Research finds declines in drug-overdose death rates in eight Eastern Kentucky counties and explores the many reasons for it

From "Understanding Declining Rates of Drug Overdose Mortality in Eastern Ky.;" click it to enlarge

By Melissa Patrick
Kentucky Health News

A decline in drug-overdose deaths in several Eastern Kentucky counties in the last decade was likely the result of state policies and strategies, stakeholders in the region told researchers for a newly published study. 

“The findings of this study are very encouraging, as eight counties in Eastern Kentucky were among the 10 counties nationally with the greatest decline in drug-overdose mortality,” Fran Feltner, director of the University of Kentucky Center for Excellence in Rural Health, said in a news release. "Of the top 20 counties nationally, 14 were in Eastern Kentucky.”

The study looked at the two five-year time periods between 2008 and 2017, using data from an opioid mapping tool from the Walsh Center for Rural Health Analysis in the National Opinion Research Center at the University of Chicago and drug-overdose death data from the Centers for Disease Control and Prevention's National Center for Health Statistics. 

The eight Eastern Kentucky counties with the greatest decline in overdose death rates between 2008-12 and 2013-17 were Clay, Johnson, Floyd, Magoffin, Breathitt, Bath, Powell and Letcher, according to the report. 

The researchers from UK and NORC noted that the declines in overdose death rates in those Eastern Kentucky counties happened even as overdose rates went up across the nation, in the state as a whole, and in the Appalachian regions of neighboring states such as Ohio and West Virginia. 

This prompted them to try to find out why, by asking key stakeholders in the Eastern Kentucky region what they thought was driving those declines. The stakeholders included representatives from criminal justice, prevention and education, economic development and recovery, substance use treatment, state and local health departments, health care and harm reduction. 

The report details some policies, programs and interventions that key informants gave as reasons for why the region saw such declines. They include: 

Shifts in drug-use patterns: "Across all sector types, interview respondents described the increased use of methamphetamines, in particular, as a primary contributing factor to reduced opioid mortality rates as access to prescription opioids declined," says the report. 

Improving prescribing behaviors:  "Many interview respondents indicated that less access to prescription opioids is likely contributing to the declines in drug-overdose mortality," the report says. 

In 2012, the General Assembly required health-care providers who prescribe controlled substances to use the prescription-drug monitoring program that the state created in 1998.

The legislature also limited who could own and invest in a pain clinic to being "only a physician having a full and active license to practice medicine." A representative from the state Office of Drug Control Policy told the researchers  that “from 2011 to 2018, 100 million fewer dosage units of opioids a year were prescribed …we got rid of 36 pain clinics. Low-hanging fruit with that 2012 legislation.”

Increasing access to substance-use treatment: One of the major reasons given for the decreased overdose deaths in the region was the increased access to treatment for substance-use disorder that came from the Patient Protection and Affordable Care Act, fully implemented in 2014. 

Prior to the ACA, Kentucky did not cover drug treatment for Medicaid enrollees, and any such treatment had to be individually approved by the federal Centers for Medicare and Medicaid Services. Under the ACA, Kentucky added a wide range of treatments to its Medicaid, which was expanded to those with household incomes up to 138% of the federal poverty level. 

"The number of enrollees in Kentucky’s Medicaid expansion program receiving substance-use services increased by more than 700 percent between the first quarter of 2014 and the second quarter of 2016, from approximately 1,500 to more than 11,000 care encounters," says the report. 

Some respondents also noted the wide range of ways that people could access treatment in the region, whether from referrals from judges, law enforcement, harm-reduction sites or community organizations. 

Focus on individuals in recovery: Several respondents said a focus on helping people in recovery gain work and housing, along with peer support, has contributed to the region's decreased overdose death rate.

A stakeholder from the criminal-justice field noted that the Kentucky Chamber of Commerce's efforts in this area, and another respondent said, "The willingness of employers to hire people with a record or a history of addiction has helped keep people in recovery, which ultimately would contribute to the decline in mortality rates.”

Evolving approach to criminal justice: Law-enforcement stakeholders told researchers that there has been a shift in how police officers interact with people who use drugs, noting that many of them now try to refer them to treatment, instead of immediately arresting them. The State Police Angel Initiative, started in 2016, allows anyone with substance-use disorder to come to a KSP post and get help to find treatment. 

Others pointed out that judges across Eastern Kentucky have shifted from sentencing people who use drugs to prison, to sending them directly to treatment. A representative from Operation UNITE said every county in the Fifth Congressional District operates a drug court, as do 113 of the state's 120 counties. Some noted that the effectiveness of these programs vary by county. 

Expansion of syringe exchanges: Interviewees also attributed the low death rates to syringe-exchange programs, which they said provide a safe place for individuals who use drugs to learn about the resources available to help them.

As of October 2020, the report says Kentucky had 74 such harm-reduction sites, mostly in the eastern part of the state. The report notes that number was more than all neighboring states combined.

Longstanding political commitment:  Respondents described the "consistent and bipartisan" political support of state leaders as one of the reasons for the declining death rates. In particular, respondents said Fifth District U.S. Rep. Hal Rogers' longstanding commitment to the issue was a reason for the decline. Rogers launched Operation UNITE in 2003. 

"Prior to Medicaid expansion, Operation UNITE’s treatment vouchers were one of the main sources of funding for treatment and recovery services, making UNITE an essential stakeholder supporting Kentucky’s longstanding history of addressing addiction concerns," says the report.

Stakeholders also pointed to former Gov. Ernie Fletcher's efforts to facilitate continued growth of the recovery housing community in Eastern Kentucky and former Gov. Steve Beshear's support of the ACA and his role in expanding Medicaid to more people in Kentucky. 

Increased distribution of naloxone: Some respondents pointed to increased distribution of naloxone, which blocks an overdose, as one of the reasons for the region's decreased overdose-death rates. However, others said the notable increase in naloxone distribution has occurred more recently and may not have played a significant role by 2017.

Appalachian culture: Some stakeholders credited the resiliency of the Appalachian people, and others noted the importance of local coalitions and grassroots efforts to address substance use, as reasons for the decline in overdose deaths. Some of the respondents also talked about how reduced stigma has increased enrollment in treatment. 

While the study acknowledges that the key respondents' findings are based on their thoughts and opinions, it notes that many of the strategies thought to be successful in reducing overdose mortality in the region could be adapted and leveraged elsewhere. 

“This story of success and progress in Eastern Kentucky highlights the strength and resilience of the Appalachian people, and shows what can be accomplished with collaboration, bipartisan support and a longstanding commitment to addressing substance use across the region,”  Michael Meit, NORC project manager and senior fellow, said in the news release.

