UK team promotes proper use of antibiotics to help thwart development of bacteria that are resistant to antibiotics

Graphic from The Conversation

By the Antimicrobial Stewardship Team
UK HealthCare Pharmacy Services

In the U.S., more than 2.8 million antimicrobial-resistant infections occur each year. Antimicrobials — a group of essential medications including antibiotics, antivirals, antifungals and antiparasitics — are used to prevent and treat infections in humans, animals and plants.

Antimicrobial resistance happens when germs like bacteria evolve to defeat the drugs that have been designed to kill them. Resistance has the potential to affect people at any stage of life, as well as health care, veterinary and agriculture industries. This makes antimicrobial resistance one of the world’s most urgent public health problems. Antibiotics can save lives when used appropriately to fight off bacterial infections, but they are not always the answer.

Here is some important information about responsible antibiotic use:

• Antibiotics do NOT treat viruses, like those that cause colds, flu, respiratory syncytial virus (RSV) or Covid-19. Other medications, like antivirals, can treat viruses.
• Antibiotics are only needed for treating certain infections caused by bacteria, but even some bacterial infections get better without antibiotics.
• When antibiotics aren’t needed they won’t help you and the side effects could still cause harm.
• If you need antibiotics, take them exactly as prescribed. Talk with your health care providers if you develop side effects or have questions about your antibiotics.
• Do your best to stay healthy and keep others healthy. This helps reduce antibiotic use and fights antimicrobial resistance.

What should you do when you feel sick?

• Contact your primary care provider.
• If you have been prescribed an antibiotic, take it the way it has been prescribed to you.
• Keep yourself and others around you healthy by washing your hands with soap and water for at least 20 seconds or using hand sanitizer containing at least 60% alcohol, covering your mouth and nose with a tissue when you cough or sneeze, staying home when you are feeling under the weather, and getting all recommended vaccines like the yearly flu vaccination.

For more information, follow the Centers for Disease Control and Prevention’s initiative, Be Antibiotics Aware: Smart Use, Best Care at www.cdc.gov/antibiotic-use/index.html.

About UK HealthCare's antimicrobial stewardship

At UK HealthCare, a dedicated team of pharmacists and physicians are fighting the battle against drug-resistant infections every day. The antimicrobial stewardship team is committed to overseeing the type, dose and duration of antimicrobials our patients receive to ensure the best possible clinical outcomes.

The mission of UK HealthCare’s antimicrobial stewardship program is to optimize antimicrobial use to improve clinical outcomes and decrease the spread of resistance.

“The antimicrobial stewardship team is on clinical services, so we evaluate patients and provide guidance on the right dose and duration of antibiotics through the ID-consult service,” said Donna Burgess, pharmacy coordinator of the antimicrobial stewardship program. “If antibiotics are not needed, we are able to discontinue use in order to decrease antibiotic resistance and protect patients from potential side effects.”

USA Today reports on its analysis of Covid-19 deaths in nursing homes last winter, with a focus on Trilogy Health Services

Some Trilogy Health Services residents who died of Covid-19 (Photos contributed to USA Today)

USA Today recently published its findings from an in-depth analysis that looked at Covid-19 nursing home deaths during the 2020-21 winter surge, with a focus on one company that had twice the national average of deaths for nursing homes and has as many as 20 facilities in Kentucky. 

The year-long analysis was done by Letitia Stein, Jayme Fraser, Nick Penzenstadler and freelancer Jeff Kelly Lowenstein. It was published mid-March as a series of  stories, titled "Dying for Care."  

USA Today says, "In a first-of-its-kind analysis, they identified nursing-home ownership webs invisible to consumers. They scored the performance of every nursing home in America to probe questions of corporate responsibility left unanswered by government regulators and dozens of research papers on the pandemic's 140,000-plus nursing home deaths."

The series opens with pictures of people who died in nursing homes of Trilogy Health Services, found to have the "highest death rates reported by any large nursing home chain at the height of the pandemic."  

The analysis found that residents in Trilogy's 115 homes died of Covid-19 last winter at twice the national average for nursing homes, based on figures facilities must file weekly with the federal government. 

After being presented with USA Today's findings, the company told the newspaper that it had mistakenly reported hundreds of deaths during the surge and offered a revised tally that reduced the count by more than 40 percent, but it declined to provide documentation of those claims. It has since "filed new numbers with the federal government and hired a consultant to help it review its death count," the newspaper reports. 

But even with those lower numbers, the paper found Trilogy's Covid-19 death rates were "well above the national average" during the winter surge. 

