FDA OKs updated Covid-19 booster targeting latest Omicron subvariants; Beshear says it could be available in Ky. next week

medpagetoday.com photo

By Melissa Patrick
Kentucky Health News

The new, updated Covid-19 booster shots that target the original strain of the coronavirus and major Omicron subvariants could be available to Kentuckians as early as next week, Gov. Andy Beshear said Wednesday.

The Food and Drug Administration authorized the updated booster shots from Moderna and Pfizer-BioNTech on Wednesday, Aug. 31. They are called bivalent Covid-19 vaccines because they have two major targets.

“The Covid-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of Covid-19,” FDA Commissioner Robert M. Califf said in a news release. “As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent Covid-19 vaccine to provide better protection against currently circulating variants.”

Omicron variants are responsible for nearly all current Covid-19 cases in Kentucky and are expected to circulate throughout the fall and winter. The FDA says the updated boosters are designed to provide broad protection against Covid-19 and even better protection against the currently circulating Omicron variants.

The new vaccine arrives at a time when Covid-19 "continues to spread across Kentucky," Beshear said at his weekly news conference. This week's state report showed an increase in all of the metrics used to measure the impact of the coronavirus in the state, with new cases up 15.6%, to 14,312, an increase of cases among school-aged children and a positivity rate -- which does not include at-home tests- over 20%. 

"We continue to recommend that everyone six months of age or older stay up to date on their vaccinations and receive any booster doses," said Beshear. 

So far, state data shows that fewer than half (46.6%) of the 2.6 million fully vaccinated Kentuckians have been boosted. 

The updated booster shots will become available after they are recommended by the Centers for Disease Control and Prevention, which is scheduled to vote Thursday. Then, the CDC director must sign off on the recommendation. 

The updated Moderna booster is authorized for use in individuals 18 years of age and older if it has been at least two months since they completed their primary vaccination or have received the most recent booster dose. 

The updated Pfizer booster is authorized for use in individuals 12 years of age and older if it has been at least two months since they have completed their primary vaccination  or have received the most recent booster dose, according to the FDA.

The FDA no longer authorizes the original boosters for administration to those 12 and older, but does authorize it for individuals 5 through 11 years of age at least five months after completing a primary series of the Pfizer Covid-19 vaccine, says the release. 

Further, the FDA says, "You are eligible for an updated Covid-19 vaccine booster, the updated booster you receive does not need to be from the same manufacturer that made the vaccine you received for your primary vaccination or previous booster." 

Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in the release, “The public can be assured that a great deal of care has been taken by the FDA to ensure that these bivalent Covid-19 vaccines meet our rigorous safety, effectiveness and manufacturing quality standards for emergency-use authorization.”

FDA has authority to crack down on illicit vapes, but isn't doing it, Stat reveals; study finds increased e-cig use among lesbian girls

Food and Drug Administration photo

Even though the U.S. Food and Drug Administration has ordered hundreds of flavored, nicotine-heavy vaping products off of the market, "a Stat investigation found that vape companies are regularly flouting the FDA’s orders. They’re making, stocking, and selling the illicit goods. And the agency is just letting it happen," Nicholas Florko and Elissa Welle report for Stat, the medicine-and-science publication of The Boston Globe.  

The authors write that while the FDA has ordered more than 100 vape manufacturers to stop making more than 250 specific flavors and vapes, "We found scores of companies across the country that are defying the FDA's demands." 

And despite having "sweeping legal authorities" to crack down on vape companies that ignore its bans, "ranging from levying seven-figure fines to physically pulling products off shelves," the Stat investigation found that the FDA has never used those powers, according to its own data. And in several cases, "It’s even dropped cases against companies that it knows are still selling illegal products," Florko and Welle write. 

The authors note that the FDA declined Stat’s request for an interview with FDA Commissioner Robert Califf or the head of the FDA’s Center for Tobacco Products, Brian King, but say a spokesperson implied the agency may soon get tougher against companies that ignore its orders,

“The agency is currently working on further enforcement in situations where companies that have [been banned from the market] continue to sell illegal products,” the spokesperson told Stat in an email. “The FDA is currently engaged in discussions with the Department of Justice regarding specific potential enforcement actions.”

Vape shops argued that the FDA’s orders aren’t clear enough, and that until they are more so, they'll keep selling the products.

The shops “are doing their best, despite a complete lack of clarity or transparency from the agency, to piece together what products are still legally able to be sold,” Amanda Wheeler, president of American Vapor Manufacturers, told Stat. “It would be legally and morally irresponsible for us to recommend that companies should voluntarily close down their businesses because FDA cannot sort out their filing systems.”

The authors walk through the FDA's regulation process for vaping products that ultimately requires every company that manufactures a vaping product to get the FDA's permission before selling their products in the United States. After being pushed back from November 2018, the deadline for asking permission was September 2020. And last year, the FDA finally started denying some companies' requests to sell their vaping products, resulting in many companies ignoring the requests. 

As part of the investigation, "Stat reviewed 120 letters issued to vaping companies between August 2021 and May 2022, covering bans on some 274 named products. According to company websites and information provided by vape shops by phone, at least 139 of the products are still being sold — more than 50% of the products named in those warnings." 

“If a large portion of the vaping products FDA has ordered off the market are still being sold, I’m baffled," Bill Schultz, a former deputy FDA commissioner who also served as the federal health department’s top lawyer and represents the Campaign for Tobacco Free Kids, told Stat.  “Congress gave the agency the authority to act decisively and they should be using it.”

The authors note that their investigation is likely an underestimation of the issue, since they only analyzed warning letters sent to companies that formally asked the agency for permission to sell their products, and then had that request denied and did not focus on the hundreds more companies that received warning letters for never asking the FDA for permission at all.

Much of the impetus for the FDA  to crack down on vaping companies' sale of products came from the surge in teenagers' use of these highly addictive devices. From 2019 to 2020, the popularity of disposable electronic-cigarette use among U.S. high school students who currently vaped went up by 1,000 percent, from 2.4% to 26.5%, according to the Centers for Disease Control and Prevention. 

Researchers are beginning to look at which groups of teens vape and the underlying reasons that put them at risk to start with. 

One such study recently published in the American Journal of Preventive Medicine, looked at the prevalence of vaping among high-school students in different sexual orientation, race and ethnicity groups. The study used survey data from more than 38,000 U.S. high-school students from 2015-2019.

The study uncovered significant differences in the prevalence of current electronic-cigarette use between lesbian and heterosexual girls when comparing across racial groups, says a news release from the Annenberg School for Communication at the University of Pennsylvania.  

"Current e-cigarette use was higher in Black girls who identify as lesbian compared to Black girls who identify as heterosexual (18.2% versus 7.1%)." the release says. "The rate was also higher in multiracial girls who identify as lesbian compared to multiracial girls who identify as heterosexual (17.9% versus 11.9%). On the other hand, white girls who identify as lesbian were found to be at lower risk of current vaping compared to white girls who identify as heterosexual (9.1% versus 16.1%)."

