As last days of summer approach and pandemic continues, here are many tips to navigate outdoor and social gatherings safely

Barbecues can be risky. (Photo from High Speed Training blog, The Hub)

First, remember that any such gathering needs to be small. Gov. Andy Beshear issued an executive order on July 20 that only allows for gatherings of 10 or fewer people. 

The order also calls for such gatherings to adhere to the Centers for Disease Control and Prevention guidance to the greatest extent possible, which includes social distancing, wearing masks indoors and outdoors if guest are unable to stay six feet apart, ample access to hand sanitation, and reminders for guests to stay home if they are sick.  

The Los Angeles Times reported 42 ways to minimize the risk of entertaining during the pandemic, with suggestions from disease specialists and caterers. 

First and foremost, the Post and others say it's important to keep everyone outside, where the virus is less likely to spread --and to only invite the number of people your outdoor space can safely handle. For example, if your outdoor space can only accommodate six people, six feet apart, then that's as many people as you should include. And if the weather is bad, cancel the event, don't take it indoors.  

The Times stresses the importance of limiting the number of people who touch items that are commonly shared, such as serving spoons, condiments and even the food, especially if it is a pot-luck event. One way to minimize this is to assign servers, who should be wearing both face masks and gloves, or to provide individual servings of "fixings," chips, dessert and drinks for each of your guest, while one person serves the main dish. And while disposable dishes and utensils are not the greenest options, they are the safest choices. 

Another suggestion: Consider each guest's level of risk before inviting them, and reveal the guest list to everyone invited so that they can make their own decisions about risk. 

In the bathroom, provide paper towels and liquid soap instead of shared cloth towels and bar soap. 

And most importantly, the Times says to make sure your guests understand your expectations before they arrive, and to be clear about what is non-negotiable.  

The Washington Post offers tips on how to navigate several outdoor activities. 

Public restrooms: Gretchen Snoeyenbos Newman, an infectious-disease physician at the University of Washington, told the Post that "public restrooms are already gross" and many have poor ventilation. Her advice: wear a mask, wash your hands when you go in, close the lid before you flush (flushing aerosolizes dirty water), wash your hands again; don't touch your phone or your face in the restroom; and as soon as you are out, use a hand sanitizer. And as with all indoor spaces, don't go into a crowded bathroom. 

Restaurants: While takeout continues to pose the lowest risk, if you decide to eat in a restaurant, make sure your server and other employees are wearing masks, and ideally, all of the other patrons if they are not eating; eat outside if at all possible; make sure appropriate social distancing is practiced; and don't linger too long after your meal.

Bike paths and other outdoor exercise: "Infectious-disease experts say that if you are outside and keeping a proper distance, the risk is actually pretty low," says the Post. 

Farmers' markets: Everyone should be wearing a mask and social distancing. It's also important to pay attention to crowd control and to wash your produce when you get home. 

Road trips with someone outside your household: This is a high-risk activity, Nahid Bhadelia, an infectious-disease physician, told the Post. You can reduce the risk by opening the windows, wearing mask and spacing yourself. However, she advises that if you or someone you live with is in a high-risk category, you should drive separately. 

Hotels and other lodging: Bhadelia called these a moderate risk, as long as linens are clean and the surfaces have been disinfected. That said, avoid the common areas and keep your hands washed. 

Barbecues: The Post says experts consider these "a pretty high-risk activity" because it is hard to wear a mask while socializing with food. The risk at barbecues also increases because people often drink alcohol at them and when people drink they stand closer to each other and talk louder, both of which increases the risk of transmission.

Camping: If you are camping with people you live with, that is fine. If you are camping with others, then make sure you maintain the six-foot distance rule. 

Swimming: The Post reports that there is no evidence to suggest the virus is transmitted through water, so any risk comes from other people, especially in close, confined spaces like locker rooms or indoor showers. Pools and public beaches should provide some kind of crowd control to help people stay six-feet apart. 

Playgrounds: The Post reports there is still not much consensus on how to manage playgrounds, which has caused many to remain closed. The CDC and other groups of experts have found that transmission of the virus from contaminated surfaces is low, so the biggest risk is likely from interactions with other children. If your child does go to a playground, experts advise making sure they can sanitize or wash their hands afterward. 

