Tuesday, November 30, 2021

As Kentucky's pandemic numbers catch up with the holiday weekend, they jump; state's positive-test rate is now 8.31%

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

By Melissa Patrick

Kentucky Health News

Kentucky's coronavirus metrics took another jump Tuesday, with new cases and the share of Kentuckians testing positive up, and the fallout from that reflected in hospitalizations and deaths. 

The state reported 2,558 new cases, bringing its seven-day rolling average to 1,469 per day. Tuesday's number was likely inflated due to delays in testing and reporting over the holiday, but that said, it is the highest one-day new-case number since Oct. 7. Of today's new cases, 25% are in people 18 and younger. 

The share of Kentuckians testing positive in the past seven days went up again, to 8.31%, maintaining a a steeper rate of climb that began last week. 

The state's seven-day infection rate is 29.41 daily cases per 100,000 residents, up from 27.84 on Monday. Counties with rates more than double that rate were Carroll, 73.9; Powell, 69.4; Cumberland, 64.8; Harlan, 61.5; and Robertson, 61. Seventy-three of the state's 120 counties have more than 25 cases per 100,000 residents, labeled a high level of transmission and showing red on the state infection map.

Hospital numbers also jumped. Kentucky hospitals reported 930 Covid-19 patients, an increase of 71 from Monday. That was the largest one-day rise since Sept. 8; both days followed holiday weekends in which hospital admissions may have been delayed. (Hospital numbers are recorded at midnight.)

The number of Covid-19 patients in intensive care grew by 25, to 266; and those on mechanical ventilation went up 11, to 122.

Eight of the sate's 10 hospital readiness regions are using at least 80% of their intensive-care beds, with two over 90%: Northern Kentucky (96.25%) and Barren River (95.35%). 

The state reported 30 more Covid-19 deaths Tuesday, bringing the pandemic death toll to 10,943. 

The Hopkinsville Art Guild memorialized seven people who have died from Covid-19 with portraits, each of them with a connection to Western Kentucky and most of them from the Hopkinsville area, Jennifer P. Brown reports for the Hoptown Chronicle. 

Other pandemic news Tuesday: 

U.S. District Judge Gregory F. Van Tatenhove of Lexington issued a preliminary injunction Tuesday effectively blocking implementation of President Biden's Covid-19 vaccine mandate for federal government contractors and subcontractors, Austin Horn reports for the Lexington Herald-Leader. The order came in response to a challenge from Attorney General Daniel Cameron, who joined other state attorneys general in the challenge. 

Van Tatenhove "said that the question before him was a narrow one: whether or not Biden had the authority to impose vaccines on the employees of federal contractors and subcontractors," Horn wrote, quoting the judge: “In all likelihood, the answer to that question is no.”

An independent advisory committee to the U.S. Food and Drug Administration narrowly endorsed the first antiviral pill developed by Merck & Co. for Covid-19, called molnupiravir. The vote was 13-10, with some members voicing concerns over the drug's potential impact on people of childbearing age and concerns over whether the drug could drive mutations of the virus, The Hill reports.

Merick said the drug, which is administered as a five-day treatment, showed a 30% reduction in hospitalizations and deaths, based on data from 1,433 patients, The Hill reports.

Aleria Companies and bankrupt Trinity HealthShare told to pay $4.7 million in Lexington class-action lawsuit that is still going on

"A purported health care cost-sharing company . . . has lost a class-action lawsuit resulting in a nearly $4.7 million judgment" in U.S. District Court at Lexington, reports Jeremy Chisenhall of the Lexington Herald-Leader

After representatives of The Aliera Companies "failed to appear in court multiple times, according to records, Senior Judge Joseph M. Hood "declared that the company should have been subjected to Kentucky insurance laws because their claims of selling health care sharing ministry plans were inadequate," Chisenhall reports. "Members in health care sharing ministries share medical expenses among themselves. Health-care sharing ministry plans aren’t subject to the same regulations as insurance, but they have to meet strict requirements. Aliera didn’t meet those requirements, Hood ruled."

Jay Prather, one of the plaintiffs' attorneys, said “Aliera and its partners have taken advantage of hundreds of Kentuckians, many of whom trusted the company because it professed Christian beliefs. “Aliera’s customers sought affordable healthcare coverage to protect their families in times of need. But when those times of need came, Aliera was more likely to shut the door in the face of its own customers. This ruling by Judge Hood is the first step in helping those families recover what they have lost.”

"Aliera created, marketed, sold and administered health care plans for Unity HealthShare and Trinity HealthShare, companies that were purported to be health-care sharing ministries, according to the lawsuit. Unity HealthShare later rebranded itself as OneShare Health, according to court records," Chisenhall reports. "Hood sided with the victims that purchased a plan while Aleria was partnered with Trinity. Assuming each policyholder would elect to receive the higher payout of those two options, Hood reached an aggregate judgment of $4.7 million, according to court records. Trinity has since filed for bankruptcy, according to court records."

The lawsuit continues because Hood's ruling applies only to policies sold through Trinity. Attorneys for the plaintiffs said Aleria sold plans to "hundreds, if not thousands, of Kentucky residents" and kept 84 percent of their payments. Conversely, insurance companies are required to pay out 80% of the premiums they received, but the law doesn't apply to health care cost-sharing companies.

Aleria denies that it was a health care cost-sharing company. It said in a court filing, “It is a for-profit entity that contracted with Unity and then Trinity (through its subsidiaries) to market memberships in their sharing programs and to create processes to facilitate member-to-member sharing of medical expenses. Aliera has created a system that is designed to afford members the ability to consent to their contributions being shared on a real-time, case-by-case basis with other members as their needs arise. But, as previously noted, all members are informed that their requests for sharing payments may not be met — there are no payment guarantees or indemnification.”

Monday, November 29, 2021

State's positive-test rate above 8%; Beshear and Biden say new Omicron variant creates cause for concern, but not panic

Kentucky Health News graph shows data for the last 30 days.
By Melissa Patrick

Kentucky Health News

The share of Kentuckians testing positive for the coronavirus in the last seven days is 8.14%, more than a full percentage point higher since the state's last pandemic report the day before Thanksgiving.

On Thanksgiving eve, the rate hit 7.05%, which was the first time it had been above 7% in five weeks. The quick jump shows how the virus is surging, "And that's cause for concern," Gov. Andy Beshear said on Facebook. 

"If this hadn't been Thanksgiving week, this last week . . . would have been our highest week in three or four weeks" in case numbers, Beshear said, referring to testing and reporting lags that happens over holidays. The state's infection and new-case rates declined over the holiday period.

Since the last report, the state has reported 5,584 new cases, with 943 of them on Monday. Of Monday's cases, 27% were in people 18 and younger. The seven-day rolling average of daily new cases dropped from 1,763 on Thursday to 1,388 on Saturday, then rose to 1,410 on Monday.

The state's seven-day daily infection rate is 27.84 cases per 100,000 residents. Counties with rates more than double that rate were Carroll, 75.3; Powell, 75.1; Lawrence, 59.7; and Estill, 56.7. The statewide rate was 33.88 on Thursday, but dropped to 27.46 on Sunday, almost surely due to less testing and reporting.
Beshear also addressed concerns about the new Omicron variant of the virus, which the World Health Organization labeled "a variant of concern" that poses a "very high" global risk. On Monday, President Joe Biden imposed restrictions on travel to the U.S. from several nations in southern Africa.

