Beshear says new vaccine is 'game changer' and the end of the pandemic is in sight, but masks and distancing are still needed

Margaret Brennan of CBS News interviewed Gov. Andy Beshear on "Face the Nation" Sunday.

By Al Cross

Kentucky Health News

As a new vaccine was released and the coronavirus and Covid-19 kept waning in Kentucky, Gov. Andy Beshear said the end of the pandemic is visible and the third vaccine "is going to be a game-changer."

The Centers for Disease Control and Prevention said the one-shot, easily handled vaccine developed by Johnson & Johnson could be given to anyone over 18, and shipments of it began moving out of the company's distribution center in Bullitt County to locations around the country.

"Johnson and Johnson is going to be a game changer," Beshear said on CBS's "Face the Nation" Sunday morning. "We can fully vaccinate everyone in just one shot . . . and we're going to get tens of thousands of additional vaccines per week, per state. It's just gonna get us to the finish line that much faster."

In a video Sunday afternoon, Beshear said new cases of the virus in the state went down for the seventh consecutive week, with final numbers to come Monday, and vaccinations are going faster than ever. He said that in the current vaccination week, with two days to go, more than 91,191 first doses have been administered, the most yet in a week.

"We're getting these vaccines out faster than the federal government can get 'em to us, and we'll get them to you," Beshear said. "Just make sure that you're patient and don't stop doing what is protecting us right now: Masking up, engaging in social distancing, reducing your contact. We can see the end; the light of the tunnel is getting brighter, and the directions that we're headed are good but we can't quit until we get the job done." 

Daily numbers: Beshear reported only 675 new cases of the virus, the lowest number on a Sunday in almost five months. Testing is down, but so is the percentage of people testing positive; in the last seven days, that figure was 5.02%, the lowest in more than four months.

The seven-day rolling average of new cases, generally the best indicator of the pandemic, fell to 1,094, the first time it has been under 1,100 since Oct. 19. Before the daily number was announced, the state remained 10th in new cases per population, according to a daily compilation by The New York Times.

Hospital numbers were down, except the number of Covid-19 patients on ventilators, which jumped to 118 after dropping to 87 the day before. Covid-19 hospitalizations in Kentucky hospitals totaled 732, down 33 from Saturday, with 187 in intensive-care units, down 22. An unusually large share of the ICU patients, 63 percent, were on ventilators.

The state added 12 more people to the list of people dying of Covid-19, bringing the toll to 4,637. Over the last 14 days, the number of people added to the list after review of cases has averaged 25.4 per day. The state does not issue detailed lists of Covid-19 deaths on weekends.

The state reported a new-case rate of 20.9 per 100,000 residents in the last seven days. Counties with rates more than twice that were Caldwell, 240; Taylor, 61; Lyon, 57.4; Clay, 46.7; and Russell, 42.2. The Caldwell and Lyon numbers appear to come mainly or partly from state prisons.

 

Counties with 10 or more new cases were Jefferson, 180; Fayette, 55; Pulaski, 31; Kenton, 24; Daviess, 16; Boone and Madison, 15; Bullitt, Jessamine and Scott,11; and Lincoln, 10.

National TV: The major premise for Beshear's appearance on "Face the Nation" was his high priority for vaccinating teachers and other school personnel. "We're about to be the first state to fully vaccinate all of our educators," he said, omitting his usual caveat: That doesn't include those who declined a shot.

"For us, this was a workforce issue," Beshear said. "It was development for our children, scholastically, emotionally and socially; and it was about getting back to some form of normal while we were still very careful. We made this call early on, we stuck to it, and no matter what you decide during Covid, some are going to oppose it, but it's about trying to do the right thing, the best thing for your people, and then let the consequences be what they'll be."

Host Margaret Brennan asked why Kentucky is "lagging" in vaccine rollout, at 29th in total vaccinations. Beshear replied, "We don't think that we're lagging," because the state has prioritized first doses. "We believe that we have to be as fast as possible with the first dose, to give people some level of immunity, and as of last week we had used 98.5% of all the first doses provided," he said. "We think differently on the second dose; that is meant for a very specific person, and so we made the decision that if it takes a little longer to get it to them, then we were gonna make sure it gets to them."

Asked about the relief-and-stimulus bill moving through Congress, and Senate Minority Leader Mitch McConnell's criticism of its money for state and local governments, Beshear said, "Every county judge-executive and every mayor across Kentucky, whether Democrat, Republican or independent, they'll tell you they desperately need this assistance."

He added, "This gives us the ability to make up for some of that harm. On the state level, this gives us an opportunity to stimulate our economy without having to borrow or go into debt." It's the federal government that will go further into debt to pay for the $1.9 trillion package. 

Beshear said the nation has a decision to make; "Are we gonna be FDR or are we gonna be Herbert Hoover? Do we want to make the decisions to get us out of this recession more quickly, which benefits every family, Democrat or Republican? But you gotta be bold to do that, and you can't worry about credit, whether it happens under a Democratic president or a Republican president. In the midst of a pandemic, can't we put that aside for just a little but and help all our families out there? I hope so."

Asked about the post-election remark by Sen. Joe Manchin, D-W.Va., that "a radical part of the so-called left" scared off rural voters, Beshear said "Our party, like others, has lots of different people with lots of different views. . . . People are passionate about the views they have, but we also have to be respectful of one another, to make sure that what brings us together isn't who we dislike but it's what we stand for. So when those debates are occurring, if they're actually on issues, then we're moving in the right direction, even if there is disagreement on those issues. I'm highly concerned that what is bringing too many people together in our country is who they dislike and not what they actually stand for."

Bills for local control of tobacco haven't even been assigned to committees, though advocates say they would pass on the floor

By Melissa Patrick
Kentucky Health News

With less than two weeks left in the 2021 legislative session, bills to let local governments regulate tobacco products are among the many that legislative leaders haven't even assigned to a committee.

Image: Public Health Law Center

The bills' sponsors told Kentucky Health News that they think the bills may have been lost in the shuffle of a short session that has to write a budget amid a pandemic, plus severe weather that cost a week. 

Sen. Julie Raque Adams, R-Louisville, said she has asked for her measure, Senate Bill 81, to be assigned to a committee, but has been told it's not likely to move. 

"It's not about the content of the bill, it's about the bandwidth of the bill," she said. 

Rep. Kim Moser, R-Taylor Mill, said she has not gotten much response from efforts to get House Bill 147 "referred or heard." 

"I think that we've got a lot on our plate and maybe they think this is bigger than it really is," she said. "All we're trying to do is to give local cities and counties control over their marketing and distribution of tobacco products."

Laura Leigh Goins, the spokeswoman for leaders of the House's Republican majority, told Kentucky Health News that the bill has not been assigned to a committee because "no committee chair has requested that bill."

Moser, who is chair of the House Health and Family Services Committee, said in an e-mail that she was hoping that the Local Government Committee would pick it up.

"Although in the big picture HB 147 is a health issue, it is really a Local Government issue," Moser said in an e-mail. "In order for this to gain support and momentum, it is important that Local Government be able to weigh in. . . . If I cannot get it assigned elsewhere, I will ask for it in my committee."

Rep. Michael Meredith, R-Brownsville, chair of the Local Government Committee, did not respond to an emailed request for comment. 

If passed, the bills would repeal a 1996 law, adopted after lobbying by tobacco manufacturers, that stripped local communities of power to regulate the sale and distribution of such products. 

Advocates say bills would pass

These bills are priority legislation for the Foundation for a Healthy Kentucky and the Coalition for a Smoke-Free Tomorrow who say local control is necessary to slow youth use of tobacco and electronic cigarettes, which Kentucky's youth say have increased during the pandemic. 

"We've actually got a lot of support in the legislature and if we could just get it to a committee, we believe we can pass it through both chambers," Ben Chandler, president and CEO of the foundation, which staffs the coalition, told Kentucky Health News.

