Friday, July 31, 2020

Hospitals overall are losing money, and it's likely to get worse; Cynthiana hospital says it's 'at a negative 25% margin'

A report prepared for the American Hospital Association predicts half of the nation's hospitals will be losing money by the end of the year unless Congress gives them more relief money, and some of those hospitals are in Kentucky.

Overall, hospitals usually have an operating margin of 3.5 percent, but that is expected to be minus 3% for the second quarter of this year, once the figures are compiled, and could sink to minus 7% in the third and fourth quarters -- and half of all hospitals are likely to operate with a negative margin, said the report by Kaufman Hall, a health-care consulting firm.

"That drop would have been negative 15% without funding from Congress, which gave providers $175 billion a few months ago," Robert King reports for Fierce Healthcare. Hospitals had to give up their most profitable function, elective surgery, in the early months of the pandemic, and now many Americans are reluctant to enter a hospital.

AHA organized a call with reporters and hospital executives, including Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana. She said the hospital tries to get an 0.6% operating margin in a good year, but “We are at a negative 25 percent margin.”

Rural hospitals like Cynthiana's have struggled most, and that's par for the course, says Alan Morgan, CEO of the National Rural Health Association. “For the last 20 years, rural hospitals have been struggling,” Morgan said. “That’s kind of who they are.” NRHA says "Many rural hospitals are also facing workforce reductions at a time when residents need care most," and quotes Debrin Jenkins of the West Virginia Rural Health Association: “I think it’s redline dangerous … I think it will be a huge increase in death.”

New virus cases up for 5th day; covid-19 patients' ICU use spikes; positive-test rate declines; studies don't look good for school

By Al Cross and Melissa Patrick
Kentucky Health News

New cases of the novel coronavirus in Kentucky increased for the fifth straight day, to 778, the fourth largest number yet, and the number of Kentuckians in intensive care for the virus's covid-19 disease rose to the highest in months.

Gov. Andy Beshear emphasized the third consecutive decline in the percentage of Kentuckians testing positive for the virus in the last seven days.

The 5.43 percent rate was slightly under the daily average for the week so far, 5.51%, and notably under the 5.81% reported Wednesday. Last week, the rate rose above 5 percent for the first time since testing became generally available, helping prompt Beshear to impose new restrictions.

"We still have too many cases and we need to do everything we can to try to decrease those," Beshear said in a press release. "We’re also seeing an increase of patients in the ICU."

The release didn't mention the intensive-care-unit numbers from the state's daily report: 150, up from 110 on Thursday, a 36% increase, and exceeding the recent ICU high of 145, reported July 22. Higher numbers were reported in the spring, during the pandemic's first surge in Kentucky.

Beshear continued to say the latest surge has slacked off to a plateau, based on weekly figures. He said it appears that this week will end with about the same number of cases that were reported last week. That is speculative, because two days remain in the reporting week, which runs from Monday through Sunday.

Two different snapshots of the data illustrate how different it can look. The state's seven-day rolling average stands at 609, close to where it has stood for the last five days. But the three-day average is at 685, the highest since the 748 recorded on July 25, when the state recorded its third-highest number of new daily cases, 836. Here are graphs of the three-day and seven-day averages this month:
Kentucky Health News graphs, based on daily reports from state Department for Public Health
Counties with more than 10 new cases Friday were Jefferson, 203; Fayette, 51; Warren, 45; Madison, 26; Graves, 23; Boone and Mercer, 19 each; Kenton, 17; Bullitt and Hardin, 16 each; Harlan and Pulaski, 15 each; Barren and Scott, 13 each; Campbell, McCracken ans Oldham, 12 each; and Shelby, 11.

Studies on virus spread by children have implications for schools

A study released today by the Centers for Disease Control and Prevention suggests that children of all ages are susceptible to the novel coronavirus, SARS-CoV-2, and can spread it to others. The study is one of the few that documents spread among children, so it could guide school officials as they decide when and how to resume classes.

"Asymptomatic infection was common and potentially contributed to undetected transmission, as has been previously reported," CDC said. "This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports might play an important role in transmission."

The study looked at an outbreak at an overnight camp in Georgia last month, where 260 children and staff got the virus. The median age of the campers was 12, all were required to test negative before arriving, and staff were required to wear masks, but the campers were not.

Another study has found that children under age 5 with mild to moderate covid-19 had as much or more virus in their their upper respiratory tract as adults, Dennis Thompson reports for MedicineNet. The authors wrote in a research letter in JAMA Pediatrics that "Young children can potentially be important drivers of SARS-CoV-2 spread in the general population."

The studies "could have massive impact when it comes to school reopenings," CNN's Jake Tapper reported. Dr. Michael Saag, professor of medicine and infectious diseases, University of Alabama at Birmingham, told him, "This is a giant experiment; we don't know what to expect."

In other covid-19 news Friday:
  • Kentucky's covid-19 death toll rose to 735, with the deaths of a 75-year-old man from Fayette County, an 86-year-old woman from Jefferson County, a 63-year-old man from Perry County and an 80-year-old woman from Taylor County.
  • "The $1 trillion coronavirus relief plan U.S. Senate Majority Leader Mitch McConnell and other Senate Republicans unveiled this week will not meet the needs of struggling Kentuckians, said a group Thursday representing restaurants, the homeless, education and local governments," Jack Brammer reports for the Lexington Herald-Leader.  Ryland Barton of WFPL also reports on critics of the plan, and USA Today breaks down what Democrats and Republicans want, along with easy to read graphs.  
  • Dr. Anthony Fauci, the nation's top infectious-disease expert, told the House Select Subcommittee on the Coronaviurs today that he was "cautiously optimistic" we could have a vaccine by late fall or early winter. A Herald-Leader story offers a short overview of the vaccine's progress. 
  • The Hispanic population in Kentucky has been particularly hard hit by the coronavirus.  Only 3.9% of the state's population is Hispanic, but 14.4% of coroanavirus cases and 4.19% of covid-19 deaths are among Hispanics. Louisville health officials plan to expand testing sites aimed at Hispanic communities, Deborah Yetter reports for the Courier Journal. 
  • The U.S. Food and Drug Administration offers a Q&A page on antibody, or serology, testing for the virus. Antibody tests can help identify people who may have been infected but had no symptoms. 
  • As scientists have converged on a theory that the virus is largely spread among people through large droplets expelled in sneezes or coughs, or through smaller aerolsolized droplets, like those created by talking, public-health experts have put more emphasis placed on wearing masks and social distancing, and less emphasis on extensive surface cleaning in public places, except in health-care settings. It is also important to remember the importance of keeping hands washed, Derek Thompson reports for The Atlantic. Emanuel Goldman, a microbiology professor at Rutgers New Jersey Medical School, told him, “Masks, social distancing, and moving activities outdoors. That’s it. That’s how we protect ourselves. That’s how we beat this thing.”

UK HealthCare again best Ky. hospital in U.S. News & World Report rankings; Baptist Health has two of seven on state list

By Melissa Patrick
Kentucky Health News

Seven Kentucky hospitals are included in the nation's "Best Regional Hospitals" in the latest annual rankings by the magazine U.S. News & World Report

They are, in order: the University of Kentucky hospital; in a tie for second, Baptist Health Louisville and St. Elizabeth Healthcare Edgewood-Covington Hospitals, Louisville's Norton Hospital and Baptist Health Lexington; and in sixth, the University of Louisville's Jewish Hospital and Saint Joseph Hospital-Lexington. 