"It does appear that there is reason for concern, but not for panic," said Beshear -- a message similar to one that Biden shared earlier in the day. The governor added, "So in this uncertain period where we wait, use it to get that booster, pull out that mask again and wear it when you think it's appropriate, because even without Omicron, our cases have been going up again." 

Norton Healthcare System's chief medical officer, Dr. Steven Hester, said at a news conference that his advice at this point is the same as before: wash your hands, wear mask, physical distance when appropriate, get the Covid-19 vaccination and get a booster shot, Sarah Ladd reports for the Courier Journal.

MedicineNet reports on what experts know about the Omicron variant, and says so far the Centers for Disease Control and Prevention says "no cases of this variant have been identified in the U.S. to date" and that if it emerges in the U.S., the agency expects it to be identified quickly. 

No Omicron cases have been identified in the U.S. but are expected. A statement from Biden's Sunday meeting with the Covid-19 response team on the variant says, "Dr. [Anthony] Fauci informed the president that while it will take approximately two more weeks to have more definitive information on the transmissibility, severity, and other characteristics of the variant, he continues to believe that existing vaccines are likely to provide a degree of protection against severe cases of Covid. Dr. Fauci also reiterated that boosters for fully vaccinated individuals provide the strongest available protection from Covid."

Kentucky hospitals reported 859 Covid-19 patients Monday, an increase of 41 from Wednesday, with 241 of them in intensive care (up 37) and 111 on mechanical ventilation (up four).

Seven of the state's 10 hospital regions are using more than 80% of their intensive-care beds. Northern Kentucky is at 100% capacity, with 27.5% of its beds used for Covid-19 patients. 

Beshear said the good news in Monday's Covid report is that with vaccinations given over the holiday weekend, the percentage of Kentuckians who have received at least one dose of a Covid-19 vaccine increased to 60%. 

Since Thursday, the state has reported 118 more Covid-19 deaths, including 14 reported Monday. That brings the pandemic death toll in Kentucky to 10,913.

Sunday, November 28, 2021

Ky. ranks first in lung-cancer cases, and low in survival and early diagnosis, but prevention, screening and treatment are easier now

At 89 cases per 100,000 residents, Kentucky is No. 1 in the rate of new lung cancer cases. The national rate is 58. (Map from the American Lung Association 2021 State of Lung Cancer report)

By Melissa Patrick
Kentucky Health News

Lung Cancer Awareness Month falls in November, but in Kentucky the promotion of prevention and early detection of lung cancer is needed all year because the state leads the nation in lung-cancer cases and has a death rate from the disease that is 50 percent higher than the national average.

A year-long multimedia campaign, led by the Kentucky Medical Association, the Kentucky Foundation for Medical Care and the Anthem Foundation, aims to do just that. The Breathe Better Kentucky campaign is designed to educate Kentuckians on lung-health issues and encourage them to schedule appointments to discuss any symptoms, risk factors, or screening tests that they might be eligible for.

"For patients who have small, early-stage lung cancer, early detection is critical to successful treatment, as the cure rate can be as high as 80 to 90 percent when caught in the beginning stages," Dr. Neal Moser, Dr. Shawn Jones and Dr. Jeff Reynolds wrote in the Northern Kentucky Tribune. 

Far too few Kentuckians know lung cancer has become easier to prevent, find and treat, Dr. Timothy Mullett, medical director of the University of Kentucky's Markey Cancer Center Affiliate & Research Network.

At a news conference about Lung Cancer Awareness Month, Mullett said he was frustrated about that, partly because "the burden of lung cancer on the people in Kentucky is unequaled." 

American Lung Association graphic; for a larger version, click on it.
The fourth annual American Lung Association State of Lung Cancer report places Kentucky among the worst five states for smoking, new cases, early diagnosis and survival.

The report ranks Kentucky second in screening, perhaps driven by its high case rate, but says it's worse than average in the percentage of lung-cancer patients (19%) not receiving treatment. It ranks 18th for this measure. 

The national rate for lack of treatment is 21%. The report adds that over the last five years, the percent of cases receiving no treatment in Kentucky increased by 10%. 

One of the best ways to prevent lung cancer is to prevent it and that involves helping the 23.4% of smokers in Kentucky to quit. Smoking is the number one cause of lung cancer, causing about 90% of cases, according to the American Lung Association. Kentucky ranks 2nd in the nation for smoking, following behind West Virginia. 

The state Department for Public Health 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.

The only recommended screening test for lung cancer is low-dose computed tomography, also called a low-dose CT scan, according to the Centers for disease Control and Prevention. 

Annual CT scans are recommended for adults ages 50 to 80 who have smoked at least 20 "pack-years" (a pack-year amounting to one pack of cigarettes a day for a year, or an equivalent amount, such as half a pack a day for two years) and either still smokes or has quit within the last 15 years.

Map shows potential of indoor radon accumulation; click to enlarge.
The second leading cause of lung cancer is exposure to radon, an invisible gas that comes from bedrock. You cannot see, taste or smell it, so the only way to know the concentration of it in your home is to test for it. Concentrations of radon in and under homes are high in many parts of Kentucky.

Some local health departments, as well as the Kentucky Radon Program, offer free short-term radon test kits to Kentucky residents. If elevated levels of radon are detected, radon mitigation systems can be installed to reduce it. 

It's also important to know that there is an even higher risk of lung cancer for people who smoke and also have radon exposure. According to the UK College of Nursing, the lifetime risk of radon-induced lung cancer is 62 per 1,000 ever-smokers compared to seven per 1,000 never-smokers. Because of this, people who smoke or use vape products should smoke outside, says the college's BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) project.

Other causes of lung cancer include exposure to certain hazardous chemicals, pollution, and genetics. 

Symptoms of lung cancer are coughing that gets worse or doesn't go away, chest pain, shortness of breath, wheezing, coughing up blood, feeling very tired all of the time or weight loss with no known cause, according to the CDC.

Omicron could be more contagious than Delta, but experts say it's unlikely to be completely resistant to vaccines; research needed

By Meryl KornfieldAdela Suliman, Christine Armario and María Luisa Paúl
The Washington Post

A new variant of the coronavirus that causes Covid-19 is raising concern around the world.

South Africa confirmed Thursday that it had detected a variant with many mutations that could make it more transmissible than the Delta variant, and adept at evading the body’s immune defenses. On Friday, the World Health Organization labeled it a “variant of concern” and gave it a Greek letter designation: Omicron.

Several countries, including the United States, have since restricted travel from southern Africa while epidemiologists race to learn more. Cases have been identified in nearly a dozen nations, most but not all tied to recent travel to Africa.

There is too little research to draw conclusions, with experts urging caution but not panic. Studies are underway to examine how vaccines hold up against the new variant, with some experts expressing initial optimism that they will offer protection. Even if the variant limits the effectiveness of vaccines, it probably will not completely subvert the protections that vaccines provide, experts say.

Vaccine makers are working to understand how well their vaccines can control Omicron, A Pfizer spokesperson said in a statement, “In the event that vaccine-escape variant emerges, Pfizer and BioNTech expect to be able to develop and produce a tailor-made vaccine against that variant in approximately 100 days, subject to regulatory approval.”

