ED visits, hospitalizations for respiratory disease decline in state

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

Kentucky's influenza levels remain elevated, but are declining, and hospitalizations for overall respiratory illness are moderate and declining, according to the state Department for Public Health.

In the week ended March 9, emergency-department visits for the three main respiratory diseases showed a 16% drop in visits for Covid-19, flu and RSV, to 2,734. Of those, 79% of the visits were attributed to the flu. 

Hospital admissions for the diseases dropped 28% in the week ended March 9, to 387. Of those admissions, 216 were for the flu, 154 were for Covid-19 and 17 were for RSV (respiratory syncitial virus).

In the week ended March 9, 10 Kentucky counties had a Covid-19 hospital admission rate between 10 and 19.9 admissions per 100,000 people, a rate that is considered "medium" by the Centers for Disease Control and Prevention. 

Those counties were McCracken, Marshall, Lyon, Livingston, Hickman, Graves, Crittenden, Carlisle and Ballard, in West Kentucky, and Letcher, on Kentucky's southeastern border.

The state reported 2,762 laboratory-confirmed cases of the flu in the week ended March 9 and 1,605 lab-confirmed cases of Covid-19. Both of these numbers have dropped for four weeks in a row. 

Since the flu season began in October, the state has recorded 439 Covid-19 deaths, 110 flu deaths and two co-infection deaths, both reported in recent weeks. One Covid-19 victim and one flu victim were children.

Emergency-department visits and hospitalizations for respiratory illness in Kentucky were down slightly from last week's uptick

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

While still considered high, Kentucky hospitalizations for respiratory disease dropped 15% in the week ending Feb. 17 after increasing in the previous week. 

The state Department for Public Health's weekly respiratory-illness report says 454 Kentuckians were hospitalized during the week, with big drops in all three respiratory viruses the state tracks -- flu, Covid-19 and respiratory syncytial virus (RSV). 

However, even with an 11% drop in Covid-19 hospitalizations, 15 Kentucky counties had a Covid-19 hospitalization rate between 10 and 10.9 per 100,000 people, considered an elevated or medium rate by the Centers for Disease Control and Prevention, and four Kentucky counties continued to have high rates of Covid-19 hospitalizations: Elliott, Menifee, Morgan and Rowan, all with rates of 21.2 per 100,000. 

The counties with medium rates of Covid-19 hospital admissions were Pike and Letcher, in far eastern Kentucky; Daviess, McLean, Ohio and Hancock, in western Kentucky; and Ballard, Carlisle, Crittenden, Graves, Hickman, Livingston, Lyon, Marshall and McCracken, in far west Kentucky.

Emergency-department visits for respiratory illness in Kentucky dropped 4% in the week ended Feb. 17, to 3,481. The biggest drop was among patients with RSV (down 27%), followed by a drop in Covid-19 visits (down 12%). 

ED visits by 5- to 17-year-olds leveled off, largely because flu visits, while still high, leveled off. During the week, 880 children in this group visited EDs for flu. 

Both flu and Covid-19 saw slight drops in laboratory-confirmed cases in the week ended Feb. 17. Lab-confirmed flu cases dropped to 3,860 and lab-confirmed Covid-19 cases dropped to 2,430. 

Since the respiratory-illness season began the first week in October, 361 Kentuckians have died from Covid-19, and 51 from the flu, according to the health department. One Covid-19 victim and one flu victim have been children. 

It's important to remember that flu and Covid-19 related deaths are reported in the week they happened, which can create an uptick in these numbers on any given week even though the deaths did not happen in that week. 

For example, this week's report shows an increase of 34 Covid-19 deaths and an increase of 23 flu deaths over the last report even though no new deaths were reported in the week ended Feb. 17.

Respiratory illness in Ky. resurged in the week ended Feb. 10, with 5-to-17-year-olds having an 84% jump in ED visits for the flu

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

After weeks of overall decline, three major respiratory illnesses increased in Kentucky during the week ended Feb. 10, with children between the ages of 5 and 17 getting hit hard by influenza.  

The Kentucky Department for Public Health's weekly report says flu and Covid-19 activity is elevated and increasing and hospitalizations for respiratory illnesses are considered high.  

Emergency-department visits for the three respiratory viruses tracked by the state -- flu, Covid-19 and respiratory syncytial virus (RSV) -- increased nearly 16% in the week ended Feb. 10, to 3,583.  

This increase was driven by a 16% increase in visits for flu, to 2,745, and a 26% increase in Covid-19 visits, to 740. RSV visits dropped 26%, to 98. 

In the same week, Kentucky hospital admissions for the respiratory diseases increased 6% from the previous week, to 509. Flu was the only one of the tracked viruses to see an increase in hospital admissions in the week ended Feb. 10, with a 17% increase to 288. Covid-19 and RSV admissions had slight drops.  

Four northeastern Kentucky counties had high rates of Covid-19 hospital admissions in the week, according to the Centers for Disease Control and Prevention, which considers high to be 20 or more admissions per 100,000 residents. Rowan, Morgan, Menifee and Elliott counties had 27 Covid-19 admissions per 100,000. 

Ten Kentucky counties had admission rates between 10 and 19.9 Covid-19 admissions per 100,000, a rate the CDC considers "medium." They were Pike County, in far Eastern Kentucky, and McCracken, Marshall, Lyon, Livingston, Hickman, Graves, Crittenden, Carlisle, and Ballard counties, in far Western Kentucky. 

Children between the ages of 5-17 saw an 84% jump in emergency-department visits for respiratory illness in the week ended Feb. 10, to 970. This was driven by flu-related visits, which were up 82% over the previous week, to 876. Hospital visits for this age group dropped to 15 in that week, down from 22 the prior week. 

In the week ended Feb. 10, the state reported 3,912 laboratory-confirmed cases of the flu, up 17% from the prior week. It reported 2,459 laboratory-confirmed cases of Covid-19, up 16% from the week prior. 

Since the respiratory-illness season began the first week in October, 327 Kentuckians have died from Covid-19, and 28 from the flu, the health department says. One Covid-19 victim and one flu victim have been children.

More than 1 in 10 minors ambulanced to ERs have behavioral issues, but EMS lacks guidelines in Ky. and most other states

Photo illustration by Maga Doctor News

Kentucky Health News

Here's another indication that the country has a youth mental-health crisis: More than 1 in 10 minors who were brought to the hospital by ambulance in 2019-20 had a behavioral-health emergency, and 85 percent were between 11 and 18 years old, says a study in the journal Academic Emergency Medicine.

“Our study found that pediatric behavioral-health emergencies requiring an ambulance were much too frequent,” said the study's senior author, Dr. Jennifer Hoffmann, emergency-medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor at Northwestern University Feinberg School of Medicine.