The paper's analysis found that the deaths were not driven by residents who were older or more fragile, and could not be explained solely by the company's presence in states hard-hit by the virus. An unusual distinction was that Trilogy had been acquired by a company specializing in real estate in a test of a business model new to large nursing-home chains. 

The analysis found that "millions of dollars continued to flow from Trilogy to a California-based real estate venture busy preparing its next investment pitch – a stock listing expected to launch this year." 

The story digs into the business model behind these nursing homes and their efforts to increase profits, including staff cuts. It says Trilogy "went further than any other major chain in shrinking care hours delivered to residents before the pandemic," that "half of its facilities were cited by health inspectors for violating Covid-19 safety rules in 2020" and that "Trilogy's poor Covid outcomes stood out by measure after measure." 

The company divided its facilities "into red, yellow and green zones to limit exposure to the virus," the story says, but "Eyewitness interviews and the reports filed by health inspectors indicate this safety regimen was often a charade." The story also includes interviews with families of those who died. 

The series also includes short stories about some of the Trilogy residents who died and another includes a video of families reflecting on their loss. In addition, there is a link to share the story of how you lost a loved one in a nursing home due to Covid-19. 

Also in the USA Today "Dying for Care" series: 

The reporters break down their findings into four key things to know about their investigation into nursing home failures during Covid-19, including why Trilogy stood out, impact of staffing on care, impact of ignoring safety lapses pointed out in inspections, and impacts from the real-estate business model. 

In response to the story, federal nursing home regulators have said they need to collect better information about real estate ownership model's like Trilogy's, they report. Further, President Joe Biden  proposed reforms in February that would track problem owners across states  and shed light on Wall Street profits from nursing homes. 

The analysis revealed ownership webs invisible to consumers and said "problems across chains eluded federal officials overseeing nursing homes, who were focused on individual facilities during the pandemic." 

A story by Fraser walks through the details of how they did the analysis. She writes that USA Today took a closer look at nursing-home performance in the winter surge from October 2020 to February 2021 because half the nation's 140,000 Covid-19 deaths in nursing homes happened during that period, "months after best practices were established and federal aid issued for coping with the coronavirus." 

Another story, written by Penzenstadler, offers a guide to choosing the right nursing home for a loved on in three steps. 

Penzenstadler also explores the question, "When does a nursing home Covid-19 death count?" 

There is also a section that allows you to look up nursing-home ratings from the analysis and see how they fared during the pandemic's winter surge, 2021-21. 

There are no Kentucky data in the spreadsheet; USA Today reports there are 13 Trilogy Health Services facilities in Kentucky, but its website lists 20: Cooper Trail Senior Living in Bardstown; Cedar Ridge Health Campus in Cynthiana; Walker's Trail Senior Living in Danville; The Willows at Harrodsburg; The Springs at Oldham Reserve in La Grange; The Willows at Citation in Lexington; The Willows at Fritz Farm in Lexington; The Willows at Hamburg in Lexington; Forest Springs Health Campus in Louisville; Franciscan Health Care Center in Louisville; Glen River Health Campus in Louisville; Park Terrace Health Campus in Louisville; The Legacy at English Station in Louisville; The Springs at Stony Brook in Louisville; The Willows at Springhurst in Louisville; Westport Place Health Campus in Louisville; Sanders Ridge Health Campus in Mt. Washington; Calumet Trace Senior Living in Owensboro; Shelby Farms Senior Living in Shelbyville; and Boonesboro Trail Senior Living in Winchester. 

Masks can prevent Covid-19, and there ways to make them more effective; claim that they trap excess carbon dioxide is false

Photo by Kemal Yildirim, Getty Images

Wearing a face mask can help prevent the spread of Covid-19, ad certain mask combinations and modifications can increase a mask's effectiveness.

A study led by researchers from the National Institute for Occupational Safety and Health looked at how efficiently different mask types, combinations, and modifications blocked respiratory aerosols like those that carry the coronavirus. The study involved humans and simulator mannequins in various experiments to simulate coughs and exhalations to see how well aerosols were blocked.

The study found that layering a three-ply cloth mask over a medical mask (double masking) or securing a medical mask with an elastic brace provided the best protection. Using earloop toggles or an earloop strap, or knotting and tucking the mask, also increased performance as compared to medical masks without modification. Two other modifications, crossing the earloops or placing a bracket under the mask, did not increase performance. The study is published in the peer-reviewed American Journal of Infection Control.