The Centers for Disease Control and Prevention says Omicron has not been detected in the United States, but public-health experts say there is a high probability that the new variant is already spreading in a number of countries beyond those where cases have been detected.

Dr. Anthony Fauci, the nation’s leading infectious-disease expert, told ABC News’s “This Week with George Stephanopoulos” that the variant’s arrival in the United States is essentially unavoidable.

“When you have a virus that has already gone to multiple countries, inevitably, it will be here. The question is: Will we be prepared for it?” Fauci said.  Read more here.

Dr. Ashish Jha of Brown University said on PBS, "There are a lot of features here that concern me and many of us, but we really need more information." He said the "fast takeoff" of the virus suggests that it may be more contagious, and the numerous mutations raise concern about vaccine effectiveness.

But he added, "This pandemic doesn't end until most of the world is vaccinated."

Saturday, November 27, 2021

TV commercials from aging quarterbacks and others for private Medicare plans don't tell the whole story, such as high deductibles

Joe Namath, in image from Medicare Advantage TV commercial aired in Fall 2020
By Trudy Lieberman

It seems nothing ever changes when it comes to hawking insurance to fill gaps in Medicare coverage. The fervent sales pitches, the misinformation, and the incomplete and deceptive information continue to proliferate.

For the last several weeks I’ve heard ad after ad urging older viewers to call 800 numbers to learn about the latest and greatest Medicare Advantage (MA) plans. Retired football star Joe Namath says you need to “get everything you’re entitled to.” Namath rattles off a bunch of extra benefits MA plans offer – dental, vision, hearing, prescription drug coverage – “all at no extra cost.” He urges viewers to “call the number on your screen now. It’s free.”

These are new benefits the government has let private insurers sell in hope of getting more seniors to leave traditional Medicare for a privatized system. By transferring more costs to seniors, the government saves taxpayers money.

Another commercial promises “free eyeglasses and free rides,” presumably to doctors’ offices. Yet another tells viewers they “may qualify” to get $144 added back to their Social Security benefits. The Medicare Part B premium for 2021 is $148.50, which is, presumably, what the commercial promises to save those who choose the privatized system.

I suspected those ads were misleading and deceptive come-ons, designed to persuade listeners to call. So I made some calls. The 800 numbers lead to an insurance brokerage firm or agency that apparently has a network of licensed agents located around the country. Callers are asked to give their ZIP code and then are transferred to an agent who can give the “free benefits” review.

I have heard close to 100 Medicare sales pitches over the years and know that those free consultations are meant to result in a sale, whether or not the senior needs the insurance or is really getting a better plan.

Seldom is there talk about making sure people are covered for the huge amounts doctors and hospitals sometimes charge and Medicare doesn’t cover. What are the trade-offs, for example, between buying an MA plan, which pays those charges after you satisfy a large out-of-pocket maximum ($6,700 per person next year) or buying a traditional Medigap insurance supplement Plan G, which covers those charges right away? A couple with Medicare Advantage could pay as much as $13,400 a year before their plan would pay for anything!

With so many choices, what’s a consumer to do? I rang up Bonnie Burns, one of the best Medicare consumer advocates in the country, for advice.

“It’s just too complicated,” she said. “No wonder people throw up their hands. That’s why people sign up for an Advantage plan with little or no premium and find out what the costs really are as they use benefits through the year.” She added, “It would be so much easier if Medicare Advantage plans and drug plans were standardized so people could figure this out.”

Congress could do that, but hasn't, resulting in today’s chaotic marketplace. Congress wanted to allow every insurer in the universe to throw something out there so the companies could make money and could entice more people to leave traditional Medicare. The goal was to reduce taxpayer costs, all the while side-stepping any action to control run-away medical costs.

Congress did standardize Medigap policies in the early 1990s because that market was as chaotic and misleading then as the MA market is today. I like to think of that action as the high-water mark of consumer protection, and I have no illusions that anything like it will happen again anytime soon.

One final bit of crucial advice is missing in today’s ads. Even after you enroll in an MA plan, perhaps enticed by a few dollars in savings for a pair of glasses, you can return to traditional Medicare in the future. But in all but four states (New York, Connecticut, Massachusetts, and Maine) state laws prohibit you from buying a Medigap plan without an insurer scrutinizing your health status.

If you have developed a pre-existing condition, you may be ineligible for a Medigap policy. I’ve met many people over the years who bought an Advantage plan, got sick, and needed to go to out of network for treatment. They learned the hard way they were shut out of the Medigap market for good.

Trudy Lieberman wrote this in 2020 for the Community Health News Service.

Friday, November 26, 2021

Another reason to get the Covid-19 vaccine: Every case of the coronavirus is an opportunity for the virus to mutate

hopkinsmedicine.org photo

Every case of the coronavirus -- whether in an adult or a child and whether it is symptomatic or not -- gives the virus another opportunity to mutate. 

"David O'Connor, a virology expert at the University of Wisconsin-Madison, said he likens infections to "lottery tickets that we're giving the virus." The jackpot? A variant even more dangerous than the contagious delta currently circulating," Laura Ungar reports for The Associated Press.

The fewer people who are infected, the fewer "lottery tickets" the virus has, "and the better off we're all going to be in terms of generating the variants," he told Ungar, who writes that variants "are even more likely to emerge in people with weakened immune systems who harbor the virus for a long time."

And that's one more reason why it's so important for all eligible people to get the Covid-19 vaccine, because in doing so it limits the opportunity for spread, especially children who often have the virus, but don't have any symptoms.

"Vaccinating kids also means reducing silent spread, since most have no or mild symptoms when they contract the virus," Ungar writes. "When the virus spreads unseen, scientists say, it also goes unabated. And as more people contract it, the odds of new variants rise." 

Cadell Walker of Louisville told Ungar that she rushed to get her 9-year-old daughter Solome vaccinated to not only protect her from the virus, but to also keep it from spreading and mutating into more dangerous variants.  

"The only way to really beat Covid is for all of us collectively to work together for the greater good," Walker, told Ungar. 

Ungar reports that while researchers disagree on how much kids have influenced the course of the pandemic, one estimate from the Covid-19 Scenario Modeling Hub, a collection of university and medical research organizations that consolidates models of how the pandemic may unfold, shows that "for this November through March 12, 2022, vaccinating 5- to 11-year-olds would avert about 430,000 Covid cases in the overall U.S. population if no new variant arose." If a variant 50% more transmissible than Delta showed up in late fall, 860,000 cases would be averted, which would be "a big impact,"  project co-leader Katriona Shea of Pennsylvania State University told Ungar.

Another big unknown is that dangerous variants may arise in largely unvaccinated parts of the world and make their way to the U.S. That concern is showing itself in real-time as the U.S. and several other nations restrict travel to and from southern Africa, where the new Omicron variant emerged. The World Health Organization says it is "a variant of concern." 

“It’s going to buy us some time,” Dr. Anthony Fauci said of the travel ban. “It’s not going to be possible to keep this infection out of the country. The question is: Can you slow it down?”

Wednesday, November 24, 2021

Anchorman Sam Dick retires at Lexington's WKYT-TV; he went public with his prostate cancer, surely saving the lives of others

Sam Dick goes public with his cancer. (WKYT-TV image Tuesday, from broadcast several years ago)
Sam Dick, a familiar face to millions of Kentuckians over a record 34 years as evening anchor on Lexington television, did his last newscast Wednesday night. Thousands of Kentuckians remembered him as the man who used his own case of prostate cancer as a teachable moment that surely saved lives.