To make the list, a hospital must offer a full range of services; either be ranked nationally in one of 12 measured specialties or have three or more high-performance rankings for procedures and conditions; and have at least two more high-performing than below-average rankings for procedures and conditions. The last criterion is new.

The report offers an overview of 122 Kentucky hospitals with a breakdown of each of the measured categories, as relevant to the services the hospital provides. 

UK HealthCare, for the fifth consecutive year, claimed the No. 1 ranking with its Albert B. Chandler Hospital. The hospital also ranked in the top 50 for cancer care for the fourth straight year, and moved up to its highest ranking yet in that specialty, 29th. The hospital's Markey Cancer Center is the state's only National Cancer Institute-sponsored center, one of 71 in the nation. 

Dr. Mark F. Newman, UK executive vice president for health affairs, said in a news release, “This has been a challenging year, to put it mildly. But in these times, it’s more important than ever that Kentuckians with complex health problems have a medical center they can come to for best treatment options possible.”

UK also ranked as high-performing in these specialties: gastroenterology and gastrointestinal surgery, geriatrics, nephrology (kidneys), orthopedics and urology.

The 31st annual rankings compared more than 4,500 hospitals in 26 specialties, procedures and conditions. A release said 134 were nationally ranked in at least one specialty, and 563 were ranked among the Best Regional Hospitals in a state or metro area. Data used for the rankings predate the covid-19 pandemic.

Baptist Health had two of the state's top seven hospitals. Baptist Health Paducah fell off the Best Regional Hospital list this year, after being added last year for the first time ever, but it continued to be rated high-performing in heart failure and COPD.

Baptist Health CEO Gerard Colman said in a news release, “Baptist Health has long been known for its compassionate clinical care, and the U.S. News & World Report Best Hospitals rankings validate the high quality care provided by our physicians, nurses and staff as they live out our mission of leading in clinical excellence, compassionate care and growth to meet the needs of our communities.”

The report recognizes hospitals that are "high-performing" for 10 common adult procedures and conditions, including repair of abdominal aortic aneurysms, aortic valve surgery, trans-catheter aortic valve replacement (added this year) chronic obstructive pulmonary disease, colon-cancer surgery, heart-bypass surgery, lung-cancer surgery, hip replacement, knee replacement and congestive heart failure.

UK Healthcare ranked high-performing in all those categories except abdominal aortic aneurysms and trans-catheter aortic valve replacement, both dealing with the body's main artery, and knee replacement. It ranked average in those three categories. 

Baptist Health Louisville ranked high-performing for all procedures and conditions except trans-catheter aortic valve replacement and lung-cancer surgery. It ranked average in both.

St. Elizabeth Healthcare ranked high-performing in all the categories except aortic valve surgery, trans-catheter aortic valve replacement and heart-bypass surgery, in which it ranked average. It ranked high-performing in one specialty, orthopedics.

Baptist Health Lexington ranked high-performing in all but four categories, in which it ranked average: aortic valve surgery, trans-catheter aortic valve replacement, colon-cancer surgery and hip replacement.

Norton Hospital ranked high-performing for four procedures and conditions: heart failure, hip replacement, knee replacement and COPD. It ranked average for the other seven. 

Saint Joseph Hospital-Lexington ranked high-performing for colon-cancer surgery, heart failure and COPD, and average for the rest.

UofL Health-Jewish Hospital ranked high-performing for lung cancer surgery, heart failure and COPD. It ranked average for the remaining categories. 

Click here for information about how the magazine ranks the hospitals, including details on this year's methodology changes. 

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot, followed by Cleveland Clinic and Johns Hopkins Hospital in Baltimore, according to a news release

Thursday, July 30, 2020

Cases up, positive-test rate down; Beshear says mask mandate having effect, but suggests more people should work from home

State chart adapted by KHN; current period has 3 of 7 days remaining; at current rate would be 3845.
By Al Cross and Melissa Patrick
Kentucky Health News

Thursday's coronavirus numbers were mixed, but Gov. Andy Beshear kept accentuating the positive, saying he sees the impact of his July 9 order requiring Kentuckians to wear masks in indoor public spaces and outdoors when they can't stay six feet apart.

"It appears that face coverings are making a difference," Beshear said as he announced 659 new cases of the virus, raising the seven-day rolling average by seven, to 612. But Beshear pointed to week-to-week trends.

"We at least stopped the significant escalation in that last week we're showing, and we believe we are going to be somewhere in that zone at the end of this week," he said. "We believe what we are generally seeing is a leveling off or at least a significant decrease in the escalation" that began in early July.

Thursday's best number on the state's daily report was 5.66 percent, the share of Kentuckians testing positive for the virus in the last seven days. Wednesday's seven-day percentage was 5.81.

Beshear said the state remains in "a danger zone, but again with the time to do things right." In a new suggestion, he said businesses could help by letting more of their employees work from home.

"I think the further that we've gotten into this virus, the more people have tried to pull 100 percent of their employees back in the office, and that doesn't help," he said, adding later that he had heard, anecdotally, that many workplaces are operating at 100%. "I would still really suggest people stay down around 50 percent," he said. "If people are productive virtually, don't mess with their production."

Health Commissioner Steven Stack also pointed to the bar graph of weekly case numbers showing that Kentucky was able to maintain a long, sustained plateau for almost three months, but has recently started to escalate in such a way that he said "is scary again."

"We are all dying, some just more quickly than others. So I accept that; that's called mortality," said Stack, an emergency-room physician by trade. "I am not here to separate you from your death. I would just like to delay it as long as I reasonably can." 

The old and the young: Stack said some people have been "cavalier" about the facts that 97% of Kentuckians killed by the virus were over 50, and 90% were over 60, suggesting that these are people who are going to die anyway. He said people in those age groups seek his help.

"I get letters every day from people who tell me they really don't want to die, that they kind of value the one life they have, and so for them it does matter. And so if you are in those high-risk categories, it really matters. They are relying upon the rest of us to behave responsibly so they don't pay a price with the one life they have." 

Though younger people don't often die from covid-19, it is a disease with many effects, and we still don't know a lot about it, Stack said. 

He noted that we didn't know for months that it could cause multi-system inflammatory disorder in children, and we still don't know what kind of long-term or permanent damage it will cause.

And in young adults, he said the virus can cause blood-clotting disorders, including strokes, pulmonary embolisms and heart problems, that can cause permanent damage. Recent studies show that as many as one in five young adults still have symptoms up to three weeks after diagnosis, he said.

"That's not the flu," he said, using a familiar comparison used by skeptics. "The flu lays you low for a while and then you bounce back, that's a lot longer recovery." And people over 50 are twice as likely as young adults to have symptoms three weeks after diagnosis, he said.

Also, some people suffer irreversible lung damage. "There's a lot we don't know," he said. "And so, I'm not trying to fear-monger. I'm just trying to tell you there's a lot we don't  know," he said. The New York Times published a long update about the pandemic with a rundown of strange things the virus can do.

Contact tracing: The July surge did not overwhelm the state's contact tracers, the employees who call people who have had contact with those who have tested positive for the virus, said Mark Carter, the official overseeing them.

Carter said the tracers are reaching 70% to 75% of those identified as contacts, and they have "overwhelmingly" been cooperative when asked to self-quarantine for 10 days or until they get a negative test of their own.

