Monday, August 31, 2020

Almost half of Kentucky's counties are in federal report's danger zones, reflected in the state's slowly rising daily virus case count

Table from White House Coronavirus Task Force report; for a larger image, click on it.

By Melissa Patrick

Kentucky Health News

Fifty-nine of Kentucky's 120 counties are in danger zones for the federal coronavirus reporting week of Aug. 22-28, an increase of seven from last week. Gov. Andy Beshear named them all in his daily briefing, then said, "I think maybe we’ve been taking a nap the last couple of weeks. Let’s make sure we wake up and start doing the things it takes to defeat this virus."

Beshear and his health subordinates also announced new rules for child-care centers, and took strong issue with a new presidential adviser's idea that the nation should seek "herd immunity" from the virus and what they said were misrepresentations of Centers for Disease Control and Prevention figures.

The numbers: Beshear reported 381 new cases, a typically low number for a Monday, but one that two months ago would have been high for any day of the week. The good news was that the share of Kentuckians testing positive for the virus fell to 4.42 percent, the lowest in more than a month. Seven of the last eight days have seen a rate below 5%, a key threshold in suppressing the virus.

"While our positivity rate is going down, we have more people than ever ... coming down with covid, almost 10 percent of which end up hospitalized and, sadly, 2 percent of which right now lose their lives," the governor said. "Let's remember how serious this is and let's not act like everything is normal during a worldwide health pandemic." 

Of the 59 counties listed in the weekly White House Coronavirus Task Force report, 14 were in its "red zone" for places where new cases of the virus numbered more than 1 per 1,000 residents and the share of residents who tested positive during the week was over 10%.

Beshear read names of counties listed in the report.
The report put 45 counties in the yellow zone, up from 36 last week. This zone is for counties with 0.1 to 1 case per 1,000 and a positive test rate between 5% and 10% in the reporting week, or those with one of those metrics in yellow and the other in red.

The seven-day rolling average of new cases is now 660, the fourth highest of the pandemic. It has increased every day but one for 10 days, from 584 on Aug. 20. 

Among Monday's new cases, 43 are in Kentuckians 18 and younger. Of those, two were children five or younger, with the youngest a one-year-old from Madison County. 

Beshear again urged Kentuckians to follow the rules and honor the 10-person limit for social gatherings as the state nears the Kentucky Derby on Saturday and Labor Day on Monday. 

"If we say, 'Oh, it's my right to have a huge party in my backyard,' you're playing Russian Roulette, but not with your own life, with somebody else's, probably someone else that you don't know," he said. "And if enough people do it, it means somebody loses that game. Remember, we're living for each other." 

Child care: Beshear and Eric Friedlander, secretary of the Cabinet for Health and Family Services,  announced long-anticipated new rules for child care.

Beshear said the changes are necessary as a form of "harm reduction" because different groups, such as catering companies with large and unused indoor spaces, have been opening nontraditional learning programs.

The new rule allows 15 children in a class, up from 10, and allows centers to give limited tours to prospective clients. Friedlander noted that the positivity rate is declining and centers have become accustomed to limits.

The rule allows accelerated certification and licensure to child-care centers in homes, as well as a $2,500 startup incentive to encourage them to get licensed. Friedlander said he hopes groups that have opened or may open centers to help children with online learning will take advantage of the new incentive to get legal. He said "learning pods" led by parents who don't charge fees are not included, but "If they are operating illegally, we are going to ask them to stop."

The rules also allows licensed infant and one-year-old classrooms to return to typical group size and will aid background checks on nontraditional instruction spaces as well as offering them safety guidance.  

The changes come after child-care operators and legislators have asked Beshear to lift the restrictions he imposed months ago, citing a shortage of child care. Bradley Stevenson of the Child Care Council of Kentucky, said at the Aug. 26 meeting of the Interim Joint Committee on Health, Welfare and Family Services that 276 providers, or 43% of the total in a recent survey, said they would have to close if size restrictions were not removed.

Fighting some feds: Beshear and Health Commissioner Steven Stack had strong words when asked about a Washington Post story reporting that President Trump's new health adviser, Scott Atlas, is urging him to embrace a "herd immunity" strategy to combat the pandemic, according to five people familiar with the discussions. To achieve herd immunity, the virus would be allowed to spread to allow the population to build up collective resistance to it. 

"That is incredibly reckless; we'd lose over a million people. I'm absolutely against it. We should not be that callous," Beshear said as Stack made his way to the lectern. 

Stack said, "That assertion that herd immunity is a viable way to go [is] not just reckless, it's irresponsible. It's a failure of leadership. It's the kind of language that shouldn't be coming out of a serious, educated professional in that role at the national level."

After the story was published, Atlas sent the Post this statement: “There is no policy of the president or this administration of achieving herd immunity. There never has been any such policy recommended to the president or to anyone else from me.” The Post added, "At an event Monday in Florida with Gov. Ron DeSantis (R), Atlas falsely said The Washington Post never asked him for a comment."

Stack walked through the math of herd immunity in terms of the death toll, concluding that the approach would result in the deaths of 1.6 to 2.3 million people nationwide, depending on whether the death rate was figured at 0.7% or 1%. Kentucky's current death rate is 2%, but most fatalities are residents of long-term-care facilities. 

Stack also pointed out that smallpox and polio "ran rampant" for many years without creating herd immunity, "so anyone who's advocating herd immunity who is in a position of leadership probably should not be in that position of leadership."

Stack was then asked whether health officials overstate the number deaths from covid-19, a question perhaps prompted by social-media reaction to a weekend post on the CDC website saying that "for 6% of the deaths, covid-19 was the only cause mentioned."

Stack said that fact has been misrepresented because death certificates list a primary cause of death and contributing causes. He said health officials have always said covid-19 is a disease that attacks older people and those with underlying health conditions.

He noted that 35% of Kentuckians are obese, that one in seven Kentucky adults have diabetes, and one in nine are pre-diabetic. "If you add it all up, you should take no solace that only 6% of people on a death certificate only have covid-19 because the vast majority of people have some co-morbid condition," he said. "But even in that I don't think we're overstating these numbers. . . . We try to scrub that data to make sure we remove anything that is incorrectly attributed."

Beshear said, "I know we all want to get back to our normal lives, but not believing we have a worldwide health pandemic when 183,000 Americans have died? I mean, what, how many do you need to actually believe it's happening? I would certainly hope 183,000 is enough. The fact that we have politicize something that is killing us, that is hurting us is just an absolute shame."

Earlier in the day, the Lexington-Fayette County Health Department, also issued a statement to address any confusion: "The CDC did not change data to say only 6% of the listed deaths were from covid-19; instead, the data shows that 6% of covid-19 deaths were in people without pre-existing or underlying health conditions. We have consistently said that people with highest-risk of complications, including death, from covid-19 are people with underlying health conditions, including heart and lung disease, cancer and diabetes."

Drugs: Beshear opened the briefing by marking International Overdose Awareness Day, noting that public-health officials have said that since the start of the pandemic they are seeing the largest number of overdose deaths since 2017. 

