Closed hospitals in Ky. border counties in Va. and W.Va. are reopening, one as part of a chain, one bought by a local clinic

Its old slogan: "Your Friends on the Hill." (HD Media photo)

"Rural hospitals must leverage the full resources of their communities in order to survive." That's the "most critical" lesson learned from last year's closing of Williamson Memorial Hospital in West Virginia, Taylor Sisk writes for National Geographic in a well-illustrated story about hospital closures in Appalachian counties bordering Kentucky.

The hospital is "scheduled to reopen, most likely in the fall," Sisk reports. It has been bought by the Williamson Health and Wellness Center, "a federally qualified health center that over the past few years has been a catalyst in the community for a wide range of public health initiatives" in a county ranked the state's second unhealthiest. But keeping people healthy also keeps them out of hospital, so "The health of the community and viability of its hospital will be dependent on a successful symbiosis."

The solution to the hospital's problem is not typical, but could provide a lesson to rural communities at a time when rural hospital closures are accelerating and one in five rural hospitals have been estimated to be at risk of closing due to financial difficulties.

"In some cases, the answer is the merging of hospitals or acquisition by an outside entity, solutions that offer economy of scale—purchasing power, consolidated administration, access to advanced technology—but come at the risk of the loss of attention to the community’s needs and concerns," Sisk writes. "The other option, maintaining an independent hospital, is increasingly difficult. Doing so requires rethinking."

There's another unusual aspect to the Williamson hospital, which once billed itself as "Your Friends on the Hill." Sisk notes, "There’s another hospital just a couple of miles from Williamson, across the Tug Fork [of the Big Sandy] River in Kentucky," Tug Valley ARH Regional Medical Center in South Williamson. "But crossing state lines creates issues with insurance, both public and private. The closest in-state hospital is 35 minutes away in Logan. Neither hospital is home to 'Your Friends on the Hill'."

Sisk also looks at the closed Jellico Medical Center on the Kentucky border in Tennessee, which has had more hospital closures, population-wise, than any other state; and at Lee County Community Hospital, at Virginia's western tip, which reopened July 1 "under ownership of the region’s new health-care behemoth, Ballad Health. Ballad is the product of the merging in 2018 of two hospital systems—Mountain States Health Alliance and Wellmont Health System. They were competitors in southwest Virginia and eastern Tennessee, an arrangement most health-care observers in the region agree was impractical. In exchange for approval of the merger, the hospital systems signed agreements with Tennessee and Virginia regulators committing to addressing persistent public-health concerns. Ballad selected as its primary areas of focus substance misuse, tobacco use, obesity, and childhood trauma."

Coronavirus cases decline, but more nursing homes are infected, and Kentuckians' behavior and attitude worry health officials

Kentucky Health News chart shows daily cases and the trendline for the last two weeks.

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

Amid an encouraging decline in Kentucky coronavirus cases, the number of nursing homes with cases took a big jump, and unhealthy behavior and lack of testing signups made officials worry.

The state confirmed 141 new cases Sunday, 122 Monday and 117 Tuesday, reversing last week's slight uptick and accelerating the downward trend over the last two weeks, the period that federal officials say state officials should watch as they reopen their economies.

Weekend numbers are often reduced by limited reporting, but the Lexington Herald-Leader reports the latest three-day average was 127, the lowest since April 17. The number of deaths has also declined, to only three in the last three days, raising the state toll to 394.

“These are some of the lowest daily numbers we have seen,” Gov. Andy Beshear said. “But that is fragile, and with a disease that can so easily spread we have to want and put into action our desire to continue to see that downward movement.”

The bad news is that 26 more long-term-care facilities have had at least one case of the coronavirus, bringing the total to 105, and one had a major outbreak.

Health Secretary Eric Friedlander said 39 residents and 20 employees tested positive over the weekend at Nazareth Home Clifton in Louisville, sending 37 residents to hospitals because there was not enough healthy staff to care for them. The state is providing staff support while the employees recover.

"We're going to see this probably again in Kentucky and we will have plans in place and we will respond aggressively," Friedlander said.