The study found that among boys, there were no significant interactions between sexual orientation and race or ethnicity in relation to vaping prevalence.

The authors note, "Previous surveys of gay and lesbian teens suggest that e-cigarette use might be a coping mechanism to deal with the stress of sexual orientation or gender identity-based discrimination or bullying — or a way to bond with others in their social circle." 

They also suggest that a possible reason for finding disparities in e-cig use at the intersection of sexual orientation and race among girls — but not among boys — may be due to higher levels of targeted e-cig marketing toward lesbians of color. 

“For years, the tobacco industry has targeted marketing toward traditionally marginalized groups, whether in clubs, bars, Pride events, or through magazines,” Andy Tan, co-author of the study, said in the release. “Sexual, racial, and ethnic minority youth are more likely to report engaging with online tobacco advertising including e-cigarette ads on social media.”

Every metric used to measure Covid-19 in Ky. went up last week; weekly report shows big jumps in youth cases, ICU patients

Kentucky Health News graph, from state data; to enlarge, click on it.

By Melissa Patrick
Kentucky Health News

All the metrics to measure the impact of the coronavirus in Kentucky went up last week, with new cases up 15.6 percent, a big jump in the share of youth among the new cases, the most Covid-19 patients in intensive care since early March, a positive-test rate over 20%, and the highest new-case incidence rate the state has seen in more than six months.

The state's latest report for the Monday-through-Sunday reporting week showed 14,312 new cases, up from 12,381 the previous week. The daily average increased to 2,044 from 1,769. 

Of the week's new cases, 37% were in people 18 and younger, the highest this number has been in some time and a one-fourth higher than the week before. This increase among young people comes as school districts across the state—many of them in counties that the CDC risk map shows have high risk of Covid-19 transmission—open their doors to students and only one district (Jefferson County) with mandatory masking.

The big increase among Kentuckians 18 and younger "could be a result of school openings or other factors," said Susan Dunlap, spokeswoman for the state Department for Public Health. "We continue to recommend that everyone 6 months of age and older stay up to date with their Covid-19 vaccinations and receive any booster doses, when eligible."

The statewide incidence rate of new cases was 46.98 cases per 100,000 residents, up from 41.07 the week before. The rate is the highest it's been since Feb. 22, when the state was still issuing daily reports.

The counties with the 10 highest rates were Wolfe, 173.7; Harlan, 162.6; Rockcastle, 147.2; Perry, 130.9; Powell, 130.6; Menifee, 105.7; Bath, 105.1; Knox, 105.0; Whitley, 97.3; and Morgan, 95.5.

Kentucky continues to the nation's second highest rate of new cases in the last seven days, according to The New York Times, which ranks Tennessee first among the states and its Scott County (on the Kentucky border) first among U.S. counties, with Harlan County, Kentucky, second. Third is Jefferson County, Indiana, just across the Ohio River from Carroll and Trimble counties; sixth is Perry County; and eighth is Macon County, Tennessee, which borders Allen and Monroe counties.

State officials say their figures and those in the Times differ due to methodology, such as use of duplicate results. 

The state report showed the percentage of Kentuckians testing positive for the coronavirus in the last seven days increased to 20.07%, up from 18.96% the week prior. The numbers do not include results of at-home tests.

The report showed 621 patients with Covid-19 in Kentucky hospitals, up from 570 the week earlier. Those in intensive care increased to 104, up from 76, a jump of 37%. Those on mechanical ventilation increased by two, to 28. 

Two of the state's eight hospital regions are using more than 90% of their ICU hospital capacity, though the number of Covid-19 patients in them remains low. 

The state attributed 76 more deaths to Covid-19. That was up from 63 the week before. The state's pandemic death toll is 16,679.

Fauci is leaving, but Comer and Paul say they're coming after him

Dr. Anthony Fauci and Sen. Rand Paul at July 2021 hearing

Dr. Anthony Fauci's announcement that he will retire from the federal government at year's end prompted two members of Kentucky's congressional delegation to reiterate that they plan to put him under oath about the origins of Covid-19, reports David Catanese of the Lexington Herald-Leader.

Sen. Rand Paul, one of Fauci's leading critics in Congress, hopes to chair the Senate Health, Education, Labor and Pensions Committee, and First District Rep. James Comer is likely to chair the House Oversight and Reform Committee, on which he is the ranking Republican. The GOP is more likely to gain control of the House, so "Comer’s path to a congressional gavel looks more likely," Catanese writes.

Rep. James Comer

Comer told Paducah's WPSD-TV Wednesday, “I think it’ll be the most high-profile committee in Congress next year.”

Paul solicited $22 campaign contributions to join his "Fauci retirement club" and formally asked the National Institutes of Health, where Fauci works, to retain Fauci’s documents for review, Catanese reports. Fauci responded on Fox News that he welcomed “legitimate, dignified oversight.” 

Bianca Keaton, campaign manager Charles Booker, for Paul’s Democratic opponent in the Nov. 8 election, "said Booker believes in oversight but panned Paul’s motives," Catanese reports. Keaton said Paul is trying to "rile up his shrinking base, sow confusion and boost his fundraising another failed presidential run.

Paul has said he believes the novel coronavirus was accidentally leaked from a Chinese laboratory, and treats it as a fact, tweeting that "He will be asked to testify under oath regarding any discussions he participated in concerning the lab leak." Catanese points out, "While the main scientific consensus is that the virus originated from a wet seafood market – moving from infected animals to humans – some scientists continue to probe the theory of a lab leak. Fauci said this week he’s always maintained he’s kept 'an open mind … as to the origin'."

Paul and Fauci have crossed swords several times. In "Correcting Misinformation about Dr. Fauci," D'Angelo Gore of FactCheck.org writes:

Paul accused Fauci of lying when Fauci said in a May 2021 Senate hearing that "The NIH has not ever and does not now fund gain-of-function research in the Wuhan Institute of Virology." But there’s no evidence that Fauci lied to Congress, as Paul asserted in a July 20, 2021, hearing, about funding gain-of-function research — which the U.S. government generally defined in 2014 as aiming to "increase the ability of infectious agents to cause disease by enhancing its pathogenicity or by increasing its transmissibility." Fauci has said that the research that was funded "was judged by qualified staff up and down the chain as not being gain-of-function," and the NIH has said the same. The issue is that scientists have differing opinions on what counts as gain-of-function research. Paul has posited that Fauci, among others, "could be culpable for the entire pandemic" if the SARS-CoV-2 virus leaked from a Wuhan lab that was conducting gain-of-function research. But there is no proof of a lab leak, and there is evidence that the bat coronaviruses studied under the NIH grant could not have caused the pandemic.

