19, for a of total of 418. Six were in Butler County, which has the state's highest infection rate, 17.46 per 1,000 residents; they were three women, aged 70, 83 and 90; and three men, 51, 74 and 88. The others were a 55-year-old man in Oldham County and two men in Gallatin County, 64 and 68. Butler County was the site of a nursing-home outbreak and is near a meatpacking plant that also had one.

Official state map, enhanced and labeled by Kentucky Health News; for a larger version, click on it

Beshear gave his daily report by race, which included the figure that 17.8 percent of Kentucky's deaths have been among African Americans, more than twice their 8.4% share of the state's population. He said those numbers and the civil unrest in Louisville over police actions reflected "the vestiges of slavery, segregation and Jim Crow . . . This pandemic we're facing has laid bare the inequities that still exist in our society and many times are fatal."

He said the march that included the shooting of seven people "started with a very peaceful protest" that was "one of the safest, one of the most compliant with CDC guidelines" for gatherings in the pandemic, but was disrupted by "a rogue element." Later, he said "There are groups out there that want to create a violent situation. Let's not let groups like these Three Percenters, these extremists, turn people against each other and create violence."

Parkside Manor personal-care home in Cynthiana (WKYT)

Health Secretary Eric Friedlander said the state has tested 15,000 residents and employees of long-term-care facilities, and expects to test 50,000 to 60.000. He said residents of personal-care homes are being tested as well as those in nursing homes.

Lexington's WKYT-TV reported that the 63-bed Parkside Manor personal-care home in Cynthiana has had 24 cases of the virus, including three staffers, and three residents are hospitalized. 

Beshear said 77 more residents and 27 more staffers had tested positive in long-term-care facilities, for respective totals of 1,285 and 600. They have had 244 deaths, including two staffers, accounting for 58.3 percent of the state's deaths. Fifteen deaths were added to the total yesterday, from previous daily reports.

The River’s Bend Retirement Community in Kuttawa, which had the first major outbreak among long-term-care facilities, reported that its three staff members and six residents who had tested positive have recovered, leaving no active cases remain at the facility, two residents of which died.

"Mass testing allowed us to detect, isolate, and stop the spread of the disease in our community. This early intervention was the key to ensuring the health and safety of everyone at our facility," River's Bend said in a press release. "While friends and family are not permitted to enter the facility to visit, we have set up ‘visitation stations’ outside for safe social interactions with residents."

In other covid-19 news Friday:

• Beshear acknowledged a spike in drug overdoses as a result of the pandemic. The Lexington Herald-Leader reported that Fayette County had 42 percent more overdoses in April than in April 2019.
• On a tour of hospitals to thank health care workers for their efforts during the pandemic, and to "tout federal virus-relief aid sent to Kentucky," Senate Majority Leader Mitch McConnell "preached the importance of wearing masks in public," Bruce Schreiner reports for The Associated Press. “There should be no stigma attached to wearing a mask," McConnell said during an appearance in Owensboro. “And even among age groups that are least likely to either contract this disease or die from it, you could be a carrier. So I think what we all need to do is say, ‘OK, I’m going to take responsibility, not only for myself but for others.’”
• Behsear announced that people whose driver's licenses expired or were lost after March 18, the date of his emergency order extending them for 90 days, will be able to get new licenses by mail from their circuit court clerks. He said more information would be coming from the Administrative Office of the Courts.
• Two studies in the British medical journal The Lancet show how dangerous the virus is for current and former cancer patients, AP reports. The first, of patients in the U.S, Spain and Canada, found that half of 928 current and former cancer patients with the virus were hospitalized, and 13% died. The second study found that 800 patients in England with various types of cancer and the virus had a death rate of 28%. The risk increased if the patients had other health problems. Dr. Jeremy Warner, a Vanderbilt University data scientist who led the larger study, told AP that the results show the wisdom of measures that many hospitals have taken to delay or modify care for many cancer patients, and the need for people treated in the past to be extra careful now. Kentucky leads the nation in the rate of people who get cancer and the rate of people who die from it. 
• Other recent studies show that the U.S. is a long way from "herd immunity" to protect Americans from covid-19, the New York Times reports. Epidemiologists say that while the herd immunity threshold for covid-19 is still uncertain, they believe it will be reached when 60% to 80% of the population has been infected and develops resistance. So far, the best current estimates show that only 20% of people in New York City, which has been hit hard with the virus, have antibodies to the virus; in Boston, it's 10%.
• The Lexington Herald-Leader offers up two stories to help you make the best decisions around getting your hair cut and getting your pet groomed during the pandemic. The Louisville Courier Journal examines returning to the gyms, which are allowed to open Monday, June 1. 
• Researchers from the University of Kentucky, as part of the Covid-19 Prevention Project, are asking Kentuckians from all walks of life to take a 15-minute, confidential survey that will ask about your efforts to protect yourself from the coronavirus and your sense of risk for getting it. Click here to take the survey.

Beshear offers statistics to show that his 'drastic and significant steps' saved thousands of lives, says to 'remember the lessons'

This chart was topped with a headline, "Kentucky in Lockstep with White House/CDC Guidance;"
Gov. Andy Beshear said May 4-10 included about 350 cases found by mass testing at a prison.

By Melissa Patrick and Al Cross

Kentucky Health News

Gov. Andy Beshear said Thursday that Kentucky would have had tens of thousands more cases of the coronavirus if not for the "drastic and significant steps" that he took to control it. He said the number of new cases is clearly declining, but "We have to remember the lessons that we've learned."

At his daily briefing Beshear showed a bar graph of new cases by week, showing a doubling of cases through the week of April 6-12, about two weeks after he all but ordered Kentuckians to shelter in place. Two weeks is the incubation period of the virus.

