Observing 'Dry January' can bring lasting benefits, studies show

Photo illustration for The Washington Post by Linnea Bullion

People who observe "Dry January," abstaining from alcohol during the month, often drink less the rest of the year and show "striking improvements in their health," Anahad O'Connor of The Washington Post reports. The observance "is widely viewed as a temporary test of willpower — followed by a return to old drinking habits when the month ends. But according to research, that’s often not what happens."

Studies in the United Kingdom have shown that people who participate in sobriety challenges "frequently experience lasting benefits," O'Connor reports. "Often, they drink less in the long run and make other sustained changes to their drinking habits that lead to striking improvements in their health and well-being." One possible reason: a month "provides opportunities to form new habits — like turning down alcohol in social settings, which in the long run can be empowering. And taking a break from alcohol can trigger immediate health benefits, like weight loss, better sleep, and a boost to your mood and energy levels, which can reinforce the new habit."

Richard de Visser, a psychologist at Brighton and Sussex Medical School in England, who has studied the phenomenon, told O'Connor, “It becomes a reinforcing message instead of a punishing message. Instead of public health people wagging their fingers and saying, ‘Don’t drink, it’s bad for you,’ people do it and say, ‘I didn’t realize how good I would feel.’ They often don’t realize how much stopping drinking will improve their sleep, or their concentration, or even just their levels of energy in the morning.” But 11% of participants have a rebound effect, drinking more afterward.

The observance was started 10 years ago by Alcohol Change UK, a British nonprofit that has a website where you can sign up to get support, also available via a mobile app. "Last year, 130,000 people globally signed up to participate in Dry January," OConnor reports, offering other "tips that could increase your odds of success:" Do it with a friend. Find a new favorite drink that has no alcohol. Track how much money you save (which you can do on the app). "Manage your triggers; instead of meeting your friend at a bar after work, suggest going to a movie, taking a long walk, or having dinner at a restaurant instead."

UPDATE, Jan. 2: The New York Times recommends non-alcoholic wines.
Jan. 3: The Courier-Journal offers tips on how to be "sober curious" and still have fun.

CDC's Kentucky risk map looks about the same as last week, but Beshear says 'Covid is definitely increasing' and counsels caution

Beshear points to graph showing increases in share of Kentuckians testing positive for the virus.

By Al Cross
Kentucky Health News

The latest Centers for Disease Control map of Covid-19 risks in Kentucky is about the same as last week's, but "Covid is definitely increasing," Gov. Andy Beshear said at his weekly press conference, before the map was released.

"We’re seeing that holiday bump," Beshear said. "I don’t want to call it a surge [but] this is a real bump and cases obviously are under-reported," because of home testing. He said some people who test positive at home don't report their infection because they are vaccinated, feel good and are likely protected from serious disease.

Pointing to graphs showing more new cases by week, and positive results of lab-analyzed tests for the virus, the governor said, “When you come and you get the full PCR test by a professional, you're pretty positive you've got something pretty serious."

Centers for Disease Control and Prevention map

The latest CDC map, based on new cases and hospital data, shows two fewer counties at high risk, 15, and most of them were a West Kentucky cluster that has been orange on the map for weeks. Medium-risk counties, in yellow, still number 42, and there are 61 low-risk counties, in green.

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality 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 those who are at high risk of getting very sick to wear 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 advised those who are "immuno-compromised" to mask up when they go out. "I see people now being very accepting of folks in masks, and that’s where we need to get to," he said, advising the non-compromised to think ahead: "You might have something coming up you don’t want to miss."

Perhaps even more important, he said, "If you feel sick, don’t go to work. . . . Don’t send sick kids to school. If we do[n't do] just those two things we’ll continue to do better and better against Covid."

CDC map; to enlarge any image, click on it.

The CDC has another map, mainly for hospitals and researchers, that shows transmission levels. Most counties are at a high level, shown in red,, and most of the rest are at a substantial level, in orange. State officials say the orange, yellow and green map should be used as guidance for preventive measures.

Beshear also counseled precautions to prevent the spread of influenza, saying "The flu remains very serious and still very high in Kentucky. We've confirmed eight Kentucky children have died from influenza this flu season." He said only one was vaccinated and some were "co-infected with other viruses, and Kentucky is part of a national surveillance to see if strep infections are playing a role in higher-than-usual deaths of children. 

Like Covid-19 vaccines, the flu vaccine is more effective at preventing serious disease than infection. “It will really help if you get the flu,” Beshear said.

The other respiratory illness threatening children, RSV, "does appear to be declining, thankfully, but it's still contributing increased hospitalizations of children," Beshear said. Some pediatric beds in the state have opened up, he said, "but there are still a lot of kids in the hospital, and we don't want to see that." 

Also on the health front, Beshear asked Kentuckians to donate blood at the Kentucky Blood Center, which is running short of most blood types and needs 400 donors a day across at its eight locations in Pikeville, Corbin, Somerset, Lexington, Frankfort and the Louisville area. 

Kentuckians' sense of well-being, as measured by analysis of Gallup polls from 2008 to 2017, was second lowest in U.S.

By Al Cross
Kentucky Health News

Kentuckians' sense of well-being from 2008 to 2017 was the worst of any U.S. state except West Virginia, according to a research paper that uses polling data to compare life satisfaction, enjoyment, smiling and being well-rested along with the negative affects of pain, sadness, anger and worry. 

The research also looks at 163 other nations, and ranks them along with U.S. states. In those rankings, Kentucky is 89th, just below Russia and Uruguay and just above South Korea and Belgium. West Virginia is 101st, just below Sri Lanka and just above Mauritania.

The research is being done by economics professor David G. Blanchflower of Dartmouth College in New Hampshire and the University of Glasgow in Scotland, and social-science professor Alex Bryson of University College London. It is published as a working paper by the National Bureau of Economic Research, a nonprofit organization that says it is "committed to undertaking and disseminating unbiased economic research among public policymakers, business professionals, and the academic community."

The researchers write that their four positive measures aren't just the flip side of the negative measures: "It seems they are, at least to some extent, measuring different things. . . . The implication is that we might need more than life satisfaction alone to obtain a robust assessment of state rankings on well-being."

The four negative questions in the Gallup Inc. polls asked respondents if they had experienced physical pain, sadness, worry or anger "during a lot of the day yesterday." The four positive questions were:

• Please imagine a ladder with steps numbered from zero at the bottom to 10 at the top. Suppose we say that the top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. If the top step is 10 and the bottom step is zero, on which step of the ladder do you feel you personally stand at the present time?
• Did you experience the following feelings during a lot of the day yesterday? How about enjoyment?
• Did you smile or laugh a lot yesterday?
• Now, please think about yesterday, from the morning until the end of the day. Think about where you were, what you were doing, who you were with, and how you felt. Did you feel well-rested yesterday?