"They want to protect their health, they want to protect their loved ones," Carter said. "Certainly, there are those that are uncooperative, but so far those have been far in the minority."

He said more cases could overwhelm the program, so it's important to recognize it as one measure of the state's response to the pandemic. He suggested that its big test will come when students return to classrooms. "Indoor settings are an issue," he said, "and as we look at school returning, whenever that happens, that is of significant concern to us."

In other covid-19 news Thursday:
  • The state reported seven more deaths from covid-19, raising its toll to 731. The fatalities were a 75-year-old man from Casey County; a 65-year-old man from Christian County; a 92-year-old woman from Green County; an 82-year-old man from Greenup County; an 81-year-old woman from Ohio County; a 63-year-old woman from Simpson County; and a 70-year-old woman from Warren County.
  • Counties with more than 10 new cases were Jefferson,138; Fayette, 42; Warren, 22; Laurel, 20; Hardin, 18; Shelby, 17; Graves and Henderson, 15 each; Christian and Daviess, 14 each; Kenton and Mercer, 13 each; Barren, Oldham and Scott, 12 each; and Franklin and Pulaski, 11 each.
  • Beshear said the day's 659 new cases included 22 children under 5.
  • In long-term care facilities, 12 more residents and 18 more employees tested positive for the virus, but no new deaths were attributed to the facilities. Five more facilities were added to the list of those with a least one case, raising the total to 253.
  • He cast some doubt on the Sept. 5 Kentucky Derby, to be held at 60% spectator capacity, when asked if he would go if it were held now. "I think everybody wants us to see improvements on where our numbers are," and if the recent escalation continued, "I would have to think long and hard before really going anywhere and that's about a decision for me and my family," he said. "If the numbers are still where they are right now in September, that means we've done a great job plateauing them, and if that's the case I probably would go and hand out that trophy." He said he hopes Churchill Downs is continuing to find ways to make the event safer.
  • Asked abut the state fair, set for Aug. 20-30, he said the Department for Public Health "sent an additional series of recommendations . . . for them to consider in light of where we are right now. And remember, anything that is held out there or anywhere else around Kentucky that is large, if not done well, can ultimately upset other opportunities to do large events." He said he did not know what the agency's recommendations were. 
  • Beshear said mediation failed to resolve Northern Kentucky landlords' lawsuit challenging his ban on evictions, so the suit will head toward trial. The state Supreme Court is allowing eviction cases to be filed, but Beshear's order bans execution of eviction judgments. He acknowledged that some renters are "gaming the system . .. but are there people out there that are suffering because of this virus or its economic impact that we can't allow to be kicked out on the street? Yes."
  • Muncie McNamara, whom Beshear fired as unemployment insurance director, told legislators that during the early-spring crush of jobless claims, the Beshear administration approved thousands that should have been investigated, until the U.S. Department of Labor “got wind that we were doing that and told us that we had to stop.” He "also said the unemployment insurance system wasn’t technologically prepared when Beshear in March offered the jobless aid to people who wouldn’t normally qualify such as independent contractors, ahead of the federal government taking similar action," Chris Otts reports for WDRB.
  • Beshear replied that it's not unusual for a fired official to make "big allegations" that don't pan out. "I believe here we have somebody who, their relationships certainly got messy by the end, but it appears that the termination was valid and they are not kind of exhibiting some of these same things that we have seen in the past. My understanding is that everything that was raised by that individual as they were leaving was addressed."
  • Regarding a data breach that McNamara said he reported, Beshear said McNamara forwarded" an email to people who are getting thousands of emails, and then went home. If you are the head of something, you've got a bigger obligation than that." Still, he said the pending inspector general's report on the data breach will "show a number of people in leadership positions should have done more. And we're going to make sure that we correct that and we're going to make sure we are transparent about it."

Wednesday, July 29, 2020

Beshear says case numbers likely stabilizing, but positive test rate keeps rising, 'a sure-fire sign you've got to be careful,' Fauci says

Beshear showed this chart to illustrate what Kentucky needs to avoid: a spike like Oklahoma's.
By Melissa Patrick
Kentucky Health News

Even though new cases of the coronavirus crept up Wednesday, and the percentage of Kentuckians testing positive in the last seven days was the highest it's been in a while, Gov. Andy Beshear continues to be optimistic that the state's numbers are stabilizing. 

Beshear announced 619 new cases on Wednesday, up from 590 yesterday and 522 the day before, but nowhere near the second highest number of 836 reported Saturday. The seven-day average of cases increased to 605, from 590. The governor also announced a positive test rate of 5.81 percent, the highest since testing became widespread.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Tuesday that a rising positive test rate is "a sure-fire sign that you’ve got to be really careful." He told ABC News that Kentucky, Tennessee, Ohio and Indiana are among states in danger of covid-19 outbreaks.

Beshear accentuated the positive. "Right now, it looks like we are on track to be relatively stable as compared to last week’s numbers, and that’s a good thing," Beshear said at his daily briefing. 

Beshear noted that the number of new cases have increased the last three consecutive weeks: the week of July 6-12 brought 2,482; the week of July 13 had 3,772; and last week saw 3,918. He attributed that relative stabilization to his mask mandate, which took effect July 10. 

"Right now, even with today's number, we are on track to be right around what we have seen the last two weeks," he said. "That is showing that our willingness to wear a facial covering is stabilizing our numbers or reducing the growth that we would be seeing right now."

But he also warned, "We are nowhere near out of the woods and we are not going to be for at least a couple of weeks." 

He encouraged Kentuckians to "be diligent" about the things they have been asked to do to thwart the spread of the virus. Those include wearing a mask while in public, social distancing, keeping non-commercial social groups to 10 people or less, and not traveling to states with a 15% or more positive test rate, and if they do anyway, quarantining for 14 days when they get back.

To show what could happen, Beshear showed a graph of states' one-week case rates, based on population, and pointed to Oklahoma. He noted that just a few weeks ago the Sooner State had just a few more cases than Kentucky, but once the virus started spreading there and wasn't checked, the state's case numbers escalated quickly. 

"Our job right now, right now is to make sure that we don't have that increase you see in that graph of Oklahoma, and certainly make sure that we don't go that same way as Florida," which was also highlighted on the graph and is the nation's hotspot. "Right now is the moment where we either stop this increase, like you see in Oklahoma or in Florida, or we ultimately suffer the same fate."

Ben Smith, recovering from brain-cancer surgery, holds up a mask
and tells viewers, "Wear it for me," in a new public-service video.
The governor showed one of the Foundation for a Healthy Kentucky's video public service announcements in its "Wear it for Me" campaign, which will run through August and focus on the importance of wearing masks. The graphics and PSAs are available for download.

Beshear said 17 of Wednesday's new cases were children under 5, the youngest four months old. "Remember, wear your mask for your kids too," he said. "None of us want to ever have to live with the knowledge that we might have spread this to our children, even though it happens. Let's just make sure that we are doing all of the steps to reduce that probability of it ever happening." 

On July 27, the state Supreme Court issued an order saying eviction cases could be filed starting Saturday, Aug. 1, unless they are protected by the latest federal relief law, the CARES Act. Beshear has barred evictions during the pandemic, but three Northern Kentucky landlords have challenged the legality of that in a lawsuit, which is in mediation.

