Medicare-certified nursing homes will open to visitors Monday; guidelines criticized; 1C vaccine category qualifications expanded

Screenshot of interactive New York Times map shows in black counties that have had more than 250 new coronavirus cases per 100,000 residents in the last seven days. Lyon County is highest, and adjoining Caldwell is high, due to outbreaks at state prisons in Lyon. To enlarge this image, click on it.

By Melissa Patrick
Kentucky Health News

Medicare-certified nursing homes in Kentucky will be allowed indoor visitation Monday, March 15, Gov. Andy Beshear announced Thursday. 

"This is great news for Kentucky and our so many families that have missed their loved ones," he said at his last Covid-related news conference of the week. "The light at the end of the tunnel is getting brighter, but we have to continue to remain vigilant." 

In compliance with Centers for Medicare and Medicaid Services guidance issued Wednesday, Beshear said that with the exception of end-of-life situations, everyone entering the skilled-nursing facilities will be screened for Covid-19 upon entry and public-health precautions will remain in place. 

Cabinet for Health and Family Services Inspector General Adam Mather encouraged potential visitors to get vaccinated, and said those who haven't been will be required to have a negative test within 72 hours of the visit. Also, he said, anyone with a known exposure to the virus should not visit. 

He said visitation should not be allowed when a visitor is unvaccinated and the county has a positivity rate of 10% or higher, or is in a "red zone" county, those averaging 25 or more cases per 100,000 people over the previous seven days, and less than 70% of the home's residents are fully vaccinated; or if the resident is infected with the virus or is quarantined due to potential exposure.  

Mather said close contact with a resident is allowed as long as the resident has been fully vaccinated and the visitor wears a mask and practices proper hand hygiene before and after contact. 

"I've spoken to many family members," he said, "and they just want to touch their loved ones' hands."

He also encouraged visitors to reach out to the facility prior to the visit to ensure that it can accommodate the visit. 

Kevin Kavanagh

Dr. Kevin Kavanagh, a retired Somerset physician who heads Health Watch USA, which focuses on infection control, objected to the new government guidelines.

He told Kentucky Health News that he had many concerns, including rules that allow visitation to continue as soon as one round of testing is completed and reveals no cases after a new case is identified.  "That doesn't work," he said. "You've got a long incubation period and we saw that in the Rose Garden" event Sept. 26 for new Supreme Court Justice Amy Coney Barrett, which led to several Covid-19 cases.

Kavanagh also objected to the part of the federal guidance that will allow visitation in certain units of a home that have tested negative for the virus, while closing other units that still have active cases.  Because the virus is aerosolized, he said, it can spread through the home's ventilation system to other units. 

"That's kind of like smoking in the back of an airplane," he said. "This thing's aerosolized. That doesn't work." 

He added, "These are our highest risk individuals. . . . This virus is relentless, it does not care. And we cannot set up the elderly in an unsafe situation, especially when vaccines are available. If people want to visit the elderly, they should get vaccinated . . . . At a minimum, one of the two should be vaccinated, especially in times of high community spread." 

He expanded on his concerns in an op-ed for Infection Control Today titled, "Nursing Home Guidance Endangers Elderly."   

The state reported Thursday that there are 121 active cases among residents of long-term-care facilities and 136 among staff. It said on Feb. 1,  more than 70% of residents and 45% of staff had been vaccinated as part of the federal program. The numbers did not reflect employees that may have been vaccinated elsewhere. 

In mid-February, the state relaxed some visitation restrictions at assisted-living homes, personal-care homes, intermediate-care facilities for individuals with intellectual disabilities, and independent-living facilities whose residents are fully vaccinated.

Kentucky's nursing homes will use a "smart entry screening platform" that will allow employees in the 285 Medicare-certified homes to enter them in a touchless manor with "smart badges."  Mather said the device has a touchless infrared thermometer attached to a tablet with screening questions. 

Beshear said Kentucky will be the first and only state to provide these contactless screening devices designed to help reduce the spread of infection. CMS approved the Trilogy Foundation proposal to implement the program at a cost of nearly $6.8 million. The foundation's website says it was established in 2018 to support families and communities affected by tragedy, disaster and poverty. 

Mather said the federal vaccination program to vaccinate long-term care residents and staff had wrapped up, and that the state was now moving into a "maintenance program" along with independent pharmacies. When asked, Mather could not provide updated numbers on how many residents and staff had been vaccinated in the program, but said they were working on getting those numbers. "Anecdotally, we've seen similar numbers to the national numbers," he said. 

Vaccines: Health Commissioner Steven Stack said that with the exception of smoking, Kentucky would expand the list of health conditions allowed in the current vaccination category to include health conditions that "might be at an increased risk" for severe illness from the virus as defined by the Centers for Disease Control and Prevention.

Some of the newly added conditions include asthma, high blood pressure, dementia, being overweight and Type 1 diabetes. The 1C category already included people with conditions known to increase risk of the virus, essential workers and people 60 and older.