Recreational games: Experts tell the Post that as long as you are maintaining social distancing and not touching shared objects, the risk is low. Think tennis, pickle ball or bocce ball, not volleyball or basketball.

Ice cream shops: While there is some evidence that the coronavirus survives better in low temperatures, experts again say the biggest risk here is the other people in the store, so masks and social distancing remain key measures of prevention. 

State health department offers food safety tips to keep your family and guests safe during the holiday season

A properly prepared turkey and safe food handling practices go a long way in keeping friends and families safe from foodborne illness during the holiday season, and the state health department is offering tips on how to do just that.

Centers for Disease Control and Prevention photo

Defrosting the turkey:There are three safe ways to thaw a turkey: in the refrigerator, in cold water and in the microwave. Never thaw a turkey or other meats on the kitchen counter.

The safest way is to thaw it in the refrigerator. Leave the turkey in its original wrapping and place it on a tray in the bottom section of the refrigerator. Every five pounds needs at least one day to thaw in the fridge, so a 10-pound turkey will take two full days and a 20-pound bird will need at least four.

Turkeys can also be thawed in a cold-water bath. This requires submerging the bird in its original wrapper in cold tap water and adding new cold water about every 30 minutes. Every pound needs about 30 minutes to thaw, so a 10-pound bird would need five hours. Using this method, the turkey must be cooked immediately.

For thawing in a microwave, the health department recommends following the guidelines for thawing that came with the appliance. Turkeys thawed in the microwave also must be cooked immediately.

Be wary of cross-contamination: "Wash your hands, but not your turkey!" That's the advice of the U.S. Department of Agriculture. USDA warns that it's nearly impossible to wash bacteria off the bird, and juices that splash during washing can transfer bacteria onto kitchen surfaces, other foods and utensils. The best way to avoid the spread of harmful bacteria is to wash your hands with warm water and soap for 20 seconds before and after handling the turkey and its packaging.

The only way to destroy bacteria on a turkey is to cook it to a minimum internal temperature of 165 degrees Fahrenheit as measured by a food thermometer. Be sure to check the turkey's temperature in the innermost part of the thigh and wing, and the thickest part of the breast.

Safe cooking temperatures for other foods: Seafood, 145 degrees Fahrenheit; ground beef, veal, lamb and pork, 160 degrees; ground turkey, chicken and other poultry products, 165 degrees.

Keep it clean: Keep utensils and surfaces clean with hot, soapy water. And wash your hands before and after handling all food. It's also important to wash fresh fruits and vegetables before preparation.

Separate foods: Use two cutting boards, one for meat and the other for everything else. And never put cooked food back on plates or platters where raw meat or poultry was previously stored.

Safe Food Storage:Keep hot foods at 135 degrees or warmer. Keep cold foods at 41 degrees or below. And foods that sit out for longer than two hours should be discarded. Remember, when in doubt, throw it out!

Eggs: Use pasteurized eggs for dishes containing raw eggs because Salmonella and other harmful germs can live on both the outside and inside of them. Pasteurized shell eggs can be identified by a red “P” in a circle stamped on the shell. And as a reminder, the health department says to never eat uncooked cookie dough or batter, which may contain raw eggs.

Leftovers: Refrigerate leftovers as quickly as possible, preferably in shallow containers that can cool off more quickly. The shelf-life of leftovers varies, but most are only good for three to four days. Frozen leftovers will last between two and six months. Reheat all leftovers to 165 degrees Fahrenheit throughout or until steaming hot. Soups, sauces and gravies should be brought to a rolling boil for at least one minute.

Signs and Symptoms of Foodborne Illness

Food poisoning symptoms may range from mild to severe and may differ depending on the germ. The most common symptoms are upset stomach, stomach cramps, nausea, vomiting, diarrhea and fever. Symptoms may take hours or days to show up. The federal Centers for Disease Control and Prevention recommends seeing a health care provider if your symptoms are severe, including bloody stools, a temperature over 102 degrees Fahrenheit, frequent vomiting, signs of dehydration and diarrhea that lasts more than three days.

Each year, the CDC estimates one in six Americans get sick from eating contaminated food, and of those 48 million people, 128,000 are hospitalized and 3,000 die.

