Saturday, October 30, 2021

Even if you have a history of severe allergic reactions to vaccines, Pfizer and Covid shots are still a good idea, big study says

Image from CNBC.com
The Pfizer and Moderna coronavirus vaccines using messenger RNA are shown to be safe for people with a history of severe allergic reactions to vaccines, medications, or allergens, according to a study of more than 52,000 employees in the Mass General Brigham health-care system in Massachusetts.

In the study, published in JAMA Network Open, 474 participants reported a history of such allergic reactions, and significantly more suffered from allergic reactions following the mRNA vaccine than those who did not report a history of allergic reactions, 11.6% to 4.7%. The most common reaction was swelling in the skin. Despite these symptoms, 97.6% of the employees received two doses of an mRNA vaccine.

Lily Li, the study's lead author, said, "The results of this study can help guide expectations for patients with high-risk allergy histories. Symptoms such as hives and swelling may occur, particularly with the first vaccine dose, but most reported allergic symptoms did not impede completion of the two-dose mRNA vaccine series."

Friday, October 29, 2021

Pandemic's decline stalls in Kentucky; more schools drop masks; shots for kids 5-11 are days away; vaccination data corrected

Graphic from Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention
By Al Cross
Kentucky Health News

The pandemic's decline in Kentucky stalled Friday. On the state's daily report, the last one until Monday, the seven-day infection rate rose for the second day in a row, to 24.01 cases per 100,000 residents. It had hit a recent low of 23.58 on Wednesday, after 12 days of decline.

The state reported 1,623 new coronavirus cases, lowering its seven-day rolling average by only one daily case, to 1,307. However, the share of Kentuckians testing positive for the virus in the last seven days continued falling. It dropped almost 0.1 percentage point, to 5.08%.

Most of the state's hotspots are in south-central Kentucky. Counties with infection rates more than double the state rate are Russell, 145.1; Green, 130.6; Adair, 111.6; Clinton, 106.3; Powell, 57.8; Jackson, 55.7; Letcher, 49.7; and Cumberland, 49.7.

As the statewide decline in new-case numbers lagged, the decline in Covid-19 hospital numbers reversed, at least for a day. Kentucky hospitals reported 864 Covid-19 patients, three more than Thursday, with 273 in intensive care, up two; and 144 on mechanical ventilation, unchanged. 

Seven of the 10 hospital regions had more than 80% of their intensive-care beds occupied, but only about 20% were occupied by Covid-19 patients.

The state reported 49 more Covid-19 deaths, raising the pandemic toll in Kentucky to 9,766. Gov. Andy Beshear said in a Facebook post that one of the dead was 31.

Dept. for Public Health map, adapted by Ky.Health News; click to enlarge.
Masks coming off in schools: More school districts decided this week to drop their mask mandates, citing relatively low numbers of virus cases.

Pulaski County did so Monday, and Bardstown dropped its rule Wednesday. Boyle County and Somerset will go mask-optional Monday, Nov. 1; Jessamine County will follow suit Nov. 3; and Madison County will do likewise Nov. 8, WKYT-TV reports. Pulaski Supt. Patrick Richardson told the station that the county has citizens who are "very outspoken" on each side of the issue.

Beshear said Thursday that it's too soon for many schools to drop mask mandates.

Vaccine for kids: On Friday, the Food and Drug Administration paved the way for children 5 to 11 to get the Pfizer two-dose vaccine. Vaccinations are expected to begin Wednesday, after a Tuesday meeting of the CDC advisory committee that will make more detailed recommendations on which children should be vaccinated.

Beshear said Thursday that he would take his 11-year-old daughter, Lila, to get her shot as soon as possible.

"I can tell people a lot of things, but I can tell people that I love my kids . . . and I will take my daughter the first day I can to get this vaccine," he said. "I believe for her it is the way that her school gets back to normal. . . . I so want her world to be a post-pandemic world and not a continuing pandemic world."

The CDC released a study showing that people who had a case of Covid-19 and do not get vaccinated afterward were five times more likely to test positive for the virus than vaccinated people.

Corrections being made: Kentucky's better-than-average ranking for vaccination against the coronavirus is likely to slip next week, as state and federal officials finish correcting databases that included hundreds of thousands of duplicate vaccinations administered by Kroger Co. clinics.

Beshear said about 431,100 duplicates will be removed, and about 252,500 are first doses, which are the basis for the numbers on the state's vaccine dashboard. Friday afternoon, it showed 2,788,884 first doses, giving the state a vaccination rate of 62%. Beshear said the new figure would be 56% to 57%.

He said some counties that relied heavily on Kroger for vaccinations, such as Franklin County, could see as many as 20% of their vaccinations vanish from the database. Franklin County currently ranks second in the state with 80% vaccination, second only to adjoining Woodford County's 81%.

UPDATE, Oct. 31: In the revised database, Franklin County lost 20 percentage points (not 20 percent), falling to 60% and out of the state's top five. The new top five are Fayette, 68%; Woodford, 67%; Jefferson, 64%; and Campbell, 62%. The bottom five are Spencer, 28%; Christian, 33%; Edmonson, 34.4%; Elliott, 34.6%; and Hart, 35%.

"We believe this has happened in at least three states that will likely be reporting it," Beshear said. He said Kroger reported to both the state and the federal government, incorrectly "expecting that there would be a de-duplication algorithm." He added, "This was not intentional by anyone."

Beshear said Kentucky officials raised the issue with the Centers for Disease Control and Prevention after they noticed the federal data showed more than 100% of some age groups in some counties as vaccinated. "What it does to our numbers hurts a little bit," he said, "but if we're going to get everybody vaccinated and protect everybody, we really have to have the most accurate count of who is and who isn't" vaccinated.