He said that if the doubling of cases had continued at the first month's rate, by May 4 the state would have had 16,000 new cases in a single week, and 32,000 cases the following week. But instead, from the week of April 6-12 the weekly case numbers were on a plateau, not an escalation.

Kentucky Health News chart shows trendline of cases for the last 14 days.

"We took drastic and significant steps and it worked," he said. "Kentuckians came together, we sacrificed, we did what it took, we put our dreams on hold, and we stopped that pandemic curve. . . . We now have one of the better declines over the last 14 days."

Beshear noted that the news-and-data site Vox identified Kentucky as one of only three states (the others are New York and Alaska) that meet federal requirements for reopening. Vox looks at cases over the last week as well as the last two.

The two-week period is a key metric in the federal guidelines for states to reopen their economies: a downward trajectory of new cases over a two-week period. Beshear called this decline fragile.

"We are in a better place, but one where we have to remember the lessons that we’ve learned," he said. "Our goal now is to keep this decreasing."

Beshear said it was "staggering" that more than 100,000 Americans have died of covid-19 in just over four months, including 400 in Kentucky.

"We have to recognize the toll that this virus has taken, and the toll that it's going to take, until we get to that vaccine," he said. "And we have to honor these families and this loss that this country has experienced by being committed to making sure that we reduce the loss going forward."

Asked when the state might see an increase in cases due to recent reopenings, Beshear said, "We might not see the continued full decrease, but based on our numbers for the last couple of days for 'Healthy at Work' it looks like people are doing really well."

He said that if there are outbreaks, "I believe our response can be surgical and not necessarily an across the board pause," because the state will have plenty of testing, and tracing of contacts of people who test positive.

He said the control of outbreaks at the Green River Correctional Complex in Central City and Western State Hospital in Hopkinsville show the state "can stabilize outbreaks even in difficult settings. I believe we’re gonna be seeing that in long-term-care facilities."

Executive Cabinet Secretary J. Michael Brown said the outbreak at the prison had leveled off "to a great extent," with only six new cases since inmates were separated by categories of infection and exposure two weeks ago. He said the other 12 state correctional institutions learned lessons from the outbreak; they have had only one inmate and two employees test positive. "It's an example of a plan implemented under stress, but one that worked," he said.

Beshear, asked if it's time to let visitors back into prisons, said it is still too risky. He said that also applies to long-term-care facilities.

The governor also announced several new openings.

He said the Lake Cumberland, Lake Barkley, Buckhorn Lake and Blue Licks Battlefield state resort parks would reopen June 1, no longer being needed for quarantine of covid-19 patients who aren't sick enough to be hospitalized. He said state Rep. Jeff Hoover, R-Jamestown, made a "compelling" case for reopening; Sen. Max Wise, R-Campbellsville, told Kentucky Health News that he also asked for the reopening.

Asked why he made the decision, Beshear said, "We think that we are on a decline," have other facilities that can be used, and Health Commissioner Steven Stack "thought we could get by."

After commending Kentucky Kingdom's extensive proposal for reopening, Beshear said the Louisville amusement park would be allowed to open the week of June 29, but cautioned that "it will look very different."

He said "we believe" that in that same week, guidance will be in place to allow "limited opening" of swimming pools. "It isn't going to be easy to meet that guidance," he said, which will include social distancing. He noted that some communities may choose not to open their pools, and asked Kentuckians to trust their local leaders with this decision.

The governor had the Rev. C.B. Akins Sr. of First Baptist Church Bracktown in Lexington offer a prayer for those who had died. Akins spoke about the racial disparities that exist among those who have died from the virus, and society as a whole, and called for systemic change to fix it.

Akins said the nation has long had a "racial pandemic . . . emboldened now afresh by people in powerful positions." That reflected the language Beshear used after being hung in effigy, blaming the actions of right-wingers on Republican politicians who had "embraced and emboldened" them.

Each day, Beshear breaks down the number of coronavirus cases and covid-19 deaths by race and ethnicity. He reported Thursday that 14.71 percent of the cases and 18.21% of the deaths are among African Americans, while only 8.4% of the state's population is black.

Repeating a goal he voices frequently, Beshear said, "As we emerge, and we will, from this pandemic, let us be committed to addressing inequalities that have existed in our country for far too long and let's start with health."

In other covid-19 news Thursday: 

• Beshear announced 113 new cases of the coronavirus, bringing the adjusted total to 9,184. He said 494 patients are hospitalized with covid-19, with 88 in intensive care. At least 3,181 people have recovered from the virus. Click here for the state's daily report. 
• The counties with the highest number of cases were Jefferson, 15; Warren, 14; Fayette, 12; and Allen and Muhlenberg, seven each. 
• Beshear reported nine more deaths, for a total of 409. They were of a 74-year-old woman, an 80-year-old man and two 85-year-old men from Boone County, a 71-year-old man from Grant County, a 66-year-old man from Jefferson County, a 72-year-old woman from Warren County, a 67-year-old woman from Butler County and a 70-year-old man from Kenton County.
• In long-term care facilities, Beshear reported that 23 more residents and 10 more staff had tested positive, for totals of 1,208 and 573, respectively. He said five more residents had died of covid-19, bringing the death toll up to 244 residents and two staff. 
• Beshear said 221,118 coronavirus tests have been done in the state, a jump of about 20,000 from yesterday because of a data dump from one lab's negative results.
• Beshear said he is moving unemployment insurance back to the Labor Cabinet from the Education and Workforce Development Cabinet, following delayed notification of a confidentiality breach on April 23, when a claimant reported access to other claimants' identity-verification documents. He said the incident was handled correctly, but it took "way too long" to notify the public of the breach. Click here for the news release about this incident.
• Workforce Deputy Secretary Josh Benton said 10,000 claims from March and 30,000 from April remain to be adjudicated. Beshear said, "There's a lot of federal law and a lot of hurdles with these."
• Beshear said his moratorium on evictions would be extended beyond June 1, so no one should be evicted.
• The State Fair Board has proposed a fair in August with smaller crowds, reduced hours and some mask requirements, WDRB reports. Agriculture Commissioner Ryan Quarles, a board member, called the proposal "reasonable and responsible." Beshear said he hadn't seen the plan.
• Beshear said he is reviewing a proposal for reopening of "historical racing" betting parlors.
• The Democratic governor said his office hasn't been invited to attend a legislative hearing on his emergency powers, which is to feature Attorney General Daniel Cameron, who is a Republican, as are the majorities in both legislative chambers. "I would hope we simply don’t choose who comments based on party, but that we have a real discussion," he said.