Fauci has not testified before any House committee. "Comer has accused the NIH and Fauci of redacting critical information in emails and obstructing any investigation into the origins of Covid-19," Catanese reports.

Comer told Laura Ingraham of Fox News that he would ask Fauci, “Why didn’t you tell the Trump administration early on and why didn’t you tell the American people early on that even your closest advisers suggested that this virus originated in the Wuhan lab?” He cited emails from January and February 2020, when there was much uncertainty about the source of the virus. 

"Jimmy Ausbrooks, Comer’s Democratic challenger this year, said he would support hearings to analyze the health crisis that ravaged the country," Catanese writes, quoting him: “If it is a deliberate attempt to discredit [Fauci], I would see no relevance in the hearings and it would be a waste of taxpayer money. I believe with the level of knowledge that citizens and government leadership had, Dr. Fauci did his job.”

Lexington nurse accused of killing patient worked at 2 hospitals

A Lexington nurse who was indicted Monday on charges of murdering a patient at Baptist Health Lexington had worked at the University of Kentucky's main hospital until the charge was filed, the Lexington Herald-Leader reports.

Eyvette Hunter (Fayette County Detention Center photo)

"Eyvette Hunter, 52, was charged with murder for allegedly committing intentional medical maltreatment, causing a 97-year-old patient’s death on May 5," Christopher Leach reports. "The patient, James Morris, died as 'a direct result' of Hunter’s actions on April 30, Lexington police said in a news release Tuesday. Hunter was arrested on Tuesday and is being held at the Fayette County Detention Center on a $100,000 bond, according to jail records."

UK spokesman Jay Blanton confirmed to Leach that Hunter was also working at the Albert B. Chandler Hospital as a traveling nurse, placed by an outside agency, from November 2021 to the date of her arrest. Blanton said she was immediately released from her duties after UK HealthCare learned of her suspension by the Kentucky Board of Nursing and the indictment Tuesday. 

Those records show that Hunter previously held nursing licenses in other states, but did not face discipline from boards in those states, Leach reports. Blanton and a Baptist Health spokesperson told Leach that Hunter had no maltreatment incidents before the one alleged. She was licensed as a registered nurse in Kentucky in 2018 and as a licensed practical nurse in 2007, state records say.

According to Hunter's suspension order, Morris, who was admitted to the hospital "after a slip and fall injury," was aggressive and agitated while in the hospital, Leach reports. Hunter requested medication to calm him down on April 30, which was denied. Hunter then allegedly withdrew a vial of lorazepam meant for another patient and appeared in Morris's room several minutes later with a syringe and "proceeded to administer something intravenously," the order says. 

Lorazepam is in a group of drugs called benzodiazepines, used to treat anxiety.

The Board of Nursing order suspending Hunter said another hospital employee saw what happened, asked Hunter what she gave Morris, and Hunter answered "something special." The order said his oxygen saturation equipment had been turned off and he aspirated food or medicine, developed pneumonia and was admitted May 3 to hospice care , where he died two days later. 

Leach reports the order says Hunter later admitted that she had given Ativan, the brand name for lorazepam, to Morris without an order "as well as subsequently feeding him."

Covid-19 risk in Kentucky remains about same as a week ago, and the 7-day new-case rate is second highest among the states

CDC map, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

The risk of catching Covid-19 in Kentucky last week was about the same as the week before, with nearly 92% of the state's counties at a high or medium level of risk and The New York Times still ranking Kentucky first second among the states for new coronavirus cases in the last seven days. 

"Covid is still with us and everybody needs to get vaccinated and get your booster. . . . We need people to protect themselves. And then especially if you're in the high-risk category in a red county, you need to think about wearing that mask," Gov. Andy Beshear said at his weekly news conference. 

The latest Covid-19 risk map, issued Thursday by the Centers for Disease Control and Prevention, shows 74 Kentucky counties at high risk (shown in orange, not red, on the map), one more than a week ago. 

The CDC map shows 36 counties at medium risk (yellow on the map) and 10 at low risk (green). Last week, 38 were at medium risk and nine were at low risk. 

In high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Beshear said he is hopeful that Kentucky is seeing a plateau in cases, but when asked what Kentuckians need to be doing to protect themselves with case rates still high, he cautioned that there are still a lot of Kentuckians getting "fairly sick" from the virus and again encouraged people to get vaccinated and boosted, especially if they have heart, lung or kidney disease, or if they had the virus and it made them really sick.  

"When we look at our numbers, there's a lot of people out there that could go out and get their booster now and be much better protected," Beshear said. "Obviously, we're watching the news about whether we will have a booster targeted more towards Omicron, but we need people to protect themselves." 

Covid-19 vaccine boosters targeting recent Omicron strains of the virus are expected to roll out next month. The Times reports that they will be offered to anyone ages 12 and up who has completed a primary vaccine series. 

Fewer than half (46.5%) of the 2.6 million fully vaccinated Kentuckians have received a Covid-19 booster shot. 

Beshear also encouraged Kentuckian who test positive for the coronavirus to seek medical care and treatment, which he said are now better than they have ever been.

"It can take what could be a miserable or even a concerning, or maybe even possibly a deadly experience and gets you feeling better, fairly quickly," he said. 

And if you are sick, he said, "Stay home. Please stay home."

This story has been edited to reflect a change in the New York Times rankings after it was published. Alaska now ranks first, with 48 new cases per 100,000 in the last week; Kentucky's rate is 47 per 100,000.

In 2020, Kentucky's life expectancy fell by 2 years, more than the U.S. drop of 1.8, and is now fourth from the lowest in the nation

Map by NBC News, adapted by Kentucky Health News

Kentucky Health News

One of the most striking measures of the pandemic is the decline in life expectancy from 2019 to 2020, the year the novel coronavirus hit; it declined more in Kentucky than it did in most other states.

Nationally, life expectancy declined from 78.8 years in 2019 to 77 in 2020, a drop of 1.8 years. Kentucky's decline was a full two years, from 75.5 to 73.5, according to a report from the National Center for Health Statistics. 

Kentucky's decline in life expectancy tied for 10th largest in the nation, with Indiana, Alabama, South Carolina and Michigan. The greatest decline, in New York, was three years, followed by the District of Columbia, Louisiana, New Jersey, Arizona, Mississippi, New Mexico, Illinois (2.2 years) and Texas.

Among other neighboring states, Arkansas' life expectancy fell 1.9 years, Tennessee 1.8, Missouri 1.8, West Virginia 1.7, Ohio 1.6, Virginia 1.5, and North Carolina 1.5.

Kentucky's 2020 life expectancy of 73.5 years ranks 47th in the nation. Below it are Alabama, 73.2; Louisiana, 73.1; West Virginia, 72.8; and Mississippi, 71.9.