Pandemic roundup: Ky. ranks 29th in full vaccination; U of L Health to require staff shots; daily new-case average below 400

Kentucky ranks 29th among the states in percentage of population fully vaccinated for the coronavirus and 28th in the share of residents who have received at least one dose of vaccine, according to The Washington Post.

Chart of Centers for Disease Control and Prevention data by The Washington Post

Post graph from CDC data shows national figures

The Centers for Disease Control and Prevention says 38 percent of Kentucky's population is fully vaccinated and 46 percent of state residents have received at least one does of a vaccine. Two of the three available vaccines require two doses.

State officials emphasize the one-dose percentage. The state Department for Public Health says that among the Kentuckians who are eligible to get a vaccine, those age 12 and older, 54 percent have had a shot.

Screenshot of state Dept. for Public Health interactive map, labeled by Kentucky Health News

The University of Louisville's health system will be the first major one in Kentucky to require employees to get a coronavirus vaccine. The rule will take effect Sept. 1, when it U of L Health expects at least one of the three vaccines currently approved for emergency use will have final federal approval. It estimates more than 70% of its 12,000 workers in five hospitals, four medical centers and over 200 physician practices have been vaccinated. "Atria Senior Living, an assisted-living company based in Louisville, requires the Covid-19 vaccines for its 10,000 member workforce nationwide, as do two other senior living companies with sites in Louisville, the Courier Journal reports.

Kroger Co. is offering customers, employees and other people who get a vaccination the chance to win $1 million or free groceries for a year, the Courier Journal reports: "The sweepstakes are being offered in collaboration with the Biden administration as part of the president’s bid to get the U.S. toward the threshold of herd immunity, where so many Americans are protected against the new coronavirus that it can’t spread."

Alexandra Ellerbeck writes for The Washington Post: "The vaccination rate in the United States has fallen sharply from an average of more than 3 million shots a day in early April to around 1.62 million shots. And although the administration only needs to average about half a million shots a day to reach the July 4 deadline, the number of people who say they want a vaccine but haven’t gotten one is quickly shrinking. Only 4 percent of adults fall in the category of unvaccinated people who say they want a shot 'as soon as possible.' A similar proportion of people have an appointment scheduled for a vaccine or plan to make one in the next three months, even though they say they want to “wait and see” before getting a shot," according to a Kaiser Family Foundation poll. "If both those groups follow through, it may be just enough to reach Biden’s goal."

Daily numbers: The state reported 415 new cases of the virus, lowering the 7-day rolling average by 19, to 394 per day. This is the first time it has been below 400 since July 14, 2020. The new-case rate fell again, to 5.98 per 100,000 residents. Counties with rates more than double the statewide rate were Webster, 39.7 per 100,000; Owen, 21; Union, 20.9; Robertson, 20.3; Bath, 17.1; Harlan, 15.9; Rowan, 15.8; Laurel, 14.8; Rockcastle, 13.7; Montgomery, 13.2; Taylor, 12.8; Adair, 12.6; and Casey, 12.4.

The percentage of Kentuckians testing positive for the virus over the last seven days fell 0.08 percentage points, to 2.43%. It has been below 3% since May 15.

Kentucky hospitals reported 338 Covid-19 patients, 103 of them in intensive care and 64 of those on a ventilator.

On Friday, the state lifted capacity restrictions on businesses and venues with capacities of 1,000 or less; restaurants and bars can fill to 75%. Memorial Day weekend travel will be a test of resistance to the virus, USA Today reports.

The Kentucky Chamber of Commerce has gently joined calls for Gov. Andy Beshear to end extra unemployment benefits, as Republican governors have done but he and other Democrats have not. The chamber wrote Beshear Friday, "asking that the administration consider phasing out" the $300 weekly benefit by July instead of the federal program's Sept. 30 ending date, Jacqueline Pitts writes for the chamber's Bottom Line.

The business lobby told Beshear that a phase-out would "help address a serious workforce shortage faced by employers." It said that wouldn't be "a cure-all," and "Steps must also be taken to increase access to high-quality child care, retrain and reskill workers, and increase vaccination rates. We also believe that return-to-work incentives, which other states have implemented, are worth exploring, particularly incentives that assist working parents to afford and have access to child care."

Now that the governor is giving pandemic news briefings just once a week, and has resumed a travel schedule that looks to be aimed in part at getting re-elected in 2023, "Politicos are busy jostling over what voters should think of Beshear’s handling of the crisis," writes Lexington Herald-Leader political reporter Daniel Desrochers. "Was he the steady leader who took decisive action to save the lives of thousands of Kentuckians during an unforeseen emergency or the power-hungry executive who overstepped his authority to control the daily lives of Kentuckians?" Kentucky's infection rate was 29th among the states and territories, and its death rate was 32nd, Desrochers reports.

Northern Kentucky jail offers treatment and care after release as part of drug treatment for inmates who want it

Photo: Liz Dufour/The Enquirer

A jail in Northern Kentucky has embraced science-based research for inmates with addiction for inmates who want it since 2015, and now that program includes care after release, Terry DeMio reports for the Cincinnati Enquirer.

DeMio walks through what the Kenton County Detention Center in Independence offers inmates, while regularly reminding readers that while the program is not what standard incarceration looks like, "It is still a jail." 

"But it is rare for jails and prisons in the United States to offer a full continuum of treatment for inmates with addiction, and especially, to include medication – even though it is the standard of care," she writes. 

In 2015, the detention center hired Jason Merrick, a certified drug and alcohol addiction counselor with degrees in social work who was in recovery himself to a newly created role: addiction services director. Merrick designed the program around what addiction specialist consider best practices, DeMio reports. 

In 2018, the jail partnered with Hazelden Betty Ford Foundation in a program called Strong Start Comprehensive Opioid Response with 12 Steps and Reentry, which includes three months of treatment that includes opioid-use disorder medications, followed by three months of aftercare. 

DeMio reports that it appears to be working. Only 24% of those who completed both the jail and aftercare program have been rearrested and jailed after three years, said John Clancy, director of strategic partnerships at the Life Learning Center, a focal point of the aftercare program. That compares to 68% recidivism after three years nationally, according to the Department of Justice.

The program, which is voluntary, has evolved to include two deputy/counselors, two re-entry specialists, a population management specialist and three social-work interns from Northern Kentucky University.

The staff makeup is just what people with substance-use disorder need, says Lindsey Vuolo, vice president of health law and policy for the Partnership to End Addiction, a national nonprofit dedicated to transforming how the United States addresses addiction.

“It is really important for jails and prisons to include medical professionals and individuals with lived experiences when designing this type of program,” Vuolo told DeMio, citing research from the National Council for Behavioral Health.