'Take It From Me' campaign has 18 new video public-service announcements to promote coronavirus vaccination

The "Take It From Me" campaign of public service video announcements has released 18 more videos urging Kentuckians to get a coronavirus vaccine. The campaign is a partnership between the Kentucky Medical Association, its Kentucky Foundation for Medical Care, the Kentucky Hospital Association, the Kentucky Primary Care Association and the Foundation for a Healthy Kentucky.

"The partners encourage community organizations, health providers, and others to download and share the PSAs with their networks," the foundation said in a press release. To watch and download the videos, click here.

Thursday, October 28, 2021

New toolkit aims to help rural organizations create medication-assisted therapy programs for opioid misuse

A new toolkit from the Rural Health Information Hub aims to help rural communities and organizations develop, implement, evaluate and sustain Medication for Opioid Use Disorder programs. MOUD programs, sometimes called Medication-Assisted Therapy, are the gold-standard for treating OUD, but they're harder to find in rural areas, often because there's not enough money, not enough qualified prescribers, or because of community worries that drug treatment centers might attract more crime.

The toolkit has seven detailed modules that provide an overview of MOUD and the challenges rural communities face; identify different models for rural MOUD programs, along with promising examples; and dig into how organizations can implement, sustainably fund, evaluate, and get the word out about their own program.

Target audiences for the toolkit are rural organizations including: healthcare providers, non-profit organizations, faith-based organizations, businesses, and community-based organizations. Click here for more information.

Kentucky's decline from the peak of the pandemic has been steeper than the nation's; vaccination rate now 24th among states

Washington Post map, adapted by Kentucky Health News, shows rates in bordering and nearby states and Puerto Rico, the national leader.
Kentucky Health News

The decline of new coronavirus cases in Kentucky has been steeper than the national decline from the peak in early September.

Wednesday's seven-day average of new cases in Kentucky, 1,320 per day, was 70 percent lower than the average at the peak of the pandemic in the state on Sept. 5, which was 4,398 per day.

The national seven-day average of infections on Wednesday was about 69,000, "reflecting a 58% drop from the latest surge’s peak around Sept. 13, when the average for that week was 164,475," The Washington Post reports.

The New York Times, also using data reported to the Centers for Disease Control and Prevention, says new cases in Kentucky have declined 36% in the last 14 days, the fifth fastest rate in the nation.

"The effect of vaccinations is clear in regions with the highest uptick," Post reporter Andrew Jeong writes, noting a huge reduction in cases in Puerto Rico, where 73% of the population is fully vaccinated. "But a handful of states are still struggling to turn the tide, especially as colder weather brings more people indoors again. In Montana, 45 out of every 100,000 people are hospitalized because of covid-19 — the highest rate in the country. Just over half of the state’s population is fully vaccinated, below the national rate of 57.5 percent."

Kentucky is slightly behind the national rate, with 54.6% fully vaccinated. That is 24th among the states, but better than all bordering states except Virginia's 63%. Kentucky now ranks just ahead of No. 25 Illinois, which long had a slightly better rate than Kentucky but is now at 54.4%.

UPDATE: The state reported 1,711 new cases Thursday, lowering the seven-day rolling average by 12, to 1,308 per day. There was much more improvement in the share of Kentuckians testing positive over the last seven days; it went down almost 0.4 percentage points, to 5.17%.

The daily infection rate for the last seven days was 23.67 cases per 100,000 residents, up slightly from 23.58 on Wednesday; counties with rates more than double that rate were Russell, 106.8; Adair, 79.6; Green, 74.4; Clinton, 67.1; Cumberland, 64.8; Powell 54.3; Jackson, 51.4; Letcher, 51; and Lawrence, 49.4.

Kentucky hospitals reported 861 Covid-19 patients, eight fewer than Wednesday; 271 of them in intensive care, down five; and 144 on mechanical ventilation, down one. Eight of the 10 hospital regions had more than 80% of their intensive-care beds in use; Northern Kentucky and the Lake Cumberland region were at 96.3% and 962%, respectively.

The state reported 20 more Covid-19 deaths, raising Kentucky's pandemic toll to 9,717. Over the last 14 days, the state has averaged 32.6 deaths per day.

Obesity is big risk factor for severe Covid-19, and that's important in Kentucky, which is No. 1 in obesity of children aged 10 to 17

Despite the recent decline in new coronavirus infections, appears to be on the decline, "The risk to children and adults is still significant," Hilary Brown reports for the University of Kentucky. "Of the number of risk factors associated with severe Covid-19, obesity appears to be one of the most prevalent."

Since Kentucky ranks first in obesity of children 10 to 17, "This puts a significant percentage of Kentucky’s children and adolescents at risk for severe Covid-19," Brown reports after interviewing Dr. Aurelia Radulescu of the Kentucky Children’s Hospital obesity clinic. Here is their Q and A:

Brown: How does obesity affect a child's overall health?
Radulescu: Obesity is a new disease that we learned more about it in the last 20 years. We learned that obesity in children is associated with several medical complications that are also seen in adults. For example, children with obesity can develop prediabetes or diabetes. They can also have hypertension, dyslipidemia, sleep apnea and fatty liver disease. All these obesity-associated medical complications place them at high risk for severe health problems later in life.

Brown: Why is obesity such a big problem in Kentucky?
Radulescu: One of the most important reasons is that children have limited resources. In Kentucky, we have a large population of children from low-income households who lack access to healthcare and healthy food. Many children are counting on the meals offered in school, and those meals are not always healthy. There is limited access to fruits and vegetables. If a child grows without eating a large variety of food and is exposed to unhealthy food over the years, it will be tough to change those taste preferences.
Another reason is that many communities lack resources for children to engage in physical activities. Many schools do not offer gym classes or offer them only once a week. Children may live somewhere where there are no sidewalks, or where it's not safe for them to go outside to play. A lot of children now interact with each other through screen time activities. Instead of playing outside together, they play video games, a sedentary behavior itself.
If we also look at data from the adult population, Kentucky ranks high in obesity there, too. Many children in Kentucky come from families with a strong history of obesity. So it's not just the child; parents and other siblings may have obesity as well. The combination of a genetic predisposition and an obesogenic environment plays a significant role in developing obesity.