The story began with “Three words from my doctor that changed my life,” Dick said. “We found something.” Soon, he shared his journey, through surgery, follow-up tests and, after the cancer returned, radiation treatments.

“The first few times, I was pretty anxious and a little nervous about it,” Dick said in a story by Garrett Wymer, broadcast Tuesday evening on WKYT-TV. “I definitely said some prayers. But after about five or six days of the radiation, I got more comfortable, and actually, I try to take a nap.”

Wymer reports, “He used his platform to open up a dialogue, talking about the importance of annual prostate exams and early detection. . . . It was personal to Sam even before his own diagnosis. His father, David, passed away after a 17-year fight against prostate cancer. He pushed Sam to get annual exams, starting in his 40s.” David Dick was a former CBS News correspondent who directed the University of Kentucky journalism school.

Going public with his story made Sam Dick a resource for other men battling prostate cancer.

Rusty Parsons told Wymer, “Sam’s response was: ‘This is my phone number. Call me.’ We talked and we talked, and I cried. and he said the words that came out of his mouth was: ‘I’ve been through everything you’re going through. You are normal. There is nothing wrong with you.’”

Kentucky's coronavirus positive-test rate goes above 7%; lack of home tests will make Thanksgiving riskier than it should be

New York Times map, adapted by Ky. Health News; click it to enlarge or here for interactive version.
By Al Cross
Kentucky Health News

The pandemic in Kentucky mostly plateaued Wednesday as the nation began a long holiday weekend offering many more opportunities for the coronavirus to spread, especially among the unvaccinated. And the untested.

"Thanksgiving is bound to cause a spike in America’s covid infections," says a headline on The Economist's website. The subhead on the story: "Blame resistance to getting jabbed and a lack of home testing," which could have made Thanksgiving gatherings safer.

"We need to flood the system with testing," Dr. Anthony Fauci told CBS News.

The Economist reports, "These kits are still hard to come by in local pharmacies, and they are costly. The Quidel QuickVue test is priced at $23.99 on Amazon, and the On/Go one at $34.99—and even then they are not available until after the holiday. A family of four would need to spend about $100 or more. By contrast, in Britain the National Health Service allows each person, every day, to order a pack of seven rapid tests free."

“In other countries, we see it’s become the norm for friends and family to get tested before a party, before dinner, before celebrations,” Leana Wen, former health commissioner of Baltimore, told The Economist. “We need to get to that point in this country.” She said the Food and Drug Administration is "letting perfect be the enemy of the good" with an approval process that is too stringent. 

On Wednesday the percentage of Kentuckians testing positive for the virus in the last seven days hit 7.05%, the first time it exceeded 7% in five weeks. It hit a low of 4.98% on Oct 31; the high was 14.16% on Sept. 8.

The state reported 2,144 new cases of the virus, two more than Tuesday but lowering the seven-day rolling average by 7, to 1,733 per day. Almost 26 percent of the new cases were in Kentuckians 18 and younger.

The state's seven-day infection rate ticked up slightly, from an average of 32.49 daily cases per 100,000 residents on Tuesday to a 32.62 average on Wednesday. Counties with rates more than double that rate were Robertson, 94.9; Powell, 92.5; Carroll, 72.6; Magoffin, 70.5; Harlan, 69.2; and Breckinridge, 67.

Kentucky hospitals reported 818 Covid-19 patients, 17 fewer than Tuesday, with 204 of them in intensive care (down 13) and 107 on mechanical ventilation (up 9). Eight of the 10 hospital regions had more than 80% of their intensive-care beds occupied, led by Lake Cumberland at 96%, with Covid patients in 16%.

The state reported 35 more Covid-19 deaths, raising Kentucky's pandemic death toll to 10,795.

Over the last 14 days, the state's new-case average has gone up 29%, more than the national gain of 25%, but its national ranking has gone down slightly, to 28th, because of steeper increases in other states, mainly to the north, where the weather has been colder and people are spending more time indoors.

So says The New York Times, which has changed its method of calculating averages to eliminate days on which states don't report cases, such as holiday weekends. Kentucky's next report will come Monday.

"The previous method displayed the average of the day and the previous six days of data," the Times explains. "In the new method, if the seven-day window includes days with no data reported, the period is extended to older days until it includes seven days of reported data."

UPDATE: Gov. Andy Beshear said on Facebook, "As we sit down at our Thanksgiving meals tomorrow, remember there are folks across the commonwealth with empty seats at the table because of this virus. Tonight, let's show compassion and light our homes green. We must never forget we're in this together."

Kentucky is one of seven states to get grants from Bloomberg to fight the record-setting epidemic of opioid overdoses

Kentucky is among seven states that will get millions of dollars from Bloomberg Philanthropies to fight the opioid-overdose epidemic.

Gov. Andy Beshear announced the $10 million grant to the state "with the goal of reducing overdoses and saving lives by increasing access to medications and expanding preventative services," a news release said.

Michigan, New Jersey, New Mexico, North Carolina, Pennsylvania and Wisconsin are also getting grants over five years. "The Bloomberg Philanthropies Overdose Prevention Initiative also includes partners such as Johns Hopkins University, the U.S. Centers for Disease Control and Prevention, The Pew Charitable Trusts and more," the release said.

Michael R. Bloomberg
Former New York Mayor Mike Bloomberg, founder of Bloomberg Philanthropies, said in the release, “The overdose epidemic is one of the worst public-health crises we’ve ever faced; 254 Americans die every single day from drug overdoses. It’s tearing families apart across the country, and we need bolder, nationwide action, especially from the federal government – but we can’t afford to wait until that happens.”

Kentucky's overdose deaths fell 15 percent from 2017 to 2018, more than the national decline, but started going back up in late 2019. In 2020, overdoses killed 1,964 Kentuckians, the most ever in a 12-month period; it was a 49% increase over the prior year.

The increase has largely been driven by synthetic opioids such as fentanyl. "The presence of fentanyl analogues in other substances, including stimulants and pressed pills, has also exacerbated the crisis," the release said. "While an increase in mortality rates were observed across all genders, age brackets, races and regions of the state, the largest increase in drug overdose deaths has been among Black Kentuckians, at 64%."

State Cabinet for Health and Family Services Secretary Eric Friedlander said, “There is no single cause or cure. The disease of addiction is complex, multi-factorial and intersects with many long-standing priorities and challenges related to health, wellness, economic security and justice. We look forward to this collaborative partnership, lives saved and the recovery of many more Kentuckians.”

Fewer than 8% of overdose survivors are given or prescribed drugs that can block overdose and help them fight addiction

Buprenorphine is given with naloxone to
stop overdose, and alone as drug treatment.
As deaths from opioid overdoses continue to set records in Kentucky and the nation, a new study has found that less than 8 percent of overdose patients in U.S. emergency departments are not given or prescribed two medicines that can block another overdose and help them fight drug addiction.

Analyzing data from nearly 149,000 emergency-room visits before and during the pandemic, researchers at the University of Michigan found that 7.4% of patients received a prescription for naloxone (brand name Narcan), which can block an overdose, within 30 days. Only 8.5% were prescribed buprenorphine, a drug use to treat substance-use disorder.