And all along, the University of Kentucky Center on Drug and Alcohol Research tracks and evaluates the Kenton County treatment plan, DeMio reports.

DeMio reports how the Life Learning Center in Covington, which offers the aftercare, helps the former inmates. She notes that it offers a range of services that include helping the former inmates connect with health care providers who offer medication assisted therapies to providing job-readiness skills and job-finding help. 

She also notes that the center helps the former inmates find appropriate clothing for work, offers childcare, helps them find affordable dental care and offers an on-site location that will remove their tattoos for free. 

DeMio also walks through how the program is funded and how officials say it ultimately saves taxpayers money. 

She writes, "Here's how: A year of incarceration costs about $24,000 for one person. Almost every inmate in the treatment program is spared a conviction likely to yield an 18-month jail sentence. The inmate is jailed instead for 90 days – which yields 15 months not served. That 15 months would cost $30,000 if served in jail. Merrick's records show that about 450 graduates have gone through women's and men's programs each year. That's $13.5 million saved every year, he says. Beyond that: Without evidence-based treatment in jail, it's likely inmates with opioid use disorder will relapse after release. And if they don't overdose and die, it's likely they'll be arrested again and return for more jail stays." 

For Bethany Ball, associate director of Addiction Services, and her staff, it's not just about the dollars, DeMio reports.

"We are trying to address the areas that we see people struggling with consistently, especially those that aren’t always addressed: culture, mental health, trauma, childhood trauma," Ball told DeMio. "We are committed to not just saving lives, but helping to show that there is a life worth living and they are worthy of that life."

Pandemic metrics, still tilting down, pass more milestones

State Dept. for Public Health map, relabeled by Ky. Health News; click on it to enlarge.

By Al Cross
Kentucky Health News

Measures of the pandemic passed more milestones in Kentucky Wednesday.

The percentage of Kentuckians testing positive for the coronavirus fell to 2.4%, the lowest level since testing for the virus became widely available just over a year ago.

The state reported 440 new cases of the virus, lowering the seven-day rolling average to 434 per day. It hasn't been that low since July 17, and has dropped for nine consecutive days. In the last 14 days, the daily average has dropped 22%, according to The New York Times. 

The statewide rate of daily new cases fell to the lowest level since the state began reporting it in December: 6.66 cases per 100,000 residents. The Times says the rate is 16th among the states.

Counties with rates more than double the statewide rate were Webster, 33.1; Owen, 27.5; Union, 22.8, Adair, 20.8; Robertson, 20.3; Bath, 19.4; Montgomery, 18.3; Gallatin, 17.7; Harlan, 17.6; Rockcastle, 17.1; Whitley, 16.2; Laurel, 14.8; Powell, 13.9; Bourbon, 13.7; and Knox, 13.3.

Kentucky hospitals reported 349 Covid-19 patients, 109 of them in intensive care and 50 of those on ventilators. Those figures have also trended downward; the average hospital count in the past seven days has been 352; in the previous week it was 397, so the latest weekly average was a drop of 11.3 percent. 

Two hospital regions reported more than 80% of intensive-care beds in use: Lake Cumberland, 91%, and the easternmost region, from Lee to Pike counties, 82%. In the former region, 22% of ICU beds had Covid-19 patients; in the latter, only 6% did, about average for the state other than Lake Cumberland.

The state reported 19 more Covid-19 deaths, 16 from regular health-department reports and three from an ongoing audit of death certificates. Over the last two weeks, the state has averaged 7.3 deaths per day; in the previous two weeks, it was 9.3. The state's Covid-19 death toll is 6,744.

Chamber, UK school starting public-policy series with discussion of health differences and disparities between rural and urban Ky.

The health disparities between rural and urban Kentucky, and differences in health-care access and delivery, will be discussed in the first of a new series of public-policy webinars sponsored by the Kentucky Chamber of Commerce and the Martin School of Public Policy & Administration at the University of Kentucky.

The sponsors say the event, scheduled from noon to 1:30 p.m. ET Tuesday, June 8, will examine the intersection of health care and the urban-rural divide: How do health care systems differ between Kentucky’s urban and rural areas and what makes these differences significant? Does public policy in Kentucky accurately reflect the diverse health care needs of our urban and rural populations? How does the urban-rural divide impact access to health care in Kentucky? Answers will come from a panel:

• Mark Birdwhistell, UK Health Care chief of staff and vice president for health services administration
• Larry Gray, president of Baptist Health Louisville and former president of Baptist Health Corbin
• State Sen. Ralph Alvarado, R-Winchester, chair of the Senate Health and Welfare Committee and a physician
• State Rep. Kim Moser, R-Taylor Mill, chair of the House Health and Family Services Committee and a former nurse

Chamber Senior Policy Analyst Charles Aull will moderate the discussion. He said it will include the opportunity for questions from participants. The webinar is free; to register, click here.

“We look forward to not only engaging in these roundtable discussions but also serving as a resource for policy-makers and other interested parties,” said Kate Shanks, vice president of public affairs at the Chamber and a Martin School graduate. “Our goal is that these sessions will lead to better understanding of these important issues and help develop Kentucky-specific solutions.”

Future programs in the series will address the rural-urban divides in education (July 15) and economic development (Aug. 10).

Beshear says Ky. data prove vaccines work; asks younger Kentuckians, who make up most new cases, to get vaccinated

Graphic by The Washington Post is updated daily.

By Melissa Patrick

Kentucky Health News

At his only announced pandemic press briefing of the week, Gov. Andy Beshear shared Kentucky data that shows how well coronavirus vaccines work, and again implored younger Kentuckians to go get one. 

First, he showed how deaths related to Covid-19 have plummeted since Kentuckians have been able to get vaccinated, falling from a high of 1,672 deaths in December, when the first vaccines became available to some, to only 56 in May, with less than a week left in the month. 

In March and April, of the people who tested positive for the virus in Kentucky, 97.5% were not vaccinated; of those who were hospitalized, 94.3% of them were not vaccinated; and of all the Covid-related deaths, 94.4% were not vaccinated, Beshear said. 

"These things work," he said. "Yes, they are not 100% effective, but when you look at these numbers, they are much more than 90% effective. Folks, these vaccines have earned an A, and we all ought to recognize that and take them. Those are incredible numbers that show just how effective the vaccines are." 

So far, 2,006,742 Kentuckians have received at least one dose of a vaccine, which amounts to 45% of the total population or 56% of the adult population. 

Beshear said he was proud to see an increase in the number of people who got a first dose of a vaccine last week, up nearly double from the prior week, to 74,553. 

He said 23,409 12- to 15-year-olds have received at least one dose of a vaccine since it became available to them, and "You want to keep that up."