Brown: How does obesity contribute to severe Covid-19?
Radulescu: We're still learning about Covid-19, but descriptive and observational studies show a strong link between obesity and severe Covid-19 infections in children. Obesity creates a proinflammatory state in the body. So the adipocytes, the fat cells of a child with obesity, are enlarged and become dysfunctional. They produce some inflammatory molecules, and those are toxic to the body. So people with obesity are in a chronic low inflammatory state. After it infects the host cell, SARS-COV-2 causes an exaggerated inflammatory reaction. In combination with an already existing proinflammatory state, the hyperinflammatory reaction creates a perfect storm that damages the immune, cardiovascular, and respiratory systems. So this is one of the theories that is postulated.
We also know that obesity produces inflammation of the endothelium, the thin membranes that lines the insides of blood vessels and the heart. When this membrane is inflamed, it becomes conducive to abnormal blood clotting perpetuating this chronic inflammation response. It's a vicious cycle.
Concerning the respiratory system, children with obesity are more likely to suffer from obstructive sleep apnea. They also may have decreased respiratory function due to mechanical forces related to obesity. Those forces don't allow the chest wall to expand well, resulting in impaired respiratory function and an increased need for ventilator assistance. This may be another reason why children with severe obesity are more likely to end up on ventilators.

Brown: How has the pandemic affected children?
Radulescu: The relationship between the Covid pandemic and obesity is a two-way road. We are aware that obesity is a risk factor for severe Covid infection. But we’ve also learned that during the pandemic, the rate of obesity in children has increased. That is no surprise because the pandemic environment was very conducive to that. Children were more isolated. Access to healthy food was even more limited than before. The pandemic disrupted many children’s daily routines; their schedule became unstructured; children became more sedentary. And all of these behaviors led to an increase in the rate of obesity.
In a recent study published by the Centers for Disease Control, the pediatric obesity rate in 2019 was 19%. Now it is 22%. That same study found that the rate at which body mass index (BMI) increased almost doubled in the first six months of the pandemic.

Brown: What can parents and caregivers do?
Radulescu: It's more important than ever that children with obesity adhere to preventative measures – wearing masks, washing hands, and maintaining a social distance. Those who are qualified to receive the vaccine should get it.
If parents are concerned if their child has obesity, they should talk to their pediatrician. Parents should ask about the child's weight status, BMI, and what they can do to help the child achieve healthy body weight.
We are more knowledgeable now than we were years ago about obesity as a disease, and we have more guidelines and recommendations on how to take care of these children.

The Pediatric High BMI Clinic for obesity accepts patients through physician referral.

Wednesday, October 27, 2021

Most pandemic metrics are favorable, except intensive-care cases

Washington Post chart, adapted by Ky. Health News; click to enlarge.
By Al Cross
Kentucky Health News

Most measures of the pandemic in Kentucky declined Wednesday, and vaccinations are on an uptick after a slight decline.

The state reported 1,702 new cases of the coronavirus, lowering the seven-day rolling average by 28, to 1,320. It is the 20th straight day that the seven-day average has declined.

Reported vaccinations rose to a seven-day average of 11,262, so the ratio of vaccinations to new cases is 8.5 to 1. Late last week, it was less than 7 to 1.

Despite the decline in cases over the last several weeks, health officials are concerned that the arrival of cold weather, moving more activity indoors, will cause more spread of the virus and flu viruses, again threatening the capacity of hospitals, where intensive-care units remain near capacity.

Kentucky hospitals reported 869 Covid-19 patients Wednesday, 24 fewer than Tuesday, but the number in ICUs rose by 10, to 276. Eight of the 10 hospital regions reported more than 80 percent of their ICU beds in use, with Northern Kentucky highest at 98.3%.

Daily new cases over the last seven days have averaged 23.58 per 100,000 residents, continuing a 12-day decline that took the state as a whole out of the red "high transmission" category into the "substantial" orange level. But many hotspots remain, especially in Southern Kentucky; counties with rates more than double the statewide rate are Russell, 82.1; Adair, 66.2; Jackson, 57.9; Clinton, 57.3; Letcher, 54.4; Green, 53.5; Cumberland, 51.8; and Owsley, 51.8.

The state reported 20 more Covid-19 deaths, making Kentucky's pandemic toll 9,685. The seven-day average of deaths dropped just below 30; the 14-day average is 34.

An attorney for the state Public Protection Cabinet is suing Gov. Andy Beshear in federal court after being disciplined repeatedly for refusing to wear a mask at work. Dana Simmons alleges that the executive branch's mask policy violates court rulings and the legislature's limits Beshear’s ability to issue emergency orders, specifically mask mandates, the Lexington Herald-Leader reports. The cabinet said employees are obliged to follow its "personnel safety policies."

Foundation gives $20,000 to spur vaccination in low-vax counties

State Department for Public Health vaccination-rate map, adapted by Kentucky Health News
The Foundation for a Healthy Kentucky has awarded grants totaling $20,000 to increase uptake of the Covid-19 vaccines in counties with the lowest vaccination rates. They are "intended for rapid deployment" for new or expanded vaccination efforts, the foundation said in a news release.

Two grants are aimed at Christian County, which has the state's second-lowest percentage of residents who have received at least one dose of vaccine, 34.2%. The rate may be depressed by the presence of Fort Campbell, but the county also has a big population of African Americans, who nationally have a low vaccination rate. The money will go to the the Hopkinsville-Christian County Branch, NAACP, and the Christian County Health Department.

