Tuesday, October 31, 2023

Kynect website opens Wednesday, Nov. 1, for shopping and enrollment in federally subsidized health-insurance plans

Kynect home page
Kentuckians can shop and enroll for federally subsidized health-insurance coverage on the state-based marketplace, Kynect, starting Wednesday, Nov. 1.

Enrollment will be open through Jan. 16. Coverage for those who sign up on or before Dec. 15 will start Jan. 1, 2024. Those who sign up in the following month will get coverage starting Feb. 1.

Kentuckians who don’t have coverage through an employer, Medicare, Medicaid, the Kentucky Children’s Health Insurance Program, or the Pentagon's Tricare program can shop for individual coverage on Kynect.

All plans offered on the marketplace cover 10 essential health benefits, including emergency services, hospitalization, lab services, prescription drugs and certain no-cost preventive services.

State Cabinet for Health and Family Services maps; click to enlarge
Four carriers offer health-insurance plans through Kynect: CareSource, Passport by Molina Healthcare, WellCare of Kentucky and Anthem.

All counties have at least two carriers to choose from, with most counties having three carriers and many with four. Since last year, Passport has grown by 22 counties, and WellCare by 26. 

98 of Kentucky's 120 counties have a choice of dental plans.
Under the qualified health plans offered on Kynect, no one can be dropped from coverage or have their premiums increased because of health issues.

More plans have been certified for 2024 than for 2023, and Anthem and Best Life will offer dental plans. 

Not all plans are the same, noted Carrie Banahan, deputy secretary of the state Cabinet for Health and Family Services, who encouraged consumers to visit kynect.ky.gov for details. “There’s more to plans than the monthly premium,” she said in a press release. “Make sure your doctors and other clinicians are in their network. Check out whether your favorite pharmacy is among their preferred.”

Some plans new features or benefits, including enhanced diabetes coverage, fitness memberships and vision benefits. Telehealth is covered by all plans at differing out-of-pocket costs. Kentuckians still have access to the more generous financial assistance originally made available as part of the American Rescue Plan passed as a result of the pandemic.

Open enrollment in a qualified health plan overlaps with other annual enrollment periods, including Medicare. Medicare beneficiaries may make changes through Dec. 7 and enrollment choices take effect Jan. 1.

For enrollment assistance, visit kynect.ky.gov or call 855-459-6328. You may also get help at your local Department for Community Based Services office, from a kynector or a licensed health-insurance agent.

Monday, October 30, 2023

UK will study the effects of newly prevalent drug xylazine ('tranq')

Terry Hinds Jr. and Cassandra Gipson-Reichardt (UK photo by Mark Cornelison)
By Elizabeth Chapin

Two University of Kentucky researchers have received a $2.65 million federal grant to study how the brain is changed by the mixture of fentanyl and xylazine, a veterinary anesthetic commonly referred to as “tranq.” It is increasingly being used to enhance the effects of fentanyl, a potent opioid that can be deadly even in small amounts. 

Cassandra Gipson-Reichardt and Terry Hinds Jr. associate professors in the College of Medicine’s Department of Pharmacology and Nutritional Sciences, received the five-year grant from the National Institute on Drug Abuse to see how the drugs change the brain’s signaling pathways.

These are the only preclinical studies now funded by NIDA to address an epidemic of xylazine-fentanyl use, and will be the first to determine neurobiological and behavioral impacts of the drug combination and identify treatment targets to reverse xylazine’s effects on fentanyl.

The combination of xylazine and fentanyl caused a 1,127% increase in xylazine-positive overdose deaths in the South in 2020-21, and other problematic health effects, including tissue death from poor circulation.

Xylazine is posing other new challenges to the fight against opioids, since it decreases the usefulness of naloxone (branded as Narcan), the drug that reverses the effects of an opioid overdose.

Gipson-Reichardt and Hinds will study the brain circuits that are changed when xylazine and fentanyl are used together and see if these changes are responsible for making naloxone less effective. They have already identified unexpected pathways controlled by the combination that may reduce the actions of naloxone. In their work, they will determine if targeting these pathways could be therapeutic.

“By studying these processes in detail, we hope to better understand the ways xylazine and fentanyl interact in the brain and how they affect behavior,” said Gipson-Reichardt. “This knowledge could lead us to new strategies for treating people who are struggling with the combined use of these substances and help make naloxone more effective in saving lives.”
Gipson-Reichardt and Hinds will collaborate with Kelly Dunn of Johns Hopkins University in Baltimore to translate findings to inform the public on individual factors that may lead to worse clinical outcomes during withdrawal from the xylazine-fentanyl combination.

Sugar season has started, so brush your teeth twice a day, floss daily, and drink plenty of water, UK dental-school dean advises

Photo illustration by Viktoriia Hnatiuk, iStock/Getty Images Plus
By Jeff Okeson, D.M.D.
Professor and dean, University of Kentucky College of Dentistry

From Halloween through New Year's, holiday parties and family events are filled with gifts and delicious treats. Kids go trick-or-treating, pies are baked and cookies are decorated. It’s the time of year that brings everyone together.

But with all the sugary treats, increased potential for cavities can be a concern. Cavities are small holes in the teeth caused by tooth decay. Eating sugar without proper dental hygiene can lead to plaque buildup on teeth, which can dissolve the enamel on teeth and eventually cause cavities.

It’s important to pay attention to holiday favorites like sugary baked goods, candied nuts and candy canes that contain a lot of added sugar which can lead to tooth decay. It’s also easy to forget that holiday drinks like apple cider and cocktails can be acidic leading to tooth erosion.

While sweet treats can be enjoyed, as we head into the fall and winter months it is important to stay on top of your oral health to ensure your dental visits are cavity-free. Here's how to do that:

Brush your teeth properly. Adults and children alike should brush their teeth twice daily with fluoride toothpaste for a full two minutes. Divide the mouth into four sections, top right, top left, bottom right, bottom left and brush each section for 30 seconds. Gently rotate the toothbrush bristles in circles, being careful not to irritate the gums. Rinse the mouth to wash out all toothpaste.

Floss daily. Flossing is equally as important as brushing. Flossing cleans hard-to-reach areas between the teeth and below the gum line. One of the most common places for a cavity to form is between the teeth, which is why flossing is necessary when cleaning the entire mouth. Adults and children should floss their teeth at least once a day, ideally at night before bed.

Drink plenty of water. Staying hydrated is beneficial for overall health, but drinking water is also one of the easiest ways to help prevent cavities. Water containing fluoride strengthens teeth and prevents decay. Water also washes away leftover food and residue that can lead to cavity-causing bacteria.

Visit the dentist regularly. Adults and children should visit the dentist for routine check-ups every six to 12 months. Visiting the dentist regularly lets people know if they are at risk for cavities. Once a patient is seen, dentists can understand which treatments might be needed or what changes in oral hygiene or diet might help reduce their risk of tooth decay.

While these tips can help prevent tooth decay, even the most diligent brushers can still get a cavity. There are a few telltale signs that indicate a dental visit is needed. Contact a dentist or health care provider if you experience any of the following symptoms:
  • Toothache or pain
  • Sensitivity to heat or cold
  • Tooth discoloration
  • Swollen gums
Holiday sweets and drinks are something to look forward to and may be hard to avoid completely. Instead of worrying about what isn’t okay to eat, focus on consuming in moderation. Drinking plenty of water and keeping up on your brushing and flossing are some of the best ways to take care of oral health.

Sunday, October 29, 2023

Flu and RSV cases increasing in Kentucky, but Covid-19 cases are still by far the leader in lab tests and emergency-room visits

By Melissa Patrick
Kentucky Health News

The state Department for Public Health's weekly Respiratory Virus Update, released Thursday, Oct. 26 showed that Covid-19 activity was moderate, and influenza and respiratory syncytial virus activity was low but increasing, and hospitalizations for all three infectious respiratory diseases remained low.

The state's Respiratory Viruses website shows that in the week ended Oct. 15, emergency-department visits associated with respiratory diseases continued to inch up, with 1,666 visits reported. This was up by 102 visits, or 6.5 percent, from the prior week, when 1,564 ED visits were reported.  

In that same reporting week, ED visits increased the most for RSV patients, to 176 from 131 the prior week. Flu increased to 716 visits, up from 672; and Covid-19 visits increased to 774, up from 761.

In the same week, according to the Centers for Disease Control and Prevention, Kentucky reported 1,204 laboratory-confirmed tests for Covid-19, down from 1,281 the prior week; and 109 positive laboratory tests for the flu, up from 96 the prior week.

Health officials say the best ways to protect yourself and others from these viruses are to stay up to date with your vaccines, stay home if you are sick, keep your hands washed, cover your mouth and nose with a tissue when you cough or sneeze and then throw the tissue in the trash, and if you don't have a tissue, cough or sneeze into your elbow, not your hands. In addition, they ask people who are at high risk for serious illness to consider wearing a mask. 