Picnic season has arrived, which calls for extra food-safety steps; CDC offers four rules to follow: Clean, Separate, Cook, Chill

By Melissa Patrick
Kentucky Health News

Summer picnic and barbecue season is in full swing, which also means it's the season for an uptick in the number of people who get food borne illnesses, which most people call food poisoning.

According to the Centers for Disease Control and Prevention, each year in the U.S., about 48 million, or one in six, people get ill, 128,000 are hospitalized, and 3,000 die from foodborne disease.

All of those people didn't get sick at a picnic, but foodborne illnesses increase in the summer, largely because the bacteria that cause such illnesses multiply faster in warmer temperatures and preparing food outdoors makes safe food handling more difficult.

One problem is that most of us give little thought to how our food is stored, prepared and handled at these fun summer events, let alone if those preparing our food are washing their hands -- but we should, because it only takes one small mishap to sicken all of  the guest.

CDC graphic

The CDC and the state health department offers four simple rules to decrease the likelihood of anyone getting a food borne illness when eating outdoors: Clean; Separate; Cook; and Chill.
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Clean: Wash your hands and clean your work and dining surfaces. If there is not a source of safe drinking water at your outdoor location, bring enough water for both preparation and cleaning. Otherwise, make sure you bring wet, disposable washcloths, wipes, or hand-sanitizer. Wash your hands both before and after handling any raw meat.

If you are serving multiple meals in an outdoor setting, take a lesson from seasoned campers and bring three large pans, biodegradable dish soap, bleach and plenty of extra water to set up a cleaning station. Pan one is the wash pan, with hot water and a few drops of soap; pan two is for a hot-water rinse; and pan three is for a sanitizing soak, with a small amount of bleach added to kill bacteria.

Separate: Cross-contamination during preparation, grilling and serving food is a prime cause of foodborne illness. To minimize this risk, wrap raw meats securely to keep their juices away from all other food; throw out marinades and sauces that have touched any raw meat; and remove cooked meat from the grill with clean utensils and place it on a clean plate.

Cook: The best way to ensure that meat is cooked hot enough to kill harmful germs is to use a food thermometer. Temperatures for beef, pork, veal and lamb needs to be 145° F, with a stand-time of three minutes at this temperature; 145° F for fish; 165° F for poultry and all pre-cooked meats, like hot-dogs; and 145° F for fish. After cooking, meats need to be kept at 140°F or warmer until served. Grilled foods can be kept hot by moving it to the side of the grill rack away from the coals.

Chill: Keep all meats at 40°F or lower in an insulated cooler with ice or frozen gel packs. Pack canned beverages in one cooler and food in another, since the beverage cooler is likely to be opened frequently. Meat, poultry, and seafood can also be packed while still frozen so that they stay colder longer. When driving, keep the cooler in the coolest part of the car and once outside place it in the shade if possible. Bring extra ice and pack it in a separate cooler. Don't use loose ice used to keep food cold in beverages.

The CDC also notes that it's important to not let food sit out for more than two hours, and if the temperature is 90°F or above, it should sit out for no more than one hour. One way to keep track of how it's been sitting out is to bring a timer, or set a timer on your cell phone. And it's not just meats; all perishable food should be monitored closely, especially salads made with mayonnaise or anything dairy-based. And a good rule of thumb: If you have any doubt, throw it out!

The health department also warns that if you clean your grill using a wire-bristle brush, check to make sure that no detached bristles have made their way into grilled food.

The CDC says symptoms of food poisoning can range from mild to severe and may differ depending on the germ you swallowed, but the most common ones are: upset stomach, stomach cramps, nausea, vomiting, diarrhea and fever. Symptoms may take hours or days to develop, and can be life-threatening. And see a doctor if you have severe symptoms that include blood in your stool, fever over 102 degree, frequent vomiting, dehydration and diarrhea that last more than three days.

E. coli outbreak keeps spreading, but may be slowing down

The outbreak of E. coli infection centered in Kentucky has spread to nine other states, the federal Centers for Disease Control and Prevention announced April 23. However, preliminary evidence suggests the number of new cases is declining.

Officials said they are still trying to find the source of the outbreak, which evidence suggests is ground beef.

"CDC is not recommending that consumers avoid eating ground beef at this time," the agency said. "Consumers and restaurants should handle ground beef safely and cook it thoroughly to avoid foodborne illness. At this time, CDC is not recommending that retailers stop serving or selling ground beef."

