Health chief goes another round with legislators, pushing back on data questions and answering queries on schools, other topics

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – Republican legislators kept up their questioning of the state's coronavirus data Thursday, and the state health commissioner and Democratic lawmakers pushed back.

Sen. Danny Carroll

Sen. Danny Carroll of Paducah, co-chair of the Program Review and Investigations Committee, was the leading questioner and most outspoken legislator, just as he was at the panel's Aug. 13 meeting, when the committee heard from Dr. Steven Stack, commissioner of the Department for Public Health, and Doug Thoroughman, the state's acting chief epidemiologist.

Carroll kept relying Thursday on Thoroughman's tacit acknowledgement, in response to a Carroll question last month, that the positive-test rate that the state reports daily is not accurate, because of imperfect state and federal reporting systems. Thoroughman also said that the rate is useful for comparison over time because its method of calculation remains the same.

Thursday, Carroll noted that some test results have been delayed for weeks, and asked, "How can we have faith in daily numbers?" He said Democratic Gov. Andy Beshear never includes a disclaimer when giving the figure.

Dr. Steven Stack

Stack replied that while the data is "imperfect," it is "incredibly valuable. He noted that the state's daily report has an asterisk leading to a long footnote explaining how the rate is calculated.

He noted that the rate is an average over the previous seven days, and “I believe it becomes a very useful and accurate measure” for seeing trends. He said his department has undertaken "an unprecedented process" to get enough data for rates for about 80 counties.

Carroll replied, "The public sees the governor on TV talking about cases and positive rate" that changes from day to day . . . There is a stress that is put on our people as a result of these numbers." He quoted Thoroughman as saying that the numbers are not accurate, and said. "From an ethical standpoint, I struggle with the comfort level of putting this information out on a daily basis."

Stack replied, "I’m sorry you have such low confidence . . . " and Carroll interjected, "It’s not me. I hear it from my constituents daily. They’re mad about this."

Stack said he hears from others who are grateful for the information, and "It's possible for people to reach different conclusions from same information."

He added, "I don’t feel my ethics are compromised or challenged. . . . The metrics we use and the way we create them are consistent with the state of the art as best as public-health professionals can do it." He said President Trump uses weekly data on positive tests, and told Carroll, "Your concern might be that the president of the United States is misleading the public."

At another point, Carroll noted that the committee had also asked to hear again from Thoroughman, and asked why he wasn't present. Stack replied, "I’ve got him doing a lot of other work and I’m the commissioner," the person ultimately responsible for answering questions about the department.

Carroll said that was "disappointing . . . were it not for Dr. Thoroughman, I’m not sure we would know now that our positivity rates were off."

Toward the end of the meeting, after he and Stack went back and forth about a medical waiver to exempt a special-needs student from the mask mandate, Carroll boiled over.

He said of the state's reporting, "It’s being used to manipulate our people, to make our people scared, to control our people. It’s not accurate and its portrayed as being accurate."

Essentially repeating what he said at the last meeting, Carroll said, "Half of this state does not believe a word that you all say when it comes to the data." He said "All of this could have been avoided had the administration reached out" to leaders of the legislature's Republican majority about pandemic matters.

Sen. Karen Berg, M.D.

Earlier, Democratic Sen. Karen Berg of Louisville, a physician, complimented state health officials' work and said, “They need us to understand it and trust it” so legislators can tell constituents “We have got our best minds working on it . . . It will never be perfect. . . . My constituents have different reactions from Senator Carroll’s. . . . Our responsibility is to get on board and let’s do the best we can.”

Apparently addressing her colleagues, Berg said health-care providers are scared of the virus, and “You all need to understand . . . this is not the flu, this is not a hoax, this has nothing to do with politics or how you want it to be.”

Rep. Adam Koenig

A moderate voice: Rep. Adam Koenig, R-Erlanger, said health-care providers “deserve more thanks than they’re getting,” but “There’s nothing wrong with asking difficult questions.” He told Stack, “It’s been a wonderful opportunity for you to dispel misinformation. . . . No one up here thinks this is a hoax; this is not a political witch hunt; these are questions we get; there’s a lot of frustration.”

Earlier, Carroll had asked Stack, "Why do we not react the same way to these other diseases that we do to covid-19?"

Stack replied, "It's much more dangerous, everybody’s susceptible, and the sheer numbers . . . It's killing a lot more people," and there is no treatment that works on most patients. "There’s over 190,000 Americans who have died in six months. That way outstrips influenza." 