Hospital admissions associated with respiratory diseases have steadily decreased in Kentucky during the past four weeks and were down to 235 in the week ended Oct. 15, from 244 the week prior. 

The biggest drop in hospital admissions was among Covid-19 patients, which numbered 170 in the week of Oct. 15, down from 184 the week prior.

The CDC, with information through Oct. 21, shows Pike County with a hospital-admission rate of 24.7 per 100,000 people. That is in CDC's high level, for counties with 20 or more hospital admissions per 100,000. Adjoining Logan County, West Virginia, had a similar rate.

Five Kentucky counties had medium hospital-admission levels for Covid-19 in the last week, meaning they had between 10 and 19.9 hospital admissions per 100,000 people. Those counties include Bracken, Fleming and Mason, each with 15 admissions per 100,000; and Henderson and Union, each with 13.4.

Hospital admissions stayed about the same for flu patients (41) and RSV patients (24) compared to the prior week. 

Deaths: In the week ended Oct. 1, Kentucky reported eight deaths associated with Covid-19 and in the week ended Oct. 8, the state reported one death associated with Covid-19 and one flu-associated death. All of the dead were adults.

Friday, October 27, 2023

Kentucky Health Commissioner Steven Stack is the new president of the Association of State and Territorial Health Officials

Gov. Andy Beshear listened as Dr. Steven Stack spoke during
a pandemic press briefing. (Photo by Matt Stone, Courier Journal)
Dr. Steven J. Stack, commissioner of the state Department for Public Health, is the new president of the the Association of State and Territorial Health Officials.

Stack has been state health commissioner since February 2020, when he was appointed by Gov. Andy Beshear. The next month, the Covid-19 pandemic hit, starting a controversial era for public health.

“During the past few years, I have gained invaluable insight as an ASTHO member,” Stack said in a news release from the organization. “I’m honored to step into the role of president at this pivotal period in public health to further ASTHO's vision of advancing health equity and optimal health for all.”

Beshear, a Democrat, is running for a second term in the Nov. 7 election. If he loses, and Republican Daniel Cameron appoints a new health commissioner, Stack would also lose his position as ASTHO president. 

Stack has an MBA degree and "expertise in emergency department and hospital management, health system reform, physician licensure and regulation, and non-profit organization leadership," the news release says, noting that he was the youngest president of the American Medical Association.

He said in the release, “As president, I am committed to supporting ASTHO’s mission in partnership with other state health officials as we seek to strengthen public health workforce and infrastructure across the nation to ensure that every American can reach their full human potential.”

Stack played a central role in Beshear's handling of the pandemic. ASTHO CEO Michael Fraser said of Stack, “He has led Kentucky diligently as commissioner, and we know he will do the same for ASTHO. His dedication to innovation and improving public health will be integral in this upcoming year.”

Before becoming AMA president and stat health commissioner, Stack was a board member and secretary for the Washington-based eHealth Initiative, an association dedicated to innovation and solutions in health care through implementation of health technology, the release said.

Stack, an Ohio native, studied at the College of the Holy Cross in Worcester, Mass., before completing medical school and an emergency-medicine residency at Ohio State. He began his clinical practice in Memphis before moving with his wife and daughter to Lexington.

Thursday, October 26, 2023

A Covid-19 reporter gets the disease, and learns some lessons

Sarah Ladd took this photo of herself as she suffered from Covid-19.
By Sarah Ladd
Kentucky Lantern

For more than three years, I’ve written about Covid-19. The people who caught it and those who kept it longer than they should have. The people who bought into misinformation. And, worst of all, those who died from it.

Finally, I tested positive myself.

Don’t get me wrong, I’ve had several Covid-19 scares over the last few years. In early 2020, before tests were available to young and healthy people, my doctor at the time believed me to have it. But she couldn’t spare a test for me, so we never knew for sure. Since then, I’ve had several flu-like bouts, but always got “negative” back from Covid-19 tests.

That changed on Wednesday, Oct. 4, 2023. And now that I have hard confirmation of a Covid-19 infection, I see that nothing I experienced before compared to this. Does that mean this is my first true bout with the disease? Maybe I’ll never know.

Here’s what I do know. I’ve come to understand Covid-19 during my time in isolation in a way I never did before.

There’s a sick sort of forced independence in this illness. No one can rub your back when you ache or hold a cool rag to your fevered head. Getting a comforting hug? Out of the question.

While lying on my back in air that felt heavier than it ever had before, I thought to myself: No wonder Covid-19 is so divisive. We deal with it alone. Without seeing a smile or feeling a pat on the back. Without humanity.

Similar isolation is true for other illnesses, but this was all new to me.

All these things I knew — in theory. I’ve sat through enough press conferences with infectious disease specialists to know Covid-19’s symptoms backwards and forwards. But I think I fell into the age-old trap of never expecting a thing that affects other people to affect me as bad or the same. And my idea of a Covid-19 infection was, I realize now, very clinical. Distanced.

I’d been renovating my house the day I tested positive. All day long, I scraped old paint from 100-year-old wooden door frames. Too busy to check in with myself, I never stopped to question why I kept having to sit down because I felt like I might pass out.

By the end of the work day, my throat burned and the air was heavy around me. I gasped for air, but thought maybe I was just tired from a day of physical labor. Better take a test just to be safe, I thought. My nose burned and throbbed when I stuck the cotton swab up one nostril, then the next.

My 15-minute timer wasn’t two minutes in when a deep red dash popped on the second line of the at-home test. A “positive” indicator. Oh well, the instructions say not to read the test before 15 minutes. So, I left the bathroom and came back at the 15-minute mark. Two bright red lines. Positive.

I had a few thoughts in quick succession: I just unknowingly exposed my friend to the virus the night before and needed to let her know. I’d have to miss another friend’s birthday party over the weekend. And, finally, well, I’m young and healthy. This will run right through me.

It was a mistake to think that. Over the next few days I’d lose my sense of smell and taste. I’d grow weaker until I could barely walk across a room without a break. All of my strength disappeared. I’d go on Paxlovid within days.

Through all this, I abandoned the subconscious idea that people under 30 don’t suffer. But – I still consider myself extremely fortunate to not have ended up in a hospital, like so many have before me.

After testing positive, I withdrew to the attic to isolate away from my dog and spouse for the recommended five days.

In isolation I felt humanity slipping from me. My friends can tell you I am a notorious introvert. But this level of aloneness was new, unwanted. I heard my dog, Ronon, cry for me at the bottom of the stairs. He could not understand why we had to be apart, that he could catch it. I was afraid to touch anything in my bedroom, worried I’d contaminate everything and hyper aware that anything I touched now would need to be sanitized later.

I feel like a walking plague, I texted my friends.

So, I cataloged my very existence. I touched the door handle to the bathroom, my jewelry box. What have I forgotten? What have I breathed on?

With no smell or taste, I laid strong mint toothpaste across my tongue to try and feel. Nothing. Covid-19 is the first illness that ever robbed me of my senses. It was disorienting and depressing. I grasped at sensations but found little to satisfy. The Paxlovid made my eyes burn. So for days, I did little but sleep. Eyes closed. No strength, no scents, no taste — except for the disgusting “Paxlovid mouth.” All this felt like a horrible limbo, like my life had stopped at the door to the upstairs. 

I decided to post on social media about having the virus. I thought little of it, until comments riddled with misinformation about Covid-19 poured into my mentions.

The rhetoric from 2020 and 2021 about vaccines not working, Covid-19 being nothing more than a cold, and more flowed in after I posted about my experience. It was frustrating to hear the debunked myths thrown at me in a moment of vulnerability.

Much of my role as a Covid-19 reporter has been — and still is — unpacking misinformation. But my mentions after posting about my Covid infection told me we have a long way to go in educating people about the virus.

Indeed, three years in, I wonder if we may never fully get there. But I promise to keep trying.

How can we face a pandemic in unity and with compassion when they’re stripped from us when the virus comes for us? I don’t know the full answer to that, but I think it involves putting in a lot of work toward empathy. As we continue to deal with Covid-19 and its fallout, I hope we can try to come together on that one singular point, if nothing more.

As for me, I’ll never again take for granted the smell of a pumpkin candle in the fall, the greasy french fries at my favorite restaurant, or the way it feels so good to move my legs.

My strength is returning a bit more each day, and I’m able to go for walks again and wrestle my dog. I feel my other senses returning, too, despite being a bit slower than I’d like.

Every day, I feel such gratitude to be alive, to breathe.

Sarah Ladd covers health for the Kentucky Lantern. This story was first published Oct. 23.