Kentucky's highest rank among the states and nations, 62nd, was for enjoyment the previous day. It ranked 71st in the ladder of life, 88th in smiling or laughing, and 138th in being well-rested.

Among the negative questions, with stronger responses resuilting in a lower ranking, Kentucky did best with anger, ranking 80th. It was 103rd in pain, 113th in sadness and 118th in worry.

The top state in the rankings was Hawaii, followed by Minnesota, North Dakota, South Dakota, Iowa, Nebraska, Kansas, Alaska and Wisconsin. The bottom 10, starting with No. 41, were Rhode Island, Nevada, Oklahoma, New Jersey, Ohio, Tennessee, Arkansas, New York, Kentucky and West Virginia.

Robert Slaton dies at 81; was a catalyst for many health projects, including Passport Health Plan and Kentucky Health News

Robert Slaton, Ed.D.

Robert Slaton, a health-care consultant and former Kentucky public-health commissioner who was a catalyst for various health-improvement projects in the state, including Passport Health Plan and Kentucky Health News, died Dec. 27 after suffering a stroke a few days earlier. He was 81 and lived in Louisville.

Slaton, who had master's degrees in education and social work and a doctorate in education administration, was state health commissioner in 1978-79, then ran the Public Service Institute at Kentucky State University and was external-affairs administrator for Trover Clinic, now Baptist Health Deaconness Madisonville, his hometown, from 1983 to 1989. While at the University of Louisville, he was Gov. Brereton Jones' special assistant for health-care reform, executive director of the university's primary-care center, executive director of the Medical School Practice Association and executive vice president of University Health Care, retiring in 2007. As primary-care director, Slaton was part of a small group that planned, developed, and implemented Passport Health Plan, which started in 1997 and became a national model for managed care of Medicaid patients.

As a member of the national advisory board of the Institute for Rural Journalism and Community Issues at the University of Kentucky, he was the catalyst for funding of the institute's Kentucky Health News by the Foundation for a Healthy Kentucky. Sitting with Institute Director Al Cross and then-Foundation President Susan Zepeda at a Kentucky Chamber of Commerce luncheon in 2010, he said, "Al, you ought to ask Susan for some money." When Zepeda asked what the money would be for, Cross (who had no idea the proposition was coming) replied that the goal would be improving health coverage in Kentucky news media. The foundation continues to fund Kentucky Health News.

Slaton later chaired the advisory board, helping the Institiute develop a strategic plan. He was a member of the foundation's Community Advisory Council and chair of the chamber's Health Care Policy Council. In 2018, he won the Russell E. Teague Award from the Kentucky Public Health Association for his achievements and contributions to public health.

"Throughout his career in both public service and as a health-care consultant, he provided a politically savvy perspective and an astute management style that enabled institutions and organizations to make significant headway in policy change to improve the health of Kentuckians," his obituary says. "Robert always believed that health care was a right, not a commodity, and he worked very hard in a variety of settings to help move it in that direction."

As health commissioner, "He demonstrated an understanding of social and structural determinants of health that was ahead of its time," the obituary says. "Robert was a consensus builder and a natural organizer who was described as generous and down-to-earth. His talents included problem solving, strategic planning, and organizing a group of people to get a project done. He was proud that over his career he had helped young staff members develop beyond what they thought they could do. He could often see what needed to be done before most people, and he could handle personalities and egos to bring about change in organizations. Robert focused much of his career on building linkages and coalitions between different groups. This was eased by his genuine rapport with people. Robert’s strategic planning skills, insightful opinions, and wise counsel were valued by many leaders in the business, nonprofit, and political world."

He was co-author of two books about management, From Green Persimmons to Cranky Parrots, and Caught in the Middle Management. At the time of his death, he was working on a book about his mother’s life, based on the diaries she kept for decades. As he moved into assisted living, Robert was already making plans for his next book, stories of his colorful adventures as a parole officer in Western Kentucky in the 1960s. He was a delegate to the 1992 Democratic convention.

Slaton is survived by five adult children, Andrea, Lyle, Tom, Danny (Elizabeth), and Mike (Jake), and three grandchildren: Thia, Henry, and Lila. He is also survived by his companion, Mary B. Bradley, and her two children, whom he very much thought of as his own: Lizi Hagan and Clay McClure.

A memorial service will be held at 10 a.m. ET Saturday, Dec. 31 at Pearson’s, 149 Breckenridge Lane, Louisville. Visitation will be held from 4 to 7 p.m. ET Dec. 30 at Pearson’s. In lieu of flowers, donations may be made to Down Syndrome of Louisville, the Foundation for a Healthy Kentucky, or the Institute for Rural Journalism and Community Issues.

Parents in 21 more counties get CPR kits for infants, for total of 32; hundreds still available, with money from health insurers

The CPR Anytime® training kits are given to parents.

Three times as many Kentucky counties will get cardiopulmonary resuscitation kits for infants, funded by the Kentucky Association of Health Plans, representing health-insurance companies in the state.

The American Heart Association is delivering the life-saving CPR kits to health-care facilities to give to new parents. Each kit includes an inflatable mannikin and video that teaches infant CPR in as little as 20 minutes.
 
The initiative, launched in May 2022, has provided 3,000 kits to neonatal intensive-care units in 11 counties. A $150,000 grant from KAHP is funding 4,350 more kits, nearly 2,500 of which have been distributed in 21 counties: Bath, Bell, Boyd, Casey, Clark, Estill, Floyd, Garrard, Harlan, Hyden, Jackson, Johnson, Madison, Montgomery, Nicholas, Perry, Pike, Powell, Rockcastle, Rowan, and Warren.

“Rural communities often face a critical shortage of health-care professionals,” said Ashley Sokoler, AHA's Kentuckiana director. “That’s why it’s so important to make CPR training available to new parents in rural areas and provide the healthcare facilities they visit with the resources needed to implement training without causing additional strain on their staff.”

Hospitals, clinics, and other healthcare providers interested in requesting kits can contact AHA Kentuckiana Community Impact Director Tracy Monks at tracy.monks@heart.org for information.

New coronavirus cases in Kentucky jumped 40% last week; state's increase over last two weeks ranks second among states

New York Times graphs, from state data, adapted by Kentucky Health News; click image to enlarge

By Al Cross

Kentucky Health News

Kentucky recorded 40 percent more new coroinavirus cases last week than the week before, despite the Christmas holiday that probably limited reporting.

The state Department for Public Health's latest weekly report showed 8,920 new cases, or 1,274 per day. The previous week's total was 6,376, or 911 per day.

The share of people testing positive for the virus rose to 12.23%, up from 9.85%. That's an increase of 24 percent and does not include at-home tests.