Among other neighboring states, the 2020 life expectancy is 73.8 in Arkansas and Tennessee, 75 in Indiana, 75.1 in Missouri, 75.3 in Ohio, 76.1 in North Carolina, 76.8 in Illinois and 77.6 in Virginia. Hawaii has the highest life expectancy, 80.7, and had the smallest decline in 2020, only 0.2 years.

Agency that handles Medicare and Medicaid says it will propose a rule next spring for minimum levels of staffing in nursing homes

Photo from RTI.org

Efforts to require minimum levels of nursing-home staffing, which have failed in Kentucky and some other states, are now focused on the federal level, where the Biden administration is working on it.

The Centers for Medicare and Medicaid Services says it will issue a draft rule in spring 2023 after studying the issue and gathering opinions of stakeholders.

CMS says it has received more than 3,000 comments from "advocacy groups; long-term care ombudsmen; providers; labor unions and organizations; nursing home staff and administrators; industry experts and researchers; family members; and caretakers of nursing-home residents," reports Bridget Early of Inside Health Policy.

"A vast majority of the comments CMS received from families, beneficiary advocates and caretakers of nursing home residents highlighted deep concerns about unsafe care stemming from a lack of staff," Early reports. CMS said, “Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers.”

The nursing-home industry told CMS "that staffing in nursing homes has not rebounded from the Covid-19 pandemic and recruiting is a challenge -- and facilities will allegedly have to close because they are unable to meet minimum staffing levels," Early reports.

The pandemic is on a rough plateau in Kentucky, which still has highest rate of new coronavirus cases of any state in last 7 days

New York Times maps show Kentucky is the U.S. hotspot, mainly because of southeastern counties.

By Al Cross
Kentucky Health News

The pandemic remained at a rough plateau in Kentucky last week, with 14 percent fewer cases than the week before, but other indicators reflected the fact that Kentucky's rate of new cases in the past seven days, as reported by The New York Times, remained the highest among the states.

The state's latest report for the Monday-through-Sunday reporting week showed 12,381 cases, down from 14,409 the previous week. The daily average declined to 1,769 from 2,058.

In a statistical anomaly, the state Department for Public Health's incidence rate of new cases per 100,000 population rose to 41.07, from 35.32 the week before. Susan Dunlap, spokeswoman for the department, said the rate "includes only newly reported cases that had onset/test date in the prior 14 days. By doing this, older cases that are reported late do not artificially inflate the weekly case counts. Covid-19 surveillance data are dynamic and subject to change as data are reviewed."

The state report showed the counties with the top 10 rates were Harlan, 218 per 100,000; Wolfe, 169.7; Perry, 133.7; Leslie, 105.6; McCreary, 99.5; Knox, 91.3; Powell, 89; Martin, 88; Whitley, 84.3; and Knott, 83. The New York Times said McCreary had the nation's highest rate over the last week, 185 per 100,000, followed by Perry at 156. Other Kentucky counties high in the Times list Monday were Rockcastle, Harlan, Knott, Letcher, Knox, Breathitt and Jackson, ranging from 127 to 99 per 100,000.

Kentucky's rate has led the nation for more than a week on the Times report, not counting U.S. territories such as Puerto Rico and Guam. Among the states, West Virginia ranks second, followed by Alaska, Mississippi, Alabama, Tennessee, South Carolina, North Carolina, Georgia and Oklahoma.

In every region of the U.S., "All metrics (reported cases, test positivity rate, hospitalizations, and wastewater) remain high but have clearly peaked and well into their descent," California epidemiologist Katelyn Jetelina reports on her Your Local Epidemiologist newsletter on Substack.

The state report showed the percentage of Kentuckians testing positive for the coronavirus in the last seven days rose slightly, to 18.96% from 18.51%. The numbers do not include results of at-home tests.

The report showed 570 patients with Covid-19 in Kentucky hospitals, down from 615 a week earlier. Those in intensive care numbered 76, up two, and those on mechanical ventilation fell by one, to 26.

The state attributed 63 more deaths to Covid-19, or nine per day. That was down from the previous week's figure of 76, which was the highest in 12 weeks. The state's pandemic death toll is 16,603.

In other pandemic news Monday:

Pfizer and BioNTech applied to the Food and Drug Administration for emergency use of a new coronavirus booster. "This adapted bivalent vaccine booster – meaning it stimulates an immune response for both the original virus strain and the Omicron variant – would target the BA.4/BA.5 Omicron subvariant in people 12 and older," reports Sabrina Malhi of The Washington Post.

“Given the ongoing evolution of SARS-CoV-2 and its variants, it's of great importance that vaccines can be rapidly adapted to the major circulating Omicron lineages,” said Ugur Sahin, CEO and co-founder of BioNTech, a German firm. Clinical trials of the new booster are expected to start this month.

The virus continues "mutate at a remarkable rate," Your Local Epidemiologist reports. "Another Omicron subvariant, BA.2.75, is on the horizon. . . . It will likely take over in the U.S., but relatively slowly, causing a small blip on our radar. Another possibility is that, for the first time, we see two subvariants co-circulating at the same time."

Jackie Starkey of the Lexington Herald-Leader answers readers' questions about Covid-19 testing, undercounted cases and more.

Seven Healthy Kentucky Champions named by Foundation for a Healthy Kentucky; finalists for Friedell Award to be given Oct. 17

The Foundation for a Healthy Kentucky has announced its 2022 class of Healthy Kentucky Champions. The awards recognize individuals dedicated to improving the health of Kentuckians at a community level or state level; they are finalists for a statewide award to be announced in October.

“These seven Healthy Kentucky Champions are an inspiration to all working to better the health of our state,” said Ben Chandler, president and CEO of the foundation. “We owe them much gratitude for their dedication to addressing some of the health challenges Kentuckians face. The commonwealth is better because of these Healthy Kentucky Champions.”

The seven Healthy Kentucky Champions are nominees for the 2022 Gil Friedell Memorial Health Policy Champion Award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner’s choice. This year’s Friedell Award winner will be announced at the Howard L. Bost Memorial Health Policy Forum Oct. 17. The forum will focus upstream the social determinants of health on the connection between educational opportunities and health outcomes of Kentuckians. To learn more and register for this free, virtual event, click here.

The Healthy Kentucky Champions are Dr. Patricia Bautista-Cervera of Louisville, Eric Crawford of Maysville, Terry Gehrke of Louisville, Denise Hall of Trimble County, Michelle Howell of Scottsville, Dr. Patrick Kitzman of the University of Kentucky and Mark Thomas of Todd County.

