Friday, October 22, 2021

Daily vaccinations and new coronavirus cases in Ky. are falling at about the same rate, but jabs outnumber cases by almost 7 to 1

Chart by The Washington Post; for a larger version, click on it.

By Al Cross
Kentucky Health News

As booster shots of all coronavirus vaccines approved in the U.S. become generally available, the daily rate of vaccinations in Kentucky is declining. But the number of daily new cases of the virus in the state is also declining, at a slightly faster pace, and new vaccinations far outnumber new cases.

The state reported 1,626 new cases Friday, lowering the seven-day rolling average by 55, to 1,480. That is 24 percent less than the average for the previous seven-day period. 

Vaccinations for the virus averaged 10,262 per day over the last seven days, a 22 percent decline from the previous seven days.

The ratio of vaccinations to new cases is 6.9 to 1, slightly lower than it was two weeks ago. At the start of September, just before the summer surge in new cases peaked in Kentucky, the ratio was 3.4 to 1.

Other measures of the pandemic in the state continued to decline Friday. The share of Kentuckians testing positive for the virus in the last seven days fell by more than a quarter of a percentage point, to 6.25%.

Dept. for Public Health map, adapted by Ky. Health News; click to enlarge.
The state's seven-day infection rate fell to 25.52 daily new cases per 100,000 residents, nearly taking the state as a whole out of the high-transmission zone, shown in red on the state's map of new-case rates. Counties with rates more than double the state rate were Owsley, 87.4; Cumberland, 86.4; Powell, 62.4; Jackson, 62.2; and Floyd, 51.4.

The state's infection rate as calculated by The New York Times is 17th in the nation and has declined 38% in the last two weeks, the ninth steepest decrease among the states during that period.

Kentucky hospitals reported 1,012 Covid-19 patients Friday, 28% fewer than two weeks ago; 289 in intensive care, down 34%; and 187 on mechanical ventilation, down 40%.

Those declines have slightly reduced stress on hospitals' intensive-care units, but numbers remain high. The state's daily report showed seven of the 10 regions with more than 80% of ICU beds in use. Northern Kentucky rose to 100%, with 34% of ICU beds filled by Covid-19 patients; Barren River was second at 96%. Overall, 87.5% of ICU beds and 70% of all beds are occupied.

The state reported 29 more Covid-19 deaths Friday, raising the pandemic's toll to 9,559. Over the last seven days, the state has reported 38 deaths per day; in the last 14 days the average is 36.

In other pandemic news Friday:
  • Children-sized doses of Pfizer's vaccine appear safe and nearly 91% effective at preventing symptomatic infections in 5- to 11-year-olds, according to study details released Friday as the federal officials consider opening vaccinations to that age group.
  • The Centers for Disease Control and Prevention released a study saying "There is no increased risk for mortality among Covid-19 vaccine recipients" and "Vaccine recipients had lower rates of non–Covid-19 mortality than did unvaccinated persons."
  • The University of Kentucky reported that 89 percent of its community was either partially or fully vaccinated. The breakdown: students, 86%, staff, 92%; health care, 92%; and faculty, 97%.

Pandemic made chronic shortage of nurses in Ky. an acute shortage; now 1/4 of Ky. nurses say they plan to leave their jobs

Nurse Cydney Kanis at Baptist Health Lexington
(Photo by Alex Slitz, Lexington Herald-Leader)
One in four Kentucky nurses say they plan to leave their job in the next three months, saying they are "exhausted, overworked and underpaid,"
writes Alex Acquisto of the Lexington Herald-Leader, reporting on a survey of 850 licensed nurses this month by the Kentucky Nurses Association.

The poll found that 73% "said the driving factor behind their burnout and the overall workforce shortage was untenable patient loads and too few nursing staff, while just over 40% cited insufficient pay," Acquisto reports. "A quarter said it was 'likely' or 'extremely likely' they would leave their current position in the next three months, and 16% said they were likely to leave the profession altogether.

“I don’t want to leave the nursing field, but I cannot imagine being a nurse in five years with no change,” one unnamed nurse said in her response to the survey.

At a press conference about the poll, "Nurses and leaders of state health-care associations proposed that Kentucky allocate $100 million in federal pandemic money to aid in the nursing workforce shortage," Acquisto reports.

Gov. Andy Beshear has asked the legislature to provide bonuses to front-line essential workers who stayed employed throughout the pandemic, using $400 million in pandemic relief, and the nurses' prescription calls for the state to a forth of that for nursing, including $50 million for retention bonuses, $20 million for loan forgiveness for nursing faculty, students and graduate nurses who work in under-served areas.

The pandemic has pushed nurses to their physical and emotional limits, Kristin Pickerell, director of critical care and emergency services at Norton Healthcare in Louisville and past president of the Kentucky Organization of Nurse Leaders, said at the press conference.

“We started this pandemic with nurses being heroes — it was really a rallying point for the public,” she said, but in recent months, “It’s really kind of morphed into something different,” she said, citing occasional instances of “violence against nurses in the hospital, all because of the pandemic and one’s belief that [Covid-19] isn’t real.”

KNA board president Donna Meador said that due to frequent cases of “physical and verbal abuse,” at least one health-care employer in Kentucky issued “panic buttons” to its nursing staff during the pandemic, which she said is “almost unbelievable.”

Of the nurses who responded to the survey, "61% had more than 21 years of experience," Acquisto reports. "Roughly a quarter said physical exhaustion and fear of spreading coronavirus to a loved one was also contributing to the shortage. A majority cited better pay, financial incentives and more staffing support as critical solutions."

Could we eliminate Covid-19? New study says it's possible, if some portion of the population keeps practicing social distancing

Getty Images via Florida Atlantic University
Some experts have said Covid-19 will become an endemic disease, like the flu, that may require annual vaccinations. But a study published in the Journal of Biological Dynamics says eliminating it is possible if some unknown percentage of the population practices social distancing.

Researchers at Florida Atlantic University and the University of Florida created a model that allowed them to see how economic growth interacts with human behavior and the spread of infectious diseases, and compared the results with those from a model that examined human behavior and infectious diseases but left out economics. 

Including economic growth showed greater potential for eliminating Covid-19. According to the model that did not include it, the only way the disease could be eliminated would be if everyone practiced social distancing. The second model showed that, when "the economy is stronger than social norms," the disease could be eliminated by a portion of the population practicing social distancing "at the expense of the economy." However, the study did not suggest what percentage of the population would be need to socially distance for this to work. For the full study, click here.

Thursday, October 21, 2021

Most Covid-19 measures in Kentucky continue to trend downward; 53 more Covid-19 deaths reported Thursday

State Department for Public Health graph; for a larger version, click on it.
By Melissa Patrick
Kentucky Health News

All of Kentucky's coronavirus trends continue to be positive, except for deaths, but Gov. Andy Beshear cautioned Thursday that the numbers are still too high. 

"All trends continue to be, again, pretty positive," he said, later adding, "So let's not cheer and celebrate. While we're still at where we are, let's do what it takes to continue to push this decline." 

The state reported 1,796 coronavirus cases Thursday, lowering the seven-day average by 73, to 1,535.  Of today's cases, 27% were people 18 and under. 

The percentage of Kentuckians testing positive for the virus in the last seven days dropped again, to 6.53%

Beshear said two of today's 53 Covid-19 fatalities were children, one in their late teens and one an infant with multiple health issues. He said these young deaths are a reminder that this virus "can impact anyone" and stressed that the way to stop it is through vaccinations. 