Tuesday, October 24, 2023

Cameron, other attorneys general sue Meta, accusing Facebook and Instagram of purposely harming mental health of youth

Illustration from DB Investing
Kentucky Health News

Attorney General Daniel Cameron is among a large, bipartisan group of attorneys general suing Meta, the parent firm of social-media platforms Facebook and Instagram, accusing them of purposefully harming the mental health of youth in those states.

The suit alleges that Meta knowingly designed and deployed addictive features that put Kentucky’s youngest residents at risk despite claiming the features were safe. It was filed in federal court for the Northern District of California. 

“Protecting the safety and well-being of our most vulnerable remains my utmost priority,” Cameron said in a news release. “Meta has disingenuously downplayed the devastating effects of its platforms to exploit every scroll, click, and tap of our youth. This social media giant must stop these reckless actions and must be held accountable.”

The release said, "Meta maximized profits by monetizing children’s addiction. Features like infinite scroll and near-constant alerts were created with the express goal of hooking young people, according to former employees, and its algorithms push users into descending 'rabbit holes' in an effort to maximize engagement. The social media company also targeted young users to maximize their profits, calling them a 'valuable, but untapped market'."

Citing reports, the suit alleges that the social media giant knew the techniques negatively impacted young people’s physical and mental health, such as undermining their ability to get adequate sleep. However, Meta failed to make meaningful changes to minimize the harmful effects. The suit also cites the finding of a “youth mental health crisis” by the U.S. surgeon general.

The news release said the suit was "brought by General Cameron and 41 attorneys general on behalf of their states," but also said it was filed by "Kentucky and 32 states" and the complaint listed only 33 states. Cameron's spokeswoman, asked for a clarification, did not reply Tuesday.

Scientists have been reluctant to say outright that social media are addictive, but David Greenfield, a psychologist and founder of the Center for Internet and Technology Addiction in West Hartford, Conn., told The New York Times that the platforms use powerful tactics to keep users using.

One is “intermittent reinforcement,” which creates the notion in a user could that a reward is in the offing, but its timing is unpredictable. “Just like a slot machine,” he said, noting the platforms' use of lights and sound. Even more powerful, he said, are information and rewards that are tailored to users.

"Young people are particularly at risk, because the brain regions that are involved in resisting temptation and reward are not nearly as developed in children and teenagers as in adults, the Times reports, quoting Greenfield: “They’re all about impulse and not a lot about the control of that impulse.” Also, "the adolescent brain is especially attuned to social connections," the Times notes. Social media are “a perfect opportunity to connect with other people,” Greenfield said.

"Meta responded to the lawsuit by saying that it had taken many steps to support families and teenagers," the Times reports, quoting the company: “We’re disappointed that instead of working productively with companies across the industry to create clear, age-appropriate standards for the many apps teens use, the attorneys general have chosen this path.”

UK finds drug-resistant fungus on 5 patients on a floor of hospital

C. auris develops on the skin. (helivideo/iStock photo)
Kentucky Health News

A sneaky, infectious, drug-resistant fungus called Candida auris has been found on five patients on one floor at the Albert B. Chandler Hospital at the University of Kentucky, UK announced Tuesday.

"All cases have the fungus on their skin, but it is not causing an active infection and there are no active infections with Candida auris at UK HealthCare," the university said. "Our team quickly identified the pathogen and began isolation and disinfection precautions to prevent further transmission."

Citing the Centers for Disease Control and Prevention, UK noted that people "can carry Candida auris on their skin and may not have any symptoms. Often those who get it are already admitted to a health-care facility with another serious illness or condition and may have risk factors such as mechanical ventilation, tracheostomy, invasive medical devices and frequent health care encounters."

The fungus is a yeast that can cause infections in the blood, wounds, the respiratory tract and the urinary tract. It is most likely to infect people who are already sick, but "can be resistant to multiple antimicrobials and is responsible for outbreaks in health-care facilities across the globe," UK noted, concluding:

"As an academic medical center, UK HealthCare is steadfast in the surveillance and identification of infections and the implementation of interventional and prevention strategies to contain and help prevent reoccurrence and transmission of diseases and has a dedicated infection prevention and control team that monitors infections and the possibility of outbreaks that could become a threat to public health."

For a CDC fact sheet on C. auris, click here.

Monday, October 23, 2023

Beshear defends pandemic work as Cameron cites learning loss, makes false claim about founder of Planned Parenthood

Candidates' supporters at KET Monday night (Kentucky Lantern photo by Matthew Mueller)
By Al Cross
Kentucky Health News

In their next-to-last debate before the Nov. 7 election, Gov. Andy Beshear defended his response to the Covid-19 pandemic against criticism from Republican Attorney General Daniel Cameron. Appearing for an hour on KET, the candidates also debated each other's positions on abortion, and Cameron made  a false claim about the founder of Planned Parenthood.

Moderator Renee Shaw opened the "Kentucky Tonight" forum by asking Cameron how he would have handled the pandemic that hit the state in March 2020. He said he would have "done like other red-state governors" and tried to get businesses "open as quickly as possible."

Asked if he would have shut down schools at any point, he did not say, but said "I wouldn't have infringed on your constitutional rights." That was a reference to court decisions, some successfully sought by Cameron, that said a few of Beshear's state-of-emergency restrictions went too far.

Beshear was asked if he had any misgivings about the strength and duration of his restrictions, specifically the application on Easter Sunday of his ban on mass indoor gatherings.

He did not address that specific point, but said, "This is about leadership. I showed people during the pandemic I was willing to make the hard decisions, even if it cost me. I put politics out the window, and I made the best decisions I could to save as many lives as possible.”

Asked if he would do it all over again the same way, Beshear didn't answer directly, but said "I believe we made the best decision we did with the information we had," and said he was the first governor to prioiritized teachers for immunizations when vaccines for Covid-19 became available.

Cameron claimed that Beshear "said he had no regrets," and said he would not admit regret "because of pride."

Noting repeatedly that Beshear closed schools, Cameron said "Your kids are behind because of this short-sighted decision," and noted his "catch-up plan" to help them.

Beshear, asked if he has a strategy for that, said he does, but tried to spread blame to the Republican-controlled legislature: "This is something that was happening before the pandemic, primarly because of not enough educators," due to low pay causing teacher shortages.

He also shifted blame when asked if he would take responsibility for the huge backlog in unemployment claims during the pandemic. He noted the downsizing of the agency under his GOP predecessor and said "If we'd had the resources that were there in the last administraton we could have done much better."


Cameron has said that if the legislature sent him a bill to put rape and incest exceptions into the state's abortion ban, he would sign it. Asked to say "yes or no" if he personally favors such exceptions, he repeatedly declined to answer, and made a false claim about the founder of Planned Parenthood.

Cameron, an African American, noted the organization's strong support of Beshear, and said its founder, Margaret Sanger, favored the extermination of his race. This claim has been made and debunked several times, but Cameron said Sanger "said I didn't deserve to live." UPDATE, Oct. 25: In a debate Tuesday night, Cameron put it another way: "Margaret Sanger wanted to destroy the Black community," and said 79% of abortion clinics are in Black neighborhoods. 

Sanger believed in eugenics, which taught white superiority and discouraged reproduction of races and ethnicities it deemed inferior. In 1939 she started a project to expand birth-control services for African Americans in the South. In a letter, she told a director of the program that it should hire African American doctors and ministers to gain trust in Black communities because “We do not want word to go out that we want to exterminate the Negro population ...”

That was “inartfully written” but was “frequently taken out of context to suggest Sanger was seeking to exterminate blacks,” The Washington Post reported in 2015. The Reuters news service said in a fact check last year, "Sanger’s concern was to avoid a suspicion that the program’s objective was to stop Black people having babies, which having white people in charge could create."

Sanger's full quote was, “We do not want word to go out that we want to exterminate the Negro population, and the minister is the man who can straighten out that idea if it ever occurs to any of their more rebellious members.”

During the debate on abortion, Shaw noted that Cameron and 18 other attorneys general signed a letter in June opposing a proposed federal privacy rule that would keep state officials from getting information on any reproductive health-care services that in-state residents obtained outside the state, and asked if he wants to criminalize women seeking abortions.

"Absolutely not," Cameron replied, returning to the attack: "Andy Beshear is trying to gaslight you tonight. . . . He wants no limits on abortion." Not so, Beshear said.

Asked if a woman be allowed to terminate a pregnancy at any point, Beshear said his long-held position is that "I am in favor of reasonable restrictions on abortion, especially late-term abortions. . . . He signed a letter saying that he should be able to come after your medical record if you go out of state for care."

On another hot-button social issue, Beshear was asked about an early campaign commercial in which he said that transgender surgeries are not performed on minors in Kentucky. A letter from UK HealthCare, written in March but not released by state Rep. James Tipton, R-Taylorsville, until August, said UK had “a small number of non-genital gender reassignment surgeries on minors, such as mastectomies for older adolescents.”

