Quarles says that if elected governor, he would work with the General Assembly to legalize medical marijuana in Kentucky

Quarles spoke on the Capitol steps. (KL photo by McKenna Horsley)

By McKenna Horsley
Kentucky Lantern

Agriculture Commissioner Ryan Quarles told reporters Tuesday he would work with the General Assembly to legalize medical marijuana if he is elected governor.

“It needs to be dialogue between a doctor and their patient, and keep big government out of it,” Quarles said, adding that patients in end-of-life care could benefit from medical marijuana, and some are already self-medicating.

Quarles touted his experience running Kentucky’s hemp-licensing program in his seven-plus years leading the state Department of Agriculture. He criticized Democratic Gov. Andy Beshear’s executive order on medical marijuana, saying it “muddied the water on this issue” and failed to involve Kentucky agriculture.

 
He said provisions should be made to benefit production from Kentucky farmers, including those who already grow hemp, and medical marijuana should, like other medications, be exempt from sales tax.

Beshear has said that 90% of adult Kentuckians support legalizing medical cannabis. His executive order, which took effect Jan. 1, set criteria for Kentuckians with certain medical conditions to access medical cannabis in small amounts through legal out-of-state purchases.

Quarles said that because the General Assembly was bypassed in implementing the order, doctors and patients are confused.

“As a former legislator, I feel like I have the ability to work with the General Assembly and not sue them constantly like the current governor is doing,” he said. The legislature is controlled by fellow Republicans.

When asked how he plans to get legislation like this through the Senate — where bills to legalize medical marijuana have failed in recent years — Quarles said he’s worked to get other pieces of legislation passed and will approach it with the attitude of “consensus-driven” policy-making.

“I believe that over the course of the next year, we can find common ground that gets something that works for Kentucky and again is focused on that doctor-patient relationship,” Quarles said.

Bills to legalize medical marijuana have been filed in the current legislative session, such as Senate Bill 47 from Sen. Stephen West, R-Paris.

Asked about recreational marijuana, Quarles said Tuesday’s press conference would focus only on medical use. He said products with Delta-8 tetrahydrocannabinol — a psychoactive ingredient similar to delta-9 THC, the active ingredient specified by federal law — should be regulated. 

Quarles said none of the other candidates are “better positioned in this race to have a conversation about what the framework would be like to help pass a responsible medical marijuana bill through the General Assembly,” but in response to a question about how this issue sets him apart from the field, he said that he’s not focused on other campaigns, only his.

“Look, there’s 12 of us in this crowded primary,” he said. “All of them are my friends. They’re going to be my friends after May 16.”

The field includes Attorney General Daniel Cameron and former United Nations Ambassador Kelly Craft. Their campaigns have not responded to email questions from Kentucky Lantern about their positions on medical and recreational marijuana.

Somerset Mayor Alan Keck, another Republican running for governor, told the Bowling Green Daily News in January that medical marijuana is “a ‘common-sense solution’ for things like pain management, insomnia in veterans and children who suffer from seizures.”

Coronavirus cases in Kentucky have dropped for four weeks in a row, and Covid-19 hospital numbers in state remain low

Adapted screenshot of interactive New York Times map; for interactive version, click here.

By Melissa Patrick
Kentucky Health News

New coronavirus cases in Kentucky last week were 9 percent lower than the week before. It is the fourth week in a row that the state has seen declining cases. 

The state Department for Public Health's latest weekly report says there were 3,289 new cases of the virus last week, or nearly 470 cases per day. Of those, 17% were people 18 and younger. 

The share of Kentuckians testing positive for the virus in the past seven days was 8.78%, down from 10.14% the week before. These numbers do not reflect at-home testing. 

The weekly new-case rate was 9.23 cases per 100,000 residents, down from 11.16 in the prior weekly report. The top 10 counties were Garrard, 25.1; Clinton, 23.8; Simpson, 19.2; Powell, 18.5; Trigg, 17.6; Russell, 17.5; Lewis, 17.2; Morgan, 17.2; Greenup, 16.7;  and Hickman, 16.3.

The New York Times ranks Kentucky's seven-day case rate 14th among states, with a 33% drop in cases in the last two weeks.

Kentucky's  hospital numbers related to Covid-19 continue to be low. The state's hospitals reported 300 patients with Covid-19 on Monday, 59 fewer than the prior week; 46 Covid-19 patients were in intensive care, up two; and 15 were on mechanical ventilation, the same as the week before. 

The state attributed 39 more deaths to Covid-19 last week, down from 56 the week before. The state's pandemic death toll is now 18,094.

Opinion: Covid-19 vaccine effectiveness declines rapidly; seniors need to keep up their immunity, and we need a better vaccine

Covid-Net graph, adapted; gray area may have some delayed reporting and does not indicate trends.

Kevin Kavanagh, M.D.

By Kevin Kavanagh for Infection Control Today

I am at high risk for severe Covid-19, being 65 years or older, with additional health problems. I received my bivalent booster as soon as possible and am approaching my 6-month anniversary. I, thus, watched the CDC’s last Advisory Committee on Immunization Practices meeting with great interest regarding their recommendations for when to obtain my next booster.

Reuters reported that the committee concluded, “There is not sufficient evidence to recommend more than 1 Covid-19 booster shot a year for older people and those with weakened immune systems,” but the committee did voice some flexibility. It needs to be stressed that there was an absence or lack of data—rather than a presence of data—indicating the durability of vaccine immunity, justifying annual boosters.

There was no vote regarding the timing of booster doses, but there was nowhere near a unanimous consensus. Michael Hogue of the American Pharmacists Association said, “We want those clinicians to be able to make good decisions for the individual patient based upon their comfort and desire as long as we have safety in mind, and it is clear that we do have a very safe vaccine with our bivalent vaccine. So, I feel that flexibility needs to be put into this some way, with both older adults and people with immunocompromising conditions.”

I did not hear calls for approving a more frequent administration schedule. One committee member said those over 65 should be allowed to discuss off-label use with their physician in order to receive the booster sooner. Almost all the discussion centered on messenger-RNA vaccines, with little mention of Novavax or the urgent need for newer, more durable vaccines.

Vaccine effectiveness is an important point. Although much of the younger population received a get-out-of-hospital free card for the latest variant, senior citizens were in its crosshairs. Since May 2022, those over 75 had a higher rate of hospitalization than in the Delta surge; those 65 to 75 had about the same. Both age groups continue to be at high risk for death and disability.

