Monday, January 31, 2022

Kentucky's weekly Covid-19 case numbers and positive-test rate are on the decline, offering hope for the weeks to come

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

By Melissa Patrick

Kentucky Health News

Kentucky got a hopeful Covid-19 report from Gov. Andy Beshear at his weekly pandemic press conference, with the state's weekly coronavirus case numbers and positive-test rate on the decline. 

"We certainly hope that between these two points of data, total cases and positivity rate, that we are headed in the right direction," he said. 

Since Saturday, Kentucky reported 19,915 new coronavirus cases, bringing the seven-day rolling average to 10,946, 11 percent below Friday's. Of Monday's 4,950 new cases, nearly 25% are in people 18 and younger. 

Kentucky reported 74,376 new cases in the Monday-to-Sunday reporting week ended Jan. 30, down from 81,473 the prior week, but still higher than two weeks ago, when the state reported 72,165 cases. 

"We hope what we are seeing is a cresting and hopefully the beginning of the downward slope in Omicron cases," Beshear said. 

That said, he cautioned that case numbers are still too high, noting that last week's case number was the second highest and more than double the peak during the Delta surge. 

Other good news is that the weekly positivity rate, which is a leading indicator, has also gone down, and is lower than it was two weeks ago.

The share of Kentuckians testing positive for the virus in the last seven days is 28.49%, a rate that has slowly decreased since a high of 33.1% on Jan. 23.

The bad news is that hospitalizations are still going up on a weekly basis and are close to the high seen during the Delta surge. The hope, Beshear said, is that they will soon start coming down and the question is, "When and how much longer will our hospitals be pushed to the brink?" 

Kentucky hospitals reported 2,413 Covid-19 patients Monday, with 454 in intensive care and 232 on mechanical ventilation. The total was 40 fewer than Friday, but it often drops on Monday, Beshear noted.

Nine of the state's 10 hospital regions continue to use at least 80% of their intensive-care beds, with four over 90%. Northern Kentucky is again at 100%. 

Beshear reiterated that Kentuckians should get a Covid-19 vaccine and booster shots, pointing to an article in The New York Times that breaks down Centers for Disease Control and Prevention research that shows how getting vaccinated -- and boosted -- offers significant protection from dying from Covid-19. David Leonhardt wrote: "That risk is not zero, but it is not far from it." 

The data shows that the average weekly chance of a boosted person dying of Covid was about one in a million during October and November, compared to about 2.4 per million of dying in a car crash or about three per million of dying from the flu or pneumonia, reports the Times. 

"While the vaccine provides incredible protection, the booster shot provides even more,"Beshear said. "In fact, deaths of those that have gotten a booster is almost zero. Look, people are are dying because of the lack of a vaccine. These shots are safe and effective. If you haven't gotten it yet, get your vaccine. If you haven't gotten your booster, don't put it off for any reason. Go in and get it, your level of protection will be significantly increased." 

So far, 2.85 million Kentuckians, 64% of the population, have received at least one dose of a Covid-19 vaccine; 2.5 million are fully vaccinated, or 55% of the total; and 1 million have been boosted, or 41.7% of the eligible population. 

The statewide infection rate is 193.8 daily cases per 100,000 residents. Eight counties have rates above 300 cases per 100,000: Muhlenberg, 359.2; Hopkins, 345.6; McCracken, 343.5; Mercer, 327.6; Powell, 327.1, Clay, 320.9; Whitley, 314.4; and Hardin, 304. Every county remains red on the state incidence map, for having more than 25 daily cases per 100,000 residents, considered a high level of transmission. 

The Times ranks Kentucky's seven-day infection rate third among the states, with a 32% rise in cases in the last 14 days. The rankings are based on data from the CDC, which uses different calculation methods than the state. The Times places seven Kentucky counties in the nation's top 22 in infection rate: Hopkins, Morgan, McCracken, Mercer, Boyd, Muhlenberg and Clay. 

Under questioning, Beshear said he still has confidence in schools participating in the "test-to-stay" program, which allows exposed students to remain in school as long as they are not testing positive, as long as they are also enforcing a universal masking policy. Some states are moving away from this program, citing that case numbers are too high to make it effective. 

"We think it is an important and valuable tool when it is paired with universal masking," Beshear said. "A test-to-stay program where you don't have universal masking might not help a lot because by the time you are doing those tests, somebody could have spread the virus to others . . .   So we believe that these two mitigation tactics need to be done in concert."

The state reported 70 more Covid-19 deaths since Saturday, bringing the pandemic death toll in Kentucky to 12,960. Beshear said one of the fatalities was 38 years old and another was 42.

Research suggests local journalists quote local experts, not Fauci et al., when discussing pandemic health guidelines

Journalists want to keeping readers informed about the coronavirus pandemic, but widespread skepticism of government-endorsed public-health measures makes it difficult, as some rural editor-publishers can attest.

Soon-to-be-published research suggests a solid approach to making public-health information seem more trustworthy to readers: Quote local sources such as doctors or health department administrators instead of "elite" sources such as Dr. Anthony Fauci, Austin Fitzgerald reports for the University of Missouri's Donald W. Reynolds Journalism Institute. So advise Associate Professors Monique Luisi and Ben Warner, who analyzed the results of a nationwide survey of more than 3,000 adults about their attitudes concerning coronavirus vaccines, politics, and trust in public-health recommendations.

The findings "were striking," Fitzgerald reports: "While demographic factors — such as age and race — and partisanship explained some variance in views about vaccination and public health recommendations, anti-elitism accounted for more than a third of this variance. Though partisanship has been seen as an important factor in the divide between the vaccinated and unvaccinated, this finding indicates the story is more nuanced, especially given that the media — one of the primary purveyors of public health information — is itself considered 'elite' by many who hold anti-elitist values."

So, local newsrooms are likely best served by quoting local sources and citing local impact. "When people hear about the burden the virus is creating in their community or learn about what their local health department is doing, they are more receptive," Luisi told Fitzgerald. "And a more receptive audience could mean more lives saved."

Sunday, January 30, 2022

Flu cases are declining in Kentucky, but season runs until May, and CDC says there's still time and reasons to get vaccinated

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

Influenza cases in Kentucky have slowly declined for five straight weeks, similar to what is going on in the rest of the nation. 

The latest weekly report from the state Department for Public Health shows that in the week ended Jan. 22, Kentucky counted 147 new flu cases. The state has recorded 2,392 cases this season and has reported no flu-related deaths. 

Most lab-confirmed cases continue to be in people between 1 and 30, with the highest rate among those 11 to 20. 

The Centers for Disease Control and Prevention's weekly surveillance report notes that while influenza activity is hard to predict, it is expected to continue for several more weeks. Flu season lasts until May.

"There’s still time to get vaccinated," the CDC says. "An annual flu vaccine is the best way to protect against flu and its potentially serious complications. CDC recommends everyone 6 months and older get a flu vaccine." 

It's also important to remember that it takes about two weeks after vaccination for antibodies to develop in the body to provide protection against the flu virus, which is why it's important to get vaccinated before the virus starts to spread in your community.

The state report shows that most Kentucky counties had little to no change in flu activity from the previous week, with Jefferson County, the state's most populous county, continuing to have the most new cases each week. It reported 57 in the week ended Jan. 22. Other counties with relatively high case numbers were Harrison, 10; Pike, nine; Warren, six; and Barren and Clark, five each.  

The state's flu level is "regional," which applies when increases in flu cases have been confirmed in at least two, but fewer than half, of the state's 16 regions. Flu season usually peaks between December and March.