Kentucky's seven-day Covid-19 death average is 38.3 per day and the 14-day average is 36.3 per day.

Beshear said hospitalizations have dropped 19% in the last seven days but 57 of the state's 96 acute-care hospitals still have critical staffing shortages. 

Beshear suggested that Kentucky Rural Hospital Loan Program, which can provide struggling rural hospitals with low-interest loans between $25,000 and $1 million, could help qualifying hospitals with their staffing issues. 

He has also recommended that the General Assembly use $400 million in federal relief funds for bonuses to "essential workers" who have stayed in their roles for at least two full years after the start of the pandemic. Beshear said this plan will require a working group to work out the details, including who will get it and how much they would get.

In response to a question, Beshear said he hasn't had any communications from Republican legislators, who wanted him to greenlight a program to supplement hospital workers' pay, but added that he has not set any deadlines for them to reply. He said he hopes they will be on board with this program and will assign people to the work group, since there are a lot of decisions it needs to make. 

Kentucky hospitals reported 1,092 Covid-19 patients, down 23 from Wednesday; 328 in intensive care, up seven; and 199 patients on mechanical ventilation, down eight. 

Nine of the state's 10 hospital regions are using 80% of their intensive-care capacity, but none of them are at 100%. 

Beshear said the rate of cases is four times higher among people who are unvaccinated than among those who are vaccinated. Among people under 50 who have died from Covid-19, eight were fully vaccinated and 238 were unvaccinated.

"With a few exceptions, if you are under 50 years old, this thing is only killing unvaccinated Kentuckians," he said. 

He also encouraged seniors to get their boosters, noting that this age group often has conditions that "Covid comes for."

He argued, "You've already taken so many steps to protect yourself, at least early indications are that if you go get that third shot, you are back up maybe even to that 90 plus percent protected." 

In the last seven days, Kentuckians received a daily average of 10,300 doses of coronavirus vaccinations, a 22% decrease over the week before. So far, the state has administered at least one dose to 2.8 million Kentuckians, or 73.1% of the eligible population, 12 and older. 

From March 1 to Oct. 20, 2021, 84.5% of Covid-19 cases, 91.6% of Covid-19 hospitalizations and 82.2% of Covid-19 deaths have been among partially vaccinated or unvaccinated Kentuckians.

Kentucky's seven-day infection rate ranks 16th among the states, according to an analysis of Centers for Disease Control and Prevention data by The New York Times. 

The state reports its seven-day infection rate to be 26.39 cases per 100,000 residents. Counties with rates more than double that rate are Cumberland, 90.7; Owsley, 87.4; Jackson, 66.5; Powell, 61.3; Mercer, 59.3; Trimble, 54.0; Floyd, 48.2; McLean, 48.1; Martin, 45.9; Owen, 45.9; Perry, 45.5; Lee, 44.4; Grant, 43.9; Muhlenberg, 43.9; Caldwell, 43.7; Grayson, 43.2; and  Lawrence, 42.9.

Schools: Beshear urged schools that are considering making masks optional to "hold on," especially because Covid-19 vaccines are on the horizon for 5-11-year-olds. 

He said he does not expect the state Department of Education to require vaccines for 5- to 11-year-olds, since it hasn't required 12- to 17-year-olds to get them. Instead, he said there needs to be a push to get accurate information to parents about the vaccines that encourages them to get their kids vaccinated. 

Asked if moving out of the red zone is a good reason for schools to remove their masking requirements, Beshear said "no," largely because at this level there is still too much virus in the community.  Further, he said we know the virus spreads in schools, that most of the students in schools are not vaccinated, and that schools generally have poor ventilation -- and "that's exactly what the virus wants." 

"The best chance of having the most days at school is universal masking," he said. 

As an example, he noted that his daughter and son's schools both have universal masking requirements, and that his daughter's school had only closed one day for Covid-19 and his son's school has not missed any.

Wednesday, October 20, 2021

Kentucky's positive-test rate drops below 7%; Moderna and J&J boosters get FDA approval, now go to CDC for further guidance

By Melissa Patrick
Kentucky Health News

Most metrics to measure the coronavirus in Kentucky continue to drop Wednesday, including the percentage of Kentuckians who are testing positive for the coronavirus in the last seven days, which dropped below 7 percent, to 6.83%. That's really good news, considering that the state was at 12.18% a month ago and hit a high of 14.16% on Sept. 8.

Kentucky reported 1,899 new coronavirus cases Wednesday, lowering the seven-day average by 68, to 1,608. Of the day's new cases, 26% were in people 18 and younger. 

Kentucky's seven-day infection rate ranks 15th among the states, up one spot from Tuesday, according to an analysis of Centers for Disease Control and Prevention data by The New York Times

The state reports its seven-day infection rate to be 28.57 cases per 100,000 residents. Counties with rates more than double that rate are Cumberland,, 92.9; Owsley, 87.4; Powell, 76.3; Floyd; 57.4; and Mercer, 57.3.

Hospital numbers went down Wednesday. Kentucky hospitals reported 1,115 Covid-19 patients, 87 fewer than Tuesday; 321 in intensive care, down 34; and 207 patients on mechanical ventilation, down 19. 

Eight of the state's 10 hospital regions continued to use at least 80% of their intensive-care capacity, with the Northern Kentucky region still at 100%. 

The state reported 52 more Covid-19 deaths, raising the pandemic's toll to 9,477. Kentucky's seven-day Covid-19 death average is 38 per day and the 14-day average is 36 per day. One of today's fatalities was a 35-year-old, according to a Facebook post by Gov. Andy Beshear.

The Washington Post reports CDC data showing that Kentucky gave 10,533 doses of coronavirus vaccinations in the last seven days, a 17% decrease over the previous seven. So far, Kentucky has administered at least one dose to 2.8 million people, covering 73% of the eligible population, 12 and older. 

 The U.S. Food and Drug Administration has authorized the use of Covid-19 boosters from Moderna and Johnson & Johnson, and says that people can receive a different brand of vaccine as a booster than they did their initial shots, Politico reports.

Those eligible for the Moderna booster include people 65 and older and adults at high risk of severe Covid-19 or with high exposure to the coronavirus through their jobs or living situations. The Moderna booster can be given six months after initial vaccination.

The Johnson & Johnson booster will now be available to anyone 18 or older two months after their first dose.

Further guidance for public employees and health-care workers would come from the CDC's vaccine advisory panel, "which will meet Thursday to set guidelines for use of the Moderna and J&J boosters and to address the FDA’s decision to permit 'mix-and-match' boosters," Politico reports. 

The Pfizer-BioNTech Covid-19 booster was approved last month for the same at-risk populations approved by the FDA for Moderna.

Tuesday, October 19, 2021

Pandemic declining in Ky. faster than most other states; New York Times ranks state's infection rate 16th, after weeks in the top 10

State Department for Public Health map, adapted by Kentucky Health News; to enlarge, click on it.
By Melissa Patrick
Kentucky Health News

After weeks of being one of the top 10 states for its coronavirus infection rate, Kentucky took a plunge to No. 16 in The New York Times rankings Tuesday, as the state's case numbers and positive-test rate kept falling. 

The state reports Kentucky's seven-day infection rate to be 30.25 daily cases per 100,000 residents, down from 31.67 cases Monday. Counties with rates more than double that rate are Owsley, 87.4; Powell, 78.6; Cumberland, 77.8; and Mercer, 61.2.

Counties with more than 50 daily cases per 100,000 residents -- double the rate needed to put a county in the red on the state's map -- are Floyd, Grayson, Harrison, Jackson, McLean, Caldwell, Trimble, and Rockcastle. 