But there are no national guidelines for emergency medical servcies to manage such patients, Hoffmann said in a news release: “We found considerable variation in the use of sedative medications and restraints across different parts of the country. There is a great need for standardized EMS protocols for pediatric behavioral health emergencies. Currently only four states have these available.” Those are Maryland, Michigan, Rhode Island and Utah.

Among children 6 through 11, the study found that children with developmental, communication and physical disabilities were three times more likely to be restrained than children without these disabilities.

“EMS personnel are likely less comfortable with weight-based dosing of sedative medications, and EMS agencies in most states don’t have pediatric-specific sedative protocols, which might contribute to the increased use of physical restraints for younger children while in the ambulance,” said Julia Wnorowska, a Northwestern medical student who was first author on the study.

“Also, protocols for EMS personnel are needed to help manage children with autism spectrum disorders and other neurodevelopmental disabilities. Specific interventions could be developed to prevent and reduce agitation in this population, such as personalized emergency information forms that delineate patient-specific triggers and de-escalation techniques.”

Hoffman said, “Future research should determine whether the use of restrictive interventions can be reduced, while simultaneously promoting staff safety, through strategies such as education and adoption of pediatric-specific protocols.”

More Kentucky youth received emergency care for self-harm in 2021 than in 2020, reversing decline in youths' intentional injuries

Ky. Injury Prevention Research Ctr. graph, adapted by Ky. Health News

By Melissa Patrick

Kentucky Health News

Fewer young people in Kentucky got emergency care in the first year of the pandemic for intentional injuries, but in the second year, the number rose, mainly due to a 15 percent increase in cases where youth, mostly girls, harmed themselves.

That's according to a report from the Kentucky Injury Prevention and Research Center on intentional injury-related emergency department visits among Kentuckians aged 10 to 24. It says people in this age group, which it calls youth, have an increased risk for these injuries that often require medical care. 

Intentional injuries are violence-related injuries, whether they be directed toward oneself, called self-harm or intentional injury in this report; or directed toward others, which this report refers to as assault.

The researchers found that from 2016 to 2021, Kentucky resident youth made 40,579 emergency-department visits for intentional injuries, amounting to about 6,763 visits per year. It notes that the median cost of an ED visit for self-harm injuries was $2,577 and for assault injuries was $1,644.

In those years, most of the intentional injury-related ED visits occurred in people aged 15 to 24, followed by those 10 to 14, the report says. And when it comes to self-harm, an overwhelming number of those ED visits, or 71%, involved girls or women. 

Slightly more male youths, 52%, visited EDs as a result of assault. Most self-harm injuries (58%) and assault injuries (63%) were among youth living in metropolitan areas.

Most injuries were among white youth, 84% for self-harm and 71% for assault. For Blacks, the numbers were 11% and 24%, respectively.  

The report also breaks down injury-related ED visits by the nature of the injury. The top two self-harm injuries in 2016-21 were drug poisoning, 50.3%, and cut or pierce, 31.5%. The top two assault injuries were striking by or against, 68%, and child or adult abuse, 10.7%. Only 2.1% of the ED visits for assault injuries were related to firearms. 

Among self-harm injuries, the most common types were poisoning (52%), open wounds (22%), and superficial injuries or contusions (11%). The most common types of assault injuries were superficial or contusion (30%), open wound (18%), other effects of external causes (15%), and fractures (13%).

The report also found that most Kentucky youth ED visits for injuries related to intentional harm were discharged to home or to self-care: 48.4% of those admitted for self-harm and 93.8% of those admitted for assault. It said 13.5% of the self-harm patients were discharged to an inpatient facility and 34.2% were discharged to a health-care facility.

The ED visit rate for youth self-harm injuries varied by region in Kentucky from 181 per 100,000 people in the Buffalo Trace Area Development District to 333.7 per 100,000 in the Kentucky River ADD. The Green River ADD had the second highest rate, at 305 per 100,000. 

The ED visit rate for youth assault injuries ranged from 385.4 per 100,000 in the Barren River ADD to 718.3 in the Kentucky River ADD. Two other ADDs were among the highest rates for this measure, KIPDA, at 705.2 per 100,000 and Green River, at 565.6 per 100,000.

Graph by Kentucky Injury Prevention Research Center; for a larger version, click on it.

Fewer than 8% of overdose survivors are given or prescribed drugs that can block overdose and help them fight addiction

Buprenorphine is given with naloxone to
stop overdose, and alone as drug treatment.

As deaths from opioid overdoses continue to set records in Kentucky and the nation, a new study has found that less than 8 percent of overdose patients in U.S. emergency departments are not given or prescribed two medicines that can block another overdose and help them fight drug addiction.

Analyzing data from nearly 149,000 emergency-room visits before and during the pandemic, researchers at the University of Michigan found that 7.4% of patients received a prescription for naloxone (brand name Narcan), which can block an overdose, within 30 days. Only 8.5% were prescribed buprenorphine, a drug use to treat substance-use disorder.

The study was published in Annals of Emergency Medicine shortly after the Centers for Disease Control and Prevention announced that in the first year of the pandemic, U.S. drug-overdose deaths exceeded 100,000 for the first time in any 12-month period. That period, ending in April 2021, had 28.5% more overdose deaths than the same period a year earlier. The study looked at prescriptions written after emergency-room visits for overdose between August 2019 and April 2021. Overdose deaths in Kentucky set a record in 2020.

“In light of the record levels of opioid-overdose deaths, the low levels of naloxone and buprenorphine prescribing are simply unacceptable,” said Kao-Ping Chua, lead author of the study and assistant professor of pediatrics at Michigan Medicine. “Clinicians are missing critical opportunities to save lives both in the emergency department and during follow-up after overdose visits.”

In contrast, nearly half of patients treated for severe allergic reactions (anaphylaxis) in the same emergency departments over the same time period were prescribed an emergency epinephrine device, such as an Epipen, within 30 days of their visit.

“The same standard we use in caring for patients after anaphylaxis and preparing them with a potentially life-saving prescription should also be applied to patients after an opioid overdose,” said Keith Kocher, senior author of the paper and associate professor of emergency medicine at Michigan Medicine.

Naloxone, which can be administered nasally or through an injection, is designed to restore normal breathing during an overdose and is increasingly available for free from pharmacies and other locations.

"Buprenorphine is also an opioid, but it is designed to block the action of other opioid drugs, including prescription medications, heroin and fentanyl," a Michigan Medicine news release said. "The medication helps people reduce or eliminate their dependence on using opioids, without causing a high on its own."

"The risk that patients who survive an opioid overdose will go on to die from another overdose is high," the release noted. "In a 2019 study, researchers found 1.1% of patients treated for opioid overdose died within one month and 5.5% died within one year."

Chua said, “There are some clinicians who think that prescribing naloxone encourages patients to engage in risky behaviors, increasing their risk of overdose again, but there’s not a lot of evidence that this occurs.”