However, when I saw data on effectiveness of the monovalent vaccines, the two-dose-or-more immunization that preceded the bivalent vaccine, I felt foreboding. The data showed that for those 65 years and older, the effectiveness of two or more monovalent doses at preventing hospitalizations fell to 28% in less than a year.

Among younger people, the monovalent vaccines were only 19% effective. This finding may seem paradoxical, but could be explained by the elderly leading a safer lifestyle and the possibility that immunity produced by previous infections may not have been as durable. Neither explanation bodes well for vaccine effectiveness lasting a year.

For the bivalent booster, effectiveness against hospitalization fell rapidly, from 52% at a median of 32 days to 31% at a median of 74 days (67-85 days) after the last dose. It should be noted that this effectiveness is on top of some residual immunity from the monovalent vaccine, since the monovalent vaccine was used as the reference.

Let’s face it. The results are dismal, with little durability from an immunity boost from a bivalent booster after an individual has had a monovalent vaccine. The benefit from the bivalent booster rapidly diminishes, and its efficacy in preventing hospitalizations two months after receiving the booster is poor and would be expected to be poorer in the elderly.

Is the bivalent booster worth taking? Yes, definitely. However, this differs from the booster or vaccine we need to navigate this pandemic. We need another warp-speed initiative for vaccine development—a vaccine that is more durable and can reduce spread. The risk of continuing to use a vaccine with reduced effectiveness is shown when the vaccine was seemingly less effective in the young. When vaccinated, many view themselves as invincible and can increase risky behavior far beyond the vaccine's benefits.

It is critical for the elderly to keep their immunity as high as possible. Monoclonal antibodies are no longer effective with the new variants, and far too many cannot receive Paxlovid because of drug interactions. Molnupiravir is often not prescribed since it works by creating viral mutations and has been implicated in speeding variant evolution.

At the conclusion of the CDC committee meeting, my primary impression was that we senior citizens might be viewed as expendable. Far too few policymakers are concerned about our well-being and willing to make the hard decisions that must be made to assure our safety during this pandemic. After looking at the data, I will consult my physician about receiving a booster on an accelerated schedule, possibly at six months.

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA. This is an edited version of his original article, which was first published in Infection Control Today.

Bill to let advance-practice registered nurses prescribe controlled substances on their own passes Senate, until now its roadblock

By Melissa Patrick
Kentucky Health News

After years of debate and months of negotiations, a bill to create a path for Kentucky's advanced-practice registered nurses to prescribe controlled substances independently has passed the state Senate and gone to the House on a 30-2-1 vote. 

Senate Bill 94 was the result of a compromise brokered by Sen. Julie Raque Adams, R-Louisville, between the Kentucky Medical Association, which has strongly lobbied against the legidslation for years, and the Kentucky Association of Nurse Practitioners and Nurse Midwives.

Sen. Julie Raque Adams

"I'm sure that you will applaud both of these groups, as I do, for coming together for serious negotiations and for reaching a compromise agreement that will increase access to quality health care across Kentucky and will hopefully lead to other joint efforts between these two critically important health care professions in our state," Adams said in presenting the bill.

KMA said in a statement: "Scope-of-practice issues are always of significant concern to the Kentucky Medical Association, especially when controlled substances are involved. . . . The final product preserves the physician-led, team-based care model, while also maintaining and strengthening the CAPA-CS," which stands for Collaborative Agreement for Prescriptive Authority for Controlled Substances. "This will ensure meaningful collaboration between APRNs and collaborating physicians as well as safeguard public health." 

Kentucky APRNs have been able to prescribe controlled substances since 2006 under a CAPA-CS with a physician. They are allowed to prescribe a 72-hour supply of a Schedule II drug, the highest class of controlled substance that can be prescribed, and SB 94 would not change that.

Under the bill, an APRN who wants to prescribe controlled substances independently must work under a CAPA-CS for four years, undergo a license review by the Kentucky Board of Nursing, maintain a U.S. Drug Enforcement Administration registration and a master account in the Kentucky All-Schedule Prescription Electronic Reporting system.  

Adams said the bill creates "significant improvement in the structure and communication" between APRNs and their collaborating physician by creating a committee made up of APRNs and physicians who will meet at least twoce a year to review an APRN's controlled-substance prescriptions.  

The bill would establish the Controlled Substances Prescribing Council in the Office of the Inspector General at the Cabinet for Health and Family Services, which will meet at least quarterly to discuss the safe and appropriate prescribing and dispensing of controlled substances.

American Assn. of Nurse Practitioners map, adapted by Ky. Health News

“This legislation has been seven years in the making and I am particularly pleased because it included the stakeholders from the beginning,” Adams said in a news release. “We rarely get everything we want in Frankfort, but with SB 94, I believe everyone who came to the table got most of what they wanted.”

In the last legislative session, the House overwhelmingly passed a bill to increase APRN prescriptive authority after a four-year collaborative agreement, but it got nowhere in the Senate.

Republican Floor Leader Damon Thayer of Georgetown said he had opposed the idea for his entire 20 years in the Senate, but supports it now because of the compromise between the KMA and APRNs.  "I hope it works," he said. "I know it's something we're going to be watching very closely."

Senate President Robert Stivers, R-Manchester, said he voted for the bill to increase health-care accres for Kentuckians, but he called for more oversight of the providers who continue to prescribe too many opioids.

The two "no" votes came from Republican Sens. Phillip Wheeler of Pikeville and Donald Douglas of Nicholasville, a physician. Sen. Adrienne Southworth, R-Lawrenceburg, passed. 

Wheeler said he voted no because he was concerned about the potential to increase the prescribing of opioids: "What we do not need to do is to provide another mechanism to provide greater access to pain medications and opioids in rural areas. I mean, if I could restrict the prescribing abilities of doctors more on narcotics and opioids, I would do it here today."

Douglas, a physician, said he was "concerned about the bill" because an APRN's training is not as rigorous as a physician's. He also voiced concerns about what he called "clinical creep." 

Nurse practitioners have up to seven years of education, including post-graduate training. They may prescribe medications, diagnose conditions, order and interpret tests, and deliver general care.

"My only concerns are for those who we deliver the health care to," Douglas said. "My only concern is that they are getting optimal health care, not just good health care or not just health care that's available, but optimal health care."

Free-standing birth centers would no longer be subject to 'competitor's veto' under bills awaiting votes in Senate and House

Sen. Shelley Funke Frommeyer

By Melissa Patrick

Kentucky Health News

Bills to exempt free-standing birth centers from Kentucky's certificate-of-need law have cleared committees in the House and Senare and are poised for floor votes, despite opposition from the chair of the House health committee and two legislators in the sponsor's home region of Northern Kentucky.