The Times, using Centers for Disease Control and Prevention data, says Kentucky has seen a 39% drop in its infection rate in the last 14 days. Only six states saw faster drops in the period. (The Times's rates and the state's rates vary due to methodology; the example cited by the state is that it removes duplicate test results.)

Four of Kentucky's 120 counties are in the yellow category, for average daily case rates between 1 and 10 per 100,000 residents: Menifee, 2.2; Elliott, 7.6; Morgan, 9.7; and Hickman, 9.8. 

Thirty-four counties are in the orange category, with 10 to 25 daily cases per 100,000; 82 are in the red category, for counties with more than 25 cases per 100,000 residents. 

Kentucky reported 1,786 new coronavirus cases Tuesday, lowering the seven-day average by 82, to 1,676. Of the new cases, 24% were in people 18 and under. 

The percentage of Kentuckians testing positive for the virus in the past seven days is 7.17%, down from 7.36% on Monday.

All of the hospital numbers were up Tuesday, reflecting a typical early-week trend of hospitals trying to get healthier patients home on the weekend and admissions perhaps being delayed by the weekend. Hospitals reported 1,202 Covid-19 patients at midnight Monday, an increase of nine; 355 intensive-care patients, up 18; and 226 patients on mechanical ventilation, up seven. 

Eight of the state's 10 hospital regions are using at least 80% of their intensive-care beds. Northern Kentucky is at 100% and three others are above 90%: Barren River, at 95%; and Bluegrass and Lake Cumberland, at 92%. 

The state reported 29 more Covid-19 deaths. The death toll is 9,425. Kentucky continues to average reporting about 35 Covid-19 deaths per day.

Tammy and Carl Clark (Image from WLKY)
Vaccinations vs. hospitalization and death:
 Tammy Clark of Shelbyville lost her mother-in-law and her husband of 41 years to Covid-19 while battling the disease herself. Out of hospital for about a month, the 61-year-old told Sarah Ladd of the Louisville Courier Journal that she wishes she'd been vaccinated: "I was afraid of it. But then look what I went through."

Her husband, Carl Clark, was partially vaccinated, WLKY-TV reports. "You can still get Covid while being vaccinated, but it will be less severe and your odds of surviving and surviving without limitation are significantly higher," Dr. Greg Pfister, who treated Clark and her family, told Ladd. "And it's just unbelievable that people are denying that level of protection."

So far, 2,765,473 Kentuckians have received at least one dose of a vaccine, or 62% of the total population. The fully-vaccinated rate is 54%, which ranks 25th among the states, just barely behind Illinois, and ahead of all other bordering states except Virginia, which ranks 12th.

There's still a lot of room to get more students vaccinated, especially as Kentucky schools begin to loosen mask requirements. Among youth 12 and older, the only ones who can get be vaccinated at this time, 47% of those 12 to 15 and 52% of those 16 and 17 having received at least one shot. 

The importance of vaccinations to protect youth against severe Covid-19 was reinforced by a CDC study of U.S. Covid-19 patients 12 to 18 from June to September. It found that two doses of the Pfizer vaccine were 93% against hospitalizations. 

Centers for Disease Control and Prevention chart; to enlarge, click on it.

Monday, October 18, 2021

As pandemic keeps trending down, some school districts make masks optional; the governor says they shouldn't be doing that

State Dept. for Public Health graph and map, adapted by Ky. Health News; click to enlarge
By Melissa Patrick
entucky Health News

As the state's coronavirus infection rate keeps falling, and some school districts are making masks optional, Gov. Andy Beshear strongly urged them to keep universal mask mandates in place, cautioning that removing the requirement could "pop these numbers back up."

"If you really want to stay in school, keep them on until we are in a better place," Beshear said at his weekly Covid-19 news conference.

The Hardin County schools, a large district, told Louisville's WDRB that masks are optional there this week because the county's seven-day infection last week rate fell below an average of 50 daily cases per 100,000 residents, a marker the district set at the start of the school year.

The county's current rate is 34.9, which leaves it in the state's red category, which has a bottom threshold of 25. Beshear said districts should not consider making masks optional even if they are in orange, for 10 to 25: "Certainly I would not do it in the orange and try to get to the green or at least the yellow." Thirty-four counties are in the orange category; 85 remain in red.

Hardin schools spokesman John Wright said, "We are still contact tracing, so if your student is not wearing a mask and he or she is a contact of a person who's turned into a positive case of Covid, then there's still protocols in place: either the test-to-stay option, or symptom-monitor, or you can quarantine." 

Wayne County, which has an infection rate of 19 per 100,000, also made masks optional for this week. Several school districts in Western Kentucky are re-evaluating their mask mandates, since many of the counties in the region are in the orange category, Shamarria Morrison reports for Paducah's WPSD.

In August, when most districts did not require masks and some early-starting districts had outbreaks of the virus, the Democratic governor issued a mask mandate, but the Republican legislature stripped him of that power.

Beshear said the Department of Education and his Department for Public Health both believe that every Kentucky school should require universal masking because it keeps children in school by preventing outbreaks of the virus; it protects the immunocompromised and children who are at higher risk of getting the virus while in school; and it protects teachers and staff. 

Further, Beshear noted that the virus is easily spread in schools because they have large groups of people indoors with low rates of vaccination and that most of the school buildings are poorly ventilated.

Chart by state Cabinet for Health and Family Services, adapted by Kentucky Health News; click on it to enlarge.
Daily report: Beshear said he was encouraged by Monday's Covid-19 report because most of the metrics were down. 

"In today’s report, what we are going to see is just about everything is moving in the right direction and actually at a speed – the decrease in cases and in hospitalizations, ventilator and ICU use – that is significant,” he said. “It is a real trend, it's a positive trend. It has not plateaued. It is moving downward, which is reason for optimism. But our deaths, which trail cases and hospitalizations, ICUs and ventilators, are still very high.”

Beshear reported 678 new coronavirus cases Monday, lowering the seven-day average to 1,758. On Friday, the last day reports were issued, it was 1,943.

Beshear said last week's drop in cases brought the state below the high numbers of cases it was seeing during the fall and winter surge.

"If we continue to see these numbers come down at the rate that they are, we will be in a much better place within a month or so," he said. "But the trick, the thing we've got to work towards is making sure we can keep it down and not see another surge again." 

The share of Kentuckians testing positive for the virus in the last seven days is 7.36%, which Beshear called "a significant drop" from last week's average of about 8%. Again, he cautioned that it's still too high, noting that 5% was once the worrisome threshold.

Hospital numbers are also showing a strong downward trend, Beshear said. Hospitals reported 1,193 Covid-19 patients, down 44 from Friday; 337 intensive-care patients, down 36; and 219 on mechanical ventilation, down 20. 

Eight of the state's 10 hospital regions are using at least 80% of their intensive-care-unit capacity. The Northern region has the highest ICU use, at 98.63%, followed by Lake Cumberland (94.74%) and Barren River (94.25%).

From March 1 to Oct. 12, 84.9% of Covid-19 cases, 91.4% of Covid-19 hospitalizations and 82.8% of Covid-19 deaths in Kentucky have been among those who are unvaccinated or partially vaccinated, said a news release from Beshear's office.

Kentucky's seven-day infection rate ranks ninth among the states, one slot higher than Friday, according to an analysis of Centers for Disease Control and Prevention data by The New York Times. 