Kocher said emergency departments have not traditionally been seen as the place to start addiction treatment, but are being used as “teachable moments” to try and start patients on many other kinds of treatment and lifestyle changes.

As emergency rooms fill up across the country, two doctors give guidance on what to consider before going to an ER

Waiting in an emergency department (RogerStanmore.com)

Emergency rooms across the country are overrun, largely due to Covid-19 and other respiratory diseases, and people who go to ERs face long wait times. Two doctors at the University of Michigan, Marisa Louie and Brad Uren, offered tips for determining whether or not an ER trip is the best option.

The fundamental rule, Uren said, is this: "If you have a medical issue that you or a family member believes puts your life, limb or body function at risk, come to the emergency room." For example, chest pain, facial droop, weakness in the arms or legs, or altered consciousness can be signs of a heart attack or stroke.

"These conditions are time-sensitive, meaning the more time that passes, the more brain or heart tissue that may be permanently damaged," Uren said. "Don’t delay care if you believe you may be having a heart attack or a stroke. It is always safest to call 9-1-1 or your local emergency number rather than driving yourself in such cases."

How about children? "If they have difficulty breathing, that is a sign to come and get checked at the ER, whether you think it’s Covid-19 or another issue," Louie said in a news release. "Not drinking or urinating may be a sign of dehydration, another reason to get seen."

Despite concerns about coronavirus transmission in hospitals, Louie said that ERs are "definitely safe. . . . Even during heightened periods of Covid-19 before the vaccine, transmission of the coronavirus in healthcare settings was very low due to the health precautions taken by hospital staff. The emergency department is a safe place to be."

Common precautions such as wearing masks and social distancing are great for preventing virus transmission, but Louie and Uren said vaccination is the most effective way to prevent hospitalization. "The vast majority of our patients sick with Covid are not vaccinated," Uren said. That's also true in Kentucky.

Health officials encourage Kentuckians without symptoms to get coronavirus tests at testing sites, not hospital emergency rooms

By Melissa Patrick

Kentucky Health News

Lexington health officials are imploring Kentuckians without Covid-19 symptoms who want or need to get tested for the coronavirus to go to a testing site, and not the busy emergency departments of local hospitals. 

“If your question is, ‘Do I have Covid?’ there are many, many options better than our emergency departments to get that question answered,” Dr. Roger Humphries, chair of emergency medicine at UK HealthCare, said at a virtual press conference Friday. 

 

WHAS11.com photo

Physician leaders and administrators from CHI Saint Joseph Hospital and Baptist Health Lexington, who made the plea along with UK, said they are seeing similar difficulties in their organizations' hospitals across the state.

Colleen Swartz, UK HealthCare's vice president for hospital operations, said there are "hotspots" all across Kentucky, and many hospitals are experiencing a surge of Covid-19 patients that need inpatient care, including those in Pikeville, Danville and Bowling Green, Somerset and the rest of the Lake Cumberland area. She said many hospitals "are fairly overrun right now."   

The officials said many people often come to emergency departments to get tested because they think they've been exposed. Humphries called them the "worried well." 

Dr. Mark Sloan, medical director at Saint Joseph's emergency department, said such patients have been 10 to 15 percent of his patient volume this month. 

He said any strain on the Lexington hospitals "propagates out" to other hospitals, limiting the number of patients that can be transferred in from other CHI St. Joseph sites if they need a higher level of care. 

Swartz said when an emergency department is used as a testing site it consumes "precious resources" such as personal protective equipment, and uses space often needed by those who are critically ill. 

The officials said laws that don't let them question the motives of people who come to an emergency department, so they can't ask them why they are getting tested there instead of one of the many free testing sites in Lexington. 

All that said, the officials stressed that patients with covid-19 symptoms need to be seen by a health-care provider, and those with severe symptoms need to come to the emergency room. 

'We want to be clear: If you're symptomatic and you're short of breath or you're having any of the other symptoms that we can talk about, you should be seen by a provider," Swartz said. "And if your symptoms are severe, then certainly the emergency department is the appropriate venue. But if you're just wondering if you're Covid-positive because you may or may not have had an exposure, we have good alternatives for testing in the community and that would be the preference, that you get tested at one of those venues." 

Humphries added, "If you're having severe shortness of breath or you can't get up and walk a few steps without getting severely short of breath or if it's so difficult you're having trouble talking . . . we want you to come to the hospital with those symptoms as soon as possible." 

The Centers for Disease Control and Prevention offers a "Coronavirus Self-Checker" tool to help you make decisions on when to seek testing and medical care. Humphries suggested people managing Covid-19 symptoms at home should buy a pulse oximeter to measure oxygen levels, noting that an oxygen level in the low 90 percent range is concerning. 

With spread of the virus so heavy, the officials said their greatest concern is their ability to keep staffed. Swartz said UK has 100 staff members out due to because they have been infected or exposed to the virus. 

"It makes the work difficult to get done when we're challenged not only with an increase in demand and volume, but reduced resources to deploy," she said. 

Dr. David Dougherty, infectious disease specialist at Baptist Heath Lexington, said hospital and ICU capacity "doesn't just have to do with beds, it has to do with staff. And if our staff is getting infected out in the community and people aren't masking, because our staff still has to go to the grocery stores and get food, then we're going to run into bigger problems."

While waiting on vaccines to become widely available, Swartz called on Kentuckians to "double-down" on masking, social distancing, hand washing and not gathering with anyone outside of your immediate household. 

"Those very basic practices literally can save lives," she said, adding later, "Part of our call to action today is to really think about your own practices and then to choose venues of care wisely, so that we can have the highest level and intensity of care available for those who are the most ill." 

For a list of testing sites near you go to Govstatus.egov.com/ky-covid-testing. The site includes a link to sites that offer free testing throughout the state. 

Data and health directors' observations suggest that pandemic lockdown increased overdoses, which declined as state reopened

Graph from Kentucky Injury Prevention Research Center, University of Kentucky

By Melissa Patrick

Kentucky Health News

Apparent overdoses reported by Kentucky hospitals and ambulance services shot up in the two months after Gov. Andy Beshear declared a state of emergency because of the covid-19 pandemic, and have been on a downward trend since the state started reopening in mid-May.

"I don't want to give false hope," Dana Quesinberry, research core director for the Kentucky Injury Prevention and Research Center, said as she explained the data on hospital emergency departments' and emergency medical services' reports of "overdose encounters," a term KIPRC uses because overdoses may be suspected but not necessarily confirmed.

"We are still at higher levels than we've ever been, but the fact that we are seeing that decline over the last few weeks is very important," Quesinberry said. "There is hope that we are making progress again, so whatever triggered the increase is being managed or mitigated in some way." 