Ky. Dept. for Public Health map, adapted by Ky. Health News

The New York Times ranked Kentucky's rate of new cases over the last seven days ninth among the states, with a 44% increase in the last two weeks, second only to Michigan's 55%. Tennessee was redder than Kentucky on the Times' county-by-county map, but none of its most populous counties had high new-case rates.

Kentucky's high-rate counties were also rural. Those with new-case rates more than double the statewide rate of 14.54 were Leslie, 40.5; Crittenden, 37.3; Simpson, 31.5; Rowan, 31; Bath, 30.9; Johnson, 29.6; and Lyon, 29.6.

In recent weeks, the state has reported more new cases of influenza than coronavirus cases. Kentucky's weekly flu report for the week ended Dec. 17 had not been posted by 7 p.m. Tuesday, but the page said it would be coming soon.

Among the new coronavirus cases, only 10.6% were in Kentuckians 18 or younger. The state attributed 45 more deaths to Covid-19, bringing Kentucky's pandemic toll to 17,670.

Kentucky hospitals reported 405 patients with Covid-19 Monday morning, up from 370 a week earlier, with 49 in intensive care (up 7) and 16 on mechanical ventilation (down 4).

The current surge of the coronavirus in China increases the risk of a mutation that could overcome current vaccines, report Aniruddha Ghosal and Laura Ungar of The Associated Press: "Every new infection offers a chance for the coronavirus to mutate, and the virus is spreading rapidly in China. The country of 1.4 billion has largely abandoned its 'zero Covid' policy. Though overall reported vaccination rates are high, booster levels are lower, especially among older people. Domestic vaccines have proven less effective against serious infection than Western-made messenger RNA versions. Many were given more than a year ago, meaning immunity has waned."

As he leaves public office, Dr. Anthony Fauci says the biggest change in public health has been the normalization of falsehoods

Dr. Anthony Fauci (Associated Press photo by Alex Brandon)

As Dr. Anthony Fauci retires after five decades in public health, he says he worries that lies and misinformation are creating a "profoundly dangerous" time for science and the public.

"Untruths abound and we almost normalize untruths," Fauci told The Associated Press. "I worry about my own field of health, but I also worry about the country."

Fauci has made the same point in several other exit interviews. In August, he said on MSNBC, "There's no much lying going on over there that people accept it as part of the norm," and when lots of people accept it as truithful, "that is the beginning, I believe, of the destruction of our democracy."

In December, he told ABC News, "Misinformation and disinformation is really hurting so many things, including people's trust in science. It becomes very difficult to get people to fully appreciate the truth of what's going on — which will ultimately impact how we respond, in this case, to a pandemic, like Covid-19."

AP notes, "Fauci, who turned 82 on Christmas Eve, has been a physician-scientist at the National Institute of Allergy and Infectious Diseases for 54 years, and its director for 38 of them. Because he candidly puts complex science into plain English, Fauci has advised seven presidents, from Ronald Reagan to Joe Biden, about a long list of outbreaks -- HIV, Ebola, Zika, bird flu, pandemic flu, even the 2001 anthrax attacks."

Fauci said his policy has been to "stick with the science and never be afraid to tell somebody something that is the truth -- but it's an inconvenient truth in which there might be the possibility of the messenger getting shot/ You don't worry about that. You just keep telling the truth. That's served me really quite well with one exception that, you know, the truth generated a lot of hostility towards me in one administration."

AP sums up: "As the world enters another year of Covid-19, Fauci still is a frequent target of the far right -- but also remains a trusted voice for millions of Americans. . . . The public did struggle to understand why some of his and others' health advice changed as the pandemic wore on, such as why masks first were deemed unnecessary and later mandated in certain places. Fauci said one of the pandemic's lessons is to better convey that it's normal for messages to change as scientists make new discoveries.

"That doesn't mean you're flip-flopping," he said. "That means you're actually following the science."

Opinion: U of L Health should repay all its state loan, not just half

By Jim Waters
Bluegrass Institute for Public Policy Solutions

The University of Louisville Cardinals men’s basketball squad gave its fans a timely stocking stuffer Dec. 14 with the team’s first win of the season, beating the Western Kentucky Hilltoppers at the KFC Yum Center.

U of L’s health-care system should follow suit and offer taxpayers some Christmas joy by fully repaying the $35 million borrowed from the Commonwealth under the auspices of needing the money to purchase Kentucky One Health’s assets, including Jewish Hospital.

The money was neither needed nor used for these purchases.

In previous columns, we urged lawmakers to “invite the university to either pay for this project out of its already-flush-with-cash pockets or seek a loan from the private sector.”

Kentucky’s taxpayers “should be outraged that U of L lobbied heavily for this loan even though the university is flush with hundreds of millions in cash and is more than capable of making this acquisition without one red cent from Frankfort’s coffers,” we opined.

But taxpayers’ voices were drowned out by the Santa-sized claims of former U of L President Neeli Bendapudi, who doubled down on her assertions that the loan was “vital” to purchasing the additional facilities and that there was no other way for the university to absorb Kentucky One Health’s operating losses.

Documents obtained by the Bluegrass Institute Center for Open Government reveal that not only was U of L capable of acquiring the funds to make needed improvements to the previously faltering Kentucky One Health system without the government loan, but that the monies were used for a variety of capital purchases, including upgrades to the system’s emergency medical records platform, computer replacement/remediation and even a new roof at Jewish Hospital.

Such outlays can improve a hospital’s ability to provide quality care, but were they so “vital” that UofL needed a subsidized, partially forgivable taxpayer-backed loan from state government to purchase them?

“Partially forgivable”? This health-care giant is only required to pay back half the loan even though the enterprise reaped year-over-year total operating revenues of $2.2 billion while holding more than $1 billion worth of total assets during the most recent fiscal year, according to audited financial statements obtained by the Center for Open Government via the open-records law.

In their annual report to the Legislative Research Commission, officials indicated they anticipated paying back “the obligated portion of the loan” ($17.5 million) ahead of schedule.

Bluegrass Institute Visiting Policy Fellow Andrew McNeill instead urges the company to “meet this moment by respecting Kentucky’s working families and taxpayers who ponied up for what has proven to be an unnecessary loan” by going beyond what’s statutorily required and repaying the entire loan.

New U of L President Kim Schatzel, whose administration officially begins in February and who has extensive business and private sector experience, should appreciate what a welcome gift that would be for the Commonwealth. Perhaps she could help spread some needed holiday cheer by voicing her own support for full repayment.

McNeill wrote in a letter to Interim Joint Appropriations and Revenue Committee members that such a gesture “would make an immediate and positive impression with Kentucky’s taxpayers, especially those from outside of Jefferson County.”