The state reports Kentucky's seven-day infection rate to be 31.67 cases per 100,000 residents. Counties with rates more than double that rate are Owsley, 100.3; Powell, 87.8; Cumberland, 82.1; Grayson, 66.5; Jackson, 65.4; and McLean, 65.2.

Since Friday, the state recorded 103 more Covid-19 deaths, 31 on Monday. Beshear said nine of those were people in their 40s. The death toll is 9,396. 

Former secretary of state Colin L. Powell, 84, died Monday from complications related to Covid-19. Powell was fully vaccinated but had multiple myeloma, a blood cancer that can reduce the ability to fight infection.

Following a presidential proclamation, Beshear directed that flags in all state office buildings be lowered to half-staff until sunset on Friday, Oct. 22 in Powell's honor, and encouraged others in the state to join the tribute. 

Vaccinations: In a story about Powell's death, Phillip Bump of The Washington Post analyzes recent CDC data that again shows the benefits of being vaccinated for protection against new infection and death from the coronavirus. However, the study also shows that the incidence of Covid deaths among those 80 and over was nearly as high as the incidence among the unvaccinated age 50 to 64.

In an article headlined "Colin Powell's death is a reminder that vaccination is about every person, not just one person," Bump writes, "The reason that health experts advocate vaccination is, in part, because it offers increased protection to individuals both from infection and death. But that, to some extent, is the icing on the cake. The broader advantage in widespread vaccination is that the virus has far less ability to spread, given how well protected the vaccinated are against contracting the virus. This is the goal of reaching herd immunity, creating a situation in which the virus can’t spread because it can’t find hosts without antibodies prepared to fight it. When the United States achieves herd immunity, 84-year-olds with preexisting conditions will be better protected against death simply because they will be at much lower risk of contracting the virus." 

The Post reports that Kentucky administered 14,369 doses of a vaccine in the last week, a 11% increase over the week before. So far, more than 2.7 million Kentuckians have received at least one dose of a vaccine, amounting to 72.9% of the eligible population, 12 and older. 

State Public Health Commissioner Steven Stack provided updates on the Moderna and Johnson & Johnson Covid-19 vaccine boosters, noting that a U.S. Food and Drug Administration advisory committee has recommended the same recommendations for the Moderna vaccine as they did for Pfizer's, which includes people 65 and older, adults who are at high risk for severe Covid and those who work at jobs with increased exposure risk. 

The same committee recommended all adults who got the J&J vaccine to get a booster at least two months after their initial vaccination. 

On Sunday, Dr. Anthony Fauci told ABC's Martha Raddatz on "This Week" that given the data provided to a Food and Drug Administration advisory group, which recently recommended a Johnson & Johnson booster shot, the J&J Covid-19 vaccine likely should have been a two-dose vaccine to begin with, The Hill reports.

The CDC's Advisory Committee on Immunization Practices will meet Oct. 20-21 to discuss the boosters.

Sunday, October 17, 2021

Churches could be key to overcoming vaccine misinformation, resistance to perceived coercion by 'The Man' in Eastern Ky.

Pastor Billy Joe Lewis at his Leslie County church. (Kaiser Health News photo by Jessica Tezak)
The key to keeping Eastern Kentucky hospitals from being overwhelmed by Covid-19, the flu and other illnesses this winter may depend on rural churches helping vaccination campaigns, Sarah Varney reports for Kaiser Health News.

"In Leslie County, in the foothills of the rugged Pine Mountain ridge that anchors the state's eastern coalfield, gravel roads wind through thick forests blanketed with kudzu vines," Varney writes. "House by house, church by church, public health workers are trying to outsmart the fantastical tales spread on Facebook about the Covid-19 vaccines, while also helping residents overcome the everyday hurdles of financial hardship and isolation."

Leslie County has better full-vaccination rates than most counties in southeastern Kentucky: 46% of the population and 54% of the vaccine-eligible (12 and older). Clay County, to the east, has only 39% and 45%, respectively, despite special campaigns to get shots in arms. The region matches what national polls show tend to be the most adamant anti-vaccine part of the U.S. population, citing "tends to be disproportionately white, rural, evangelical Christian and politically conservative," The New York Times reports.

"Local health agencies have been eager to enroll churches in the all-hands-on-deck vaccination effort," Varney reports. "Some church leaders have refrained from encouraging vaccination, afraid of offending congregants in a state where mistrust of government intrusion runs deep."

But not Billy Joe Lewis, pastor of the Full Gospel Church of Jesus Christ on Cutshin Creek, which rises in the shadow of Pine Mountain and drains much of Leslie County.

"Lewis, who has thick silver hair and a luminous smile, spends long stretches of the day in prayer, and he says God told him to protect his flock," Varney reports. "When 'Sister Maxine' from the regional health department suggested a drop-in vaccine clinic in the church parking lot, Lewis says, he was all in favor. He promoted it from the pulpit and on the church's must-read Facebook page."

Lewis's sister in Christ is Maxine Shepherd, a regional health coordinator for the county and a member of his church since he started it in 1972. But his stand wasn't a personal favor. "We've still got to use common sense," he told Varney. "Anything that can ward off suffering and death, I think, is a wonderful thing."

He has seen both. "In recent weeks, Lewis held a funeral service for a 53-year-old unvaccinated former coal miner, suspended Sunday services after more members fell ill and, with a heavy heart, canceled Homecoming — a cherished yearly gathering of area churches that marks the fall foliage with a celebration of the gospel and shared faith," Varney writes.

Varney notes that getting people to vaccine sites in the region isn't as easy as it is in most places, because some people lack transportation. But another big obstacle is "the specter of coercion" in a region "where government directives have been met with derision," she reports.

"We do not like to be shoved," Louisa nursing-home owner David McKenzie told her. "We resent it, and we shove back."

In Lawrence County, the fully-vaccinated rates are 40% of the total and 48% of the eligible. Opposition to the vaccines there "is not overtly political so much as defiant," Varney writes.

"They're fearful of 'The Man'," McKenzie told her. "The Man could be your employer, it could be the government, it could be a newspaper reporter."

And there's another kind of fear, Varney reports, paraphrasing and quoting McKenzie: "People who boasted about refusing the vaccines cannot change their minds, or 'They'll look like they're weak, or they caved to The Man'."

'Long Covid' hits over half of survivors, threatens health systems

Pharmaceutical Journal illustration
According to a recent study at Penn State, more than half the people diagnosed with Covid-19 will suffer from "long Covid," which can include one or more of a long list of lingering health issues.

Researchers found that survivors suffered from fatigue, decreased mobility, difficulty breathing, hair loss, chest pain and palpitations, diarrhea, anxiety, and more. How long will they suffer? That's still uncertain. The rates of long Covid remained steady from one month after recovery to six months and longer.

The threat that long Covid poses to survivors is one that "governments, health-care organizations, and public-health professionals should prepare for," the researchers said. Long-term health complications may increase demand for medical care, which could overwhelm health-care systems.

The study's findings "could help shape treatment plans to improve care for Covid-19 patients" and those suffering from long-term complications. One solution the researchers mentioned is one-stop clinics, which they said would be able to more efficiently serve Covid patients who don't have the time or energy to go back and forth to their primary-care providers.

The study, published in JAMA Network Open, reviewed data from 57 studies that included data from over 250,000 unvaccinated adults and children who had Covid-19. Because the study "examined a larger population, including people in high-, middle- and low-income countries, and examined many more symptoms … the findings are quite robust," said co-lead researcher Vernon Chincilli.