Moderna announced today that its early trials show the vaccine is 100% effective for 12- to 17-year-olds and said it will seek emergency approval from the U.S. Food and Drug Administration to expand its use in teens. Currently, the Pfizer-BioNTech vaccine is the only one approved for that age group. 

Beshear said if the Moderna vaccine is approved for this age group, it will help get them vaccinated before school starts in the fall. 

The weekly federal pandemic report for Kentucky shows its share of fully vaccinated people has dropped from 27th to 31st among the states in the last three weeks. Asked why, and what the state is doing about it, Beshear and Health Commissioner Steven Stack pointed to lack of second doses.

Stack said coming back for that second shot is "very important" in order to be fully protected and for it to last longer. He added that just because it looks like we are resuming normal activities, that doesn't mean you don't need to get that second shot. 

The Centers for Disease Control and Prevention says that as of May 21, 37% of Kentuckians are fully vaccinated. Nationwide, 50% of U.S. adults are fully vaccinated. 

Prisons: Beshear announced that the Department of Corrections and the Department of Juvenile Justice will resume in-person visitation the week of June 20. It has been stopped since the pandemic began. 

He said visitation will open by appointment to fully vaccinated family and friends of inmates. A state news release says available times will be published on the agencies' websites June 4. Beshear said 76% of adult inmates have been vaccinated, and vaccines will be offered to new inmates and those who originally declined one. 

State Dept. for Public Health graph, relabeled by Ky. Health News; click on it to enlarge.

Daily numbers: The share of Kentuckians testing positive for the virus in the last seven days is 2.52%. It hasn't been that low in almost a year.

Beshear announced 580 new cases of the virus, saying it was the lowest Tuesday number in three months. It lowered the seven-day rolling average by nine, to 456 down for the eighth straight day.

He said the highest new-case rate is still among 10 to 19-year-olds, closely followed by those 20-49. “Our incidence rate is much higher among younger Kentuckians than older Kentuckians,” he said. “It’s directly associated with . . . whether you’re vaccinated.”

The state reports that 81% of Kentuckians 65 and older have received at least one dose of a vaccine; 61% of people 50-64; 47% of people 40-49; 42% of people 30-39; and 31% of people 18-29. 

Kentucky has seen three straight weeks of declining cases and positive-test rates. Beshear called this yet more "real-world proof" of how effective these vaccines are. 

The statewide rate of daily new cases over the last seven days is 7.01 per 100,000 residents, down 0.42 from Monday and the lowest since the state began reporting the figure in December. Counties with rates more double the statewide rate are Owen, 27.5; Adair, 23.8; Bath, 22.9; Union, 21.9; Webster, 19.9; Rockcastle, 18; Montgomery, 16.7; Gallatin, 16.1; Bourbon, 15.2; Harlan, 14.8; Carroll, 14.8; Laurel, 14.3; Mason, 14.2; and Whitley, 14.2.

The state reported five more Covid-19 deaths, four from regular health-department reports and one from the ongoing audit of death certificates. The state's Covid-19 death toll is 6,725.

Kentucky hospitals reported 353 Covid-19 patients; 108 of them in intensive care and 49 of those on a ventilator. All hospital readiness regions are using less than 80% of their intensive-care beds. 

Beshear also acknowledged the loss of two people who he said had made an impact on his life, both of them to cancer. One was his Aunt Mary Ann Miller and the other was 9-year-old David Turner Jr., who advocated for childhood cancer research and early in the pandemic asked Kentuckians to wear a mask. 

In other pandemic news Tuesday: 

• U.S. Sen. Rand Paul says he won't get a coronavirus vaccination until he sees that it would be more effective than the natural immunity he says he has from having been infected with the virus more than a year ago. Paul said on WABC Radio in New York, "Until they show me evidence that people who have already had the infection are dying in large numbers, or being hospitalized or getting very sick, I just made my own personal decision that I’m not getting vaccinated because I’ve already had the disease and I have natural immunity." Fox News notes, "The Centers for Disease Control and Prevention has encouraged people who have had Covid to get vaccinated because "experts do not yet know how long you are protected from getting sick again after recovering." Research says at least eight months, and the degree of immunity appears to increase with the severity of the case. Paul had a mild case.
• "The daily vaccination rate has sunk below where the United States needs to be to meet President Biden’s July 4 vaccination goals," Paige Winfield Cunningham reports for The Washington Post. "Yet Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said he thinks the targets will still be met. 'I believe we will attain' the president’s goal of having 70 percent of Americans vaccinated with at least one dose of a coronavirus vaccine, Fauci told my colleague Yasmeen Abutaleb during a Washington Post Live interview."
• The source of the virus remains a mystery, "but in recent months the idea that it emerged from the Wuhan Institute of Virology, once dismissed as a ridiculous conspiracy theory, has gained new credence. How and why did this happen?" Glenn Kessler of The Washington Post asks and answers.
• Experts generally believe that the pandemic has killed more people than accounted for in government lists of Covid-19 deaths, but estimates vary. Recently The Economist estimated that the global death toll is 10 million, three times the official counts; now the Institute for Health Metrics and Evaluation at the University of Washington estimates that there have been 6.9 million deaths, more than double the official toll. The estimated U.S. difference is smaller, 58% (574,043 official deaths, 905,289 estimated deaths).
• Why do we get coronavirus shots in the arm? Because the muscles there are good at picking up antigens in the vaccine that stimulate immune responses and are close to the lymph nodes, which have more immune cells that recognize the antigens "and start the immune process of creating antibodies," Purdue University professor Libby Richards writes for The Conversation. "Muscle tissue also tends to keep vaccine reactions localized. . . . Another consideration during vaccine administration is convenience and patient acceptability. Can you imagine taking down your pants at a mass vaccination clinic? Rolling up your sleeve is way easier and more preferred."

Places with more uninsured had more Covid-19 cases, deaths, and Ky. did well; its Medicaid rolls grew more than all but 2 states'

Chart by Dustin Pugel, Kentucky Center for Economic Policy, click on it to enlarge.

By Melissa Patrick
Kentucky Health News

People living in communities with high rates of uninsured people were much more likely to get the coronavirus and to die from it than people living in communities with fewer uninsured people. 

That's according to a new Families USA report, "The Catastrophic Cost of Uninsurance: Covid-19 Cases and Deaths Closely Tied to America's Health Coverage Gaps," which found from the start of the pandemic through the end of August, every 10 percent increase in the proportion of a county's residents who lacked health insurance was associated with a 70% increase in coronavirus cases and a 48% increase in Covid-19 deaths. 

In that same period, the report found 30% of Kentucky's total coronavirus cases (14,580 of 48,396) and 23% of the state's Covid-19 deaths (217 of 933) were associated with gaps in health coverage. 