Friday, January 28, 2022

Legislature sends Beshear a bill to ban any 'zero visitor' policies in nursing homes other facilities, a legacy of the pandemic

State Sen. Julie Raque Adams (Legislative photo)
By Melissa Patrick
Kentucky Health News

A bill to guarantee an essential caregiver's right visit a resident at long-term care facilities, assisted-living communities and state-owned mental health hospitals has passed unanimously through both chambers of the General Assembly and awaits Gov. Andy Beshear's signature. 

Senate Bill 100, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes that the caregiver can be either a family member, legal guardian, outside caregiver, friend or volunteer who is important to the mental, physical or social well-being of the resident. 

"This will put in statute and codify their ability to visit their loved one in any of these facilities," Adams told the House Health & Welfare Committee Thursday, Jan. 27. 

The committee chair, Rep. Kim Moser, R-Taylor Mill, described the bill this way: "The gist of this is that there will never be zero visitors allowed."

SB 100 is modeled after provisions that were included in bills passed in regular and special sessions last year. Those provisions are set to expire on Jan. 31, so Adams' bill was put on a fast track to passage.

While presenting the bill to the House committee, Adams said changes in the House the committee substitute would allow more than one caregiver to visit a loved one, clarify that a facility can allow the caregiver to visit their loved one in their room rather than a designated location if there is a need, and allow the facility to limit the total number of caregivers allowed to visit at one time. 

Sherry Culp, the state's long-term care ombudsman, told the panel that while about 60% of long-term care residents don't have visitors, the visitation ban imposed early in the pandemic had a "devastating effect" on the 40% who do, many of whom not only relied on caregivers for social and emotional support, but for personal care. 

"We hope that we never again see all visitors banned from visiting . . . residents in long term care facilities because we're concerned about an unnecessary decline and we are so grateful for Senator Adams for recognizing these devastating effects of visitation bans," Culp said.

Marla Carter of Owensboro told the lawmakers by remote video about the devastating impacts the lockdown had on her mother-in-law, Linda, who lives in a nursing home. Carter and her husband are her co-guardians: "The lock-downs and isolation have definitely had a very detrimental effect on Linda."

When the visitation ban was relaxed to allow weekly 15-minute outdoor visits, with participants six feet apart, her mother-in-law found that confusing, and that no matter the explanation, "She really thought that we were abandoning her," Carter said, adding that when outside visits were stopped because of last fall's surge in cases, Linda's condition rapidly declined. 

"So when we last saw her in November of 2020, she was talking, playing Jeopardy, painting craft projects and then when we saw her in January 2021, just two months later, she was completely nonverbal, barely alert or aware of her surroundings," she said. "And yet when we would call to speak to the staff and inquire about her condition, they told us she was fine. She obviously was not." 

Carter said nursing homes are doing the best that they can amid chronic staffing shortages, and must keeping clients safe, but also noted the valuable role that family members play as 'staff extenders" who not only provide personal care, but also provide social and spiritual support to their loved ones. 

"Family members are direct care partners," she said. "No one knows our loved ones like we do. No one cares for our loved ones as much as we do. We provide their connection to their memories, to their sense of self and well-being."

Moser said the bill is very important to her, saying she wished it had been in place when her father, Dr. Floyd G. Poore, was living in an independent living community and they were completely shut off from him in the last year of his life. She added, "Had we had access, maybe we would have gotten him, known that he needed the care that he needed a little sooner." Poore, who was state transportation secretary in the 1980s and later ran for governor and Congress, died at age 83 on Jan. 26, 2021. 

While presenting the bill on the Senate floor Jan. 21, Adams said, "Patient care is not just about medical care, as we all know. It's about considering the holistic needs of the individual, their mental, emotional and spiritual needs -- and that will go toward some of these people's survival in these facilities." 

Sen. John Schickel, R-Union, told the Senate that this bill was one of the most important pieces of legislation to pass this session. 

"The people in our long-term care facilities and nursing homes in the last year have suffered immensely," he said. "I’ve had some very personal experiences in the last two years of people who have been isolated, literally begging to be with their families, and being held in a sterile environment, where they were really willing to accept more risk, because they wanted to a live a full life with their families in their very last days."

The bill, with the House committee substitute, passed the House Jan. 27 and the Senate agreed to the House changes Jan. 28. It has an emergency clause so it would become law upon the governor's signature.

Pope Francis sees an "infodemic," says access to accurate information about the coronavirus and vaccines is a human right

Pope Francis (Photo by Franco Origlia/Getty Images)
Pope Francis said Friday that an “infodemic” is spreading, defining it as “a distortion of reality based on fear, falsified or invented news.”

The head of the Roman Catholic Church said information based on scientific facts is a human right, and urged Catholic journalists to help people who were misled by false reports about the coronavirus and vaccines.

“To be properly informed, to be helped to understand situations based on scientific data and not fake news, is a human right,” the pope told members of the International Catholic Media Consortium on Covid-19 Vaccines.

He added that journalists and scientists should treat with respect those who believe falsehoods, and not put them in “ghettos.” "Instead, they should try to build bridges to those who need to hear scientific truths," Gaia Pianigiani reports for The New York Times.

Coronavirus cases remain high in Kentucky, but other measures of the pandemic, including Covid-19 hospitalizations, decline

Kentucky Health News graph; click it to enlarge.
By Melissa Patrick

Kentucky Health News

Coronavirus cases remain at near-record highs in Kentucky, but Covid-19 hospitalizations and the seven-day positive-test and infection rates appear to be in a slight decline. 

Kentucky reported 15,822 new coronavirus cases Friday, its second highest daily number. But the seven-day average fell to 12,295, because the record high was eight days ago. 

The share of Kentuckians testing positive for the virus in the past seven days is 30.5%, and has fallen slowly since setting a record of 32.65% six days ago.

Kentucky Health News graph; click it to enlarge.
Kentucky hospitals reported 2,453 Covid-19 patients, down 55 from Thursday, a drop of 2.2%, which is the largest one-day drop since Oct. 20. Hospitals reported 446 Covid-19 patients in intensive care, down 27, or 5.7%, and 254 Covid-19 patients on mechanical ventilation, down 3, or 1.9%. 

Nine of the state's 10 hospital regions continue to use at least 80% of their intensive-care beds, with four above 90%. The state's daily report says 86% of ICU beds are in use, with 208 beds available.

The state's seven-day infection rate is 222.9 daily cases per 100,000 residents. Ten Kentucky counties have a rate above 300 per 100,000: McCracken, 389.4; Hopkins, 376.6; Muhlenberg, 354.1; Clay, 343.1; Whitley, 340.4; Mercer, 334.8; Daviess, 331.4; Harrison, 326.8; Hardin, 320.3; and Powell, 304.

The New York Times ranks Kentucky's infection rate fourth among the states, and reports that Hopkins County has the nation's 14th highest rate, with Boyd and McCracken counties Nos. 20 and 21. The rankings are based on data from the Centers for Disease Control and Prevention, which uses different calculation methods than the state.

The state reported 34 more Covid-19 deaths, bringing Kentucky's pandemic death toll to 12,890. Gov. Andy Beshear reported on Facebook that one of today's deaths was 38-years-old. 

The Lexington-Fayette County Health Department said Fayette County's Covid-19 deaths now exceed 500. "We mourn the loss of these individuals, and remain steadfast in following public health guidelines by focusing on vaccines and boosters, wearing protective face coverings, and maintaining social distance in public," Mayor Linda Gorton said in a press release.