Saturday, October 16, 2021

Task force's draft recommendation says most adults don't need a daily low-dose aspirin to prevent a first heart attack or stroke

ABC News photo
After years of saying middle-aged and older Americans should take a low-dose aspirin every day to prevent a first heart attack or stroke, the nation's chief prevention task force now says that isn't necessary, and that it could even increase the risk of potentially serious side effects like bleeding.

“Our message … is if you don’t have a history of heart attack and stroke, you shouldn’t be starting on aspirin just because you reach a certain age,” Chien-Wen Tseng, a member of the U.S. Preventive Services Task Force, told The Washington Post. 

The task force is an independent, volunteer panel of experts in disease prevention. Its draft recommendation, now in a public-comment period that must precede final adoption, is against low-dose aspirin use for people 60 and older, and says the decision for people between 40 and 59 would be between themselves and their doctor, warning that "the net benefit of aspirin use in this group is small."

The draft recommendation would not change guidelines for people who take aspirin to prevent a second heart attack, Dennis Thompson reports for HealthDay.

Heart disease is the leading cause of death in Kentucky, according to the Centers for Disease Control and Prevention. America's Health Rankings reports that 12.1% of Kentucky adults have been told by a health professional that they have some form of heart disease, compared to 8.4% nationwide.

HealthDay reports that new data suggest that "the increased risk of bleeding associated with aspirin use occurs relatively quickly after initiating aspirin," with the absolute risk of bleeding increasing with age, the task force says in its draft recommendation.

The new advice would make the task force's guidelines more closely resemble "those of the American College of Cardiology and the American Heart Association, which were updated in 2019," Allyson Chiu writes for the Post. "The ACC/AHA guidelines say that low-dose aspirin 'might be considered' for primary prevention in 'select' adults between the ages of 40 and 70 who aren’t at increased risk of bleeding. The guidelines also recommend against regular aspirin use in people who are older than 70."

Friday, October 15, 2021

Kynect open to preview federally subsidized health plans, with more options and bigger subsidies; enrollment open Nov. 1

Cabinet for Health and Family Services map, adapted by  Ky. Health News
By Melissa Patrick
Kentucky Health News

Open enrollment for federally subsidized health-insurance coverage beginning in January will be offered through Kynect, the state's insurance exchange, which is now online for Kentuckians to explore their options.

The revived Kynect will replace the state's use of the federal exchange, and will have two more insurers in 2022 than this year -- and its first vision coverage. It will also offer less expensive coverage to some people, thanks to greater federal subsidies.

Open enrollment on runs from Nov. 1 through Jan. 15 for health insurance coverage beginning Jan. 1.

Gov. Andy Beshear and U.S. Health and Human Services Secretary Xavier Becerra officially launched the reopening of Kynect as the portal for state-managed health care options Friday at an online news conference. 

Becerra called Kynect "Kentucky-made, Kentucky-driven and Kentucky-based" and said the advantages of having a state-based marketplace is that it can be tailored to the needs of Kentuckians. 

"I don't think anyone in Washington, D.C., knows the state of Kentucky and its people better than the governor of Kentucky," Becerra said. "So his team is going to be able to tailor their marketplace to meet the needs of all the different communities rural, urban, poor, middle class, disabled, you name it, they're going to know where they need to go, and how to go there better than folks in Washington." 

Kynect was re-launched last year on a limited basis, as a one-stop shop for Kentuckians to apply for Medicaid and connect qualified families to other resources, including the Supplemental Nutrition Assistance Program (formerly known as food stamps) and family and child-care assistance programs.

Now, the platform will again allow Kentuckians to access and compare state-managed insurance options, apply for coverage and complete their enrollment all on one platform, which was its original intent when it was created in the governorship of Beshear's father, Steve Beshear.

"That makes it a lot easier," said Priscilla Easterling, outreach coordinator for Kentucky Voices for Health, an umbrella organization of lobbying groups that support continuation and expansion of programs under the 2010 Affordable Care Act, which created federal subsidies for qualified health plans. 

Easterling said Kynect allows Kentuckians to access just one platform to determine if they qualify for a qualified plan with income-based subsidies, or for Medicaid, in addition to the other services offered on the site. 

"As people's jobs change or their incomes change, it makes it much simpler to be able to move back and forth between Medicaid and the marketplace, without having to go back and forth between the state and the federal" platforms, she said. 

Easterling encouraged Kentuckians without coverage to explore their options on -- especially those who looked at plans in the past and found them unaffordable.

That's because the latest pandemic relief bill, the American Rescue Plan Act, increased the subsidies, and most of its provisions will remain in place through 2022. Easterling said people generally saw a 48% savings on their health-insurance plans with the enhanced subsidies, or an average of $75 a month. 

"It doesn't hurt to just check out what your options are and [find out] what's going to be available for you and your family," Easterling said. "You might be surprised, but it's more affordable than you thought and it's worth looking into."  

Some small additional savings will result because people who buy health plans through the federal site pay a surch`1arge on premiums, which Kynect will not do. Beshear said it will pass along those savings to consumers.

Easterling reminded Kentuckians that Kynectors, who help Kentuckians sign up for health coverage through Kynect, are available for free in every county to answer questions and help people sign up for coverage. 

"Kynectors are a priceless resource that everyone should take advantage of," said Easterling, who is a Kynector. "If you're nervous about anything, if you're confused about any of this process, just call a Kynector because they can walk you through it and will be happy to do so."

In addition to Anthem’s statewide coverage and CareSource, which is offeing health plans in 100 of the 120 counties, consumers can shop for plans available in select counties from two new health insurers; Ambetter from WellCare of Kentucky, in six western counties, and Passport Health Plan by Molina, in Jefferson, Oldham and Bullitt counties.

Fourteen counties will have only Anthem plans to choose from, down from 26 this year. Most are small and rural, but they include Warren County, the core of metropolitan Bowling Green, the state's third-largest city. Warren and eight neighboring counties also had Anthem as their only choice this year.

And for the first time, Kentuckians will be able to purchase a vision coverage plan through Kynect. VSP Individual Vision Plans will offer enrollees a comprehensive eye exam from an in-network doctor, an eyeglass-frame allowance and lens enhancements, such as progressives.

Kynect was closed in 2017 by Republican Gov. Matt Bevin, who said the site was too expensive to maintain and was redundant. Beshear, a Democrat, said the return to the state-based exchange is expected to save Kentuckians about $15 million a year.

Beshear said Kentucky is getting $650,000 in ARPA funding through the Centers for Medicare and Medicaid Services to help pay for the reopening of Kynect. 

He said 280,000 Kentucky adults and 45,000 Kentucky children remain uninsured, and that the goal is to get all of them signed up for health insurance. 

Calling Kynect the "gold standard," Beshear said with Kynect being a one-stop-shop for so many services that provides local supports, a brand that remains strong across the state and the state's commitment to address any challenges that may come up,  "We believe it's going to be successful." 

Kentucky is among three states to transition from to their own state-based exchange for 2022 coverage, along with Maine and New Mexico.

Clark County judge-executive dies of Covid-19; Kentucky's rural Covid-19 death rate is 6th in nation; infection rate is 13th

By Melissa Patrick
Kentucky Health News

Overall, the metrics used to measure the pandemic in Kentucky were favorable on Friday: Coronavirus cases showed a slight drop, the percentage of people testing positive for the virus stayed about the same, and all three hospital numbers went down. 

Kentucky reported 2,008 new cases Friday, lowering the seven-day average by 20, to 1,943 per day. Of Friday's new cases, 27% are in people 18 and younger. 