More than 1/3 of Kentuckians are enrolled in Medicaid. How many in your county? How many kids? What are their big health issues?

Screenshot of health portion of Cabinet for Health and Family Services report on Clay County

By Al Cross

Kentucky Health News

Most Kentuckians probably don't know much about Medicaid, but for more than one in three people in the state, it is a lifeline. In some counties, more than half the residents are Medicaid beneficiaries. But Medicaid runs somewhat under the radar, because many Kentuckians frown on the receipt of public assistance -- even though Medicaid benefits come only with demonstrated medical need.

Medicaid is a combined federal-and-state program, created in 1965 by the law that created Medicare. Originally it was for the very poor, the disabled and the pregnant, but in 2014 expanded to households with incomes up to 138 percent of the federal poverty level because then-Gov. Steve Beshear embraced the 2010 Patient Protection and Affordable Care Act, better known as Obamacare.

The federal government pays 90 percent of the cost for people covered by the expansion, and about 72 percent of others' costs. The state pays the rest, which means Kentucky taxpayers put billions of dollars a year into it. It's not the sort of program that needs to run under the radar; if we are paying the freight, we need to know what's in the haul, and it helps to know it at the local level.

That's easier now that the state Cabinet for Health and Family Services, which runs Medicaid in Kentucky, has posted monthly Medicaid enrollment reports on its website.

These county-by-county reports are more useful than the annual reports that the cabinet circulates more more to show the local impact of its programs. The Medicaid figure on those reports is the number of people in the county who received Medicaid benefits at any time during the program's fiscal year (April to March). That number overstates the rolls at any particular time, because many people go on and off Medicaid each month.

For example, the Fiscal 2022 report for Clay County, one of the nation's poorest, shows 15,922 total beneficiaries in the year, but only 12,815 in the month of June. That is still 62.6 percent of the county's estimated population of 20,484.

That said, the annual reports provide much more information about Medicaid than the monthly reports; among other things, they:

• Break down Medicaid enrollment into types of enrollees: traditional, expansion, children in foster care, and "presumptive eligibility," people who have been enrolled during the pandemic without all the usual checks for eligibility, under legislation passed by Congress. Starting April 1, states will have to start running all the usual checks, and many people will no longer be eligible. In Clay County, for example, 2,842 presumptive eligibles were on the rolls in fiscal 2022, or 18% of the total enrollment.
• Give the number of children who were beneficiaries at any time during the year; in Clay County, 4,612 kids were helped by Medicaid in fiscal 2022. 
• Give the top five diagnoses for adults and children on Medicaid, which can vary widely from year to year. In another poor county, Clinton, the top five diagnoses for adults in fiscal 2021 were chronic obstructive pulmonary disease, hypertension, unspecified illness, opioid dependence and diabetes, in that order. In fiscal 2022, they were hypertension, Covid-19, contact with and suspected exposure to Covid, myopia (nearsightedness) and "other fatigue."
• Give the top five procedures performed on beneficiaries and the top five medications prescribed for beneficiaries. In both Clay and Clinton counties in the last two fiscal years, the most-prescribed drug was naloxone, which reverses the effect of a drug overdose.
• Show the number of health-care providers who served residents of the county and the total they were paid. For example, in Clinton County in fiscal 2022, residents were served by 48 providers who were paid $33 million; $14.3 million of that went to local providers.
• Show the number of newborn screenings and other figures on programs for children, including the percentages of foster children who had an official goal of adoption, and the number with other official goals, such as reunification with their birth families.

The annual reports give much information on programs other than Medicaid, such as the Supplemental Nutrition Assistance Program (once known as food stamps), behavioral-health services (including syringe exchanges), other services by local health departments, health-insurance assistance, child-care assistance, child-support enforcement, social services (such as meals, home care and other services to seniors), and funding of Family Resource and Youth Service Centers, which serve public-school students and their families. The reports also list the number of cabinet employees working in each county.

Poll of rural Americans finds them more aware of, and more willing to discuss, opioid problems; 47% still see stigma

Morning Consult graph: 2017 and 2022 responses to question about access to care. Click to enlarge.

Rural Americans say they are more aware of, and more willing to talk about, the opioid problem in the nation and their communities than they were five years ago, according to an online poll of rural adults sponsored by the American Farm Bureau Federation and the National Farmers Union.

Sixty percent said adults are more aware of the crisis than they were five years ago, and 77% said they would comfortable having a conversation about opioids, but 47% said there is stigma or shame associated with opioid abuse in their community.

Rural adults increasingly regard drug addiction as a disease. Asked if addiction to opioids is a disease or is due to a lack of will power or self-control, 57% said it's a disease and 21% said otherwise. In 2017, the numbers were 46% and 26%, respectively. Likewise, 78% said someone can accidentally or unintentionally get addicted to opioids; five years ago, 71% said that.

The poll found that more rural adults than five years ago believe there is a higher rate of opioid misuse in rural communities than in urban and suburban areas), and 48% said they know someone who is or has been addicted to opioids or prescription painkillers.

Asked if they had taken an opioid or prescription painkiller without a prescription, 5 percent said yes. The same percentage said they had abused opioids or prescription painkillers or been addicted to them. Asked how comfortable they would feel talking about that, 70% said they would feel very or somewhat comfortable discussing it with friends, 52% with siblings and 46% with parents. Beyond their immediate families, most said they would be not too comfortable, or not comfortable at all.

The margin of error for that subsample of 110 people is plus or minus 9.3 percentage points. The error margin for the whole sample of 2,010 rural adults is 2.2 percentage points. The poll was conducted online Oct. 6-13 by Morning Consult and the results were weighted to reflect gender, age, race, ethnicity, census region and education. The results are available from Farm Bureau here.

Farm Bureau and NFU, long rivals in representing farm interests, "have consistently worked to publicize and compile useful material to help address rural stress, mental health challenges and opioid misuse," they said in a press release. NFU President Rob Larew said, “We must continue to reduce the stigma to connect our loved ones with health care and treatment they may need. I thank AFBF for being a teammate on this project, and the survey results show what is possible when farm organizations work together.”

Kentucky again 43rd in America's Health Rankings, scoring lowest in behavior and health outcomes, high in having a care provider

By Melissa Patrick
Kentucky Health News

After not ranking states for two years due to the pandemic, America's Health Rankings again placed Kentucky among the 10 unhealthiest states, ranking its healthiness 43rd, the same slot it had in the last rankings, in 2019. 

Kentucky has found itself among the bottom 10 unhealthiest states since the rankings were first released in 1990, with the exception of 2008, when it ranked 39th. 

The rankings by the United Health Foundation are meant to help state leaders determine health benchmarks that can help them inform actions as they work to improve the health of their communities. 