He said not being able to spend time with legislators because of pandemic restrictions has made "a big difference" in getting these bills to move. 

 

Chandler said  the holdup on these bills is likely with convenience stores and gas stations and "vape" shops. He said such stores, particularly vape shops, are regularly popping up across from schools and playgrounds. "A locality . . . ought to have the authority to deal with that. That's what we're asking for," he said.

Nearly 25 years after the pre-emption law was enacted, Kentucky continues to have nearly the highest adult smoking rate in the nation, at 24 percent, with rates as high as 49% in some areas. 

Meanwhile, electronic cigarettes are addicting a whole new generation of youth to nicotine, with one in four Kentucky high-school students and nearly one in six middle schoolers regularly using e-cigarettes.

Opponents of the bill

The main argument from two opponents of the bills is that local control of tobacco and e-cigarettes would create a patchwork of regulations hard for consumers, employees and employers to follow. 

"A non-uniform local regulatory regime makes operating a business more complex and confusing for retailers trying to operate within the bounds of the law," David Sutton, a spokesman for Altria Group, the nation's largest cigarette maker, said in an email. "Giving localities the authority to impose local regulations encourages increased cross-border sales or purchases from other sources with different regulations."

Altria is 35 percent owner of Juul Labs, the largest e-cigarette company. Joe Sonka reports for the Louisville Courier Journal that Altria is regularly either the top or second-largest lobbying spender in Frankfort, but placed fifth in January, at $25,686.

The Kentucky Grocer and Convenient Store Association is also actively lobbying against the bills. 

"It would potentially allow more than 400 cities and every county to set their own regulations on tobacco sales, display and distribution," Steve McClain, spokesman for the association, told Kentucky Health News. "What we could see happening from this is that [this would form] a patchwork quilt of varying regulations across county and city lines that will confuse consumers and the stores."

Further, McClain said varying local rules would result in consumers going across county, city or state lines to purchase these products and when this involves states, they are taking their tax dollars with them. In addition, he said carding rules are already in place to ensure people under the age of 21 aren't able to buy these products.

McClain is also director of communications and public affairs for the Kentucky Retail Federation. Sonka reports that this group was the 10th highest legislative lobbying spender in January, at $14,418. 

Moser said of the opponents' arguments, "I don't know that I necessarily agree with that. I think that retailers and business centers are very used to paying attention to local ordinances, and that's all this would be."

What next? 

Moser said if these bills aren't heard, this session may have to be devoted to "getting the conversation started and reiterating the fact that we have a tobacco use problem in Kentucky and it causes a lot of health problems."

Raque Adams said she didn't expect the bill to move on the Senate side this year and certainly not before the House moved on it. She added, "I clearly support eliminating that preemption" and said she would sponsor the bill again next session if it does not pass.

In a blast of social media posts over the weekend in support of the bills, the foundation included videos of state and local leaders, and a legislator long identified with tobacco, who support them. 

Sen. Paul Hornback, R-Shelbyville, says, "I support giving local communities the tools they need to help with community health and making our country better."

Chandler said of legislators, "We recognize that they've got a lot of things on their plate. . . . they've got a lot of things that are higher priorities than this. But all we ask is that they assign it to a committee and let the committee chair hear it and then, of course, let it go to the floor."

New virus cases keep going down, but still 10th in U.S.; share of Kentuckians testing positive rises after falling for eight days

New York Times table, adapted by Kentucky Health News; for the full list, click here.

By Al Cross

Kentucky Health News

Cases of the novel coronavirus in Kentucky continued a downward trend Saturday, but the percentage of Kentuckians testing positive for the virus went up slightly.

Meanwhile, some experts worried that more contagious strains of the virus were already increasing new-case numbers in many states, and would require a larger-than-expected share of Americans to be vaccinated before the end of the pandemic could be declared.

The good news was that the U.S. Food and Drug Administration gave emergency-use authorization for the vaccine developed by Johnson & Johnson, which requires only one dose and can be stored in normal refrigerators, unlike the Moderna and Pfizer vaccines in use since December.

Once the Centers for Disease Control and Prevention gives the final go-ahead, perhaps Sunday, the new vaccine is expected to increase supplies 25%. However, “We're not going to have nearly enough in time” to prevent increases in cases from more contagious variants, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The variants mean that the U.S. will not achieve "herd immunity," protection of the unvaccinated, until 80 to 90 percent of Americans, including children, have been vaccinated, Dr. Peter Hotez, dean of Baylor University's National School of Tropical Medicine in Houston, told CNN. But Dr. Scott Gottlieb, a former FDA commissioner, said that as more Americans are vaccinated, the less the virus will spread.

Daily numbers: Kentucky reported 1,025 new cases of the virus Saturday, lowering the seven-day rolling average to 1,138 per day, the lowest since Oct. 19.

Gov. Andy Beshear said Thursday that the current Monday-to-Sunday reporting week probably wouldn't be the seventh straight week of fewer new cases, but the state appears to be on track to do that; unadjusted daily reports through Saturday totaled about 300 fewer cases than the same period a week earlier. 

After declining for eight days, the share of Kentuckians testing positive for the virus rose .04 percentage points, to 5.56%.

The state listed 25 more Kentuckians dead from Covid-19, all but one of them confirmed, for a total of 4,625 (4,199 confirmed). That was very near the average of 25.2 deaths per day in the last two weeks.

Hospital numbers improved, with only 765 Covid-19 patients hospitalized in Kentucky, 53 fewer than Friday. That was the first time since Oct. 21 the count has been under 800. Covid-19 patients in intensive-care units declined by 9, to 209, and ventilated ICU patients dropped by 18, to 87. Only 42% of Covid-19 ICU patients were on ventilators, an unusually low percentage. 

Two of the state's 10 hospital readiness regions were using more than 80% of their ICU beds: Lake Cumberland, 88.89% (20% for Covid-19 patients) and the easternmost region, from Lee to Pike counties, 80.15% (14% for such patients).

Counties with 10 or more new cases Saturday were: Jefferson,  149; Fayette, 74; Boone, 36; Kenton, 36; Campbell, 31; Taylor, 26; Hardin, 25; Scott, 25; Clay, 24; Pulaski, 21; Warren, 21; Laurel, 20; Madison, 19; Perry, 19; McCracken, Mason and Russell, 18; Knox, Lyon and Whitley, 16; Daviess, 15; Jessamine and Oldham, 14; Bell and Franklin, 12; Hopkins, 11; and Bullitt and Calloway, 10.

An outbreak of cases at the Western Kentucky Correctional Complex between Eddyville and Fredonia appeared to be connected to the high rate of infection this week in Caldwell County. The prison is in Lyon County, but its mailing address is Fredonia, which is in Caldwell County.

The state Corrections Department's Covid-19 report showed the complex had 232 of the 241 active cases among inmates in state prisons, and 18 of the 29 active cases among employees.

It's National Children's Dental Health Month, time to think about improving the poor oral health of Kentucky's children

By Stephanie Poynter
Chair, Kentucky Oral Health Coalition

It is no secret that Kentucky has historically had a poor reputation when it comes to our dental health. In a recent study ranking states with the best and worst dental health, the state ranked 41st in the nation in indicators of dental wellness. We have among the lowest dentists per capita, highest sugar-sweetened beverages consumption, and highest percentage of adult smokers – all contributing factors to poor oral health outcomes.

This is a reality that dental providers and advocates have grappled with for decades. And this is the reality that motivates the Kentucky Oral Health Coalition and its diverse membership in its collaborative oral health campaign designed to educate parents, activate policymakers, and inspire health professionals, as well as engage the public to create optimal oral health for all.