She said the data coincides with preliminary reports that also shows an uptick in overdose deaths during April and May. Quesinberry said official 2020 overdose death numbers are not yet available, but "Preliminary data indicates that we have had increases in drug overdose deaths during covid." For April, "We are still looking at a monthly count that exceeds at least anything in the prior couple of years, in a month total." She added later, "We are seeing increases in May as well." 

Quesinberry, an assistant professor for the Department of Health Management and Policy at the University of Kentucky, said researchers will need to explore what triggered the peak in overdose encounters and then look at what slowed it down.  

"We know that there has been an impact on the opioid epidemic during covid and we are working very hard to understand what that impact has been," she said, adding later, "This is a time of tremendous uncertainty driven by the pandemic. It's important to understand that it has consequences beyond the spread of infectious disease."

Public health reports coincide

"Covid has had a huge impact on substance use because it has led to more isolation," John Moses, team leader for harm-reduction services at the Lexington-Fayette County Health Department. "I have a feeling that we are seeing a lot more people relapse and go back to using again. I think that people who maybe work full time and only did drugs on the weekend were laid off and now may be doing drugs seven days a week. We know that when people are isolated like that, there is a lot more depression and that always has an effect on drug use."

Moses said his county is on pace to equal the number of overdose deaths in 2017, which were the most ever. "Last year Lexington-Fayette County had a total of 122 overdose deaths; we are already at 107 for the year," he said. "Last year we did a really good job of getting the overdose rates down, but thanks to covid, I believe that we are seeing more overdose deaths." 

Moses also noted that anytime there is an interruption in the drug supply, which has been seen during the pandemic, more fentanyl comes into the community.  He said it is being mixed in with heroin, methamphetamine, cocaine and even THC vape cartiridges, and "This disruption in the drug supply has caused more fentanyl to be here, and more overdoses."

Christie Green, public-health director of the Manchester-based Cumberland Valley District Health Department, said she had heard anecdotally that there were several overdoses about three weeks ago related to a batch of pressed pills that were being sold as Xanax, but were mostly fentanyl -- a synthetic opioid that is much stronger than heroin. 

"This is the first time that I've gone through something that is socially stressful like covid . . . while working so closely with people who are active in substance-use disorder, and it's just been really hard on them," Green said. "A lot of their social supports are gone. I really worry about them, honestly."

Marcy Rein, public-health director of the Whitley County Health Department, said her health department signed up for a system called ODMap in May to track overdoses in the community, along with about 40 other counties and health departments in the state.

"The system allows us to look at the big picture, to look at the maps to see if we have hotspots in a particular area or not," she said. She said a rash of overdoses in May prompted them to join the system. 

Rein said preliminary data shows that the pandemic is having an impact on rates if suspected overdoses: "We're not saying that covid causes the increase in overdoses, but certainly some of the factors that go along with covid most certainly put people at higher risk, like the isolation and also the economic impact."

Andrea Brown, public-health director of the Bourbon County Health Department, said it saw an increase in overdoses in April, and started keeping track of those numbers more diligently in May after signing up for ODMap, which she said only records EMS-related encounters, at least for now.

She said the EMS-only data shows that from from May 5 to July 19, almost two and a half months, Bourbon County had 28 overdoses and five fatalities. Brown estimated that the county had 11 overdoses in April but wasn't sure how many died.

"We are still getting overdoses," she said. "I feel like last year we may have had 12 overdose deaths, something in that ballpark, so if we've already had five between May and July, then I think we are really, once the data actually comes out, we're probably going to see a much higher increase." 

Brown said the health department's harm-reduction syringe exchange has been giving out more Narcan, which can block the effects of an overdose, "so I think the word on the street is probably getting around that there has been an increase of overdoses in our community. The Narcan is definitely a hot ticket item right now."

Jamey Whaley, harm-reduction and-peer support specialist with the Maysville-based Buffalo Trace District Heath Department, said some of his syringe-exchange participants have reported an increase in overdoses where they have had to administer Narcan. He said he is also seeing people relapse and return to the program. 

"I don't know if that's because of the covid and the mental-health side of it that has made them decide to go back to using," he said. 

Scott Lockard, public health director at the Hazard-based Kentucky River District Health Department, said Eastern Kentucky has seen an influx of pressed tablets with fentanyl and carfentanyl, noting that Lee County saw a huge uptick in overdoses from a substance called "smurf dope" just a few weeks ago. WLEX-TV reported July 1 that smurf dope is a bright blue substance that is a mixture of methamphetamine or heroin and fentanyl. 

"I think any time you see a different substance than what people normally utilize, there is an adjustment period in how they use it and the strength, the purity level of it when it is a fentanyl or carfentanyl," Lockard said. "If somebody has been abusing Suboxone, which is a pharmaceutical-grade substance, and then now they are dealing with these pressed tablets, that's where I think it increased a lot of the issues that we were seeing with the increase in overdoses."

He said anecdotally, based on what he hears from EMS, law enforcement and harm-reduction people, there have been fewer overdoses near the end of June and in July.

For help in finding treatment for substance-use disorder for yourself, a friend, or loved one, the state has a website: findhelpnowky.org.

Beshear defends actions to control virus as trendline keeps going up; nursing homes will likely be last to lift covid-19 restrictions

Today's report increased the upward tilt of the two-week trendline. (Kentucky Health News chart)

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 further signs that the coronavirus is resurging in Kentucky, Gov. Andy Beshear offered his most comprehensive defense of his actions to control it.

"We didn't take these steps because anybody loves power or is trying to do anything; we took them to save lives," the Democratic governor said, repeatedly saying that all his moves were in step with White House guidelines.

After two weeks of a downward trajectory in new cases, a key federal metric for reopening state economies, four of the last six days have shown an increase, with today's number hitting 265. That made for a six-day average of 216, well above the previous six days' average of 128.

"I don’t think this 265 is a cause for alarm, though it is at least a reminder … that this virus is still out there and spreading," Beshear said. "We do have to watch this pretty carefully."

Health Commissioner Steven Stack used a different metric, the percentage of tests that find infection. That number has been on a slow decline for two weeks, to about 4 percent. The goal is 3 %.

Stack didn't give a number for Wednesday, but said the positive results at Kroger-sponsored testing sites, which are likely a "decent snapshot" of the overall rate in a community, are generally about 1 %, ranging from near zero to over 2%.

He said the positive rate at health departments and hospitals in the last week has ranged from 1.1% to 4.4%, and that has been "relatively consistent over the last two to three weeks." The rates have been higher at long-term-care facilities, where the state is testing all residents and employees.

"So right now the data does not say that we are in an uptick," Stack said. "At worst it would be a plateau of some sort; it may still be a downward slope."

rt.live estimate of transmission rate, with low point noted

He said the CovidActNow website estimates the rate of transmission of the virus in Kentucky to be 0.96. A rate of less than 1 means the virus should eventually stop spreading because the average number of people infected by an infected person is less than 1. However, the rate estimated by the rt.live website is 0.99, and has been on an uptick since May 7, when it was 0.95.