Thursday, January 27, 2022

Lexington students' contacts with counselors, social workers and other mental-health professionals have quadrupled in pandemic

The pandemic has quadrupled the "contacts between Fayette County students and district counselors, social workers and other mental-health professionals," reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

In the current school year, there have been 303,607 such contacts, compared to 74,174 for the same period in 2018-19 and 220,797 in 2019-20, the school year in which the pandemic began, Spears reports. When instruction went remote, the schools began providing mental-health services, Fayette County Supt. Demetrius Liggins said Tuesday at a Commerce Lexington luncheon.

Liggins said the use of those services “is probably the biggest surprise for educators in general. We knew about the learning loss. We knew kids were home and they weren’t learning as effectively as they would have been if they had been in person. We really did not realize the impact that the isolation and the lack of socialization had on our students and on our staff, quite frankly, and how that would impact the school year.”

Spears reports, "Students elsewhere in the state recently told Kentucky lawmakers that students were suffering from mental health issues as a result of their time in at-home learning." The state House has passed a bill that "would excuse student absences for mental health reasons." It is in the Senate Education Committee.

Pandemic numbers seem to be nearing peak in Ky., but Beshear advises caution, warning that hospitals could still be overrun

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

As the daily data signaled that the Omicron surge in coronavirus cases is nearing a peak in Kentucky, Gov. Andy Beshear said Kentuckians should still be careful because Covid-19 cases could still cause a crisis in hospitals.

"We hope and we do think that Omicron is cresting," Beshear said at a regular briefing. But he also said, "Hospitalization is near a record high. We are close to the height of inpatient census that we saw it in the Delta-variant surge. Yes, Omicron is less deadly, but a heck of lot more people have it, meaning that there are a significant number of people that are getting really sick."

The state reported 12,756 new cases Thursday, the eighth highest daily total of the pandemic, but that figure was lower than last Thursday's, so the seven-day rolling average of daily new cases fell by more than 100, to 12,339.

But the average had set a record Wednesday, and The New York Times ranked Kentucky's seven-day infection rate fourth among the states, based on Centers for Disease Control and Prevention data. The state, which calculates the rate differently, said it fell slightly, to 230.3 cases per 100,000 residents.

Counties with rates above 300 on the state's daily report were: Hopkins, 406.6; McCracken, 393.1; Clay, 348.2; Harrison, 348; Muhlenberg, 346.2; Daviess, 337.6; Whitley, 324.6; Harlan, 321.3; Hardin, 320.8; Boyd, 319.5; Spencer, 313; Mercer, 312; Powell, 306.3; Ohio, 303.6; and Shelby, 300.1.

Kentucky hospitals reported 2,508 Covid-19 patients, just short of the record 2,541 recorded at the peak of the Delta surge. But that was only 15 more than the day before, a much smaller gain than the daily averages of the last few weeks, and there was one fewer Covid-19 patient in intensive care and 12 fewer on mechanical ventilation (473 and 259, respectively.)

Beshear said he didn't have a hospitalizations prediction model because Omicron and Delta behave differently, but said he expects Covid-19 hospital cases to continue trailing coronavirus case reports by about two weeks. 

The Omicron variant is less likely to cause severe illness, but is infecting many more people at a time when hospital admissions are typically high. Beshear said fewer than 100 intensive-care beds were available in the state Wednesday, and noted staff shortages. Some hospitals have suspended elective surgeries.

"We have a lot of staff that’s also out from our hospitals," the governor said. "Folks, be careful. When this happens, we don’t have room or beds for people who get hurt in car accidents or have a stroke."

The percentage of Kentuckians testing positive for the coronavirus in the last seven days is 31.6%. It has declined slightly for the last five days from the pandemic record of 32.65%.

The state reported 39 more Covid-19 deaths Thursday, equaling the highest daily total reported in the past month. That raised Kentucky's pandemic death toll to 12,856.

"It is difficult, it is astounding," Beshear said of the total. "It's more than in any three wars put together, and that’s in 20 months, and that’s not including all the people we’ve lost to other things during this period of time. I just hope even as tired as we are, that we take a minute and realize that people are losing people very close to them, and that ought to give us the strength to … push through."

State Department for Public Health graph; click on it to enlarge.
Beshear displayed graphs showing that vaccination has prevented death in almost all fully vaccinated Kentuckians under 60 since Omicron became dominant. Because the variant is highly contagious, it has affected more people, increasing middle-aged Kentuckians' share of total deaths. For example, he noted that before Omicron, people in their 30s and 40s accounted for only 2% of Covid-19 deaths, but since then they have been 10% of the total.

“These numbers tell the entire tale,” Beshear said, adding later, “Covid-19 right now is killing younger people at a higher rate that certainly we saw earlier in the pandemic.”

He also said, “If you get vaccinated, you need to still be careful, but you’re well protected” against “the deadliest thing in all our lifetimes.”

Covid-19 can cause psychological problems; UK case is an example, and also of surgery that can prevent epileptic seizures

From left: Sally Mathias, M.D.; Aleina Milligan; her sister Kelly Milligan, the patient; Farhan Mirza, M.D., and Timothy Ainger, Ph.D. (University of Kentucky photo by Pete Comparoni)
By Hillary Smith
University of Kentucky

Aleina and Kelly Milligan of Columbia are more than sisters; they are truly best friends. For Kelly, her older sister has been a lifeline during the past two years.

“I was so excited when she decided she wanted to move down here because I thought, ‘This is awesome! I’m going to get to have my sister,’” Aleina said. “And then she got so sick.”

Kelly has dealt with seizures her entire life. She lived and worked in a sheltered employment program in Michigan and had worked as a custodian for 29 years. After experiencing some health issues while at work and after their mother passed away, Kelly decided to move in with her sister.

“She had no support system in Michigan, and it was just too much,” said Aleina.

But Aleina became concerned when she noticed a change in Kelly’s seizure patterns, so they came to see UK HealthCare’s Dr. Sally Mathias, an assistant professor of neurology who specializes in epilepsy.

“When I first saw her, I knew we needed to know more,” Mathias recalled. “She had never had some of the basic testing that is required for epilepsy, so we started off with that.”

The fact that Kelly’s seizure patterns had changed stood out to the epilepsy specialist, but that wasn’t all. “What is very rare is that her heart was actually stopping with every seizure — it is called ‘ictal bradycardia’,” said Mathias. “We noticed that on the Epilepsy Monitoring Unit. The longest her heart stopped while she was in our hospital was 20 seconds.”

To explore this further, they sent her home with a heart monitor for a few weeks. While at home, the heart monitor detected 30 seconds when Kelly’s heart had stopped.

“This was very serious and needed immediate attention,” said Mathias. “We directly admitted her to cardiology, and she got a pacemaker.”

Kelly was shocked to learn about what was happening with her body. This was all new for Aleina, but as they learned, she more says it did start to make sense.

“I was with her several times and experienced when she would just drop,” Aleina said. “There was one time I kept looking at her and thought ‘She is not breathing … surely not though, she must be breathing.’ After we found this out, I’m like, ‘OK, she wasn’t breathing.’ We are very fortunate that nothing has happened, and her heart continued to restart.”

After receiving her pacemaker, the next step for Kelly was epilepsy surgery, something she had never considered before meeting the doctors at UK HealthCare.

“It still baffles me that no one ever did basic testing for epilepsy on her, and that when I discussed epilepsy surgery with them, it was the first time they had heard of it,” said Mathias.

In August 2020, Dr. Farhan Mirza, assistant professor of neurosurgery and director of epilepsy surgery, successfully did surgery on Kelly’s brain. For the first time, she or her sister can remember, Kelly was seizure-free.

“We could go places and not have to go through the thought process of ‘What if?’” said Aleina. “For example, I had been thinking it would be wonderful to visit the beach and go swimming, but I was always afraid to get her in the water, because, what if she dropped?”