Most of Kentucky's Federally Qualified Health Centers and Rural Health Clinic are testing for the coronavirus; anyone can get a test

By David Bolt

CEO, Kentucky Primary Care Association

The covid-19 pandemic has amplified the importance of health-care providers, networks and collaborations in our local communities. In particular, the Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) are providing essential services to help keep our local populations healthy.

David Bolt

At the Kentucky Primary Care Association our mission is to promote access to comprehensive, community-oriented primary health care services for the under-served. As part of our work, we are proud to partner with the FQHC and RHC facilities to provide resources, technical and operating assistance, and support for their innovative care delivery models. They are an essential component of a health-care system that serves all people, in every corner of our great state. These facilities provide access to high-quality care, improve health outcomes, and reduce health disparities. They also have a tremendous economic impact by creating direct jobs in more than 300 Kentucky communities.

Our FQHC and RHC partners are helping lead the way in the covid-19 pandemic response. They are collaborating with other local healthcare professionals, the Kentucky Department for Public Health, local health departments, federal experts, and other healthcare entities working to develop strategies to defeat covid-19. They are vital partners who can reach vulnerable populations in both urban and rural settings. Time and again these clinics and health centers, which operate in nearly 100 counties, step up to deliver front line care to our citizens who need it most.

Our data indicates the majority of FQHC and RHC facilities in Kentucky are involved in drive-thru testing and/or are planning their role in antibody testing. Around 60 percent of those sites are open to the general public. Anyone who wants a test can get a test. Increasing our testing capacity is paramount to gathering the data we need to make well informed decisions. Experts are also able to use the testing experience from these facilities to generate data that can be used to make future decisions about personal protective equipment distribution, supplies, packaging, and other elements involved in the testing process.

All frontline health-care workers are to be applauded for their selfless, heroic actions “on the front lines” during this pandemic. We know many heroes work at hospitals, doctors’ offices, nursing homes, with the state department for public health, at local health departments, and at other healthcare facilities. We also want to highlight the many dedicated providers, nurses, and other healthcare professionals who go to work every day at a FQHC or RHC to keep Kentuckians safe and healthy. Thank you!

To find the FQHC and/or RHC in your community go to: https://kpca.net/map/ql/health-care and search the category map.

The Kentucky Primary Care Association was founded in 1976 as a not-for-profit 501(c)(3) corporation of community health centers, rural health clinics, primary care centers and all other organizations and individuals concerned about access to health care services for the state’s under-served rural and urban populations. KPCA is charged with promoting the mutual interests of our members, with a mission to promote access to comprehensive, community-oriented primary health care services for the under-served. To lean more, visit https://kpca.net/

400 Kentuckians have died of covid-19; Beshear confronts the politics of masks and resistance of some local officials to testing

The governor's mansion uses green lights to memorialize the deaths of Kentuckians from covid-19.

By Melissa Patrick

Kentucky Health News

On the day when the national covid-19 death toll passed 100,000, Gov. Andy Beshear announced that with the addition of six new deaths, Kentucky's toll from the pandemic has hit 400.

"Let's all acknowledge that losing 400 people to anything, at any time, for any reason, isn't OK," Beshear said at his daily briefing. "Let's just remember that we've lost 400 Kentuckians, and this thing isn't over yet."

The governor and Health Commissioner Steven Stack spent much of their briefing saying why masks are needed, and addressing the politics of that.

"Masks have somehow become this division among people," Beshear said. "Yes, they're not comfortable; and yes, they can be hard to breathe from; and yes, they keep people from seeing your beautiful face; but they protect people."

As Stack urged all Kentuckians to wear a mask, he also encouraged those with divergent views to be respectful of each other, asking those who choose to not wear a mask to not ridicule those who do, and asking those who do wear one to protect themselves by giving a wide berth to those who don't.

"I want you to be patient and kind and tolerant of each other so that we don't have something like this -- which is a simple public-health step to try to keep people safe -- turn into strife and conflict among ourselves," he said.

Stack stressed that there is no disagreement among public-health professionals about the importance of wearing a mask to slow the spread of the disease, since we know that the virus is spread by the spit and saliva from our mouths when we talk, cough, sneeze and sing -- and that many have the virus, but no symptoms. Estimates range from one-fourth to one-half of cases.

He said some Kentuckians may not understand how bad the pandemic could have been in Kentucky if Beshear had not taken all the measures he did to slow its spread.

"I think we forget because we didn't have the same magnitude of crisis we might have had, because we didn't live in Kentucky what they lived through in New York City," Stack said. "We didn't see the horrors at the scale that they had to see in other places and I think that that's made this feel too distant and too removed from our present reality."

Beshear cautioned that as the economy reopens, it's even more important to keep our hands washed and wear a mask, reminding Kentuckians that the novel coronavirus is easily carried into long-term-care facilities, where most of Kentucky's covid-19 deaths have occurred.