The CovidActNow site estimates rates for counties; Kentucky's high counties include Christian, 1.36; Shelby, 1.32; Allen, 1.24; and Logan, 1.20.

Stack, who has expressed concern about a resurgence of the virus because not enough Kentuckians are taking it seriously, cautioned that "there is significant time delay" between actions that may increase the spread of the virus and a significant increase in cases, because of its incubation period.

"So if we are going to see a surge after a major event, it is going to be two or three weeks later that maybe we start to see a signal that there is a surge, and it's probably going to be a month and a half to two months later that we really hit a bad place," he said. "So we'll keep watching carefully."

Beshear's pitch: In his presentation of his actions to combat the virus, Beshear noted that the state's mortality rate is much lower than that of the nation as a whole and the world. Kentucky's rate is 4.3%, compared to the U.S. rate of 5.7% and the world rate of 6.1%.

"We are not just beating the national and the world average, but we're doing it with a population in Kentucky that is relatively sick, that has heart and lung and kidney disease more so than many other places," he said. "Yet still, we are taking care of each other in very important ways." He estimated that the economic restrictions he imposed saved more than 10,000 lives, based on modeling that forecast tens of thousands of deaths.

Beshear said the actions he took were similar to those of other governors, and he highlighted the actions of Republican governors in Indiana, Ohio, Maryland and Massachusetts. He said actions were taken in "red states, blue states; it didn't matter." What he didn't say is that Republican governors have generally been quicker to relax restrictions than their Democratic counterparts.

Beshear reported an adjusted total of 10,410 positive cases of the virus in the state, with at least 3,283 of them having recovered. He said 488 people are hospitalized with covid-19, including 68 in intensive care, which is the lowest number for this measure the state has seen in a while.

Infant death: He said eight more people have died from the virus, including a nine-month-old girl from Hopkins County, a case he mentioned at the start of his briefing. "This is a reminder of how deadly this virus can be," he said.

Stack said that if not for the pandemic, the death would have been attributed to Sudden Infant Death Syndrome, but he said it would be counted as a covid-19 death because the infant tested positive for the virus. He said the virus may or may not have contributed to the child's death, and the truth may never be known.

He reminded parents that children "overwhelmingly do just fine" with the virus and the vast majority of them have no symptoms. Some have developed a multi-system inflammatory syndrome that is linked to the virus; Kentucky has reported four cases, and all the children have recovered. "I would encourage parents to not worry overly, but that you should be concerned," he said.

More warnings: Stack also cautioned that while younger people also tend to recover from the virus or don't have symptoms, this is not always the case, pointing to a 48-year-old man from Shelby County with no pre-existing conditions who was among the list of those who have died from the virus.

Stack cautioned that as the weather warms and normal activities resume, it becomes even more important to do everything we can to slow the spread of the disease, because there is no vaccine and no treatment, and no evidence that warm weather will slow the virus.

“I have tried all along not to be sensational about these things, but to be factual, to be even-handed,” he said. "This is a very serious disease. It is not influenza. . . . It can rapidly spread, it can rapidly overcome the health-care system."

Today's other deaths were two women, ages 91 and 99, from Edmonson County; an 84-year-old woman from Gallatin County; and three women, 91, 92 and 93, from Jefferson County.

In long-term care facilities, Beshear reported that 15 more residents and nine more staff have tested positive for the virus, bringing those totals up to 1,366 and 633, respectively. He said 10 more deaths in these facilities were attributed to covid-19, bringing that number up to 245 deaths.

Beshear said testing for the virus has been completed in about half of the state's nursing homes, and to his and others' surprise, some of them had no positive cases. Nursing home have accounted for about 58 percent of the state's covid-19 deaths.

Beshear warned against "testing fatigue," and urged Kentuckians to sign up for free, drive-thru testing sites for next week at Kroger-sponsored sites in Louisville, Lexington, Bowling Green and Elizabethtown. Spots are still available this week and sign-ups have opened for next week.

Beshear once again asked Kentuckians who are protesting against police violence to make sure they are wearing masks, social distance where possible, to protect those in their lives who may be more vulnerable to the disease, and to consider getting tested in the coming days.

In other covid-19 news Wednesday:

• The counties with the highest number of new cases Wednesday were Jefferson, 55; Fayette, 37; Boone, 30; Kenton, 27; and Warren, 24. Beshear said only one county has no reported cases. That is Robertson, which has about 2,300 people. 
• Nursing homes and medical centers will be among the last places to lift covid-19 rules, Bailey Loosemore reports for the Louisville Courier Journal. "Normal considerations where people were coming in like they used to, I think, is way down the road, maybe even until we get a vaccine or effective therapeutics," Tim Veno, president of LeadingAge Kentucky, a group that represents nursing homes and assisted-living centers, told Loosemore. "We hear from residents every day who want to see their loved ones, and it's very painful, with regard to that. But we also believe we have a paramount duty to protect their health and welfare."
• Emergency department visits declined 42% during the early part of the pandemic, with the steepest decreases in persons 14 or younger, females and the Northeast, all while the proportion of infectious disease-related visits was four times higher, according a study published in the Morbidity and Mortality Weekly Report of the Centers for Disease Control and Prevention. The CDC advises increased health messaging about the importance of seeking immediate care for serious conditions, and to encourage virtual visits for those who have conditions that are not emergencies.
• Among other coronavirus information, The Guardian offers a coronavirus "deaths per capita" and "cases per capita" map, pointing out that the actual death toll is thought to be far higher than the tally compiled from government figures. It says that as of June 3, Kentucky has 10 deaths per 100,000 citizens and 228 cases per 100,000.  
• Becker's Hospital Review has compiled a non-exhaustive list of data and stories about why racial disparities and covid-19 matters in healthcare. 
• The Lexington Herald-Leader explores safe sexual practices during the pandemic.

Dentists and state officials scramble to set rules for reopening dental offices; Beshear says they won't reopen Monday, but soon

About 15 motorists, most honking their horns, circled the Capitol about 15 minutes before Gov. Andy Beshear's briefing, conducted in the white-curtained room at the building's southeast corner. State police have restricted access to the area near the room, but provided an area for protesters to park. The yellow sign says "The cure is worse than the virus;" the white one says "Gov. Andy, you lied; every life matters," apparently referring to Beshear's veto of a bill that would have required medical care for a baby born alive after an attempted abortion. He said existing law provides full protection in such cases.

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 Al Cross
Kentucky Health News

Gov. Andy Beshear said Saturday that dentists' offices won't be able to open Monday because they and state officials haven't agreed on rules for it, but suggested that other businesses might reopen on a regional basis.