"It's still important to have hospitals that have great options for giving birth, but consumers are asking for more," Sen. Shelley Funke Frommeyer, R-Alexandria, told the Senate Licensing and Occupations Committee Feb. 21. "Consumers are asking for free-standing birthing centers. . . .  Kentucky is one of only eight states that does not offer free-standing birthing centers." 

Funke Frommeyer, a freshman senator, is the sponsor of Senate Bill 67 and veteran Rep. Jason Nemes, R-Louisville, is the sponsor of House Bill 129, the latest version of legislation he has sponsored in previous sessions. 

Mary Kathryn DeLodder, director of the Kentucky Birth Coalition, told the Senate committee that Kentucky hasn't had a freestanding birthing center since the late 1980s, although it has administrative regulations for licensing them and qualifying them for Medicaid reimbursement. 

But the state's certificate of need law requires a propsoed center to prove that there is an unmet need for its services before it can open, a process that allows providers and hospitals to challenge the would-be competitor's application. DeLodder said the CON law is sometimes called "the competitor's veto," adding, "It is not about safety, but it's about market share." 

Frontier Nursing University said in a letter of support for the bills that it did a feasibility study in 2018 of establishing a free-standing birth center on its campus in Versailles and found the CON law was "the major barrier. . . . The CON process has been lengthy and effective at the goal which appears to be to allow hospitals to block the development of FSBCs regardless of the benefits to the women of Kentucky." 

Christy Peterson, an advanced practice registered nurse and certified nurse midwife, explained to the Senate committee what a freestanding birthing center is: "A freestanding birth center is a health-care facility. It offers a home-like setting where families can receive maternity care and give birth with appropriate levels of intervention. These facilities are not hospitals and they do not perform C-sections or anesthesia. They provide evidence-based care using the midwifery model of care and use informed consent and shared decision-making. One of the key components of the birth center is continuous risk screening. . . . Not everyone is a candidate for birthing at a freestanding birth center. There are mothers who should be in the hospital setting, and so birth centers don't just take on anybody." 

She also pointed to studies that show that care in freestanding birth centers is "safe, cost-effective and leads to excellent outcomes." 

Meredith Strayhorn, a Campbell County resident and senior certified professional midwife student, told the committee that in 2022, 34% of Kentucky births resulted in Caesarean sections, ranking the state in the top 10 for the procedure. She said C-section births have "been associated with maternal mortality and severe maternal morbidities." 

She added, "Research shows that when low-risk women give birth within the midwifery model of care, there are lower rates of Caesarean. That's also decreasing the rates of repeat cesareans and the various complications that follow. This will also save thousands and thousands of dollars for the state."

Sen. Donald Douglas, R-Nicholasville, a physician, voted against the bill, saying, “I don’t see it as a competition issue; I see this as a patient-care issue." Douglas said he was not convinced that birth centers would result in the best care and improved health outcomes. 

The committee approved the bill by a vote of 9-2, with Sen. Chris McDaniel, R-Ryland Heights (Kenton County), casting the other "no" vote. Sen. Damon Thayer, R-Georgetown, said he voted "yes" to get it out of committee, but said Douglas's concerns should be noted. 

Rep. Jason Nemes

The next day, there were no dissenting votes as the House Licensing, Occupations & Administrative Regulations Committee approved Nemes's bill. Nemes told the committee that each year he has been presented the legislation it has been improved. 

"The touchstone for me has been safety," Nemes said. "We want to make sure that this is a safe environment for women to have their babies."

He said in Kentucky mothers can have babies in a hospital or at home, and he thinks many who are choosing home births would choose a birthing center if it were available, "which I believe are safer for those individuals." He noted that the American College of Obstetricians and Gynecologists supports free standing birth centers. 

The maternity mortality rate in Kentucky is "alarmingly high," especially among women of color, said Kazia Bryant, executive director of Mama to Mama, a Louisville nonprofit support group for mothers.

"The more and more that Black women and women of color learn about the climate and rate of maternal deaths that plague our community, the more and more we are searching for alternatives to birth our babies," she told the committee.

While no House committee member voted against the bill, Rep. Kim Moser, R-Taylor Mill, passed, along with Rep. Mike Clines, R-Alexandria.

Moser is chair of the House Health Services Committee. She agreed that Nemes had improved the legislation, but she noted her work as a neonatal intensive-care nurse and said, "I am concerned about safety." She asked if there was a geographic requirement for transfer agreements to hospitals, and was told that there is not one that is related to distance between the facilities. 

Nemes said he considers birth centers safe and secure because their licensing requirements are strict, women are making a choice to have their babies there, and the centers constantly screen their patients to make sure they have low-risk pregnancies.

Both bills would also require the state Cabinet for Health and Human Services to update and modernize its regulations, including requiring accreditation by the Commission for the Accreditation of Birth Centers, compliance with the American Association of Birth Centers standards, and consistent plans for transfer and safe transport to a hospital as needed.

If passed, the legislation would be called the Mary Carol Akers Birth Centers Act, after a certified nurse midwife who wanted to open a birthing center in Elizabethtown and was thwarted by the cabinet and the state Court of Appeals. She exhausted her resources and left the state, Birth Monopoly reports.

With 'low confidence,' Energy Dept. says Covid-19 likely from lab; FBI confidence 'moderate;' intel panel, 4 other agencies disagree

The Wuhan Institute of Virology is located in the city where
the pandemic began. (Photo by Hector Retamal, AFP/Getty)

The Department of Energy has concluded that the Covid-19 pandemic "most likely arose from a laboratory leak, according to a classified intelligence report recently provided to the White House and key members of Congress," The Wall Street Journal's Michael Gordon and Warren Strobel report.

The department "made its judgment with 'low confidence,' according to people who have read the classified report," the Journal reports. The agency thus joins the FBI "in saying the virus likely spread via a mishap at a Chinese laboratory," the Journal notes. "The FBI previously came to the conclusion that the pandemic was likely the result of a lab leak in 2021 with 'moderate confidence' and still holds to this view. . . . While the Energy Department and the FBI each say an unintended lab leak is most likely, they arrived at those conclusions for different reasons."

Four other agencies and a national intelligence panel still judge with "low confidence" that the pandemic "was likely the result of a natural transmission, and two are undecided," the Journal reports. "The Energy Department’s conclusion is the result of new intelligence and is significant because the agency has considerable scientific expertise and oversees a network of U.S. national laboratories, some of which conduct advanced biological research."