Dr. Patricia Bautista-Cervera

Dr. Patricia Bautista-Cervera is a pediatrician and pediatric allergist at the La Casita Center, an organization dedicated to enhancing the well-being of Louisville’s Latinx and immigrant community. As health empowerment coordinator, Bautista-Cervera works to promote health through workshops, informational videos, one-on-one communications, and other various means. During the COVID-19 pandemic, she delivered important information to the Spanish-speaking community through the online video series, “Consejos de Salud con la Dra. Paty.” She also was instrumental in developing virtual forums with stores and restaurants to educate the Hispanic community about the virus and promote preventive measures and vaccination. In 2020 she supported 994 Covid-19-positive patients, offering medical guidance and, through an empowering model, connecting them to LCC’s wrap-around services and other resources in the community.

Eric Crawford

Eric Crawford, a Maysville native, joined Kentuckians for Medicinal Marijuana in 2013. Crawford’s education in the endocannabinoid system and cannabis, as well as his experience as a quadriplegic, has fueled his passion for advocating for the legalization of medical marijuana in Kentucky. He has been involved in crafting legislation and has testified at the state Capitol about how cannabis improves his quality of life. He is a member of the Governor’s Medical Cannabis Advisory Committee and has also traveled the state with Kentuckians for Medicinal Marijuana for more than 50 medical cannabis educational seminars. Crawford remains active in the Maysville community by serving on the Lions Club and volunteering at a nursing home. He is a Finis Davis Fellowship recipient through the Kentucky Lions Eye Center and a past member of Kentucky Partners in Policymaking through the Commonwealth Council for Developmental Disabilities.

Terry Gehrke

Terry Gehrke has been in the fitness-wellness industry for more than 30 years. She founded Balanced Wellness LLC in 1999 in Jefferson County and still leads the organization as president and wellness consultant/health educator. Gehrke joined the Kentucky Diabetes Network in 2019 as executive director and has guided the organization to promote better health for Kentuckians at-risk for and living with diabetes. She leads KDN’s symposium committee each year to offer the largest professional education opportunity for diabetes training in the state, the Kentucky Diabetes Symposium. Gehrke’s background includes teaching in the University of Louisville Health and Sport Sciences Department and working with Southeast Christian Church’s Sports & Fitness Ministry. Gehrke is a member of several organizations including the National Wellness Institute, the National Physical Activity Society, and Exercise is Medicine.

Denise Hall

Denise Hall of Trimble County began working in the substance use prevention field in 1998 at Seven Counties Services. In 2003, she became coordinator for Trimble County Family Resource and Youth Services Center before writing two Drug Free Communities grants and directing them. The DFC grant is now in its 10th and final year. Hall’s work includes implementing a Drug Education Series in Trimble County and a Sources of Strength group at Trimble County Junior/Senior High School. She administers a survey to middle and high schoolers to understand the needs for substance-misuse prevention. Hall was crucial in getting vape detectors installed at the high school and is managing director of the Trimble CARES Coalition.

Michelle Howell

Michelle Howell co-owns Need More Acres Farm in Scottsville with her husband Nathan. She has an agriculture degree from Western Kentucky University and previously worked for University of Kentucky Cooperative Extension assisting tobacco farmers as they transitioned to fruit and vegetable production. She collaborates with local and state partners to increase equitable opportunities for farmers. Howell has also been involved in writing grants worth more than $2.4 million to benefit food access, women’s life courses, and urban-rural development. Need More Acres co-founded the Community Farmers Market in Bowling Green, which piloted several Supplemental Nutrition Assistance Program incentives. CFM was essential to growing Kentucky Double Dollars into a statewide program and CFM is one of the organization's pilots of the Fresh Rx MOMs program for expecting mothers on Medicaid. Both programs help under-resourced Kentuckians access fresh, healthy food from farmers markets. Additionally, Howell partners with UK, WKU and Kentucky State University for interactive professional development on diversity and inclusion.

Patrick Kitzman

Dr. Patrick Kitzman is a professor in the University of Kentucky Department of Physical Therapy. He’s also founding director of the Kentucky Appalachian Rural Rehabilitation Network, a team that develops strategies to reduce disability and improve the quality of life for individuals with neurological impairments living in underserved rural Appalachian counties. Kitzman and his team established projects CARAT and CARAT-TOP. In CARAT (Coordinating and Assisting the Reuse of Assistive Technology) students learn to refurbish used medical equipment and donate it to those in need in the community. CARAT-TOP (Coordinating and Assisting the Reuse of Assistive Technology- Together One Priority) is a training program created through a partnership with the UK Center of Excellence in Rural Health. It brings together community members and high-school students of all abilities to learn new skills to help individuals and communities affected by disability.

Mark Thomas

Mark Thomas, Todd County Schools superintendent, was instrumental in establishing the AXIS Program: Centering All Services in the district. In partnership with the Todd County Health Department, the program addresses students’ social and emotional well-being through mental-health case management. The program also assists with basic needs such as nutrition, clothing, toiletries, housing, transportation, and treatment for substance use disorder. Thomas played a crucial role in gaining needed buy-in of the program from staff and the community. Through his support, the program is expanding services to include parenting classes, prenatal classes, and mental health awareness programs for students and staff. Thomas began his career in Shelby County in 1996 as a middle school teacher. He has served in a number of school and district administrative roles across Kentucky before starting his current position in 2020.

Ky. has had 18 monkeypox cases: 10 in Jefferson, 2 in Warren, 1 in Barren, Fayette, Kenton, McCracken, Montgomery counties

By Melissa Patrick

Kentucky Health News

While the number of American with monkeypox increases every day, so far only 18 of them have been reported in Kentucky. Monkeypox was declared a public health emergency in the U.S. on Aug. 4. 

On Aug. 18, the Centers for Disease Control and Prevention reported 18 cases of monkeypox in Kentucky, among 14,115 cases confirmed nationwide. The top five states for cases on that day were New York (2,774), California (2,663), Florida (1,372), Texas (1,079) and Georgia (1,066).  

The day before, that number was only 17 in Kentucky, with 10 in Jefferson County (Louisville Metro), two in Warren County (Bowling Green) and one each in Barren, Fayette, Kenton, McCracken and Montgomery counties, according to the state Department for Public Health. Sixteen of the cases were in adult men and one case was in a woman.

Monkeypox is a viral disease that is part of the same family of viruses as smallpox that causes flu-like symptoms and a rash. It is not related to chickenpox. 

 Symptoms can include chills, fever, body aches, swollen lymph nodes, headache, respiratory symptoms  and a rash. The CDC says you may experience all or only a few of these symptoms. 

The rash may be located on or near the genitals or anus, and could be on other areas like the hands, feet, chest, face or mouth. The rash initially looks like pimples or blisters and may be painful or itchy.

Symptoms usually start within three weeks of exposure to the virus and the illness typically lasts two to four weeks. 

Individuals are infectious from the time the symptoms start until the rash has completely healed, meaning that every scab has fallen off and a fresh layer of skin has formed. 

It can be spread through close, personal contact, often skin-to-skin; by touching objects and surfaces that have been used by someone who has the virus; and through contact with respiratory secretions. 