Beshear encouraged Kentuckians to look out for each other. "Covid doesn't make this any easier, it makes it harder," he said. "It makes it harder on us mentally and emotionally, which can fuel more addiction. It makes it harder for us to be there and to know when someone is suffering from an addiction. It may make it harder to get to them when we need to. So please, keep up all your efforts, redouble them if we have to. It is about saving lives."

Kentuckians struggling with substance use disorders can call the KY Help Call Center at 833-859-4357, which provides information on treatment options and open slots among treatment providers, or use an online website that provides similar services called

In other covid-19 news Monday: 

  • Beshear reported three more deaths from the disease, bringing the state's death toll to 933. The fatalities were a 61-year-old man from Lincoln County; a 72-year-old woman from Martin County; and a 65-year-old man from Owen County.
  • The state's daily report shows 557 people are hospitalized in Kentucky with covid-19 and 144 of those are in intensive care. Beshear did not report the number on ventilators. 
  • Counties with 10 or more new cases were Jefferson, 111; Fayette, 39; Madison and Warren, 21; Pulaski, 20; and Calloway, 17. 
  • In long-term care, eight new residents and 12 new staff have tested positive for the virus and 607 residents and 343 staff have active cases of it. Ten more resident deaths can be attributed to covid-19, Beshear said. 
  • The daily K-12 school report shows 14 new students and three new staff tested positive for the virus and 159 students and 61 staff have active cases. This report has been updated with data for individual schools.
  • The daily college and university report shows seven new student and no new staff cases and 582 students and 16 staff with active cases. 
  • "Kentucky’s students and staff should wear masks at all times while they are in school, even if they are at least 6 feet apart, according to updated #HealthyAtSchool guidance" from the state. Billy Kobin reports for the Louisville Courier Journal
  • The governor's travel advisory, asking people to avoid traveling to state's with positive-test rates of 15% or higher and to self-quarantine if they do, now applies to South Dakota, Iowa, Nevada, North Dakota and Alabama. 
  • The Lexington Herald-Leader is hosting "Lexington's Learning Curve: Navigating Education Access in a Pandemic," an online conversation about how to safely educate Kentucky students during the pandemic, The seven panelists, who include Beshear, "will help us understand how we can keep our students safe and on track academically, athletically, emotionally as we also focus on keeping them safe in K-12 schools and our colleges and universities," the newspaper says. The event will be held Tuesday, Sept. 1 at 12:30 p.m. ET. RSVP here and to see the list of panelists. 
  • The infection rate among health-care workers in Louisville has tripled since May, mirroring a boost in positive cases seen in the general population in July, according to researchers tracking it, report the CJ's Grace Schneider and Deborah Yetter. In its latest round, the University of Louisville Co-Immunity Project tested about 1,100 health-care workers for both the live virus and antibodies, which indicate past exposure. The active infection rate was 0.45%, up from 0.14% found in 1,372 workers in April and May. About 2.2% had antibodies, compared with 1% in April, they had a lower infection rate than the general Louisville population: 2.2% and 9.2% respectively. The researchers also found that 78.5% of those who had antibodies in the first round maintained a high level of antibodies. 
  • In a 12-state study, many novel-coronavirus infections in health-care personnel who routinely cared for covid-19 patients went undetected. Among the 6 percent with antibody evidence of infection; 29% were asymptomatic, and 69% had not been diagnosed with infection. Antibodies were less common among the 6% who said they always wore a face covering while caring for patients, according to research published in the  Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. The researchers conclude, "Universal use of face coverings and lowering clinical thresholds for testing could be important strategies for reducing hospital transmission."
  • Kentuckians who have general questions about covid-19, such as symptoms, treatment or tests, can call the Kentucky Poison Control Center at 800-722-5725. The state's official covid-19 site is at

Somerset-area legislators decry Beshear's restrictions at Chamber meeting with little use of masks or social distancing

L-R: Sen. Rick Gidler, Reps. David Meade and Ken Upchurch, unopposed House nominees Josh Branscum and Shane Baker (Photos by Caleb Lowndes, the Commonwealth Journal)
By Al Cross
Kentucky Health News

Chafing under Democratic Gov. Andy Beshear's executive orders, several Republican legislators said Thursday evening that the General Assembly will rein in the emergency powers that the Democratic governor has used to fight the novel-coronavirus pandemic.

Photo provided by the Commonwealth Journal;
for a larger version, click on it.
The lawmakers from the Somerset area spoke to "a packed house" that included "a whole host of the community’s business and political leaders," reported Chris Harris of the Somerset Commonwealth Journal. The newspaper's editor, Jeff Neal, told Kentucky Health News that "There wasn’t a whole lot of social distancing, and since they were eating, there were not a lot of masks being used." 

Most "who took the microphone asked the legislators questions about how the Kentucky House and Senate could address or repeal Beshear’s numerous executive orders," the newspaper reported.

“I’ve heard from all of you,” said Sen. Rick Girdler of Somerset. “A ‘state of emergency’ was not put in to have somebody in charge for six months. It was put in for an earthquake or a tornado or something where there were no communications for four or five days. We don’t need, Republican or Democrat, somebody up at the office deciding for six months or a year that that’s what we’re going to do. We are three branches of government, and we need to use all of our three branches of government."

Leaders of the legislature's Republican majorities have said Beshear should have consulted with them before making major moves, such as his July 9 order to wear masks in indoor public spaces and outdoors when six feet of distance can't be maintained. The governor has said Republicans dislike the highly public role he is playing and are politically motivated.

Girdler said of his leaders' request, “Some people say that’s political. No, that ain’t political. The political part is coming from the other side. We’ve meant to be a part of this conversation, and we’ve not been a part of it.”

Girdler was joined by Reps. Ken Upchurch of Monticello and David Meade of Stanford, who is House speaker pro tem, at Lee's Ford Marina on Lake Cumberland for an event sponsored by the Somerset-Pulaski County Chamber of Commerce, the newspaper reported. Josh Branscum of Russell Springs and Shane Baker of Somerset, Republicans who are unopposed for seats being vacated, also attended.

“We’ve got to do some things that pull back that power of the governor,” Upchurch said. “I’m fairly confident . . . that you’re going to see some pretty powerful legislation that’s passed in both houses that can do that.”

The newspaper reported that Girdler endorsed a pre-filed bill that would limit governors' emergency orders to two weeks and ban them from suspending any laws, and limit to three weeks anti-disease actions of the Cabinet for Health and Family Services -- unless the governor starts a special legislative session.

Girdler said he also favors a constitutional amendment that would let the legislature call itself into session, the newspaper reported.

“I get calls all the time, I get text messages asking me, ‘Why are you all staying at home? Why don’t you go up there and do something?’ I wish I could,” Girdler said, adding later, “We’ve got to have the legislators involved in making the decisions based upon economic development, tourism. . . . I really believe we have to take our state back.”

Meade said, “I didn’t feel like the shutdowns were necessary because I truly believe that the people of Kentucky are smart enough and intelligent enough to make the decisions for themselves in order to protect themselves.”

The legislators and would-be legislators sat together, without masks. "All the Chamber workers and Harbor Restaurant workers were masked," newspaper editor Neal said, adding later, "You have to remember that in this neck of the woods, no one pays much attention to the virus. People here are rabid anti-maskers. And our numbers are rising. Go figure."
Photo provided by the Commonwealth Journal
The event concerned Dr. Kevin Kavanagh, a retired Somerset physician who heads Health Watch USA, which focuses on infection control in health care.