Beshear had planned to allow reopening of medical, dental and other health-care providers Monday, but said “Dentists aren’t gonna be ready to reopen on Monday because there isn’t agreed-upon guidance. . . . We have to make sure were doing it right, given how those oral secretions happen in a dentist’s office.”

He said in response to a question at his 5 p.m. briefing, “Before a dentist’s office can reopen we need agreed-upon rules. . . . “We think that the guidelines will come together fairly quickly.” He said they will leave “some risk, but we believe we will have mitigated that risk.”

Sharon Turner, secretary-treasurer of the Kentucky Dental Association, said in an email at 7 p.m. that KDA, the Kentucky Board of Dentistry, the Kentucky Dental Hygenists Association and the Kentucky Oral Health Coalition "all agreed on a plan today. It will be filed later today."

She said acceptance of the plan is still up to Health Commissioner Steven Stack, "but we worked with the state director of public health dentistry, Dr. Julie McKee. We tried to address each bullet point that Stack provides in terms of his concerns needing to be addressed. We have scientific evidence behind recommendations."

Turner said in a telephone interview that KDA cited research from the University of Washington about what sort of personal protective equipment is appropriate for the wide range of procedures that dentists, hygenists and oral surgeons perform. She said rubber mouth dams, which neither providers or patients like, are likely to be used more, as well as high-powered suction.

She said some dentists may not be ready to reopen, or may want to test patients for the coronavirus before treating them, and the proposed plan allows room for professional judgment. "We hope it'll be accepted," she said. "If it's not, it will only be around what's enhanced aerosol protection." The virus travels on droplets that are so tiny they remain suspended in the air.

Turner, former dental dean at the University of Kentucky, added that KDA "heard about the need for the filing of the plan Thursday evening," when Stack issued a call for help during Beshear's briefing. "I think we have done a remarkable job of getting consensus from a large group of divergent stakeholders pretty darn quick."

On Friday, Beshear dismissed the idea that other relaxation of social-distancing rules could occur on a county-by-county basis, as some officials in Clark and Jessamine counties requested. Saturday, he opened the door to the possibility of regional differences, but remained cautious.

Asked about those requests, he said, "If a county makes the wrong decision and causes an outbreak, that sets the whole state back." Then he added that there could come a time when reopenings could be done by region, but “It’ll still have to have a lot of thought.”

At the start and end of his daily briefing, Beshear kept urging Kentuckians to stick with his emergency restrictions.

“Today, I'm tired, just like I know so many of you are, but every day we’ve got to bring it,” he said at the start. “We have to be strong, we have to be patient, we have to be resilient.” At the end, he said, “Let’s not be the generation that got halfway through meeting covid-19 and then just decided it was gonna be too hard. . . . There is hope, there is light, but we gotta do it the right way; we have sacrificed too much … to not finish it out the right way.”

Some protesters returned to the Capitol to protest restrictions, circling the Capitol and honking their horns before the briefing, and chanting during it. Without referring to them directly, Beshear said, “We might have some out there that are anxious but I believe we are more united than we have ever been.”

In other covid-19 news Saturday:

• The governor reported 171 new coronavirus infections in Kentucky, for a corrected total of 3,905. The number was lower than the previous two days; he said that could be a result of some labs not reporting on Saturdays, “but we still think we are plateaued, or we’re somewhere in the very top part of that curve.” He said the state “could be potentially starting our decline” needed for major reopenings, but several more days would be needed to confirm that.
• Beshear corrected some news-media reports that major reopenings can't occur unless the number of new cases decline every day for 14 days. “We just have to have a declining rate for 14 days; one day we may have a little more,” he said.
• The number of deaths reported daily declined for the third day, to five, and Beshear said he thought all were “in senior-living settings.” They were an Adair County woman, 79; a Graves County woman, 92; and three Jefferson County women, 87, 88 and 93. He said 17 percent of the deaths have been of African Americans, twice their percentage of the state's population.
• Counties with more than five new cases were Jefferson, 33; Graves, 20; Warren, 19; and Fayette, 9.
• Long-term-care facilities added 24 residents and five employees to the list of those testing positive, for a total of 602 and 273, respectively. Of the 205 covid-19 deaths in Kentucky, 94, or 46 percent, have been in such facilities. The state is issuing a daily report on each facility with a case.
• Beshear cited the number of cases in Warren County as he announced that a planned three days of testing next week at South Warren High School would be expanded to four days and the following week. He said labs have processed 46,558 tests, and “Our testing capacity is significantly increased; we need to do a lot more.”
• Of the approximately 3,900 Kentuckians who have been identified as having the virus, 1,266 have been hospitalized, and 301 remain so, Beshear said; 605 have been in intensive care and 164 still are; and 1,501 have recovered.
  
  Read more here: https://www.kentucky.com/news/coronavirus/article242296216.html#storylink=cpy
• After some recovered patients retested positive, a three-county health department has adopted a stricter definition for being free of the virus. The Wedco District Health Department, which serves Harrison, Nicholas and Scott counties, said 41 people thought to be recovered were retested and 11 tested positive for the virus. Now the department considers patients to be recovered and able to stop quarantine only after they have tested negative and have had the disease for at least 14 days, with seven of those days symptom-free, including at least three without fever. "The decision is crucial to determining who no longer quarantines to prevent spreading the virus, Rick Childress reports for the Lexington Herald-Leader. "There is no indication other counties are following Wedco’s lead." Harrison County had Kentucky's first covid-19 case.
• Emergency-room use at the University of Kentucky hospital has dropped by more than half in the last month, UK officials said. The likeliest explanation? "People are avoiding hospitals — even when they really need to go — because they’re scared of catching the novel coronavirus from patients who are infected, John Cheves of the Herald-Leader reports. "Similar no-show stories are being repeated at hospital emergency rooms around the country, worrying doctors who say people could be putting their lives at risk by not seeking health care right away for serious ailments."

Health-care interests, using TV ads that hide who's paying for the air time, fight legislation to limit surprise or 'balance' billing; some ads come from air-ambulance companies, the big players

This ad claims the bill would help insurance firms and hurt patients.

Unknown people and businesses are giving millions of dollars to kill legislation nearing passage in Congress that would protect consumers from surprise medical bills. That's who's paying for those ads you're seeing on television. They're called "dark money" groups because they don't reveal their contributors.

"Pity the poor consumer trying to understand the coming congressional debate," writes journalist Trudy Lieberman, who considers patients' point of view. She says surprise bills have heaped "staggering amounts of debt ... on unsuspecting patients after they believed insurance had paid for their care. Those bills are growing rapidly and ensnaring more and more Americans in what has become one of the medical industry’s most unsavory business practices."

Lieberman notes a study just published in the journal JAMA Internal Medicine: "The number of surprise bills for both ER and inpatient admissions are rising. In 2010, about 32% of all ER visits resulted in surprise bills. In 2016, nearly 43% did. Surprise bills for inpatient admissions jumped from about 26% to 42% over the same period. What’s more, the average amount billed to patients for ER visits nearly tripled and the cost for inpatient admissions more than doubled."