A blog post by the Kentucky Equal Justice Center reported that Beshear is scheduled to mediate with the landlords Thursday at 9:30 a.m. in the federal courthouse in Covington. Housing advocates are asking Beshear to keep the moratorium in place, arguing that 220,000 households in the state and at least 1,500 renters in Lexington alone are at risk of being evicted, Beth Musgrave reports for the Lexington Herald-Leader. 

In other covid-19 news Wednesday:
  • Beshear reported that 571 Kentuckians are hospitalized with covid-19 and 112 of them are in intensive care. Both figures were 2.2% less than Tuesday.
  • The state reported five more deaths from the coroanvirus, bringing its death toll to 724: an 87-year-old woman from Clay County; an 82-year-old man from Graves County; a 77-year-old man from Jefferson County; a 58-year-old woman from Knott County; and a 71-year-old man from McCracken County. 
  • Beshear announced that the death rate from the virus has decreased to 2.5%, from 3%.
  • The governor announced that 23 more residents and one more employee in the state's long-term care facilities have tested positive for the virus. Three more deaths in these facilities have been attributed to covid-19, bringing that total up to 477, including four staff deaths. 
  • Counties with more than 10 new cases Wednesday were Jefferson, 231; Fayette, 45; Kenton, 37; Hopkins, 33; Boone, 24; Graves, Logan and Shelby, 22 each; Warren, 21; Adair, 19; Butler, 15; Jackson, 14; Campbell, 13; Edmonson, 12; Grayson, 11; and Oldham, 10. 
  • Beshear announced that in-person unemployment services will be offered in Louisville Aug. 3-7 at United Auto Workers Local 862, 3000 Fern Valley Road. Click here to register. 
  • Beshear said the Office of Unemployment Insurance reported another security breach on Monday, though he said officials don’t believe anyone’s financial or credit information has been compromised. He said the individuals whose information was viewed have been notified. 
  • J. Michael Brown, secretary of the executive cabinet, said the administration is screening 700 inmates to see if they would qualify for commutation due to then pandemic; he said only those nearing the end of their sentences and are incarcerated for nonviolent, nonsexual offenses are being considered.  Brown said there are 379 active inmate cases of the coronavirus and 53 active staff cases in the state's correctional facilities. He said 432 inmates and 69 staffers have recovered, and eight inmates have died of covid-19. 
  • Health Commissioner Steven Stack posted links on Twitter to "just a handful of articles" about hydroxychloroqine and chloroquine as treatments for covid-19 that show "at this time, medical research has not shown these medications to be meaningfully helpful for this disease.
  • "Two new studies from Germany paint a sobering picture of the toll that covid-19 takes on the heart, raising the specter of long-term damage after people recover, even if their illness was not severe enough to require hospitalization," Elizabeth Cooney reports for Stat. 
  • After being shut down for the next two weeks, two bars in Lexington that have been singled out by the governor told Janet Patton of the Lexington Herald-Leader that they have been working hard on compliance, but need help enforcing the rules. Beshear noted that he had received a thoughtful email from a bar in Lexington. He said that while he recognized that many bars are trying to follow the rules, the industry must do better. 
  • As people lose jobs and health insurance during the pandemic, a Kaiser Family Foundation report shows that Kentucky has led the way in signing people up for Medicaid. The program now covers more than 1.5 million people and grew 7% between March and April, Deborah Yetter reports for the Louisville Courier Journal, writing that the state's Medicaid program has been adding new members at a rate of about 8,000 to 10,000 a week during the pandemic. 
  • Testing shortages and delays have hampered the state's efforts to trace coronavirus clusters, Ryan Van Velzer reports for Louisville's WFPL. "We’re seeing tests take seven to 10 days to come back, which makes contact tracing not possible or feasible, and so it actually makes it seem like why was the test even worth doing in the first place,” said Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness
  • The Washington Post reports on "Who should get a coronavirus vaccine first?"
  • The New York Times has published the latest federal report on states' response to the virus, dated July 26, that was distributed to states by the Coronavirus Task Force. 

Tuesday, July 28, 2020

Republicans' new relief plan has less for hospitals, nothing for Medicaid; McConnell 'faces flak from both left and right'

Senate Republicans' latest covid-19 relief proposal "sets up new fights over health funding even as the pandemic continues to overwhelm the country," report Dan Diamond and Adam Cancryn of Politico.

"There’s more hospital bailout cash, but it’s well short of demands. Senate Republicans are pitching a $25 billion boost to a hospital bailout fund, bringing the total to $200 billion when combined with past relief measures. That’s well short of the $100 billion infusion the industry has demanded — and that Democrats provided in their relief bill, which passed largely along party lines in May."

Also, the bill has "no additional dollars for Medicaid," Politico reports. "Republicans decided against boosting federal funds for the safety-net program, despite bipartisan calls from governors warning they’ll have to cut benefits without more federal help."

Senate Majority Leader Mitch McConnell faces "a difficult path," Politico's John Bresnahan and Andrew Desiderio report: "He faces flak from both his left and right, as Democrats are seeking trillions of dollars more in funding than the Kentucky Republican wants to approve, while a large group of GOP hard-liners opposes new spending altogether. . . .And then there’s Donald Trump and White House officials, who seem more concerned with saving the president’s political career than they are about preserving GOP control of the Senate."

Asked about using part of the August recess to accomplish a package, McConnell responded: "We'll keep you posted. . .. There's no way to answer all those hypotheticals. The interaction with the Democrats has seriously begun."

Beshear sees signs that his mask mandate is slowing the spread of the coronavirus; both key seven-day averages show declines

Kentucky Health News chart; daily case numbers may be adjusted after initial report.
By Melissa Patrick
Kentucky Health News

Although the number of new coronavirus cases reported Tuesday in Kentucky remained high, at 532, the seven-day average of cases suggested a downward trend, and the percentage of Kentuckians testing positive in the last week dropped a bit.

Gov. Andy Beshear said it is "too early to draw conclusions," but the daily data "at least gives us hope that we may be seeing a plateau or stabilization" because "the time period is right where the facial covering requirement is starting to kick in and help."

Beshear ordered that masks be worn in public places, or in social gathering with people outside the household, starting on July 10 -- with an expectation of seeing results after two weeks, which is roughly the incubation period for the virus. He also limited non-commercial gatherings to 10 people.

But despite those measures, new cases kept escalating, prompting Beshear to take the other two measures recommended by the White House Coronavirus Task Force: closing bars and reducing indoor restaurant capacity for the next two weeks, starting Tuesday.

Then Tuesday brought hopeful signs. The seven-day rolling average for the positive test rate fell to 5.08%, the first time it's gone down in four days, and the seven-day average of daily new cases fell to 590. Four days before, it had been 668, more than triple the average of 220 on July 1.

Looking ahead: Beshear said he expects the state will be able to increase capacity in restaurants again in two weeks. He didn't mention bars, which seem to have had a harder time following the mask mandate and social distancing orders. 

"It is my expectation because I believe these steps will work," he said. "Two weeks gives us a real opportunity and our hope is that we see the impact of the facial coverings before we see some of the impact on restaurants." He said the mask mandate will likely be extended. 

Asked why his latest orders were directed only at bars and restaurants, Beshear said the White House believes they are causing significant spread of the virus. According to limited cluster data provided by the state's health departments, Beshear said 17 percent of the spread in Kentucky has been from restaurants and bars.