"Events like this are very problematic," Kavanagh told Kentucky Health News. "They usually have many cases or none. With the number of individuals present and the prevalence of the virus in Pulaski County, the odds are nothing will happen, but if the virus was present at the event it can be catastrophic. . . . This could be a super-spreader event."

Bobby Clue, the chamber's executive director, did not return a call from Kentucky Health News. He told the Commonwealth Journal, “We’ve said for months now that it was time to get back to business. I believe people are starting to agree with us on that philosophy. We think that people can come out to events, that we can do that in a safe and responsible way, and we have to live our lives at some point. This is a tremendous turnout with over 100 people here tonight, and I’m very confident that we’re going to see more and more people start coming out to events.”

He added, “If people aren’t comfortable, that’s why we still have virtual options: the Facebook Lives, the Zoom.” He added, “The virtual component for us is important and we’re going to keep that in place indefinitely moving forward at all Chamber events.”

Sunday, August 30, 2020

Sunday's new-case report gives state largest one-week total; health commissioner again urges safe behavior next weekend

Plantings in the Floral Clock, to the west of the State Capitol and the Capitol Annex (at left) reflect
Gov. Andy Beshear's "Team Kentucky" slogan for fighting the novel coronavirus. (Photo by Al Cross)
By Al Cross
Kentucky Health News

The state reported 462 new cases of infection by the novel coronavirus Sunday, making its Monday-to-Sunday weekly total the largest ever: 4,503. The previous high was 4,333, two weeks ago.

“That means we have to do better,” Gov. Andy Beshear said in a press release. “With this number of cases we see more people hospitalized, we see sadly more people being lost. So please wear your mask, please make good decisions. This is a time when this virus is spreading aggressively.”

Reports on Sundays, unlike other days, do not give hospitalizations or the percentage of Kentuckians who have tested positive for the virus in the past seven days. Saturday's number was 4.59%, concluding a week in which only one day saw a number larger than 5%, the level that prompts public-health officials to recommend restrictions on activity.

“Do your best,” Beshear said. “We can’t be tired, we can’t give up. We have to bring it every week, because this virus is going to continue to take people we love. So, mask up, Kentucky. Let’s beat covid-19.”

Beshear's press release said 79 of the new cases were in Kentuckians 18 and younger. “That’s a lot of school-age kids, so please be careful,” said the governor, who has recommended that schools delay in-person instruction until Sept. 28. About 30 of the state's 171 school districts have started in-person classes, and some of the remainder have authorization from their local school boards to start before Sept. 28, depending on local conditions. 

Thirteen of Sunday's new cases are in children 5 and under, down to two months old, the release said. Case reports on Sundays and Mondays are usually the lowest of a week due to limited weekend work at testing laboratories.

Beshear reported nine more covid-19 deaths, raising the state's total to 930. The fatalities were a 75-year-old man and an 87-year-old woman from Casey County; an 82-year-old man and a 90-year-old woman from Fayette County; an 82-year-old man from Lincoln County; a 66-year-old woman from Russell County; a 71-year-old man from Green County; an 80-year-old woman from Calloway County; and an 83-year-old man from Harlan County. 

Health Commissioner Steven Stack doubled down on his warning for next weekend, noting that the state's two biggest horse races will coincide with the last holiday weekend of the summer.

“What might be considered in Kentucky a ‘trifecta of holidays’ begins this coming Friday,” said Stack, a physician. “Enjoy watching the fillies on Oaks Day this Friday. Watch the Kentucky Derby, the 146th Run for the Roses, on Saturday. And, enjoy the entire Labor Day weekend. Just do it in ways that keep you and others safe. Stay healthy at home as much as you can. When you go out in public, please practice social distancing, wear a mask whenever you are near others, and wash your hands often. If we all do these things, we have a much better chance for safer, healthier fall and winter holidays with family and friends. These changes to our routines make an immense difference and save lives. Together, Team Kentucky can get through this.”

Counties with five or more new cases are Jefferson, 131; Fayette, 77; Madison, 35; Boone, 10; Bullitt, 10; Clay and Warren, 9 each; Campbell, 8; Caldwell, Green, Jackson and McCracken, 7 each; Boyle, Franklin, Jessamine, Kenton Pulaski and Scott, 6 each; and Boyd, Calloway and Graves, 5 each.

In other covid-19 news Sunday:

  • The CovidActNow website estimates high virus-transmission rates for several Kentucky counties: Todd, 1.73; Rowan, 1.47; Jackson, 1.34; Green, 1.28; Warren, 1.21; and Madison, 1.13. A rate of 1.13 means that every 100 infected people will inflect 113 other people, and those 113 will infect 128 (1.13 x 1.13), and so on. McCreary and Monroe counties also appear in red on the CAN map but the site says their transmission rates are unknown. The site estimates Jefferson County's rate to be 0.90 and Fayette County's to be 1.01.
  • President Trump hyped the Food and Drug Administration's approval of convalescent plasma as a covid-19 treatment beyond what the FDA was planning to say about it, after pressuring the agency to make the move, The Washington Post reports. Then FDA Administrator Stephen Hahn grossly overstated plasma's likely effectiveness, adding up to "a stunning debacle for the FDA, shaking its professional staff to the core and undermining its credibility as it approaches one of the most important and fraught decisions in its history amid a divisive presidential election — deciding when a covid-19 vaccine is safe and effective." Hahn promised Sunday that the vaccine review "will be transparent to the public, with any clearance by the agency driven by data alone," Bloomberg reports.
  • Getting kids to wear a mask is hard," writes Rachel Buchholz, kids-and-family editor at National Geographic. "Getting kids to keep their shirts and shoes on is hard enough—how do you convince them to wear a restrictive covering for hours, especially when you’re not there to enforce the rules? One idea is to appeal to a child’s natural sense of kindness and fairness, says psychotherapist and parenting coach Alyson Schafer . . . 'Say things like, "We wear masks and stay six feet apart because we don’t want to spread our germs to others who may not be as healthy. We wear our masks because we want to help everyone, not just ourselves." (Superhero-style masks help reinforce that thinking.) Other ideas: outings for treats like ice cream where they have to follow the safety rules in order to get their frozen reward, and rehearsed retorts when confronted with non-mask-wearing peers. ... And of course, figuring out which mask looks best on them. After all, you might as well look cool while you’re saving the world."

Nursing homes say they need more help from the state; their residents have accounted for 58.6% of covid-19 deaths in Ky.

By Melissa Patrick
Kentucky Health News

As they remain the main sites for deadly infections of the novel coronavirus, Kentucky's nursing homes are asking for more help from the state, which says much of the help they seek has already been provided or can't be rendered.

At a legislative committee meeting Aug. 26, the head of Kentucky's main nursing-home association said nursing homes are grateful for the federal dollars and testing programs the state has funneled to them during the pandemic, but it's not enough.

Betsy Johnson told legislators, "I believe
the toughest days are actually ahead of us."

"We still need help," Betsy Johnson, president of the Kentucky Association of Health Care Facilities, told the Interim Joint Committee on Health, Welfare and Family Services.