"Remember, it gets into these facilities somehow. It's not just starting there," he said. "It's passed between people outside these facilities and brought in there."

Testing: Warren and Shelby counties contrasted

The governor also called for more people -- especially in Western Kentucky, where infection rates are highest -- to take advantage of the free Kroger-sponsored testing sites. He noted that there are still hundreds of empty slots available in Bowling Green and Henderson.

The day before, Beshear called on local officials in the region to encourage their constituents to get tested, revealing that some had rejected testing sites while those in Bowling Green had set a good example.

"None of this, 'We don't want testing, so we don't know there's a problem'," he said. "Our Warren County leaders haven't done that, though we've had some others that have declined testing sites. That is turning your back on your people. We've got to know the level of our problem if we are going to protect the people that are out there. That means we have testing everywhere so we make sure we  keep people safe."

Beshear said officials in Shelby County, which recently had a 50 percent increase in cases among Hispanics,"turned down a Walmart testing facility. We thought that that was interesting, but ultimately the health department and the county judge have to make decisions on that." 

Citing federal and state health officials, Beshear said, "The only way that we can reopen our economy safely is if we have significant testing, and that requires you the people of Kentucky to be willing to get tested and get tested regularly."

Asked how often a person should be tested, he said that while the Centers for Disease Control and Prevention has not issued guidelines on that yet, he advised anyone regularly in the workforce to get tested about once a month if they are not showing symptoms, and immediately if they are. 

The free drive-thru Kroger testing next week will be Louisville, Lexington, Elizabethtown and Bowling Green; sign ups are now open. So far, at least 200,762 tests have been done in Kentucky.

Lt. Gov. Jacqueline Coleman said the Team Kentucky Fund, which is available to Kentuckian who have lost employment or have had their hours or wages cut by half or more because of the pandemic, has received more than 1,900 applications for assistance. 

The $3.2 million fund is available to all Kentuckians, but Coleman especially urged people in Breathitt, Fleming, Harlan, Knott, Knox, Lee, Leslie, Letcher, Mason and Wolfe counties to apply because they had received few applications from those counties. Click here to apply.

In other covid-19 news Wednesday: 

• Beshear announced 127 new cases of the coroanvirus, bringing the adjusted total to 9,077. "Our numbers today continue to suggest that we are no longer in a plateau, but on a decline," he said.
• The counties with the highest number of new cases were Jefferson, 35; Boone, 11; Ohio, 10; Fayette, 7; Shelby, 6; and Oldham, 5.
• The latest deaths were of a 71-year-old man and a 97-year-old woman from Boone County; a 78-year-old man from Hopkins County; two men, 77 and 79, from Jefferson County; and an 88-year-old man from Oldham County.
• Beshear said 512 people were in hospital with covid-19, and 82 of them are in intensive care. At least 3,124 people have recovered from the virus. Click here for the state's daily report.
• In long-term care facilities, Beshear reported that 15 more residents and 16 more staff have tested positive for the virus, for a total of 1,185 and 563 respectively. He said five more residents have died of covid-19 in the last several days, bringing the death toll up to 239 resident deaths and two staff deaths, in 120 facilities. Click here for the daily long-term care facility report.
• Beshear said the first 10 minutes of tomorrow's briefing will feature videos for young children, one about masks and one about anxiety. 

Coronavirus cases decline, but more nursing homes are infected, and Kentuckians' behavior and attitude worry health officials

Kentucky Health News chart shows daily cases and the trendline for the last two weeks.

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

Amid an encouraging decline in Kentucky coronavirus cases, the number of nursing homes with cases took a big jump, and unhealthy behavior and lack of testing signups made officials worry.

The state confirmed 141 new cases Sunday, 122 Monday and 117 Tuesday, reversing last week's slight uptick and accelerating the downward trend over the last two weeks, the period that federal officials say state officials should watch as they reopen their economies.

Weekend numbers are often reduced by limited reporting, but the Lexington Herald-Leader reports the latest three-day average was 127, the lowest since April 17. The number of deaths has also declined, to only three in the last three days, raising the state toll to 394.

“These are some of the lowest daily numbers we have seen,” Gov. Andy Beshear said. “But that is fragile, and with a disease that can so easily spread we have to want and put into action our desire to continue to see that downward movement.”

The bad news is that 26 more long-term-care facilities have had at least one case of the coronavirus, bringing the total to 105, and one had a major outbreak.

Health Secretary Eric Friedlander said 39 residents and 20 employees tested positive over the weekend at Nazareth Home Clifton in Louisville, sending 37 residents to hospitals because there was not enough healthy staff to care for them. The state is providing staff support while the employees recover.

"We're going to see this probably again in Kentucky and we will have plans in place and we will respond aggressively," Friedlander said.

Health Commissioner Steven Stack said the evacuation was the state's largest to date, taking four hours and involving six local hospitals.

The 101-bed facility had requested facility-wide testing after several residents began to show symptoms of covid-19 last week, and had previously reported only one resident with the virus, Bailey Loosemore reports for the Louisville Courier-Journal. 

The state is working to test every resident and staff person at these facilities, an effort that Stack said will take several months. Friedlander said the state has done at least 11,000 tests in facilities, with a few thousand more scheduled in the next few days.

Since Friday, a total of 54 residents and 27 employees tested positive, raising those numbers to 1,170 and 547, respectively. He said there had been three new deaths "going back," for a total of 215 resident deaths, plus two staff deaths from the virus. Click here for the daily update.

So far, at least 193,576 tests have been done in Kentucky. The governor's daily news release said the testing rate in the past week was 138 per 100,000 residents, well above the recommended rate of 100 per 100,000. Click here for information on how to register for testing at more than 70 locations throughout the state.