The percentage of Kentuckians testing positive for the coronavirus in the past seven days is 8%, a slight increase from Thursday when it was 7.91%. 

The state reported 31 additional Covid-19 deaths. The death toll is now 9,293, and the state is averaging about 35 per day. Today's deaths included two Kentuckians as young as 44 years old, according to a Facebook post by Gov. Andy Beshear.

Chris Pace
A death not included in the reports yet is that of Clark County Judge-Executive Chris Pace, who died Thursday from Covid-19 complications after battling the virus for a few days before being taken to the emergency room Thursday night, Christopher Leach reports for the Lexington Herald-Leader.

Rural Kentucky's high infection and low vaccination rates have led to a high Covid-19 death rate, according to data compiled by The Daily Yonder, a rural news site. It ranks Kentucky's death rate in non-metropolitan counties sixth in the nation, behind Georgia, Idaho, Wyoming, West Virginia and South Carolina. Indiana and Tennessee are 16th and 17th; Ohio is 23rd and Illinois is 29th.

Kentucky's rural infection rate is 13th among the states; West Virginia and Ohio are seventh and eighth, respectively. A death rate higher than the infection rate indicates a population with underlying health problems; that's Kentucky.

Kentucky hospitals reported 1,273 Covid-19 patients, down 81 from Thursday; 373 in intensive care, down 26; and 239 on mechanical ventilation, down 31. 

Nine of the state's 10 hospital regions are using at least 80% of their intensive-care unit beds, with the Northern region at 100% capacity. Two regions are above 96%, including the easternmost region (96%) and Lake Cumberland (97%).

Kentucky's seven-day infection rate ranks 10th among the states, a drop of one slot from Thursday, according to an analysis of Centers for Disease Control and Prevention data by The New York Times.

The state reports its seven-day infection rate to be 36.85 daily cases per 100,000 residents. Counties with rates more than double that rate are Owsley, 84.1; Powell, 80.9; and Russell, 76.5.

So far, almost 2.77 million Kentuckians have received at least one dose of a coronavirus vaccine, amounting to 62% of the total population and 75% of those 18 and older. 

A U.S. Food and Drug Administration advisory panel voted unanimously in favor of authorizing Johnson & Johnson booster doses for adults, at least two months after receiving the first shot, CNBC reports.

The same committee on Thursday recommended Moderna booster shots for people 65 and older and other high-risk adults. 

The FDA usually follows the advice of the committee, and a final decision by its regulators could come within days.

Another approach to slowing the spread of the virus is to ramp up testing. Toward that end, Louisville is giving away free at-home test kits to thousands of people in areas where the virus spread is the highest and where the population might be the most vulnerable, WDRB reports.

"Many people are returning to their pre-Covid lifestyles, or similar to that," Connie Mendel of Louisville Metro Public Health and Wellness told WDRB. "So we need to determine — when we wake up and we don't feel well, or our kids have a cough or a sneeze or a headache or a fever, being able to determine quickly if that's Covid."

Thursday, October 14, 2021

52 more in Ky. die from Covid-19, but daily new-case average drops below 2,000; Estill Co. schools warn parents about threats

State Department for Public Health map, adapted by Kentucky Health News; to enlarge, click on it.
By Melissa Patrick
Kentucky Health News

Kentucky reported 52 more Covid-19 deaths on Thursday, a lagging effect of weeks of high coronavirus case numbers now in decline.

The expectation is that as that trend continues, along with a declining positive-test rate, deaths will come down too, but between the highly contagious Delta variant, low vaccination rates in much of Kentucky and case numbers that are still too high, that has been slow to happen.  

One of the 52 fatalities reported Thursday was 38 years old, according to a Facebook post by Gov. Andy Beshear. The death toll is now 9,262. Deaths are averaging about 35 per day, down from about 40 two weeks ago.

Kentucky reported 2,305 new cases of the coronavirus Thursday, 26% of them in people 18 and younger. That cut the seven-day rolling average by 75, to 1,963, the first time since Aug. 7 it has been under 2,000.

The percentage of Kentuckians testing positive for the virus in the last seven days also dropped again, to 7.91%, from 8% Wednesday.

Kentucky hospitals reported 1,354 Covid-19 patients, 11 fewer than Wednesday; 399 in intensive care, up 1; and 270 on mechanical ventilation, down 5. 

Eight of the state's 10 hospital readiness regions are using at least 80% of their intensive-care beds, with Northern Kentucky at 100% and the Lake Cumberland region at 96.6%. 

Kentucky's seven-day infection rate ranks ninth among the states, according to an analysis of Centers for Disease Control and Prevention data by The New York Times. 

The state reports its infection rate to be 36.73 daily new cases per 100,000 residents. Only two counties had rates more than double that rate: Russell, 84.5; and Powell, 76.3.

Only one of the state's counties is in the yellow zone, for counties with moderate transmission rates, between 1 and 10 daily cases per 100,000 residents: Morgan, with 7.5. The orange zone, with "substantial" transmission rates (10 to 25 daily cases per 100,000 residents), has 21 counties. The rest are in the red zone, with high levels of transmission (more than 25 or more daily cases per 100,000). 

Covid-19 vaccinations, masking, social distancing, and staying home if you are sick continues to be the best way to thwart this virus, and most Kentucky schools are working to implement these policies. 

But not everyone is happy about it. Valarie Honeycutt Spears of the Lexington Herald-Leader reports that one school district has warned parents to stop threatening and abusing staff over their coronavirus policies. 

The Estill County Board of Education issued a "civility statement" Thursday with a severe warning about such incidents, the Herald-Leader reports.

“In recent weeks, we have seen an increase of incidents where parents have been abusive to school employees and have made comments of a threatening nature," the statement said. "This is a direct violation of state law."

Vaccinations: The state's daily report shows 2.75 million Kentuckians have received at least one dose of a vaccine, which amounts to 62% of the total population and 75% of those 18 and older. 

Woodford County leads the state in share of residents with at least one dose of a vaccine, at 80%. It is followed by Franklin, 79%; Fayette, 76%; Campbell, 76%; and Boone, 73%. 

Seventeen of the state's 120 counties have less than 40% of their residents vaccinated with at least one dose, with Spencer (33%); Christian (34%); Elliott (35%); Jackson (35%) and Hart(36%) at the bottom of the list, according to the CDC. 

An advisory panel to the U.S. Food and Drug Administration unanimously recommended a booster dose of the Moderna coronavirus vaccine for people 65 and older, adults with high risk of severe illness, and those who could be exposed at work, CNN reports.

The recommendations mirror the eligibility criteria for the Pfizer-BioNTech booster authorized in September. Third doses of the Moderna and Pfizer Covid-19 vaccines are already authorized for some immuno-compromised people.

The advisory panel will continue to meet Friday and are expected to vote on boosters for the Johnson & Johnson vaccine, and will hear a presentation on mix-and-match vaccines, CNN reports.

Wednesday, October 13, 2021

Ky. positive-test rate drops to 8%, but Covid-19 hospital numbers rise; more unvaccinated pregnant women getting sick, premature

State Department for Public Health table; to enlarge, click on it. Counties in regions are listed here.
By Melissa Patrick
Kentucky Health News

The share of Kentuckians testing positive for the coronavirus in the last seven days dropped to 8 percent Wednesday, a good sign for waning transmission rates across the state, especially if it holds.  

Even so, Kentucky's seven-day infection rate ranks eighth among the states, despite a 40% drop over the last 14 days, according to an analysis of Centers for Disease Control and Prevention data by The New York Times.