The study was published in Annals of Emergency Medicine shortly after the Centers for Disease Control and Prevention announced that in the first year of the pandemic, U.S. drug-overdose deaths exceeded 100,000 for the first time in any 12-month period. That period, ending in April 2021, had 28.5% more overdose deaths than the same period a year earlier. The study looked at prescriptions written after emergency-room visits for overdose between August 2019 and April 2021. Overdose deaths in Kentucky set a record in 2020.

“In light of the record levels of opioid-overdose deaths, the low levels of naloxone and buprenorphine prescribing are simply unacceptable,” said Kao-Ping Chua, lead author of the study and assistant professor of pediatrics at Michigan Medicine. “Clinicians are missing critical opportunities to save lives both in the emergency department and during follow-up after overdose visits.”

In contrast, nearly half of patients treated for severe allergic reactions (anaphylaxis) in the same emergency departments over the same time period were prescribed an emergency epinephrine device, such as an Epipen, within 30 days of their visit.

“The same standard we use in caring for patients after anaphylaxis and preparing them with a potentially life-saving prescription should also be applied to patients after an opioid overdose,” said Keith Kocher, senior author of the paper and associate professor of emergency medicine at Michigan Medicine.

Naloxone, which can be administered nasally or through an injection, is designed to restore normal breathing during an overdose and is increasingly available for free from pharmacies and other locations.

"Buprenorphine is also an opioid, but it is designed to block the action of other opioid drugs, including prescription medications, heroin and fentanyl," a Michigan Medicine news release said. "The medication helps people reduce or eliminate their dependence on using opioids, without causing a high on its own."

"The risk that patients who survive an opioid overdose will go on to die from another overdose is high," the release noted. "In a 2019 study, researchers found 1.1% of patients treated for opioid overdose died within one month and 5.5% died within one year."

Chua said, “There are some clinicians who think that prescribing naloxone encourages patients to engage in risky behaviors, increasing their risk of overdose again, but there’s not a lot of evidence that this occurs.”

Kocher said emergency departments have not traditionally been seen as the place to start addiction treatment, but are being used as “teachable moments” to try and start patients on many other kinds of treatment and lifestyle changes.

Tuesday, November 23, 2021

Pandemic numbers continue to tick up, especially Covid-19 hospitalizations; 53 more deaths reported, raising recent average

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

As Kentucky heads into a cold Thanksgiving weekend that is sure to keep family gatherings indoors, the metrics to measure the coronavirus continue to go up: New cases and infection rates are up, the share of Kentuckians testing positive is up, and Covid-19 hospitalizations keep rising at an accelerating rate. 

Kentucky reported 2,142 new coronavirus cases Tuesday, raising the seven-day rolling average to 1,740, 2.7 percent higher than yesterday's 1,694. Of those, nearly 26% are in people 18 and younger.

The percentage of Kentuckians testing positive for the virus in the past seven days is 6.77%, up from 6.56% on Monday and 5.05% three weeks ago.

The state's seven-day infection rate is 32.49 daily cases per 100,000 residents, up from 31.54 on Monday. Counties with rates more than double that rate were Robertson, 135.5; Powell, 87.8; Magoffin, 79.9; Cumberland, 77.8; Bourbon, 75.1; Carroll, 72.6; and Bath, 66.3.

The number of counties with more than 25 daily cases per 100,000 people also keeps ticking up. The state infection map shows those counties in red to indicate the highest category of transmission. Today, 86 of the 120 counties are red, up from 81 Monday; 31 are in orange zone ("substantial" transmission) and only three are in the yellow ("moderate" transmission): Elliott, Lee and Wayne. 

Hospitals reported 835 Covid-19 patients, 26 more than Monday. That was more than twice the average daily gain of 11.8 seen over the last two weeks. The average daily gain over the last seven days was 13.7. The last time Kentucky had consecutive days of gains of more than 20 Covid-19 patients was Sept. 9 and 10, when it set the record number of 2,541.

The state's daily report showed 217 Covid-19 patients in intensive care, up 14 from Monday, and 98 on mechanical ventilation, down 3. Eight of the state's 10 hospital readiness regions are using at least 80% of their intensive-care beds, with three above 95%: Barren River, Northern Kentucky and the easternmost region, stretching from Lee County to Pike County.

There was at least one spot of good news, according to a Facebook post by Gov. Andy Beshear: Kentucky ranks first in its region and above the national average in the percentage of fully vaccinated residents who have gotten a booster shot. On Monday, Beshear said 504,028 Kentuckians had gotten a booster. So far, 2.65 million have received at least one dose of a Covid-19 vaccine, or 59% of the total population. 

The state reported 53 more Covid-19 deaths Tuesday, raising the pandemic death toll to 10,760. One of the victims was 25 years old, Beshear said. Today's reported deaths tie for the 13th deadliest day of the pandemic. The seven-day death average is 43 and the 14-day average is 40, based on counting 140 of the 212 deaths reported Friday as deaths found by rechecking death certificates dating back to 2020. 

Health Commissioner Steven Stack has warned that the Covid-19 death toll will continue to be high over the next few months because of the recent surge in cases, and expected further surges.

Other pandemic news Tuesday: Attorney General Daniel Cameron has challenged President Biden's mandatory vaccination requirement for health-care workers in facilities that get Medicare and Medicaid funding. Cameron joined 13 other states in a lawsuit in federal court in Louisiana, arguing that the mandate is unlawful and unconstitutional, and that the Centers for Medicare & Medicaid Services lacks authority to issue it. 

Approximately one-third of Kentuckians are covered by the Medicaid program. In the state fiscal year ended June 30, the state received more than $12 billion in federal funds for Medicaid, and Medicaid funding accounts for more than 25 percent of the state’s total budget.

Monday, November 22, 2021

Coronavirus cases, positive-test rate and hospitalizations keep rising in Ky., creating more risk as Thanksgiving approaches

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

In the last week, coronavirus cases, the share of Kentuckians testing positive for the virus, and Covid-19 hospitalizations all went up again.

"Though we don't necessarily think there's cause for alarm now, we've got to watch this very carefully," Gov. Andy Beshear said at a news conference. He added later, "It ought to tell everybody that we need to be real careful on Thanksgiving this week, as well as Christmas coming up."

Beshear encouraged eligible Kentuckians to get an immunization or booster shot before the holiday if possible, to not attend any social gatherings if you are feeling sick, to wear a mask indoors if you are not vaccinated or boosted, and to keep attendance numbers at gatherings low. 

Slide from Beshear's news conference
"Unlike last year, there's an opportunity for it to be safe," he said. 

Beshear also made a special plea for Kentuckians aged 65 to 74, who have the highest rate of having received at least one dose of a vaccine, 94%, to encourage their children and grandchildren to get vaccinated at an appropriate time during the holidays. Vaccinated seniors are more vulnerable to breakthrough cases.

Beshear said the case numbers for Saturday, Sunday and Monday were all the highest they've been for those days of the week in at least four weeks, and haven't just crept up, but are "moving up." 

Since Saturday, Kentucky reported 3,888 new cases, with 822 Monday. The seven-day rolling average for cases is 1,694, up 7.8% since Friday. Of today's new cases, nearly 24% are in people 18 and younger. 