Health Commissioner Steven Stack said the evacuation was the state's largest to date, taking four hours and involving six local hospitals.

The 101-bed facility had requested facility-wide testing after several residents began to show symptoms of covid-19 last week, and had previously reported only one resident with the virus, Bailey Loosemore reports for the Louisville Courier-Journal. 

The state is working to test every resident and staff person at these facilities, an effort that Stack said will take several months. Friedlander said the state has done at least 11,000 tests in facilities, with a few thousand more scheduled in the next few days.

Since Friday, a total of 54 residents and 27 employees tested positive, raising those numbers to 1,170 and 547, respectively. He said there had been three new deaths "going back," for a total of 215 resident deaths, plus two staff deaths from the virus. Click here for the daily update.

So far, at least 193,576 tests have been done in Kentucky. The governor's daily news release said the testing rate in the past week was 138 per 100,000 residents, well above the recommended rate of 100 per 100,000. Click here for information on how to register for testing at more than 70 locations throughout the state.

Beshear once again implored Kentuckians to get tested, noting that the numbers at the free drive-thru sites sponsored by Kroger were disappointing, especially in Bowling Green, where only 206 signed up to be tested Tuesday, 84 on Wednesday, 39 on Thursday and 22 on Friday. The capacity at each site is typically 400 per day.

"We have a major outbreak in Warren County that our testing can help us identify and control, but you -- you've got to go in and you've got to get tested," Beshear said.

He also pointed out that the Kroger site in Henderson, near an area with many cases, had tested only 24 people Tuesday, with only 21 signed up for tomorrow and seven on Thursday.

"Folks, this is real. It is in this part of the state. We need you to take advantage of this. This is about protecting your community," he said.

In another worrisome moment, Stack showed a video of a Lexington bar/restaurant crowded with people and warned that the virus is easily spread in large gatherings, especially where people are talking loudly.

"The evidence is absolutely overwhelmingly clear that a small number of large events or a small number of a lot of people getting together with one or two infected folks spreads this thing like wildfire," he said. He later added, "I don't know what it will take for us to learn that this is not a game, that this is serious."

Beshear added that the bar was not ensuring a safe environment and said, "I wouldn't go there, and I won't go there, and you shouldn't either, because if we are not going to enforce social distancing in places, they are not safe."

Stack also talked about the importance of wearing masks to decrease the spread of the virus, though they can be a nuisance.

“This infection has taken a horrible toll on humanity, and unfortunately it will continue to take a toll until we find a vaccine and a way to prevent this," he said. "Until we find a treatment or we can cure it, we are left with old-school, old-fashioned public-health measures which we know work, but are difficult to implement because they require us to make sacrifices -- sacrifices that protect us and the people we love and care about, but also sacrifices that protect other people who rely on us."

Beshear, as he wrapped up talking about the Sunday protest that ended with him being hung in effigy, said as he redonned his mask, "After everything that has happened this weekend, do we still think it is too much to wear a  mask? To protect our fellow human beings? I wear it to protect my family. I think other people should wear it to protect theirs."

In other covid-19 news Tuesday: 

• Beshear said Tuesday's deaths include an 85-year-old woman from Adair County, a 63-year-old man from Allen County and a 72-year-old woman from Jefferson County. He encouraged everyone to turn on green lights, as he and his family would at the governor's mansion, saying, "We show compassion there, not anger. We show love there, not hate."
• Beshear said 489 patients are hospitalized with covid-19, including 78 in intensive care. He said at least 3,115 Kentuckians have recovered from the virus. Click here for the daily summary. 
• The counties with the highest number of new cases over the last three days were Jefferson, 146; Shelby, 41; Warren, 30; Fayette, 26; Kenton, 10; and Logan, 10. 
• In an Appalshop Twitter post Dr. James Brandom Crum, a diagnostic radiologist in Pikeville, warns coal miners with black lung or chronic lung disease about how dangerous covid-19 could be for them, and asks them to self-isolate as much as possible, wear a mask and make sure those around them are doing all they can to protect them, because they could have the virus without symptoms. "Miners, let people help you," he says. "Isolate yourself, let people go to the store for you, so you can stay away from people 'til this thing is better under control." 
• Norton Healthcare plans to open a "first of its kind, permanent drive-thru and walk-up facility" in the fall, WDRB reports. Services will include vaccines, covid-19 testing, flu, strep, EKG and minor x-rays. 
• The state Department of Public Advocacy, which provides public defenders, is concerned about their health and that of others in the system if courts resume in-person hearings too soon. Some courts plan to do that June 1, DPA says in a news release. It says that was not the intent of a May 15 Supreme Court order saying trial courts could on June 1 “resume hearing civil and criminal matters using available telephonic and video technology to conduct all proceedings remotely." Public defenders often represent multiple defendants in one court session.
• ProPublica "scoured the latest research and talked to seven infectious disease and public health experts" to report on the latest information parents need to know about coronavirus as children return to day cares and camps. Beshear has said small, in-home child cares can open June 8, with some center-based programs and day camps allowed to open on June 15