Other recipients, targeted counties and vaccination rates are:
  • The school district in Clinton County, which has an at-least-one-dose vaccination rate of 40.9%. 
  • The Lake Cumberland Community Action Agency and the Lake Cumberland District Health Department, for Clinton, Casey (36.8%), Cumberland (42.1%), McCreary (42.7%) counties.
  • Pennyrile Area Development District, for Crittenden County, 40.9%.
  • Barren River District Health Department, for Edmonson (37.4%), Hart (36%) and Metcalfe (39.3%) counties.
  • Grace Community Health Center, for Knox County, 36.3%.
  • Lewis County Health Department, 37.6%.
  • Buffalo Trace District Health Department, for Robertson County, 37.3%.
  • Todd County Health Department, 41.8%.
  • Green River District Health Department, for Union County, 40.5%. The statewide rate is 62%. 
“These organizations are on the front line of the effort to get more Kentuckians vaccinated against Covid-19,” foundation President and CEO Ben Chandler said. “We are proud to support their hard work to protect our citizens against serious injury or death from the virus.”

"The organizations will employ various efforts such as videos and graphics to be posted on social media, as well as radio, television and print advertisements, school-based outreach, a 24-hour information hotline, bilingual efforts, and other outreach, especially to vulnerable populations," the news release said. "The foundation also has a number of resources on its website to assist organizations, health care providers, family and friends in sharing the truth about COVID-19 and the vaccines. This includes public service announcement videos, a fact sheet, and links to the CDC and Kentucky Covid-19 dashboard."

Tuesday, October 26, 2021

Kentucky's pandemic map is mainly orange, but has plenty of red counties; kids could start getting Pfizer shots as early as Nov. 3

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

New York Times map shows how state compares. Interactive version here.
By Al Cross
Kentucky Health News

Kentucky's coronavirus map is now mainly orange, indicating the continued decline in new cases in the last five weeks, but the state's new-case rate is still above the national average, and it has many hot spots.

The state reported 1,493 new cases Tuesday, lowering the seven-day rolling average by 42, to 1,348; and the percentage of Kentuckians testing positive in the last seven days fell for the 10th straight day, to 5.66%.

The state-reported rate of daily new cases over the last seven days was 23.98 per 100,000 residents. Counties with rates more than double that rate were Cumberland, 77.8; Russell, 75.7; Owsley, 71.2; Jackson, 62.2; Adair, 61.7; Powell, 56.6; Letcher, 56.3; Carroll, 49.7; and Grayson, 48.1.

Over the last 14 days, the new-case rates in Grant, Anderson and Rowan counties are among the highest in the nation, according to The New York Times' analysis of Centers for Disease Control and Prevention data. Grant's 14-day rate is 62nd in the nation, Anderson's is 91st and Rowan's is 97th. Rates reported by the state differ due to methodology, including removal of duplicate test results.

The Times says Kentucky's statewide rate is 19th among the states and has declined 36% in the last 14 days, the fifth greatest drop among the states; Tennessee's drop ranks first, at 59%.

Kentucky hospitals reported 893 Covid-19 patients Tuesday, 35% fewer than two weeks ago, with 266 of them in intensive care, down 33%; and 157 on mechanical ventilation, down 43%.

Eight of the state's 10 hospital regions reported more than 80% of their intensive-care-unit beds in use, but none were above 94%. That was the rate in Northern Kentucky, where all ICU beds have been occupied recently.

The state reported 25 more Covid-19 deaths, raising the pandemic's toll to 9,665. Kentucky is averaging just over 34 deaths per day over the last seven to 14 days.

In other pandemic news Tuesday:
  • Without dissent, a Food and Drug Administration advisory committee recommended authorizing Pfizer vaccines for children 5 to 11. "The vaccine would be administered in two small doses, a third of the amount given to teens and adults, given three weeks apart," Katie Camero reports for McClatchy Newspapers. "Officials found the smaller dose offered adequate protection and led to less intense side effects." The next steps are approval by the FDA, which usually follows the committee's advice; a recommendation from a CDC advisory panel; and final approval by the CDC director. Children could get shots as early as Wednesday, Nov. 3.
  • Masks are now optional in Trimble County Schools, following the school board's 4-1 adoption last week of a new tiering system that makes them mandatory only if the system has 25 active cases, or 2.25% of its student population, Olivia Gennaro reports for The Trimble Banner. The principal of the county's high school told the board that enforcement of masking "takes up a lot of time, often focused on the same students," Gennaro writes.
  • More than 130,000 Americans probably died because the Trump administration was “distracted” by last year’s election and ignored experts' recommendations to fight the pandemic, former coronavirus response coordinator Deborah Birx told congressional investigators this month, The Washington Post reports. “I believe if we had fully implemented the mask mandates, the reduction in indoor dining, the getting friends and family to understand the risk of gathering in private homes, and we had increased testing, that we probably could have decreased fatalities into the 30-percent less, to 40-percent less range,” Birx said. When Trump left office, more than 435,000 people had died. Now the total is over 735,000. "Birx said she analyzed data from states with more robust mitigation measures, concluding there was between a 10 to 15 percent increase in fatalities without a mask mandate," the Post reports.

UK physician Peterson will be co-presenter in Nov. 9 webinar about the critical role of family physicians in rural America

Lars Peterson, M.D., Ph.D.
A University of Kentucky physician and a University of Washington researcher will hold a webinar at 1 p.m. Tuesday, Nov. 9 to discuss the critical role of family physicians in rural America, how they're trained, their rural distribution, and differences in scope of practice in rural vs. urban family doctors.

The webinar will last about an hour. It's free, but registration is required. Click here for more information about the webinar and to register.

Lars Peterson and Davis Patterson will present the webinar. Peterson is a family physician and health services researcher, vice president of research of the American Board of Family Medicine, an associate professor of family and community medicine at UK and a faculty member at its Rural & Underserved Health Research Center. His major research focuses on how continuing education can improve quality of care. 

Patterson is a sociologist, research associate professor of family medicine and director of the Rural Health Research Center and the Collaborative for Rural Primary Care Research, Education, and Practice, and an investigator in the UW Center for Health Workforce Studies. His research focuses on improving rural health-care access and examining trends in rural workforce supply.