With the TV ads, "the special interests that benefit from socking patients with additional bills" are trying "to convince consumers that any congressional efforts this fall to correct the surprise billing problem may actually harm patients," Lieberman writes. Noting the "Harry and Louise" ads that helped kill the Clinton health-care plan in 1994, she says "This kind of advertising works."

Lieberman says the industry is fighting hard because it fears "any kind of cost containment . . . something sorely needed, and bitterly fought for decades by the medical businesses whose incomes are at stake." 

The advertisers include a dark-money group called Another group, Doctor Patient Unity, which is targeting eight Republican senators, including Kentucky's Rand Paul and Majority Leader Mitch McConnell. KARE-TV in Minneapolis notes in an analysis that one of the bills "doesn’t set actually set rates for out-of-network procedures, but instead sets benchmarks for how much out-of-network providers can collect if a surprise bill shows up," Lieberman notes. "But in a TV ad that lasts a few seconds, how would the viewer be able to make that distinction?

University of Southern California research via Brookings Institution

"The air ambulance industry, which has gained notoriety over the last few years for its surprise billing tactics, too, has added its own ads to the confusing pile of persuasion aimed at the public," Lieberman reports. "According to OpenSecrets.org, the industry has spent hundreds of thousands of dollars on TV and radio ads" using the name Global Medical Response. "The scary message is that air medical services are at risk. More than 30 bases have closed this year, disappearing from rural communities that need these services the most, the ad says."

The ad urges viewers to contact Congress about the surprise-billing legislation. "It’s not hard to see that someone living in a remote rural area might just do that," Lieberman writes. "Never mind that in the last few years media stories have revealed how families have been financially devastated from air ambulance bills, and that state laws are ineffective in regulating this industry."

"And if all this isn’t confusing enough," Lieberman writes, "there’s yet another group, called the Coalition Against Surprise Medical Billing. It represents large employers, health insurance agents, and business associations like the National Business Group on Health." This coalition wants to eliminate "balance billing," the main type of surprise billing, when "a patient is involuntarily treated by an out-of-network doctor, and wants to require health insurers to reimburse out-of-network providers based on local market rates negotiated by local providers. That would avoid what it calls a cumbersome arbitration process, the approach preferred by the aforementioned doctors’ groups.

Steve Wojcik, vice president of public policy at the National Business Group on Health, told Lieberman, “I believe that the investor-driven physician staffing firms fear that if our preferences become law, their business model — go out of network and raise prices — is shot.” He added, “Everyone agrees on banning balance billing. The disagreement is over payment rates and processes for determining payment for out-of-network physicians.”

Lieberman concludes, "The scary TV ads flooding the airwaves from this group or that mask the real issue. It all comes down to money and who gets how much. . . . How this turns out is anyone’s guess right now, and it may be that Congress has been sufficiently spooked by the TV ads targeting its members that it will be too timid to pass any legislation addressing this growing problem. But there’s one thing we do know from the history of health care battles: The longer the legislative fixes twist in the wind and the attack ads run, the less likely any real protections for patients become."

Crusade for Children grants help 3 CHI St. Joseph hospitals

The WHAS Crusade for Children has given the Saint Joseph London Foundation $100,000 to establish a Level II neonatal intensive care unit at Saint Joseph London hospital. The unit will be one of only two Level II NICUs in southeastern Kentucky.

The unit “will be equipped to continue providing the best care to infants affected by premature birth, neonatal abstinence syndrome, fetal anomaly and respiratory disease,” said Leslie Buddeke Smart, president of the foundation.

The crusade also gave the foundation $36,000 to enhance patient care in the NICU and birthing center at the Women’s Hospital at Saint Joseph East in Louisville, and $35,000 to the Flaget Memorial Hospital Foundation to make its emergency department and operating rooms at Flaget Memorial Hospital more accommodating for young children. The Bardstown hospital gets more than 4,000 visits from children each year, CHI St. Joseph Health said in a news release.

As Jewish Hospital struggles, so does its organ-transplant program, with bad implications for U of L and regional health care

"Jewish Hospital’s pioneering transplant program is in trouble, and its demise could produce far-reaching repercussions" on the greater Louisville area, reports Boris Ladwig of Insider Louisville.

"Surgical teams have performed only one heart transplant in the first six months of the year, according to the most recently available data, running afoul of federal minimum requirements," Ladwig reports. The program is also under threat that the hospital, which has been unable to find a buyer, might close altogether.

The transplant program is linked to the University of Louisville's hospital and its medical school. U of L told Ladwig that it would keep supporting the program, “either at Jewish or in another location.” That would require new certification from the federal Centers for Medicare & Medicaid Services, "which would take more than a year and cost the university millions of dollars," Ladwig reports.

"Even more worrisome, the national consultant told Insider that an interruption of the transplant program could prompt an exodus of transplant surgeons, which could lead to departures of medical staff in transplant-related subspecialties," Ladwig adds. "Those developments could jeopardize UofL Hospital’s status as a Level 1 trauma center [one of only two in the state], and cause it to lose medical residency spots."

That helps explain "the increasing desperation with which university officials in the last few months have tried, so far in vain, to save the struggling Jewish Hospital, which, together with related facilities, has been losing more than $1 million per week."

KentuckyOne Health, has been trying to sell Jewish and seven other facilities in Louisville, and Jewish Hospital Shelbyville, for more than two years. The university in December "tried to find a partner to acquire the properties, primarily to save Jewish Hospital," but that failed, Ladwig notes.

U of L declined to comment on why the number of heart transplants has declined, but KentuckyOne blamed a national change in how hearts are allocated. The United Network for Organ Sharing told Insider that it changed the allocation policy in October, partly "to better identify the most medically urgent transplant candidates," Ladwig reports.

Insider Louisville chart

That does not seem to have had as much impact on other transplant centers in the region. "The University of Kentucky Medical Center is on pace to perform 24 heart transplants this year, which would be a drop of 17 percent," Ladwig reports. "Nationally, transplants are on pace to be down 12.6%."

Other types of transplants "have seen a precipitous decline at Jewish Hospital," Ladwig writes. "Kidney transplants are down 56%, liver transplants are down 29%. Both have fallen just 11% nationally. Only lung transplants at Jewish are in line with national declines.

Under the bylaws of the Organ Procurement and Transplantation Network, "heart-transplant programs that fail to perform at least one transplant every three months are deemed to be functionally inactive," Ladwig notes. "OPTN and UNOS manage the U.S. organ transplant network by contract with the federal government. The agency’s website lists no action against Jewish Hospital. UofL said it has not been notified by anyone to say the program is inactive or out of compliance."