The state reports its infection rate to be 37.53 daily new cases per 100,000 residents. Counties with rates more than double that rate are Russell, 79.7; Powell, 78.6; Whitley, 77.6; and Mercer, 76.9.

Kentucky reported 2,380 new cases of the coronavirus Wednesday, lowering the seven-day rolling average by 45, to 2,009. Nearly 29% of Wednesday's new cases were in people 18 and younger. 

The state's Covid-19 numbers in hospitals did not improve Wednesday, unlike most recent days. Hospitals reported 1,365 Covid-19 patients, up 36 from Tuesday and the biggest daily increase since Sept. 14; 398 in intensive care, the same as Tuesday; and 275 of them on mechanical ventilation, up 13.

Seven of the state's 10 hospital regions are using 80% of their intensive-care-unit beds. Northern Kentucky remains at 100% capacity, with 32.9% of its ICU capacity being used for Covid-19 patients. In the Lake Cumberland region, 95% of ICU beds are in use, 38% for Covid. In the region that includes Owensboro, Hopkinsville and Henderson, 82% of ICU beds are in use, 48% for Covid, highest in the state.  

The state reported that 26 more Kentuckians has died from Covid-19, raising the death toll to 9,210. 

Kentucky has administered at least one dose of a vaccine to 2.76 million residents, covering 72.6% of the eligible population, 12 and older, according to The Washington Post

Recently, the CDC issued an "urgent health advisory" to urge pregnant women to get vaccinated. Alex Acquisto of the Lexington Herald-Leader takes a deep dive into the health risk facing unvaccinated pregnant women in Kentucky and reports that severe Covid-19 among unvaccinated pregnant women is causing more premature births in Kentucky. "Five obstetricians and perinatologists at clinics and hospitals in Lexington have noticed a troubling increase," Acquisto reports.

As the nation awaits the decisions of a U.S. Food and Drug Administration advisory panel that is to meet this week on whether there is a need for a Moderna or Johnson & Johnson vaccine booster, data emerged Wednesday saying that while recipients of the J&J vaccine may benefit from a second dose of the original one-dose vaccine, they may get even greater protection if the boost comes from the other type of vaccine, Carolyn Y. Johnson reports for the Post. 

"That preprint study found that a second shot of a messenger RNA vaccine — Moderna — triggered the biggest boost of virus-neutralizing antibodies in Johnson & Johnson recipients, resulting in a 76-fold increase in antibody levels," Johnson reports. "A Pfizer booster increased antibody levels 35-fold. A matching Johnson & Johnson booster triggered only a four-fold increase."

Some chiropractors are sources of vaccine misinformation

"At a time when the surgeon general says misinformation has become an urgent threat to public health, an investigation by The Associated Press found a vocal and influential group of chiropractors has been capitalizing on the pandemic by sowing fear and mistrust of vaccines," the AP reports. "They have touted their supplements as alternatives to vaccines, written doctor’s notes to allow patients to get out of mask and immunization mandates, donated large sums of money to anti-vaccine organizations and sold anti-vaccine ads on Facebook and Instagram, the AP discovered."

In many rural communities a chiropractor is one of the few specialists, and they may appeal to people who are wary of traditional doctors. It should be noted that many of the nation's 70,000 chiropractors endorse vaccination, but "the pandemic gave a new platform to a faction of chiropractors who had been stirring up anti-vaccine misinformation long before Covid-19 arrived," AP reports. Since 2019, "chiropractors and chiropractor-backed groups have worked to influence vaccine-related legislation and policy in at least 24 states."

It's unclear how many chiropractors are anti-vaccine, but a recent survey pegs it around 20%. And though there are no nationwide numbers on vaccination rates among chiropractors, Oregon tracks vaccination rates among all health-care providers. As of September 5, only 58% of chiropractors in the state were vaccinated, compared to 92% of medical doctors and 75% of the general public, AP reports.

Anti-vaccine chiropractors commonly say their care can help patients weather viral infection or even keep them from being infected, and at least one allegedly said the pricey supplements he sold would do the trick. "Public-health advocates are alarmed by the number of chiropractors who have hitched themselves to the anti-vaccine movement and used their public prominence and sheen of medical expertise to undermine the nation's response to a Covid-19 pandemic that has killed more than 700,000 Americans," AP reports.

"People trust them. They trust their authority, but they also feel like they’re a nice alternative to traditional medicine," Erica DeWald of Vaccinate Your Family, which tracks figures in the anti-vaccine movement, told AP. "Mainstream medicine will refer people out to a chiropractor not knowing that they could be exposed to misinformation. You go because your back hurts, and then suddenly you don’t want to vaccinate your kids."

FDA authorizes (but doesn't 'approve') three vaping products, saying benefits of helping smokers quit outweigh risk to youth

New York Times photo
By Melissa Patrick
Kentucky Health News

The U.S. Food and Drug Administration has authorized three electronic-cigarette products for sale in the United States, marking the first time ever such products have been given FDA authorization – but that doesn't mean they are "approved."

The agency determined that the potential benefit to smokers who use these products to significantly reduce their cigarette use outweighs the risk to young people, who favor them over traditional cigarettes.

"While today's action permits the tobacco products to be sold in the U.S., it does not mean these products are safe or 'FDA approved'," the FDA said in a news release. "All tobacco products are harmful and addictive and those who do not use tobacco products should not start."
The authorization was given to R.J. Reynolds Vapor Company for an e-cigarette device and accompanying tobacco-flavored e-liquid pods, all sold under the brand name Vuse.

The FDA denied R.J. Reynolds' request that it authorize 10 flavored products under the Vuse Solo brand, citing the 2021 National Youth Tobacco Survey, which found most youth and young adults who use e-cigarettes begin with flavors such as fruit, candy or mint, not tobacco flavors. The agency is still evaluating Reynolds' application for menthol-flavored Vuse products. 

The FDA release says the authorized products met the standard of protecting public health because participants in a study who used only the authorized products were exposed to fewer harmful and potentially harmful chemicals from aerosols, compared to users of combusted cigarettes, and because the authorized products' aerosols were found to be significantly less toxic than combusted cigarettes.

"The manufacturer’s data demonstrates its tobacco-flavored products could benefit addicted adult smokers who switch to these products – either completely or with a significant reduction in cigarette consumption – by reducing their exposure to harmful chemicals,” Mitch Zeller, director of the FDA’s Center for Tobacco Products, said in the release.

The Campaign for Tobacco-Free Kids did not support the authorization.

"While it is a positive step that FDA denied applications for 10 flavored Vuse e-cigarettes, it is concerning that a product that has three times the nicotine concentration as legally permitted in Canada, the UK and Europe was authorized. Vuse products with this level of nicotine leave our nation’s youth at an undue risk of addiction," Mathew L. Myers, the group's president, said in a statement

The FDA authorization came with strict marketing restrictions, including digital, radio and television advertising restrictions, aimed at reducing the potential for youth exposure. The agency said that if "evidence emerges of significant use" by individuals who did not previously use a tobacco product, including youth, it would take action, including withdrawing the authorization. 

"We must remain vigilant with this authorization and we will monitor the marketing of the products, including whether the company fails to comply with any regulatory requirements or if credible evidence emerges of significant use by individuals who did not previously use a tobacco product, including youth," Zeller said. "We will take action as appropriate, including withdrawing the authorization."

The youth tobacco survey found that approximately 10% of high school students who currently use electronic cigarettes named Vuse as their usual brand, and that compared to users of non-tobacco flavored e-cigarettes, young people are less likely to start using tobacco-flavored products and then switch to traditional tobacco products, the news release says.