Dr. Steven Stack, the state's public-health commissioner, again emphasized masks. "That is the single thing, if we just do it," he said. "If we get over the cultural divide about not wearing these things, this is how we keep businesses open, we keep people working, we get people back to the activities, we get kids back to school." 

Travel risks: Beshear has also issued a travel advisory, asking Kentuckians to not travel to states with a 15% or greater positive-test rate, and to quarantine for 14 days when they get home if they choose to. The official state covid-19 website now includes a list of those states.

The governor said he is hearing that Kentuckians are still traveling to Florida, even with older parents, and "I need everybody that has plans to go to Florida or Georgia, Alabama, South Carolina, Texas, Arizona -- cancel them." 

Beshear pointed out that the virus "continues to ravage" states around the country, noting that Florida has set a single-day record for deaths and that the virus is now killing a Texan every 6 minutes and 16 seconds. 

"We have the ability to stop this before it gets anywhere close to what we've seen in those states," he said, adding later, "Our goal, and I think what we have done, is to act quickly, to not let it get dire before we take the steps we need and to fully commit, to fully commit to doing what it takes to protect our people, keep our economy open and ultimately get our kids back in school." 

Beshear said 21 of Tuesday's new cases were children under 5, the youngest a two-month-old. He said this is a nationwide trend, which could be driven by more tests, but also because more young people than ever are getting infected. "We can't live under any illusion that kids don't get the virus," he said. 

He said there isn't enough data to show how children are contracting it, but "We know one driving cause is people going on vacation and taking their kids to places that they shouldn't be taking them, and then coming back and then their kids interact with other kids."

Trump and his drug: Nationally, one of the big covid-19 stories Tuesday was President Donald Trump's tweeting, more than a dozen times, in defense of hydroxychloroquine as a treatment for covid-19, despite no evidence of its efficacy. Trump doubled down on his promotion of the drug at his press conference Tuesday.

Stack, asked about the effectiveness of hydroxychloroquine, provided a lengthy answer about its lack of efficacy:

"All the credible evidence I have seen so far is hydroxychloriquine and chloriquine are not materially helpful; they do not help enough to be worth while for coronavirus. They don't effectively prevent you from getting the disease after you've been exposed to it. When you are sick, they don't help you get better more quickly. When you are sick, they don't help prevent you from having a bad outcome. So, maybe someday there will be some example or some narrow situation where that is not the case, but hydroxychloriquine and chloriquine, with or without the antibiotic Zithromax, which is known as azithromycin, the generic name, have not been shown to meaningfully improve your outcomes."

Stack added, "People, when they are desperate or unwilling to listen to science and facts and evidence, do things . . .that are foolish. O.K. People were taking aquarium chemicals and ingesting them because they thought that it was somehow going to help them with the coronavirus. Ingesting aquarium chemicals will kill you, it won't help you with the coronavirus. So please don't do those things."

Asked if Trump's comments undermined public-health messaging, Stack reiterated the question as asking about when "leaders and others" communicate things that are not supported by science. 

"I would continue to urge everyone in the public, please find people who have dedicated their lives and their professional lives to studying and learning about these things that are important, and listen to credible sources," he said. "I would look to a physician or a public-health expert to advise me on public health stuff. I don't take my car to a medical doctor to get fixed." 

In other covid-19 news Tuesday:
  • Beshear reported that 584 Kentuckians are in hospitalized with covid-19 and 115 of them are in intensive care, declines of 4 and 12 percent from Monday, respectively.
  • He reported that 77 more long-term care residents and 31 more staff had tested positive for the virus, and attributed nine more nursing-home deaths to covid-19. 
  • Beshear reported 10 new deaths from the virus, bringing the total to 719: a 74-year-old woman from Butler County; an 84-year-old man from Fayette County; a 37-year-old man from Lyon County (an inmate at the Kentucky State Penitentiary); a 73-year-old woman from Oldham County; and three each from Jefferson County (two women, 86 and 87, and a man, 82) and Logan County (two women, 89 and 101, and a man, 83). 
  • Counties with 10 or more new cases included Jefferson, 130; Kenton, 24; Madison, 19; Warren, 17; Barren and Graves, 14 each; Boone and Harlan, 12 each; Christian, 11; and Laurel, 10.
  • The Lexington-Fayette County Health Department, which reports on a different schedule than the state, reported a record 116 new cases Tuesday. "The number of cases reported in the last two weeks has matched the total number of cases reported in all of June," 2,972, the Lexington Herald-Leader reports. The new one-day high means each of Lexington’s top five case days have come since July 10." 
  • Health and Family Services Secretary Eric Friedlander said the state will not continue temporary Medicaid plans beyond July 31, and is working to sign up those who qualify up for regular Medicaid plans. 
  • The Kentucky High School Athletic Association Board of Control voted Tuesday to delay football games until Sept. 11 due to the pandemic. The previously scheduled start date had been Aug. 21.
  • As schools make plans to re-open this fall, their budgets are being stretched by the added cost of the coronavirus, Kristen Kennedy reports for Lexington's WKYT-TV: “We’re spending about $50,000 to replace water fountains with water-bottle fillers. We’re spending another $40,000 with new no-touch cleaning equipment,” said Scott County Supt. Kevin Hub. “We’ve got about $25,000 we’ve already spent on the point and shoot thermometers to meet the requirement, the temperature check, before school entry.” Hub said the county had received about $1.2 million in federal relief funding as well as money from the governor's allotment to school districts. 
  • A recent survey of 1,011 parents by Vanderbilt University found that since covid-19 hit, nearly 27% said their mental health had worsened, 14.3% said their children's behavioral health had declined, and 9.6% said both their mental health and their children's behavioral health had declined, Medpage Today reports.
  • Becker's Hospital CFO Report notes that seven of the nine things in Senate Republicans' proposed $1 trillion covid-19 relief package.  Inside Health Policy expands on the details of the package. Jason Bailey, executive director of the Kentucky Center for Economic Policy, said in a detailed statement that this proposal "provides nowhere near the aid Kentucky and the nation needs to get through the re-surging covid-19 economic and health crisis." 

Smoking and vaping can make covid-19 more severe

Getty Images photo via University of Ky.
By Audrey Darville
Associate professor of nursing
University of Kentucky

Though studies are still ongoing, more is known about the risks of smoking and covid-19. Early reports found people sickened with covid-19 had worse outcomes if they smoked. Recent studies have found that people who smoke have double the risk of severe infection compared to those who do not smoke.

Smoking and vaping:
  • Damage to the lungs' natural defenses against invasive bacteria and viruses.
  • Expose users to chemicals that weaken the immune system and limit the body’s ability to fight infection.
  • Increase the risk of heart and lung disease, conditions which increase the risk of severe complications from covid-19.
The hand-to-mouth action of smoking and vaping can increase the risk of exposure to bacteria and viruses. Smoking one pack a day results in around 300 hand-to-mouth contacts. Smoking and vaping also decrease mask-wearing time, limiting protection from virus exposure.

Monday, July 27, 2020

Beshear closes bars, cuts restaurant capacity, advises schools to delay in-person classes 'til 3rd week of Aug.; positive-test rate up

Kentucky Health News chart
By Al Cross
Kentucky Health News

Bars will have to close and restaurants must cut their indoor capacity to 25 percent, from 50 percent, under Gov. Andy Beshear's latest orders to control the surge of the coronavirus in Kentucky.