"It seems clear to me that coverage matters when it comes to getting and staying healthy and Covid-19 is no exception," said Dustin Pugel, policy analyst for the Kentucky Center for Economic Policy. "Kentucky moved really quickly, more so than our neighboring states, to make sure our folks were covered by a special Medicaid program when many lost their jobs and their health insurance with it. I can only imagine how much worse things might have been here if we had hundreds of thousands more without access to health care." 

Those changes helped give Kentucky the third highest percentage increase in Medicaid enrollment of any state between February and November 2020, according to state Medicaid Commissioner Lisa Lee.

Conversely, in the percentage of Covid-19 cases and deaths associated with health-insurance coverage gaps, Kentucky ranked low: 40th among the states, according to Families USA.

Its report provides numbers for counties with more than 50 cases or deaths. Todd County, at 40%, had the highest share of total cases linked to health-insurance gaps. Campbell and Boone counties, at 21% each, were lowest. 

Fayette County, at 28%,  had the highest percent of deaths linked to health-insurance gaps. Oldham County, at 14%, was lowest. 

"Kentucky has had more people covered than our neighboring states and has fared much better in terms of both Covid cases and deaths," said Emily Beauregard, executive director of Kentucky Voices for Health. 

Thirty percent of Kentucky's Covid-19 cases were linked to health coverage gaps, less than any adjoining state: 48% in Tennessee, 42% in Virginia and 34% in West Virginia, 34% in Ohio, 41% in Indiana, 37% in Illinois and 44% in Missouri. Kentucky's Covid-related deaths that were linked to health coverage gaps were also lower than each of those states. 

Every state saw some increase in Medicaid enrollment due to the pandemic started, but the percentage increase in Kentucky's Medicaid rolls was more than any state but Oklahoma and Utah, Lee said.

The Beshear administration  launched a campaign to get more Black and Hispanic residents enrolled in health coverage as a way to reduce racial disparities in health.

Kaiser Family Foundation graph; click on it to enlarge.

It also adopted a broad "presumptive eligibility" option, which is temporary, time-limited Medicaid coverage that allows the state to get people into the program quickly and before completing the full Medicaid application. 

Data from Lee's presentation at the May 20 Medicaid Oversight and Advisory Committee shows that in March 2020, the month the pandemic began, Kentucky had nearly 1.4 million people (1,383,005) in the program, with 2,573 signed up through presumptive eligibility. 

Thirteen months later, in April 2020, that number had increased to nearly 1.7 million people (1,667,628), with 131,833 signed up through presumptive eligibility.  

Of the newly enrolled, Lee said 52,797 of them are children and most are between the ages of 18-65, who qualified because of Medicaid expansion. 

"This increase in enrollment reflects changes in our economy," said Lee. " Individuals have lost their jobs or they have reduced incomes." 

Lee added that Kentucky has qualified for a 6.2% increase in what the federal government reimburses for Medicaid since the pandemic hit and this has allowed the state to stay within its budget during the public health emergency. 

Kentucky already had a low rate of uninsured residents -- 6.4% in 2019 -- mainly because the state expanded Medicaid to more low-income adults in 2013 under the Patient Protection and Affordable Care Act, which added about 450,000 people to the Medicaid rolls. Prior to the expansion, this program was limited to children, pregnant women, people with disabilities and people in nursing homes. 

And as Kentuckians get back into the workforce, Lee and Beauregard both noted that Kentuckians who no longer qualify for Medicaid should look for coverage on the federal exchange since the Biden administration has extended a special open enrollment period to Aug. 15. The special enrollment period includes enhanced premium subsidies, also known as tax credits, to help offset the cost of the health plans and also makes more people eligible for the subsides. 

Lee said the state has been doing outreach to those who enrolled presumptively to help them complete that full Medicaid application that would move them over to the traditional Medicaid program. And if they no longer qualify for Medicaid, they work to help them gain coverage through the federal marketplace, commonly called Obamacare. 

The Families USA report says it will use the findings from this report to ask one fundamental question, "If everyone in America had health insurance, how many people who contracted Covid-19 could have been spared, and how many who died might still be with us today?" 

As of May 24, there have been at least 456,053 total cases of the coronavirus in Kentucky and 6,720 deaths, according to the state's daily report.

Kentucky's 7-day average of daily new coronavirus cases is below 500 for first time in 10 months; positive-test rate keeps falling

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

By Melissa Patrick
Kentucky Health News

Kentucky's seven-day average of new coronavirus cases dropped below 500 Thursday, for the first time in 10 months, and its positive-test rate is among the lowest since testing became widely available. 

The state reported 575 new cases, with 23% (133) in people 18 and under. The seven-day average for cases is 489. The last time it was under 500 was July 18, at 447; the next day, 979 new cases raised it by 100. That was the start of a long-term increase that peaked in January; the seven-day average on Jan. 12 was 4,002.

Nationwide, the seven-day average for cases is also on a decline. It was 30,206 on May 19, according to The New York Times. 

The rate of new cases over the last seven days was 8.05 per 100,000 people,. Each day since May 6, the rate has dropped to the lowest since the state began reporting it in December. The Times says Kentucky's rate is 18th in the nation but its new-case numbers have dropped 29% in the last 14 days.

Rockcastle, Owen and Webster counties, with more than 25 cases per 100,000, are the only Kentucky counties that remain in the red zone, which is considered a "critical" level. Other counties with rates more than double the statewide rate were Adair, 23.1; Union, 21.9; Henderson, 19.9; Grayson, 18.4; Bourbon, 17.3; Taylor, 17.2; Knox, 16.5; Estill, 16.2; Powell, 16.2; Lewis, 16.1; and Gallatin, 16.1.

The share of Kentuckians testing positive for the virus is 2.70%, the lowest it's been in the past seven days and among the lowest since testing became widely available in May. 

Kentucky hospitals reported 357 Covid-19 patients, the lowest number since April 5; 104 of them were in intensive care, and 44 of those were on a ventilator. Only one hospital readiness region is using at least 80% of its intensive care unit beds: Lake Cumberland, at 93%. The state's daily report shows 20% of those beds are being used by Covid-19 patients. 

The state reported 15 more Covid-19 deaths, 13 of them from health department reports and two of them from an ongoing audit of death certificates. 

The state's vaccine dashboard shows 1,945,674 Kentuckians have received at least one dose of a vaccine. That's 44% of the state's population and 55% of its adult population. The leading counties are Woodford, 58%; Franklin, 57%; Fayette, 55%; Scott, 49%; and Campbell, 48%. The lowest are Christian and Spencer, 18%; Ballard, 20%; and McCreary and Lewis, 21%.

The Christian County Health Department is starting off-site vaccination clinics, Hoptown Chronicle reports. Go to vaccines.gov/search/ to find a vaccine site anywhere.