The weekly case numbers have gone up for two weeks in a row, to 11,572 in the Monday-to-Sunday week ending Nov. 21. The latest weekly case number is the highest in five weeks, Beshear said, "so we're going to have to watch this very, very closely. Our testing has been fairly steady, so something real is happening." 

The share of Kentuckians testing positive for the virus in the last seven days is 6.56%, up from 6.24% on Friday.  This rate has gone up for three weeks.

Dept. for Public Health graph, adapted by Kentucky Health News
Also of concern is that hospitalizations for Covid-19 have gone up 21% in the last two weeks. Kentucky hospitals reported 809 Covid-19 patients, 31 more than Friday; 203 of them in intensive care, the same; and 101 on ventilation, down 3. 

Eight of the state's 10 hospital-readiness regions are using at least 80% of their intensive-care beds. Northern Kentucky region is the only region above 90%, with 19.3% of its ICU patients having Covid-19.

The state's daily infection rate is 31.54 cases per 100,000 residents, up from 30.02 on Friday. Counties with rates more than double that rate were Robertson, 128.8; Magoffin, 89.3; Cumberland, 82.1; Bourbon, 80.9; Powell, 75.1, and Breckinridge, 70.5. Eighty-one of the state's 120 counties have more than 25 daily cases per 100,000 residents, considered a high level of transmission. 

All these increases have led to an increase in the demand for monoclonal antibody infusions, said Beshear. He reminded Kentuckians that there is not an unlimited supply of these infusions, although at this time the state has enough supply to meet demand, largely because the demand has been low.

"If we had any type of surge like we did the last time we would not have enough," he said. "And it's a lot better to get a couple of shots and to have to have an infusion."

Monoclonal antibodies, laboratory-produced, mimic the body's natural immune response and reduce the likelihood of severe infection and hospitalization. They must be given soon after the infection is diagnosed and are not a substitute for a Covid-19 vaccine. 

So far, 2.6 million Kentuckians have received at least one dose of a Covid-19 vaccine, with 32,774 of them children between the ages of 5-11, or 8% of this population. Beshear said 504,028 Kentuckians have received a booster shot. There is still plenty of time to be fully vaccinated by Christmas. 

A Wall Street Journal analysis of new data finds that breakthrough cases of Covid-19 are hitting older people and those with underlying health conditions the hardest. Public health experts told the Journal that it is important to track such cases, especially as we shift to managing Covid-19 for the long term. Asked if the state has such data, Beshear said he would check into it. 

The state reported 42 more Covid-19 deaths Saturday, 15 Sunday and 44 Monday, raising Kentucky's pandemic death toll to 10,707. Three of the fatalities were in their 40s and one was 36, Beshear said.

Sunday, November 21, 2021

Not sure how to talk about Covid-19 vaccines with loved ones? Nurses offer a guide to 'productive conversations'

The American Association of Critical Care Nurses' guide
to productive conversations about Covid-19 vaccines

Covid-19 vaccines are likely to be a topic of conversation during the holidays, which could bring tension to family gatherings.

The American Association of Critical-Care Nurses created a guide to help those who have been vaccinated to engage in constructive conversations with family members and friends who are hesitant about the vaccine. The toolkit is part of AACN’s "Hear Us Out" campaign to report nurses’ reality from the front lines of the pandemic and urge those who are unvaccinated to get a shot.

“Covid-19 is still here. The majority of patients with Covid we’re seeing in ICUs haven’t been vaccinated, and their journey often ends with a nurse holding their hand as they die,” said Beth Wathen, AACN president. “Nurses need allies to end this pandemic, and productive conversations about the vaccine among family, friends and those who trust each other can open minds.”

A recent AACN survey of more than 6,500 acute and critical care nurses found that 76% of respondents say that people who have yet to be vaccinated threaten nurses’ physical and mental well-being. It also found that 92% of nurses surveyed said they believe the pandemic has depleted nurses at their hospitals and, as a result, their careers will be shorter than they intended.

“We know that people in communities with low vaccination rates are at greater risk for becoming seriously ill with Covid-19 and dying from what is now largely a preventable disease,” said Amanda Bettencourt, AACN president-elect and an assistant nursing professor at the University of Pennsylvania. “The pandemic has brought the nursing profession into crisis, and the public is a critical part of the solution. The fastest way out of this is by more people getting vaccinated.”

Estill County paramedic and EMS trainer is recognized as one of the nation's 50 'Community Stars' on National Rural Health Day

Sheila Wise (Photo courtesy of Sheila Wise)
Shelia Wise, a paramedic and training major at Estill County EMS in Irvine, has been recognized today by the National Organization of State Offices of Rural Health  as a “Community Star” for her community education efforts and her work in helping to shape her hometown EMS service into what she considers one of the best in the state.

Wise, who began a career in accounting before switching  to EMS in the 1990s, holds just about every instructor certification available in the field (and others outside of it), and she puts them to use — not just in training first responders, but also staff at the local hospital, other clinics, health departments, schools, churches, other community organizations and students in a nearby university-based paramedic program.

She’s been involved in efforts to combat substance use disorder, including serving as a member of the region’s Overdose Task Force. She also serves as a medical liaison to the county coroner’s office.

And Wise has been instrumental — along with her husband, Jimmie, the director of the EMS service — in developing the close relationship that exists between the service and Mercy Health-Marcum & Wallace Hospital, the critical-access hospital that is the service’s next-door neighbor.

“I can tell you I am so honored to have received this recognition. I don't feel that I do anything special,” Shelia Wise said. “I just do a job that I love in a community that I grew up in, where I know most everyone. A lot of my patients have watched me grow up. So, when I am working in this community, I am caring for not just patients — but truly my friends and family.”

She added: “Jimmie and I have worked with EMS for a very long time. We eat, sleep and drink emergency services and would not have it any other way.”

As part of the Community Star recognition, Wise is featured in an electronic book released on National Rural Health Day, Nov. 18. The publication, on the powerofrural.org website, features stories of 50 Community Stars from across the country. The book is also available for purchase in print.

“Shelia Wise is one of those health care professionals who really gets it — she understands what it means to work in a rural community, that those communities often face limited resources, but that the residents living there deserve the highest level of care possible,” said Ernie Scott, the director of the Kentucky Office of Rural Health. “Rural Kentucky is where she’s from. Rural Kentucky is where she works. Rural Kentucky is who she is. And, rural Kentucky is where her heart is. The Irvine community, Estill County and all of Kentucky are lucky to have her here.”

Each Community Star was nominated for recognition by someone familiar with their rural health work and contributions. A selection committee reviewed and evaluated nominations and made recommendations on which stories to include in this year’s publication.

Past nominees have included physicians, nurses, allied health providers, hospital administrators, board members, volunteers, community health workers and first responders. Other nominees have included coalitions and collaborators working together on initiatives that address a specific health crisis or need, or drive large-scale health and wellness programs.

The Community Stars initiative, begun in 2015, shines a spotlight each year on individuals and organizations who work every day to close gaps, open doors, address challenges and develop solutions through collaboration, education, innovation and communication.

Outgoing National Institutes of Health director says disinformation, misinformation are fueling distrust in science and 'Truth is losing'

Francis Collins, head of the National Institutes of Health, and Anthony Fauci,
head of the National Institute of Allergy and Infectious Diseases
(NIH photo)
By Rachel Roubein
The Washington Post

National Institutes of Health Director Francis Collins has a stern message for the American public: The country has an epidemic of misinformation and disinformation, and it’s fueling a dangerous distrust in science.