Beshear once again implored Kentuckians to get tested, noting that the numbers at the free drive-thru sites sponsored by Kroger were disappointing, especially in Bowling Green, where only 206 signed up to be tested Tuesday, 84 on Wednesday, 39 on Thursday and 22 on Friday. The capacity at each site is typically 400 per day.

"We have a major outbreak in Warren County that our testing can help us identify and control, but you -- you've got to go in and you've got to get tested," Beshear said.

He also pointed out that the Kroger site in Henderson, near an area with many cases, had tested only 24 people Tuesday, with only 21 signed up for tomorrow and seven on Thursday.

"Folks, this is real. It is in this part of the state. We need you to take advantage of this. This is about protecting your community," he said.

In another worrisome moment, Stack showed a video of a Lexington bar/restaurant crowded with people and warned that the virus is easily spread in large gatherings, especially where people are talking loudly.

"The evidence is absolutely overwhelmingly clear that a small number of large events or a small number of a lot of people getting together with one or two infected folks spreads this thing like wildfire," he said. He later added, "I don't know what it will take for us to learn that this is not a game, that this is serious."

Beshear added that the bar was not ensuring a safe environment and said, "I wouldn't go there, and I won't go there, and you shouldn't either, because if we are not going to enforce social distancing in places, they are not safe."

Stack also talked about the importance of wearing masks to decrease the spread of the virus, though they can be a nuisance.

“This infection has taken a horrible toll on humanity, and unfortunately it will continue to take a toll until we find a vaccine and a way to prevent this," he said. "Until we find a treatment or we can cure it, we are left with old-school, old-fashioned public-health measures which we know work, but are difficult to implement because they require us to make sacrifices -- sacrifices that protect us and the people we love and care about, but also sacrifices that protect other people who rely on us."

Beshear, as he wrapped up talking about the Sunday protest that ended with him being hung in effigy, said as he redonned his mask, "After everything that has happened this weekend, do we still think it is too much to wear a  mask? To protect our fellow human beings? I wear it to protect my family. I think other people should wear it to protect theirs."

In other covid-19 news Tuesday: 

• Beshear said Tuesday's deaths include an 85-year-old woman from Adair County, a 63-year-old man from Allen County and a 72-year-old woman from Jefferson County. He encouraged everyone to turn on green lights, as he and his family would at the governor's mansion, saying, "We show compassion there, not anger. We show love there, not hate."
• Beshear said 489 patients are hospitalized with covid-19, including 78 in intensive care. He said at least 3,115 Kentuckians have recovered from the virus. Click here for the daily summary. 
• The counties with the highest number of new cases over the last three days were Jefferson, 146; Shelby, 41; Warren, 30; Fayette, 26; Kenton, 10; and Logan, 10. 
• In an Appalshop Twitter post Dr. James Brandom Crum, a diagnostic radiologist in Pikeville, warns coal miners with black lung or chronic lung disease about how dangerous covid-19 could be for them, and asks them to self-isolate as much as possible, wear a mask and make sure those around them are doing all they can to protect them, because they could have the virus without symptoms. "Miners, let people help you," he says. "Isolate yourself, let people go to the store for you, so you can stay away from people 'til this thing is better under control." 
• Norton Healthcare plans to open a "first of its kind, permanent drive-thru and walk-up facility" in the fall, WDRB reports. Services will include vaccines, covid-19 testing, flu, strep, EKG and minor x-rays. 
• The state Department of Public Advocacy, which provides public defenders, is concerned about their health and that of others in the system if courts resume in-person hearings too soon. Some courts plan to do that June 1, DPA says in a news release. It says that was not the intent of a May 15 Supreme Court order saying trial courts could on June 1 “resume hearing civil and criminal matters using available telephonic and video technology to conduct all proceedings remotely." Public defenders often represent multiple defendants in one court session.
• ProPublica "scoured the latest research and talked to seven infectious disease and public health experts" to report on the latest information parents need to know about coronavirus as children return to day cares and camps. Beshear has said small, in-home child cares can open June 8, with some center-based programs and day camps allowed to open on June 15

Beshear says 'right-wing militia group' that hung him in effigy was 'embraced and emboldened' by GOP legislators at earlier rally

By Al Cross

Kentucky Heath News

Two days after being hung in effigy, Gov. Andy Beshear returned the fire Tuesday, using much of his daily coronavirus briefing to talk about the incident near the governor's mansion on Sunday.

He said the presence of protesters on the mansion porch after crossing barricades, “just a window pane away from where my kids play,” and the effigy hanging that followed on the Capitol grounds across the street, were “intended to use fear to get their way.” (His children, 9 and 10, were not present.)

“I will not be afraid, I will not be bullied and I will not back down, not to them and not to anybody else,” he said, reading from notes for about 10 minutes. He said it is his responsibility to lead in a dangerous time “and I know that the people out there are with me. I owe it to the people of Kentucky not to bow to terror, but to continue to do what is right.”

Beshear said the Three Percenters, "a right-wing militia group," shares the blame with unnamed but previously identified Republican legislators who spoke at an earlier Capitol rally involving the group, which “had been embraced and emboldened by elected leaders that rallied with them weeks before.”

Alluding to other Republican officials' condemnation of the incident, he said they should not “cater to these groups” and “You cannot fan the flames and then condemn the fire.” He said those who spoke at the earlier rally “have to claim responsibility, because they absolutely know what could have happened. And, they are in part responsible for what did happen.”

The effigy bore the motto "Sic semper tyrannis," Latin for "Thus ever to tyrants," which John Wilkes Booth reportedly said after fatally shooting President Abraham Lincoln. Beshear called that “a celebration of assassination on our Capitol grounds.”