He said that the ultimate mortality rate for covid-19 will probably be about 1 percent, and if only one-third of Kentuckians got infected in a year's time, and 1% died, "That’s 15,000 Kentuckians. . . . That’s why it’s getting so much attention."

Death data: Rep. Lynn Bechler, R-Marion, the other co-chair, asked Stack about the recent notice from the Centers for Disease Control and Prevention that only 6 percent of covid-19 fatalities had no other health conditions that could have contributed to their deaths.

"I didn’t think it was newsworthy, quite frankly," Stack said, "because what we have said all along is that the most vulnerable population is people over 60 or 65 and with chronic medical conditions."

Bechler asked if it was "reasonable to suspect that 94 percent of deaths in Kentucky have underlying conditions." Stack said, "It could be even higher," since Kentucky ranks very high in chronic medical conditions.

Sen. Steve West, R-Paris, told Stack that "a lot of Kentuckians are wondering" about the death rate.

Stack replied, "The question is, how do we assign the immediate cause of death?" He said it's possible that people who have died of covid-19 "would have died in six months anyway" from another condition, but the state "follows the long-established norms we use for any other disease case."

In one of his written responses to questions asked at the last meeting, Stack said, "For death certificates for which the cause of death is not clear as to the contribution of covid-19, or appears to incorrectly include or exclude covid-19 as contributory to the cause of death, the committee reviews patient medical records, discusses the information available, and reaches consensus opinion on whether covid-19 is appropriate for inclusion or exclusion." 

He said the committee had reviewed 41 deaths through Sept. 8 and found that 17 had been removed from the covid-19 list. Through that date, the state had reported just under 1,000 covid-19 deaths.

Sen. Whitney Westerfield

In another written response, to a question posed by Sen. Whitney Westerfield, R-Hopkinsville, Stack said the positive-test rate "is more challenging to make precise due to variable timing of sample collection vs. test-result reporting and due to longstanding limitations in test-reporting policies, processes, and technologies. However, when these limiting variables stay constant, and data are averaged over a period of time, this metric is very helpful for trending purposes."

Asked how long health officials keep contact-tracing data, and whether it is being used for any purpose other than to trace contacts, Stack said, "Basic information is gathered; name, address, phone number, e-mail, etc. Local health departments and Department for Public Health epidemiologists, disease investigators and limited supervisory personnel have access to this. This data is not used for any other purpose other than to trace contacts. Privacy and data security standards are well established and maintained."

Schools: Westerfield asked Stack if he had "any information indicating a return to in-person schooling" before Sept. 28, the date Beshear has recommended.

Stack said they are sticking to that date, and wanted the extra time to learn from the experience of other states. He said he and Beshear are "working on number of things to announce Monday." They have indicated that will include county-level data to guide local decisions.

He said fans are being allowed in stadiums, with strict limits, because "the public demands to be in those stadiums. . ..  Going into a stadium in the middle of an epidemic is not a good idea." He said one stadium wanted 18,000 fans, "which means 600 infected people, shouting and screaming," and people in VIP suites. He estimated that could result in nine to 20 hospitalizations per game, and two deaths.

“We certainly can’t live in fear and not get back to some activities, but we can’t be reckless and careless about it, Stack said. “You could just turbocharge an epidemic,” especially in a major city like Louisville.

In a written question from the last meeting, Westerfield asked if "school data related to abuse/dependency/neglect referrals, substance use [and] behavioral health referrals [is] weighed against covid data when making the recommendations and orders related to schools."

Stack replied in writing, "These are all public-health issues. Social-emotional status of students, food insecurity, drug overdoses, child abuse, etc. all weigh on the minds of public health. Balancing these issues with the effects of a deadly virus that spreads so rapidly presents challenges. However, death or long-term health impacts on individuals from this virus cannot be reversed. Currently, these unintended consequences of managing covid-19 are not contemporaneously measureable as [are] individuals diagnosed with covid and any associated deaths. Data is being collected on abuse/neglect as well as for overdose deaths and other behavioral health impacts. The use of medication-assisted therapy, telehealth and other tele-visitation put in place since the very early stages of covid-19’s entrance into Kentucky has been very helpful. The assessment of the full consequences of covid-19 and impact of the measures taken to minimize the impact on individuals and the economy will be measured and studied for years to come."

A video of the committee meeting is on the KET website.