"We need a lot of help, mainly funding to retain our workforce, which has been decimated, funding to require additional PPE and to support ongoing covid testing," she said. PPE, personal protective equipment, includes masks, gloves and gowns.

Johnson also pointed to research that found quality ratings of facilities was not a factor in coronavirus outbreaks. The Centers for Medicare and Medicaid Services five-star quality rating system gives 69 of the state's nursing homes a two-star or below average rating and 61 of them a one-star or much below average rating. 

"The experts agree covid-19 cases in the community are top factors in whether there is a covid outbreak in a facility," she said. "Covid deaths in a long-term-care settings have nothing to do with the quality of that facility."

WKYT-TV image
The day before the hearing, the Georgetown News-Graphic reported that the death toll at Dover Manor, a long-term care facility in Georgetown, had reached four, and all the deaths had occurred within four days of each other. On Aug. 26, WKYT-TV reported the long-term care facility's fifth death. 

On Aug. 29, the state's daily long-term care report showed 26 residents and 12 employees at Dover Manor had active cases of the virus. Since March, 59 residents and 26 staff have tested positive.

“You don’t have this many positive cases in a facility without a breach in your infectious-disease protocols, so we're very concerned," Crystal Miller, public health director at the WEDCO District Health Department, told WKYT. She said some employees have quit and the department is educating the remaining employees about PPE and how to isolate residents who test positive.

Scott County's coronavirus case numbers started rising in late June and didn't come back down till mid-August, according to the WEDCO covid-19 report. The CMS five-star rating system gives Dover Manor one star. 

At the committee meeting, Johnson said a July survey of nursing homes showed that their labor and benefit costs had risen 8 percent since the pandemic hit in March; nearly 51% of homes had less staff; nearly 21% saw an increase in use of employment agencies; and such agencies had increased their costs between 10% and 75%.

Johnson reminded the lawmakers that her association has warned them for some time that there is a "workforce crisis" in long-term care, and "Covid-19 has only made this worse." 

She also pointed to the state's use of federal relief money to pay for its "strike teams," which help with staffing issues in nursing homes hit hard by the virus but put them in direct competition with the state for much-needed employees.

An advertisement in Madisonville showed the state is paying registered nurses $65 an hour, licensed practical nurses $50 an hour and nursing assistants $32.50 an hour, "significantly higher than the average nursing facility can pay," Johnson said, while still expressing thanks for the help the teams give.

Asked about the strike teams at the governor's daily press conference later that day, Cabinet for Health and Family Services Secretary Eric Friedlander said they have been used, but not recently. "That has obviously been a very controversial piece, " he said.

Johnson said an April survey of her association's members found 87% were in need of some form of personal protective equipment; 9% said they didn't have a week's supply of surgical masks; 10% didn't have a week's supply of N95 respirator masks; and 10% didn't have a week's supply of gowns.

The survey also found PPE costs had increased by 10% or more. Sen. Danny Carroll, a Paducah Republican who owns a non-profit agency that provides therapy and medical-based child care, said he had been told the cost of a case of gloves had increased from $49.70 to $108. 

Johnson added that nursing home are also squeezed financially by an 8% drop in their patient numbers, caused not only by deaths, but by a decrease in elective surgeries because these patients often rehabilitate in nursing homes. 

Association offers ideas, state explains why they won't work

Johnson said the best way to help nursing homes would be increasing the amount the state pays for residents covered by Medicaid by $12.55 per resident per day, instead of the additional $270 per day it is paying for positive covid-19 residents only.

“We were grateful for this funding, but we found it a little problematic,” Johnson said. “Not everybody in a facility is Medicaid eligible; a lot of them are Medicare or private pay. A lot of people went immediately out to the hospital, so it really wasn’t providing the necessary funding to arm ourselves in fighting off covid-19.”

She said the association has asked twice for the change, has been denied once and expects that the second request will also be denied, based on an Aug. 13 letter from Friedlander. 

She suggested that the payment boost could come from the 6.2% increase in Medicaid contribution that the federal government is paying states during the pandemic, since it "was intended to assist providers in fighting covid-19."

Secretary Eric Friedlander
However, Friedlander told Kentucky Health News in an interview that states got the increase to cover the cost of expanding their Medicaid populations during covid-19, not to pay providers.

Many people who have lost their jobs have become Medicaid beneficiaries, and Kentucky has led the nation in the percentage of people gaining Medicaid coverage during the pandemic, according to a July 24 report by the Kaiser Family Foundation. It found that Kentucky Medicaid, which now covers more than 1.5 million people, grew 7% from March to April.

Friedlander had another reason to oppose Johnson's request: "When you give a provider group a raise, you can't ever take it back. And then it becomes a matter of, 'Do you have the budget to support that, ongoing?' And I think we know, Kentucky's got a lot of budget challenges and so it's pretty clear that we wouldn't have that ongoing." 

In an email, Johnson offered an alternative, that the state use federal relief money to help nursing homes "acquire (and/or maintain) these important things to continue to fight covid-19," including "needed PPE, testing beyond what the state or the federal governments are willing to pay for, and to continue to pay 'heroes pay' to staff." 

That doesn't seem to be an immediate option. Some have criticized Gov. Andy Beshear for spending only about 6% of the state's relief money, but he has held firm that Kentucky and other states are stuck between "a rock and a hard place" not knowing whether Congress will provide more money to stabilize state budgets, or allow states to do that with money they already have. The way it is now, "it doesn't allow for an informed decision," Beshear said Aug. 19. 

Money from the Coronavirus Aid, Relief and Economic Security Act can be spent only on programs that directly respond to effects of the virus. In addition to the strike teams, the state has used it to finance testing and surveillance at long-term-care facilities. States are also waiting on the details around another $5 billion in federal funding that has been promised to skilled nursing facilities.

Friedlander said the state has also done other things to help nursing homes, like allowing them to hold beds longer for patients who leave temporarily, making Medicaid enrollment easier, and increasing their Medicaid payments. The inspector general's written presentation to the committee, which wasn't presented for lack of time, says this increase was 8.5%. 

Impasse in committee

Greensburg Republican David Givens, president pro tem of the Senate, said Johnson's request for state funding of PPE, testing and personnel "sounds like it is a very critical ask for them, and a very appropriate ask in use of CARES money," and asked Adam Mather, the cabinet's inspector general, to respond. 

Insp. Gen. Adam Mather
Mather said he could not speak about Medicaid, but said "large swaths" of federal money have been provided to nursing homes and that a "significant amount" of PPE has been distributed. Johnson's slides showed the federal government has provided $33.6 million to skilled nursing facilities in Kentucky, an average of $169,000 each.

Mather said the state used CARES Act money to test every long-term care facility resident and employee and is using it for testing through the end of the year. 

He said the state's universal testing was "one of the more robust programs in the country" and that its current testing is happening "at a much quicker swath and more appropriate swath than many other states." 

Givens asked, "So then why would she make the ask if the need has already been met?"

Mather said he didn't know, adding that he recognized that while there is always a need for more PPE, "I don't know what to say about the ongoing testing; it is there, and available." 

"We seem to be at an impasse," Givens said.