The report examines a number of measures that influence health, broken into four categories: social and economic factors, physical environment, clinical care, behaviors, and health outcomes. 

Kentucky ranked lowest, 46th, among states in the behaviors category. 

Two measures in this category show that Kentucky adults don't get enough exercise, with only 15.3% of them saying they meet the federal guidelines for exercise in the past 30 days and 30.5% saying they didn't get any physical activity beyond their regular job in the past 30 days. For these measures, Kentucky ranked 49th and 45th, respectively. 

In the same category, Kentucky continues to have some of the highest teen birth rates in the nation at 23.8 teen births per 1,000 females aged 15 to 19; the national average is 15.4. In rankings that put the highest numbers at the bottom, Kentucky ranked 45th for this measure. 

Likewise, the state also continues to be a national leader in vaping and smoking, ranking 48th for adult use of electronic cigarettes and 45th for cigarettes (again, with higher numbers at the bottom). The rankings say 9.3% of Kentucky adults reported using e-cigarettes and 19.6% said they are regular smokers. 

Kentucky also ranked 48th in sufficient sleep, with 39.6% of adults reporting that they get, on average, fewer than seven hours of sleep in a 24-hour period. 

One of the Kentucky's better rankings in the behavior category was 11th for fruit and vegetable consumption.

In the health outcome category, Kentucky ranked 45th. With higher numbers at the bottom, it scored in the bottom 10 states for drug deaths (49th), frequent mental distress (45th), non-medical drug use (41st), premature death (46th), frequent physical distress (48th), multiple chronic conditions (48th) and obesity (48th). 

Though Kentucky ranked among the worst states in health outcomes, it does have a low prevalence of excessive drinking (fifth, with lower numbers at the top) and a low racial disparity in premature death (sixth). 

In social and economic factors, the state ranked 39th, with some of its worst scores in food insecurity (42nd), adverse childhood experiences (46th), access to high-speed internet (44th) and volunteerism (46th). 

The good news in this category is that Kentucky ranks fourth in the percentage of students who graduate from high school in four years and eighth in the difference between the high school graduation rates of white students and the racial/ethnic group with the lowest rate. 

In the clinical-care category, where it ranked 31st, Kentucky was in the bottom 10 states for dental visits (49th), flu vaccinations (42nd) and preventable hospitalizations (47th). 

Kentucky did not get any top-10 rankings in clinical care, but got top-20 rankings for its number of primary-care providers (16th), percent of uninsured population (13th), colorectal-cancer screenings (20th) and having a dedicated health care provider (13th). 

The physical environment category was the state's highest ranking, 15th, largely because it ranked first in two categories: drinking water violations and water fluoridation.

Critical access hospitals, which turned 25 in 2022, are vital to providing health care in rural areas; Kentucky has 28 of them

Update 1/3/2023: This story has been updated to correct the number of Critical Access Hospitals in Kentucky to 28. 

By Melissa Patrick
Kentucky Health News

Critical access hospitals celebrated their 25th anniversary in 2022. The designation was created to ensure the financial viability of the nation's small, rural hospitals. Kentucky has 25 28 of them, and at least one health official says they may be more important now than ever. 

"I could even make the argument, they're more important today than they were 25 years ago just simply because the stress and strain that's been put on the healthcare system in general gets tougher every year," said Hal Clark, vice-president of the Kentucky Hospital Association's solutions and member-services group. 

Barbourville ARH Hospital serves mainly Knox County.

Barbourville ARH Hospital CEO Charles Lovell also pointed to the value of CAHs, noting that during the pandemic they had to turn offices into patient rooms because there were so many patients and larger hospitals couldn't accepts transfers. More recently, he said, they have been near capacity because of respiratory illness.

"We are the lifeline for many of those patients," he said. "I just want people to realize that even though critical-access hospitals are smaller hospitals inside, we're not smaller in the care and the quality of care that we provide." 

The CAH designation came about after the closure of more than 400 hospitals during the 1980s and 1990s. The legislation that created the designation, spearheaded by Montana Sen. Max Baucus, was aimed at reducing the financial vulnerability of rural hospitals and improving quality, while also improving access to health care by protecting essential services for rural communities. 

Two key requirements for a CAH is that it have no more than 25 acute-care inpatient beds and be more than 35 miles from another hospital, with some exceptions. In return, CAHs are reimbursed at 101% of the costs reported to Medicare for inpatient, outpatient, laboratory and therapy services, as well as post-acute care in the hospital's swing beds, which are beds that allow for the care of acute patients as well as those who need skilled, longer-term care.

Lovell also spoke about how important expansion of the Medicaid program has been to the viability of rural hospitals. More than 400,000 Kentuckians gained health insurance coverage through Medicaid after the state expanded the program in 2014 to people who earn up to 138% of the federal poverty level, under the Patient Protection and Affordable Care Act.

"We, as hospitals, are fortunate that Kentucky adopted Medicaid expansion," Lovell said, calling it a "financial windfall" because it led to more of their patients having health insurance. He said 80% of the Barbourville hospital's revenue comes from Medicare and Medicaid. 

Clark, of the hospital association, called CAHs "an absolutely critical piece of the puzzle" when it comes to taking care of rural Kentuckians and said the state would be in a tough position without them. 

"If those hospitals were to close, in an under-served, very rural part of our state, then patients that needed to access health care are going to have to drive very long distances to receive care," he said. "That could mean the difference between life and death for some people. And so it's very important that those services remain viable and remain available to people in rural parts of our state." 

Further, he said, transportation remains a huge barrier to getting care for many Kentuckians in rural areas and CAHs provide much needed services close to home. 

These small hospitals are also important economic engines in their communities, Clark said. Hospitals are often one of the largest employers in rural communities, with some of the best-paying jobs. 

Rural hospitals continue to experience financial, operational and staffing challenges, and whether they have one patient or 25, they must remain fully operational, said Lovell. 

But Lovell said his hospital is not considering converting to the new "rural emergency hospital" program that allows hospitals with 50 or fewer inpatient beds to convert to outpatient-only service.

"As health care evolves, we may have to look at things differently," he said. "But we all want to be around 25 years from now." 

Clark said none of the qualifying rural hospitals in Kentucky are actively pursuing then new option, but  KHA has encouraged them to be aware of the program and to know it is an option going forward.

Emily Baumgaertner of The Washington Post wrote recently about the program, "The government’s reasoning is simple: Many rural hospitals can no longer afford to offer inpatient care. A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide outpatient services that the community needs. But the new opportunity is presenting many institutions with an excruciating choice."