Beshear said Monday he was acting to protect lives, maintain the economy and get children back in classrooms. He also announced that he was recommending to public and private schools that they should wait until at least the third week of August to begin in-person classes.

"You can't do that with an uncontrolled surge in the virus," he said, adding later, "If we see a lot of early cases in schools it will be harder to get all of our schools open for in-person classes in a way that it works for those families."

All three announcements were expected, because Beshear had been laying the groundwork for about a week. He had voiced hope that his July 9 order to wear masks would stem the surge that began that week, but it continued largely unabated, except a typical drop in the number of new cases on Sunday, attributable to limited testing.

The state reported 522 more cases of the virus Monday, raising its seven-day rolling average to 611. At the start of the month, it was 220.

Also going the wrong way was Beshear's other key metric: the percentage of Kentuckians testing positive for the virus. The seven-day rolling average is 5.51 percent, the highest it has been since testing was largely limited to people with symptoms of the covid-19 disease.

"There has been a steady increase over time," Beshear said. "We have to start to see that coming down."

He announced nine more deaths from covid-19, bringing the state's death toll to 709, and warned that deaths will increase because cases have: "Deaths can trail the cases by weeks, sometimes even more."

Against the background of an issue that has become politically divisive, the Democratic governor of a state that generally votes Republican put himself on the same page as the national Republican administration, and asked constituents to do likewise.

He said he was following recommendations of President Trump's administration, which came to Kentucky Sunday in the person of Dr. Deborah Birx, the coordinator of the White House Coronavirus Task Force.

"They and we agreed with over 74 counties in their red or yellow zone, that this virus is now escalating and spreading so much statewide, that statewide action is necessary. That’s the position of the Trump administration; that’s the position of this state government," Beshear said, adding later, "We also agree on steps that have to be taken."

Beshear had already taken two of the recommended steps, the mask mandate and reducing to 10 from 50 the number of people allowed at social, non-commercial gatherings. He said the new orders would be in effect for two weeks, with the hope that all the measures together will stop the surge. But he implicitly acknowledged that may be difficult.

He started Monday's briefing by saying, "We all have to start out with believing and understanding that this is real, that the virus doesn’t just go away, and wherever you live in Kentucky, and you can look at the maps, the virus is spreading, and spreading significantly in your community. We all need to be singing from the same sheet of music."

Health Commissioner Steven Stack summed up the Beshear administration's case: "It's not politics, it's not ideology; it’s just science. When we come together, we spread the virus. . . .Masks are what keep Kentucky open; to keep Kentucky open, wear a mask when you go out."

Beshear said Birx told him that the conversation they had Sunday was like those she had with Florida and Texas, which Beshear used as examples of what Kentucky needs to avoid. "At one point, Florida and Texas were just where we are today," he said. "We can look at what’s happened to them and know that we absolutely have to act."

Beshear said the risk of harm that would come from not acting was greater than the harm that will come to bars, some of which may not survive closure, and restaurants, whose success may depend on outdoor seating.

"We are going to work with our cites and localities to do what we can administratively to allow that outside seating to expand," he said, adding later, "Everybody, please order a lot of takeout these next two weeks."

He said the orders are in the businesses' long-term economic interests. "If we don’t do this now with our restaurants it’ll result in longer-term closures," he said. "I believe most of our restaurants are trying really hard."

Beshear showed a photo of what he said were "hundreds of people, way closer than six feet, not a mask in this picture at all," Saturday night in downtown Lexington. "There’s plenty of blame to go around," he said, not just to proprietors and customers: "There’s been not enough enforcement out there; we can admit to that."

Asked if local health departments are still in "education mode," in which they use information and persuasion rather than take action against businesses that don't enforce masking and social distancing, Beshear indicated that they need to step up their game: "We’re at a point now where we gotta stop this thing . . . . We can’t let ‘em do it twice."

Asked about the perception of unfairness created by protests that violate several of his orders, Beshear said, "We can control what we can control. I need people to do the right thing in their homes and in their backyards. … We're gonna fail in this if we say that guy over there isn’t wearing a facial covering so I’m not gonna wear mine either."

And what if his latest orders don't stem the tide? "We'll be looking at all options."

In other covid-19 news Monday:
  • The nine additional deaths were of a 61-year-old man from Livingston County, a 74-year-old woman from Bell County; and seven from Jefferson County: four men, 70, 71, 82 and 98, and three women, 61, 76 and 84.
  • Beshear said 21 of the new cases were from children 5 and younger, including a 4-month-old from Jessamine County and a 9-month-old from Bullitt County. He said the youngest was 11 days old but didn't give the county.
  • Counties with more than five new cases on the daily report were Jefferson, 185; Fayette, 93; Daviess, 22; Warren, 21; Oldham, 19; Barren, 12; Jessamine, 9; Boyle, Hardin and Kenton, 7 each; and Boyd and Bullitt, 6 each.
  • In long-term-care facilities, 30 more residents and 35 more employees tested positive for the virus, and seven more deaths were attributed, for a total of 465. Asked why he wasn't tightening restrictions on the facilities, Beshear said the state has tested all residents and is doing surveillance testing of staff, and that spread of the virus to the facilities often "starts in bars," with younger people spreading it to their parents and/or grandparents. But he added, "If we continue to see spread, we may have to look back at visitation" at the facilities.
  • Beshear acknowledged that Kroger Co. will stop sponsoring drive-thru testing and move its testing into its in-store clinics, but he hopes to find a new partner next week that will meet or exceed Kroger's capacity. He said the state would have to pay for that, and thanked the Cincinnati-based grocer for its help: "They didn’t take a dollar from us."
  • Asked about prospects for the Sept. 5 Kentucky Derby, to be conducted with spectators at 60% capacity, “We’re still far enough away” to see how the mask mandate and other measures work. He said he has been impressed by success of the 50% capacity at the new Lynn Family Stadium for professional soccer in Louisville.
  • Beshear said he advised leaders of the state House and Senate about his announcements beforehand, and discussed them "in further depth" late last week with one leader he did not name. Leaders of the legislature's Republican majority have criticized him for taking actions against the virus without consulting with them.
  • Beshear has said that Kentucky has enough coronavirus tests, but Norton Healthcare says the federal government is steering test supplies away from Louisville, Grace Schneider reports for the Louisville Courier Journal. In a letter to U.S. Rep. John Yarmuth, D-Louisville, Norton Chief Medical Officer Steve Hester wrote: "Each time we make a financial investment in a platform for testing to maintain services for the state of Kentucky we find ourselves at the mercy of the federal government moving these supplies to other states." Beshear said he had not heard form Norton on the issue.
  • Julie Cerel, a licensed psychologist and professor in the University of Kentucky College of Social Work, talked about covid-19's impact on suicide. Asked how to help someone who is struggling, Cerel said, "This is a time of tremendous emotional and economic upheaval. Many people are physically isolated. But technology — now more than ever — means no one has to be alone. Anyone can reach out to the National Suicide Prevention Lifeline. Therapists are available for people to see from home, and support groups have been meeting virtually. It’s imperative to take advantage of those resources."