Mirza said, “Kelly's journey, like so many of our patients with refractory epilepsy, highlights two important things: No one should have to suffer from uncontrolled epilepsy for decades, and all patients who are resistant to anti-epileptic medications deserve to be evaluated for possible surgical options in a timely fashion. This can be done effectively only at highly specialized centers like UK where we offer advanced multi-disciplinary care for refractory epilepsy.”

The sisters were thrilled to have a greatly improved quality of life as Kelly celebrated her 50th birthday complete with a crown and a sash, less than two months after her epilepsy surgery.

“She was not limited anymore, and that is fantastic,” said Aleina.

Second chapter: Just weeks after celebrating her 50th birthday, two and a half months after her brain surgery, Kelly contracted Covid-19. She started showing symptoms about a week after Aleina came down with the virus. As Aleina recovered, Kelly’s symptoms worsened.

“She started telling me that she was having these strange neurological symptoms – tingling, burning, rushing feelings in her hands and feet, and continuous thoughts that she could not control,” said Aleina. “Kelly had never had any mental problems other than minor anxiety.”

After a few months of feeling like they could finally enjoy life together, Aleina was again reaching out to doctors with great concern for her sister.

“I read some articles about studies looking at the possibility that Covid can attack the weakest part of a person,” said Aleina. “I just assumed that would be her brain because she just had this major surgery.”

At that point, Covid-19 was still relatively new. Aleina says the doctors she spoke with did not know much about the virus other than to tell her that if Kelly’s breathing was okay, then she was okay.

“She continued to get worse … her brain, the tingling,” said Aleina. “It never presented in her lungs, but she just kept acting more strangely. She would say she was on fire and that she felt there was something evil after her.”

Kelly does not remember much of that time, and Aleina says that's a good thing. After about 10 days, Aleina took her to their local emergency department because she was afraid her sister was having another seizure. She wasn’t, though she had a fever and a low level of sodium.

The sisters continued to live like this for several more days and found themselves in the midst of the holiday season. Kelly continued to have a growing feeling that something was invading her body and mind. She then ended up back in the hospital with pancreatitis, which doctors attributed to her Covid-19 infection. Then just a few days after Christmas, Kelly tried to harm herself, and she was admitted to Eastern State Hospital.

“She was in full-blown psychosis,” said Aleina. “She was hallucinating and thought she was being told to harm herself or us.”

Her neurology doctors “were very concerned for her, but at that time there really were not any reports of COVID harming anybody mentally,” Aleina said. “They just didn’t know if it could be related.”

After three weeks at Eastern State, Kelly returned home on some medication that helped a little while, but quickly took a turn for the worse.

“She had gotten so bad … she was no longer my sister,” Aleina said. “It was horrible.”

Kelly was not eating. She would not communicate. Then, she began abusing her medications.

“I got ahold of Dr. Mirza and Dr. Mathias, and I was very honest with them and begged them to get her in for an appointment,” said Aleina. “I said, ‘I don’t know what is going on, but something is wrong, and she is going to die if we do not figure this out.’”

Drs. Mirza and Mathias, and neuropsychologist Timothy Ainger met with Kelly and decided that she couldn’t be sent back home. They knew right away that something was not right because she had undergone a neurocognitive evaluation as part of her pre-surgical workup, and the new results were much different.

“It is a very comprehensive evaluation of your cognitive abilities and how well your mind is functioning,” Ainger said. “She had gone from being talkative, engaged, and polite to being terrified, psychotic, and reserved.”

Her epilepsy doctors, Mirza and Mathias, had seen this surgery done successfully on so many patients and knew that this reaction was not typical. Mathias recalled, “We were naturally thinking, ‘Okay, what else is going on?’”

They said they felt good about Kelly’s surgery, but also knew that these issues occurred not long after it.

“She was doing great from a procedure perspective and didn’t have any issues,” said Mathias. “After surgery, some issues can develop. So that is what we were thinking … Maybe it wasn’t entirely because of the surgery … but I did have that in the back of my mind, because I can’t exclude that.”

The doctors also said operating on that area of Kelly’s brain wasn’t a likely cause for the type of psychiatric symptoms she was having. When Ainger looked through Kelly’s medical notes and history, he discovered the culprit.

“It then became very obvious,” Ainger said. “Right after she had just come out of the acute Covid illness, she had this rapid and sudden onset of symptomology. It was very similar to what the literature has been suggesting in the few cases that existed and very similar in one or two other patients that we had treated.”

They treated Kelly's case as some form of Covid-induced encephalitis, swelling of the brain, starting immunoglobulin therapy and changing one of her seizure medications.

“Within one week, my sister was back,” Aleina recalled. “She was still medicated with the anti-psychotic medication, but she was Kelly again.”

Since then, Aleina says they have been able to back Kelly off from 20 milligrams of her antipsychotic medication to one milligram.

“We completely believe we are going to be able to have her off that completely very soon,” Aleina said. “She is doing great. It has been a real journey.”

In the course of a year, Kelly has been on a roller coaster with her health: a dramatic brain surgery to rectify seizures, a bout of ovid-19, the development of psychosis, and then - thanks to intervention - back to normal and seizure-free. Through all those ups and downs, she and her sister are thankful for the team at UK.

“Because of the way this team works together, it was not six months, nine months, or even 12 months of working with other hospitals and dealing with referrals,” said Ainger.”We were able to just walk into each other’s offices, have meetings, and get this managed right away. That is not the kind of service people get from hospitals that don’t have multidisciplinary teams like this.”

In this case, the teamwork even went outside of the neurology department – it also included cardiology, considering Kelly’s prior heart issues and pacemaker.

“This one was different and a lot of cross-functional teamwork, but we do this for every patient,” said Mathias. “We come together to help our patients especially when they are going through such difficult times.”

Thanks to their teamwork and dedication, Kelly and Aleina are now finally getting to enjoy living in the same place.

“I’ve got her back and so now we can grow old together,” said Aleina. “I’m kind of already there, but we are so looking forward to it.”

“Kelly's story is truly one of years of anguish, a glimpse of seizure freedom, a calamitous decline, followed by a complete recovery,” said Mirza. “We are thrilled to see her faring so well and are honored to have been a part of Kelly and Aleina's inspirational journey.”

Wednesday, January 26, 2022

Virus infection rate stalls, but new-case average hits a new high and Covid-19 hospitalizations jump 4% in one day, nearing record

Regions in red are using over 80% of ICU beds. (State table, adapted by Ky. Health News; click to enlarge)
By Al Cross
Kentucky Health News

Covid-19 hospitalizations in Kentucky jumped 4 percent from Tuesday to Wednesday, to nearly 2,500, as the state seemed likely to set a new record this week for residents hospitalized with the disease.

The seven-day average of new coronavirus cases reached a new high, 12,462, as the state reported 12,827 new cases Wednesday. However, the state's infection rate dropped slightly, and now ranks 11th in the nation, rather than second, as it did Tuesday, according to The New York Times.

The percentage of Kentuckians testing positive for the virus in the last seven days also fell slightly; it is 32.44%, based on 185,522 laboratory tests. The figures do not include at-home tests.

Kentucky hospitals reported 2,497 patients with Covid-19 as of midnight. That was 96 more than 24 hours earlier, one of the biggest jumps ever, and just 44 short of the record 2,541 Covid-19 patients reported on Sept. 10.

However, a smaller share of patients with Covid-19 are in intensive-care units than during the late-summer surge. ICUs reported 474 Covid-19 patients, with 271 on mechanical ventilation; at the high point in September, ICU cases numbered 698, with 448 ventilated.

Hospitals have said they are discovering Covid-19 cases in some people who have been admitted for other reasons, but several hospitals are limiting or suspending elective surgeries that require an overnight stay, perhaps due more to staffing shortages than the increase in Covid-19 patients.