So far, men who have sex with men have been among those most infected with monkeypox in the U.S., but it's important to remember that the virus can be transmitted by close contact of any kind. It is not considered a sexually transmitted disease. ABC News reports that so far the U.S. has confirmed nine pediatric cases of monkeypox.

"To reduce the risk of transmission, individuals should avoid close contacts with partners who have skin rashes or lesions," Gov. Andy Beshear said at an Aug. 17 news conference.  "Anyone's concerned they may have symptoms, or who may have been exposed to the monkeypox virus, should go talk to their health care provider right now. Anybody eligible for a vaccine, go get it." 

The CDC advises that if you have a new or unexplained rash or other symptoms, avoid close contact, including sex, with others until you have been checked by a health-care provider. 

Vaccines exist for monkeypox, but because of the limited supply, the U.S. does not have enough for every at-risk American, let alone for broad, preventive campaigns. 

At this time, the state health department says the following are eligible for the vaccine:

• Anyone with a high or intermediate risk of exposure to someone with the virus
• Men who have sex with men, including those who identify as gay, bisexual, transgender, gender-nonconforming or gender nonbinary AND have had multiple or anonymous male, transgender or gender-nonconforming sex partners in the past 14 days; or had a diagnosis of gonorrhea and/or early syphilis in the last year; or are on HIV pre-exposure prophylaxis (PrEP). 
• People who who have attended an event/venue with a high risk of exposure to a confirmed case via skin-to-skin or sexual contact in the last 14 days. 
• Individuals who are determined to have reasonable suspicion of recent direct skin-to-skin contact to a known or suspected case. This determination is done on a case-by-case basis.

If you think you are eligible to receive a monkeypox vaccine, contact your local health department for vaccination options. 

Judge says UK should repay money to patients whose debts it 'improperly' referred to state Revenue Department for collection

A judge has ruled that the University of Kentucky "improperly used the Kentucky Department of Revenue and state tax statutes to collect unpaid bills from patients," reports Monica Kast of the Lexington Herald-Leader: "Douglas Richards, attorney for the plaintiffs, said the final amount that will have to be repaid is not yet known, but he estimated it could be upwards of $90 million."

The Revenue Department stopped collecting debts for UK HealthCare this year because the legislature passed a law that keeps it from collecting “any consumer debt owed for health care goods and services.”

Judge Thomas Wingate

Franklin Circuit Judge Thomas Wingate ruled in a class-action lawsuit filed in 2018 on behalf of more than 5,000 debtors whom UK had referred for collection. "The department added interest . . . and a 25% collection fee, taking payment from patients’ wages and tax returns to cover the bills." Kast notes.

Wingate's ruling is not the end of the controversy, which has gone on for years. In 2018, a Fayette circuit judge ruled that UK couldn't use the Revenue Department as a collection agency, on grounds that it is not part of the state executive branch. The state Supreme Court said it was.

In defending the class-action suit, UK cited state laws that executive agencies use to recover funds that were improperly paid, but those laws "only relate to collections for payments that were improperly made because of error, fraud or abuse, Wingate wrote in Monday’s ruling," Kast reports.

UK spokesman Jay Blanton said Wingate's ruling did not address a law that allows the university to refer debts to the Revenue Department, under an agreement between the two agencies.

Kast writes, "Because it is a class-action lawsuit, people who were impacted by this policy will have the option to opt in or out of the payout. The process of gathering information from people affected and returning payments to patients could take several years," according to plaintiffs' attorney Douglas Richards.

Richards told Kast, “This is just completely bad public policy and morally indefensible, because these are two of the biggest institutions in the state — UK and the Department of Revenue — and they’re punching down on people who generally make $10 to $12 an hour,” That's why they lacked the money to pay and fell behind, he said.

Fewer counties at high risk, but Ky. new-case rate remains No. 1 among the states; counties in southeast among nation's top 10

Centers for Disease Control and Prevention map

By Al Cross

Kentucky Health News

The pandemic slacked a bit in Kentucky in the last week, but the Bluegrass State still has the highest rate of new coronavirus cases of any state, according to The New York Times.

The latest weekly Covid-19 risk map, issued Thursday by the Centers for Disease Control and Prevention, shows 16 fewer counties at high risk, down to 73 from 89 last week.

The CDC map shows 38 counties at medium risk and nine at low risk. Last week, 20 were at medium risk and 11 were at low risk.

In high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The Times, which updates its figures at least daily, shows that new cases in the state have declined 18 percent in the last two weeks, but Kentucky still has the highest new-case rate among the states for the last seven days. Puerto Rico and Guam have higher rates, but they are not states.

The Times shows McCreary County with the highest rate of any county or county equivalent in the nation, with Perry County second. Rockcastle, Harlan and Knott counties are fifth, sixth and seventh.

State Supreme Court keeps abortion ban in place; oral arguments to be heard Nov. 15, a week after voters may decide the issue

By Melissa Patrick

Kentucky Health News

A divided Supreme Court of Kentucky upheld Thursday an appeals-court ruling that made nearly all abortions illegal in Kentucky while a lawsuit on the issue moves through the court. But the voters may have the final say, in a referendum a week before the court is set to hear oral arguments in the case.

The American Civil Liberties Union, ACLU of Kentucky and Planned Parenthood Federation of America had sought emergency relief for the state's two abortion providers, EMW Women's Surgical Center and a Planned Parenthood clinic, both in Louisville.

They wanted the court to restore a Louisville judge's injunction that blocked two abortion bans the state legislature passed in 2019: a "trigger law" that took effect when the U.S. Supreme Court overturned Roe v. Wade, making abortion illegal in Kentucky except when the woman's life is threatened; and a ban on abortions after six weeks of pregnancy, about the time that fetal heart activity can be detected. 

Jefferson Circuit Judge Mitch Perry's injunction was based on his finding that the laws violate the rights to privacy, self-determination and religious freedom established by the state constitution and court decisions based on it. But the injunction was vacated by Court of Appeals Judge Larry Thompson of Pikeville, who said abortions performed while the case is pending "cannot be undone."

The court was divided. Only three of the seven justices (Robert Conley of Russell, Debra Lambert of Somerset and Laurance VanMeter of Lexington) fully concurred; the majority was made by Justice Michelle Keller of Fort Mitchell, who concurred in the result only and wrote a separate opinion, and Justice Shea Nickell, who joined in that opinion.

Justice Michelle Keller

Keller wrote that Thompson "not only failed to give appropriate deference to the trial court but also failed to undertake a thorough analysis that is required in a case of this magnitude, failing to even set forth the appropriate standard of review. That being said, remanding this matter to the Court of Appeals to engage in a proper analysis would only further delay the final resolution of these compelling issues."