“Conspiracies are winning here. Truth is losing. That’s a really serious indictment of the way in which our society seems to be traveling,” said Collins, who will soon step down as NIH director after serving in both Republican and Democratic administrations.

Collins defended his colleague, Anthony Fauci, President Biden’s chief medical adviser, against the biggest onslaught of angry messages and threats he's received throughout the entire pandemic.

Those attacks stemmed in part from a viral and false claim that Fauci, who leads the National Institute of Allergy and Infectious Diseases, had funded a medical experiment that involved trapping beagles' heads in mesh cages filled with diseased sand flies. Fauci received so many messages — 3,600 phone calls in 36 hours — that his assistant quit answering the phone, the Post's Yasmeen Abutaleb and Beth Reinhard report.

The claim was amplified by a little-known animal rights group called the White Coat Waste Project, which leveraged existing hostility among conservatives toward Fauci to further its cause, the Post’s investigation found. The outrage was supercharged by a bipartisan letter signed by 24 members of Congress that questioned the agency’s funding of medical research on dogs.
The claim originated with an error by scientists. NIAID was initially listed as a funder on the study in a paper in a scientific journal in late July. Even after the researchers and the medical journal corrected the error, White Coat Waste continued to promote and fundraise off the false claim. The group said it does not believe NIAID's denial or the corrections.
White Coat Waste's message was amplified by a right-wing echo chamber eager to thrash Fauci over everything from vaccine directives to NIH funding of coronavirus research at the Wuhan Institute of Virology and created the biggest firestorm yet for Fauci.

The episode serves as a prime example of how fast a false claim can spread online — and how it can stymie the highest levels of government. The surge of threats and harassment in recent weeks has forced Fauci's staff to spend significant time debunking misinformation and grappling with security concerns.

The rapid-fire spread of misinformation has altered public opinion of the pandemic and coronavirus vaccines. Some 6 in 10 Americans say they either believe the government is exaggerating the number of deaths from the virus or aren’t sure. Nearly 1 in 4 Americans believe covid-19 shots contain microchips or don’t know if the claim is true, according to a recent Kaiser Family Foundation survey.

“Truth is supposed to be truth,” Collins said, “and the fact that your truth would be so heavily modified by your social circle or where you get your news tells you we’re in real trouble.” He said he worries about a society where “somebody’s Facebook post carries as much weight as a statement from the director of the CDC about what is the truth of a public health crisis.”

Collins sees two ways of attempting to curb the spread of misinformation, though admits he’s unsure how successful either has been. The first: Identify those who are purposefully spreading false information online and bring them to justice. The second: Find a better way to counter false claims with real information. He didn’t specify what exactly either one would entail.

Saturday, November 20, 2021

The sooner you quit smoking, the better off your lungs will be; but the sooner you start, the higher will be your risk of cancer death

Photo: Getty Images/Wavebreakmedia
Smoking's negative health consequences are well known, but smokers can reduce―or even erase―their risk of dying from lung cancer by quitting at a young age, and the younger the better.

new study led by the American Cancer Society analyzed data on more than 410,000 Americans participating in an ongoing federal health survey between 1997 and 2014, and the researchers found that quitting by age 35 can effectively eliminate the risk of dying from lung cancer and quitting by 45 can lower the risk by 87%. Even middle-age smokers between 55 and 64 can can cut their risk in half by quitting.

"Smoking definitely has a cumulative effect,” said Dr. Patrick Ma, an oncologist at Penn State Cancer Institute. “Of course, the best advice is never start smoking, but this study shows it’s never too late to quit and see some benefit."

On the flip side, the sooner one starts smoking, the higher their chances of dying from cancer. People who started smoking before age 10 are four times more likely to die from cancer than lifelong nonsmokers, and people who started before age 18 are three times more likely.

The good news overall is that lung cancer-related deaths are on a downward trend, Ma said. Lung cancer mortality among men has decreased by 51 percent since 1990 and by 26 percent among women since 2002.

Annual scans for lung cancer are recommended for adults ages 50 to 80 who have smoked at least one pack of cigarettes for 20 years and currently smoke or have quit within 15 years.

November is Lung Cancer Awareness Month.

Rural Americans are the most likely to say the pandemic is over, and least likely to take precautions against it

The Atlantic/Leger poll was conducted Nov. 5-7. Click the image to enlarge or click here for the rest of the report.

Though the coronavirus remains entrenched in rural areas, rural Americans are more likely than their suburban or urban peers to have rejected or given up on social distancing, masking and/or vaccinations. "They feel, in short, that the pandemic is 'over,'" Olga Khazan reports for The Atlantic. According to a recent Atlantic/Leger poll, "people in rural areas are most likely to feel like things are 'back to normal' where they live—45 percent thought so, compared with 30 percent of urbanites and 36 percent of suburbanites. Rural Americans were also the least likely group to say they wished their neighbors would be more cautious about Covid-19."

Rural Americans were less likely than suburban or urban residents to say most adults they know are vaccinated against the coronavirus, and more likely to say they socialize indoors with unmasked friends, Khazan reports. State and community laws were more likely to foster rural Americans' attitudes: Only 27% of rural residents said they have to wear a mask to work, and rural schools and daycares were less likely to require kids to wear masks or require kids to stay home if they have Covid-19 symptoms.

"For a lot of people who aren’t wearing masks or getting vaccinated, they think that this has just been blown out of proportion, and that people are just too fearful and need to go about their lives," Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, told Khazan.

"Among the rural unvaccinated, this is a false sense of security. Covid is spreading rapidly in rural areas, which is worrisome because rural people tend to be older, poorer, and in worse health to begin with," Khazan reports. "If they do get sick, they have less access to hospitals—more than 100 rural hospitals have closed since 2013. The Covid-19 death rate in rural America is now twice the death rate in urban areas. And the longer that pockets of unvaccinated Americans remain, the greater the likelihood that new variants will take hold and spread elsewhere."

But, Khazan notes, policy makers may not have tried hard enough to understand rural Americans' viewpoints on the pandemic. And it's difficult for many rural counties to get accurate information, especially since many lack health departments and good local newspapers, she writes: "Of course they feel abandoned, and at this point, defiant."

Exercise increases the body's cannabis-like substances, which can help reduce chronic inflammation, English study shows

Photo: Shutterstock
Exercise can reduce chronic inflammation by increasing the body's own cannabis-like substances, which have the potential to treat conditions ranging from arthritis to cancer to heart disease.

In a study published in Gut Microbes, researchers from the University of Nottingham in England split 78 people with arthritis into two groups. One group performed muscle-strengthening exercises for 15 minutes every day for six weeks, and the other group did nothing. At the end of the study, the participants in the exercise group not only reduced their pain and the amount of inflammatory substances but also increased the amount of cannabis-like substances. Exercise caused these improvements by altering the participants' gut bacteria.

Doctor Amrita Vijay, the first author of the paper, said, “Our study clearly shows that exercise increases the body’s own cannabis-type substances, which can have a positive impact on many conditions."

Friday, November 19, 2021

Health commissioner says to expect more coronavirus surges, so it's important to keep encouraging vaccines despite resistance

Steven Stack, M.D. (State photo)
By Melissa Patrick
Kentucky Health News

Kentucky will continue to see coronavirus surges from time to time, and because Covid-19 still has the potential to overwhelm the health-care system, it's too early to start treating it as just another infection to live with, state Health Commissioner Steven Stack told Kentucky Health News in an interview.