February is National Children’s Dental Health Month – a time when dental health providers and advocates promote the importance of establishing good oral hygiene habits early in life, needs around access to dental care and coverage, and ways to improve health outcomes across the lifespan.

Dr. Stephanie Poynter

Now, many of us have likely experienced some sort of tooth pain in our life – think back to how distracting or limiting that pain was for your daily life.

For children, when experiencing prolonged and persistent dental pain, it is difficult for them to develop the skills they need to learn. Once in school, students with poor dental health are three times more likely to be absent than other students. Additionally, children with poor oral health care experience higher rates of emergency room visits and have less promising job prospects as adults compared to children who receive appropriate oral health care.

The bottom line: when teeth are healthy and pain-free, it is easier for children to focus and listen, play and learn, and grow and thrive.

A recent survey of Kentucky parents and oral health, primary care, and school professionals conducted by KOHC indicated that the Commonwealth needs increased education around dental care early in a child’s life from pediatricians, school professionals, and parents as well as improved access to affordable dental care across the state for there to be real progress in health outcomes. Here are a few urgent recommendations for action in the statehouse to the schoolhouse to your house:

• Promoting oral health literacy campaigns to teach the basics of oral health.

• Integrating oral health services into doctor’s visits to prevent cavities in children, pregnancy complications in women, and oral health infection in adults.

• Ensuring all children entering Kindergarten have a dental screening/exam.

• Establishing school-based health programs and utilizing the Expanded Care Services policy in schools to increase access to care for children right where they are learning.

• Increasing access to care in rural and urban communities by leveraging tele-dentistry to detect oral health concerns – a practice that has increased in use during the Covid-19 pandemic.

• Sustaining state funding for Medicaid and Kentucky Children’s Health Insurance Program (KCHIP), and prioritizing investments focused on closing the remaining gap in child health coverage.

Oral health is much more than a bright, beautiful smile.

It takes establishing good brushing and flossing routines early in life and maintaining regular dental check-ups across the lifespan. It takes more equitable access to dental care right in our communities. It takes a commitment from state leaders to allocate funds for Medicaid and KCHIP programs and to address persistent racial disparities in coverage and access so that every child and their family can access the health care they need. It requires healthy foods and safe drinking water in every neighborhood and county.

It takes all of us to recognize that oral health IS health and that it must be prioritized in our homes, in our communities, and in our state budget. Only then will we see progress in that poor oral health ranking that has burdened Kentucky for far too long.

Dr. Stephanie Poynter is dental director at Louisville-based Family Health Centers Inc.

Nearly all metrics of the pandemic in Ky. are going the right way, with new single-dose vaccine likely to be approved this weekend

A flag is placed behind the Capitol for each Kentucky Covid-19 victim. (Photo by Melissa Patrick)

By Melissa Patrick

Kentucky Health News

The good news on a rainy Friday was that nearly all the metrics used to measure the pandemic in Kentucky are down, and the Johnson & Johnson one-shot vaccine will likely be approved this weekend. 

“We’re still not out of the woods with this horrible virus, but every week, we’re taking another step forward in our fight against it," Gov. Andy Beshear said in a news release. 

Beshear reported 1,180 new cases of the coronavirus on Friday, bringing the seven-day average to 1,182 – more precisely, 1,181.7, just 1.7 more than the daily number. That could be an indicator of stability. 

The percentage of Kentuckians testing positive for the virus in the past seven days declined again, to 5.52% on Friday, down from 5.67% Thursday. The World Health Organization says the rate should be below 5% for two weeks before governments ease restrictions imposed to thwart spread of the virus.

The state reports a new-case rate in the last seven days of 23 per 100,000 people. Counties with double that rate are Laurel, 47 per 100,000; Owsley, 51.8; Taylor, 59.9; and Caldwell, 248.8. The New York Times ranks Kentucky eighth in new-case rate over the last seven days.

Beshear reported 30 new deaths of Kentuckians from Covid-19, all but one of them confirmed. The governor continues to add new flags in memoriam of each Kentuckian who has died from Covid-19. Friday's additions brought that number to 4,600. 

Hospital numbers remain steady, with 818 people hospitalized in Kentucky with Covid-19 (down 25 from yesterday); 218 of them in intensive care (down 2); and 105 of those on a ventilator (down 17). 

Two of the state's 10 hospital readiness regions are using at least 80% of their intensive care beds: the easternmost region, from Lee to Pike counties, 81.6%; and Lake Cumberland, 93.3%. 

School openings: On Tuesday, Feb. 23, Beshear issued an executive order with recommendations for Kentucky school districts to offer or expand some in-person learning by March 1, or a week after school personnel have been fully vaccinated against the coronavirus. 

The Kentucky School Board Association tweeted that as of Feb. 23, 166 of the 171 districts have returned to in-person schooling, and that by March 15, at least 65 plan to have all students in person four or five days a week; another 16 districts plan that for elementary students, with middle and high school students in person two to four days per week. 

Valarie Honeycutt Spears reports for the Lexington Herald-Leader that at least three entire Fayette County school classes, as well as other students and staff, have been quarantined since students in kindergarten through second grade resumed in-person schooling Monday, Feb. 22.

Schools are asked to submit daily case and quarantine data to the state's K-12 dashboard, but 623 of the state's 1,477 public schools (42%, or three out of seven) did not report this week, and 181 (12%) have never reported. In the week ending Feb. 25, the dashboard shows 506 students and 86 staff have tested positive for the virus and 1,185 students and 129 staff were quarantined.  

Vaccines: The daily vaccination report shows 655,275 Kentuckians have received one dose of either the Pfize-BioNTech or Moderna vaccine. 

And with only three more days in the state's vaccine cycle, which runs Monday to Sunday, the state has only administered 39%, or 60,276 doses, of the 152,710 doses it received for first-dose distribution this week.

Beshear has said several times that this week will be a test run to see if the state's vaccine system is up to the challenge of delivering more vaccines, since it ended up with more than double the amount it normally gets because of the severe weather. 

And it looks like the supply is getting ready to stay up with approval expected to come as early as this weekend for the Johnson & Johnson single-dose coronavirus vaccine. 

An independent Food and Drug Administration advisory panel has recommended that the single-dose Johnson & Johnson's coronavirus vaccine for emergency use. Politico reports that FDA authorization could come as early as this weekend. 

"Johnson & Johnson has said that it will have 4 million doses available upon authorization, with 20 million doses delivered by the end of March. The company has promised the U.S. government a total of 100 million doses by late June," Politico reports.

As part of a campaign to increase coronavirus vaccination rates among Black communities,  Beshear joined Louisville NAACP leaders on Friday to address vaccine hesitancy in this population. So far, 4.6% of Black Kentuckians have received one dose of a coronavirus vaccine, even though they make up 8.5% of the population. 

Raoul Cunningham, president of the NAACP Louisville chapter, who welcomed the governor, said in a news release: "African-Americans are infected with COVID-19 at nearly three times the rate of white Americans and are twice as likely to die from the virus. The Louisville Branch NAACP encourages the entire community, especially our constituents, to get the vaccine." 