Sen. Ralph Alvarado
Sen. Ralph Alvarado, R-Winchester, said an unnamed Lexington nursing home didn't follow the local health department's covid-19 guidelines, but did what it had found to be successful in the past to control infectious diseases, and got a much better outcome than another Lexington facility that followed the health department's guidelines.

Alvarado would not share the names of the two nursing homes with Kentucky Health News, but said he was the medical director of one and had patients in the other.

Friedlander said in the interview that many factors influence covid-19 outcomes in a facility, such as employees carpooling or socializing in the break room without PPE. "Sometimes even the best intentions, if they're not implemented fully, don't always yield the perfect results or the optimal results," he said, adding later, "We know . . . we're making sub-optimal decisions sometimes, but it's the best decision we can make." 

Alvarado asked Johnson and Mather if the state requires a "one size fits all approach" for every facility. 

Johnson said, "It's not a one-size-fits-all kind of solution. So it would be nice to have more of a listen to what we need and you all provide support rather than dictating what should happen inside that building." 

Mather, a former nursing-home executive, told a different story. He said long-term-care facilities work with state and local health departments to make an action plan to address a case of covid-19, and with a team that fights infections associated with health care and includes Dr. Kevin Spicer of the federal Centers for Disease Control and Prevention. Mather noted his experience in the industry and that of Keith Knapp, coordinator of the state's nursing-home task force.

He said the Centers for Medicare and Medicaid Services recently commended Kentucky on what a good job it's done with long-term care facilities. "It's a very robust program," he said. "It's a best-in-class, through-all-the-states program," he said.

Most covid-19 deaths are in long-term care

During her presentation, Johnson displayed a map that showed Kentucky has one of the highest covid-19 death rates in long-term care. She was using mid-July data that showed such facilities accounted for 63% of the state's covid-19 deaths. By Aug. 29, that had declined to 58.6%.

Mather said Johnson's data was outdated, and now "We're doing much better than many states around us." The most recent CMS covid-19 nursing home data webpage, using data from the week ending Aug. 16, shows Kentucky with 107.3 cases per 1,000 residents and 23.8 deaths per 1,000 residents, ranking 21st for both measures. Friedlander said the state has been ranked about 20th for several weeks.

Beshear, asked about the topic on the day of the meeting, said "I believe the amount of assistance, the amount of expertise, the amount of resources we provided to our long-term care facilities here in Kentucky battling covid rivals if not exceeds what any other state has done, and they continue to work on that."

At least 3,415 residents and 2,029 employees at 303 nursing homes have tested positive for the coronavirus, and 535 residents and five employees have died from it.

A seat at the table

Johnson said several times that the association should have been included in state decision-making about long-term care in the early days of the coronavirus, adding that she would like a dementia expert and a long-term-care expert on staff at the state health department. "There's been a serious lack of understanding of how skilled nursing facilities operate during the covid-19 pandemic," she said. 

Friedlander said in the interview that he intentionally did not include a lobbyist on the long-term-care task force, but his cabinet has been in regular communication with Johnson's association and Leadingage Kentucky, a lobby for nursing homes and assisted-living centers. 

Friedlander said the task force includes medical personnel, a member from the association that includes medical directors for long-term care, a provider, an owner, an operator, a person from the University of Kentucky and cabinet personnel.

"We think we have a really strong representations of folks who know, one, how to operate; and then, two, on the medical side," he said. "This is a medical group, it isn't a political group. So those are the representatives that we have. So we don't have any associations on there." 

Johnson replied in an e-mail, "We want to have a true collaboration – where they ask what we need, and work with us to achieve a compromise on the “asks.”

She concluded her at times emotional presentation at the meeting by saying, "I believe the toughest days are actually ahead of us."

Saturday, August 29, 2020

State records 825 new cases, 4th highest of pandemic; positive-test rate still below 5%; health chief warns about Derby Week

Kentucky Health News chart, based on initial reports of daily case numbers, not later adjustments.

By Al Cross

Kentucky Health News

The spread of the coronavirus continued to accelerate slowly in Kentucky Saturday, with 825 new cases, the fourth largest daily number of the pandemic, and creating its third highest seven-day total. The number of cases has increased every day since Monday, a day when numbers are usually low.

The seven-day rolling average of new cases is 659. It has increased nine days of the last 10, and the only decrease was 1.

“Thankfully, our positivity rate is still below five at 4.59%,” Gov. Andy Beshear said in a press release, referring to the share of Kentuckians testing positive for the virus in the last seven days. For all but one day of the last week, it has been below 5%, a key threshold in suppressing the virus.

Beshear said, “Please do your part, live for your fellow human being, and understand that we are all connected and that your decisions truly matter.”

The release reported 145 new cases in among Kentuckians 18 and younger, 15 of them age 5 or younger, including two eight months old.

Lincoln County (Wikipedia map)
Three more deaths were reported, all from Lincoln County: an 86-year-old woman and men 81 and 94. “That’s one county grieving three losses of its own,” Beshear said. “That’s three more families who are suffering during this time.”

Health Commissioner Steven Stack looked ahead to an unusual Kentucky Derby Week. “Now is the time to consider how you will celebrate Oaks, Derby and Labor Day in a way that allows you to share time with others while respecting the required masking and social distancing protocols,” he said.

“As you may recall, as the number of new cases was leveling off months ago, Memorial Day and the Fourth of July resulted in celebrations and mingling. A noticeable spike in the number of positive covid-19 cases followed. Then, the mask mandate went into effect and Kentuckians took extra care in social distancing and avoiding visits to other states known as ‘hot spots.’ This successfully plateaued our new weekly cases.”

Stack, a physician, warned, “If the running of the Oaks, the Kentucky Derby and Labor Day activities reflect other summer holidays, though, cases will spike again and Kentucky will have a setback to the progress we have made by working together. Please, let’s show we can learn from the other holidays. Let’s not slip and lose progress against our fight against the coronavirus.”

Eighty of the state's 120 counties had a new case Saturday. Counties reporting more than five were Jefferson, 263; Warren, 65; Fayette, 49; Todd, 29; Madison, 26; Boone, 14; Hardin, 14; Pike, 14; McCracken, 13; Lewis, 12; Pulaski, 12; Jessamine, 11; Bath, Daviess, Kenton and Monroe, 9 each; Bell, Boyd, Campbell, Hopkins, Logan and Montgomery, 8 each; Christian, Harlan, Jackson, Laurel and Oldham, 7 each; Barren, Green, Hart, Nelson, Rowan and Shelby, 6 each.