Data and health directors' observations suggest that pandemic lockdown increased overdoses, which declined as state reopened

Graph from Kentucky Injury Prevention Research Center, University of Kentucky
By Melissa Patrick
Kentucky Health News

Apparent overdoses reported by Kentucky hospitals and ambulance services shot up in the two months after Gov. Andy Beshear declared a state of emergency because of the covid-19 pandemic, and have been on a downward trend since the state started reopening in mid-May.

"I don't want to give false hope," Dana Quesinberry, research core director for the Kentucky Injury Prevention and Research Center, said as she explained the data on hospital emergency departments' and emergency medical services' reports of "overdose encounters," a term KIPRC uses because overdoses may be suspected but not necessarily confirmed.

"We are still at higher levels than we've ever been, but the fact that we are seeing that decline over the last few weeks is very important," Quesinberry said. "There is hope that we are making progress again, so whatever triggered the increase is being managed or mitigated in some way." 

She said the data coincides with preliminary reports that also shows an uptick in overdose deaths during April and May. Quesinberry said official 2020 overdose death numbers are not yet available, but "Preliminary data indicates that we have had increases in drug overdose deaths during covid." For April, "We are still looking at a monthly count that exceeds at least anything in the prior couple of years, in a month total." She added later, "We are seeing increases in May as well." 

Quesinberry, an assistant professor for the Department of Health Management and Policy at the University of Kentucky, said researchers will need to explore what triggered the peak in overdose encounters and then look at what slowed it down.  

"We know that there has been an impact on the opioid epidemic during covid and we are working very hard to understand what that impact has been," she said, adding later, "This is a time of tremendous uncertainty driven by the pandemic. It's important to understand that it has consequences beyond the spread of infectious disease."

Public health reports coincide

"Covid has had a huge impact on substance use because it has led to more isolation," John Moses, team leader for harm-reduction services at the Lexington-Fayette County Health Department. "I have a feeling that we are seeing a lot more people relapse and go back to using again. I think that people who maybe work full time and only did drugs on the weekend were laid off and now may be doing drugs seven days a week. We know that when people are isolated like that, there is a lot more depression and that always has an effect on drug use."

Moses said his county is on pace to equal the number of overdose deaths in 2017, which were the most ever. "Last year Lexington-Fayette County had a total of 122 overdose deaths; we are already at 107 for the year," he said. "Last year we did a really good job of getting the overdose rates down, but thanks to covid, I believe that we are seeing more overdose deaths." 

Moses also noted that anytime there is an interruption in the drug supply, which has been seen during the pandemic, more fentanyl comes into the community.  He said it is being mixed in with heroin, methamphetamine, cocaine and even THC vape cartiridges, and "This disruption in the drug supply has caused more fentanyl to be here, and more overdoses."

Christie Green, public-health director of the Manchester-based Cumberland Valley District Health Department, said she had heard anecdotally that there were several overdoses about three weeks ago related to a batch of pressed pills that were being sold as Xanax, but were mostly fentanyl -- a synthetic opioid that is much stronger than heroin. 

"This is the first time that I've gone through something that is socially stressful like covid . . . while working so closely with people who are active in substance-use disorder, and it's just been really hard on them," Green said. "A lot of their social supports are gone. I really worry about them, honestly."

Marcy Rein, public-health director of the Whitley County Health Department, said her health department signed up for a system called ODMap in May to track overdoses in the community, along with about 40 other counties and health departments in the state.

"The system allows us to look at the big picture, to look at the maps to see if we have hotspots in a particular area or not," she said. She said a rash of overdoses in May prompted them to join the system. 

Rein said preliminary data shows that the pandemic is having an impact on rates if suspected overdoses: "We're not saying that covid causes the increase in overdoses, but certainly some of the factors that go along with covid most certainly put people at higher risk, like the isolation and also the economic impact."

Andrea Brown, public-health director of the Bourbon County Health Department, said it saw an increase in overdoses in April, and started keeping track of those numbers more diligently in May after signing up for ODMap, which she said only records EMS-related encounters, at least for now.

She said the EMS-only data shows that from from May 5 to July 19, almost two and a half months, Bourbon County had 28 overdoses and five fatalities. Brown estimated that the county had 11 overdoses in April but wasn't sure how many died.

"We are still getting overdoses," she said. "I feel like last year we may have had 12 overdose deaths, something in that ballpark, so if we've already had five between May and July, then I think we are really, once the data actually comes out, we're probably going to see a much higher increase." 

Brown said the health department's harm-reduction syringe exchange has been giving out more Narcan, which can block the effects of an overdose, "so I think the word on the street is probably getting around that there has been an increase of overdoses in our community. The Narcan is definitely a hot ticket item right now."

Jamey Whaley, harm-reduction and-peer support specialist with the Maysville-based Buffalo Trace District Heath Department, said some of his syringe-exchange participants have reported an increase in overdoses where they have had to administer Narcan. He said he is also seeing people relapse and return to the program. 

"I don't know if that's because of the covid and the mental-health side of it that has made them decide to go back to using," he said. 

Scott Lockard, public health director at the Hazard-based Kentucky River District Health Department, said Eastern Kentucky has seen an influx of pressed tablets with fentanyl and carfentanyl, noting that Lee County saw a huge uptick in overdoses from a substance called "smurf dope" just a few weeks ago. WLEX-TV reported July 1 that smurf dope is a bright blue substance that is a mixture of methamphetamine or heroin and fentanyl. 

"I think any time you see a different substance than what people normally utilize, there is an adjustment period in how they use it and the strength, the purity level of it when it is a fentanyl or carfentanyl," Lockard said. "If somebody has been abusing Suboxone, which is a pharmaceutical-grade substance, and then now they are dealing with these pressed tablets, that's where I think it increased a lot of the issues that we were seeing with the increase in overdoses."

He said anecdotally, based on what he hears from EMS, law enforcement and harm-reduction people, there have been fewer overdoses near the end of June and in July.

For help in finding treatment for substance-use disorder for yourself, a friend, or loved one, the state has a website:

Sunday, July 26, 2020

Beshear promises 'additional steps' on virus; White House task force says to close bars and decrease restaurant capacity

Dr. Deborah Birx at the old governor's mansion
Story and photos by Melissa Patrick
Kentucky Health News

After meeting in Kentucky with the response coordinator for the White House Coronavirus Task Force, Gov. Andy Beshear said he would announce new steps Monday for thwarting the spread of the virus.

"Our numbers are still going up, so tomorrow you can expect us to take some additional steps," Beshear said. "The White House has provided us some clear guidance of what those steps should be . . . I will not let us become an Alabama, a Florida or an Arizona. We've got to take proactive steps and that is what we are trying to do." 

Beshear had said for several days that he was waiting to see if the recent surge continued or would be abated by his mask order and changes in Kentuckians' behavior. Asked why he didn't announce them Sunday, he said he wanted to directly communicate them to all Kentuckians. Today's event was not broadcast on his Facebook or YouTube page.

The White House task force's Dr. Deborah Birx, on a tour of several states, said it's not too late for Kentucky to get ahead of its recent surge, but further steps are necessary, including closing bars and reducing indoor restaurant capacity, now at 50 percent.

Birx ticked off a list of recommendations for states with rising positivity rates; the only two left on the list that Kentucky hasn't already implemented are closing bars and reducing restaurant capacity.

"We believe a state that has test positivity somewhere between 5 and 7 percent, like Kentucky, has a real opportunity to get ahead of this," she told reporters after meeting with Beshear, Kentucky health officials and other stakeholders.