In other pandemic news Thursday:

• Counties with 10 or more new cases were Jefferson, 147; Fayette, 22; Boone, 21; Kenton, 19; Campbell, 17; Johnson, 15; Laurel and Pulaski, 13; Clark, 12; Adair and Floyd, 11; and McCracken, 10.
• The geographic gaps in vaccination rates worry public-health experts. “Low vaccination rates will leave room for the virus to circulate, re-emerge and possibly form new variants” that could be more contagious and/or more deadly, Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, told The Associated Press. “High vaccination rates are critical to keeping the disease under control, especially when we get back to the fall and winter.”

As Covid-19 metrics slowly trend down, we can talk about the end of the pandemic, but that's a somewhat fuzzy concept

WebMD image

For more than a year, people have pondered when the coronavirus pandemic would be over. 

A firm answer to that question depends on many factors, but several key metrics used to measure the pandemic suggest that it could be time to have that conversation, Joel Achenbach writes for The Washington Post. 

New coronavirus infections in the United States have dropped to their lowest rate since mid-September, and if trends continue, they will soon be lower than in nearly 11 months, Achenbach notes. 

Also, nearly half of adults have had at least one dose of a coronavirus vaccine that has proven remarkably effective at preventing severe illness and death. In a separate Post article, Paige Winfield Cunningham reports positive trends in three key metrics: new cases, hospitalizations and deaths. 

On Monday, May 17, Cunningham reported that average daily deaths in the U.S. had fallen 16.5% in the previous week, and are now below 580 per day; average daily hospitalizations fell 12.6%; and average daily cases fell 19.2%, with fewer than 35,000 new cases being diagnosed each day.

In Kentucky during the same week, the 7-day average of hospitalizations fell 3.5% and the weekly average of new cases dropped 12%. Death reporting in Kentucky can be slow due to delays at local health departments; the reported-death average in the state rose slightly last week.

Centers for Disease Control and Prevention models show that cases are likely to decline sharply in July. 

"We are doing extremely well in the U.S. and are well on our way of moving past the pandemic," Monica Gandhi, professor of medicine at the University of California at San Francisco, told Cunningham. 

That said, some experts say the metrics are still too high and that it is too early to declare victory. They include CDC Director Rochelle Walensky, who told a congressional subcommittee Thursday that the nation has made "extraordinary progress" but the virus has "sent us too many curveballs" to say the pandemic is over or will soon be over. "Today, I’m cautiously optimistic," she said.

Washington Post graph; to enlarge, click on it.

Carlos Del Rio, a professor of medicine at Emory University, told the Post's Cunningham that his goal is to see new cases drop below 20,000 per day and daily deaths fall under 100. He said it is concerning that daily vaccinations are sloping downward.

In the last week, vaccinations in Kentucky numbered 27% less than the previous seven days. Cunningham reports that last week, the U.S. saw an 11% decrease in the number of vaccine doses administered, compared to the week before.

Experts often say we are in a race between the vaccines and the variants -- mutations of the virus that are more contagious or more deadly. 

That means "pandemics start quickly and end slowly," Achenbach writes. He notes that infectious-disease experts have been clear that the virus is unlikely to be eradicated and that some measures to fight it, like booster vaccines and wearing masks in the winter, could remain part of our lives. 

“Covid-19 as a pandemic will end,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Achenbach. “But it won’t end uniformly throughout the world for obvious reasons, because many countries will not have capabilities to make it end. But as a pandemic, or as a countrywide epidemic, it absolutely will end in this country.”

Fauci added that achieving this will depend on getting at least 70% of adults vaccinated and if this happens by the fall, he said, "I think we're going to get out of the epidemic stage and much more into the control stage." 

Achenbach wraps up his article by noting five "caveats that cloud this sunny outlook:" polling that shows a significant number of people don't want a vaccine; the possibility that mutations could erode vaccine efficacy; experts anticipate a fifth wave of the virus this winter; the U.S. is not truly safe from the virus until the whole planet is; and it is still not known exactly how many people need to have been vaccinated or have had the disease to create herd immunity, which creates significant protection for those who are unwilling or unable to get vaccinated. 

Helen Branswell of Stat takes another approach to this topic, exploring how some scientists look to the past to see the future when they consider how this pandemic will end.

"The truth of the matter is that pandemics always end. And to date vaccines have never played a significant role in ending them," she writes, adding, "That doesn’t mean vaccines aren’t playing a critical role this time. Far fewer people will die from Covid-19 because of them."

She reports that past pandemics didn't end because the viruses went away, but because their viruses underwent a transition, and became endemic, or common. And the big, unanswerable question when it comes to this coronavirus is, "When will that happen?" 

Coronavirus vaccines work even if you don't have any side effects

Even if you don't get any flu-like symptoms after getting the coronavirus vaccine, you are still protected from the virus, Peter Loftus reports for The Wall Street Journal.

“I don’t think someone should correlate the extent of their reactions to the vaccine with protection from infection,” H. Cody Meissner, chief of the pediatric infectious diseases division at Tufts University School of Medicine in Boston, told Loftus. “We know that people who don’t respond to a vaccine in terms of the side effects still are well protected. The vaccines work even if you don’t have fatigue and headache and fever and muscle pain and joint pain.”

At the same time, other experts told Loftus that more research is needed about the side effects of vaccines.

One such study at the University of Pennsylvania found that people who had greater side effects after receiving either the two-dose Pfizer-BioNTech or Moderna vaccine had slightly higher antibody levels. However, all people in the study who got the vaccine had a good immune response, co-author E. John Wherry, director of the Penn Institute for Immunology, told Loftus. 

Loftus reports: "A Pfizer spokeswoman said the side effects don’t indicate the level of immunity conferred by its vaccine. It wouldn’t be able to demonstrate such high efficacy, if the only people protected were the ones with symptoms, she said." 

The Cleveland Clinic also offers a short question and answer on this topic, saying that the statistics from the Pfizer and Moderna trials show that a little over half of vaccinated people had no side effects, but were still 94% protected, "so you don't need to worry if you don't have any symptoms after your Covid-19 vaccinations." 

Loftus talked to experts about why people's immune systems react in different ways to a vaccine. They noted that general health, age, gender, and heredity all play a role in how one reacts. He reports that side effects are generally more pronounced after the second dose of two-dose coronavirus vaccines, and people who have had the virus have had more pronounced side effects after the first dose. 

KET show pays tribute to Kentucky's health-care workers, noting some who have died from the pandemic, including eight nurses

Nurses killed by Covid-19 and recognized on "Kentucky Health" were, from top left: Michael Rodriguez, Bonnie Hall, Michelle Wade, Debra Daniels, Connie Luscher, Dana Davis, Susan Whittymore and Sharon Combs.