Beshear said he and his wife Britainy had made a "very difficult decision" to leave "the only house my kids ever remembered" to "become the first family to live full-time in the governor's mansion for over 30 years," partly because Frankfort residents wanted them to. "One thing I never thought about and never questioned was their personal safety."

Beshear's first reference to the episode came as he gave his daily mantra: "Today maybe I need to say it as much as you do: We're gonna get through this, and we're gonna get through this together." He said he believes that because "For the most part over this Memorial Day weekend, we showed that we can continue to do the right thing."

Senate Majority Leader Mitch McConnell joined other Republicans' criticism of the episode, saying it “was completely outrageous and unacceptable. We all believe in freedom to speak in this country and the opportunity to demonstrate. But that episode, I believe on Sunday, was completely unacceptable, it’s not what Kentucky is and I hope that we will not be seeing that again.”

McConnell's Republican seatmate, Sen. Rand Paul did not respond to a request for comment, the Lexington Herald-Leader reported.

Patsy Bush, Kentucky secretary for the Three Percenters, said before Beshear's briefing that the group does not condone violence and "if she had known about it ahead of time, she would have tried to stop it," the Courier Journal reported.

Reopening when we're not quite ready to thwart covid-19 means managing risk, and there are four types, health expert writes

No state "has met the metrics to safely reopen," so the nation "needs to move to the public health strategy of harm reduction," says former Baltimore health commissioner Leana Wen. "So what does that mean in terms of choices each of us makes — what’s safe to do and what’s not?"

Wen, an emergency physician and visiting professor at George Washington University's Milken Institute School of Public Health, offers four concepts from other harm-reduction strategies: relative risk, pooled risk, cumulative risk and collective risk.

Relative risk depends mainly on three variables: proximity, activity and time. "The highest-risk scenario is if you are in close proximity with someone who is infected, in an indoor space, for an extended period of time," Wen writes, noting that gatherings where people hug, such as funerals and birthdays, can be “superspreader” events.

"You can decrease your risk by modifying one of these three variables," Wen writes. "If you want to see friends, avoid crowded bars, and instead host in your backyard or a park, where everyone can keep their distance. Use your own utensils and, to be even safer, bring your own food and drinks. Skip the hugs, kisses and handshakes. If you go to the beach, find areas where you can stay at least six feet away from others who are not in your household. Takeout food is the safest. If you really want a meal out, eating outdoors with tables farther apart will be safer than dining in a crowded indoor restaurant."

Pooled risk "is particularly relevant for separated families that want to see one another," Wen writes. "I receive many questions from grandparents who miss their grandchildren and want to know when they can see them again. If two families have both been sheltering at home with virtually no outside interaction, there should be no concern with them being with one another. Families can come together for day-care arrangements this way if all continue to abide by strict social distancing guidelines in other aspects of their lives. The equation changes when any one individual resumes higher-risk activities — returning to work outside the home, for example."

Cumulative risk means that your risk of infection increased with every person you come into close contact with. "Many people must return to work, but they can still reduce their risk overall by not having social gatherings outside of work," Wen writes. "Choose the activities most important to you. If you must have your hair cut, don’t also go out to eat in restaurants. How much you do should also depend on your personal health. By now, we know that those most vulnerable to the severe effects of covid-19 are older people with chronic medical conditions. These individuals should aim for lower cumulative risk to best protect themselves."

Collective risk means that "The higher the rate of covid-19 in a community, the more likely any one individual you come into contact with has the virus and the riskier your interactions become," Wen writes. "This is why mask-wearing is important: If most people wear a mask, it reduces the amount of virus that we will transmit. Local and state policymakers should continue to ban large gatherings and follow the CDC guidelines for gradual reopening. They must have surveillance systems in place to detect if and when infections rise and be willing to reimpose restrictions."

National health secretary says health requires reopening

By Alex M. Azar
U.S. Secretary of Health and Human Services, for The Washington Post

President Trump’s top priority throughout the covid-19 crisis and his presidency has been protecting the health and well-being of Americans. Nothing exemplifies this leadership like our new Operation Warp Speed, which is marshaling the world’s best minds to develop and deploy a vaccine in record time.

The sacrifices Americans have made through social distancing have helped slow the spread of the virus and save lives. Moving forward, we need to confront the misconception that going back to “normal life” just means balancing the health risks of reopening against the economic costs of aggressive social distancing. Returning to normal isn’t about balancing health vs. the economy. It’s about balancing health vs. health: the health risks of covid-19 balanced against the health, social and economic costs of keeping Main Streets across the United States closed for business.

Getting this balance right isn’t simple. It will look different for every state, business and family. The Trump administration is committed to helping each state and all Americans have the information and tools they need to safely reopen.

The economic crisis brought on by the virus is a silent killer. Estimates suggest that each one percentage point increase in the unemployment rate translates into a 1 percent increase in suicide deaths and a more than 3 percent increase in opioid deaths, which means this virus-induced recession will likely cause tens of thousands of excess deaths. One study of the 1982 recession found that Americans who faced higher unemployment suffered approximately 40,000 excess deaths by age 65 — as well as more divorces and having fewer children. Shortening this economic crisis through a safe reopening could save thousands of lives.

Meanwhile, at a time of social stress, states are seeing a decline in reports of child maltreatment, which is likely going unreported because children are isolated from teachers and others who can help keep an eye on the vulnerable. On Monday, the president, first lady and vice president joined me and other administration leaders to discuss these challenges and potential solutions with governors.

The covid-19 response has also restricted access to health care. Data suggests the numbers of Americans receiving important preventive services are down significantly, with mammograms down 87 percent and colonoscopies down 90 percent.