Beshear said the steps he will announce Monday are ones that White House and public-health officials think will have maximum impact, but "We've got to get better at every event that we are at. We've all got to get to the point that if we show up and we see something that doesn't look right, we go home. That should be a bar, that should be a restaurant, that should be a retail facility."
Beshear announced 316 new cases of the virus Sunday, for a seven-day rolling average of 593. He noted that Sunday numbers are often low because of fewer test results. The positive-test rate is usually not reported on Sundays; Saturday the state saw its highest rate since testing became widespread: 5.41%.

Beshear said he would also make new recommendations for schools tomorrow. Birx said her recommendations for states to reopen schools are the same recommendations to get the positive-test rates down: mandating masks, increased social distancing, closing bars, restricting indoor dining, and rules to discourage people from gathering socially in large groups. 

"There is a way to get this virus under control so that schools can open safely in Kentucky, but it will take all Kentuckians to make that their top priority," she said. "Each state needs to make that decision school district by school district, to make sure that the virus levels in that school district are low and we think every governor and every school district has the ability to get there if they follow these guidelines."

Birx said overall, Kentucky is currently in the task force's "yellow zone," because its positive-test rate is between 5% and 10%. She said states are considered in the "red zone" for positive test rates above 10%.  

In Kentucky, she said, "We do have some specific counties and some specific metros in what we call the covid red zone. We have another whole set of counties and metros in the yellow zone. As a state, we have the state. . . in the yellow zone, with clear recommendations of what to do to prevent it from becoming a statewide covid red zone and that is the part that I was talking about that the governor and I agree completely."  

Another metric the task force looks at is weekly cases, though Birx did not address this measure. After hitting a seven-day rolling average of  4,673 cases yesterday, Kentucky moved into a "red zone" for this measure because it was more than 100 per 100,000 population. That's 1,000 cases per million, and Kentucky's estimated population is 4.468 million, so its "red zone" threshold is 4,468 cases per week. Sunday's lower case number brought the 7-day total below that level, to 4,153.

Birx emphasized the importance of everyone wearing masks in indoor spaces, and expanded that recommendation to people who live in multi-generational homes if there has been a chance of exposure to the virus. 

"Frankly, people should be wearing mask if they've been in an area where the virus is significant," she said. "And they've gone on vacation and they've come back, they should wear a mask indoors in their homes if they are in a multi-generational household in order to protect our seniors optimally."

Beshear at old mansion
Beshear has said that much of the virus' spread in Kentucky now is from people who have gone on vacation to hotspots, and have brought it back. Birx said the virus is largely being spread among Southern states with high cases from people under 30 who are asymptomatic and unknowingly spread it to parents and grandparents. 

"This current wave of infection is very much across the state, probably due to people being exposed unknowingly when they were out and about, who have then brought those infections back to  their homes and back to the county," Birx said. 

She later noted that while the first wave of the epidemic was concentrated in large metropolitan areas and the "bedroom communities" around them, as well as specific congregate facilities such as nursing homes, the current spread of the virus is following a different pattern. 

"This spread is very much at the household level," Birx said. "That's why we have a real call to action for every Kentuckian to wear their mask and to protect those in their families by not going to large social gatherings. And if they do, to make sure they are protecting those in their families that have substantial vulnerabilities that we know are related to obesity, hypertension, diabetes and chronic lung, heart or kidney disease."

Birx said she is traveling from state to state. "This current group of states, Indiana, Ohio, Kentucky, Tennessee, and Virginia tomorrow, are the next set of states where we have significant concerns about the rising test posititivity rate and the rising number of cases," she said. "And it is due to that that we wanted to come in person to really discuss what we were seeing and what we think, along with the local and state governors and mayors, what they are thinking needs to be done."

Beshear reported four new deaths Sunday, bringing the state's covid-19 toll to 700: a 37-year-old man and an 87-year-old woman from Jefferson County; a 70-year-old woman from Harlan County; and a 76-year-old man from Ohio County.

Counties with 10 or more new cases Sunday were Jefferson, 55; Fayette, 23; Warren, 21; Kenton, 15; Graves and Scott, with 11 each; and Oldham, 10. Click here for the daily report. 

Asked about Beshear's offical advisory to not travel to states with a 15% or higher positive-test rates, and to quarantine for 14 days if they do, Birx said that while it is important to know what the virus activity level is in a location you are going to, she has been travelling to states with high rates of the virus and has not contracted it, suggesting that it can be safe to travel.

"You can travel if you are super careful, but that means when you are there you are not going to bars and crowded settings and you are not going into large social groups where infection can be spread," she said. " It is possible to travel safely, but you do have to take a level of precaution and those are all on the CDC website on how to travel more safely." 

Pandemic depresses vaccination rates; doctors and insurer say parents should feel safe taking children for health-care providers

By Lisa Gillespie
Kentucky Health News

Not as many Kentucky children are getting critical vaccinations as they did previous years, tracking a nationwide trend of parents staying away from health-care centers to avoid the coronavirus.

Last April, 27,906 Kentucky 1-year-olds were vaccinated for diseases such as Hepatitis B, influenza, polio and measles/mumps/rubella. But only 17,463 1-year-olds were vaccinated in April 2020.

And only 4,219 4- to 6-year-olds, a crucial age range for key vaccinations, were immunized in Kentucky in April 2020, fewer than one-fourth the 18,394 vaccinated in April 2019. That’s according to data compiled by the state Cabinet for Health and Family Services. The data is voluntarily reported, so the actual numbers may be higher.

According to the U.S. Centers for Disease Control and Prevention, vaccination rates nationwide are down. On average, about two-thirds of infants at 5 months old from 2016 to 2019 received vaccinations, but only half did in May 2020.

The CDC reports similar trends among all Americans under 18, with non-influenza vaccination rates decreasing by 21.5%. Jones said the trend puts children and babies at higher risk for diseases like the measles, whooping cough, chicken pox and others that can be prevented with vaccinations.

The trend worries public-health officials, doctors and others.

"We've seen basically no immunizations being done in March, April and May. Slowly, we are seeing parents bringing children back in now for immunizations," said Scott Lockard, public health director at the Kentucky River District Health Department, which recently found a case of measles, one of the most easily spread diseases.

Lockard asked, "With the school situation, one of biggest motivators for immunizations is having those immunizations completed by the time school starts, but with schools going virtual across the state in some areas, what's that going to look like?"

WellCare, a health insurer in Kentucky, is urging parents to get their child’s vaccinations now that health-care providers are fully open for business.

“Now that some requirements have been eased in the state, it’s likely that a catch-up period will coincide with the usual summer rush of students needing updated immunizations for school and college,” WellCare CEO Bill Jones said in a press release. “We encourage all parents to schedule immunizations now, to ensure children are protected from vaccine-preventable diseases and outbreaks.”

Dr. Sean McTigue of Kentucky Children’s Hospital told Kentucky Health News in June that most doctor's offices have created ways to minimize virus exposure. These include conducting well-child visits only in the morning, and sick child visits in the afternoon. Health providers are also having patients wait in their cars instead of waiting rooms.

Tigue also said it’s very important for children under 2 to get immunized because the majority of childhood vaccinations are recommended during those early years.

"For a child who may have been born in the month or two preceding the health emergency,” he said, “you could have a child who has received essentially no vaccines and is really unprotected against many infections that are quite deadly and are fully preventable by vaccine.”