The Journal adds, "The National Intelligence Council, which conducts long-term strategic analysis, and four agencies, which officials declined to identify, still assess with 'low confidence' that the virus came about through natural transmission from an infected animal, according to the updated report. The Central Intelligence Agency and another agency that officials wouldn’t name remain undecided . . . Despite the agencies’ differing analyses, the update reaffirmed an existing consensus between them that Covid-19 wasn’t the result of a Chinese biological-weapons program, the people who have read the classified report said."

Because no animal source for the novel coronavirus has been confirmed, and Wuhan, where the outbreak began, "is the center of China’s extensive coronavirus research, has led some scientists and U.S. officials to argue that a lab leak is the best explanation for the pandemic’s beginning," the Journal reports. "State Department cables written in 2018 and internal Chinese documents show that there were persistent concerns about China’s biosafety procedures, which have been cited by proponents of the lab-leak hypothesis."

School officials sound the alarm about students getting sick from vaping and the threat of illegal or deadly substances in devices

Kentucky Health News map; Whitley and Knox counties reflect Corbin Independent Schools.

Harlan County school officials have "asked businesses to guard against selling vape pens to minors after students in a nearby county got sick from using vape pens that may have contained an illegal drug," and school officials in other counties have issued similar warnings, report Bill Estep and Valarie Honeycutt Spears of the Lexington Herald-Leader.

The officials' letter urged businesses "to move vaping products behind the counter and to try to make sure employees don’t sell to minors. The letter said that while most businesses that sell vape products follow the law, school officials had heard from an 'alarming number of underage students' that they had bought such products locally, illegally."

“Please help us avoid a tragedy,” said the letter, which came after incidents in nearby Knox County, "in which students suffered concerning symptoms after using vape pens" Feb. 10-16, the Herald-Leader reports. "The symptoms included shortness of breath, increased heart rate and confusion . . . Four students went to the hospital for treatment and four were treated by a school nurse," according to the Appalachian High Intensity Drug Trafficking Area, a federally funded law-enforcement unit.

A Knox County school spokesman "said the district had only four incidents, not eight," the newspaper reports. "After three students at Lynn Camp Middle/High School had adverse symptoms on Feb. 15, Knox County Sheriff Mike Smith said in a news release that the vape pens they used were believed to have contained THC, the ingredient in marijuana. AHIDTA said in its bulletin two vape pens involved in the incidents may have been laced with fentanyl."

If tests at the Kentucky State Police lab "confirm any of the vape pens in Knox County were laced with fentanyl, it would be the first time that has been documented in Kentucky, and would be among only a few cases nationwide, according to the AHIDTA bulletin." Knox County school officials told parents in letters that vaping can be risky for youth because they may not know whether electronic cigarettes contain illegal or deadly substances.

"In Harlan County, school officials told businesses that the use of vaping products by young people is a growing problem," the Herald-Leader reports. School Police Matt Chief Cope said students in the district have become sick from vaping, and he and Safe Schools Director Jim Whitaker visited all 20 businesses in the county that sell vape pens to deliver their request in person.

In November, the board of the Corbin Independent School District, which includes parts of Knox and Whitley counties, published an open letter saying that some students had become ill after using vaping products. "The letter said that during a talk by an expert in the subject, more than half the middle school students in the audience raised their hands when asked if they knew someone their age who vaped regularly and couldn’t stop," the Herald-Leader reports, citing the News Journal, a Corbin newspaper.

The problem isn't just in southeastern Kentucky schools, the Herald-Leader notes: "After Kentucky State Police used dogs to do a surprise search for illegal substances at Edmonson County High School last month, the principal, Jonathan Williams, said local officials were finding that illegal substances were being sold in vaping products. . . . Earlier this month, the sheriff in Lyon County said a 14-year-old girl was facing charges after she was found with a vape device that contained THC, the chemical in marijuana. The case arose after school officials told police about getting a report that students were vaping on a bus, according to WPKY."

Surveys by the state Department of Education show that the share of middle-school students reporting frequent vaping, defined as 20 days out of the last 30 days, rose from 1.4% in 2015 to 2.9% in 2021, "and the number who said they had ever vaped rose from 21.8% to 24.1% in the same period," the Herald-Leader reports. "Among high-school students, the number reporting frequent use rose from 3.2% in 2015 to 8.1% in 2021, and the percentage who said they’d ever used a vaping product increased from 41.7% to 45.1%."

Unvaccinated attendee of big revival has state's third case of measles in 3 months; Ky. ranks very low in measles vaccinations

An unvaccinated Jessamine County resident who attended the large, spontaneous revival at Asbury University has Kentucky's third reported case of measles in three months, the state Department for Public Health said Friday.

“Anyone who attended the revival on Feb. 18 may have been exposed to measles,” Dr. Steven Stack, the state health commissioner, said in a news release. “Attendees who are unvaccinated are encouraged to quarantine for 21 days and to seek immunization with the measles vaccine, which is safe and effective.” Citing privacy, the state said nothing more about the infected person.

Stack added, “If you may have been exposed at Asbury University’s campus and develop any symptoms, whether previously vaccinated or unvaccinated, please isolate yourself from others and call your medical provider, urgent care, or emergency department to seek testing. Please do not arrive at a health-care facility without advance notice, so that others will not be exposed.”

  
Measles is one of the most contagious diseases, and spreads through the air. Early symptoms resemble those of many upper-respiratory illnesses – fever, cough, red eyes and runny nose – "and proceed to the characteristic rash three to five days after symptoms begin," the release said.

The state says it investigates all reported cases. It said the first case in the last three months was in Christian County, and it was linked to an outbreak in Ohio. The second was reported in January in Powell County, and there were no known exposures or connections to the outbreak in Ohio," the release said. "These two previous cases were thoroughly investigated and neither presented a public-health threat."

The vaccine for measles vaccine is given in combination with those for mumps and rubella ("German measles to children at 12 to 15 months of age. A second dose is usually given at 4 to 6 years old, and is required for admission to school. Two doses of the MMR vaccine are about 97% effective at preventing measles if exposed to the virus, the state says.

The state health department is working with local departments to promote MMR vaccination in communities with low vaccine rates, the release said. Recent data released by the Centers for Disease Control and Prevention shows MMR vaccine coverage among Kentucky kindergarteners is one of the nation's lowest.

The CDC reports that the rate could be as low as 86.5 percent, which could rank it sixth lowest among the states. The national average is about 93%. Kentucky's percentage is expressed as "greater than or equal to" because the state counts some or all vaccine doses that are given outside federally recommended age and time intervals, and it does not include vaccinations at certain types of facilities, which could include kindergartens in child-care facilities, online schools, correctional facilities, or military installations.