Dr. Peter Hasselbacher, an emeritus professor of medicine at U of L, "who has written extensively about the transplant program at Jewish," told Ladwig that any heart-transplant program that does fewer than five a year “shouldn’t be doing any,” due to lack of practice.

"CMS guidelines call for transplant programs to perform 10 heart transplants over any 12-month period to retain certification," Ladwig reports. "The agency could not be reached to explain what happens to programs that fail to meet that threshold."

Ky. Hospital Assn. gets grant for emergency-room software that tracks patient histories from other sites; could thwart 'ER hopping'

By Melissa Patrick
Kentucky Health News

The Kentucky Hospital Association has been awarded a $250,000 grant to equip Kentucky's emergency departments with software designed to help physicians have access to patient information from multiple sources in real time.

The grant for the software, called EDie, came from Anthem Foundation, the philanthropic arm of Anthem Inc., a major health insurer.

“Information is a powerful tool in medicine, especially emergency medicine when life and death decisions must be made quickly,” Harold C. Warman, president of Highlands Regional Medical Center in Prestonsburg, the first hospital in Kentucky to go live with the software, said in a news release. “EDie instantly consolidates information from multiple sources that would otherwise take hours to obtain, and lets emergency physicians make faster, more informed clinical decisions.”

EDie works by collecting data from thousands of hospitals, urgent cares, clinics and health plans and then packages the data and delivers it to emergency room physicians in real time.

"In one concise report, the ED team can see patient history, visit summaries, medical providers, security events, and even care recommendations like preferred language and drug allergies," says the release.

The grant funds, combined with discounts from Collective Medical Technologies, a Salt Lake City firm that developed the software, will cover one year's costs for nearly every hospital in the state, said Ginger Dreyer, director of communications for the hospital association.

"There are also separate grants to pay the cost for small, rural hospitals to have access to the EDie solution," Dreyer said.

The release says 10 Kentucky hospitals have adopted the technology and 28 others are in the process of installing it.

Dreyer said six five of the 10 that have adopted the program are actively using it, In addition to Highlands Regional, they are Breckinridge Memorial Hospital in Hardinsburg; Hardin Memorial Health in Elizabethtown; Wayne County Hospital in Monticello; and St. Claire Regional Medical Center in Morehead. ; and Twin Lakes Regional Medical Center in Leitchfield.

The release notes that this software will help hospitals identify and support high-risk patients across care settings, with the goal of reducing avoidable readmissions and further enabling statewide efforts to address the opioid epidemic,

“One particularly powerful application of this technology is in fighting Kentucky’s opioid epidemic,” KHA President Nancy Galvagni, said in the release. “Emergency-room hopping is a serious obstacle in helping people suffering from addiction and this software can tell a treating physician if the patient has a history of ER visits for pain treatment. EDie can be the difference between enabling addiction and treating it.”

Kentuckians use too many antibiotics; we're No. 1 in the nation, and a campaign has started to reduce inappropriate use

Kentucky has the highest rate of antibiotic use in the United States, and the University of Louisville School of Medicine is trying to do something about it.

The school's Department of Pediatrics has mounted a campaign to highlight the need for education and awareness on antibiotic overuse in Kentucky, and to reduce inappropriate use of antibiotics in the state.

“Although antibiotics are important life-saving drugs that treat bacterial infections – including strep throat and urinary tract infections – their overuse can lead to drug resistance, which occurs when antibiotics no longer cure infections that they should treat,” Bethany Wattles, a clinical pharmacist in the pediatrics department, said in a U of L news release.

“If we continue to overuse antibiotics, even minor infections will become untreatable. This is a serious public health threat,” Wattles said. “To combat the spread of antibiotic resistance, we must use antibiotics only when necessary.” 

The Kentucky Antibiotic Awareness campaign to health-care providers and the public is led by the department's Antimicrobial Stewardship Program, with support from the state Department of Medicaid Services, which finances health care for almost one-third of Kentuckians.

U of L researchers examined antibiotic prescriptions for Kentucky children on Medicaid and found that the rate of antibiotic use has been especially high in Eastern Kentucky. In some areas, children are receiving three times more antibiotic prescriptions than the national average.

"Antibiotics are most frequently used for upper respiratory infections, many of which are caused by viruses that antibiotics do not kill," the U of L release said. "The majority of antibiotic prescribing is done in outpatient settings, which include medical offices, urgent care facilities, retail clinics and emergency departments. Wattles said 30 to 50 percent of this antibiotic use is estimated to be inappropriate.

"When antibiotics are prescribed, it is important to take them as instructed; do not share the medicine with others or save for later use," the release says.

The campaign is on Facebook and Twitter. Health-care providers are encouraged to join the KAA Listserv for newsletter updates, or email KYAntibx@louisville.edu with questions and suggestions.

Ambulance runs for rural patients are 76% longer when their hospital closes, and for seniors, it's 98% longer, study finds

Rural and Underserved Health Research Center chart; click on it to enlarge

When a rural hospital closes, it's logical to assume that patients in its former service area will spend more time in ambulances getting to an emergency room farther away. A University of Kentucky study has figured out just how much more: "An estimated 11 additional minutes in an ambulance the year after a hospital closure in their ZIP code, a 76 percent increase compared to before the closure," reports UK's Rural and Underserved Health Research Center.

And it's even worse for seniors: "The times increased from 13.9 minutes to 27.6 minutes, a 13.7-minute or 97.9 percent increase," report researchers SuZanne Troske and Alison Davis. They noted that other studies have found that communities, rural and urban, where hospitals have closed "tended to have a higher percentage of elderly and poor residents."

The study is based on data from 2011 through 2014, with 73,000 ambulance calls and about the same number of hospital closures inside and outside metropolitan areas. The researchers found no change in transportation times in metro areas. Most of the closed hospitals were the only ones in their ZIP codes, but those areas are smaller in metros. "When hospitals close, rural patients requiring ambulance services are disproportionately affected," they write.

The researchers describe their methods: "Intuition suggests that patients are in an ambulance longer after the nearest hospital closes. However, no one has previously measured the travel time change. Our study is the first we are aware of that measures change in time in an ambulance based on reported ambulance trips." They noted that the study "should not be used to draw conclusions about transport times for rural patients who may have relied on a closed hospital but do not reside in the zip code of that closed hospital."

Addressing the implications for rural areas, Troske and Davis wrote, "More than half the hospitals in the country are located in rural areas and are the primary source of emergency medical services in these communities. When asked to rank attributes of rural health care facilities in a recent study, rural residents strongly valued access to emergency services through emergency departments s in their communities. . . . Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. In the 2017 annual report of the Medicare Payment Advisory Commission, the commissioners stressed the need to find more efficient and financially stable ways to deliver emergency services in rural communities. In the MedPAC report, they stated while there was reduced demand for inpatient hospital care, there was still need for emergency care among Medicare beneficiaries."