Monday, October 25, 2021

Share of Kentuckians testing positive for the coronavirus drops below 6%, but Beshear says daily new cases are still too high

 Dept. for Public Health graph, adapted by Ky. Health News; first-month figures are unreliable due to few tests.
This story has been updated to correct an editor's statistical error.
By Melissa Patrick
Kentucky Health News

The metrics to measure the coronavirus in Kentucky continue to improve, most notably with the percentage of Kentuckians testing positive for the virus in the last seven days dropping below 6%, to 5.84%.

"Things continue to move in the right direction and [are] moving there quickly," said Gov. Andy Beshear as he began his weekly Covid-19 press conference. 

But he closed with a warning that the case numbers are still "too high" and reminded Kentuckians that there is still a deadly variant of the virus out there, and that not enough people are vaccinated. 

The state reported 544 new cases of the virus Monday, the lowest daily number since July 25, when the it reported 504 cases. The seven-day average for daily cases is now 1,390.1,308. 

Dept. for Public Health graph, adapted by Ky. Health News; to enlarge any image, click on it.
Beshear said Kentucky's weekly coronavirus case numbers dropped to their lowest level in 11 weeks, dropping to 9,749 in the week ended Sunday, the first such week since July 27-Aug. 2 that there have been fewer than 10,000 weekly cases. 

“We are almost decreasing in cases at the speed that we increased,” said Beshear. “That is a very good sign." 

Kentucky hospitals reported 919 Covid-19 patients; 281 of them in intensive care; and 157 on mechanical ventilation.  

Beshear said Covid-19 hospitalizations decreased 20% in the last seven days, but 53 of the state's 96 acute care hospitals still report critical staffing shortages. 

Eight of the state's 10 hospital regions are using more than 80% of their intensive-care beds, with the northern region at 100%. 

The New York Times ranks Kentucky 18th among states for its seven-day infection rate and says the rate has declined 33% in the last two weeks. 

The state-reported infection rate fell to 24.39 daily cases per 100,000 residents, placing more than half of the state's counties out of the highest category of transmission. Counties with rates more double that rate are Owsley, 71.2; Cumberland, 64.8; Russell, 63.8; Jackson, 60.0; Letcher, 56.3; Powell, 53.2; Adair, 52.1; and Mercer, 50.8.

The Washington Post reports that in the last week, Kentucky averaged 10,158 doses of coronavirus vaccine per day, a 29% decrease over the previous seven days. So far, Kentucky has administered at least one dose to 2.8 million people, or 73.4% of the eligible population, 12 and older. 

The state vaccine dashboard shows that 80% of the population in Woodford and Franklin counties have received at least one dose of a vaccine.

Beshear encouraged Kentuckians 65 and older, people with significant underlying health conditions and people who have high exposure to others at work to get a booster. 

Rebecca Dutch, professor at the University of Kentucky College of Medicine, explained why it is so important for eligible Kentuckians to get a booster shot. She said that over time, a vaccinated person's immune response to the virus slowly decreases. She added that while the protection against getting severe Covid-19 and hospitalization remains, the protection against the virus wanes. 

To decrease the chances of getting the virus, she said it's important to get the booster, calling it a "protective mechanism." 

The state reported 23 more Covid-19 deaths, raising the death toll to 9,640. The seven-day death average is 34.1 deaths per day. 

Asked why Kentucky has had a higher case rate than the rest of the nation, while its death rate is just below the national average, Beshear attributed much of the state's success to his father Steve Beshear's decision as governor to expand Medicaid, noting that many of the states that did not expand the program have higher Covid-related death rates than Kentucky. He also pointed to Kentuckians working to protect each other and to the hard work of the state's health-care workers. 

"I think we have worked very hard to stay safe," he said. 

Beshear recommended that the General Assembly use $400 million in federal relief funds for bonuses to "essential workers" and asked legislators to participate in a working group to work out the details. He said leaders of the legislature's Democratic minorities sent him names for this working group on Friday but the ruling Republicans said "No, thank you" and asked him to go through the committee process. He said he would move forward with this incentive plan and will work with the parts of the legislature that are willing to work with him. 

In other pandemic news Monday:

  • Beshear reminded Kentuckians that the Federal Emergency Management Agency is offering financial assistance for Covid-19 related funeral expenses incurred after Jan. 20, 2020. For more information, go to DisasterAssistance.gov or call 1-844-684-6333.
  • In August, Kentucky had the the highest number of people quitting their jobs, at 4.5%. Asked about that, Beshear said it also had fifth-highest hiring rate in the country, which was a percentage point higher than the quit rate -- which he said reflects several things, including people looking for a different work environment, a desire for better work conditions, or better pay. He said it has nothing to do with unemployment pay, because people who quit don't qualify for unemployment benefits.
Map by The Washington Post, adapted by Kentucky Health News

Sunday, October 24, 2021

Kentucky's 10- to 17-year-old youth rank No. 1 for obesity; high-school students rank fifth, 2-to-4-year-olds in WIC program sixth

Map from foundation report, adapted by Kentucky Health News to show rates in bordering states and the Southeast

By Melissa Patrick
Kentucky Health News

In 2019-20, Kentucky had the highest obesity rate in the nation for children between the ages of 10 and 17, 23.8 percent; almost half again as frequent of the national rate of 16.2%, according to a report from the Robert Wood Johnson Foundation. 

“The state of childhood obesity in America is an urgent call to action for leaders at all levels and across all sectors," Jamie Bussel, the foundation's senior program officer for efforts to prevent childhood obesity, said in a news release. 

Six other states had youth obesity rates significantly higher than the national rate: Mississippi (22.3%), Louisiana (22.2%), West Virginia (21.9%), Alabama (21.8%), and Tennessee (20.8%).