The CDC report has a graph estimating the gap between MMR vaccination rates and the potential rates in each state, based on the percentage of unvaccinated students without a documented vaccine exemption; Kentucky's gap appears to be larger than any state but Alaska (right-click to download image):

Covid-19 risk remains low in most counties; only four estimated to have high risk; Kentucky's 7-day infection rate is 16th in the nation

Centers for Disease Control and Prevention maps

By Melissa Patrick
Kentucky Health News

Most of Kentucky's 120 counties continue to have a low risk of coronavirus transmission and only four of them are at high risk, according to the Centers for Disease Control and Prevention's weekly risk map. 

The CDC's map is based on the number of new coronavirus cases and Covid-19 patients in Kentucky hospitals. It shows 82 Kentucky counties are at low risk, shown in green, and 34 at medium risk, shown in yellow. The four high-risk counties, shown in orange, are Morgan, Elliott, Rowan and Menifee. Elliott County was also at high risk last week, along with Greenup County.

Even as the risk of coronavirus transmission decreases, the CDC continues to offer the same recommendations for medium and high-risk counties.

In high-risk counties, the CDC recommends 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.

The CDC also provides a community transmission level map, largely used by researchers and health-care facilities, that shows the level of virus in each county, at one of four levels. The map shows 26 counties with moderate levels of transmission and the rest with either substantial or high levels, showing that the virus continues to be widespread in those counties. 

As of  Feb. 24, Kentucky's infection rate for the previous seven days ranked 16th in the nation, with a 33% drop in cases in the last two weeks, according to The New York Times. 

Humana says it will drop commercial employer-sponsored health insurance and hopes to grow through government programs

Humana's headquarters on Main Street in Louisville

Kentucky Health News

Louisivlle-based Humana Inc., which originated as a nursing-home company 60 years ago, then became a hospital company and then a health-insurance company, is planning to transform itself again – into a compaany that offers general health insurance only through government plans: Medicare Advantage, Medicaid and the military plan.

Humana announced Thursday that it would stop providing employer-sponsored commercial coverage, including self-funded and Federal Employee Health Benefit plans, over the next 18 to 24 months. "Humana will still provide insurance through its military service business," reports Tom Murphy of The Associated Press. "It also will still provide employer-sponsored specialty coverage like vision and dental benefits."

Humana covers more than 13 million people, but fewer than 1 million are in employer-sponsored health insurance, not counting the Tricare plan for active-duty service members, families and retirees, which has an enrolment of nearly 6 million.

“This decision enables Humana to focus resources on our greatest opportunities for growth and where we can deliver industry leading value for our members and customers,” President and CEO Bruce Broussard said. “It is in line with the company’s strategy to focus our health plan offerings primarily on government-funded programs . . . ”

Half of Kentuckians on Medicare have Advantage plans, in which the federal government pays the insurer a flat fee per enrollee, creating an incentive for the insurer to limit the cost of claims. Managed-care Medicaid plans, like those Humana and other insurers have in Kentuckym, are funded likewise.

"Employer-sponsored enrollment growth has largely slowed for insurers, including market leaders like UnitedHealthcare," Murphy reports. "Companies have turned more to government-backed coverage like Medicare Advantage or Medicaid for growth. They also have pushed deeper into managing prescription drug plans and providing care in order to control health-care costs."

American Heart Month and Black History Month are the same month, and are related; Blacks are likelier to have heart disease

By Dr. Daniel Brunner

In February, we commemorate both American Heart Month and Black History Month, which presents an opportunity for us to raise awareness about cardiovascular health, remember the contributions of African Americans who helped shape the nation and reflect on the continued struggle to overcome disparities. As February ends, I urge everyone to commit to mind the teachings of American Heart Month and Black History Month throughout the year. That’s because a particular disparity that impacts the African American community is heart disease – the leading cause of death for African Americans and all adults across the U.S.

Daniel Brunner, M.D.

According to the Centers for Disease Control and Prevention, more than 20 million U.S. adults — approximately 7% of the U.S. population — have heart disease. The disparity lies in the fact that nearly 48% of African American women and 44% of African American men have some sort of heart disease. This is a lot higher than the 36% of white, non-Hispanic adults in the U.S. who have heart disease. In Kentucky, where heart disease is the commonwealth’s leading cause of death, 11.8% of the African American population has been diagnosed with a cardiovascular disease — higher than the national average of 9%.

While many factors contribute to their increased risk, what matters is that heart disease is killing Black Americans at a higher rate than any other group in the U.S., and the best way to fight this disparity is to successfully treat the risk factors.

Here is what people need to know:

Screening: Getting screened by a medical professional will help identify risk factors for heart disease early enough to treat it. Medical screening will identify if there are genetic risks or if factors such as weight, environment and habits are putting a person at higher risk of disease and death. Getting screened at least once a year is crucial for all adults.

Medication management: It’s not only important for people to take prescribed medication as directed for heart disease and other conditions that cause heart disease (such as diabetes, high cholesterol and high blood pressure), but is also important to communicate with a doctor to help manage conditions and adjust medication when required.

Staying active: Staying physically active reduces and helps manage weight. It may reverse early diabetes and cut cholesterol levels. It can even help control stress and hypertension. All it takes is 30 minutes a day, at least five days a week of exercise that is enjoyable, like walking, running, swimming, cycling, dancing, playing a sport or anything that gets the heart pumping.

Diet: It is extremely important to watch your diet to help maintain a healthy weight and heart. Certain ethnic food or diets and sugar-sweetened beverages are widely embraced in many communities. Some diets may be associated with a significantly increased risk of heart disease. With risk factors as high as they are, it is critical to be diligent with limiting foods that are rich in sugar, fat, calories and sodium.

Lifestyle choices: While it is not possible to change genes that are inherited, it is possible to make lifestyle changes that can influence heart health. Cutting smoking, getting six to eight hours of quality sleep at night and refraining from overeating could make a positive difference in heart health. Also important is cutting stress, since stress can increase hormones that elevate blood pressure. If stress continues long-term, it can lead to permanent hypertension, an irregular heart rhythm or a permanent heart condition.

Fighting back against heart disease doesn’t have to be undertaken alone. It’s obvious that people need their doctors to help, but in many cases, people can also turn to their health insurer for support. Many health plans offer special assistance in the form of case managers who work with patients and providers to determine a course of action that best serves a patient’s needs.