Shaw asked Beshear if he knew that when he made the ad. He said, "No, I didn't know."

Numerous pro-Cameron commercials have used the ad and the letter to argue that Beshear was lying. Immediately after Beshear answered, Cameron claimed, "The governor just told you a lie," because Beshear vetoed this year's Senate Bill 150, which banned transition surgeries for minors after the legislature overrode the veto.

Beshear said the bill "had a lot more in it" than the ban, but "Our parents should be able to make complicated medical decisions, rather than the government . . . This was all passed just for political points."

The candidates' final debate is scheduled for 7 p.m. ET Tuesday on Lexington's WKYT-TV and on sister Gray Television stations in Evansville, Ind., and Bowling Green.

Medicare Advantage isn't an advantage for many rural hospitals

Breckinridge Memorial Hospital in Hardinsburg has had financial difficulties. (Photo by Melissa Patrick)

By Sarah Jane Tribble
KFF Health News

The popularity of Medicare Advantage plans is putting a squeeze on many small, rural hospitals, those with a designation that qualifies them for slightly higher reumbursements from Medicare and Medicaid.

Medicare Advantage insurers are private companies that contract with the federal government to provide Medicare benefits to seniors in place of traditional Medicare. The plans have become dubious payers for many large and small hospitals, which report the insurers are often slow to pay or don’t pay.

Private plans now cover more than half of all those eligible for Medicare. And while enrollment is highest in metropolitan areas, it has increased fourfold in rural areas since 2010. Meanwhile, more than 150 rural hospitals have closed since 2010. Largely rural states that have not expanded Medicaid, such as Texas, Tennessee, and Georgia have had the most closures.

(Kentucky has expanded Medcaid, but 16 of the state's rural hospitals are at risk of closing, and 10 of those are at immediate risk, according to the latest analysis of hospitals' Medicare cost reports by the Center for Healthcare Quality and Payment Reform, an advocacy group. The report didn't name the 16 hospitals.)

Medicare Advantage growth has had an outsize impact on the finances of small, rural hospitals that Medicare has designated as “critical access.” Under the designation, government-administered Medicare pays extra to those hospitals to compensate for low patient volumes. Medicare Advantage plans, on the other hand, offer negotiated rates that hospital operators say often don’t match those of traditional Medicare.

“It’s happening across the country,” said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association. “Depending on the level of Medicare Advantage penetration in individual communities, some facilities are seeing a significant portion of their traditional Medicare patient or beneficiary move into Medicare Advantage.”

In Nevada, Jason Bleak runs Battle Mountain General Hospital, a three-hour drive from Reno, and four hours from Salt Lake City. Bleak suspects insurance companies simply haven’t enrolled enough of the area’s seniors to need his hospital in their network.

When several representatives from private health insurance companies called on him a few years ago to offer Medicare Advantage plan contracts so their enrollees could use his hospital, Bleak sent them away.

“Come back to the table with a better offer,” the chief executive recalled telling them. The representatives haven’t returned.

Kelly Adams is the CEO of Mesa View Regional Hospital, another rural hospital in Nevada, near the Arizona border. He said he applauds Battle Mountain’s Bleak for keeping Medicare Advantage plans out of his hospital “as long as he has.”

Mesa View, which is a little more than an hour’s drive east of Las Vegas, has a high percentage of patients enrolled in Medicare Advantage plans.

“Am I going to say I’m not going to take care of 40% of our patients at the hospital or the clinic?” Adams said, adding that it would be a “tough deal” to be forced to reject patients because they didn’t have traditional Medicare.

Mesa View has 21 Medicare Advantage contracts with multiple insurance companies. Adams said he has trouble getting the plans to pay for care the hospital has provided. They are either “slow pay or no pay,” he said. In all, the plans owe Mesa View more than $800,000 for care already provided. Mesa View lost about $1.3 million taking care of patients, according to its most recent annual cost report.

NRHA’s Cochran-McClain said the growth in the plans also narrows options for patients because “the contracting that is happening under Medicare Advantage frequently has an influence on steering patients to specific types of providers.” If a hospital or provider does not contract with a Medicare Advantage plan, then a patient may have to pay for out-of-network care. That generally wouldn’t happen with traditional Medicare, which is widely accepted.

At Mesa View, patients must drive to Utah to find nursing homes and rehabilitation facilities covered by their Medicare Advantage plans.

“Our local nursing homes are not taking Medicare Advantage patients because they don’t get paid. But if you’re straight Medicare, they’d be happy to take that patient,” Adams said.

David Allen, a spokesperson for the lobbying group America’s Health Insurance Plans, declined to respond to Bleak’s and Adams’ specific concerns. Instead, he said enrollees are signing on because the plans “are more efficient, more cost-effective, and deliver better value than original Medicare.”

Centers for Medicare & Medicaid Services Press Secretary Sara Lonardo said CMS has acted to ensure “that private insurance companies are held accountable for providing quality coverage and care.”

The reach of private Medicare Advantage plans varies widely in rural areas, said Keith Mueller, director of the Rural Policy Research Institute at the University of Iowa College of Public Health. If recent trends continue, enrollment could tip to 50% of all rural Medicare beneficiaries in about three years — with some regions like the Upper Midwest already higher than 50% and others lower, such as Nevada and the Mountain States, but trending upward.

In June, a bipartisan group of Congress members, led by Sen. Sherrod Brown, D-Ohio, sent a letter urging federal agencies to do more to force Medicare Advantage insurers to pay health systems what they owe for patient care.

In an August response, CMS Administrator Chiquita Brooks-LaSure wrote that a final rule issued in April made “impactful changes” to speed up care and address concerns about prior authorization — when a hospital and patient must get advance permission for care to ensure it will be covered by an insurer. Brooks-LaSure noted another proposed rule that, once finalized, could mandate that insurers provide specific reasons for denying care within seven days.

Hospital operators Adams and Bleak also want more federal action, and fast. Bleak at Battle Mountain said he knows Medicare Advantage plans will eventually move into his area and he will have to contract with them.

“The question is,” Bleak said, “how can we match the reimbursement so that we can sustain and keep our hospitals in these rural areas viable and strong?”

UK's latest federal grant to increase number of primary-care doctors in rural Kentucky includes new scholarship opportunities

Medical students Katelin Maggard and Anna Cox on the College of Medicine-Bowling Green Campus, a partnership of UK, Western Kentucky University and Med Center Health. (Photo by Clinton Lewis)

By Allison Perry
The University of Kentucky College of Medicine has received a four-year, nearly $16 million grant from the federal Health Resources and Services Administration. UK will get $3.97 million a year over the next four years to support efforts to increase the number and diversity of primary-care physicians in Kentucky, with the ultimate goal of improving health-care access in underserved areas of the state.

The physician shortage is not unique to Kentucky, nor is it limited to primary care. A2021 report from the Association of American Medical Colleges estimated that national demand for all physicians will exceed the existing supply by 37,800 to as many as 124,000 by the year 2034.

In Kentucky, 61% of the greatest physician needs are in rural areas. In rural and under-served areas, primary-care physicians are often the residents’ only exposure to any health-care professional, highlighting the need to improve access to these physicians.

UK's Rural Physician Leadership Program trains students
at Morehead who are interested in practicing rural medicine.
(UK photo by Jorge Castorena)
The UK College of Medicine has worked with academic and clinical partners to meet this growing need through four regional campuses in Lexington, Morehead, Bowling Green and Northern Kentucky, and graduated the largest-ever class this past spring.

These partnerships were a key to getting the new grant, which will focus on expanding pathways to support students who are interested in medical school and providing scholarship opportunities for medical students who choose primary care as a career path.

The goal is not just to increase the number of primary care physicians in the state, but to encourage new physicians to practice in underserved communities upon graduation, said Charles “Chipper” Griffith III, M.D., dean of the College of Medicine.

“As a physician who has provided primary-care services for patients of all ages, I can tell you firsthand how important it is for people to have access to these providers,” Griffith said. “An established relationship with a primary care physician is a first line of defense against acute and chronic illness and injuries. We not only provide treatment for illness, but we actively work to help our patients prevent it by identifying risk factors and screening for disease. In a state that suffers from high rates for many chronic, preventable diseases, increasing access to primary care is a critical step in improving the health of our citizens.”

Path to primary care can start in middle school 

UK already had several programs to provide educational experiences as students navigate the pre-med journey. With help from the new grant, these programs will place a greater focus on primary care, which includes family medicine, general internal medicine, general pediatrics, or the combination of internal medicine/pediatrics commonly known as Med/Peds.

The pathway to a medical career begins years before students reach college. Educational opportunities need to begin early — ideally, by the eighth grade, says James Ballard, director of UK's Center for Interprofessional and Community Health Education.