“Since the start of the Covid-19 pandemic, there has been considerable confusion about the most effective use of face masks, especially among the general public, to reduce the spread of infection,” said Ann Marie Pettis, president of the Association for Professionals in Infection Control and Epidemiology. “The NIOSH study findings are important and timely because they identify specific, practical combinations of face masks and mask modifications that may improve mask seal and thereby measurably reduce the expulsion of infectious aerosols into the environment.”

A claim that masks trap dangerous levels of carbon dioxide is false, medical experts say. "Wearing a mask does not raise the carbon dioxide (CO2) level in the air you breathe," says the Centers for Disease Control and Prevention. "A cloth mask does not provide an airtight fit across the face. The CO2 completely escapes into the air through the cloth mask when you breathe out or talk. CO2 molecules are small enough to easily pass through any cloth mask material. In contrast, the respiratory droplets that carry the virus that causes Covid-19 are much larger than CO2, so they cannot pass as easily through a properly designed and properly worn cloth mask."

As Kentucky's pandemic numbers catch up with the holiday weekend, they jump; state's positive-test rate is now 8.31%

State Dept. for Public Health map, adapted by Kentucky Health News; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

Kentucky's coronavirus metrics took another jump Tuesday, with new cases and the share of Kentuckians testing positive up, and the fallout from that reflected in hospitalizations and deaths. 

The state reported 2,558 new cases, bringing its seven-day rolling average to 1,469 per day. Tuesday's number was likely inflated due to delays in testing and reporting over the holiday, but that said, it is the highest one-day new-case number since Oct. 7. Of today's new cases, 25% are in people 18 and younger. 

The share of Kentuckians testing positive in the past seven days went up again, to 8.31%, maintaining a a steeper rate of climb that began last week. 

The state's seven-day infection rate is 29.41 daily cases per 100,000 residents, up from 27.84 on Monday. Counties with rates more than double that rate were Carroll, 73.9; Powell, 69.4; Cumberland, 64.8; Harlan, 61.5; and Robertson, 61. Seventy-three of the state's 120 counties have more than 25 cases per 100,000 residents, labeled a high level of transmission and showing red on the state infection map.

Hospital numbers also jumped. Kentucky hospitals reported 930 Covid-19 patients, an increase of 71 from Monday. That was the largest one-day rise since Sept. 8; both days followed holiday weekends in which hospital admissions may have been delayed. (Hospital numbers are recorded at midnight.)

The number of Covid-19 patients in intensive care grew by 25, to 266; and those on mechanical ventilation went up 11, to 122.

Eight of the sate's 10 hospital readiness regions are using at least 80% of their intensive-care beds, with two over 90%: Northern Kentucky (96.25%) and Barren River (95.35%). 

The state reported 30 more Covid-19 deaths Tuesday, bringing the pandemic death toll to 10,943. 

The Hopkinsville Art Guild memorialized seven people who have died from Covid-19 with portraits, each of them with a connection to Western Kentucky and most of them from the Hopkinsville area, Jennifer P. Brown reports for the Hoptown Chronicle. 

Other pandemic news Tuesday: 

U.S. District Judge Gregory F. Van Tatenhove of Lexington issued a preliminary injunction Tuesday effectively blocking implementation of President Biden's Covid-19 vaccine mandate for federal government contractors and subcontractors, Austin Horn reports for the Lexington Herald-Leader. The order came in response to a challenge from Attorney General Daniel Cameron, who joined other state attorneys general in the challenge. 

Van Tatenhove "said that the question before him was a narrow one: whether or not Biden had the authority to impose vaccines on the employees of federal contractors and subcontractors," Horn wrote, quoting the judge: “In all likelihood, the answer to that question is no.”

An independent advisory committee to the U.S. Food and Drug Administration narrowly endorsed the first antiviral pill developed by Merck & Co. for Covid-19, called molnupiravir. The vote was 13-10, with some members voicing concerns over the drug's potential impact on people of childbearing age and concerns over whether the drug could drive mutations of the virus, The Hill reports.

Merick said the drug, which is administered as a five-day treatment, showed a 30% reduction in hospitalizations and deaths, based on data from 1,433 patients, The Hill reports.

As virus mutations pop up around the world, there may be a silver lining: a single vaccine or booster shot may thwart them all

Dr. Kevin Kavanagh

By Dr. Kevin Kavanagh
Republished from Infection Control Today

This morning I awoke to a report from Public Health of England that the United Kingdom variant of SARS-CoV-2 has mutated again, and now it may be resistant to monoclonal antibodies along with possibly making the vaccines less effective. The UK variant developed the same mutation that the Brazilian and South African variants use to evade the body’s immune system.