In other pandemic news Friday: 

• Today's 30 fatalities were a Carlisle County man, 79; two Clark County women, 65 and 87;a Daviess County woman, 84; three Daviess County men, 53, 76 and 83; a Floyd County man, 75; a Garrard County man, 73; six Jefferson County women, 53, 55, 63, 66, 67 and 86; five Jefferson County men, 60, 66, 70, 72 and 83; a Lincoln County man, 70; a McCreary County man, 74; two Mercer County women, 63 and 77; a Mercer County man, 74; a Perry County man, 72; two Pulaski County men, 66,71; a Rockcastle County man, 70; and a Rowan County man, 78.
• Counties with 10 or more new cases were Jefferson, 216; Fayette, 80; Kenton, 74; Boone, 49; Warren, 36; Campbell, 29; Scott, 27; Pike and Taylor, 25; Carter, 22; Perry, 21; Adair, 20; Grant and Whitley, 20; Hardin and Madison, 19; Daviess, 17; McCracken and Oldham, 16; Knox, 15; Johnson, 14; Caldwell and Pulaski, 13; Bath, 12; Laurel and Shelby, 11; and Jessamine, Lawrence and Russell, 10.
• In long-term care facilities, 167 residents and 162 staff have an active case of the coronavirus, with nine residents and 11 staff added to that list today. 
•  As Kentucky moves to the 1C category for coronavirus vaccinations on Monday, March 1, which includes essential workers, people 60 and older and those 16 and older with certain health conditions, Deborah Yetter of the Louisville Courier Journal reports that many 70 and older are still trying to get a shot. She writes, "Of the about 100,000 people in the [Louisville] metro area 70 or older, 44,853, or fewer than half, have been vaccinated, according to the local health department. Kentucky has about 500,000 people over 70 statewide, with about 278,000 vaccinated." Yetter also expands on the many challenges people are finding to get vaccinated in a system that is not centralized. 
• Health departments in Eastern Kentucky provide Hazard's WYMT-TV with a report that includes new coronavirus cases and related deaths for each of the departments or districts. 
• Click here for this week's federal Coronavirus Task Force report. 
• The governor renewed his executive order requiring face coverings for another 30 days, says the release.  
• In September and November 2020, direct observation at six universities with mask mandates, including the University of Pikeville, found that 90% of those observed wore masks correctly, including covering the mouth, nose and chin, according to a Centers for Disease Control and Prevention report. "Among 17,200 observed persons, 85.5% wore masks, with 89.7% of those persons wearing the mask correctly (overall correct mask use: 76.7%). Among persons observed indoors, 91.7% wore masks correctly. The proportion correctly wearing masks indoors varied by mask type, from 96.8% for N95-type masks and 92.2% for cloth masks to 78.9% for bandanas, scarves, and similar face coverings," says the report. 

Beshear says 119 new vaccine sites will bring total to 410; state's positive-test rate keeps falling; other metrics remain mostly stable

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

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear announced that the state will open 119 new coronavirus vaccination sites next week, bringing the total to 410. 

Six of the new locations will be regional sites; three are federally qualified health centers; 10 are at Walmart stores; 10 are at Kroger stores; and 90 will be at Walgreens stores. The new regional sites will be in Mount Vernon, Princeton, Burkesville, Richmond, Leitchfield, and Muhlenberg County. 

"Don’t let anybody tell you different; vaccinations are going incredibly well in Kentucky," Beshear said, referring to a report that gave Kentucky a low ranking on vaccine delivery. His administration said the report was misleading because it counted second doses and last week's weather fouled up the rollout.

Beshear said even though Kentucky only got 6,825 new doses last week because of the weather, the state was able to use all of its extra and ended up vaccinating 41,835 people with a first dose. 

“Last week was disrupted . . . We used every remaining bit that was out there," he said. "We will never judge ourselves in Kentucky by how quick the second dose gets to people. When we start doing that, it means we are sending it out willy-nilly. Every single second dose is for a specific individual that we want to get to that higher level of effectiveness of the vaccine. That's what the FDA tells us to do. That's what the CDC tells us to do. And that's what we're gonna do."

  

The state's daily vaccination report shows 646,836 Kentuckians have received their first dose of either the Pfizer-BioNTech or Moderna vaccine. That's 14.7% of the state's population, said Beshear. 

Lt. Gov. Jacqueline Coleman said transit agencies are offering free or reduced-cost transportation to and from vaccine appointments. She said such services are alreasy operating in 99 of the 120 counties. To find transportation near you go to kycovid19.ky.gov or call 855-598-2246. 

“We want all Kentuckians who wish to get vaccinated to be able to do so, and we do not want transportation to be a barrier,” Coleman said.

Starting Monday, March 1, Kentuckians in Category 1C become eligible for the vaccine. The category includes essential workers, people 60 and older, and people over 16 with certain health conditions. Beshear continues to ask sites to prioritize people 60 and older. 

Asked why hair stylists and barbers weren't included in Category 1C, Beshear first commended them for doing a good job in following public-health guidelines, but said they would not be in 1C because the CDC had not included them. 

Beshear confirmed that about 1,000 Ohioans signed up at a Kroger facility in Covington to get a vaccine. He said Kroger has since fixed the process so that can't happen again, and he would ask the federal government to send Kentucky doses from Ohio's allocation to make up for those doses.  

He said the Ohioans will be allowed to get the shots: “They’re people, too, and they can spread it across the river." 

Daily numbers: The share of Kentuckians testing positive for the virus in the past seven days was 5.67%, the lowest that rate's been since Oct. 24, but Beshear announced 1,447 new cases of the Thursday, bringing the seven-day average to 1,298, up for the third straight day. 

He said this week's case numbers are on track to be a bit higher than last week's, but blamed that on less testing being last week because of the weather. For example, he said about 14,000 tests were done Wednesday, but only 9,600 were done last Wednesday. 

From the Monday start of the reporting week through Thursday, there have been 4,780 cases; the same period last week had 3,958. 

The state reports a new-case rate of 24.7 per 100,000 people over the last seven days. Counties with more than double that rate are McCreary, at 49.7 per 100,000; Owsley, 51.8; Laurel, 53.1; Russell, 56.6; Taylor, 60.4; and Caldwell, 269. The state ranks 10th in new cases, The New York Times reports.

Hospital numbers remain steady, with 843 people hospitalized in Kentucky with Covid-19 (down 40 from yesterday; 220 of them in intensive care (down 8); and 122 of those on ventilators (up 10). 

Three of the state's 10 hospital readiness regions are using at least 80% of their intensive-care beds: Lake Cumberland, 91.1%; Barren River, 84.3%; and the easternmost region, from Lee to Pike counties, 80.9%.  

Beshear announced 43 more deaths on Thursday, 39 of them confirmed and four probable. That brings the death toll to 4,570. Deaths are announced after cases are reviewed for confirmation, which can take weeks.

The governor said a cursory glance at his list shows that the "vast majority" of the deaths happened in February, a "decent amount" happened in January and eight or fewer were what he called "historic deaths," meaning that they have been held up by the review committee for one reason or another. 

"This hasn't gotten easer in 11 months," he said. "Every day you feel people's loss." 

The 14-day death average is 25.6, were it was when a climb was in progress on Jan. 11 that ended up reaching a high of 47.3 on Jan. 29.

Asked when church capacities could be raised above 50%, Beshear noted that the limit has long been only advisory, and that if the state continues in the direction its on, "There is a lot of new opportunity." 

In other pandemic news Thursday:

• The 43 fatalities reported Thursday were a Bell County man, 73; a Boone County man, 95; an Elliott County man, 78; a Fayette County man, 91; two Floyd County women, 59 and 80; a Floyd County man, 72; a Graves County man, 75; a Hardin County woman, 60; a Henry County man, 70; a Hopkins County woman, 21; four Jefferson County women, 70, 76, 78 and 81; seven Jefferson County men, 57, 63, 79, 79, 81, 90 and 97; a Kenton County woman, 95; two Larue County men, 73 and 79; a Lawrence County woman, 67; a McCracken County woman, 78; a McCracken County man, 79; a McCreary County man, 62; two Madison County men, 84 and 85; a Marshall County man, 65; two Meade County men, 72 and 87; a Menifee County man, 49; a Nelson County woman, 85; two Nelson County men, 89 and 93; a Perry County man, 72; a Pulaski County man, 58; a Shelby County woman, 71; a Spencer County man, 87; and a Taylor County man, 72.
• Counties with more than 10 new cases were Jefferson, 220; Caldwell, 187; Fayette, 78; Boone, 43; Daviess, 40; Hardin and Scott, 37; Kenton, 36; Warren, 34; Bullitt, 30; Jessamine, 28; Laurel and Madison, 27; Johnson, 26; Whitley, 24; Taylor, 19; McCracken, Montgomery, Pike and Shelby, 18; Clark, 17; Adair and Christian, 16; Barren and McCreary, 15; Bell and Campbell, 14; Floyd, 13; Marshall, Nelson, Oldham and Perry, 12; and Knox, 11.
• In long-term-care facilities, 174 residents and 168 staff have active cases of the virus, with nine residents and 11 staffers newly positive. Beshear attributed 15 more deaths to the virus in the facilities, bringing their Covid-19 death toll to 2,258. 
• Click here for more information about unemployment insurance in the governor's news release.