The state's daily report showed more ICU capacity than on most recent days, with only three of the 10 hospital readiness regions using more than 90% of their ICU beds. Another six were between 80% and 90%.

The state's seven-day coronavirus infection rate is 234.7 daily cases per 100,000 residents, slightly less than Tuesday's 235.9 but still not far from the record 237 set last Friday.

Counties with rates above 300 per 100,000 are Hopkins, 415.3; Muhlenberg, 404.5; McCracken, 396.1; Daviess, 363.5; Powell, 350.2; Henderson, 339.4; Harrison, 329.8; Boyd, 327.5; Whitley, 323.4; Hardin, 322.5; Harlan, 318.6; Spencer, 317.4; McLean, 311.9; Ohio, 311.4; Shelby, 308.9; and Henry, 308.3.

Jefferson County's rate is 240 per 100,000, just above the state average and Fayette County's rate is 248.8, but the Lexington-Fayette County Health Department reported 1,040 new cases Wednesday, the first time above 1,000. (The department's and state's numbers differ, due to reporting methodologies.)

The state attributed 31 more deaths to Covid-19, raising Kentucky's pandemic toll to 12,817.

In other pandemic news:
  • The Richmond city commission voted 3-2 Tuesday night to offer a $500 vaccination incentive to employees, using federal pandemic relief funds. The city is following the local examples of the Madison County school board and Eastern Kentucky University, reports Taylor Six of the Richmond Register.
  • Mercer County schools are again requiring masks, for at least a week, due to an increase in coronavirus cases, Lexington's WKYT-TV reports. The county's seven-day infection rate is 279.4 per 100,000 residents.

Tuesday, January 25, 2022

7-day average for Covid-19 cases a record; Ky. rate is No. 2 in nation; surge causing more hospitals to limit elective procedures

NYT chart shows states with top 7-day rates of new coronavirus cases Tuesday; click on it to enlarge.

By Melissa Patrick
Kentucky Health News

The Omicron variant of the coronavirus keeps surging in Kentucky, setting a record Tuesday for the highest seven-day rolling average, and the acceleration of hospital cases is making some hospitals limit elective procedures. 

Kentucky reported its second highest number of new coronavirus cases Tuesday, 15,305. That brings the the seven-day rolling average to 12,427, the highest yet and the first time that number has been above 12,000. 

The seven-day infection rate is 236 daily cases per 100,000 residents, the second highest ever, exceeded only by 237 on Friday, Jan. 21. Three counties are above 400 cases per 100,000: Muhlenberg, Hopkins and McCracken. State officials consider any rate above 25 a high level of transmission.

Kentucky's rate has shot up to No. 2 among the states, behind only Kansas, according to The New York Times' ranking of states and territories.

Kentucky hospitals reported 2,397 Covid-19 patients, a 3.1% rise from Monday; the increase of 71 cases was one of the largest recent daily increases. Today's Covid-19 hospital census is only 5.7% short of the all-time high of 2,541, recorded Sept. 10. 

Hospitals report that 452 Covid-19 patients are in intensive care, an increase of 12 from Monday, and 272 of them are on mechanical ventilation, up 15. The number of patients on mechanical ventilation is 60% of the intensive-care unit count, higher than usual, and the highest it's been since Oct. 13. 

Nine of the state's 10 hospital regions continue to use at least 80% of their intensive-care capacity, with two above 90%. 

The surge of hospital cases across the state is straining the system, causing some hospitals to stop non-urgent procedures. The latest report comes from Baptist Health Richmond, which will start restrictions Wednesday.

At a news conference Monday, Dr. Mark Dougherty, an infectious-disease specialist at Baptist Health Lexington, said his hospital started limiting elective procedures earlier this month, largely for those that require a hospital stay. 

“We had a limited staff; we needed to prepare ourselves to take care of more Covid patients,” Dougherty said. “Now we’ve gone to limiting all elective procedures, and we’re making a decision on that on a week-by-week basis. . . . We're hoping that we'll be able to cease doing that in one to two weeks."  

Dr. Ashley Montgomery-Yates, chief medical officer for inpatient and emergency services at UK HealthCare, said they have "not officially" limited elective surgeries during the surge, "but honestly, I'm not sure we also ever got all of our operating rooms back up and running full force, because we're so understaffed." Health Commissioner Steven Stack said Monday that Kentucky is "running out of health-care workers."

Dr. Dan Goulson, chief medical officer of CHI Saint Joseph Health said his hospital is looking at the need to stop elective procedures day-by-day. 

"For the most part [we] have not had to restrict elective surgeries, though there certainly have been days where based on staff call-outs or other other crimps on the system that we've not been able to do a particular surgical case on the day that it was originally intended for," he said. 

Health officials regularly urge more Kentuckians to get a Covid-19 vaccine and booster shot as a way to decrease hospitalizations, since most Covid-19 patients are unvaccinated and booster shots are needed to avoid substantial risk of severe illness and hospitalization.

The state said Monday that in Kentucky, 77.5% of coronavirus cases, 84.5% of Covid-19 hospitalizations and 83.1% of Covid-19 deaths from March 1 to Jan. 19 were in people partially vaccinated or unvaccinated. 

The share of Kentuckians testing positive for the virus in the last seven days is 33%. Last Monday, this rate was 30.25%, but it has been on a near-plateau for three days. Today's figure is based on 187,652 laboratory tests and does not include the results of any at-home tests.

Of today's new cases, 22% are in people 18 and younger. Vaccination rates are lowest in that age group.

Health officials are also urging Kentuckians to upgrade their masks. Deborah Yetter of the Louisville Courier Journal reports that the Biden administration will ship free N95 masks to Kentucky this week and that they can be found at Meijer, CVS and Walgreens. "N95 and KN95 masks are considered to be the most effective against the highly contagious Covid-19 virus," she writes. 

The state reported 23 more Covid-19 deaths Tuesday, bringing Kentucky's pandemic death toll to 12, 786.

Monday, January 24, 2022

Pandemic still set records but may be nearing its crest in Ky.; short-staffed hospitals struggle to keep up; better masks urged

State Dept. for Public Health graph, adapted by Ky. Health News; for a larger version, click on it.
By Melissa Patrick
Kentucky Health News

As hope mounts that the Omicron-variant surge will soon crest in Kentucky, hospitals in the state remain strained with a workforce that is struggling to stay healthy, prompting Health Commissioner Steven Stack to say the state is not running out of beds and ventilators, "We're running out of health-care workers."

Kentucky has averaged 11,489 new cases of the coronavirus in the last seven days, less than the seven-day average reported last Friday, and lower than the record high seven-day average of 11,789 set Sunday.

Another sign that the surge may be cresting is a four-day decline in the daily infection rate, now 216 daily cases per 100,000 residents. On Friday it was 237.01, the highest ever.

Sixty-six of the state's 120 counties have above 200. The lowest rate, 62.7, is in Elliott County. The New York Times ranks Kentucky's rate 16th among the states. 

In the reporting week ended Sunday, the state hit another case record and positive-test rate. It had 82,159 cases, more than 9,000 above the previous record-setting week, and a positivity rate of 33.1%, nearly four percentage points higher than the record set the previous week.

On Monday, the share of Kentuckians testing positive in the past seven days was 33.06%, meaning that one in three Kentuckians who get tested for the virus are positive. The number does not include at-home tests. 

Offering a bit of hope, Stack said if Kentucky follows the case trends in Rhode Island, New York and the United Kingdom, Kentucky should reach its peak number of cases this week or next. 