Promising students are identified with teh help of UK’s Area Health Education Center program, a collaborative effort between UK, the University of Louisville Health Science Centers, and eight regional centers. They provide support to help students meet their goals, including assistance in planning which classes to take in high school, help with applying for college, and encouragement from health-care role models.

At the high-school level, AHEC offers two free residential summer camps at UK that will be revised and funded through the new grant. The Summer Enrichment Program, for rising high school juniors, is a residential camp that allows students to gain some early college experience by spending three weeks learning, observing, and working hands-on with UK faculty, health professionals and health professions students. The program will add more mentoring specifically from primary-care physicians to provide more specific education on what a primary-care physician can do for patients, and understand how primary-care physicians function in a collaborative system.

The Health Researchers Youth Academy takes a similar approach, but is more tailored to the research side of a medical career. The residential programs connect high-school students with researchers, teach them research methods, and give them experience working in a laboratory. At the end of the camp, students will present their findings through poster presentations. In terms of primary care, the camp will educate students more on a primary care physician’s role in translational research — in other words, how basic science at the bench ultimately becomes a part of everyday patient care.

Though the Center for Intreprofessional and Community Health Education aims to create more health professionals across all spectrums, it will extol the benefits of choosing primary care, Ballard said.

“We’ve always exposed students to a variety of professions in the past, but we want to get more specific when it comes to primary care. We want them to understand ‘This is what a primary care physician does, this is why it’s important, this is why it’s valuable to you’,” Ballard said. “It’s amazing what primary care physicians can do, especially in rural and underserved areas. We want to show them what a difference they can make in their community by choosing this as a career.”

New initiatives funded by this grant will include two post-baccalaureate programs for students who have graduated from college, to provide opportunities for students to complete prerequisites for medical school and/or receive additional support and training to improve their chances of being accepted into medical school; a pre-matriculation program to prepare incoming medical students for the rigors of the curriculum and to highlight the benefits of choosing primary care as a career path; and a primary-care scholarly concentration, which will include targeted coursework and an enhanced community clinical rotation at a rural teaching health center.

Reducing debt for future primary care physicians

Research shows that students with large college debt are less likely to choose primary-care specialties because they have lower compensation in comparison to specialty and sub-specialty practices. Also, these graduates are less likely to practice in underserved communities.

The new grant will also allow the College of Medicine to provide up to $2.88 million a year in scholarships to students with demonstrated interest in primary care.

The new scholarships are positioned to decrease the debt burden by half for 80 students, and by a quarter for an additional 32 students. By reducing this burden, the team anticipates that more students will be likely to follow their passion for rural medicine and making a difference in underserved communities.

“Investing in the education of medical students through scholarships is not just an act of philanthropy, it’s an investment in the future of health care in Kentucky,” said Dr. Stephanie White, senior associate dean in the College of Medicine. “This award will be life-changing for our students who wish to pursue a career in primary care and have the desire to make a difference in underserved communities. These scholarships won’t just alleviate financial burden — they will empower dreams and nurture the talents of our next generation of primary-care physicians.”

Sunday, October 22, 2023

In debate, Cameron slams Beshear's handling of pandemic; governor says 'I'd rather save lives than win re-election'

Atty. Gen. Daniel Cameron and Gov. Andy Beshear debated Saturday night. (WLKY image via Ky. Lantern)
By McKenna Horsley
Kentucky Lantern

During a debate Saturday night, the candidates for governor were asked if the state should have an ongoing plan for a future pandemic, like the Covid-19 pandemic that began in 2020, as well as what they thought were successes and failures in the response to the coronavirus.

Republican Attorney General Daniel Cameron, who answered the question first, criticized Democratic Gov. Andy Beshear for closing schools, businesses and churches during the pandemic. Cameron has made similar comments on the campaign trail and in press conferences.

“What Andy Beshear did was wrong. I will respect your constitutional rights. I will look out for our most vulnerable populations,” Cameron said. “But at the end of the day, I will make sure that we respect you as a citizen and your constitutional rights.”

Beshear called the pandemic “the challenge of our lifetime” and noted that it killed 18,000 Kentuckians. He also praised health-care workers who worked during the pandemic and added that it was “a slap in the face of the heroism that they showed” for Cameron to refuse “to act like this pandemic was as deadly as it was.”

“I made decisions to save lives,” Beshear said. “It’s clear this attorney general would have played politics. That would have caused more death, more destruction. I’d rather save lives than win re-election.”

Saturday’s debate was hosted by the League of Women Voters of Louisville and TV station WLKY. During a couple of tense moments, Beshear directly asked Cameron to answer questions about abortion.

Cameron said last month that he would sign legislation adding exceptions in cases of rape and incest to Kentucky’s near-total abortion ban if the General Assembly passed it. However, he has not directly said if he personally supports those exceptions and continues to call himself the “pro-life candidate.”

I a rebuttal, Beshear said, “I got a few seconds left. So, General Cameron, will you look at the camera and say, ‘I support exceptions for rape and incest?’”

Cameron replied, “I’ve already said that I will sign the exceptions if they are brought to my desk. At the end of the day, this governor wants more abortions. There is no difference between him and Joe Biden on this issue.”

The next gubernatorial debate, hosted by KET, is set for 8 p.m. ET Monday. followed by the candidates' last debate at 7 p.m. ET Tuesday, hosted by Lexington's WKYT-TV.

Beshear’s running mate, Lt. Gov. ​Jacqueline Coleman, and Cameron’s running mate, state Sen. Robby Mills of Henderson, will face each other in a KET debate on Oct. 30. Voting concludes Nov. 7.

This story was excerpted from a longer one. For the original, go here.

Friday, October 20, 2023

Heart expert: Ibogaine to treat opioid addiction is safe only in hospitals; others say risk can be mitigated; 'rough' plan outlined

By Melissa Patrick
Kentucky Health News

In a session focused on challenges of getting the psychedelic drug ibogaine approved by the Food and Drug Administration for treating addiction with help of the state's opioid settlement funds, a cardiologist said it couldn't be done in a reasonable time and the drug is unsafe.

"My opinion is that ibogaine is not safe, the efficacy is unproven, it's unlikely to be approved by the FDA in a reasonable time period, and the cost to Kentucky would be unsupportable," said Dr. Mark Haigney, a board-certified cardiologist and electrophysiologist, and an attending physician at the Walter Reed National Military Medical Center.

Haigney was invited to a special Kentucky Opioid Abatement Advisory Commission meeting on Oct. 17 by commission member Patricia Freeman, a pharmacy professor at the University of Kentucky. The meeting also saw the head of the commission discuss a "rough" plan for funding ibogaine research.

Patricia Freeman
(Photos by Melissa Patrick)
After two hearings that focused on ibogaine development and personal testimonies favoring the drug, she asked to invite experts in regulatory drug development to testify about the challenges of navigating ibogaine through the FDA process, given its potential for damage to the heart and its current classification as a Schedule I drug with no medical use.

Freeman said she had concerns that people at one hearing thought there would be quick access to ibogaine with the $42 million investment and felt compelled to ensure they understand that this would be a multi-year endeavor with no guarantee of success. 

"I felt this was important as it would help make sure that at large, our commission would be as fully informed as possible prior to making a decision on proposed ibogaine funding," Freeman said. 

The proposal comes from Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor. Ibogaine is illegal everywhere but Mexico and New Zealand, but has been anecdotally reported to stop drug-withdrawal symptoms. 

Haigney, who described himself as an "expert in drug-induced sudden death and drug-induced loss of consciousness," said that while he recognized the attractiveness of a single-dose drug like ibogaine to treat opioid-use disorder, such a drug must be "safe in the immediate term, effective in the long term, FDA-approved, and affordable for the huge number of Kentuckians with opioid-use disorder." 

He said ibogaine isn't safe because it is known to cause cardiac arrhythmias and sudden death. In detail, he explained that this happens because ibogaine causes a "prolonged QT interval," which is one of the measurements taken by a standard electrocardiogram. 

A prolonged QT interval occurs when the heart muscle takes longer to contract and relax than usual, which can affect heart rhythms and lead to sudden cardiac arrest. 

Haigney said the FDA requires all drugs to undergo cardiac testing and that "the finding of QT interval prolongation is the most common reason for removal of a drug from further development." 

He added that a prolonged QT interval can happen when a drug blocks the cardiac potassium channels to the heart and that ibogaine is a "potent blocker" of this channel, even with normal therapeutic doses. 

"So this means that most if not all subjects would experience some significant degree of blocking the channel," he said. "And this is a very poor prognostic finding for a drug."

Haigney pointed to a study of 14 hospitalized patients who received a "relatively low dose" of ibogaine. The average increase in QT interval was 95 milliseconds. He said the FDA's published guidelines say it is concerned when a drug prolongs the QT interval by 5 milliseconds or more. 