The survey also found that more than 2 million U.S. middle and high school students reported currently using e-cigarettes in 2021, with more than eight in 10 of them using flavored e-cigarettes. 

In Kentucky, 26.1% of high-school students in 2019 said they had used e-cigarettes on at least one day during the 30 days before being surveyed, according to the Youth Risk Behavior Surveillance System Survey, a federal poll.

E-cigarettes were sold in the U.S. for years with little regulation, but in September the FDA ordered most of them off the market but delayed a decision on many, including the most popular brand, Juul.

Tuesday, October 12, 2021

Ky. Covid-19 metrics continue to drop, including vaccinations

Chart by The Washington Post, adapted by Kentucky Health News; click on it to enlarge.
By Melissa Patrick
Kentucky Health News

As cases of the coronavirus continue to wane in Kentucky and the positive-test rate keeps dropping, so have the number of vaccinations given. 

In the last seven days in Kentucky, 16% fewer vaccine doses were given than the previous seven, according to Centers for Disease Control and Prevention data processed by The Washington Post.

The seven-day average of 12,953 doses per day would have been considerably smaller if not for the 27,197 doses reported today, one of the state's higher daily totals of the last four months. 

The Post reports that Kentucky has administered at least one dose of a vaccine to 2.75 million people, covering 72.5% of the eligible population, 12 and older. At least 2.39 million Kentuckians are fully vaccinated. 

U.S. Food and Drug Administration advisory committee is scheduled this week to consider Moderna's request that a half-dose of its vaccine be approved as a booster, to be given at least six months after the second dose. The panel will also consider a Johnson & Johnson booster, CNN reports.

The FDA has already authorized boosters of Pfizer's vaccine for some adults, including individuals 65 and older; those living in long-term care facilities; people 19-64 with a medical condition that increases their risk of coronavirus infection; and people 18-64 who are likely to get exposed at their place of work. 

A third shot of the Pfizer or Moderna vaccine is available and recommended at least 28 days after the second shot for people who are immunocompromised. There are no booster recommendations yet for those who have received the one-dose Johnson & Johnson vaccine.

Daily numbers: Kentucky reported 2,358 new cases of the virus Tuesday, lowering the seven-day rolling average by 32, to 2,054. That makes the vaccination rate 6.3 times the new-case rate; last week it was 7 times higher. 

The percentage of Kentuckians testing positive for the coronavirus in the last seven days dropped again, to 8.12%. 

Hospital numbers also dropped again. Kentucky hospitals reported 1,329 Covid-19 patients, down 70 from Monday; 398 of them in intensive care, down 20; and 262 on mechanical ventilation, down 4. 

However, eight of the state's 10 hospital regions reported using at least 80% of their intensive-care beds, with two of them at 100%: Northern Kentucky and Lake Cumberland. 

Kentucky's seven-day infection rate remains ninth among the states, according to The New York Times' analysis of CDC data, showing a 34% drop in the last 14 days.  

The state reports its rate to be 38.52 daily new cases per 100,000 residents. Counties with rates more than double that rate are Mercer, 90.5; Pendleton, 83.2; Whitley, 81.9; Harlan, 80.7; Meade, 80.0;  and Russell, 78.1. 

The state reported 34 more Covid-19 deaths, raising the death toll to 9,184.

Covid-19 vaccine is 'best tool in toolbox' for kids to fight infection, but monoclonal antibodies are available for some who get it

American Medical Association graphic
By Melissa Patrick
Kentucky Health News

The best way to keep your child from getting Covid-19 is to get them vaccinated, and if they test positive for the disease, it's important to see if they qualify for a treatment called monoclonal antibodies to reduce their risk of hospitalization, says a pediatric physician at UK HealthCare. 

"We're still in the midst of a big surge of pediatric Covid cases that really started earlier this summer," Dr. Sean McTigue,  medical director for pediatric infection prevention and control at Kentucky Children's Hospital, said at a news conference. 

"Since July 30, we have had . . . more than six times as many admissions to Kentucky Children's Hospital for either severe or critical Covid-19 infections in children than we have for the entirety of the pandemic up until that point." 

In a case of severe Covid-19, a patient requires oxygen support or mechanical ventilation, and sometimes more advanced life-saving measures.  

McTigue said the vast majority of their Covid-19 patients have been 12 or older and thus eligible for a coronavirus vaccination. 

"We have not yet had a single patient who has been immunized to be admitted to Kentucky Children's Hospital for severe or critical Covid," he said. "So immunizations still appears to be our best tool in our toolbox to help fight this infection and to help keep kids healthy and out of the hospital." 

The state Department for Public Health reports that 47% of Kentucky's youth aged 12 to 15, and 52% of those 16 and 17, have received at least one dose of a coronavirus vaccination. 

Another way to keep children out of the hospital is for those who test positive for the virus to take a monoclonal antibody treatment, which are laboratory produced antibodies that mimic the body's natural immune response and reduce the likelihood of severe infection and hospitalization. 

McTigue said this treatment is now available for children who are over 12, are close to 90 pounds in weight and have a high-risk condition, such as diabetes, cancer, severe lung diseases and obesity, which is common. "Our number one driver of risk for admission the the children's hospital has been obesity," he said. 

McTigue cautioned that because society tends to skew towards being overweight and obese, a child may look fairly average, but actually meet the criteria for obesity, which puts them at a higher risk for Covid-19 complications. Kentucky ranks No. 1 in the nation for childhood obesity among children ages 10-17, at 23.8%. 

"If your child is infected with Covid-19, call your primary-care provider. They will absolutely be able to answer that question as to whether or not your child is considered obese," said McTigue. "One good rule of thumb I can say, though, is if you have to ask the question, there's a good chance that your child may actually meet the definition for obesity. It's much easier to meet than than most people think." 

The monoclonal antibodies have been available for several months, but it has taken some time to build an infrastructure to provide them. Toward that end, McTigue said Kentucky Children's Hospital has created the Pediatric Specialty Infusion Clinic to offer the monoclonal antibodies to children. 

There is no waitlist at the infusion clinic and children need a referral from their primary care provider to get the treatment, said McTigue. He added that the treatment should be given within 10 days after the onset of symptoms and that the earlier they are given, the more beneficial they are. 

 "I think what's very important is for parents to know that this exists, know that it's out there, and know that if their child does test positive for Covid-19 that they should be calling their PCP to discuss with them whether or not they might be a candidate," he said.  

In Kentucky, nearly 20% of all coronavirus cases have been in people under 20.

Even small breezes can increase virus transmission outdoors

In a recent study, researchers from the Indian Institute of Technology Bombay found that when someone coughs outside, "wind flowing in the same direction" can cause Covid-19 to replicate "faster over longer distances than in calm conditions." Co-author Amit Agrawal said, "The study is significant in that it points to the increased infection risk that coughing in the same direction as the wind could bring about."

The study, published in Physics of Fluids, showed that even a slight breeze of 5 miles per hour could make the virus more transmissible, and viral transmission grew with faster gusts of wind. This is because small whirlwinds allow large droplets to last longer in the air, so it takes longer for the viral load in the air to lessen.

"Based on the results, we recommend wearing masks outdoors, particularly in breezy conditions," Agrawal said. The researchers did not specify how large a gathering would need to be for viral transmission to be an issue, so wearing a mask, even with few people around, is still recommended.

"Other guidelines, such as coughing into an elbow or turning the face away while coughing, should also be followed," said a news release about the study.