Doctors tell patients to 'take their exercise pills' because physical activity is good for your mind, not just for your body

Wendy Suzuki, a neuroscientist at New York University, gives a TED talk.

By Arash Javanbakht

Associate professor of psychiatry, Wayne State University

Republished from The Conversation

As with many other physicians, recommending physical activity to patients was just a doctor chore for me – until a few years ago. That was because I myself was not very active. Over the years, as I picked up boxing and became more active, I got first-hand experience of positive impacts on my mind. I also started researching the effects of dance and movement therapies on trauma and anxiety in refugee children, and I learned a lot more about the neurobiology of exercise.

I am a psychiatrist and neuroscientist researching the neurobiology of anxiety and how our interventions change the brain. I have begun to think of prescribing exercise as telling patients to take their “exercise pills.” Now knowing the importance of exercising, almost all my patients commit to some level of exercise, and I have seen how it benefits several areas of their life and livelihood.

We all have heard details on how exercise improves musculoskeletal, cardiovascular, metabolic and other aspects of health. What you may not know is how this happens within the brain.
How exercise improves the brain.

Brain biology and growth

Working out regularly really does change the brain biology, and it is not just “go walk and you will just feel better.” Regular exercise, especially cardio, does change the brain. Contrary to what some may think, the brain is a very plastic organ. Not only are new neuronal connections formed every day, but also new cells are generated in important areas of the brain. One key area is the hippocampus, which is involved in learning and memory and regulating negative emotions.

A molecule called brain-derived neurotrophic factor helps the brain produce neurons, or brain cells. A variety of aerobic and high-intensity interval training exercises significantly increase BDNF levels. There is evidence from animal research that these changes are at epigenetic level, which means these behaviors affect how genes are expressed, leading to changes in the neuronal connections and function.

Moderate exercise also seems to have anti-inflammatory effects, regulating the immune system and excessive inflammation. This is important, given the new insight neuroscience is gaining into the potential role of inflammation in anxiety and depression.

Finally, there is evidence for the positive effects of exercise on the neurotransmitters – brain chemicals that send signals between neurons – dopamine and endorphins. Both of these are involved in positive mood and motivation.

Exercise improves clinical symptoms of anxiety and depression

Researchers also have examined the effects of exercise on measurable brain function and symptoms of depression and anxiety. Exercise improves memory function, cognitive performance and academic achievement. Studies also suggest regular exercise has a moderate effect on depressive symptoms even comparable to psychotherapy. For anxiety disorders, this effect is mild to moderate in reducing anxiety symptoms. In a study that I conducted with others among refugee children, we found a reduction in symptoms of anxiety and PTSD among children who attended eight to 12 weeks of dance and movement therapies.

Exercise could even potentially desensitize people to physical symptoms of anxiety. That is because of the similarity between bodily effects of exercise, specifically high-intensity exercise, and those of anxiety, including shortness of breath, heart palpitation and chest tightness. Also, by reducing baseline heart rate, exercise might lead to signaling of a calmer internal physical environment to the brain.

It is important to note that the majority of studies examined the effects of exercise in isolation and not in combination with other effective treatments of clinical anxiety and depression, such as psychotherapy and medication. For the same reason, I am not suggesting exercise as a replacement for necessary mental health care of depression or anxiety, but as part of it, and for prevention.

There are other perks besides the neurobiological impacts of exercise. When going out for a walk, one gets more exposure to sunlight, fresh air and nature. One of my patients befriended a neighbor during her regular walks, leading to regular taco Tuesdays with that new friend. I have made some great friends at my boxing gym, who are not only my motivators, but also a great supporting social network. One might pick a dog as their running mate, and another might meet a new date, or enjoy the high energy at the gym. Exercise can also function as a mindfulness practice and a respite from common daily stressors, and from our electronic devices and TV.

By increasing energy and fitness level, exercise can also improve self-image and self-esteem.

Practical ways for a busy life

So how can you find time to exercise, especially with all the additional time demands of the pandemic, and the limitations imposed by the pandemic such as limited access to the gyms?

Pick something you can love. Not all of us have to run on a treadmill (I actually hate it). What works for one person might not work for another. Try a diverse group of activities and see which one you will like more: running, walking, dancing, biking, kayaking, boxing, weights, swimming. You can even rotate between some or make seasonal changes to avoid boredom. It does not even have to be called an exercise. Whatever ups your heartbeat, even dancing with the TV ads or playing with the kids.

Use positive peer pressure to your advantage. I have created a group messaging for the boxing gym because at 5:30 p.m., after a busy day at the clinic, I might have trouble finding the motivation to go to the gym or do an online workout. It is easier when friends send a message they are going and motivate you. And even if you do not feel comfortable going to a gym during the pandemic, you can join an online workout together.

Do not see it as all or none. It does not have to be a one-hour drive to and from the gym or biking trail for a one-hour workout vs. staying on the couch. I always say to my patients: “One more step is better than none, and three squats are better than no squats.” When less motivated, or in the beginning, just be nice to yourself. Do as much as possible. Three minutes of dancing with your favorite music still counts.

Merge it with other activities: 15 minutes of walking while on the phone with a friend, even around the house, is still being active.

When hesitant or low on motivation, ask yourself: “When was the last time I regretted doing it?”

Although it can help, exercise is not the ultimate weight loss strategy; diet is. One large brownie might be more calories than one hour of running. Don’t give up on exercise if you are not losing weight. It is still providing all the benefits we discussed.

Even if you do not feel anxious or depressed, still take the exercise pills. Use them for protecting your brain.

Kentucky's positive coronavirus test rate drops below 6%, but state reports another spike in Covid-19 deaths: 51 listed today

Kentucky Health News graphic; click on it to enlarge

By Melissa Patrick
Kentucky Health News

The percentage of Kentuckians testing positive for the novel coronavirus dropped below 6 percent for the first time since Oct. 27, to 5.9%, Gov. Andy Beshear announced Wednesday. 

Beshear often notes that the positive-test rate is a leading indicator of the pandemic, so going forward the hope is that as this rate drops, fewer people will get the virus and fewer will die from it. 

The state announced 1,306 new virus cases Wednesday, pushing the total to 400,307 and bringing the seven-day rolling average to 1,229, up for the second day in a row. Beshear said in a video that this week's numbers are "on par" with last week's.

Kentucky's rate of new cases over the last seven days is ninth in the nation, according to The New York Times. The state reports that its seven-day infection rate averages 24.4 per 100,000 people. Counties with rates more than double that rate are Russell, 50.2 per 100,000; Taylor, 54.3; Laurel, 55.0; and Caldwell, 61.6. 

The tough news today, said Beshear, is that 51 more Kentuckians have died from Covid-19, tying for the seventh highest day for Covid-related deaths since the pandemic came to Kentucky last March. That brings the state's death toll to 4,527.  

Deaths are listed after they go through a review process to confirm that they were related to the virus, so they are not reported not on the day or week that they occurred.  

Today's spike in deaths raises the seven-day death average to 27.3, up from 22.6. The 14-day death average remained stable at 25.1, up from 25 yesterday. 