"I've never seen a drug prolong the QT interval so profoundly," he said, adding later, "This degree of QT prolongation would be expected, associated with increased risk of fatal events."

He then asked rhetorically, "Can this drug be given safely?" His answer, "Yes, in the hospital. We do a lot of dangerous things in the hospital with a lot of technology," adding that this would be "an incredibly resource-demanding" drug to administer. 

"The likelihood that this drug with this safety profile will be approved by the FDA in less than 10 years, in my opinion, is remote and the effort will require at least a billion dollars," Haigney said. "The administration of ibogaine would strain hospital resources at a time when bed shortages are severe. This is a treatment for wealthy individuals who can pay for hospitalization with intensive monitoring," so it would not help most Kentuckians "who struggle with opioid dependence." 

Freeman also invited Robert Walsh, recently retired from working in the National Institute on Drug Abuse for 36 years, where he headed NIDA's Regulatory Affairs Branch. 

Walsh spoke to the regulatory challenges of ibogaine development, including cardiac safety, ensuring enough supply of a plant-based drug from another country, creating a plant-based drug with the same dose in each pill, and the challenges of working with a Schedule I drug in laboratories and clinical settings.

Dr. Sidney Peykar, a cardiac electrophysiologist and medical director at the Cardiac Arrhythmia Institute, said the drug could be given safely in a hospital setting and said he has expanded the protocol for how to administer ibogaine safely at the Beyond Ibogaine Treatment Center in Cancun, Mexico.

"Most if not all of these deaths could be mitigated or completely prevented through safety protocols," he said.

Dr. Javier Muniz, the FDA's supervisory general-health scientist for controlled-substances initiatives, was asked if FDA would definitely not approve ibogaine. He said that without all of the information in front of him, "I have no idea." 

Asked by Freeman if a 95-millisecond QT prolongation would disqualify ibogaine from being approved, he said it's important to remember that when the FDA is considering the approval of a drug, the agency looks at a drug holistically and considers both risks and benefits. 

Bryan Hubbard, right, and
Carlos Cameron, commission
Hubbard was asked after the meeting if any speaker had caused him to change his mind about his ibogaine plan. He said, "Dr. Haigney was brought in here to oppose this initiative and he articulated all of the talking points that the opponents of this initiative have already parlayed at public remarks. So there was nothing that was either surprising, nor persuasive about his remarks, and insofar as what he has articulated, are already widely publicly disseminated talking points of opposition."

He said Haigney was "thoroughly debunked [by] individuals who serve, respectively, on an FDA advisory board for psychopharmacology, as well as the science journal for the FDA's research arm related to controlled substances."

At the end of the meeting, Hubbard gave the commission a "very rough draft" of a plan with a list of requirements that would have to be met before the commission would commit $42 million to the project. He did not release the plan, but told Kentucky Health News after the meeting that it contains these points:
  • "Viable research proposals from qualified research entities" that will match the state's $42 million
  • The state would have ownership of any patentable intellectual property that is generated
  • Clinical trials would be held in the West End of Louisville and in Wast Kentucky, "in a way that ensures social, racial, and economic equity of access to the treatment,"
  • An approved drug-investigation application from the FDA "with secured clinical-trial sites and a diverse group of qualified clinical-trial participants before the first dollar is ever matched by the commission," 
"This will have to be a viable, go project before any commission resources are put on the table," Hubbard said,. Nothing like this has ever been done. So all of this is breaking ground." He cited "the competing interests, the areas of concern, the nature of this money, the necessity of protecting it, the necessity of making sure that the Commonwealth of Kentucky has a leadership position that is protected and recognized, and consideration of risk that we are taking by making this bet."

When it comes time for the commission to vote, he said, "Theoretically, the vote will be to legally authorize a $42 million match from the commission for our clinical research team that is ready to conduct clinical trials with ibogaine in Kentucky."

Hubbard said it is imperative that no vote be taken until Dr. Nolan Williams' peer-reviewed research of veterans who have suffered from traumatic brain injury and received ibogaine is published and they hear from him about his findings. Williams is an associate professor at Stanford University.

At the commission's first public hearing, Williams said he had let other professionals look at the data from his study and they said "the findings are shocking and that they've never seen a drug do this before." 

Before the eight guests spoke, Hubbard took about five minutes to address how he and the commission came to explore ibogaine and its potential therapeutic uses. He said as far back as 2018, he became aware of emerging science on therapeutic psychedelics and an author who at the time wrote about the topic and led him to other sources of information. Her newsletter The Journey is published on Substack. She wrote under the pen name of Julia Blum now uses the name Julia Christina.

Hubbard was responding to an Oct. 9 Daily Beast story, excerpted in Kentucky Health News, which reported that about the time Cameron implicitly endorsed his plan at a public event, a major national political contributor increased its investment in ibogaine research and later gave Cameron's campaign a political boost. He is running against Democratic Gov. Andy Beshear, who has objected to Hubbard's ibogaine plan.

Hubbard said, "It's important to set the record straight in full public view, lest the fictitious narrative of a smoke-and-mirror smear job generated by a third-rate, agenda-driven political tabloid prevail in the public arena against the integrity and sincerity of all who have offered their time, expertise and visceral lived experiences for all the world to see on behalf of all Kentuckians."

The commission's next regular business meeting is scheduled for 1 p.m. Nov. 14 at 1024 Capital Center Dr., Suite 200, Frankfort.

Thursday, October 19, 2023

East Kentucky Diabetes symposium to be held in Hazard Nov. 3

The inaugural East Kentucky Diabetes Symposium will be held Friday, Nov. 3 in Hazard.

In Kentucky's Appalachian counties, 16% of adults have diabetes, and the five area development districts with the highest mortality rates are in Eastern Kentucky, according to the 2023 Diabetes Report by the state Cabinet for Health and Family Services and the Personnel Cabinet.

The statewide rate was nearly 14%, reflecting the more than 486,000 Kentuckians who had diabetes in 2021. This rate has more than doubled since 2000, and another 12% of Kentuckians are at risk for developing diabetes.

Scheduled speakers at the symposium include:
· Dr. Steven J. Stack, commissioner, state Department for Public Health 
· Barry Martin, CEO, Primary Care Centers of Eastern Kentucky
· Dr. Kristen R. Stakelin, associate chief medical officer for specialty ambulatory services, Barnstable Brown Diabetes Center at UK HealthCare
· Chlodys Johnstone, Barnstable Brown Diabetes Center 
· Kim Bayes, diabetes prevention coordinator at UK King's Daughters Hospital, Ashland

The symposium will be held from 8 a.m. to 4 p.m. Nov. 3 at Primary Care Centers of Eastern Kentucky, 101 Town and Country Lane, Hazard. It is sponsored by Shaping Our Appalachian Region. The $25 registration fee covers all programming and a diabetic-friendly breakfast, lunch, and snacks. Register here.

Wednesday, October 18, 2023

Election prompts a look at Beshear's pandemic restrictions, and Cameron's challenges to them; Kentucky fared better than feared

Gov. Andy Beshear, right, and Dr. Steven Stack, the state’s public-health commissioner, at a news conference in the governor's Capitol suite in May 2020. (Photo by Sarah Ladd, Kentucky Lantern)
By Sarah Ladd
Kentucky Lantern
On March 6, 2020, a Kentuckian tested positive for the novel coronavirus, Covid-19, and Gov. Andy Beshear declared a state of emergency.

The United States had been under a public health emergency for more than a month by then. Five days after Kentucky’s first confirmed case, the World Health Organization said COVID-19 was officially a pandemic.

The NCAA canceled March Madness rather than “contribute to spread” of the virus. The Metropolitan Museum of Art and the Museum of Modern Art shuttered temporarily. NASCAR suspended racing.

We had entered a time like nothing Americans had experienced since the flu epidemic of 1918. In other words, it was “uncharted territory,” said Dr. Paul McKinney, the University of Louisville’s interim dean of the School of Public Health and Information Sciences, in a September interview with the Kentucky Lantern.

Over the next three years, around 2 million Covid-19 tests came back positive in Kentucky. More than 19,000 Kentuckians died.

Beshear issued more orders, including restricting mass gatherings, closing schools and releasing some medically at-risk prisoners.

Now some Republicans are urging Kentuckians to make Beshear a one-term governor based on his handling of the Covid-19 pandemic.

“Andy Beshear has failed us,” says an ad by Republican nominee and Attorney General Daniel Cameron. “He locked our schools and unlocked our jails. We can do better.”

A pro-Cameron PAC is running ads accusing a “criminal coddling governor” of having unleashed dangerous criminals on Kentuckians.

To help voters navigate the criticisms, the Lantern is looking back at the pandemic, a time of economic upheaval, rapidly changing guidance and rampant misinformation.