“Obesity is a symptom of deep-rooted challenges that have only been made worse by the pandemic and are a warning sign that our nation’s policies are failing our kids,” Bussel said. “We must make real, systemic change to set kids on a path to better health.” 

The report, titled From Crisis to Opportunity: Reforming Our Nation’s Policies to Help All Children Grow Up Healthy, also reports that Kentucky's 2- to 4-year-old children who participate in the Women, Infant and Children nutrition program rank sixth highest for obesity among the states, at 16.3%, and its high-school students rank fifth.

The good news is that the obesity rate for 10- to 17-year-olds in Kentucky didn't increase from 2018-19 and that the obesity rate for its high-school students went down in 2019, to 18.4% from 20.2% in 2017. 

According to the report, national obesity rates for these age groups have held steady for the last five years, but the news release cites evidence that the coronavirus pandemic may have increased them. 

"More recent data support a surge in rates during the pandemic, particularly among younger children," says the release. "National data from a set of electronic medical records show an increase in the obesity rate for youth ages 2 to 19, from 19.3% in 2019 to 22.4% in 2020." 

Dr. Sandra Hassink, medical director of the American Academy of Pediatrics Institute for Healthy Childhood Weight, summed up how the pandemic has exacerbated the risk factors for childhood obesity. 

“Economic stressors, food insecurity, less consistent access to healthy meals at school, combined with increased sedentary time, sleep dysregulation, reduced physical activity, and social isolation have made it harder for families to stay healthy," she said in the release. "This challenge is compounded by the fact that many of the consequences of obesity—including breathing problems, high blood pressure and diabetes—increase the risks of serious Covid-19 disease. As we look out now and beyond the pandemic, we must create environments that support children and families in sustaining healthy lifestyles.”

The release cites the impact of structural racism on the health of children and families, saying "Racist policies and discriminatory practices affect our food system, access to healthcare, affordable housing, and critical family supports like child care."

The foundation's Bussel says in the report, "These challenges are deep-rooted, systemic, and interconnected—but they are not intractable."

The report says the highest obesity rates are among youth of color and those from households with low incomes. The disparities are significant. In 2019-20, non-Hispanic Asian children had the lowest obesity rate (8.1%) followed by non-Hispanic white children (12.1%). Rates were significantly higher for non-Hispanic Black (23.8%), Hispanic (21.4%), and non-Hispanic American Indian/Alaska Native (28.7%) children.

Rates by income ranged from 8.6% among youth in the highest income group to 23.1% among youth in the lowest income group.

The foundation details several key policy recommendations to address this issue, including: making permanent the pandemic policy of making school meals available to every student; extending eligibility for nutrition programs, including mothers in the first two years after giving birth and children through age 6; and expand the child tax credit that boosts the lowest-income families. 

The national and state-by-state obesity rates among 10- to 17-year-olds come from the 2019-20 National Survey of Children’s Health, along with analysis conducted by the Maternal and Child Health Bureau of the Health Resources and Services Administration. 

Obesity is measured by body mass index, calculated by dividing a child's weight in kilograms by the square of their height in meters. According to the Centers for Disease Control and Prevention, obesity is defined as a BMI that is at or above the 95th percentile for children and teens of the same age and sex; an obese child’s BMI is greater than the BMI of 95% of his or her group.

Cardiovascular endurance exercises are better than weightlifting and other resistance exercise for improving health, study finds

Endurance exercises such as running or biking may be more beneficial to human health than resistance exercises such as weightlifting, says a Swedish study published in the Journal of Applied Physiology.

Researchers from the Karolinska University Hospital and Link√∂ping University examined how endurance and resistance training affected the activity of mitochondria, known as the "powerhouse of the cell," in the participants’ bodies. Increased mitochondrial activity has been linked to improved metabolic health, including “ideal levels of blood sugar, cholesterol, blood pressure, and waist circumference,” the study notes.

Participants were assigned to one of three groups: endurance exercise, in which they cycled for 45 minutes; resistance exercise, in which they performed four sets of leg presses and four sets of knee extensions; or the control group, in which they were assigned no specific exercise. After exercising, only the endurance group showed increased mitochondrial activity in their bloodwork, and the effects appeared as early as 30 minutes into the workout and lasted as long as three hours afterward.

"This stresses it’s our own responsibility to be active and keep moving,” said co-researcher Ferdinand von Walden. “This is one small piece that adds to the importance of being a physically active individual, so stay active."

Since start of pandemic, Kentucky's case rate is 17% above U.S. average, but state's Covid-19 death rate appears near average

New York Times map adapted by Ky. Health News; click here for interactive version with county rates.
By Al Cross
Kentucky Health News

Kentucky has had a higher rate of coronavirus cases, but probably a lower Covid-19 death rate, than the national averages, according to The New York Times' analysis of Centers for Disease Control and Prevention data.

In cases per person, Kentucky is 13th among the states, at 16,571 cases per 100,000 residents. That's 17.4% higher than the national rate of 13,684.

In deaths per person, Kentucky ranks 26th, at 216 per 100,000 residents, just below the national average of 222 per 100,000. However, death rates may not be fully comparable among the states, because of state-by-state differences in how deaths are attributed to Covid-19.

The state case figures paint with a broad brush; among regions and counties, there are significant differences. Many Kentucky counties have case rates well above the national average, and a few are national leaders.

The case rate in Clay County, in southeastern Kentucky, ranks third among the nation's 3,143 counties and county equivalents. As of Sunday, it had had 5,099 cases, or 25,622 per 100,000. The highest rate is in the Bethel Census Area of Alaska, at 31,174; Karnes County, Texas, is second at 25,877.

Clay County's rate means that about one of every four people in the county have been found to have the coronavirus. The Times's interactive map shows likewise for one of every four people in Lyon County, but for unexplained reasons that county does not appear on the newspaper's list of top 100 counties. Its high rate is attributable to several prisons.