"Let's remember that this virus is still very serious," Beshear said. "It's still taking so many people around us and we have to mask up, we have to protect one another." 

The state's daily vaccination report shows 611,550 Kentuckians have received a first dose.  The state has 152,710 first doses to distribute this week, which includes not only this week's allotment, but about 64,000 doses from last week that were delayed by the ice storms. 

“We are getting these vaccines out faster than the federal government can provide them, so there’s a lot of hope moving into the future,” Gov. Beshear said on a YouTube post. “We are going to defeat this virus this year, but until then, we’ve got to protect each other.”

The nation is getting very close to having a third vaccine. A U.S. Food and Drug Administration review of Johnson and Johnson's single-dose coronavirus vaccine, released Wednesday, said it is safe and effective and has met the requirements for emergency use, CNN reports. The vaccine now moves to an external committee that is set to meet Friday for a final recommendation. That could release 3 to 4 million doses next week, the White House said.

Kentucky hospitals' Covid-19 numbers remained stable, with 883 patients (11 fewer than yesterday); 228 in intensive care (down 14); and 112 of those on a ventilator (down 9). 

Two of the state's 10 hospital readiness regions are using more than 80% of their intensive-care beds: Lake Cumberland, 97.8%, and the easternmost region, from Lee to Pike counties, 83.1%. 

In other pandemic news Wednesday: 

• Today's 51 fatalities were a Boone County woman, 59; a Boone County man, 79; a Campbell County woman, 58; a Carter County woman, 82; an Estill County man, 84; a Fayette County woman, 68; a Fayette County man, 71; two Floyd County women, 77 and 79; a Hardin County woman, 74; four Hardin County men, 44, 60, 82 and 92; a Harlan County man, 59; three Jefferson County women, 58, 84 and 84; three Jefferson County men, 62, 75 and 92; two Jessamine County men, 78 and 81; a Kenton County woman, 62, a Lawrence County woman, 71; a Lewis County woman, 66; a McCracken County woman, 79; three Madison County women, 86, 93 and 96; two Madison County men, 72 and 85; a Marshall County man, 63; a Meade County man, 66; a Menifee County woman, 92; a Mercer County man, 76; a Metcalfe County man, 65; two Montgomery County men, 61 and 64; two Nelson County men, 70 and 90; a Pulaski County man, 57; a Robertson County man, 82; a Rowan County woman, 78; a Rowan County man, 85; a Russell County man, 70; a Shelby County man, 91; two Warren County women, 75 and 77; and two Warren County men, 71 and 72.
• Counties with 10 or more new cases were Jefferson, 173; Fayette, 95; Kenton, 50; Boone, 37; Scott, 37; Warren, 37; Bullitt, 36; Pulaski, 32 ; Campbell, 31; Daviess and Laurel, 29; Barren, 27; Taylor, 25; Hardin 23; Perry, 22; Jessamine, 21; Grant and Madison, 20; Lincoln and Pike, 19; Bell, Knott and McCracken, 18; Christian, 17; Knox and Letcher, 14; Floyd, 13; Hopkins and Menifee, 12; Logan, Morgan, Nelson and Oldham, 11; and Clark, Marion and Meade, 10.
• In long-term care facilities, 187 residents and 169 staff have an active case of the virus, with 14 residents and 18 staff testing positive today. 
• A Centers for Disease Control and Prevention report said that among 81 attendees of indoor high-intensity fitness classes during one week, 55, or two-thirds, developed Covid-19. It says 22, or 40%, of those with Covid-19 attended class on or after the day symptoms began, and 76% of the attendees said they wore their masks infrequently: 84% if those with and 60% of those without it:

Health bills dealing with insulin cost, substance-use disorder and long-term-care staffing pass legislative chambers Tuesday

By Melissa Patrick
Kentucky Health News

Health-related bills are on the move in the General Assembly, with several of them passing out of their respective chambers Tuesday. 

House bills sent to the Senate include one that would help some Kentuckians with diabetes pay for their life-saving medication, another aimed at decreasing the stigma around getting syringes and needles in drug stores, and one related to temporary nurse aides.  

The Senate bill now in the House would remove prior-authorization requirements from drugs that help people who have a substance-use disorder deal with their addictions. 

Rep. Danny Bentley (LRC photo)

House Bill 95, sponsored by Rep. Danny Bentley, R-Russell, would cap the cost-sharing requirements for prescription insulin at $30 per 30-day supply for state-regulated health plans. The bill does not include Medicaid, Medicare or self-insured government plans.

Bentley, who is a Type I diabetic, said it is important for this bill to pass because many Kentuckians have to make a regular choice between paying their rent or buying their insulin. 

He explained that the cost of insulin has tripled between 2002 and 2013, even though the cost to manufacture the drug is between $3.69 to $6 per vial. 

“If I was paying cash for my insulin, if I didn’t have the insurance I have, my insulin would cost me $12,000 a year,” Bentley said while holding up a vial of insulin. 

He added that without the insulin, people can suffer serious health consequences, such as losing their sight, amputation or even death. 

Rep. Patti Minter, D-Bowling Green, whose son has Type I diabetes, said, “No one should lose their sight because they don’t have access to something that costs $6 a bottle to manufacture. ” Minter is a primary sponsor of the bill.

According to the 2020 Kentucky Diabetes Fact Sheet, 13.7% of Kentuckians have been diagnosed with diabetes, and an estimated 158,200 adults have the disease, but are undiagnosed. Not all use injectable insulin. 

HB 95 passed the House 95-0 to a round of applause. A similar bill passed the House during the last legislative session, but died in the Senate as legislative business was truncated by the pandemic.  

HB 219, also sponsored by Bentley, would remove pharmacy recordkeeping requirements for sale of hypodermic syringes or needles and allow their sale of without a prescription, with a limit of 30 of each and proof that the purchaser is 16 or older.

"House Bill 219 removes obsolete recordkeeping requirements for the sale of hypodermic syringes by pharmacies. The goal is to increase the availability of syringes in order to reduce the spread of diseases such as HIV, which turns into AIDS and hepatitis C," said Bentley. 

He added that as it stands, people who buy syringes and needles in pharmacies have to sign a black book that asks what that person plans to use them for, and removing this requirement "destroys that stigma." 

After changes in committee and on the floor, the bill would require pharmacies offering retail sale of syringes and needles to provide educational materials on safe and proper disposal of the products; referral information for syringe exchange programs and treatment of substance-use-disorder; and to offer a naloxone prescription that could be used to reverse an opioid overdose. It passed 97-0. 

HB 276, sponsored by Rep. Kim Moser, R-Taylor Mill, would allow nurse's aides who were trained as temporary Covid-19 personal-care attendants under an emergency executive order from Gov. Andy Beshear to apply their supervised training toward their state certification and registration. Moser said the bill will affect about 300 attendants who have been working in long-term care during the pandemic. The bill passed 96-0. 

Sen. Ralph Alvarado (LRC photo, Jan. 9)

Senate Bill 51, sponsored by Sen. Ralph Alvarado, R-Winchester, would ban the requirement of prior authorization for any prescription drug that is used in the treatment of alcoholism or opioid-use disorder that contains methadone, buprenorphine or Naltrexone, or that is approved by the U.S. Food and Drug Administration for the mitigation of opioid withdrawal symptoms. 

Prior authorization is a process insurers use to get their approval before a patient can get a drug. Alvarado, a physician, said such authorizations are common for these medication-assisted therapies and can take days or weeks. 

"Providers are routinely stymied by PA requirements at the critical moment when patients are ready to begin treatment and address their alcohol or opioid use disorder," he said, adding that the requirement puts the patient at risk of "relapse, overdose or even death." 

The bill also calls for an annual report to be sent to the Department of Insurance that shows the number and type of providers that have prescribed medication for addiction treatment, broken down by those who prescribed it in conjunction with behavioral therapy and those who did not prescribe it in conjunction with behavioral therapy. 