As black lung surges in Appalachia, so do lung transplants

A new study published in the American Journal of Industrial Medicine shows that, as black-lung cases have surged in the Central Appalachian coalfield, so have lung transplants. The expensive surgery can be risky, and most transplant recipients die within five years. The study, conducted by researchers from the National Institute for Occupational Safety and Health, "found that 62 black lung patients had lung transplant surgery over the past two decades, and most of the miners lived in Kentucky, Virginia, and West Virginia," Benny Becker reports for Ohio Valley ReSource. "The study also found that more than two dozen patients were placed on a wait list for transplants. Of those, 11 died while waiting."

The study's lead author, David Blackley, said that the rate of lung transplants for black-lung patients increased nearly threefold in the last decade. "That suggested pretty strongly to us that this is a problem that's getting worse," he told Becker.

Insurance from coal companies and other private sources paid for about one third of the lung transplants. Nearly two-thirds were paid for with public insurance, including 26 percent paid for by Medicare and up to 24 percent paid for by the federal Black Lung Disability Trust Fund. "That fund has paid more than $45 billion to cover benefits for miners who can’t seek benefits from their employer, because the responsible company has either gone bankrupt or can’t be identified," Becker reports. A federal study is looking into how long the fund can stay solvent given the rise in cases.

The researchers who conducted the study had also recently discovered that the spike in late-stage black lung in Central Appalachia is the largest cluster of the disease ever recorded.

Black lung affects Kentucky surface miners more than those in other states, CDC study finds and Courier-Journal reports

Photo by Getty Images.

Nearly 4 percent of surface coal miners who work in Central Appalachia who were tested for a study by the Centers for Disease Control and Prevention have black lung disease, compared to 2 percent of all U.S. surface miners and 3.2 percent of underground coal miners.

Though the study didn't test Kentucky separately from the 14 other states assessed, Laura Ungar of The Courier-Journal in Louisville asked about it and found that "13 of 230 Kentucky surface miners tested — or 5.7 percent — had black lung," she reports, quoting Cara Halldin, a CDC epidemic intelligence service officer, as calling that number " a disproportionate burden."

It's not clear why the incidence is higher in Central Appalachia than other parts of the country, but Halldin suspects it has to do with "more years spent mining, area geology or the safety culture at mines," Ungar reports. One study showed miners who work in Central Appalachia typically work 28 years in the mines while non-Appalachian miners work average 20 years.

Black-lung disease, or coal workers' pneumoconiosis, is the result of miners repeatedly inhaling the dust that comes from extracting coal. That dust occurs whether the miner is under- or above-ground. "Coal mining is really, really dusty. Don't matter what you do, you're in the dust," said John Bud Ritchie, a retired surface miner who has black lung disease. "It's real rough. You can't hardly keep the dust down on hot days."

The federal exposure limit for "respirable dust" in underground and surface mines is 2 milligrams of coal dust per cubic meter of air. That limit was set in 1969, along with a law that set up "a surveillance system for assessing prevalence of black lung among underground coal miners," Ungar reports. "But the requirement for surveillance doesn't extend to surface miners." Haldin said, "Industry should recognize this is a problem and their workers are at risk and bring down the levels." (Read more)