Other Kentucky counties in the top 100 are Whitley, eighth at 24,380 cases per 100,000 residents; Perry, 12th at 23,589; Knox, 20th (22,960); Green, 27th (22,393); Bell, 30th (22,165); Taylor, 38th (21,836); Clinton, 46th (21,570); McCreary, 52nd (21,514); Russell, 53rd (21,486); Morgan, 55th (21,407);  Laurel, 72nd (20,905); and Harlan, 90th (20,557). All but Taylor County are in Appalachia, as defined by Congress; Taylor borders the region.

Several Tennessee counties are in the top 100, reflecting the Volunteer State's No. 2 ranking, trailing only North Dakota's. Tennessee's rate is 18,208 cases per 100,000 residents. The rates and ranks of other bordering states are: Indiana, 15,201, 20th; West Virginia, 23rd, 14,836; Missouri, 29th, 14,088; Illinois, 33rd, 13,306; Ohio, 35th, 12,998; and Virginia, 43rd, 10,717. 

The bordering states' death rates are: Indiana, 16th, 245 per 100,000 residents; West Virginia, 20th at 238; Tennessee, 21st at 235; Illinois, 24th at 224; Missouri, 30th at 206; Ohio, 31st at 205; Virginia, 37th at 160.

Harlan is the only Kentucky county in the top 100. It has had 127 Covid-19 deaths, giving it a death rate of 488 per 100,000 residents, making it 52nd in the nation.

Saturday, October 23, 2021

Study: E-cigarettes don't help smokers stay off combustible cigs

truthinitiative.org photo
By Melissa Patrick
Kentucky Health News

Switching to electronic cigarettes don't help smokers stay off traditional cigarettes, according to a recent study. 

“Our findings suggest that individuals who quit smoking and switched to e-cigarettes or other tobacco products actually increased their risk of a relapse back to smoking over the next year by 8.5 percentage points compared to those who quit using all tobacco products,” John P. Pierce, distinguished professor at the University of California San Diego and first-named author of the study, said in a news release

“Quitting is the most important thing a smoker can do to improve their health, but the evidence indicates that switching to e-cigarettes made it less likely, not more likely, to stay off of cigarettes,” Pierce said.

The study, published in the medical journal JAMA Network Open, used data from the nationally representative Population Assessment of Tobacco and Health longitudinal study. It identified 13,604 smokers who were surveyed from 2013 to 2015 to explore changes in use of 12 tobacco products.

At the first annual follow-up, 9.4% of the established smokers had quit. Among the quitters, 62.9% remained tobacco-free and 37.1% switched to another tobacco product. Among the switchers, 22.8% used electronic cigarettes, and 17.6% of them used e-cigarettes daily.

At the second annual follow-up, the authors compared the former smokers who were tobacco free to those who had switched to e-cigarettes or other tobacco products. They found that the switchers were more likely to relapse than former smokers who had quit all tobacco, by 8.5 percentage points.

“This is the first study to take a deep look at whether switching to a less harmful nicotine source can be maintained over time without relapsing to cigarette smoking,” said Pierce. “If switching to e-cigarettes was a viable way to quit cigarette smoking, then those who switched to e-cigarettes should have much lower relapse rates to cigarette smoking. We found no evidence of this.”

This study was released soon after the U.S. Food and Drug Administration authorized three electronic cigarette products, saying they met the federal standard of protecting public health because study participants who used the products were exposed to fewer harmful chemicals, and the aerosols in those products were significantly less toxic than combusted products. 

However, the FDA emphasized in a news release that the products were not "FDA approved" because "All tobacco products are harmful and addictive, and those who do not use tobacco products should not start."

Audrey Darville, a certified tobacco-treatment specialist and an associate nursing professor at the University of Kentucky, cautioned that it's important to remember that the FDA's marketing approval was related to harm reduction, and not as a smoking-cessation device. 

"I think that's a big indicator that, you know, even the tobacco industry is not finding that the evidence is there, or is clear that these are actually effective for," she said. "So, is switching going to be better for health? Yes, probably. But is it going to keep people off of combustibles? Again, what this study shows is that it is not."

Darville also said electronic cigarettes are not entirely harmless because of the impact they can have on the cardiovascular system, and noted that the long-term impacts of them are still not known.  

She said more research is needed to find out what works to help people quit vaping, noting that e-cigarettes are a different delivery system for nicotine than combustibles, often at higher concentrations.

Also, vapers use the products in a "more continuous" manner, "especially when they're highly addicted; they'll be vaping during the night, they wake up and take a hit off of a vape."

All of this adds up to strong addictions because of the increased exposure to nicotine, she said. 

"All tobacco products are harmful, and addictive," Darville said. "That JAMA study acknowledges the strength and the power of that addiction, and that switching to e-cigarettes, as nice as it would be to have a magic bullet, is not going to be the panacea that the tobacco-cessation community is hoping for." 

According to the Centers for Disease Control and Prevention, in 2018 14.9% of U.S. adults had ever used an electronic cigarette, and 3.2% were current users. A 2018 Kentucky Health Issues Poll found that 24% of Kentucky adults had ever used an e-cigarette and 8% of that group used them regularly. In Kentucky, 23.4% of adults are smokers, more than any state but West Virginia.

The state health department offers a service called Quit Now Kentucky to help Kentuckians of all ages quit smoking. To learn more go to QuitNowKentucky.org, text QUITKY to 797979 or call 1-800-QUIT-NOW.

Friday, October 22, 2021

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

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

By Al Cross
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

Republican legislator gives overview of 'pro-life omnibus bill' that opponents say is designed to push abortion out of reach

By Melissa Patrick
Kentucky Health News

Foes of abortion gave state legislators an overview Wednesday of a proposed bill that would strengthen parental-consent requirements, increase abortion-medication rules, require individual cremation of aborted fetuses and let medical providers refuse to do procedures that "violate their conscience."