‘Flying blind’

At the beginning, the response to Covid-19 was “a blunt instrument,” said UofL’s McKinney, “because what could we do at that point? We had no antiviral medications to use, we didn’t have a vaccine. We didn’t have adequate testing; we didn’t have enough (personal protective equipment) to go around. All we had was basically the ability to trace contacts of people who were exposed and to … implement social distancing.”

Tim Veno, CEO of an organization of nursing homes and assisted living facilities in Kentucky, agreed.

“We were pretty well flying blind,” he said. “We had no test or any way to determine who may or may not have had Covid.”

Until the science caught up, social mitigation was the only option.

In March 2020, Beshear, who had been governor three months, issued a variety of recommendations and orders based on guidance from public-health authorities, meant to slow the virus’ spread.

Almost as quickly, Attorney General Cameron began challenging some of the orders in court.

Not all of Beshear’s orders were restrictive. He streamlined the process for out-of-state nurses to work in Kentucky, suspended evictions and expanded eligibility for unemployment benefits.

The unemployment system was quickly overwhelmed by the influx of applications, and people waited months for help. Meanwhile, Louisville’s WDRB reported that Lt. Gov. Jacqueline Coleman texted the head of the Office of Unemployment Insurance to get attention to her hairdresser’s application, as well as that of a “friend of a friend.” The administration maintained that there was no abuse of power.

Beshear also began holding daily, virtual news conferences, broadcast across the state, to share information about the virus. Health experts praised this move, but it rankled some of his political opponents.

And, he encouraged Kentuckians to light their homes green in memory of those lost to Covid-19.

Spring 2020: A ‘somber’ experience

When Beshear recommended that schools close for a few weeks, Louisville high-school freshman Spandana Pavuluri, now 18, remembers thinking the time would be “just like an extended spring break.” Two weeks to catch up on homework, nothing more.

Before the end of March, though, the virus closed all public-school buildings in the U.S., according to Education Week.

The extended remote learning and loss of social connections in a pivotal time of her life “hit me like a truck,” Pavuluri said, describing the time as “somber.”

Her bedroom, where she did school, became a “place of … stress,” not relaxation. The “really social person” was suddenly very alone, a sentiment reflected back to her from other students in research she helped conduct with the Kentucky Student Voice Team.

On top of school closures, in April 2020, Beshear halted elective surgeries so medical staff and supplies could be fully employed in addressing Covid-19. He closed the Natural Bridge and Cumberland Falls state resort parks and suspended overnight stays at other resort parks.

When several individuals sued the state challenging Beshear’s restrictions on interstate travel, Cameron took their side in court. A federal judge in a different case ruled that parts of the travel order were unconstitutional. Beshear lifted it before Memorial Day.

The state shut down visits to nursing homes except in end-of-life situations. Leaders feared that visitors would bring Covid-19 to the most vulnerable.

“That, of course, was devastating to some families,” said Veno, president and CEO of LeadingAge Kentucky.

“After that, we mobilized very quickly in setting up remote communication, iPads and other connected devices so that we could immediately, at least, at the very minimum, allow residents and families to talk via the internet,” Veno said. “Those were all very difficult decisions to make.”

Despite “some political blowback” from those moves, Veno said, “in my view, that action saved lives.”
On churches, did the governor go too far?

After Beshear banned gatherings of more than 10 people, and a religious revival in Hopkins County was linked to at least 28 cases of the virus and two deaths, some churches kept holding in-person services.

Maryville Baptist Church in Bullitt County gathered on Easter Sunday despite the order. The pastor found nails in the parking lot before the service. And attendees found notices placed by state troopers on their windshields telling them to quarantine.

The church and Tabernacle Baptist Church in Nicholasville sued Beshear. As attorney general, Cameron joined their lawsuits.

Two federal district judges ruled that Beshear’s ban on religious gatherings was unconstitutional and that the churches could hold in-person services while observing precautions against spreading the virus. But the 6th Circuit U.S. Court of Appeals disagreed, allowing the restriction on in-person services to stand. The appeals court did block Beshear’s ban on drive-in services.

By then Beshear had agreed to allow places of worship to gather. But many chose to wait. The Rev. Kent Gilbert, pastor of historic Union Church in Berea, told the Lexington Herald-Leader at the time, “No pastor wants to race back to church to do more funerals.”

Todd Gray, the executive director of the Kentucky Baptist Convention, told the Lantern that the denomination’s pastors and church leaders “made their own decisions” about protecting congregants. They “sought to be good citizens working in cooperation with recommendations from the Centers for Disease Control and from Frankfort,” he said.

The theological belief that Christians must gather together also factored into some congregations coming back to in person services “as quickly as possible,” said Gray.

“While most Kentucky Baptist churches sought to cooperate with the governor’s recommendations as much as they could,” Gray said, “most, if not all, believed the governor went too far when he specifically targeted churches while some businesses such as liquor stores remained open.” Beshear's order did not mention churches.

Politicizing a pandemic

In May 2020, angered over the shutdowns, protesters opposed to Covid-19 restrictions hanged Beshear in effigy outside the state Capitol and marched to the governor’s mansion demanding he resign.

Attached to the effigy was a sign with the words “sic semper tyrannis,” Latin for “thus ever to tyrants,” the motto of Virginia, which John Wilkes Booth famously said after shooting President Abraham Lincoln.

Republicans and Democrats alike decried those actions. Secretary of State Michael Adams, a Republican, tweeted at the time that “The words of John Wilkes Booth have no place in the Party of Lincoln.”

There were other protests of the shutdowns and social-distancing and masking measures. Misinformation was rampant, including a claim that the pandemic itself was a hoax. The politicization of the pandemic made it harder for health care workers do their jobs, they said.

“It was extremely difficult for hospitals,” said Deborah Campbell, the vice president for clinical strategy and transformation at the Kentucky Hospital Association.

In early 2021, when vaccines became available, Kentucky gave first priority to health care workers and staff in long-term care and assisted-living facilities followed by those over 70, first responders, K-12 school personnel and child care workers.

Many, including some health care workers, refused vaccination against the virus. Once vaccines were mandated by the Center for Medicare and Medicaid Services, those who refused the shots could no longer work in hospitals, Campbell said.

“It was terribly painful. It was painful for the staff, it was painful for the hospital leadership,” Campbell said,  but precautions did save lives. They also kept hospitals running better than if no mitigation measures had been in place.

Fewer sick people “means more staff were not sick and able to take care of patients in the hospital, which means they got better care, which means they did better,” she said.

Still, health-care workers often bore the brunt of people’s anger.

Some hospital visitors and even patients treated health care workers in a “demoralizing” way, said Campbell. They spit on and cursed them.

“People were threatened. Workplace violence increased in our hospitals, particularly around visitation, and any personal-freedom restrictions,” Campbell said. “Those visitation restrictions were heart-wrenching. But at some point … I think it was pretty clear it was the right thing to do.”

Veno said that in his 20 years working in health care, “I’ve never seen this kind of public reaction, anti-vaccination reaction as I saw with Covid.”

All of this helped feed burnout and exacerbated an already worsening medical workforce crisis.
On the economy

About 18% of Kentucky’s businesses had to close because of a government mandate during 2020, according to the U.S. Bureau of Labor Statistics. That’s similar to the nationwide share of about 19%.

The state designated workers as “essential” and “nonessential” to determine which employers could stay open with more flexibility. Grocery workers, for example, were deemed essential. Jewelry and clothing stores were not.

The designations remain a sore spot for some. Cameron has said he wants to make Beshear “not essential” come Election Day.

The Kentucky Center for Economic Policy reported in May that the state lost 294,900 jobs in just the first two months of the pandemic. Businesses permanently closed left and right. Thousands across the country shuttered.

“In the three years since, Kentucky has experienced a remarkable recovery,” Kentucky Policy said. It reported Kentucky had 53,800 more jobs than before Covid-19 hit the state.

Cameron said in October that, had he been governor at the time, he would not have closed small businesses and health spaces like chiropractor’s offices. He criticized what he called “inconsistency” in Beshear’s decisions.

“There are a lot of small businesses right now that have not been able to recover,” Cameron said. “Several of them closed their doors for good.”

Prisons: a ‘public health failure’

Among other steps to stifle Covid-19’s spread, Beshear closed restaurants to in-person traffic, suspended out-of-state travel for state employees, and stopped prison visits.

Beshear commuted the sentences of 1,870 inmates who were medically vulnerable and who had not been convicted of violent or sexual offenses and were withing six months of their release date.

Cameron and his allies have criticized Beshear’s pre-release vetting. They’ve cited data from the Administrative Office of the Courts that shows about half of 1,700 commutation recipients were charged with another crime by July 2023.