Accessing no-cost screenings, managing medication, and utilizing benefits designed to help members stay active or access diet programs are key to ensuring a healthy life. Reach out to your health plan to manage the thing that is most important – your health.

Daniel Brunner, M.D., is medical director for Anthem Blue Cross and Shield Medicaid in Kentucky. He is an emergency medicine physician based in Northern Kentucky.

Bill to ban transgender health or mental-health care of minors in Kentucky has a head of steam in the state House

By Melissa Patrick
Kentucky Health News

A far-reaching anti-transgender bill filed Tuesday, Feb. 21, was assigned to a legislative committee the same day it was filed, has received the first of three required readings and already has 20 co-sponsors.

Rep. Jennifer Decker

House Bill 470, sponsored by Rep. Jennifer Decker, R-Waddy (Shelby County), says "The provision of gender transition services to a person under the age of 18 years by a health-care provider or mental-health care provider is unethical and unprofessional conduct that establishes the provider is unfit to perform the duties and discharge the responsibilities of his or her position or occupation."

The bill defines gender transition as "the process in which a person goes from identifying with and living as a gender that corresponds to his or her sex to identifying with and living as a different gender and may involve social, legal, or physical changes." 

Among other things, the bill includes provisions to :  

• Require health care providers and mental health care providers to be investigated if there is any report that a provider has provided gender transition of provision of gender transition services to a person under the age of 18 years; 
• If confirmed, the provider's license is to be revoked and their public funding terminated; 
• Require that providers be jointly and severally liable for all damages and costs sustained for providing gender transition services or aiding and assisting a person under the age of 18 years to consider or to obtain gender transition services; 
• Provide defense to providers refusing to provide services; 
• Makes failure to report a gender transition service to the Vital Statistics Branch within 30 days of providing the service a crime; 
• Provides provisions for when a person's parents or guardian can bring an action because of personal injury before the person turns 18 and by the person within 30 years of the person turning 18, with exceptions under which the time may be longer;
• Includes conditions for actions and damages;
• Prohibits the use of public funds, including Medicaid, for gender transition services; 
• Prohibits a provider employed by a public agency to provide  and include gender transition procedures; 
• Allows the Attorney General to bring action to enforce provisions;
• Prohibits a public health care or mental health care  provider from intervening in a legal proceeding in defense of the provision of gender transition services; 
• Requires a school to notify each parent or guardian if a student under the age of 18 significantly changes his or her gender expression, expresses an inconsistency between his or her sex and his or her perceived gender or perceived sex; or expresses a desire to be referred to by a name, pronoun or other identifier inconsistent with his or her sex, with some exceptions related to parental abuse. 
• Includes updates to a host of laws to comply with the bill's provisions, including ones that will prohibit a court from changing a person under the age of 18's name if it is to assist them with a gender transition and another to prohibit the Department of Juvenile Justice from classifying a detainee by a sex that is inconsistent with his or her sex as defined in the bill. 

The bill, dubbed the "Do No Harm Act," has been assigned to the Judiciary Committee, of which Decker is a vice-chair. The committee meets at noon on Wednesdays; this bill has not yet been placed on the agenda. If passed and signed into law, it would become effective Jan. 1, 2024. 

This is just one of several bills targeting the LGBTQ+ community, Olivia Krauth reports for the Louisville Courier  Journal: "Several 'parents’ rights' bills include provisions either restricting gender transition services, outing students to their parents or allowing teachers to ignore a student’s preferred pronouns or name. One such measure, Senate Bill 150, already cleared the Senate and now waits in the House for consideration," she writes. "Other proposals include forcing students to use the school bathroom tied to their biological sex, even if they don’t identify with it. HB 120 also would prohibit gender transition procedures for youths."

New coronavirus cases in Kentucky continue to drop, but rate remains tops in nation and deaths from Covid-19 remain high

New York Times map as of 9 p.m. Monday, Feb. 20

By Melissa Patrick
Kentucky Health News

New coronavirus cases in Kentucky have dropped for three weeks in a row, but the state's new-case rate remains first in the nation, and deaths in the state from Covid-19 remain high, above this year's average.

The state Department for Public Health's latest weekly report says there were 3,625 new cases of the virus last week, or nearly 518 per day, That's a 10.8% drop from the week before and a 43% drop from the Jan. 30 report, which had 6,369 new cases. 

The share of Kentuckians testing positive for the virus in the past seven days was 10.14%, up from 9.92% the week prior. These numbers do not reflect at-home testing. 

The weekly new-case rate was 11.16 cases per 100,000 residents, down from 13.99 cases in the prior weekly report. The top 10 counties were Elliott, 49.4; Clinton, 36.4; Lee, 30.9; Morgan, 30.1; Oldham, 29.7; Woodford, 21.4; Gallatin, 20.9; Perry, 20; Rockcastle, 19.7; and Greenup, 19.5.

The New York Times ranks Kentucky's weekly new-case rate first in the nation, even with a 5% drop in the last two weeks. The Times says three Kentucky counties are among the top 10 for the most cases per 100,000 residents in the last week: Fayette, Clark and Greenup. 

Kentucky's Covid-19 hospital numbers are down. The state's hospitals reported 359 patients with Covid-19 on Monday, 27 fewer than a week earlier; 44 Covid-19 patients were in intensive care, down six; and 15 were on mechanical ventilation, down eight. 

The state attributed 56 more deaths to Covid-19 last week, down from 61 the week before, but still above the weekly average of 48 recorded since Jan. 2.  The state's pandemic death toll is now 18,055. 

Nationwide, "Deaths remain persistently high," the Times reports. "On average, around 3,000 people are dying of Covid in the U.S. each week." 

House panel advances bill to make insurers pay for testing that doctor says can lead to 'miraculous' treatment of certain cancers

American Cancer Society members were at the Kentucky State Capitol Feb. 16 for Cancer Action Days to support passage of House Bill 180, the biomarker testing bill, sponsored by Rep. Kim Moser, who is in the front row, sixth from the left. (KHN Photo by Melissa Patrick)

By Melissa Patrick

Kentucky Health News

A bill to require private and public insurance plans in Kentucky to cover biomarker testing for cancer and screenings for genetic-based reactions to drugs has been posted for passage Tuesday in the state House.

The House Health Services Committee unanimously approved House Bill 180 Feb. 16. It is sponsored by committee chair Kim Moser, who said "We know that these biomarker and pharmacogenetic tests are evidence-based. They are standards of care for many cancer patients and others and they must be medically necessary in order to be prescribed. But the insurance coverage is failing to keep pace."