Rep. Nancy Tate discussed her bill.
(Image from WTVQ, Lexington)
Rep. Nancy Tate, R-Brandenburg, told the Interim Joint Committee on Veterans, Military Affairs and Public Protection that her "pro-life omnibus bill" will not include exemptions for rape or incest.

Tate said, “If there’s a human baby that’s created from that tragedy,” Tate said, “then the life of that human baby needs to be treated with dignity and respect as well.”

Addia Wuchner, executive director of the Kentucky Right to Life Association and a former state representative, said the yet-to-be-filed bill will be called the "Humanity in Health Care Act."

Kentucky requires consent of one parent or legal guardian, or a "judicial bypass" court order, for a minor to obtain an abortion. Tate's bill would require a parent's identification to be recorded, and require a physician to sign an affidavit stating that proper parental consent had been given.  

While giving a summary of a PowerPoint presentation about the bill, Tate said it would also remove the ability of the physician to delegate the responsibility of obtaining proper parental consent to someone else.

Physicians who knowingly perform an abortion on a minor without following these rules would be  subject to discipline by the Kentucky Board of Medical Licensure and could be found guilty of a Class D felony, punishable by one to five years in prison. Performing an abortion without knowing that the patient is a minor would be a Class A misdemeanor, punishable by up to a year in jail. The bill has no criminal sanctions against the patient. 

Tate said the bill would also raise standards for a minor to qualify for judicial bypass. Her presentation said a judge must find "clear and convincing evidence that the minor is mature, that the abortion is in the best interest of the minor, and that the pregnancy is not a result of abuse by the parent or guardian." 

Further, the judge must ensure the minor is not seeking an abortion due to influence or pressure from an outside source, and would not be allowed to consider a minor's financial situation as a reason to approve an abortion.

Tamarra Wieder, state director of Planned Parenthood Alliance Advocates, told the committee that the bill would make getting parental consent and judicial bypass more difficult. She added that "the vast majority" of teens in Kentucky already involve their parents in their abortion decisions. 

"This bill as we heard today would make the already comprehensive judicial bypass process more onerous and prevent many young people from obtaining a court waiver to ensure their access to care, which is directly what this bill is trying to do — to stop young people from accessing abortion," Wieder said.

She noted that national groups such as the American Medical Association, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics oppose parental-consent laws because they delay access to critical care and threaten the privacy and safety of vulnerable young people.

The annual abortion report from the cabinet's Office of Vital Statistics says that in 2020, 4,104 abortions were recorded in Kentucky. Of those, 13 were performed on girls younger than 15 and 353 were for those 15 to 19. Most abortions (2,421) were among Kentucky women 20 to 29; 779 were for those 30-34; 399 for  those 35-39; and 139 for women 40 or older. 

Tate's bill would also increase regulations on abortions induced by drugs, by not allowing them to be mailed. Tate said more than half of the abortions done in Kentucky each year are done with such drugs.

The bill also would require a physician providing chemical abortions to be credentialed, and to have a signed contract with another physician "who is able to handle complications if they arise," and an emergency transfer agreement. 

It also adds a list of things physicians must do prior to the abortion, including a requirement for the physician to examine the patient in person, conduct a range of blood tests, and do an ultrasound to determine the fetus' gestational age.

Sue Liebel, state policy director of Susan B. Anthony List, an anti-abortion political action committee, said abortion activists have been "quietly building a whole new business model to target young women on their phones" and providing them with information about how to get abortion drugs by mail. 

"This is the goal that would make every bathroom, whether it's in our own homes, or in the dorm bathroom, an abortion clinic," she said. "This bill modernizes Kentucky laws to align with the pharmaceutical dangers of chemical abortion." 

The bill would add several new elements to the informed-consent form, including information about "abortion-pill reversal," and require the Cabinet for Health and Family Services to create a website and publish printed material about the reversal process, and where patients can find a provider who offers it. The technique involves a series of oral or injected doses of the hormone progesterone after the first drug used in a chemical abortion is taken.

Wieder said the claims about abortion-pill reversal are based on "junk science," pointing out that it is not recommended by the American College of Obstetricians and Gynecologists, which says claims supporting the treatment "are not based on science and do not meet clinical standards” and that "legislative mandates based on unproven, unethical research are dangerous to women's health." 

Tate disagreed, saying studies have shown abortion-pill reversal to be successful. 

The bill would also require a physician to ensure that the patient seeking an abortion is not being coerced or forced into having the procedure, and would update the reporting requirements. 

Also, the Kentucky Board of Pharmacy would be required to create a program to monitor distribution of abortion-inducing drugs. Physicians who do not follow these certificate guidelines would be subject to a $250,000 fine. 

The bill would also write new rules for handling fetal remains, giving parents options for disposal, and require each fetus to be cremated individually. 

“We recognize it as a human baby,” Tate said. “It should not be treated as medical waste, it should not be thrown into an incinerator, it should be treated with dignity; and then, therefore, it should be disposed of on an individual basis.”

Wieder said that is a “blatant attempt to create shame and stigma,” adding that there are already regulations about how medical tissue is disposed of. 

Jackie McGranahan, Kentucky policy strategist for the American Civil Liberties Union, said in a prepared statement that the legislation is a "blatant attempt to push abortion care entirely out of reach under the guise of "public protection." 

"The bills would increase the government’s involvement in family relationships and force pregnant Kentuckians, including children, to remain pregnant against their will," she said. "Additionally, the bills are rife with medical fallacies and outright untruths about abortion care." 

Late last month, Democrats pre-filed a bill that would provide every individual in Kentucky with access to comprehensive sexual and reproductive health care, including abortion and contraception. With a Republican super-majority in both the House and Senate, the bill seems unlikely to gain any traction. 

Under House Bill 91 passed by the legislature this year, Kentucky voters will decide in November 2022 if they want to add language to the state constitution a statement that the state's basic law does not secure or protect a right to abortion, or funding of it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thursday, October 21, 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wednesday, October 20, 2021

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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