"Frankly, in conclusion, this is going to help save lives here in the state of Kentucky," Alvarado said. The bill passed 34-0.

Kentucky Health News is 10 years old; here's more about us

Kentucky Health News entered its 11th year last month. How did it get started? How does it approach its work? What has it learned from its research and outreach? These and other questions were answered Wednesday by Al Cross and Melissa Patrick in a presentation for the University of Kentucky College of Communication and Information, where they work. As the college's extension professor and director of the Institute for Rural Journalism and Community Issues, Cross is editor and publisher of KHN. Patrick, a journalism graduate of UK and a former registered nurse, is KHN's only reporter. For a video of their presentation, click here.

Ky. to get more vaccine doses; Beshear recommends more in-person schooling; daily coronavirus metrics improving or stable

State Department for Public Health map, relabeled by Kentucky Health News; click it to enlarge.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear announced 1,497 new coronavirus cases on Tuesday, bringing the state's seven-day rolling average to 1,187, up from 1,152 Monday. 

Kentucky's rate of new cases over the last seven days is 10th in the nation, according to The New York Times. The state says its seven-day rate of new cases is 23.22 per 100,000 residents; counties with more than double that rate are Russell, at 48.6 per 100,000; Laurel, 49.3; and Caldwell, 53.8. 

Beshear said at a news conference that the "best piece of news today" was the percentage of Kentuckians testing positive for the virus in the past seven days had dropped to 6.3%, the lowest since Nov. 4.  

"That's good because the positivity rate is a leading indicator, instead of a lagging indicator," he said. 

A lagging indicator is deaths. Beshear announced 16 more deaths from Covid-19, all but one of them confirmed. That brings the state's death toll to 4,476. 

"While it's not the 30, 40 or 50 we've seen in other weeks, it's still too many," he said. Over the last 14 days, the state has reported an average of 25 Covid-19 deaths per day; the average was last that low Jan. 12.

Hospital numbers remain stable, with 894 people hospitalized with Covid-19 (an increase of 20 from yesterday); 242 in intensive care (down one) and 121 of those on a ventilator (up two). 

Two of the state's 10 hospital readiness regions are using more than 80% of their intensive-care beds: the easternmost region, from Lee to Pike counties, 81.6%, and Lake Cumberland, 88.9%. 

Vaccine update: The state's daily vaccination report shows 594,380 Kentuckians have received their first dose of either the Pfizer-BioNTech or Moderna vaccine. 

Beshear said the Biden administration is again increasing states' vaccine allocations, which will give Kentucky about 10,000 more doses per week for at least three weeks. He also announced that drug stores in the federal pharmacy program will also get a small boost of about 1,000 more doses. 

This week, the state is expecting to get 152,710 doses, which includes the weekly allotment and about 64,000 doses from last week that were delayed by the extreme weather.

This influx of vaccine is timely; Beshear announced Monday that Kentucky's 51 regional sites will start vaccinating people in the 1C category on Monday, March 1. This group includes all essential workers, people over 60 and people 16 and older with certain medical conditions. 

Tinglong Dai, an expert in health care operations and vaccine supply chain who works at Johns Hopkins University, wrote in The Conversation that the best way to get people signed up for vaccines is through a "trustworthy one-stop pre-registration system" that notifies a person when it is time for them to sign up and allows them to check where they are in the line. He notes that West Virginia, which has been lauded as a leader in vaccine distribution, has such a system. 

Asked about Kentucky's sign-up system, Beshear said it is designed to tell a person when they are eligible to get a vaccine and where the closest site is. 

He said information technology "is the most challenging piece" because Kentucky does not have an IT system capable of handling a one-stop system. He said the state's partnerships with private partners, like Kroger, which has more sophisticated systems, "gives us an extra level of protection of not crashing" and of protecting personal information. 

That said, he acknowledged that Kentucky's system has led to people signing up at more than one location. He said the no-show rate is 5% to 10%, "and we believe that's one of the major reasons."

"I fully understand that one system would certainly prevent some of that," he said. "All we ask is for those people, when you get your appointment, please cancel the other ones that you put in for." 

School openings: Beshear issued an executive order Tuesday that was not a directive, but a recommendation: that Kentucky school districts offer or expand some form of in-person instruction by March 1, or a week after school personnel have been fully vaccinated against the coronavirus. 

Beshear said schools must require masks indoors, should evaluate their ventilation systems and consider "appropriate safety procedures," reduce student density either through social distancing or by using a hybrid model, and provide "meaningful" virtual options for students not returning to the building.

"At the end of the day, we didn't vaccinate our educators for nothing," the governor said. "We did this because we all know that we need some form of in-person learning." He reiterated that Kentucky has led the nation in getting its K-12 personnel vaccinated.

Beshear announced that all school requirements tied to counties' color-coded infection rates will be discontinued March 1. However, he said the rates and map will still be made available and should be checked to assess community spread. 

"That should impact decisions made by a community and by a school in terms of extracurriculars or those additional things that might bring in that community spread," Beshear said. Thirty-seven of the 120 counties are in the most critical "red zone," averaging 25 or more cases per 100,000 people over the last seven days.

Beshear said 165 of the state's 171 school districts have returned to some form of in-person instruction. Click here for the latest Kentucky Department of Education Covid-19 guidance. 

In other pandemic news Tuesday:

• The 16 newly listed Covid-19 fatalities were a Hopkins County man, 51; four Jefferson County women, 70, 80, 80 and 92; three Jefferson County men, 67, 78 and 86; a McCracken County man, 80; a Muhlenberg County woman, 60; an Ohio County man, 89; a Shelby County woman, 33; a Spencer county man, 68; a Warren County man, 72; and two Whitley County women, 53 and 56. 
• Counties with 10 or more new cases were Jefferson, 208; Fayette, 133; Boone, 70; Laurel, 65; Kenton, 61; Warren, 49; Pike, 46; Daviess, 39; Hardin, 34; Madison, 31; Campbell, 29; Perry, 28; Pulaski, 27; Scott and Taylor, 26; Oldham, 25; Christian and Nelson, 24; Jessamine, 23; Knox, 22; Bullitt, 21; McCracken and Rowan, 20; Lawrence, 18; Greenup, 17; Barren, 16; Russell, Shelby and Whitley, 15; Boyd, Clay and Letcher, 12; Carter and Harlan, 11; and Adair, Marshall and Meade, 10.
• Long-term-care facilities have 196 residents and 169 staff with active cases of the virus, with eight residents and 16 staffers testing positive Tuesday. 
• Kentucky doctors say they continue to see regular cases of multisystem inflammatory syndrome in children, known as MIS-C, a rare but sometimes deadly complication in children who have had Covid-19, Deborah Yetter reports for the Louisville Courier Journal.  There have been no deaths from MIS-C in Kentucky, but it has killed 30 children nationwide. Yetter adds that between Norton Children's Hospital in Louisville and Kentucky Children's Hospital in Lexington, around 50 children have been diagnosed with MIS-C and are closely followed for complications, which could include heart damage.

Vaccinations will move March 1 to the 1C category: People over 60, those with certain health conditions, and essential workers

Ky. Dept. for Public Health graph, relabeled by Ky. Health News; for a larger version, click on it.

By Melissa Patrick

Kentucky Health News

Kentucky's regional coronavirus vaccine sites will open March 1 to people in the 1C category, which includes essential workers, people 60 and older and those 16 and older with certain health conditions. 

1C includes about 1.3 million Kentuckians, which will make it "seem like it's really hard to get an appointment," Gov. Andy Beshear said Monday, but he added, "That will loosen up." 

Beshear said the 51 regional vaccine sites will be asked to prioritize people 60 and older, and health departments will be asked to keep prioritizing those in the 1A and 1B categories, who are now getting shots.