More than 1.7 million new cancer cases are diagnosed per year in the United States. If we’re seeing an 80 percent drop in cancer cases identified, approximately, we could already have 200,000 or more undiagnosed cancer cases as a result.

According to Medicare data, breast cancer surgeries are down approximately two-thirds since January. A Centers for Disease Control and Prevention report found that vaccine administrations were down approximately 60 percent from early January to mid-March; that puts millions of American infants and children at risk for serious illnesses.

Forgoing all of these services also devastates our health-care system and the front-line heroes who have kept it running. Many health-care workers have been furloughed, and hospitals are seeing as much as 60 percent revenue declines from the cancellation of elective procedures. Hospitals in rural America operate on about a 2 percent to 3 percent profit margin, and urban hospitals have about a 5 percent to 6 percent margin. Extended disruption to our health-care system may permanently close some institutions, with lasting impacts on access to care, especially where access is a challenge already.

Pediatrician offers facts about serious syndrome that can attack children who were otherwise unaffected by the coronavirus

By Dr. Sean McTigue
University of Kentucky

There have been reports coming out of New York and other states that have been hit hard by the coronavirus about a complication experienced by children who have tested positive for COVID-19. Known as pediatric multi-system inflammatory syndrome (PMIS), doctors and the Centers for Disease Control and Prevention have made a connection between this disease and COVID-19, but there is still much to learn about it.

 Getty Images photo, distributed by University of Kentucky

Symptoms of PMIS include fever that lasts more than 24 hours along with rash and changes in skin color, swollen lymph nodes, excessive sleepiness and abdominal pain, diarrhea and vomiting. If your child shows these symptoms and has tested positive for COVID-19 or been exposed to the virus, contact your pediatrician.

PMIS closely mimics Kawasaki Disease, a rare inflammatory condition that is the leading cause of acquired heart disease in infants and children. While Kawasaki Disease can be triggered by viruses, doctors are not yet sure if these are symptoms of Kawasaki, an inflammatory response to COVID-19 or a combination of both. Both conditions cause severe swelling in the blood vessels and can lead to serious heart complications if left untreated.

COVID-19 in children and PMIS are both very rare; there have been very few cases reported in Kentucky. While doctors are still trying to understand the connection between PMIS and COVID-19, it is important to maintain social distancing and hand-washing habits to prevent the spread of the virus.

Dr. Sean McTigue is medical director for pediatric infection prevention and control at Kentucky Children’s Hospital.

Why wear a mask when you go out in public? Because you may have the coronavirus and not know it, and it's highly contagious

President Trump wore a mask on a private tour of a Ford plant Thursday but refuses to do so in public.

By Melissa Patrick
Kentucky Health News

Wearing a mask when out in public is even more important as Kentucky reopens its economy, medical professionals advise. Many Kentuckians are skeptical.

Rebecca Dutch, chair, UK Department
of Molecular and Cellular Biochemistry
(UK Photo by Mark Cornelison)

"It is actually, primarily, so that if you happen to have the virus and you don't know it -- which happens very frequently now -- you're not breathing it out, coughing it out on other people," said Rebecca Dutch of the University of Kentucky, who has spent more than 30 years studying viruses.

"Every person we add into our interactions is someone we might either get it from or pass it to, or take it home to our families," Dutch said. "Remember that the risk is still there, so think carefully about whether what you are doing is something that is a good idea."

Dutch is a professor and the chair of the Department of Molecular and Cellular Biochemistry at UK, and leader of the Covid-19 Unified Research Experts (CURE) Alliance team, which advises on covid-19 patient care and clinical trials at the university.

She said the novel coronavirus has a relatively high infection rate, with each infected person causing three more infections if there are no restrictions on activities and contacts. Emergency restrictions imposed by Gov. Andy Beshear have reduced Kentucky's infection rate to 0.87, according to a model created by the co-founders of Instagram, which displays each state's rate at rt.live. A rate of less than 1 means the virus should eventually stop spreading.

It will be important to watch this number as the state has fewer restrictions and more contacts; Beshear has refused to say how the infection rate drives his decisions, but New York Gov. Mario Cuomo has said a rate of 1.1 or above would be a trigger for him to reimpose restrictions.

As he allowed opening of Kentucky's stores and restaurants, and social gatherings of 10 or fewer people, Beshear used the rhyme "Hands, face and space" to summarize the medical advice: Keep your hands washed; don't touch people not in your immediate family; wear a mask in close quarters; avoid touching your face; keep six feet of separation; and to entertain outside, if at all possible.

"All of these are mechanisms just to try to stop as much spread as we can," said Dutch. "So that is why the governor is now asking people to mask."

The official message also came with a warning that some Kentuckians may have become complacent about their risk of getting the virus. "Some may conclude that the danger is not still there, and I’ve got to urge you, the danger is still there. If we take our eye off the ball . . . we could find ourselves in late June paying very dearly for our actions today," Health Commissioner Steven Stack warned May 22.

The most controversial piece of advice is to wear a mask, so Beshear is asking Kentuckians to say on social media posts why they wear one, and to talk to others about it.

"Some people have objected to masks, and the challenging part about that is you can object to a mask on your own personal health, but it is not your own personal health that it is going to impact," Beshear said May 19. "It is other people's health, so it is more about your willingness to protect other people if you are wearing or not wearing one."

The governor regularly points out that masks are recommended by the White House and the Centers for Disease Control and Prevention. At one point he said they shouldn't be a partisan issue.

A Kaiser Family Foundation Poll released May 22 found that Democrats are about twice as likely as Republicans to say they wear a mask every time they leave their house: 70% and 37%, respectively. Majorities of each party said they wear a mask "most of the time."

Kaiser Family Foundation chart; click on it to enlarge. More data and poll questions are here. 