Keller and Nickell said they shared many of the concerns voiced in the dissent by Chief Justice John Minton of Bowling Green and Justice Lisabeth Hughes of Louisville, the two members of the court who are retiring at the end of the year.

In an opinion written by Minton, they disagreed with the majority's finding that the issue did not present the "extraordinary cause" required for intervention in a pending case; they noted the importance of the case and said Court of Appeals Judge Larry Thompson of Pikeville had abused his discretion by vacating Jefferson Circuit Judge Mitch Perry's injunction. It said Thompson "failed to engage in any analysis regarding whether the circuit court abused its discretion" and the injunction should remain in effect while the case is decided.

"Failure to find extraordinary cause justifying interlocutory review under the circumstances presented here would constitute this court dodging its responsibility to settle legal issues of great legal importance facing the commonwealth," Minton wrote. "It is difficult to comprehend a more important or serious legal issue than legal access to abortion in the commonwealth."

Justice John Minton

Minton also wrote, "This court cannot turn a blind eye to the fact that this case involves one of the most contentious policy and political issues of our time. This case raises serious and important issues involving access to abortion, and movants make a compelling argument that women may suffer irreparable and permanent harm absent emergency relief from this court. And the attorney general also advances serious allegations of irreparable harm, alleging that any abortions performed during the pendency of this litigation cannot be reversed." Read the three opinions here.

The Supreme Court took the case from the Court of Appeals, as that court and all sides had requested, and scheduled oral arguments for Nov. 15. That is one week after the Nov. 8 election, which includes a ballot question that would add to the state constitution a statement that would negate Perry's findings, by saying that the constitution does not grant a right to an abortion or funding of it.

"We look forward to that expression of the will of the commonwealth," Keller wrote in her opinion.

Also on the Nov. 8 ballot is a nonpartisan race between registered independent Keller and state Rep. Joseph Fischer, R-Fort Thomas, who sponsored the proposed amendment and the trigger law. Four of the Supreme Court's seven seats are on the ballot. There are contested races for the seats that Minton and Hughes are giving up; Nickell is unopposed. 

Asked about the ruling, Democratic Gov. Andy Beshear, who generally favors abortion rights and is seeking re-election, again noted that neither of the two abortion bans have exceptions for rape or incest. 

"The Kentucky Supreme Court has left in place one of the most extremist laws across the United States," Beshear said. "It bans options for everyone, meaning that victims of rape and incest have absolutely no options and have to potentially carry their rapists child. It means a victim of incest. and we've seen young girls 10, 11, 12 violated by a family member has no options. I think that's wrong. And I think the majority of Kentuckians agree with me." 

Attorney General Daniel Cameron, who is seeking the Republican nomination to oppose Beshear and got Thompson to negate Perry's injunction, said in a statement, saying that since the U.S. Supreme Court has given abortion decisions back to the states, we "must allow our policymakers in the General Assembly to speak for the people they represent."

The ACLU said, “The Supreme Court’s decision to allow Kentucky’s abortion bans to remain in effect puts nearly a million people’s health care in jeopardy. Abortion is not only health care but also a critical individual freedom. Make no mistake: abortion bans result in tragic health outcomes and are a form of control over our bodies. Despite this setback, the fight continues. We will proceed with our case to restore and protect reproductive freedom in Kentucky. Politicians and the government should never have the authority to force a person to remain pregnant against their will.”

Health insurers offer $25 gift card and unlimited-ride wristbands to people getting a Covid-19 shot at the Kentucky State Fair

At the Kentucky State Fair, the Kentucky Association of Health Plans is giving free, unlimited-ride wristbands and $25 gift cards (while supplies last) to attendees who go to booth B419 in the Health Horizons Pavilion in South Wing B to get a Covid-19 vaccine or booster shot. Hours are 10 a.m. to 6 p.m. Monday through Saturday.

Medicaid members may also be eligible to receive an incentive offered by their health plan in addition to the giveaway, KAHP said in a news release.

On Aug. 19, KAHP is partnering with Kentucky Sports Radio for a live KSR pre-show and KSR broadcast at the Fair from 9 a.m. to noon ET.

“Offering vaccines and incentives in non-traditional environments has been a winning formula,” said Tom Stephens, executive director of KAHP. “We had tremendous traffic at the fair last year. We also gave away gas cards at a June pop-up clinic during the Kentucky High School Athletic Association baseball and softball championships and we’re proud to vaccinate 700 people.”

KAHP says it has been engaged in a 16-phase effort for vaccination, including a KSR tour, to a theme-park vacation-getaway drawing, gas-card giveaways, non-profit vaccine-clinic competitions with large grant payouts, school vaccine-clinic incentives.

Cameron urges Louisville schools to end their mask mandate

By Melissa Patrick
Kentucky Health News

Attorney General Daniel Cameron is urging Jefferson County school officials to end their mask mandate and telling them that he is investigating whether they are even allowed to institute it.

"While my office continues to review whether JCPS has the authority to impose such health policies, I write to urge the board to terminate its mask mandate immediately. The mandate harms children, unduly burdens teachers, and is bad public policy," Cameron said in an e-mailed letter to the Jefferson County Board of Education, selectively citing research that he said supported his claims. He also said the district is the only one in Kentucky that requires masks.

Cameron's letter was dated Aug. 16, the same day as a school board meeting. Mask policy was not on agenda, so board member James Craig made a motion to add it. The motion lost on a vote of 4 to 3. Craig said he wanted a discussion about changing the policy to only encourage masks while the county is rated at high risk, Olivia Krauth reports for the Louisville Courier Journal.

On Aug. 16, the incidence rate of new coronavirus cases in Jefferson County was 35.2 per 100,000 residents. Anything higher than 25 per 100,000 is considered to pose a high risk of transmission. The Centers for Disease Control and Prevention's weekly risk map, which looks at hospital admissions and capacity as well as new cases, also places Jefferson County, along with 88 other Kentucky counties, at high risk.

Last year, the state legislature allowed local school districts to implement their own mask policies.

The CDC recently changed some of its Covid-19 guidelines for schools, and no longer recommends that they do random screenings or participate in "test-to-stay" programs, it still recommends universal indoor masking in schools if they are in a county with high levels of transmission: "At a high Covid-19 community level, universal indoor masking in schools . . . is recommended, as it is in the community at large."

Meth use dramatically increases odds of nonfatal overdose among rural drug users, whether used with opioids or by itself

Nearly 80 percent of recreational drug users in rural areas have taken methamphetamines in the past month, according to a newly published study that included Kentucky. That's concerning, because meth use greatly increases the risk of non-fatal overdose—whether it's used alone or with opioids—and because rural drug users are more likely to suffer consequences from meth use but less likely to have access to treatment or prevention measures. Other studies have found that opioids were involved in about two-thirds of overdose deaths, and that fentanyl contamination increasingly drives opioid and meth-associated overdose deaths.