Pharmacogenetic testing determines how a patient will respond to a medication. Biomarker testing “is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Each person’s cancer has a unique pattern of biomarkers,” says the National Cancer Institute.

Kentucky ranks among the bottom 10 states for biomarker testing coverage, with 42 states having better access to such testing, according to Moser.

"House Bill 180 is about getting the right medical treatment at the right time, saving precious time, saving healthcare costs and saving lives," Moser said. "This testing allows for precision or targeted treatment, less trial and error and of course less of the devastating side effects that we see and premature death." 

The American Cancer Society estimates that more than 10,000 Kentuckians will die from cancer this year and 30,000 will be diagnosed with it. "Having access to insurance-covered biomarker testing gives them the best chance of survival," the society said in a press release. 

Moser said the bill will require all private insurance plans, Medicaid and the state-employee health plan to cover the biomarker and pharmacogenetic tests when they are medically necessary.  

Moser said the lack of consistent insurance coverage "especially affects the minority populations, Medicaid-eligible populations, and rural populations, where there's less access to this care." 

Dr. Michael Gieske, a family practitioner at St. Elizabeth Healthcare in Northern Kentucky and the director of the hospital's lung-cancer screening program, said biomarker screenings for people with lung cancer can make a big difference. He said 55% of people with lung cancer don't meet the current screening criteria and many of this group would respond to precision medicine and targeted therapies, which first requires a biomarker test to determine. 

"This treatment can be miraculous," Gieske said. "We have patients that are 5, 10, 15, even 20 years out of their cancer diagnosis with late-stage lung cancer . . . . They have no evidence of disease and most of those patients are able to say that because of targeted therapies, because they had biomarker testing."

He added, "These are medical advances that need to be embraced, they need to be available for all individuals, they should not be available for some and not others." 

 
Lung-cancer screening with an annual low-dose CT scan is recommended for adults aged 50 to 80 who have smoked at least 20 "pack-years" (a pack-year amounting to one pack of cigarettes a day for a year, or an equivalent amount, such as half a pack a day for two years) and either still smokes or has quit within the last 15 years.

Biomarker success stories

Leah Phillips, a stage 4 lung-cancer survivor from Oldham County, told the committee that she was diagnosed with the disease in 2019 as a healthy nonsmoker at the age of 43, and told she had a life expectancy of six months to a year. 

On the recommendation of her oncologist, Phillips had a biomarker test that found one of her genes had stopped working, allowing the lung cancer to grow. There was a targeted therapy to treat that type of cancer. 

"Had I not had the biomarker testing done, I would have just been treated like a typical lung-cancer patient, most of which are smokers, and been put on chemotherapy and immunotherapy," Phillips said. "If I would have chosen that route of treatment my life expectancy and my quality of life would be much decreased. . . .  So not only is this important in guiding my treatment plan but it's also allowed me now to live for 38 months since diagnosis with now the life expectancy of five to seven years."

Boyd "Bo" and Brandy Rowe

After the meeting, Boyd "Bo" Rowe of McCreary County told Kentucky Health News that he was diagnosed with stage 4 lung cancer in 2020 as a nonsmoker at the age of 41. He said the cancer had spread to his liver, hips, spine, ribcage and brain and he had a life expectancy of six months.

He said his biomarker test found a rare form of cancer called ALK-positive that could only be treated with a targeted therapy. He added that doctors didn't even know about ALK-positive lung cancer 10 years ago and the medicine to treat it has only been around for five years. Rowe said he takes eight pills a day and will for the rest of his life, but his last scan showed 90% of the cancer that had been detected is no longer detected.

"Without the biomarker, you know, there would be a tombstone with my name on it," he said. "I wouldn't have been able to get the treatment that I've gotten, which insurance has paid for -- but they didn't pay for the [biomarker] test that allowed for the targeted treatment that I need." 

Pushback 

Tom Stephens, president of the Kentucky Association of Health Plans, said the lobbying group doesn't oppose the bill, but wants to "make sure that there are appropriate guardrails on the legislation so that it isn't misapplied." He said the group is concerned that the mandated coverage will "significantly increase" the number of tests that insurers are required to cover, including tests that have not been found to improve health outcomes. 

"Broad testing leads to unnecessary testing, raising costs and lowering affordability for all enrollees," Stephens said. 

He also noted that the bill's fiscal-impact statement did not include Medicaid or the state-employee health plan. The statement, from the Kentucky Department of Insurance, said it did not expect the bill to materially increase premium or administrative costs for fully insured health plans.

Stephens asked the committee to delay consideration of the bill to consider those estimated impacts and his group's proposed amendments. 

KAHP lobbyist Scott Brinkman said one amendment would limit testing to detecting signs of cancer or a cancer-related health condition. "We also want to make clear that there has to be a medical necessity for the test," he said, as well as a narrow definition of medical necessity and a later effective date: January 2025 instead of January 2024. 

Moser said after the meeting that resistance to her bill has largely been about the "guardrails" around when the testing is required.

"I've done a lot of work with the insurance companies to date and I'll continue working with them on their concerns," she said. "But you know, I think that we've tightened this down to their specifications."

In mid-February, Kentucky Health News asked Doug Hogan, the cancer society's state-government relations director, about the costs associated with biomarker testing. "The cost really depends on the test and who is paying for it," he wrote. "Single-gene tests will be far less expensive than more comprehensive testing, but could also require multiple biopsies and multiple tests. A recent actuarial analysis found that the average cost to insurers per biomarker test in the private market was $224, and the average cost in the Medicaid market was $78.71. However, a patient forced to pay out of pocket for a biomarker test that wasn’t covered would be much more than this."

Hospitals and health clinics prepare to take a post-pandemic hit as Medicaid drops people who no longer qualify for the program

St. Claire Regional Medical Center is preparing to lose $5 million a year in Medicaid revenue.

By Casey Quinlan
States Newsroom

Donald Lloyd, CEO and president of St. Claire HealthCare in Morehead, has spent more than a year dealing with higher costs for food and medical supplies for his regional hospital.

Now he’s trying to prepare for another financial hit — the loss of Medicaid reimbursements for treating people in rural Appalachia.

“We are all being forced to try to eke out a sustainable margin because of those (inflation) factors,” Lloyd said. “And then with the potential loss of reimbursement for those who did qualify, that’s just going to add an additional layer of burden upon rural institutions.”

Lloyd is referring to the unwinding of a policy that began in 2020 as a response to the public-health emergency created by Covid-19. The ​​Families First Coronavirus Response Act required states to allow Medicaid recipients to stay enrolled even if they were no longer eligible. That requirement ends April 1, and about 260,000 Kentuckians are expected to lose Medicaid coverage.