A Kentucky Educational Television show paid tribute to Kentucky's health-care workers and honored some who have died from the Covid-19 pandemic, including eight nurses. May is Nurses Month. 

Delanor Manson, CEO of the Kentucky Nurses Association, told "Kentucky Health" host Dr. Wayne Tuckson in a show that aired in March about eight Kentucky nurses who have died since July. They were:

Bonnie Hall, a 61-year-old nurse from Flat Lick in Knox County, who worked at Pineville Community Hospital for 26 years. "She was one of those people who, her whole life, all she ever wanted to be was a nurse," said Manson. 

Dana Davis, 51, who worked at Baptist Health Louisville and was Nurse of the Year in 2018. Manson said Davis was the first Baptist Health employee to die from the coronavirus.

Michael Rodrigues, 67, who cared for Covid-19 patients at Norton Audubon Hospital, had worked there for 26 years. "His death really devastated the hospital and the entire community," Manson said. 

Michelle Wade, 53, who worked for U of L Health-Jewish Hospital. Manson said Wade's son, whom she was very close to, was in school to be a nurse. 

Sharon Combs, a 63-year-old from Tyner in Jackson County, who worked at the Owsley County Health Care Center for 26 years, was known as "Mother of the Facility."  

Connie Luscher, an 87-year-old nurse who spent 33 years at Our Lady of Peace in Louisville, where she became the director of nursing. "She was a nurse's nurse," said Manson, who was a friend of Luscher.

Deborah Daniels, 63, of Ashland, had worked at Our Lady of Bellefonte Hospital, which closed about a year ago. Manson said Daniels was also a realtor and owned an antique shop. 

Susan Whittymore, a 61-year-old nurse from London, who worked at Baptist Health.

Manson said the nurses' association has a Nightingale tribute program that honors nurses who have died. She said prior to the pandemic, a representative would attend a nurses' memorial service and read a poem about nurses and present the family with a rose. Since the pandemic, she said they have asked families of nurses who have died to let them know when they plan to have a service so that a nurse honor guard can attend at that time.

The Guardian and Kaiser Health News have published an article, "Lost on the Frontline," that aims to count and honor every U.S. health-care worker who died after contracting the coronavirus on the job in the first year of the pandemic. It says that as of April, Kentucky had lost 52 health-care workers to Covid-19.

Approval of coronavirus vaccines for children under 12 could take months; no rush needed unless a bad variant arises, experts say

"Experts say it’s a no-brainer for adults and adolescents to get vaccinated against the coronavirus. But for younger kids, the case isn’t as clear-cut," reports Alexandra Ellerbeck of The Washington Post.

When the Centers for Disease Control and Prevention authorized the Pfizer-BioNTech vaccine for children 12 to 15, the agency said it could take months to approve a vaccine for younger children. But "Children under 12 are rarely hospitalized with or die of covid-19, the disease caused by the coronavirus — and there’s evidence they don’t spread the virus as easily as adults," Ellerbeck writes, and some experts told her that it’s unclear how big a benefit such vaccinations would be.

“For adults, it’s obviously better that the first exposure is to a vaccine, not natural infection,” said Jennie Lavine, an infectious-disease researcher at Emory University in Atlanta. “Vaccinating children becomes pretty marginal. They’re not getting much of a direct benefit, and it’s not clear that the indirect benefit will be that large.”

Lavine said that could change, though if a new variant of the virus "becomes much more infectious or deadly in children," Ellerbeck writes. "There’s some debate, too, over how often covid-19 infections can cause lingering effects in children." Also, "The vaccines could be particularly life-changing for kids who are high risk or who live with adults who are immunocompromised."

As parents look toward sending their children back to school in the fall, "Many public health experts have heralded vaccines for children as a way to make in-person schooling even safer and alleviate concerns," Ellerbeck reports. "Others worry vaccines could paradoxically have the opposite effect if schools are reluctant to admit unvaccinated students or if parents don’t want to send their children back until they can get a vaccine."

CDC urges health-care providers to open coronavirus vaccine vials even if doses will go to waste; it's a boon for rural areas

"Now that the Pfizer Covid-19 vaccine has been approved for adolescents, hundreds of thousands of parents likely are searching for a place to get their kids vaccinated. Many are expected to call their pediatricians only to find they don’t have vaccines in stock, partly because doctors have been worried about wasting doses," Christine Vestal reports for Stateline. "But new guidance from the federal Centers for Disease Control and Prevention aims to persuade more doctors to stock the vaccine by assuring them that wasting some doses is an acceptable price to pay for inoculating their patients as quickly as possible. The guidance on vaccine waste is a major policy shift for the agency."

The news is good for rural areas, where physicians in small practices may not have enough patients during a day to use up the doses in a vial before its post-opening shelf life expires.

"Most state and local health departments say they’re preparing to shift more vaccines away from large venues such as hospitals and mass vaccination sites, where demand has plummeted, to the pediatricians and other doctors it’s expected many Americans will contact this week to get Covid-19 shots for their teens and preteens," Vestal reports. "But if pediatric practices and other doctor’s offices aren’t already giving their patients shots, it may take some time for them to gear up. . . . That’s why many state and local health agencies are relying on existing vaccine venues such as pharmacies and schools that already are vaccinating older children and adults."

Ky. has three weeks of declining coronavirus cases and positive-test rates; Beshear implores people under 50 to get vaccinated

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

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear says he is hopeful that three straight weeks of declining coronavirus cases and positive-test rates means the pandemic has moved out of a plateau to a downward trend in Kentucky. 

"We hope that it is a trend, but this may just be part of the plateau," Beshear said at his regular Covid-19 news conference that, in another sign of the fading pandemic, is now being held just once a week.

Beshear is eliminating  capacity limits for most businesses May 28 and will reduce nearly all the state's pandemic restrictions June 11. He reiterated that he is waiting four weeks to allow vaccinations for 12- to 15-year-olds, who were recently authorized to get a shot, and anyone who is not yet vaccinated. 

"As we return more towards normalcy, it'll be nice to hopefully see these numbers continue to decline," Beshear said. 

Asked about the confusion over the Centers for Disease Control and Prevention's recent guidance that says anyone who is fully vaccinated doesn't need to wear a mask most of the time, even though some businesses still require it, Beshear said businesses have the choice to require them, and asked patrons to honor those decisions.

"I think we can all figure that out," he said.

One of the best ways to make the pandemic numbers keep going down is for more people get vaccinated, so Beshear implored younger Kentuckians to get a shot, noting that vaccination rates for Kentuckians under 50 are much lower than for those 50 and older. 