Gov. Andy Beshear said, "We hope that we are cresting, that we are near the peak of what we'll see. Remember, even if that's the case, it's going to take us at least a couple of weeks if not three to get to a much safer place."

Stack noted that Kentucky's hospitalizations are nearing the all-time peak reached during the Delta surge, and said many Kentucky hospitals are struggling and at risk of running out of workers.

He said the virus is not hitting the lungs nearly as hard as it did as the other variants, but is infecting more people, including hospital workers.

Dr. Mark Dougherty, an infectious disease doctor at Baptist Health Lexington, said the same at a news conference with doctors from CHI Saint Joseph Health and UK HealthCare

"One of the things that has been a little more difficult for us to handle during this surge is the fact that so many health-care workers are getting infected," Dougherty said. 

He later added that he too thought cases will soon crest, if that plateau hasn't been reached already. 

"I hope that's the case," he said. "We're strained. I think all the health-care systems are strained to the max in terms of taking care of people. And remember, when we're taking care of this many Covid patients, that means that we can't take care of other patients as well as we would like to." 

Beshear said at least 33 Kentucky hospitals are reporting critical staffing shortages, "but to be fair, they are all experiencing major staffing challenges." 

On Monday, Kentucky hospitals reported 2,326 Covid-19 patients, with 440 in intensive care and 257 on mechanical ventilation. Nine of the state's 10 hospital regions were using at least 80% of their intensive care unit capacity, with three above 90%.

Cabinet for Health and Family Services graph, adapted by Ky. Health News; click on it to enlarge.
Beshear held his weekly pandemic press conference remotely, announcing that his son, Will, 12, had tested positive for the coronavirus and is generally asymptomatic. He said Will is fully vaccinated and had received a booster shot, that he and the rest of his family had tested negative, that he would get tested daily, and that he would follow federal guidelines. 

"As a parent, I never wanted . . .  either of my kids to get Covid," he said. "But I got them vaccinated to ensure that they were protected if they did."

Stack said, "If you're a parent who has not yet had your sons and daughters vaccinated, please talk to your pediatrician, your primary care provider, ask them about the vaccines. The American Academy of Pediatrics, numerous other medical associations, and other public health bodies have all recommended vaccination. It's the safest way to keep kids healthy and well and in school and also to help protect their families at home who may be more vulnerable."

Stack also noted that the vaccine helps to reduce the risk of the multi-system inflammatory disease that sometimes strikes children a couple of months after the initial infection, and sometimes puts them in intensive care. 

At the hospitals' news conference, Dr. Lindsay Ragsdale, interim chief medical officer at Kentucky Children’s Hospital, said the Covid-19 vaccine is 91% effective at preventing this inflammatory disease, called MIS-C, in children. 

She also said the Children's Hospital, part of UK HealthCare, is seeing an uptick in Covid-19 hospitalizations. Today, it was reported that there are six pediatric Covid-19 patients. 

Ragsdale strongly encouraged parents to get their children vaccinated, noting that she is worried because there has been a drop in the number of children getting vaccinated at their vaccine clinic. 

Only 50% of 16- and 17-year-olds, 47% of 12-to-15-year-olds, and 20% of 5-to-11-year-olds in Kentucky have received at least one dose of a vaccine.

Another key message at the hospitals' news conference was that it's time to step up the quality of the masks we are wearing, to either a KN95 or an N95.  

Dougherty said about 40% of Baptist Health Lexington's Covid-19 patients are admitted to the hospital for other reasons, which shows how prevalent the virus is in the community. 

"It's ubiquitous. It's everywhere. It's hyper-contagious," Dougherty said. "And because of that, I think we need to step up the quality of masks that we're using," he said, adding that the advice applies both in and out of the hospital.

Ragsdale said KN95 masks for children are available, and encouraged parents to switch to them.

"It's probably the best masks that we can offer for kids," she said. "The cloth mask is better than nothing, but it's really not as good as a KN95 to prevent spread for pediatric patients. . . . For schools, this would be a great addition as well to preventing spread," she said. 

Beshear was asked if the state was talking about supplying such masks to schools. He didn't answer directly, but said the state provides about $100 million in testing assistance and surgical or near-surgical level masks through the Covering for Kids program, but not KN95s. 

Stack's advice was to "wear the best quality mask you can get that's well fitting as reliably as you possibly can -- so do the best you can with the best you have." He noted that the federal government will be shipping KN95 masks to pharmacies and states, and they will need to figure out how best to deploy those. 

"But I agree with the governor," Stack said. "The first step is to require masks of any sort in the school setting, the next step then is to upgrade your masks. So I would be really grateful if we just got every student wearing masks to keep them in school safely." Beshear noted that some schools aren't requiring masks.

The state reported 76 more Covid-19 deaths since Saturday, bringing the pandemic death toll to 12,763. 

Stack said 23 of the deaths were in people 61 or younger, including one 20-year-old. Beshear Stack said he draws attention to these deaths because 94% to 95% of all the Covid deaths in Kentucky since July 1 have been in unvaccinated persons. 

"Unfortunately, these sufferings usually don't need to occur," he said. "Vaccination almost entirely eliminates this risk. So I do hope more folks will continue to get vaccinated and protect themselves from that horrible outcome."

UnitedHealthcare, nation's largest insurance company, posts record profit for an insurer; growth comes mainly from taxpayers

UnitedHealth Group's headquarters is in Minnetonka, Minnesota, near Minneapolis.
NEWS ANALYSIS by Wendell Potter

Just days after a Commonwealth Fund report showed that American families are sending health insurance companies more and more of their income every year even as their deductibles skyrocket, the country’s biggest insurer reported massive 2021 profits and told investors to expect even higher profits in 2022.

UnitedHealth on Wednesday reported 2021 profits of $24 billion on revenue of $287.6 billion. Executives told Wall Street they expect United will be the first insurer to take in more than $300 billion from its customers this year.

Instead of giving its health-plan customers relief from ever-increasing out-of-pocket requirements, United spent $5 billion last year buying back its own shares of stock, a gimmick that boosts the value of shares and makes shareholders richer. United also paid shareholders $5.3 billion in dividends in 2021.

No insurer has ever made that kind of money in U.S. history. It’s even more notable when you consider that United is not growing by attracting substantially more new customers.

At the end of 2021, United had about 26.6 million people enrolled in its commercial (individual and employer-sponsored) health plans. That’s just 700,000 more than the 25.9 million the company had 10 years ago. Most of United’s membership and revenue growth now comes from the company’s Medicare Advantage plans and the state Medicaid programs it manages. In other words, from us as taxpayers. United and other insurers are padding their top and bottom lines by charging their existing commercial customers higher and higher premiums every year.

Consider this: an employer-sponsored family policy that cost an average of $15,073 in 2011 cost $22,221 in 2021, a 47% increase, according to the Kaiser Family Foundation. And during that time, insurers have forced their health plan enrollees to pay more and more out of their own pockets through ever-increasing deductibles, copayments and coinsurance. Most Americans now have to pay on average twice as much out of their own pockets as they did 10 years ago.

That Commonwealth Fund report shows that with the relentless increase in both premiums and out-of-pockets, Americans are shelling out far more of their household income for health insurance and to cover out-of-pockets than a decade ago. Premiums and deductibles now take up more than 10% of median income in 37 states, up from just 10 in 2010.

Insurers argue that high deductibles are necessary to control premium increases. Unfortunately, most employers and policymakers seem to have bought that argument. But when you look at the research from both the Commonwealth Fund and Kaiser Family Foundation – and then the record profits United and other insurers are reporting – that talking point just doesn’t hold up.