Escherichia coli is a common bacterium found in the digestive tracts of mammals. Certain strains, such as the one numbered O103, which is identified with this outbreak, can produce Shiga toxin, which causes diarrhea (often bloody), severe stomach cramps, and vomiting.

The strain of E. coli has been identified in 156 sick people, 20 of whom were hospitalized. No deaths have been reported from the outbreak. Kentucky has 65 cases; Tennessee has 41, Georgia 33 and Ohio eight. A CDC chart indicated that fewer cases have been reported in recent weeks, but it can take as long as four weeks for the disease to develop.

U.S. Centers for Disease Control and Prevention chart, adapted by Kentucky Health News; click on it for a larger version

Ky. has half the cases in odd, 5-state outbreak of E. coli infection

Video from The Washington Post

Kentucky has about half of the cases in an outbreak of infections from a strain of E. coli bacteria that has also sickened people in Ohio, Virginia, Tennessee and Georgia. The federal Centers for Disease Control and Prevention said Friday that the source of the 72 infections has not been identified.

The CDC said Kentucky had 36 cases, but the day before, the state Department for Public Health said 46 people in the state had been sickened by the O103 strain of E. coli, which is among those that produce Shiga toxin.  Spokeswoman Barbara Fox said six had been hospitalized. The toxin usually sickens people two to five days after they swallow the germ, the health department says.

"Most people get diarrhea (often bloody), severe stomach cramps and vomiting," The CDC says. "Most people recover within a week, but some illnesses can last longer and be more severe. Talk to your doctor if you have symptoms of an E. coli infection. . . . Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out."

The Mercer County Health Department said in a Facebook post, "These cases have been found in children and teenagers with an extensive exposure to fast food," but added, "The outbreak is not limited to young people."

That report, and the median age of those infected, 17, indicate that “It’s probably some convenience, fast food consumed by kids,” Bill Marler, a Seattle food-safety lawyer, told The Washington Post. "One silver lining, he added, is that people in this age range are typically healthy and not prone to further complications from E. coli," reports the Post's Michael Brice-Saddler.

Still, Marler said it is “concerning” that health officials haven't been able to trace the pathogen to a food source. “Given the size and the number of states that are involved, what you’re seeing is very unusual,” he told the Post. “If it was five people or 10 people, that’s a little harder to figure out. But when there’s 72 people and they’re being interviewed by epidemiologists, it’s pretty unusual you don’t have a culprit. The real question is, what do 72 people have in common over five states? It has to be something.”

"That something, Marler said, is likely a food or water product that people can’t remember they ate," the Post reports. "State and local health officials are required to interview ill patients and determine what they consumed in the week leading up to their symptoms, but recalling one’s dietary choices is often easier said than done, he said. Condiments, garnish, toppings, and spices can all contain traces of E. coli."

Marler said, “That’s probably why it’s taking longer to figure out, because people can’t remember what was in their meal.”

"Citing a CDC data set that dates to 1998, Marler noted outbreaks of E. coli O103 are relatively uncommon. Eighteen such outbreaks have been reported in the United States since 2000, with the highest number of reported illnesses being 29 during a 2010 outbreak in Minnesota. That makes this O103 outbreak by far the largest in recent memory, he said."

The state Department for Public Health says E. coli infections can be prevented by:

• Washing hands frequently for at least 20 seconds with soap and warm water, especially before eating, after going to the bathroom, handling raw meat and eggs, and after handling or petting animals;

• Thoroughly washing produce before eating;

• Thoroughly cooking meat;

• Cleaning and sanitizing food preparation areas;

• Avoiding swallowing lake or pool water;

• Drinking only pasteurized milk;

• Frequently cleaning and sanitizing restrooms, including door knobs and faucets; and

• Reporting diarrheal illnesses to your physician.

More information can be found here: https://www.cdc.gov/ecoli/ecoli-prevention.html.

Romaine lettuce is OK to eat unless it was grown in the Central Coast region of California, federal agencies say

Romaine lettuce (Photo from Getty Images)

After urging Americans not to eat any romaine lettuce, two federal agencies have limited their warning to lettuce grown in the Central Coast region of California.