Risk of Covid-19 increased last week in Ky.; booster vax rate low; exercise can thwart severe cases; long Covid can be deadly

By Melissa Patrick
Kentucky Health News

The federal Covid-19 risk map showed more Kentucky counties at medium and high risk of transmission than last week, and the number of counties at low risk dropped to just over half. 

"Covid-19 does appear to be increasing following the Thanksgiving holiday so it's important that if you haven't gotten your booster that you do that," Gov. Andy Beshear said Thursday at his weekly briefing, held before the latest risk-map was released. 

He said current data shows that fewer than 11 percent of Kentuckians who are eligible to get the updated Covid-19 booster shot have gotten it. 

Centers for Disease Control and Prevention map

The Centers for Disease Control and Prevention's latest risk map shows 17 Kentucky counties at high risk of transmission, a number that has been creeping up since early December when 10 counties were reported to have high risk. Such counties are shown in orange on the map. 

Counties with high risk of transmission last week include the same cluster of counties in Western Kentucky from the last two reports; the other high-risk counties were scattered: Butler, Simpson, Monroe, Harrison, Robertson, Rowan, Johnson and Pike. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality 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.

Medium-risk counties, shown in yellow, increased to 42, up 15 from the week prior, and the number of low-risk counties, shown in green, dropped to 61, down from 78 the week prior. 

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear 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.

Exercise can protection against Covid-19

Besides vaccinations, boosters, social distancing, keeping your hands washed and wearing masks in public places, a study has found another way to protect yourself from severe Covid-19: exercise. 

The study looked at how exercise affected coronavirus outcomes in nearly 200,000 adults in Southern California. It found that people who worked out at least 30 minutes most days were about four times more likely to survive Covid-19 than inactive people, Gretchen Reynolds reports for The Washington Post.

The study, published this month in the American Journal of Preventive Medicine, "found that exercise, in almost any amount, reduced people’s risks for a severe coronavirus infection. Even people who worked out for as little as 11 minutes a week — yes, a week — experienced lower risks of hospitalization or death from Covid than those who moved about less," Reynolds writes.

The data in the study was collected before widespread coronavirus vaccines were available, but Robert Sallis, a senior author of the study, told Reynolds that he thinks the results would be similar among vaccinated people: "It is such a simple, inexpensive way to protect yourself."

Free Covid-19 tests

It's also important to test for Covid-19 if you have symptoms, before and after traveling for the holidays and before visiting indoors with immunocompromised or vulnerable individuals. 

Toward that end, the Biden administration has restarted a program that allows every household in the country to receive four free Covid-19 test kits. These at-home tests can be ordered at CovidTests.gov. This is the third round of free kits the administration has made available. 

People who have difficulty accessing the internet or need additional support placing an order can call 1-800-232-0233 (TTY 1-888-720-7489) to get help in English, Spanish, and more than 150 other languages, 8 a.m. to midnight ET any day. More information is at https://www.covid.gov/tests/faq.

Dogs can detect Covid-19 at mass events

Another study published this month found that dogs trained to detect Covid-19 infection by smell correctly identified individuals with active infections at concerts with a specificity of nearly 100% and a sensitivity of 81.58%.  

The study used eight dogs of various breeds who were trained to detect positive Covid-19 samples. The dogs were presented with sweat samples from 2802 concertgoers at four events in Germany organized for the study. Each participant had been tested for Covid-19 with both a rapid antigen test and the more reliable PCR test, but the researchers, dog handlers and dogs did not know the results. Most of the human participants were vaccinated against Covid-19, but this did not affect the dogs’ ability to detect active infections.

"Our results demonstrate that scent-detection dogs achieved high diagnostic accuracy in a real-life scenario. The vaccination status, previous infection, chronic disease and medication of the participants did not influence the performance of the dogs in detecting the acute infection," the researchers write in BMJ Global Health. "This indicates that dogs provide a fast and reliable screening option for public events in which high-throughput screening is required."

Long Covid can be deadly

A study by the National Center for Health Statistics "found that more than 3,500 Americans died of long-covid-related illness in the first 2½ years of the pandemic," The Washington Post reports. "While those deaths represent a small fraction of the 1 million deaths from the coronavirus, they reinforce the danger of ignoring the lingering symptoms that many patients say their physicians have dismissed."

CDC data show that women are more likely than men to develop long Covid, but the study found that men accounted for a slightly higher percentage of long-Covid deaths, the Post reports: "Most of the documented long-covid deaths occurred in older people, with adults between 75 and 84 years old accounting for almost 30 percent of the deaths, closely followed by adults 85 and older."

Kentucky to get $53 million from Walmart settlement to fight opioid epidemic; money to be split between state and local governments

Walmart Inc. photo

Kentucky will get more than $53 million from Walmart as part of a $3.1 billion, 50-state settlement for the retailer's role in the opioid epidemic.

“The commonwealth is among the states hardest hit by this scourge,” Attorney General Daniel Cameron noted in a news release. In 2021, Kentucky lost 2,250 residents to overdose deaths, and 90 percent were related to opioids.

The release does not mention the 50-state settlement but its last paragraph says Cameron "worked closely" on it with attorneys general of 17 states. Walmart's release says it reached agreements with all 50 states, the District of Columbia, Puerto Rico and three other U.S. territories. 

"Walmart believes these settlements are in the best interest of all parties and will provide significant aid to communities across the country in the fight against the opioid crisis, with aid reaching state and local governments faster than any other nationwide opioid settlement to date, subject to satisfying all settlement requirements," the release says. "Walmart strongly disputes the allegations in these matters, and these settlements do not include any admission of liability." 

Cameron's release says the "agreement resolves allegations that the company contributed to the opioid epidemic by failing to implement appropriate policies, procedures, and controls relating to the dispensing of opioids at its stores." 

Under state law, half of the money will go to local governments and half will go to the state. It is scheduled for distribution in 2023. Added to the $478 million in opioid settlement funds that the state has already been allotted from a $26 billion global settlement with opioid manufacturers and distributors, the settlements provide more than $531 million to fight the opioid epidemic. 

The terms of the settlement are "substantially similar" to those in the $26 billion settlement reached with opioid distributors Cardinal Health Inc., McKesson Corp., AmerisourceBergen Drug Corp. and Johnson & Johnson, says the release. It requires "robust oversight to prevent fraudulent prescriptions and flag suspicious prescriptions," CNN reports.

After Russell County school employees were educated about adverse childhood experiences, suspensions dropped by half

Russell County (Wikipedia map)

Suspensions of elementary-school students in Russell County have dropped by half since 2019, when teachers, staff, counselors, and bus drivers began getting intensive training on the effects of childhood trauma on students' mental and physical health, reports Nadia Ramlagan of Public News Service.

"More kids report feeling safe, cared for, and feel they 'belong' at school," Ramlagan reports, citing the Foundation for a Healthy Kentucky, which provided a grant for the project.