In other covid-19 news Saturday:

  • Hospitalizations for covid-19 in Kentucky remained steady, at 570, with 149 of the patients in intensive care, the state's daily report said.
  • The state's highest court now has all the written arguments in a case challenging the constitutionality of Beshear's emergency orders, reports the Lexington Herald-Leader. The court will hear oral arguments Sept, 17 "and then will decide what is certain to be a historic case," Jack Brammer writes. "It is not known how long it will take the Supreme Court to make a decision. At stake are dozens of emergency orders ranging from a requirement for most Kentuckians to wear a mask in public to class size in child care centers." The Courier Journal highlights the opposing arguments of Beshear and Attorney General Daniel Cameron.
  • Two Louisville bars have filed suit challenging Beshear's limits on bars, asking that they be awarded "just compensation" if the orders are judged constitutional.
  • Lexington Christian Academy told WTVQ that it started in-person classes Aug. 19, against Beshear's recommendation, because "a very deliberate communication plan" made sure students knew what was expected of them and in-person classes are better for their mental health.
  • "Experts across the U.S. say the country can mount a comeback if it embraces reality and taps into its ingenuity," National Geographic headlines a story by Craig Welch, who writes, "First, we must knuckle down and accomplish the obvious: Continue social distancing and strive for universal mask use. Close high-risk spaces, such as churches, bars, and casinos. Spend time outdoors. Limit crowds. Wash our hands. Build up contact tracing. . . . But given national failures thus far, many experts are also pushing for a new way forward based on innovation—specifically, cheaper, faster tests that millions could take at home every day. We’re still just beginning that process."

Friday, August 28, 2020

State's positive-test rate stays below 5% for the fourth day this week, while daily new-case numbers remain on a slow uptick

Kentucky School Boards Association map shows compliance with governor's request. Butler County should be in orange, and in some blue districts, school boards have authorized superintendents to start in-person classes before Sept. 28. For a larger version, click on it.
By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear announced Friday that Kentucky has 792 new coronavirus cases, continuing this week's slow uptick in daily case numbers, but a lower positive test rate of 4.5 percent. 

“We still have a whole lot of cases in Kentucky which means a number of people get sick and we lose a number of people, too,” Beshear said in a news release. “The good news is our positivity rate continues to decline. If we keep wearing these masks and we keep doing the work, we can get this to a manageable level to get our kids back in school and get back to more of our old lives.”

This is the fourth day this week the share of Kentuckians testing positive for the virus in the last seven days has been under 5%. Going over 5% puts counties and states in the White House Coronavirus Task Force "yellow zone."

The rolling seven-day average for daily new cases is 658, the fourth highest total of the pandemic. Unadjusted case totals for the Saturday-to-Friday week, which are used by the White House task force, were 4,605, well above the 1 per 1,000 residents that puts states in the task force's "red zone" for cases. 

People 18 and younger accounted for 114 of the new cases; 27 of those were 5 or younger. The youngest was a 1-month-old from Green County. 

Beshear started regularly announcing children's case numbers after getting resistance to his limits on child-care-center capacity, and his recommendation that schools delay in-person classes until Sept. 28 to help get the virus under control. He is expected to announce new child-care rules Monday. 

The state's daily K-12 school report shows 14 more students and nine more employees have tested positive, with active cases in 99 students and 40 staff.  

The universities and colleges report shows 175 new student and five new staff have tested positive for the virus; active cases involve 481 students and 15 employees. The University of Kentucky had the highest number of new cases, 118, followed by Union College at Barbourville with 26. 

Beshear reported eight more covid-19 deaths Friday, raising the state's total to 918. They were of an 85-year-old woman and an 86-year-old man from Christian County; a 69-year-old woman from Barren County; a 94-year-old woman from Carroll County; a 78-year-old woman from Scott County; a 58-year-old woman from Taylor County; a 73-year-old man from Union County; and a 92-year-old man from Warren County. 

“Again, it’s been a hard month. It’s going to probably be an even harder September,” said Beshear.  “Make sure that you’re praying for these families.”

Beshear reminded Kentuckians on Monday that with a 2% death rate from the virus, weeks with more than 4,000 cases, as the state has now seen for three weeks running, will result in the loss of 80 people  to the virus, most of them weeks after the cases are reported. 

Counties with more than 10 new cases Friday were Jefferson, 193; Fayette, 91; Madison, 56; Warren, 34; Christian and Rowan, 28 each; Daviess, 18; Kenton and Pulaski, 17 each; Green, 15; Hardin, 13; and Bullitt, 12. 

In other covid-19 news Friday:

  • The state's daily report said 572 people are hospitalized in Kentucky with covid-19 and 158 are in intensive care.
  • Lexington, which follows a different reporting schedule than the state, reported 100-plus cases of the virus on the second straight day for the second time, reports the Lexington Herald-Leader.  
  • Tina Ryan, school nurse at East Calloway Elementary, part of Calloway County Schools, one of the 30 or so Kentucky districts that have opened to in-person learning, voiced mixed feelings to Liam Niemeyer of Ohio Valley Resource. Not only are children are asymptomatic carriers of the virus, "She worries about parents and families not following covid-19 guidelines and then sending their kids to her school," Niemeyer reports. "She worries about her students with chronic illnesses who could be more vulnerable, across the hundreds of students she cares for in multiple schools." But despite those worries, Ryan said "I just feel like that kids, physically, mentally, socially, they need to be back in school. It’s time to be back. They want to be back. And again, if they don’t, if the parents choose not to, that’s their option.”
  • The Kentucky Board of Education discussed high-school sports for almost three and a half hours, then voted unanimously to send the Kentucky High School Athletic Association a letter expressing concern about high-contact sports such as football and suggesting alternatives to the KHSAA's plan.
  • WDRB graph for July 9, July 29, Aug. 27;
    for a larger version, click on it.
    The state has made little progress eliminating its backlog of unemployment claims, despite "an expensive, no-bid contract" with a national accounting firm that provided employees to do the work, Chris Otts reports for WDRB: "Kentucky has about the same amount of backlogged unemployment claims today – 73,642 – as in early July when Ernst & Young was beginning its short-term contract work."
  • The Supreme Court of Kentucky gave tenants and landlords an extra 14 days between an initial eviction filing and when a trial can be set, saying that would give "landlords and tenants sufficient time to access available rental assistance through the Healthy at Home Eviction Prevention Fund," which Beshear is creating with federal relief money.
  • "The head of the Food and Drug Administration ousted its top spokeswoman from her position on Friday in an urgent bid to restore the tarnished credibility of the agency after he made erroneous claims that overstated the benefits of plasma treatments for covid-19 at a news conference with President Trump," The New York Times reports. "The decision came just a day after the FDA’s parent agency, the Department of Health and Human Services, terminated the contract of a public-relations consultant who had advised the FDA commissioner, Dr. Stephen M. Hahn, to correct his misleading claims that 35 out of 100 covid-19 patients 'would have been saved because of the administration of plasma'." debunks the claim, also made by Trump.

Virus has spread too much for contact tracing to contain it, but tracing can still help, especially if more people would cooperate

By Lisa Gillespie

Kentucky Health News

In wide swaths of Kentucky, tracing the contacts of people with the coronavirus is no longer preventing its spread, because the spread has become too wide. Instead, it is, at best, slowing the disease rate. And many people don't cooperate with the contact-tracing process.

That’s according to several local health department officials, including Roanya Rice. She’s the public health director at the North Central District Health Department, which includes Spencer County, where over 10% of residents have tested positive for the virus, as of last week.

“It’s not a situation now that we can contact-trace our way out of,” Rice said. “The window of opportunity to contact-trace to eliminate the spread has come and gone.”

Some people don't welcome contact tracing, which usually includes an official request that they isolate for 10 days in case they have the virus. Gov. Andy Beshear said this week that there has been a decline in cooperation by people who have been identified as a recent contact or have tested positive..