This news comes after a long line of setbacks. I was hoping that the pandemic would go away in the summer after the lockdown. Then we had the severe surge in August which was to be the last; only being dwarfed by cases and deaths in our “dark” winter. Finally, there was a glimmer of hope, life-saving vaccines were becoming available and shots were going into arms. Even if the initial vaccines required 2 shots, it was worth it. But the virus struck back and mutated, making taking a booster necessary.

Now this, the same vaccine-evading mutation is popping up all over the world, making the availability of booster even more urgent. But in this news, there may be a silver lining.

So how is there good news? Simply the fact that three different viruses with three different lineages came up with the same mutation to evade natural immunity and the vaccines. And initial reports are that it only partially evades the vaccines, they will still be effective. Thus, this is not even an optimal mutation.

In order to evade the vaccines and the body’s immunity, the virus has to evolve a mutation which will prevent a myriad of different antibodies from attaching and killing it while at the same time still be able to attach to the ACE2 enzyme receptor site. This is a tall order.

The fact that all three of these lineages came up with the same mutation, means that a single vaccine or booster shot may be able to neutralize, or at last have some activity against all of these strains.

And one needs to ask, why did these viruses not come up with different mutations? After all, they do not plan the mutations; they evolve by random chance. Maybe the answer is that this random amino-acid combination is possibly the last major mutation the virus can produce without changing its ability to enter the cells or its infectivity. Yes, there was MERS and SARS, so it is possible to see another iteration of this virus, but MERS and SARS were much more lethal, asymptomatic carriage was not common and these epidemics burned out, they were easier to control.

So, after a long string of disappointments and bad news, maybe this is the beginning of the end, and if we do see another even greater surge caused by these variants, maybe that will be the last if we all get vaccinated. And of course, we do not have to wait for a “booster” to the Pfizer and Moderna vaccines. If we all follow public health advice by wearing masks and social distancing, we have the power to stop future surges from taking place.

Kevin Kavanagh is a retired physician in Somerset and founder of Health Watch USA, which focuses on infection control in health care.

Beshear issues mask order, blasts judge and attorney general for order requiring his orders to be more specific, vows appeal

Beshear played a video of Coach John Calipari endorsing the wearing of masks. He said Calipari volunteered.

This story is being updated.

By Al Cross
Kentucky Health News

Gov. Andy Beshear issued an emergency order Thursday requiring Kentuckians to wear face coverings in public to prevent a growing spread of the coronavirus.

"You can think there’s some liberty component, but that ends when you put the health and safety of someone else at risk," Beshear said near the end of a Capitol-rotunda briefing at which he announced and explained his decision.

He said he acted because of an increase in cases (with 333 more reported in the state Thursday, its seven-day rolling average spiked to 315 from 211 in just six days) and "watching what happens when people didn't act quickly enough across the country."

He compared Kentucky to Arizona, which had a similar number of daily cases two months ago but is  now running out of hospital beds. "That’s what happens when this virus gets away from you," he said. "We can’t wait until we are getting thousands a day."

Covid-19 hospitalizations and intensive-care cases in Kentucky remained steady Thursday, but recent increases have left only 26 percent of ICU beds available, and "They can get eaten up real quickly if you let your covid numbers get away from you," the governor said.

Kentucky Health News chart; hospital data for most weekends unknown. For larger version, click on it.

Beshear's order takes effect at 5 p.m. Friday. It requires a mask or other face covering indoors or outdoors "where it is difficult to maintain a physical distance of six feet from all individuals who are not members of that person's household," or while in, or waiting for, public or hired transportation.

It has several exceptions, including children under 6 and people who can't safely wear masks. It says violation "must result in loss of access to a business's services," making businesses the front-line enforcers.

Beshear said enforcement will ultimately depend mainly on local health departments, but he said the state and national lobbying groups for retailers asked for the order. "We have 'No shoes, no shirt and no service'," he said, citing a familiar sign. "It's now 'No mask, no service'."

The governor said enforcement would start with warnings, but businesses that fail to enforce the rule could be fined or shut down. He said the latter option would apply to an unnamed Western Kentucky restaurant where he said employees did not wear masks last weekend.

Restaurant customers will be required to wear masks except when eating or drinking. He said that rule in bars would "go a long way," but he will meet with bar owners Friday to talk about "what other steps they could take to prevent congregation. . . . I want to give them the opportunity to stay open if they're willing to do the things they need to."