Editor's note: UnitedHealthcare's parent firm, UnitedHealth Group, is the world's eighth largest company by revenue and second-largest health-care company behind CVS Health by revenue, and the largest insurance company by net premiums, according to Wikipedia. Wendell Potter is a former reporter Tennessee and Washington who spent more than two decades in the health insurance industry, first at Humana and then at Cigna as head of corporate communications. He has written three books: Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans (a New York Times bestseller and winner of the Ridenhour Book Prize in 2011); Obamacare: What’s In It for Me/What Everyone Needs to Know about the Affordable Care Act (an ebook); and Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It. His nonprofit corporation, To Be Fair, publishes news and commentaries on money in politics, propaganda, health care and other topics.

Sunday, January 23, 2022

School nurse advocates disappointed that the House didn't fund a nurse for every school, but say they will lobby the Senate for it

By Melissa Patrick
Kentucky Health News

Representatives of the Kentucky Nurses Association's School Nurse Task Force were disappointed that the state budget that passed the House Jan. 20 did not include their requested funding for a full-time nurse in every Kentucky school every day, but said they would take their request to the next step.

"We definitely will carry the fight into the Senate, as we think that the time has never been better to make this investment in students’ health – physical and mental – and in school safety," Sheila Schuster, KNA policy consultant and a longtime mental-health advocate, told Kentucky Health News.

The House budget is in a committee substitute for House Bill 1, which passed out of committee and the full House on the same day, and went to the Senate on an 85-8 vote.

Nurse Vicki Williams worked at a school
in Calloway County in this 2017 photo.
The House left more than $1 billion unappropriated, and even more in the budget reserve or "rainy day" fund. Legislators are planning a tax-reform package that would reduce revenue during the biennium that starts July 1.

Schuster and Eva Stone, a nurse practitioner who is the health services manager for Jefferson County Public Schools, had asked a House budget subcommittee Jan. 18 for $18 million over the next two years to ensure that every Kentucky school building has a full-time nurse in it – all day, every day. 

This amount was based on a survey of school-nurse salaries in bordering states and other Southern states, said Schuster. The total salary and benefits, for each full-time school nurse would be $56,598. 

Schuster said the advocates hope that the benefits of placing a nurse in every Kentucky school would be researched by the University of Kentucky College of Nursing.

Stone pointed out that Kentucky is in the bottom 10 states for multiple health conditions in children, including mental health, diabetes, asthma, obesity and oral health, and that having a full-time nurse in the building would help to address these conditions.

“With all these negative health indicators we have in the state of Kentucky, having some systems in place to try and address these things early on can have a big impact for children, both educationally and for their long-term health," she said. 

Stone added that research shows that schools with nurses have improved attendance rates with lower absenteeism, higher high-school graduation rates, decreased use of local emergency department services, reduced transmission of infectious diseases, earlier diagnosis and treatment of physical, mental and academic problems, better management of chronic health conditions and better mental physical and mental health screening. 

"A child's ability to learn is directly related to health status," she said, adding that more than 120,000 of the 638,236 children in Kentucky's public schools have a chronic health condition. 

Stone said 29 of the state's 171 school districts have no school nurses, and many more have part-time nurses or nurses who are shared among several schools. 

Schuster said that having a part-time nurse is better than no nurse, but is not optimal: "The ability of the students to really relate to and get to know the nurse, and for the nurse to get to know those students, when she's spread across several buildings on campus is just not the most effective."

Stone said the school secretary often ends up taking care of nursing issues when a school does not have a full-time nurse, and is more likely to send a student home than a nurse would. 

Rep. Tina Bojanowski, D-Louisville, a teacher, said she wasn't sure how we got to a place where we don't have a full-time nurse in every building.

“Let me just explain to you what happens when you don't have a school nurse,” she said. “All of the 'Band-Aid and boo-boo' issues are brought to the school secretary. . . . but all of those other areas that would really help our students become more healthy and to be more in the position where they can be learning won’t be happening.”

Schuster said that in the many years the task force has been working to get a nurse in every school, they haven't heard from a lawmaker who doesn't support the idea, but they also haven't been able to put money in the budget to make it happen – but now is the time. 

"Covid has brought out all of these issues and exacerbated them and shown the inequities, and shown the mental health and its effect on academics and physical health," she said. "We plead with you to really strongly consider putting this money in the budget."

Bill would start state program to screen for lung cancer, in which Ky. leads in cases and deaths, to catch it earlier and save lives

Updated Jan. 26, 2022 : House Bill 219 to create a lung cancer screening program passed 95-0 out of the House of Representatives on Jan. 26 and will now move to the Senate for consideration. During her floor speech, Moser spoke about how many Kentucky families have been affected by lung cancer, noting that her mother, Margaret "Margie" Poore had succumbed to the disease in 2017. 

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in lung cancer. In an effort to get more eligible Kentuckians screened for it, to catch it early and prevent death, the chair of the state House health committee wants to create a special program for it.

Rep. Kim Moser
Kentucky also leads the nation in lung-cancer deaths, and one reason is its "low level of early detection. This is why this bill is just so critical," Rep. Kim Moser, R-Taylor Mill, told the members of the House Health and Family Services committee before they approved it Jan. 20.

Dr. Timothy Mullett, a cardiothoracic surgeon at the University of Kentucky's Markey Cancer Center, told the committee that lung cancer screening is one of the most important things needed to save more Kentuckians from the disease and it's imperative that we accelerate the number of screenings.   

"While we are often successful with our operations on early-stage lung cancer, surgeons are universally frustrated by the fact that only 15 to 18 percent of lung cancer [is] discovered at that early phase," Mullett said. "And so, as mentioned, the opportunity to be able to have more success with treating patients at an earlier stage is optimal. It is also less expensive."

Kentucky ranks second in the nation in screening of people at high risk for lung cancer, but Mullett said it has the highest death rate because the screening isn't done early enough. "The majority of our patients, much more than the rest of the country, are seen with late-stage disease, over 80 percent of the time. We have a chance to change that. Lung cancer screening can be effective and can reduce mortality by as much as 20 to 50 percent." 

Dr. Michael Gieske, a family practitioner at St. Elizabeth Healthcare, said "If we find lung cancer in the earliest stages, Stage I, we have a greater than 90% chance of curing that cancer."

Mullett said the screenings only cover about 20% of eligible Kentuckians and are not evenly distributed across the state. The American Lung Association says the national rate for screening is 5.7%. "That's not enough, we can do better," Mullett said.

Moser's House Bill 219 could pass the House as early as Monday, Jan. 24. She said the program would be modeled after the state's Colon Cancer Screening Program, which has helped to move the state's colon cancer rates from 49th in the nation to 22nd. 

Moser said she would ask for funding if the screening program is approved, adding that she had already talked to the chair of the House budget committee "and he understands the importance" of this bill. 

The Colon Cancer Screening Program gets $500,000 per year from the state, Moser said. She said the program would be able to receive grants and private donations and could also get a small amount of funding from the sale of lung-cancer-awareness license plates. 

"The goal is to increase lung cancer screening and enable early detection of cancers when they're treatable, reducing the horrible morbidity and mortality that we have in Kentucky for lung cancer," Moser told Kentucky Health News. "We're number one in the nation, and that's a glaring, horrible statistic that we need to change."

The lung association's "State of Lung Cancer" report says that while Kentucky is second in lung-cancer screening, it's worse than average in the percentage of lung-cancer patients (19%) not receiving treatment, ranking 18th.

The only recommended screening 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 between 50 and 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.

Mullett said lung cancer screening with low-dose CT scans has been recommended for less than 10 years, and "we've already seen a 10% reduction in late-stage diagnosis. . . . That's something that we haven't seen, ever. So it's beginning to take effect." 