Lincoln Trail District Health Department Director Sara Jo Best said she and her staff get the feeling that some people who have tested positive don’t want to provide a list of their recent contacts.

“I feel like there are cases that are not being 100 percent truthful in their contacts,” said Best, who is based in Elizabethtown. “I think they're intentionally leaving some of those off, because people don't want to be quarantined.”

Beshear said some people reached by contact tracers are unresponsive or don’t self-isolate as requested.

"They could lead to another spike,” he said. “This is a war. Whether we win or lose, how many Kentuckians we lose, it's all based on the number of battles that we win, or lose. So please, don't get tired. Let's pick it up. ... Lives depend on it."

Local health officials say most people cooperate when a contact tracer reaches out. They say they have only rough and unscientific estimates on the percentage of people who are not cooperative, because the state only recently provided a uniform platform for health departments to track cases. Department directors, when pressed, estimated noncompliance between 2% and 40%. 

Barren River District Health Department Director Matt Hunt said the people who are not cooperative in his eight-county region are mainly those without symptoms. His district includes Barren County, where more than 10% of residents tested positive for the virus Aug. 15-21, the most recent week of the White House Coronavirus Task Force report.

“We do have some that deny the test results, [say] that it can't be, [they] don't have symptoms,” Hunt said. “Those are typically asymptomatic individuals. Those are difficult conversations to have.”

Others have used a “critical worker exemption” to refuse quarantine after a high-risk exposure. State Health Commissioner Steven Stack announced Wednesday, Aug. 26, that he had eliminated the exemption for workers in food, health care, energy and other critical industries, saying it had become “fairly distorted . . . Health departments are finding all sorts of people are claiming they’re critical infrastructure workers.”

Meanwhile, health department directors across the state say the virus has spread so much within communities that contact tracing is not containing the spread of the virus. Lexington-Fayette County Health Commissioner Kraig Humbaugh said that’s partly because of how the virus works; the key time to get folks to quarantine is when they start to show symptoms. But many never have symptoms.

“Normally [the contacts] are infectious a couple of days before they even start to show symptoms, if they show symptoms, and then 25 percent of them don't,” Humbaugh said. “So you've got all those people that are also potentially infecting others in the community. It just kind of builds on itself. It is so much easier for this strategy to work when we're in the containment phase.”

Department for Public Health graphic; for a larger version, click on it.
Kentucky has funds to hire 700 contact tracers and has hired 550, with at least one in every county. That leaves room for 150 spots. Mark Carter, the state official leading contact-tracing efforts, estimates those new hires will be made by or around mid-October, depending on the spread of the virus.

“The Department for Public Health assessment of tracing state-wide is that we have sufficient tracers,” Carter said. “The primary issues have been in masking and social distancing; that places a burden on tracing. So, I think it would be fair to say tracing is helpful, but by itself it cannot stop the spread. I do agree that certain districts are in a mitigation phase,” not a containment phase.

With many Kentuckians ignoring the mask mandate and social-distancing guidance, which is difficult to enforce, health officials say contact tracing is the actionable thing health departments can do to fight the virus without a vaccine.

But the funding for tracers runs only through December, and it’s unclear whether Congress will provide more. Hunt, with the Barren River health department in Bowling Green, is hoping the money doesn’t run out before he needs the help the most.

“I want to try to stay two to three steps ahead,” Hunt said. “If I see a spike, like instead of having 25 or 30 to investigate a day, it jumps up to 75, then I’ll start to think about, okay, we need to bring more people in.”

Contact tracing does play a role in fighting the virus, even if it’s not containing spread. Public Health Director Clayton Horton of the Green River District Health Department in Owensboro said at the very least, tracers provide important education about the virus. And it can be critical for Kentuckians who were already living in relative isolation.

“We have people that are in isolation that don't have friends and family that can help support them,” Horton said. “We have people that have real needs in terms of food and medicine, and we're able to help with that, and if we weren't there, they certainly would break their isolation and put others at risk of becoming infected.”

Another issue that may add to noncompliance is the changing guidance from the federal Centers for Disease Control and Prevention about who should be tested. Horton said one recent change, already walked back, has already created confusion and resistance to the department’s guidance.

“We had contacted them to say, you've had contact with someone that was infected,” and advised them to quarantine, Horton said. “And they said, ‘Well, I just saw on the CDC website this morning that I don’t need to do these things,’ and it was just kind of a misinterpretation.”

CDC now says people who have been exposed but have no symptoms "may consider testing." Kentucky officials are still recommending that such people get tested, because people without symptoms can still spread the disease.

Non-existent numbers

By the start of September, the majority of state health departments should be using new technology to track covid-19 data, called the Contact Tracing and Tracking system. Data on the virus now, other than the raw numbers of who has tested positive, are almost nonexistent.

“As of next Monday (8/31), all but one local health department will be CTT; at that point we will be in a much better position to be able to report this data,” Carter said. I would say that by the end of September or mid-October, we will have some usable data from the system.”

At the start of the pandemic and even now, many departments were using paper charts to log cases; others were using internal systems.

Most health department directors said they’ve just been trying to keep on top of new cases and contacts. There hasn’t been time for analysis.

That's a real disadvantage, said Best, with the Lincoln Trail district. She wants to know the number of contacts who test positive for the virus. She wants to know the percent of people who never respond to their calls, and those who initially are cooperative but then no longer answer calls or emails. She wants to know not just her district's own numbers, but also the state-wide average.

“If I know that of one thousand contacts, 20 percent of those are probably going to convert to a positive, that helps me plan,” Best said. “Or if the state's average is 20 percent, and my average is 40 percent, maybe I need to re-look at how we're educating people on isolation and quarantine. I might need to evaluate what I'm doing because it's not it's not effective. It gives you kind of benchmarks like that when you're looking at data.”

And this information might just make contact tracing a stronger tool.

McConnell announces grants of $125,000 each to 14 counties by federal Drug-Free Communities program

Federal grants of $125,000 each are going to 14 Kentucky counties, school boards and other organizations to help them educate and raise awareness about the dangers of substance abuse in their communities, U.S. Sen. Mitch McConnell announced Friday. The grants are part of the $1.75 million coming to Kentucky through the Drug-Free Communities program.

The grant recipients are: Trimble County Board of Education, Pendleton County Board of Education, Grant County Schools, WestCare Kentucky Inc., Bullitt County Board of Education, Save Our Kids Coalition of Bowling Green, Scottsville-Allen County Faith Coalition, Gallatin County Board of Education, Lyon County School District, Hope’s Hands (Owenton), Webster County Board of Education, Scott Countians Against Drugs, Madison County Health Department and Wolfe County Fiscal Court. 

Thursday, August 27, 2020

Amid flurry over high-school football, state records fourth highest seven-day rolling average of daily new coronavirus cases

Kentucky Health News chart; daily numbers may be adjusted slightly after initial report
By Mary Meehan
Kentucky Health News

One day after a covid-related announcement by the Centers for Disease Control and Prevention caused outrage among public-health officials, Kentucky had a covid-19 report that spawned rumors and flared the tempers of high-school sports fans. Meanwhile, coronavirus cases rose.