Those two categories include residents and staff in long-term-care and assisted-living facilities, health-care personnel, anyone 70 and older, first responders, K-12 school personnel and child-care workers. 

Beshear said 39 percent of all first doses so far have gone to people 70 and older, and 13.5% have gone to those 60 to 69. Nearly 92% of all Covid-related deaths in Kentucky have been in people 60 and older, according to the state Department for Public Health.  

Health Commissioner Steven Stack said the state now has more than 360 vaccine locations, and more will be announced on Thursday. Click here to find out when and where you can get vaccinated. 

The daily vaccination report shows 583,754 Kentuckians have received a first dose of a coronavirus vaccine. Because of the extreme weather, Beshear said Kentucky only got 6,825 doses of vaccine last week,  instead of the 71,000 it was expecting. 

That means the state will receive the remaining estimated 65,000 doses this week in addition to the state's regular weekly allotment. "This is a good test for us," he said, in anticipation of the time when the state gets large shipments of the vaccines. 

Daily numbers: With all of metrics used to measure the impact of the pandemic going down, Beshear said, "Provided this trend continues, we think we're going to be able to provide some additional opportunity and some additional relief in the rules and the regulations that we have in place."

Asked specifically about increasing restaurant capacity, an industry whose workers will fall under the 1C vaccination category, Beshear said that is "definitely under consideration," but will likely happen in "small steps" of increasing restaurant capacity, now limited to 50%. 

Beshear announced 530 new cases of the virus Monday, bringing the state's seven-day rolling average to 1,152, down from 1,180 on Sunday. That is the lowest since Oct. 21, but most other states have declined more rapidly, so Kentucky's new-case rate is eighth in the nation, according to The New York Times.

The share of Kentuckians testing positive for the virus in the past seven days declined again, to 6.6%, down slightly from 6.72% on Sunday.

Beshear acknowledged that testing was limited last week, which could have contributed to the low number of cases, but added that it was a "real positive sign" that the positivity rate remained low. 

Kentucky hospitals reported 870 people Covid-19 patients (down 32 from yesterday), 243 of them in intensive care (down 5); and 119 of those on ventilators (down 29). 

Only one of the state's 10 hospital readiness regions is using more than 80% of its intensive-care beds: Lake Cumberland, at 91%. 

“They are going in a positive direction, perhaps the most positive since the pandemic began,” Beshear said of the state's hospitals. “What that means is we’re doing a good job.”

The Lexington Herald-Leader reports that more than 119,000 coronavirus vaccines have been administered in Lexington, with priority given to those 70 and older and that new hospitalizations for Covid-19 over the past week are lower than they've been since October.

Deaths were also down Monday. Beshear announced 13 new deaths from Covid-19, all of them confirmed as being caused by the disease. That brings the state's death toll to 4,460. 

Beshear paid tribute to the 500,000 Americans who have died from Covid-19. 

"It is an almost unimaginable loss, worse than any war we've fought," he said. "The tragedy that is this virus is very, very real. And while we have good news about the direction things are going, and we all ought to feel that, we’re going to emerge from this with a lot of scars inside and out." 

In other pandemic news Monday: 

• Today's 13 deaths were a Bullitt County man, 70; a Daviess County man, 56; two Fayette County men, 78 and 86; three Jefferson County women, 60, 81 and 83; three Jefferson County men, 74, 85 and 93; a Mercer County woman, 89; a Shelby County woman, 69; and a Shelby County man, 85. 
• Counties with 10 or more new cases on Monday were Jefferson, 95; Fayette, 30; Oldham, 24; Campbell, 21; Kenton, 20; Boone, 19; Laurel and Warren, 15; McCracken, 14; Carter and Franklin, 13; Daviess and Knox, 11; and Scott, 10.
• In long-term care, 210 residents and 168 staff have active cases of the virus, with 26 residents and 21 staff testing positive Monday.
• A Montgomery County parent wants a judge to issue an emergency injunction against the Kentucky High School Athletic Association, calling the current rules that require middle- or high-school athletes who test positive to self-isolate for up to three weeks "unconstitutional" and "inconsistent" with the rules set forth by the Centers for Disease Control and Prevention and other sporting leagues, Ayana Archie reports for the Louisville Courier Journal. The lawsuit asks that Kentucky schools follow the same rules as the Southeastern Conference, which says an athlete is not required to quarantine after seven days if they test negative for the virus on day five, six or seven, or the quarantine can end without a test after 10 days with no symptoms. 
• A new CDC study shows that teachers and staff may play a "central role" in transmitting the coronavirus in schools where social distancing isn't followed and face masks are not worn. “Educators played an important role in the spread of Covid-19 in the schools. Covid-19 spread often occurred during in-person meetings or lunches and then subsequently spread in classrooms,” CDC Director Rochelle Walensky told reporters at a briefing Monday. “The two main reasons for the spread of Covid-19 in these schools were inadequate physical distancing and mask adherence in the schools.”

25% of Ky.'s community-health-center visits are via telehealth; bill would codify some temporary telehealth rules, such as audio visits

This story has been updated to report that HB 140 passed the House. 

By Melissa Patrick
Kentucky Health News

A  bill to codify telehealth provisions that were put into place during the pandemic to temporarily relax some of the regulations has passed out of the House and now moves to the Senate for consideration. 

Rep. Kim Moser, R-Taylor Mill, who is the co-sponsor of House Bill 140, told Kentucky Health News that it is very important for this telehealth bill to pass. 

Rep. Kim Moser

"I think that it's critical," she said. "We know that we have a healthcare access problem in Kentucky and this directly impacts and improves access to care."

She called the relaxation of the rules during the pandemic "a real godsend" and said going forward, it will continue to increase access to care for Kentuckians, especially for those with health care disparities, like transportation and poverty.

Moser said a key component of the bill is that it continues to allow audio-only visits, which she said is imperative because the state has many places without broadband and many patients who are not adept at using the technology.

The bill also requires parity of payment for services that are delivered in a like manner to an office visit, and allows licensing boards of each profession to have input around what types of visits would be conducive to telehealth services.

"The utilization of telehealth has been one of the shining moments of hope throughout the pandemic," Rep. Deanna Frazier, R-Richmond, said at the Feb. 4 House Health and Family Services Committee meeting, where the bill passed unanimously. 

Frazier, who is the primary sponsor of the bill, added that during the interim, the committee heard testimony that more than 70% of Kentucky physicians have used telehealth during the pandemic.  

Among the state's community health centers, that number amounts to about one in four, or 25.3%, according to data provided by the Kentucky Primary Care Association. 

The association has reported that such centers, which are located in medically underserved communities, provide the medical home for one in eight Kentuckians, more than 550,000 people.

Nationwide, that amount of telehealth use is a bit higher among such centers, 30.2%, or nearly one in three, according to a recent report from the Centers for Disease Control and Prevention. 

The CDC report analyzed data from 245 community health centers that provided data about their telehealth visits from June to November. It found that centers in the South and in rural areas consistently reported the lowest use of telehealth. The South, which includes Kentucky, had a weekly telehealth-visit rate of 20.4%, or about one in five.

The report said, "Telehealth is critical to improving access to health care, especially among populations with limited access to care, and to enhancing the U.S. health care system’s capacity to continue to respond to the pandemic."

The Primary Care Association, which includes federally qualified health centers, commonly known as community health centers, rural health clinics and others, said in an email that it supports legislation that "reduces health disparities and provides patients with additional treatment options." 

"The new legislation creates a successful and forward thinking telehealth infrastructure for the future," David Bolt, CEO of the association, said in an email. "This will become an essential component of increasing access to quality primary health care, which will improve health outcomes for all residents of the state.” 

Click here for a video from the association about how one of its community health clinics has prioritized telehealth.