"Covid is here to stay," Stack said. "I think the sooner people acknowledge that, the better off we'll be, but it's still premature to just try to mainstream it as if it were like any other condition, because it still has the very real potential to swamp hospitals." That is "a threat not only to people who become infected with Covid, but also to every other person in society" who needs a hospital.

"It's not yet time to say that it is just a regular part of our daily lives because it isn't," he added. "It will cause problems that the common cold and influenza don't typically cause, but we have to accept the fact that our behaviors will matter and the choices we make will determine how quickly we can normalize this and not have it be so exceptional." 

One of those behaviors is getting a Covid-19 vaccine, but a substantial number of people say in polls that they will never get one, no matter what.

Stack said that ultimately, society will need to "normalize the expectation" that getting the Covid-19 vaccine is "something all of us have to do," just like we have to follow the rules of the road when we drive an automobile. 

"The adverse consequences of the pandemic are being extended because there are still too many people vulnerable to its worst impact," and those aren't just the unvaccinated, he said. "When those consequences compromise the safety and well being of whole communities and larger populations, it is still a very much a societal need to work on this." 

Right now, Stack said, the messaging to get hold-outs vaccinated must come from people that they personally trust and respect, like local leaders. He came to the interview just after a conference call with Gov. Andy Beshear and 121 county judge-executives and mayors. They have such a call every two weeks or so, according to the Cabinet for Health and Family Services

Stack said he didn't have specific numbers for how many unvaccinated Kentuckians are firmly resistant to all messages, even from people they trust, but he said Kentucky is a conservative state and its vaccination rates are lower than many other states, so such resistance is probably strong. 

"We have work to do, and we have to continue to try, because giving up is just not an option," he said. "The consequences are too substantial. I mean, literally, people's health, wellness and lives are potentially in the balance if we don't find a way to get through this." 

In October, 27% of U.S. adults in the Kaiser Family Foundation Covid-19 Vaccine Monitor poll said they had not gotten a Covid-19 vaccine, and 60% of those identified themselves as Republican or Republican-leaning and 17% called themselves Democrats or Democratic-leaning. 

Only 5% of those polled said they will "wait and see" before getting vaccinated, a share that has steadily declined since the survey was first taken in December 2020, when 39% said so. Four percent said they would only get a shot if it is required, and 16% said they would "definitely not," a share that has held steady throughout the polling.

According to the Centers for Disease Control and Prevention, 60.5% of Kentucky's eligible population is fully vaccinated; and less than half of the total population in 67 Kentucky counties have received at least one dose of a vaccine. Becker's Hospital Review ranks Kentucky 36th among the states and Washington, D.C., for the number of people fully vaccinated. 

Stack agreed with President Joe Biden and others who have said the pandemic is now driven by people who are unvaccinated, but said, "It doesn't really serve us well to castigate and scold and lecture people and tell them that they are wrong. That's not the way to persuade people." 

And as he's said before, we have mastered the science of why such vaccines are necessary, but we haven't mastered human behavior, or the sociology of it.

"And that's a tale as old as time," he said. Drawing on his love of classical literature, he said reading Greek poet Homer's The Iliad and The Odyssey to find "that behavior has been alive and well in the human population for a very long time." 

One of the many challenges public-health officials face is behavior influenced by the plethora of Covid-19 vaccine misinformation on social media. To that end, Stack's advice is to "unplug" from all of it regularly. 

"I think we would find we would still know all of the stuff that's really important and we would be less revved up and less polarized to see each other as enemies, instead of fellow members of our community," he said. 

One key recommendation for getting Kentuckians vaccinated is easy access, a challenge for families of some youth, since most of the state's pediatric offices don't offer the vaccine at this time. 

Stack acknowledged that's a challenge in a convenience-driven society, he said more than 1,600 registered vaccination sites across the state give plenty of access, and that he expects more pediatricians to start offering vaccines, especially with them now approved for children five and older.  

At the end of the interview, Stack was asked what has surprised, disappointed and frustrated him most in the pandemic. 

He said he's been surprised that despite all of the negative comments about the state's efforts, "Hands down, 99% of what I've received has been positive." He said when he runs into folks in public, "They always have said, 'Thank you.' They've always had a smile on their face."

"As far as disappointed, it's just that we haven't found, despite all of our efforts, a way to take what unites and focus on that, instead of what divides us. I mean, we are waging a war with ourselves, where we have taken a very simple tool that works -- the vaccination -- and made it into an identity statement, whether or not I'm going to accept it. So I'm disappointed that humanity still hasn't found a way to rise above Homer or Shakespeare, or any of these others who have described it so well."

Coronavirus new-case rate goes up 7.9% in one day; state clears backlog of Covid-19 deaths and adds 212 to pandemic total

Ky. Health News graph; case numbers are from initial, unadjusted daily reports; click to enlarge.
By Al Cross
Kentucky Health News

As the rate of new coronavirus cases in Kentucky jumped almost 8 percent in one day, state officials cleared a backlog of Covid-19 deaths, adding 212 to Kentucky's toll and bringing the total to 10,606.

Gov. Andy Beshear said Thursday that 84 of the deaths added to the list were from 2020. He said they were added for two main reasons: Some death certificates used a code instead of "Covid-19," so weren't captured in a text search, and some health-care providers have amended death certificates.

The Cabinet for Health and Family Services said 56 of the newly reported deaths occurred in January and were identified in death-certificate searches done to close out reporting for 2020. The other 72 deaths broke down this way: five each in June and July, 13 in August, 23 in September, 15 in October and 11 in November.

Deaths from infectious diseases can be reported weeks or months after they occur, because of the state's confirmation process. In the last week or two, the state has reported an average of 36 Covid-19 deaths per day.

The deaths graph on the state's pandemic dashboard shows that deaths peaked in December 2020, amid a holiday-season surge in cases, and hit a secondary high in September, as the stronger Delta variant of the virus took hold.
Ky. Dept. for Public Health graph, adapted by Ky. Health News; for a larger version, click on it.

The state reported 2,201 new cases of the virus Friday, raising the seven-day rolling average of new cases to 1,572 per day. That was an increase of 115, or 7.9%, over the daily average recorded Thursday.

The state's daily infection rate rose above 30 cases per 100,000 residents for the first time in a month, to 30.02. Counties with rates more than double that rate were Robertson, 122; Magoffin 105.7; Bourbon, 79.4; Breckinridge, 78.8; Cumberland, 77.8; Powell, 68.2; Jackson, 62.2; and Monroe, 61.7.

The share of Kentuckians testing positive for the virus in the last seven days rose to 6.24%, the same level as Wednesday. Its recent low was 4.98%, on Halloween, Oct. 31. Above 5% is a level of concern.

Hospital numbers also continued to rise. Kentucky hospitals reported 778 Covid-19 patients, 28 (3.6%) more than Thursday, with 203 in intensive care (up 8) and 104 on mechanical ventilation (up 4).

Seven of the state's 10 hospital-readiness regions reported using more than 80% of their intensive-care-unit beds, and four of those were above 90%. Among those, the highest percentage of ICU beds being used by Covid-19 patients was 20%, in Northern Kentucky.