Wednesday, the CDC changed its guidance to drop advice that anyone who’s had close contact with someone who has the virus should get tested, regardless of whether they have symptoms. Gov. Andy Beshear called it reckless, and said Thursday, “The CDC looks like [it will] walk back some of the guidance changes they made just the other day, meaning everybody needs to be tested, and tested regularly.”

Thursday’s hot topic was the fate of high-school sports, mainly football. Picking up on a tweet by a Paducah TV reporter, the Lexington Herald-Leader reported at 8:05 a.m. that the Kentucky Board of Education will meet at noon Friday to discuss the Kentucky High School Athletic Association’s decision to proceed with fall sports, including football.

When the KHSAA proceeded as scheduled a week ago, it noted that the plan was subject to approval or disapproval by the board and the governor. When Beshear said Monday that he would not block the plan, despite his misgivings, many if not most coaches presumed the debate was over. They gave grumpy interviews to TV stations Thursday morning, and their teams’ fans voiced outrage.

“After a social media campaign Thursday morning encouraged people to email and call KDE offices and KBE board members,” KDE spokeswoman Toni Konz Tatman clarified that canceling the KHSAA’s decision is “not on Friday’s agenda and that their offices had been receiving threats,” the Herald-Leader reported in an update.

At noon, interim Education Commissioner Kevin C. Brown told WKYT-TV’s Dave Baker that cancellation of the football season was not being considered, but the board might authorize him to send KHSAA a letter suggesting “additional consideration or alternative option for high-contact fall sports.”

By mid-afternoon, Brown had issued a formal statement saying the board “will not be considering canceling sports seasons” and would hear from KHSAA Commissioner Julian Tackett about fall sports, and from Health Commissioner Steven Stack and superintendents. (The meeting will be broadcast live on KDE’s YouTube channel.)

When the topic arose at his 4 p.m. briefing, Beshear said, “First, everybody take a breath.” He said the issues with high-contact sports weren’t sufficiently addressed the most recent KHSAA Board of Control meeting, and said Stack would be there to answer questions. He said he had nothing to do with the meeting.

Beshear and Stack have voiced concerns about high-contact sports and stressed the potential dangers to athletes, including a serious heart condition that is showing up in covid-19 patients. The governor said superintendents, parents, and coaches need more information about the potential spread of the disease and precautions necessary to keep student athletes safe.

Daily numbers: Beshear said the percentage of Kentuckians testing positive for the virus in the last seven days is 4.8%. It is the third time this week the figure has dipped below the 5% level that puts states in the White House Coronavirus Task Force "yellow zone."

But that bit of good news was offset by other numbers. Beshear announced 775 cases, the ninth largest daily total during the pandemic. The rolling daily average was 657, the fourth highest total. The total number of cases in the last seven days, 4,598, remained above the 1 per 1,000 residents that puts states in the task force's "red zone."

People 18 or younger accounted for 130 of the cases, or 23%. Eleven were in Warren County, which Beshear has singled out repeatedly, bringing its total to 36.

“For those that think by reading this stuff, I'm picking on them, I'm not,” he said. “I want those kids to be safe.” Warren County and Bowling Green schools opened last week despite Beshear’s recommendation that all schools delay in-person instruction until Sept. 28.

According to state data, as of Wednesday there were active cases in 85 students and 31 school staff, in 48 districts and 96 schools.

Counties with more than 10 new cases were Jefferson, 157; Christian, 67; Warren, 58; Fayette, 46; Knox, 25; Madison, 22; Scott, 19; Green, 16; Hardin, 16 Laurel, 16; Bell, Kenton, and Pulaski, 14; Oldham and Rowan,11; Bullitt,  Daviess, Lewis and Russell, 10.

Beshear noted that many smaller counties are now in the double digits. “You can have a small number of cases and it balloons really fast because that's how this virus works,” he said.

Kentucky has 573 covid-19 hospital cases, 154 of them in intensive care and 88 of those on ventilators. There are 607 active cases among residents in long-term care and 351 active cases among employees. Two more residents have died, Beshear said.

Beshear announced eight more covid-19 deaths, bringing the state’s toll to 910. The fatalities were an 84-year-old man from Allen County; an 84-year-old man from Barren County; an 80-year-old woman from Green County; a 70-year-old man from Hardin County; a 90-year-old man from Lewis County; a 74-year-old man from Madison County; an 89-year-old woman from McCracken County; and a 75-year-old man from Warren County.

Thursday’s briefing was the last scheduled this week, and Beshear clearly welcomed that.

“For me, this week has been hard,” the governor said at the end of the briefing. “I'm tired just like everybody else is out there. I get frustrated, just like everybody else does out there. And there are times that I get mad. I have trouble not bringing all of this home, which isn't fair to my family.”

He said he understands that Kentuckians want to go out and celebrate “the usual milestones” like the beginning of summer or a new school year, but when people don’t wear masks or get together in large groups “we see the virus take off.”

He urged people to consider not only the health of their family and friends but of others. “We’re all living for each other right now.”

Adkins update: Beshear’s senior adviser, Rocky Adkins, came to the lectern to announce that his father, Jess Adkins, is home “after nearly two weeks in the hospital, and one week at Cardinal Hill,” a rehabilitation center in Lexington. He had spoken about his father's case on Aug. 18.

Jess Adkins, 84, was a long-time teacher and coach in Elliott County. His son said that if his dad could give the state a locker-room pep talk, he’d say, “We're in this together. This is a team effort. While we may get frustrated at times and disagree at times, it's still an effort that we've got to come together as team Kentucky.”

In other covid-19 news Thursday:

  • A new report shows that British schools reopened with little coronavirus spread, Paige Winfield Cunningham reports for The Washington Post. The report, using data from a "mini" summer term in June, found infection rates of .02% among staff and .008% among students. “The re-opening of schools was associated with very few covid-19 outbreaks after easing of national lockdown in England,” wrote experts from Public Health England, the London School of Hygiene and Tropical Medicine, and St. George’s University of London. However, the country had largely gotten its outbreak under control by June and was enforcing social distancing and mask-wearing. “I think we’re increasingly getting a sense of when schools are opening, where prevalence is relatively under control, we’re not seeing a lot of cases,”  Emily Oster, a professor of economics at Brown University, who analyzed the report, told the Post. 
  • After Beshear expressed concern over the cases at the University of Kentucky, UK spokesperson Jay Blanton said Thursday, “We will continue – as we have throughout this process – to work closely with the governor’s office and the Department for Public Health to provide information they request about what we are doing to ensure the health, safety and well-being of our campus community.”
  • The FDA is authorizing emergency use of a $5 rapid test that could help ease the nation’s coronavirus testing bottleneck, Politico’s David Lim reports: “The test’s manufacturer, Abbott Laboratories, plans to ramp up production to 50 million of the antigen tests per month, allowing patients to get their results in 15 minutes without the use of any lab equipment. The authorization could help expand testing in key areas. The test must still be administered by a health provider but can be done in point-of-care settings like doctor's offices. That could help boost testing access in underserved areas and in schools and workplaces. Results appear highly accurate. Abbott-submitted data show the test accurately detects 97.1 percent of positive samples and 98.5 percent of negative samples.”