Beshear said he had hoped to avoid issuing the order, “but it’s time to get serious. It's time to stop our escalation now. It's time to push these numbers back down to a reasonable plateau.”

Without that, he said, "We will have to roll back parts of our reopening . . . We probably will have problems reopening schools." He suggested his order would overcome resistance to the state guideline for masks in schools. "If parents wear a mask in public, their kids are gonna wear a mask in school," he said.

The order is effective for 30 days, during which "I want to see how well we can do," Beshear said, adding that he would based future acts on numbers of cases, the positive-test rate and hospital capacity. "I believe if we all embrace this, we could even eventually see a decline," he said.

At another point, he said perhaps 20 percent of Kentuckians resist masks due to "personal pride or some belief that we have liberty to spread this thing to others and therefore shouldn’t have wear something like this." He said the test would be whether "we truly care about each other and our economy . . . put those feelings aside, and serve the greater good."

"Is it too much to ask? I don’t think so."

He noted science showing that masks protect both the wearers and those around them from the virus: "If you weren't willing to do it for other people before, I hope you're willing to do it for yourself and your family now."

Health Commissioner Steven Stack said, "Because you stayed healthy at home Kentucky's not at the bottom of the pack in public health; it's at the top. If you don’t keep up the simple things we’re now asking of you ... it'll all be undone. . . .All we’re asking you to do is a simple act of kindness."

Courts and politics: Beshear said he would appeal to overturn a temporary restraining order from Scott Circuit Judge Brian Privett telling him not to issue or enforce any more emergency orders unless he states "the emergency that requires the order, the location of the emergency, and the name of the local emergency management agency that has determined that the emergency is beyond its capabilities."

Privett issued the order in a lawsuit filed by Evans Orchard & Cider Mill of Georgetown, seeking relief from Beshear's limits on attendance at the agri-tourism facility. The injunction bars Beshear from enforcing any emergency order against the business "or any of the 547 other such registered facilities.

Attorney General Daniel Cameron, who joined the lawsuit, announced the ruling in a press release: “The governor cannot issue broad, arbitrary executive orders apart from the requirements of state law. . . . This is a clear win for the rule of law and will help Kentucky families and businesses across the commonwealth who have suffered and continue to suffer financial losses and economic hardship because of the governor’s executive orders.”

Beshear said the order from "Judge Whatshisname" was "absolutely irresponsible," and he also lit into Cameron: "This shouldn’t be political, and it all seems to be; the attorney general in Kentucky is the only AG in the country suing the governor over these restrictions."

After Beshear's briefing, Agriculture Commissioner Ryan Quarles issued a release saying in part, "The process has not treated everyone the same. Why do well-connected amusement parks with lobbyists get to talk to the government, but mom-and-pops get ignored?"

In other covid-19 news Thursday:

• Beshear reported four more deaths from covid-19, raising the state's death toll to 612. The
  fatalities were a 93-year-old woman from Clark County; a 79-year-old man from Edmonson County; a 94-year-old man from Knox County; and a 61-year-old man from Pike County.
• Counties with more than 10 new cases were Jefferson, 86; Fayette, 42; Daviess, 15; Warren, 13; Bell, 12, and Boone, 11. Beshear said people in Bell County "will tell you how quickly you can got from having just a handful of cases to a significant number just in the last three or four days."
• The U.S. reported more than 60,000 new coronavirus cases Wednesday, the biggest increase ever reported by any country in a single day. Tennessee and West Virginia both had record daily increases, and infections are rising in 42 out of 50 states, Reuters reports.
• Beshear warned against vacationing on a beach in Florida, which is a covid-19 hotspot: "You’re likely to bring covid back, and it will hurt your community."
• He urged Kentuckians to get tested for the virus: "If you are regularly in contact with other people it’s time to get tested."
• Some test providers and insurers have required an order from a clinician for a test, but Stack said the state has issued an order banning such requirements.
• The Atlantic explores why daily covid-19 deaths in the U.S. are a fourth of their April peak, even as cases rise: There can be lags between the date a person dies and when that death is reported; expanded testing also helps find more cases, which tend to be milder; the average patient is now younger and less likely to die; hospitals are more prepared and less overrun; and some studies show summer temperatures might be helping.
• A horse named Fauci won a race at Keeneland Race Course. The 2-year-old colt's owner, a fellow Italian American, named him for Dr. Anthony Fauci, the nation's top infectious-disease specialist.