Health-care officials across the country are worried about how the loss of those Medicaid reimbursements will affect their facilities' financial health.

The loss is expected to be particularly hard on rural hospitals, which generally operate in areas with higher poverty rates and serve an older population and people with lower incomes — all factors that contribute to the financial pressure on hospitals.

A report from George Washington University said in January that up to 2.5 million patients of community health centers, could lose coverage as a result of eligibility redeterminations. 

Family Health Centers in Louisville plans to cut back on the low-cost or free medical, dental, behavioral health and pharmacy services it has been offering to uninsured patients because of the expected revenue dip, according to the Louisville Courier-Journal.

The Kaiser Family Foundation estimates that between 5 million and 14 million people will lose their coverage, and that two-thirds could be uninsured for several months up to a year.

That could cause problems for those “who delayed care because they lose their coverage and they’re coming in when they have a more severe situation,” said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association.

Simple mistakes in paperwork could result in many people losing Medicaid even though they’re still eligible for it, said Leighton Ku, professor and director of the Center for Health Policy Research at GWU. “We still expect there’s going to be some increase in the number of uninsured people in the U.S. over the next year, no matter how hard we try, so hospitals and community health centers are going to have some rough times ahead,” he said.

Lloyd said he expects less than 3,000 people would lose coverage in the communities that St. Claire serves, which could cost the hospital about $5 million in Medicaid revenue.

The hospital is preparing for the decrease by slowing down its capital investments even though it needs to replace operating room tables and to repair and do maintenance on a wing built in the 1960s, he said. St. Claire is also looking at “reprioritizing a number of strategic growth projects,” Lloyd added, such as accommodating robotic surgery.

He said the hospital has benefited greatly from Kentucky's expansion of Medicaid under the 2010 Patient Protection and Affordable Care Act.

Before coming to St. Claire, he was president and CEO at Christus Health Southwest Louisiana. Louisiana expanded Medicaid in 2016 and Kentucky in 2014.

“There was greater access to care and a greater sustainability to the hospitals post-expansion, both in Louisiana and here in Kentucky,” Lloyd said. “We’ve just been very fortunate in the commonwealth that we’ve had a Medicaid expansion longer than some of the other states that were kind of slow to expand … It’s just a matter of economics, and even though in some states the gap between the actual cost of care and the Medicaid reimbursement is very significant, at least it does offset some of the expense of operations.”

A new payment model that became effective in January could keep some rural hospitals from closing, but they could keep patients no more than 24 hours, couldn't have more than 50 beds, and would have to meet other eligibility requirements.

No Kentucky hospitals have said they are interested in the new designation, but Lloyd said it’s possible that a hospital in the area St. Claire serves could convert to it, which would have implications for his hospital. “We would handle the inpatient admissions for those institutions,” he said, “so it would increase our capacity, but we’re prepared to do so if necessary.”

Regarding obesity as a disease raises questions about cost of drugs for treating it, and wisdom of diagnosing children too early

Illustration by Shoshana Gordon, Axios

By Caitlin Owens
Axios

Doctors and medical experts are leading a rapid cultural shift around obesity, viewing it as a disease rather than a lifestyle choice. That shift is opening new treatments and better care, but also new controversies over who can access those treatments and how best to use them.

"Obesity is a highly prevalent chronic disease characterized by excessive fat accumulation or distribution that presents a risk to health and requires life-long care. Virtually every system in the body is affected by obesity," six obesity advocacy organizations recently wrote in a joint statement."Every person with obesity should have access to evidence-based treatment."

Some diabetes drugs has shown enormous promise for weight loss, offering a ray of hope to the millions of Americans with obesity. The drugs have become all the rage among some wealthy Americans. Billionaire Elon Musk recently responded to a tweet asking him his "secret" by saying "fasting and Wegovy."

But Wegovy, which is approved for weight loss under certain conditions, has a list price of $1,349 for a month's supply, and many insurers, including Medicare, won't cover suhc drugs for weight loss.

Kristine Grow, a spokesperson for America's Health Insurance Plans, recently told Axios that the therapies have limitations and "have not yet been proven to work well for long-term weight management and can have complications and adverse impacts on patients."The same class of drugs also can be misused. Some digital health startups are advertising and prescribing the drugs to people who aren't overweight, The Wall Street Journal reports.

The treatment landscape is changing rapidly for children as well as adults. Guidance released last month by the American Academy of Pediatrics recommends against delaying obesity treatment for children, and argues that doctors should be proactive about approaches like intensive health behavior and lifestyle treatment and, in some cases, prescription drugs or surgery.

But the guidance is already drawing pushback. Eating-disorder specialists, for example, are warning that it could backfire, NPR reports, quoting specialist Kim Dennis: "We run the risk of doing significant harm to kids who are 6 or 8 by telling them that they have a disease . . . simply based on their weight status."

An unusual array of interest groups is already pushing for Medicare to cover the drugs for obesity, Stat reports. More broadly, the existence of an effective treatment raises big questions about how to prevent yet another prescription drug from becoming commonly misused — and how to balance access to obesity treatment against the risks of perpetuating a stigma.

Even with 76% of Kentucky counties at low risk of coronavirus transmission, state ranks first in nation for new cases in last week

Centers for Disease Control and Prevention maps

By Melissa Patrick
Kentucky Health News

Three-fourths of Kentucky counties have a low risk of Covid-19 transmission, and only two of the 120 counties are at high risk, according to the Centers for Disease Control and Prevention's weekly risk map.

But the risk has been declining nationally, so on Feb. 17 Kentucky's new-case rate over the previous seven days was first in the nation, according to The New York Times. Fayette, Clark and Greenup counties ranked fourth, fifth and sixth in the nation for new cases in the last seven days, according to the Times.

The CDC's risk map is based not just on new cases, but on the number of patients in hospitals with Covid-19. It shows 91 Kentucky counties at low risk, shown in green, and 27 at medium risk, shown in yellow. The two high-risk counties, shown in orange, are Greenup and Elliott. 

Even as the risk of Covid-19 transmission decreases, the CDC continues to offer the same recommendations for medium and high-risk counties. 

In high-risk counties, the CDC recommends 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.

The CDC also provides a transmission level map, largely used by researchers and health-care facilities, that shows the level of the virus spread in each county, at one of four levels.

For the first time in a while, the map shows two counties with a low level of transmission: Ballard and Robertson. Thirteen counties had a medium level of transmission, and the rest had either substantial or high levels of transmission, showing that the virus continues to be widespread.