The foundation's senior policy and advocacy officer, Amalia Mendoza, told Ramlagan that rural communities face challenges in reducing behavior problems from adverse childhood experiences.

"We're talking about toxic stress, we're not talking about just any adversity," Mendoza said. "There's really that kind of stress that is ongoing, and that can produce changes even in the brain and in the immune system."

According to the Child and Adolescent Health Measurement Initiative, nearly 40% of American children have had at least one adverse childhood experience (ACE): neglect or abuse, living with someone with a drug, alcohol or serious mental-health problem, the death of a parent, or exposure to violence or discrimination in the home or community.

Tracy Aaron, director of health education for the Lake Cumberland District Health Department, told Ramlagan that adverse childhood experiences have been linked to heart disease, stroke, diabetes, cancer and mental-health problems in the 10-county district. "If you look at the data that backs up ACEs," she said, "we have a very high rate of poverty, we have teen pregnancy. Substance use is an issue."

Russell County School Supt. Michael Ford told Ramlagan that schools can't fix family problems, but can remove barriers that affect academic performance and provide spaces where students see de-escalation, self-care and effective problem-solving techniques, and healthy relationships.

Ford said, "We want our kids to be resilient, right? Number one, we want to prevent anything that we can help prevent. Kids, regardless, are going to have ACEs, but ACEs do not have to hold them back."

He said successful strategies in the district include parent and grandparent training on how to build kids' resilience, increasing support for school counselors, and changing discipline policies.

Ky. Covid-19 cases up 22% last week; flu kills 31 more, including several kids; doctors worry about diseases and weakened seniors

Dr. Dan Goulson

By Melissa Patrick

Kentucky Health News

As Covid-19 cases in Kentucky rose 22 percent last week and influenza killed 31 more Kentuckians, including three more children, physicians encouraged Kentuckians to follow tried and true public-health measures and to get their annual flu vaccine and updated Covid-19 booster shots.

The doctors from Lexington's three largest hospitals urged people to protect themselves and others during the holidays, with a special warning to protect the elderly, who are being affected differently from Covid-19 these days.

"It's not too late," said Dr. Dan Goulson, chief medical officer for CHI St. Joseph Health. "You can see some benefit from the vaccine within a few days. And so, if people are questioning whether they want to get the vaccine, they should get it and not convince themselves that it's too late."

Dr. Mark Spanier

Dr. Mark Spanier, chief of emergency medicine at Baptist Health Lexington, said about Covid,  "We're seeing a lot more generalized weakness in the elderly . . . profound weakness leading to falls, leading to hip fractures, leading to just generalized stability, which can lead to other infections, pneumonia, urinary tract infections, and other more serious things for the elderly."

Spanier encouraged seniors who are getting progressively weaker to get tested for these diseases, even if they don't have respiratory symptoms. "If you get in that shape, make sure you seek medical care," he said.

Goulson said it's important to remember that flu, Covid-19 and respiratory syncytial virus (RSV), which is most dangerous to seniors and infants, are spread by droplets produced when we talk, cough, laugh and sing.

"That means that if you’re sick, the best thing to do to help keep other people from getting sick is to either mask or to isolate or both … and if you’re not sick and need to protect yourself, the best thing to do is to mask and to maintain social distancing,” Goulson said. 

Dr. Gena Cooper

Dr. Gena Cooper added frequent hand washing to that list, for both adults and children. "Those are all the things that still make the biggest difference, and are often the things you can individually control," said Cooper, emergency medical director at Kentucky Children’s Hospital at the University of Kentucky, 

Goulson acknowledged that vaccines don't keep everyone from getting sick, and that sometimes creates skepticism, but said it's still important to get the shots because they keep people from getting sick enough to require hospitalization. 

He pointed to two Centers for Disease Control and Prevention studies, released last week, that found the new bivalent Covid booster shots are more effective at reducing risk of hospitalization than boosters of the original version. The updated booster targets both the Omicron variants and the original virus strain to offer broader protections. 

One of the studies showed a  45% lower risk of hospitalization among people who had gotten the updated booster, compared with people who received two to four doses of the original vaccine and received their last shot 11 or months earlier. The other study showed a 73% reduction in hospitalization among people 65 and older who had gotten the latest, updated booster, compared to those who had gotten two to four doses of the original vaccine.

Studies have also found that the flu vaccine prevents severe illness for both adults and children, with a recent study showing that it reduces children's risk of severe life-threatening flu by 75%. 

Cooper, of the children's hospital, noted that while RSV rates are declining in Kentucky, the virus is still infecting Kentucky's children and most strongly affects those younger than 2. 

She said she calls  RSV "the mucus monster" because it creates so much mucus, which young children especially have trouble clearing from their respiratory system. She encouraged parents to use a bulb syringe after inserting a drop or two of nasal saline in each nasal cavity to help suction the mucus at home, especially before meals and at bedtime.  

She added that cases of flu and RSV had "almost flip-flopped" at the children's hospital, which is good news because there is a vaccine to protect children against the flu. 

The three physicians said their hospitals are almost full, but said that shouldn't deter a person from seeking medical care if they need it, recognizing that there may be increased wait times or the possibility of being cared for temporarily from the lobby or in a hallway. 

Spanier encouraged Kentuckians to seek care for minor illnesses, such as cold symptoms, at their doctor's office and to seek care in an emergency room "if you have any doubt that you might have something more serious going on." He noted that emergency rooms are generally less busy in the morning.

He also encouraged Kentuckians to us a pulse oximeter at home to assess their oxygen level and to help determine if they need emergent care: "If you're getting down to 90 [percent] or below, you definitely need to be seen in an emergency department."  

Flu deaths spike; six children die recently

        

The state's latest flu report shows that flu activity in Kentucky remains high, but decreased 13% from the prior week's report.

State Department for Public Health graph

In the week ended Dec. 10, the state reported 6,240 confirmed cases of the flu, down from 7,192 the prior week. The total number of confirmed cases this flu season is 29,341. Most cases continue to be in people 20 and younger. 

The report said the flu has killed at least 57 Kentuckians this season, three of them children. Of those deaths, 28 were reported in week ended Dec. 10 (27 adults and one child).

Since that report was compiled, the state has "reported six new, flu-related pediatric deaths, including three in the past week," said a press release from Gov. Andy Beshear late Monday afternoon. "This toll already meets the prior record for the highest number of pediatric influenza deaths ever reported in Kentucky in a single flu season. The prior record was established during the 2019-2020 flu season, when six children died of influenza."

As of Dec. 20, the state reports that six children total have died from the flu during the current 2022-2023 flu season. 