The Centers for Disease Control and Prevention and the Food and Drug Administration say romaine  grown elsewhere, or in greenhouses or hydroponically, has not been linked to the outbreak of E.coli bacterial infections.

The agencies advise consumers to check labels or store signs for the source of any romaine lettuce, and if you have already purchased romaine (or any lettuce mix containing it) and aren't sure where it was grown, throw it out and thoroughly clean your refrigerator.

No single grower, supplier or distributor has been identified as the source of the lettuce that caused the infections.

"CDC officials recommend that clinicians not prescribe antibiotics to anyone infected with this bacteria as some studies suggest that these drugs could increase a patient’s risk of developing a serious complication from the illness," Sheri Rudavsky reports for The Indianapolis Star.

CDC says don't eat any romaine lettuce while it investigates a multi-state outbreak of E.coli infections related to it

The Centers for Disease Control and Prevention is advising Americans to not eat any romaine lettuce, and retailers and restaurants to not sell it, while it investigates the multi-state outbreak of Shiga toxin-producing E.coli infections that have been linked to the lettuce.

CDC photo

The CDC warning includes all types of the lettuce, including whole heads, hearts, bags of pre-cut romaine and salad mixes that contain it. If you are unsure, the CDC says, "Do not eat it, and throw it away. It also suggests washing and sanitizing drawers and shelves where romaine was stored.

The warning comes after 32 people in 11 states have become sick from eating the contaminated product. None of the cases have been in Kentucky. Also of concern, Canada has reported 18 people infected with the same strain of E.coli. The illnesses range from Oct. 8 to Oct. 31 and no deaths have been reported.

The CDC notes that symptoms of Shiga toxin-producing E.coli vary, but often include severe stomach cramps, diarrhea (often bloody), vomiting, and sometimes a low-grade fever. Most people will get better in five to seven days, but others can have severe, life-threatening infections. The illness can start anywhere from one to 10 days of infection.

If you believe you have an E.coli infection, call your health-care provider, write down what you ate in the week before you got sick, report your illness to the health department, and be prepared to answer questions about your illness.

The current outbreak is not related to another recent multistate outbreak of E.coli related to romaine lettuce, says the CDC.

Weather preparedness tips for hypothermia, carbon monoxide poisoning and food safety

By Melissa Patrick
Kentucky Health News

As the full brunt of winter approaches, the state Department for Public Health offers tips on cold-weather preparedness to prevent hypothermia, carbon-monoxide poisoning and unsafe food from power outages. The message is part of a "First 72 On You" campaign to remind Kentuckians to be prepared to manage without help for at least three days in the event of a weather emergency.

Hypothermia happens when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. If left untreated, it can affect the brain, making the victim unable to think clearly or move well. It can also lead to heart and lung failure, and even death.

Hypothermia is often caused by immersion in cold water, but can also be a result of exposure to extremely cold temperatures. The Centers for Disease Control and Prevention says it can also happen during cool temperatures (40 degrees) if a person is wet (from rain, sweat or cold water) and becomes chilled.

Symptoms include shivering; an altered speech pattern; abnormally slow rate of breathing; cold, pale skin; and lethargy. In infants, the symptoms include bright red or cold skin and very low energy levels. The health department advises that you seek medical attention if you or a loved one experiences the signs of hypothermia.

Here are the health department's tips to prevent hypothermia:

• Wear appropriate clothing, including layers of synthetic and wool fabrics, hats, coats, scarves and gloves. The best outerwear is water-resistant.
• Avoid consuming alcohol if outdoors, which can speed the loss of heat from the body.
• Avoid activities that cause excessive sweat, which leads to damp clothing, and chilling.
• Stay as dry as possible
• Outdoor workers should take special precautions to stay warm and dry.
• The CDC recommends making a car emergency kit that among other things includes extra hats,coats and mittens, blankets, a cell phone and portable charger, water, snacks, a working flashlight and jumper cables.

Carbon monoxide: State health officials warn Kentuckians that using alternative heating sources like portable generators, kerosene heaters, propane gas stoves and ovens heated with gasoline can lead to carbon-monoxide poisoning.

CDC graphic

Carbon monoxide is an odorless, invisible gas produced when gasoline, natural gas, propane, kerosene and other fuels are not completely burned during combustion. Breathing in carbon monoxide prevents the body from using oxygen normally, and can result in death.