Gieske said that before low-dose CT scans, it was difficult to diagnose lung cancer in its earliest stages, since symptoms that typically bring a patient to the doctor don't show up until late in the disease process. "We have patients with Stage III and Stage IV lung cancer now [who] might have been alive for 10 to 15 years with no evidence of disease," he said.

Since 2013, when St. Elizabeth's started screening patients for lung cancer, it has done 22,000 screens and is finding one case of cancer for every 64 screenings, with 55% of them in Stage I and 69% of them in either either Stage I or Stage II.

"We are making a tremendous difference," said Gieske, who joined the hospital's thoracic oncology disease management team in 2016.

Rep. Ryan Dotson, R-Winchester, asked what is the driving force behind the state's high lung cancer rates, Mullett offered several reasons, including a culture of fatalism around lung cancer that discourages people to seek care, a disease that is largely asymptomatic until its late stages, and the state's high rates of smoking. 

Smoking is the No. 1 cause of lung cancer, causing about 90% of cases, according to the lung association. Kentucky ranks second in the nation for smoking, at 23.4% of the population, behind West Virginia.

Mullett said he had intentionally not mentioned tobacco in his presentation because it's important to separate the diagnosis of lung cancer with tobacco use. 

"There's a tremendous amount of stigma associated with the diagnosis of lung cancer and a bit of guilt associated with the exposure to tobacco," he said. "So the opportunity to be able to dissect, separate a person who smokes, from a diagnosis of lung cancer is really important -- because the truth is the majority of patients, when they are diagnosed with lung cancer, are not smoking, and so it's difficult for us to burden them with a diagnosis of tobacco use when they've already made that choice to quit." 

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, text QUITKY to 797979 or call 1-800-QUIT-NOW.

It's too early for school boards to lift mask mandates, but they need to plan for it, former FDA commissioner Gottlieb says

Ky. Health News map, based on Ky. Dept. for Public Health data Jan. 15-21. Click on it to enlarge.
Pediatrician Horace Hambrick attended the Jan.
10 meeting of the Scott County school board
to ask it to keep a mask mandate, which it did.
(Georgetown News-Graphic photo by James Scogin)
By Al Cross
Kentucky Health News

As Kentucky schools wrestle with demands by some parents to lift mask mandates, a physician who headed the Food and Drug Administration for Donald Trump says it's too early to do that.

Dr. Scott Gottlieb said on CBS's "Face the Nation" Sunday that masks are central to school's plans for preventing spread of the highly contagious Omicron variant, so they should still be required as long as infection levels remain high.

But Gottlieb said schools should decide now at what point they are going to lift their mask mandates. "Setting an end point and sticking to it . . . is very prudent," he said.

Gottlieb didn't suggest a specific level for lifting mask mandates, but said it should be higher than the seven-day average of 10 daily cases per 100,000 residents that federal officials consider a high level of transmission. He said schools could use a higher benchmark to "try to preserve as much of that environment for learning as you can."

Even under a very expansive definition of Gottlieb's recommendation, or state officials' higher definition, every Kentucky county has a way to go to reach a safe level. Every county has an infection level above 50 per 100,000, almost all are above 100, most are above 200 (the average is 237) and 11 are above 300.

Those counties and their rates, as of Friday, are Carroll, 391; Henderson, 389.3; Harrison, 332.1; Warren, 331.6; Spencer, 330.7; Daviess, 329.5; Henry, 319.8; Muhlenberg, 319.6; Powell, 319; Shelby, 312.1; and Fayette, 303. Kentucky officials say a rate above 25 is high, calling for mask mandates.

Children under 5 probably won't be able to get a Covid-19 vaccine "at least until late March," as Pfizer Inc. extends the clinical trial of its vaccine in that age group, said Gottlieb, a Pfizer board member.

Fewer than 20 percent of Kentucky children aged 5 to 11, and fewer than half aged 12 to 17, have received even one dose of Covid-19 vaccine. Two doses plus a booster are needed for real immunity from the Omicron variant, studies have shown.

In recent weeks, more than a fourth of new coronavirus cases in Kentucky have been among people 18 and younger. Getting infected probably provides "as good if not better" immunity against a particular variant as a vaccine does, but "vaccines provide the broadest possible immunity," Gottlieb said. "The primary utility of the vaccines is protection against severe disease and hospitalization."

Saturday, January 22, 2022

Study: Covid-19 shots don't affect fertility, but the disease might

Vaccines for the coronavirus don't affect the fertility of men or women, but the virus "could cause short-term fertility problems in men," Robert Preidt reports for HealthDay News.

The study debunks a fear that has been an obstacle to vaccination for some people who want to have children.

"Many reproductive-aged individuals have cited concerns about fertility as a reason for remaining unvaccinated," said lead study author Amelia Wesselink, a research assistant professor of epidemiology at the Boston University School of Public Health.

"Wesselink's team analyzed data from more than 2,100 American and Canadian women and their male partners in an ongoing study of women trying to conceive," Preidt reports. Senior researcher Lauren Wise, a BU epidemiology professor, said the study's large sample and diverse population make it strong.

"The researchers found that the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines had no effect on male or female fertility," Preidt reports. However, men infected with Covid-19 may have a temporary decline in their fertility, the investigators found."

The study, published Jan. 20 in the American Journal of Epidemiology, supports previous research linking Covid-19 infection in men with reproductive dysfunction, including poor sperm quality. The researchers said the findings should ease concerns prompted by anecdotal reports of women having menstrual cycle changes after getting a coronavirus vaccination.

Friday, January 21, 2022

Ky. again breaks record for new Covid-19 cases, over 16,000; new studies show robust protection against virus if boosted

By Melissa Patrick
Kentucky Health News

Kentucky hit another daily record for new coronavirus cases, surging beyond the last record by more than 1,000 cases. It also has a new record high positivity rate, with nearly one in three Kentuckians testing positive for the virus. 

Kentucky  reported 16,130 new cases of the virus Friday, beating its previous record of 14,896 on Saturday, Jan. 15 by 1,234 cases. Of today's cases, 25% are in people 18 and younger. 

The share of Kentuckians testing positive for the virus in the past seven days also hit another record high, at 32.1%.

"Folks, take care of yourselves," Gov. Andy Beshear said in a Facebook video. "New studies today absolutely prove that being vaccinated and boosted protects you from getting real sick from Omicron, and certainly wear the mask. It's real helpful to prevent you from getting it." 

Beshear is referring to three Centers for Disease Control and Prevention reports released today that offer real-world data showing that being fully vaccinated and boosted provide robust protection against severe disease from the Omicron variant, The Washington Post reports.

"One of the CDC reports analyzed data from hundreds of thousands of emergency room visits, urgent care visits and hospitalizations between August 2021 and Jan. 5, 2022. It showed that a third dose of either the Pfizer-BioNTech or Moderna shots was 90% effective at preventing hospitalization, and 82% effective in preventing a trip to the emergency room or urgent care," the Post reports.  

Kentucky hospitals reported 2,347 Covid-19 patients, 49 more than Thursday; with 439 of them in intensive care (up five) and 268 on mechanical ventilation (down three). 

Nine of the state's 10 hospital regions are using at least 80% of their intensive-care capacity, with four of them above 90%. Northern Kentucky remains at 100% capacity. 

The daily Covid-19 incidence rate in Kentucky is 237 cases per 100,000 residents. Eleven Kentucky counties are above 300 cases per 100,000; the lowest rate in the state is in McCreary County, at 52.2 cases per 100,000. The New York Times ranks Kentucky's infection rate 16th among the states. 

The state reported 28 more Covid-19 deaths, bringing Kentucky's pandemic death toll to 12,686.