The state Department for Public Health said none of the children who have died this season had received a flu shot. “We are urging our families to get vaccinated as soon as possible to get protected from contracting the flu and Covid,” Beshear said.

Health Commissioner Steven Stack said, “This current flu season is on track to be the worst in Kentucky in at least 10 years. The flu vaccine is the single best way to protect you and your loved ones against the flu and reduces the risk of becoming dangerously ill or spreading disease. Unfortunately, fewer than 40% of Kentucky children have received their flu shot this season. It is imperative that every Kentuckian take the essential steps to protect themselves, their loved ones and their communities.”

Several Kentucky counties saw 100 or more confirmed cases in the week ending Dec. 10, including Barren, 169; Boone, 413; Boyd, 109; Campbell, 220; Daviess, 171; Fayette, 276; Floyd, 184; Grant, 162, Jefferson, 1,170; Kenton, 573; Muhlenberg, 100; Perry, 116; Pike, 318; Warren, 122; and Whitley, 111. 

Covid cases up 22%, but hospital numbers stable 

In the week ended Dec. 19, the state Department for Public Health reported 6,376 new coronavirus cases, an average of nearly 911 per day. That's 22% more than the week before, when the state was averaging 745 per day. Of last week's cases, 13% were in people 18 and younger. 

The state attributed 45 more deaths from Covid-19, bringing the state's pandemic death toll to 17,625. 

The share of Kentuckians testing positive for the virus in the last seven days was 9.85%, up more than a percentage point from the prior week's rate of 8.63%. The figures do not include at-home tests. 

Covid-19 hospitalizations have been stable for two weeks in a row. Hospitals reported 370 patients with Covid-19 Monday morning, a decrease of 18 over the prior Monday; 42 were in intensive care, down three; and 20 were in need of mechanical ventilation, up one. 

The weekly new-case incidence rate was 16.08 cases per 100,000 residents, up from 15.82 the week before. The top 10 counties are Calloway, 37.7 per 100,000; Crittenden, 37.3; Caldwell, 37; Monroe, 30.9; Leslie, 30.4; Carlisle, 30; Lyon, 29.6; Simpson, 29.2; Spencer, 27.3; and Powell, 26.6.

The New York Times ranks Kentucky's incidence rate 31st among the states, with a 21% increase in cases in the last two weeks.

Big, real-world study confirms Covid-19 shots provide much more protection than natural immunity, especially against death

Vaccines give significantly more protection than natural immunity against Covid-19, especially against death, according to one of the first large, real-world studies comparing the two forms of immunity.

The study found that to be true of all age groups in protecting against death, hospitalizations and emergency department visits. "The lower death rate of vaccinated individuals was especially impressive for adults ages 60 years or older," said a press release from the Regenstrief Institute at the Indiana University School of Medicine and the Vanderbilt University Medical Center, which did the study.

“The data raises questions about the wisdom of reliance on natural immunity when safe and effective vaccines are available,” the release said.

Vaccinated people had a higher rate of Covid infection than individuals previously infected (6.7% to 2.9%), but the vaccines “protected against severe disease while natural immunity did not confer the same benefit,” said Dr. Shaun Grannis, the study's corresponding author and vice president for data and analysis at the Regenstrief Institute. 

The release said, "The all-cause death and hospital-admission rates for vaccinated individuals were 37 percent lower than the rates for those with natural immunity acquired from previous Covid infection. The rate of ED visits for all causes was 24 percent lower for vaccinated individuals than for the previously infected."

Gannis said, “This large population study of the entire state of Indiana should encourage individuals everywhere to get themselves and their children vaccinated and not rely on natural immunity. As vaccinated individuals were more likely to actually get Covid than those with natural immunity, the lower death rate of vaccine recipients who develop Covid appears to be due to vaccination and not to a tendency for risk-averse behaviors, such as mask-wearing, hand sanitizing and social distancing.”

The study analyzed data on pairs of vaccine recipients and people with prior infections, matched by age, sex, dates of initial exposure to the vaccines or the virus itself, and Covid risk scores as defined by the U.S. Centers for Disease Control and Prevention. The data came from the Indiana Network for Patient Care, one of the nation’s largest health information exchanges, as well as death reports from the State of Indiana, the release said.

The study is important because previous studies didn't look at emergency-department visits, hospitalizations and mortality for non-Covid reasons, said its first author, Regenstrief Institute Research Scientist Wanzhu Tu, Ph.D. “Our work confirms that mRNA vaccines have kept people out of the ED and the hospital as well as lowered the likelihood of death from any cause. And we saw this pattern in every age group.”

The study, SARS-CoV-2 infection, hospitalization and death in vaccinated and infected individuals in Indiana USA, November 2020 - February 2022, is published in the American Journal of Public Health. 

How to manage your mental health in the holiday season

By Dr. Gopalkumar Rakesh

Assistant professor of psychiatry, University of Kentucky

For many, the holiday season is not always the most wonderful time of year. With work and school deadlines quickly approaching, holiday shopping expenses piling up, and back-to-back large social gatherings, this time of year can eventually take a toll on one’s mental wellness.

According to the National Alliance on Mental Illness, a study showed that 64% of people with mental illness report holidays make their conditions worse. In a separate study conducted by the American Psychological Association, 38% of people surveyed said their stress increased during the holiday season.

Photo by Tommaso79, Getty Images / iStock Plus

Increased stress can cause symptoms of physical illness, depression, loneliness and more. If you or a loved one are experiencing increased stress this year’s holiday season, here are some tips to help make your season a bit jollier.

Manage your time: Remember that your priorities still matter, and procrastination is not your friend. Putting off important projects can cause unwanted stress. Be sure to prepare ahead of time if you have important deadlines approaching to ensure that you do your best. Try making a schedule of when you will work on your projects and do your holiday prep to make sure your schedule is balanced, productive and not rushed.

Set boundaries: Communicate your limits as early as possible to friends and family so that everyone is on the same page. It is okay to say no to social obligations that may be too stressful. Choosing to set boundaries surrounding stressful conversations on topics that may be contentious in a family setting may also be advised.

Take care of yourself: The holiday season is not only about spoiling those you love but making yourself a priority as well. Fight seasonal depression by staying on top of your sleep and exercise schedule. If you can, work near a window throughout the day to get as much sunlight as possible. Even adding bright holiday lighting throughout your work or engaging with mindfulness apps on your smartphone can help boost your mood.

Seek support: Check in with a local support group or friends who understand what you may be going through. Surrounding yourself with people who feel similar can help combat feelings of loneliness.

If you or someone you know needs additional support, reach out to your therapist if you have one, talk to a mental-health professional or contact your primary-care physician.

Additionally, if you or a loved one are experiencing a suicidal crisis or mental distress, call or text 988 to reach the Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline) to access free and confidential support 24/7.