Early symptoms of carbon-monoxide poisoning include headache, nausea, vomiting and fatigue. If you are experiencing symptoms or if you have questions, call the Poison Control Hotline at 1-800-222-1222.

On a Facebook live event on this topic, Dr. Ardis Hoven, a consultant with the department, noted that about 170 people die every year in the U.S. from carbon-monoxide poisoning and that the state has upwards of 180 cases reported each year. "And this is something that is preventable," she said.

Here are tips for avoiding carbon-monoxide poisoning:

• Install battery-operated carbon-monoxide detectors in your home and replace the battery and device as required. If the detector sounds, leave your home and immediately call 911. It is recommended that a detector be placed outside each bedroom, on each level of the house, and in the basement.
• Don’t use a generator, charcoal grill, camp stove or other gasoline or charcoal-burning device inside your home, basement or garage or near a window.
• Don’t run a car or truck inside a garage attached to your house, even if you leave the door open.
• Don’t burn anything in a stove or fireplace that isn’t properly vented. Have your chimney checked or cleaned yearly.
• Don’t use a gas oven to heat your house.
• Don’t place a portable heater within reach of children or pets, and don’t use a power strip or extension cord with it. Look for an Underwriter’s Laboratories (UL) safety label, and carefully read instructions before use.
• Seek immediate medical attention if you suspect carbon-monoxide poisoning

Food safety: Power outages during extreme weather are something to plan for, especially when it comes to food safety and avoiding foodborne illness.

nutritionaction.com photo

The symptoms of foodborne illness include vomiting, diarrhea, abdominal pain, and flu-like symptoms such as fever, headache and body aches. The U.S. Food and Drug Administration says foodborne illness usually occurs within one to three days of eating the contaminated food, but can also occur within 20 minutes or up to six weeks later.

Here are some food safety tips:

• Make sure you have appliance thermometers in your refrigerator and freezer.
• Refrigerated foods should be safe as long as power is out for no more than four hours.
• If the thermometer in the freezer reads 41 degrees Fahrenheit or below, or the food still contains ice crystals, the food is safe and may be refrozen.
• Throw out any perishable food in your refrigerator, such as meat, poultry, lunch meats, fish, dairy products, eggs and any prepared or cooked foods that have been above 41 degrees Fahrenheit for four hours or more.
• Fresh fruits and vegetables are safe as long as they are still firm and have no evidence of mold or sliminess.
• Freeze refrigerated items that you may not need immediately to keep them at a safe temperature longer.
• Have coolers on hand to keep essential items refrigerated if the power will be out for more than four hours.
• Keep the refrigerator and freezer doors closed to maintain the cold temperatures.

Other advice  includes having about three days of non-perishable food on hand in case of an emergency, refill medications before the bottle is empty during the winter months, and to make sure to have working flashlights in the home.

"Remember, the first 72 is on you," Doug Hogan, spokesman for the Cabinet for Health and Family Services, said on Facebook.

For more information, you can re-watch a Facebook live event that is archived on the CHFS Facebook page. More information on this topic can be found at https://www.cdc.gov/disasters/winter/index.html.

Index of readiness for disasters and health emergencies has Ky. about same as U.S.; slips in environmental, occupational health

By Melissa Patrick
Kentucky Health News

Is Kentucky ready to manage a natural disaster or a health emergency? Just as much as the nation as a whole is, according to a recently released Robert Wood Johnson Foundation report.

The annual report, called the 2018 National Health Security Preparedness Index, gives Kentucky an score of 7.1 on a 10-point scale for preparedness, the same as the national average. The state and nation saw a slight improvement from the previous year's score, following continuous improvements since 2013.

"Five years of continuous gains in health security nationally is remarkable progress," Glen Mays, who leads researchers at the University of Kentucky who develop the index, said in a news release. "But achieving equal protection across the U.S. population remains a critical unmet priority."

Kentucky was one of 11 states more or less at the national average. Those below average were largely in the Deep South, Southwest and Mountain West regions. Maryland had the top score of 8.0 and Alaska and Nevada shared the bottom number of 6.4.

Such numbers are becoming more important. "The United States experienced the most active and expensive year on record for disasters and emergency events in 2017, with total economic damages exceeding $300 billion," the report begins, adding that the "uneven pace" of improvement for health security across the U.S. is "leaving large and growing segments of the American population under-protected."