The poll also found that while 72% of Americans think President Trump should wear a mask when meeting with others, only about half of Republicans, 48%, agree. The report says that the partisan difference in largely driven by Republican men.

A pushback on several levels

Trump says he doesn't need to wear a mask because he is tested daily for the virus, but critics say he is missing an opportunity to set an example that would save lives. Thursday, he refused to wear a mask in front of news cameras while touring a Ford plant in Michigan, saying "I didn't want to give the press the pleasure of seeing it." He wore a mask when news cameras weren't around, but someone on the tour took a picture of him and it was widely circulated.

Senate Majority Leader Mitch McConnell regularly wears a mask, bit U.S. Sen. Rand Paul, an ophthalmologist, says he won't wear one because he has had the disease and is immune. However, experts warn that this hasn't been proven, and there have been reports of people testing positive weeks after they have recovered, and that it is uncertain if they are contagious or not.

Fourth District U.S. Rep. Thomas Massie weighed in on Twitter yesterday, saying "There is no authority in the Constitution that authorizes the government to stick a needle in you against your will, force you to wear a mask, or track your daily movements. Anyone who says you have to right to avoid those things fundamentally misunderstands the 9th" Amendment, which says the Constitution's language "shall not be construed to deny or disparage others retained by the people."

Lexington Herald-Leader photo

And in a move that got national notice, a Manchester convenience store posted a sign banning masks. Alvin's responded to complaints by saying it was a "joke," the Lexington Herald-Leader reported. Later, it clarified the statement in a Facebook post, saying it would not turn away mask-wearing customers and "It's your choice to wear one or not, not our government's choice for us." Newsweek reports that the sign has since been taken down.

Earlier, Chris Kenning and Sarah Ladd of the Louisville Courier Journal took a look at who was or wasn't wearing masks around Kentucky and found a low percentage of compliance in one of the hardest-hit parts of the state.

Mason Barnes, Judge-Executive of Simpson County, just south of Warren County, which continues to have one of the state's highest infection rates, told the CJ, "I'd say 70 percent to 80 percent of the people are not wearing masks when they're out and about."

Beshear has said Kentuckians will not be cited or arrested for not wearing a mask in public.

So, why should you wear a mask?

The simple answer is because the virus is primarily spread by tiny droplets from infected people, not just coughing and sneezing, but from talking and breathing. A mask can stop the spread of those droplets, especially from people who have the virus but don't know that they do.

Stack, the health commissioner, said May 18 that about 25 percent of people with the virus have no symptoms. Later in the week, the Centers for Disease Control and Prevention estimated the number at 35 percent.

UK HealthCare photo

Dutch, the UK virologist, pointed out that people can be very infectious just before they get symptoms.

She said, "When people can spread it before they know they are sick, we actually have to take extra precautions because we all have to think, 'Oh, I might have this, what do I need to do to protect people when I go out?'"

More than 40% of Kentucky adults are at higher risk of serious illness if infected with the virus because they have heart disease, chronic obstructive pulmonary disease, uncontrolled asthma, diabetes or a body mass index of 40 or more, indicating morbid obesity, according to the Kaiser Family Foundation. It did not include people with another risk factor, cancer, in which Kentucky is a national leader.

The value of wearing a mask is illustrated by a new study, published in The Proceedings of the National Academy of Sciences. It shows how normal speaking can launch thousands of droplets that can remain suspended in the air for eight to 14 minutes, allowing them to be inhaled by others. "There is a substantial probability that normal speaking causes airborne virus transmission in confined environments," the study report says.

The researchers said in a letter to The New England Journal of Medicine that the same experiment, using scattered laser light, found that use of a cloth face mask blocked nearly all droplets emitted when talking. They posted a video, the last part if it in slow motion, to show their finding.

The latest study to confirm the effectiveness of cloth masks was published May 22 in the peer-reviewed journal Annals of Internal Medicine.

Science supporting mask wearing is so strong that more than 100 prominent health experts have asked governors to require them. They write that the research "strongly suggests that requiring fabric mask use in public places could be amongst the most powerful tools to stop the community spread of covid-19."

So why did the CDC recommend not wearing a mask two months ago? The Mayo Clinic says face masks were not recommended at the start of the pandemic because experts didn't know the extent to which people with covid-19 could spread the virus before symptoms appear, nor was it known that some people have covid-19 but don't have symptoms.

The CDC now recommends the use of reusable cloth masks so that surgical masks and N95 respirator masks, which continue to be in short supply, can be saved for health-care workers.

The CDC guidance says cloth masks should: fit snugly but comfortably against the side of the face; be secured with ties or ear loops; include multiple layers of fabric; allow breathing without restriction; and be able to be laundered and machine-dried without damage or change to shape. It also cautions that they should not be placed on children under age 2, anyone who has trouble breathing, or anyone who would have trouble removing the mask without help. The Mayo Clinic recommends that cloth face coverings be washed after every day of use.

Beshear's "healthy at work" rules require businesses to have employees to wear a cloth mask, unless it is a health or safety hazard to do so, or if they are working alone or in an enclosed space, or if they are working in an area that allows for appropriate social distancing. The order also encourages customers to wear masks, and allows businesses to refuse to serve customers not wearing them.

Dutch urged caution as the state reopens its economy, saying that the "long road ahead of us" will require all of us to make smart choices if we are to slow the spread of this virus, like continuing to practice social distancing and wearing a mask.

"I think it is really critical that people understand that as we are reopening the economy, we've done a good job of slowing down the rate of infections, but the virus is not gone," she said.

She added later, "The best we can do is anything that can just slow down how often people spread this virus from them to someone else, and that's how we win. Hopefully we will do well. We will see."