The daily vaccination report shows 910,353 Kentuckians have received one dose of a coronavirus vaccine. No new vaccination sites were announced this week.

State Dept. for Public Health chart, adapted by Ky. Health News; for a larger version, click on it.

Daily numbers: Kentucky ranks 15th for its new-case-rate, according to data collected by The New York Times, which also shows Lyon County to have the highest rate in the nation, 539 per 100,000. That is due to an outbreak at the Kentucky State Penitentiary and the Western Kentucky Correctional Complex. 

The state reports Lyon County's rate to be even higher, 673.4 per 100,000, and the statewide rate as 14.11 cases per 100,000. Other counties with rates more than double the statewide rate are Knox, 31.6; Carroll, 32.3; and Owsley, 35.6.

Prisons accounted for 213 of the 1,211 new cases Beshear announced Thursday, raising the seven-day new-case average to 819, 21 more than Wednesday. He said more information would be provided Monday. The Corrections Department report shows 494 active cases among inmates and 43 among staff at the penitentiary, and 288 and 26 at the complex.

The share of Kentuckians testing positive for the virus in the past seven days was 3.95%, virtually the same as the 3.94% on Wednesday.

Beshear announced 37 more deaths from Covid-19, 30 of them confirmed and seven of them probable. The state's death toll from the virus is 4,921.

The fatalities were an Anderson County man, 76; a Fulton County man, 96; a Graves County woman, 75; a Graves County man, 85; a Greenup County woman, 64; three Greenup County men, 52,74,84; a Harlan County man, 66; two Harrison County women, 78,81; a Hopkins County woman, 85; a Jefferson County woman, 81; six Jefferson County men, 47,61,70,72,74,88; a Jessamine County woman, 94, a Jessamine County man, 83; a Kenton County man, 63; a Knott County woman, 78; two Letcher County men, 72,85; a Livingston County man, 74; two McCreary County women, 73,76; a Marion County woman, 89; a Perry County woman, 76; a Perry County man, 85; a Pulaski County woman, 69; a Taylor County man, 76; and a Washington County woman, 88.

In other pandemic news Thursday: 

• Counties with 10 or more new cases are Lyon, 254; Jefferson, 167; Kenton, 92; Boone, 61; Fayette, 58; Campbell, 50; McCracken, 29; Knox, 20; Daviess, 18; Franklin, 16; Bullitt and Hardin, 15; Madison and Warren, 14; Pulaski, 13; Laurel, Oldham, Russell and Scott, 12; Grant and Graves, 11; and Whitley, 10.
• Hospital numbers remained stable, with 523 Covid-19 patients, 136 of them in intensive care; and 75 of those on ventilators.
• The Lake Cumberland hospital readiness region, and the easternmost region, from Lee to Pike counties, continue to use at least 80% of their intensive-care beds: 86.67% and 80.15%. respectively.
• The highly infectious variant of Covid-19 discovered in the English county of Kent, which swept across the United Kingdom last year before spreading worldwide, is between 30 and 100 percent more deadly than previous strains, a new analysis shows. The study found that the variant led to 227 deaths in a sample of 54,906 patients, compared to 141 among the same number of closely matched patients who had previous strains.
• A single shot of a two-dose vaccine may be sufficient to provide immunity to people who have previously been infected by the virus, thus eliminating the need for a second dose and helping to stretch vaccine supplies, a study from Mount Sinai Hospital in New York has found. Such a change could also spare people the side effects of a second dose, which researchers found to be significantly greater in those with pre-existing immunity to the virus.
• CVS Health will offer coronavirus vaccines at three stores in Jefferson and Bourbon counties through a federal program that ships vaccines directly to participating drugstores, Deborah Yetter reports for the Louisville Courier Journal. Appointments will become available online or through the CVS app on Saturday with the first vaccines available as soon as Sunday.
• The Centers for Disease Control and Prevention is looking to partner with Dollar General Corp. to provide access to coronavirus vaccines in rural communities, WDRB reports.
• CDC data shows that 2,617 children have been diagnosed with Multisystem Inflammatory Syndrome in Children, a sometimes fatal disease, and 69% are Black or Latinx, Side Effects Public Media reports. Nationwide, at least 33 children have died from MIS-C. 
• Click here for Beshear's press release with information about the Healthy at Home Eviction Relief Fund and and unemployment insurance. 
• Former presidents joined forces in an advertising to encourage people to get vaccinated. One of the ads, titled “It’s Up To You” and posted Wednesday to YouTube, shows Barack Obama, George W. Bush, Bill Clinton and Jimmy Carter and former first ladies Michelle Obama, Laura Bush, Hillary Clinton and Rosalynn Carter getting their shots while discussing the importance of the coronavirus vaccine. The second ad shows three of the former presidents — Obama, Bush and Clinton — sharing information about the vaccines and again encouraging Americans to get it.