The Courier Journal of Louisville and the Herald-Leader have reported, though, that many of those re-offenders would have been free to commit their alleged subsequent crimes because their original prison sentences would have expired by then anyway. Beshear says they were "the vast majority."

Prison Policy Initiative, a Massachusetts-based national nonprofit that researches criminalization in the United States, reported in April that Kentucky’s overall incarceration population decreased 13% from January 2020 to December 2021. The national average in that perios was 15%.

Wanda Bertram, a communications strategist with Prison Policy Initiative, says the real mistake by Kentucky and most states was not releasing more prisoners — despite warnings that prisons would become “hotbeds for coronavirus spread” and “endanger not just people who are inside and people who are working inside but also the entire community that surrounds the prison.”

Kentucky, like most states, continued to imprison people for technical violations of probation and parole, Bertram said. “We actually did prove that mass incarceration probably added at least half a million Covid cases nationwide in the summer of 2020 alone,” she said.

In 2021, Bertram's group gave states letter grades based on their treatment of incarcerated populations during the pandemic. Kentucky, along with many others, received an F.

“Beshear’s commutations of 1,800 incarcerated people is a bright spot in what, otherwise, I would consider to be a complete public health failure when it comes to protecting incarcerated people and the communities that surround prisons,” Bertram said.

Kentucky had the nation’s third highest rate of Covid infections and deaths among prisoners from March 2020 to June 2021, according to the Marshall Project, which collaborated with The Associated Press to keep track. The numbers are an undercount because inconsistent testing caused infections to go undiagnosed, especially early in the pandemic, according to the report.

During those 15 months, Kentucky prisons recorded 7,909 cases — 6,503 cases per 10,000 prisoners, lower than only Michigan and Arkansas — and 48 deaths, or 39 per 10,000, lower than only Nevada and New Mexico.

Eight state prison staff in Kentucky died of Covid-19, the Department of Corrections said earlier this month.

Learning loss

By the start of the 2020-21 academic year, four states had ordered schools to open in person, but in Kentucky most schools continued remote learning. In November, a deadly “third wave” struck and Beshear announced that public and private K-12 schools would close.

Danville Christian Academy and Cameron challenged the school closing order and won before U.S. District Judge Gregory Van Tatenhove. But the Sixth Circuit U.S Court of Appeals upheld Beshear’s order, saying it treated all schools, religious or otherwise, the same.

The appeals court took note of one of Beshear’s justifications: “Kentucky leads the nation in children living with relatives other than their parents — including grandparents and great-grandparents, who are especially vulnerable” to the virus. The U.S. Supreme Court refused to hear the case.

By early 2021, a year into the pandemic, most Kentucky schools had returned to in-person instruction.

Some research suggests school closures helped keep Covid-19 transmission lower than if the doors had stayed open, but children suffered from the disruption in their education.

Many children suffered learning loss during remote and hybrid classes in 2020 and 2021 across the country, according to a 2022 study at Harvard University’s Center for Education Policy Research.

In Kentucky, reading and math proficiency dropped during the pandemic when comparing 2018-19 assessments with 2021-22 data.

At the time of that October 2022 report, Education Commissioner Jason Glass said “The Covid-19 pandemic has had a profound impact on our students and our schools as they continue to recover from the interrupted learning that occurred over the past two years.”

Cameron has said that should he be elected governor, he will institute a “catch-up” plan with tutoring to bring kids up to speed.

Looking back at her high-school experience, Pavuluri, now a piublc-policy student at Vanderbilt University, says that despite the disruptions in her education, school closures and other restrictions were worth it.

Because her mother is a geriatrician who works with older adults, she felt more empathy toward people at higher risk. “That was always in my mind and Covid was something I feel like I took pretty seriously,” she said. “I didn’t necessarily have someone very … immunocompromised in my family. (But) I think I really … empathize with the students who do.”

“There was obviously … negatives to the experience,” she added, “but I think just the massive negative would have been to … lose someone.”

In 2021, Harvard Medical School researchers found that while most children who contracted Covid-19 were only mildly symptomatic or had no symptoms at all, they could still carry the virus on to others. 

How did Kentucky compare to other states?

Kentucky is famously one of the sickest states — ranked third most unhealthy by Becker’s Hospital Review in January ahead of only West Virginia and Mississippi.

“Everyone had a reason to expect that we would be absolutely devastated” by Covid, said UofL’s McKinney.

Kentuckians suffer high rates of heart disease, diabetes and cancer. And the state’s population is shifting older. All these factors mean a lot of Kentuckians went into the pandemic with at least one “comorbidity” — a pre-existing condition putting them at higher risk for Covid-19 complications and death.

“Among our neighbor states, we were much more vulnerable than almost all of them,” said McKinney.

And yet CDC mortality data, which only includes 2020 and 2021, shows Kentucky’s death rate was lower than Tennessee’s and West Virginia’s, and higher than those of Indiana, Ohio and Virginia.

McKinney credits measures “implemented by the leadership and state” for saving Kentucky lives.

A study published in April in the international medical journal The Lancet took into account age and health when comparing states. and found that Kentucky’s death rate was lower than the national average.

Kentucky’s unadjusted Covid-19 death rate from January 2020 through July 2022 was 472 deaths for every 100,000 residents, higher than the national average. After adjusting for age and comorbidities, the rate was 341 deaths per 100,000 population, lower than the national rate of 372.

The state with the lowest adjusted death rate was Hawaii (147 per 100,000 residents). The highest was Arizona (581 per 100,000).

In April 2020, professors in the University of Kentucky's Gatton College of Business and Economics released research estimating that the state would have been much worse off without social-distancing measures early in the pandemic.

UK did not make those researchers available to the Lantern for this story. At the time, they estimated Kentucky would have had 45,000 Covid-19 cases by April 25, 2020, had the state not closed communal businesses like gyms and restaurants. Instead, the state had around 4,000.

The researchers also estimated that, a month into the pandemic, those actions saved about 2,000 lives.

more comprehensive study by The Royal Society in London examined the effectiveness of non-pharmaceutical interventions like social distancing and mask wearing during across the globe.

The August 2023 report found that social strategies like mask wearing and physical distancing helped reduce virus spread. However, scientists found that this was most true when powerful variants like Delta and Omicron, which were particularly good at evading protective barriers, weren’t spreading.

McKinney asked, “Could they have … relaxed restrictions more rapidly? Could they have … let us get to a normal life faster? That’s a tough call. You have to play it a little bit by ear. And, again, you’re trying to probably err on the side of protection of human life.”

He added, “Everything’s clearer in hindsight. . . . I think that the leadership of both the commissioner of public health and the governor, who worked closely together in implementing policy, the primary concern was preservation of lives.

“Freedom of the population is very important. But if you’re dead, you can’t be free. So if you preserve life first, and then . . . worry about how tight the controls have to be later. I think that was the general plan: to be as tight as possible to hopefully stop the progress of the virus.” 

Lessons for the future

Kentucky’s response to Covid-19 wasn’t perfect, experts say, and there is much the state can learn from it for the future.

For example, Kentucky needs more vigorous respiratory-virus surveillance, automated data reporting and well-maintained stockpiles of personal protective equipment.

The ability to produce vaccines quickly will ease government reliance on social mitigation measures as well, McKinney said.

Kentucky — and the nation — will need to guard against complacency, McKinney said. Although “hopefully” there won’t be another pandemic in the near future, “there’s no guarantee.”

Kentucky also must rebuild its health-care workforce. The pandemic “taxed” health care workers “beyond belief,” said Veno, with LeadingAge. And the staffing challenges this caused continue.

Pavuluri said leaders must keep in mind that students need social connections, mentorship and relationships. Many lacked that during NTI learning and will need it for the next public health crisis, she said.

And, even though the emergency years of the Covid-19 have ended, “staffing remains a huge problem,” said Campbell, with the state hospital association.

“We are incredibly concerned as hospitals and the hospital association about trying to increase the pipeline and retain the staff that we have,” she said.

Before the pandemic hit, she said, there was already a concerning trajectory of an aging nursing workforce. “Then we had Covid, which caused burnout.”

Looking to the future, climate change is a concern.

“Warming of the climate will affect … a lot of disease transmission,” McKinney said. “If winter weather that wipes out the mosquito population every year did not do so, and they survived and thrived and carried something like malaria … throughout that time, it would be … a big concern, obviously, for the nation.”

Covid-19 is shifting more into an annual flu-like nuisance, public health experts have said. People will still get sick, but the science is there to manage large waves.

For now, many facilities are still using universal precautions–like wearing personal protective equipment–during outbreaks. They also use screening tools to keep the spread low.

“Make no mistake about it,” said Veno, of LeadingAge. “We’re still dealing with Covid, and we’re going to be dealing with Covid for quite some time.”

Jamie Lucke and McKenna Horsley contributed to this story.