Overall, 22% of survey participants who co-used opioids and meth had survived an overdose in the past six months, compared to 14% of those who used opioids alone and 6% who used meth alone. Participants who co-used most often (44%) were also more likely to have tried and failed to access drug treatment measures than those who used opioids alone (36%) or meth alone (30%).

Publishing in the Journal of the American Medical Association, the researchers noted that meth use has been endemic in rural areas for decades, and that meth-related hospitalizations nationwide skyrocketed 270% from 2007 to 2015. Even so, not much research has focused on the characteristics of purely rural meth use, or meth use combined with opioid use.

Researchers gathered data for the study between January 2018 and March 2020, surveying drug users in rural communities in the 10 states participating in the Rural Opioid Initiative Research Consortium: Kentucky, Illinois, Massachusetts, New Hampshire, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin. The findings suggest that harm reduction and drug treatment programs must address meth use as well as opioids to decrease overdoses in rural communities, the researchers write.

Kentucky continues have the nation's highest rate of new Covid-19 cases, even though case numbers dropped 7.9% last week

New York Times map shows Kentucky continues to be the national hot spot. Click to enlarge.

By Melissa Patrick
Kentucky Health News

New coronavirus cases in Kentucky have gone up and down over the last few weeks in what could be the beginning of a plateau. Last week, they dropped 7.9% after increasing 6.8% the previous week. 

The state's weekly report for the Monday-to-Sunday reporting period shows 14,409 new cases last week, an average of 2,058 per day. The prior week, it was 2,236. 

Of the new cases, 19.5% were in people 18 and younger, up from 16% in last week's report. This increase in new cases among youth comes as Kentucky children head back to school amid new guidance from the Centers for Disease Control and Prevention, which no longer calls for routine testing or "test-to-stay" programs. Health officials still urge school-aged children to get a Covid-19 vaccine. 

The percentage of Kentuckians testing positive for the coronavirus increased slightly to 18.51%, up from 18.41% the week before. The numbers does not include at-home tests. 

The statewide incidence rate of new cases declined again, to 35.32 per 100,000 residents. Last week that rate was 39.05. The top 10 counties were: McCreary, 154.2; Harlan, 95.6; Perry, 95.4; Leslie, 94; Wolfe, 87.8; Menifee, 81.5; Letcher, 78.2; Breathitt, 73.5; Knott, 73.3; and Knox, 71.1.

The New York Times ranks Kentucky's infection rate first among the states, even with an 11% drop in cases in the last two weeks. The Times says McCreary County has the highest rate in the nation, at 149 cases per 100,000. A federal prison there has had outbreaks in the past. State officials have attributed the differing numbers to differing methodologies, including the state's removal of duplicate test results.

Kentucky hospitals reported fewer Covid-19 hospitalizations last week, but the same number of Covid-19 patients in intensive care and on mechanical ventilation. They reported 615 Covid-19 patients Monday, down from 623 a week earlier. They reported 74 Covid-19 patients in intensive care and 27 on mechanical ventilation. 

The state attributed 76 more deaths to Covid-19 last week, up from 67 the week before. The pandemic death toll is now 16,540.

Keynote speaker at harm-reduction summit calls for not requiring abstinence for drug users to get access to 'recovery capital'

By Melissa Patrick
Kentucky Health News

Helping people in addiction recovery meet their basic needs should not focus on abstinence, but instead should be provided along the continuum of a person's drug use as a way to mitigate harm, with a focus on wellness and autonomy, says an expert who knows recovery from his own experience. 

Alex Elswick

Alex Elswick, an assistant extension professor for substance-use prevention and recovery at the University of Kentucky, was the keynote speaker for the virtual Kentucky Harm Reduction Summit Aug. 10 and 11.

"Harm reduction and capital building are the things that we should be doing all the time for everyone," Elswick said. "We shouldn't be waiting until someone becomes abstinent, or until they become involved in the criminal legal system, or until they reach out for treatment. We can go and engage people who are suffering in our communities and we can mitigate harms. And we can build capital right now, without any barriers to access." 

Elswick, who is in long-term recovery, often says that there is nothing special about his addiction to OxyContin and heroin, since it followed the same path as many others have experienced. What he says is special is his recovery, largely because of the abundance of resources that were available to support him, including housing, transportation, employment, education, access to medical and mental-health care, and relationships with family and community.

Elswick calls those resources "recovery capital" and described them as anything that promotes recovery, or anything that improves the odds that a person will be successful in their recovery. 

He stressed that everyone recovery needs such resources, and not just after they stop using drugs. And just like Maslow's Hierarchy of Needs, which describe motivation, he said a person who has an addiction to drugs must have their basic needs met first before they can even consider seeking treatment and recovery.

But the problem, he said, is that we often use abstinence as a precondition to providing these basic needs for people in the recovery process. 

"I want to suggest that we're flipping it upside down. We're expecting people to do the incredibly, in some cases impossible, work of becoming abstinent without providing them with all the resources that they need in order to do so." 

A key example of this upside-down thinking is housing, because there is little to no housing available for people who use drugs or who are in the early stages of the recovery process, Elswick  said. Nor is there housing for people who are abstinent but are on a medication for opioid-use disorder, like buprenorphine or methadone.

Instead, he said, we have sober housing for people who are already abstinent -- and if a person living in one of these houses experiences a recurrence, which is common, they are kicked out. 

He added that the same is true for drug users' access to social services, which often requires a drug test; that people are kicked out of treatment if they relapse, even if they sought treatment for exactly that problem; and that families are often told to deny support of a loved one if they are using drugs, regardless of circumstances.

In each of those circumstances, "You're going to be deprived of your recovery capital, despite the fact that research says that would improve your odds of recovery," he said. And the only way to change this, he added, is to prioritize recovery above abstinence. 

Elswick traced the concept of recovery capital to a study by University of Denver Professor William Cloud, who found that college students with addictions were recovering at a significantly higher rate, than the general population, sometimes with no formal interventions. 

Cloud determined that the students recovered better because most came from relatively privileged backgrounds and had access to most of the social supports that they needed to recover. 

"The value of recovery capital and harm reduction is that it allows us to have a relationship with someone, as opposed to saying, 'Come to me when you're sober'," said Elswick. "It allows us to have a relationship so that that relationship itself can be a therapeutic. That relationship itself can be a component of recovery capital." 

Elswick concluded with pushes to battle the stigma that still plagues drug users, even among health-care providers and treatment centers, and to make medication-assisted treatment for opioid-use disorder more accessible. He cited studies that prove this is the gold standard of care, but 90% of people who need treatment don't get it. 

"My main takeaway message is, I want us to shift the focus away from abstinence toward recovery capital and building recovery capital and mitigating harms, because it's the more effective approach and I think you might find it'll lead to more abstinence than you realize." 

Elswick is the co-founder of Voices of Hope, a recovery community organization.