He also noted that Kentuckians between 10 to 19 have the highest Covid-19 rate of new cases of any age group in today's report, followed by those 20 to 49, while the state's older groups have lower rates.

"This virus is shifting who is getting infected, because of who is — but more importantly who is not — getting the vaccine," he said, asking a bit later, "So what does that say? It says if you are between 12, when you qualify, and 49, not enough people are getting their vaccines. Please get out there and get it. because people in your age group are getting the virus at a higher rate than other age groups."

Washington Post chart shows Ky. vaccine progress; click it to enlarge.

Beshear said 54 percent of Kentucky adults have received at least one dose of a vaccine. He said 80% of Kentuckians 65 and older have received at least one "shot of hope"; 60% of people 50-64;  45% between the ages of 40-49; 40% of people between 30-39 and 29% of people between 18-29. 

After adding Kentuckians who have been vaccinated in other states and removing out-of-state people from Kentucky's vaccine numbers, Beshear said 1,939,657 Kentuckians have received at least one dose of a vaccine.

The top five counties by percent of residents getting at least one dose of a vaccine are: Woodford (57%), Franklin (56%), Fayette (54%), Scott (48%) and Campbell (47%).The bottom five counties are: Christian (18%), Spencer (18%), Ballard (20%), McCreary (21%) and Lewis (21%).

Since last Thursday, the first day vaccines were given to children 12-15, Beshear said, 6,319 in that age group had received at least one dose of the Pfizer-BioNTech vaccine, the only one now approved for the age group.

Nationally, only a few pediatricians have stocked the vaccine, largely out of concern that they will not be able to administer all doses in a vial before they expire. New guidance from the CDC aims to persuade more doctors to stock the vaccine by assuring them that wasting some doses is an acceptable price to pay for inoculating their patients as quickly as possible, Christine Vestal reports for Stateline.

“We recognize that as we continue to create more opportunities to vaccinate more people, it may increase the likelihood of leaving unused doses in a vial,” the CDC said in an advisory memo obtained by Stateline. “While we want to continue to follow best practices to use every dose possible, we do not want that to be at the expense of missing an opportunity to vaccinate every eligible person when they are ready to get vaccinated.”

Daily numbers: The state reported 285 new cases of the virus Monday, raising the seven-day average 17, to 533; it went up by 13 Sunday. Today's average is about the average for the past month (530). 

The rate of new cases over the last seven days declined again, for the 13th consecutive day. It was 8.59 cases per 100,000 residents. Counties with a rate more than double the statewide rate are Webster, 38.6; Rockcastle, 27.4; Adair, 25.3; Estill, 23.3; Lewis, 21.5; Owen, 21.0; Casey, 20.3; Union, 19.9; Montgomery, 19.3; Taylor, 18.8; and Henderson, 18.6.

Only three Kentucky counties remain in the red zone, which means they have at least 25.1 cases per 100,000 residents and are considered to have the highest risk of transmission. Asked if the state was doing anything to help pull Adair, Rockcastle and Webster counties out of the zone, Beshear said the state still has "red county recommendations" and that it remains willing and ready to help any county that ask for help. Not so long ago, almost all of Kentucky's 120 counties were in the red zone. 

The percentage of Kentuckians testing positive for the virus in the past seven days is 2.78%, down slightly from Sunday when it was 2.79%, and now the 12th straight day of decline.

Kentucky hospitals reported 389 Covid-19 patients, up eight from Sunday; 112 of them in intensive care (the same); and 73 of those on a ventilator (up 20). The Lake Cumberland hospital readiness region is the only one using at least 80% of its intensive care unit beds, at 89%. 

The state announced six more Covid-19 deaths, all of them from the regularly reported health department reports. That brings the death toll to 6,662. 

The fatalities were a Daviess County woman, 66; a Fayette County woman, 71; a Green County woman, 55; a Jefferson County woman, 67; a Jefferson County man, 69; and a Pike County woman, 62. All of the deaths were reported in March and April. 

In other pandemic news Monday: 

• Counties with 10 or more new cases were Jefferson, 89; Campbell, 20; McCracken, 17; Kenton, 16; and Boone, 14. 
• Beshear said 70% of Kentucky's prison inmates have been vaccinated, and his administration was working to allow in-person visitation of vaccinated inmates by vaccinated visitors.
• Beshear said his current expectation is that there will be no mask mandate in schools in the fall. 
• A study, published in the Journal of the American Geriatrics Society, confirms what health officials have been widely reporting: Covid-19 vaccines are highly effective at preventing illness and death from the coronavirus in nursing homes, Deborah Yetter and Sarah Ladd report for the Louisville Courier Journal. According to a recent survey, they report, 70% of nursing-home residents but only 44% of nursing-home workers are vaccinated. 
• CDC says Covid-19 mask guidance is based on science; here's what the studies say, reports the Lexington Herald-Leader. 
• Kentucky schools hope to make it easy to get 12-15-year-olds vaccinated against Covid-19, the Herald-Leader reports.

Positive-test rate for coronavirus in Kentucky declines again, to a level not seen since testing became widely available

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

By Al Cross

Kentucky Health News

The percentage of Kentuckians testing positive for the coronavirus in the last seven days is almost at low as it has been since testing became widely available last June. The seven-day average was 2.79% on Sunday, the 11th straight day of decline.

The seven-day average of new cases rose by 13, to 516, with Sunday's report of 287 new cases. However, the rate of new cases per 100,000 residents declined again, for the 12th consecutive day. It was 8.61 per 100,000, the lowest it has been since the state started reporting the rate in December.

Counties with rate more than double the statewide rate on the state's daily report are Webster, 40.8; Rockcastle, 27.4; Adair, 25.3; Owen, 24.9; Estill, 23.3; Lewis, 21.5; Casey, 20.3; Henderson, 19.9; Union, 18.9; Powell, 18.5; Taylor, 18.3; and Montgomery, 17.8.

Those counties showed the scattered nature of local outbreaks of the virus. None of the three counties with rates considered critical (above 25 per 100,000) border each other, and two of them (Adair and Webster) border counties that have reported no cases in the last seven days (Crittenden and Cumberland).

Three other counties (Carlisle, Trigg and Knott) have reported no cases in the last week. Thirty-five counties have accelerated transmission and appear in orange on the state's county map of new-case rates.

Kentucky hospitals reported 381 Covid-19 patients, 22 fewer than Saturday and the lowest number in five weeks; 112 were in intensive care and 53 of those were on a ventilator. Only one hospital region, Lake Cumberland, reported over 80% of intensive-care beds occupied, at 91%, but most were not being used by Covid-19 patients.

The state reported eight more Covid-19 deaths, all from regular health-department reports, raising the state's death toll to 6,656.