The index analyzes 140 measures, such as the number of pediatricians, flu-vaccination rates, bridge safety and food and water safety, to calculate a composite score of health security for each state and the nation as a whole.

The measures are then grouped into six larger categories including, health security surveillance; community planning and engagement; information and incident management; health-care delivery; countermeasure management; and environmental and occupational health.

Kentucky improved or stayed about the same as the national averages in all but one of those broad areas -- environmental and occupational health, which measures state's ability to maintain the security and safety of water and food supplies, to test for hazards and contaminants in the environment, and to protect workers and emergency responders. Kentucky's score for this measure dropped about 5 percent from the prior year, to 6.0. The national score is 6.6.

Kentucky saw its greatest improvement in health security surveillance, which rose 13.2 percent between 2013 and 2017. This measure looks at the state's ability to monitor and detect health threats, and to identify where hazards start and spread so that they can be contained rapidly. Kentucky's score for this domain was 8.6, compared to the national average of 8.1.

The state's lowest score, 5.2, is in health-care delivery, but that is the same as the national average. This category measures a state's ability to ensure access to high-quality medical services across the continuum of care during and after disasters and emergencies.

Suggestions from the report to to improve health security include: improving data sources and metrics; strengthening networks and coalitions; improving workforce policies, like offering paid leave and health insurance; improving health care delivery preparedness; assuring a dedicated and adequately resourced health security emergency response is in place; assuring adequate funding for an established health security infrastructure; and allowing for flexibility in the existing health security funding mechanisms.

Writer considers salad a wasteful luxury, and not all that nutritious

Salads should be considered a "resource-hungry luxury" instead of a staple because they offer little nutritional value, require "precious crop acreage" to grow, requires fossil fuel and refrigeration to ship, is the top source for food waste and a top transporter of food born illnesses, Tamar Haspel writes for The Washington Post .

"As the world population grows, we have a pressing need to eat better and farm better," Haspel writes.

Haspel notes that while she has pointed out problematic foods such as almonds, for their water use; corn, for the monoculture it encourages; and beef, for greenhouse gases from cattle, "none of them is a clear-cut villain," unlike salad, which "has almost nothing going for it." She backs up her claim with these arguments:

Salad is mostly water: Haspel writes that a nutrient quality index that rates foods based on how much of 27 nutrients they contain per 100 calories found "four of the five lowest-ranking foods (by serving size) are salad ingredients: cucumbers, radishes, lettuce and celery. (The fifth is eggplant.)" This is because they are 95 to 97 percent water, unlike other more nutritious vegetables like the sweet potato, which is only 77 percent water. "A head of iceberg lettuce has the same water content as a bottle of Evian (1-liter size: 96 percent water, 4 percent bottle) and is only marginally more nutritious."

Salad fixings are expensive, with little nutrition: "The makings of a green salad — say, a head of lettuce, a cucumber and a bunch of radishes — cost about $3 at my supermarket," she writes. "For that, I could buy more than two pounds of broccoli, sweet potatoes or just about any frozen vegetable going, any of which would make for a much more nutritious side dish to my roast chicken."

Eating less salad saves the planet: "When we switch to vegetables that are twice as nutritious — like those collards or tomatoes or green beans — not only do we free up half the acres now growing lettuce, we cut back on the fossil fuels and other resources needed for transport and storage."

Salad add-ins can make you fat: "Lots of what passes for salad in restaurants is just the same as the rest of the calorie-dense diabolically palatable food that’s making us fat, but with a few lettuce leaves tossed in. I won’t be the first to point out that items labeled 'salad' at chain restaurants are often as bad, if not worse, than pastas or sandwiches or burgers when it comes to calories."

"Take Applebee’s, where the Oriental Chicken Salad clocks in at 1,400 calories, and the grilled version is only 110 calories lighter. Even the Grilled Chicken Caesar, the least calorific of the salads on the regular menu, is 800 calories. Of course, salad isn’t always a bad choice, and Applebee’s has a selection of special menu items under 550 calories (many chain restaurants have a similar menu category)."

Lettuce is the top source of vegetable food waste and food borne illnesses: "It’s the top source of food waste, vegetable division, becoming more than 1 billion pounds of uneaten salad every year," and "According to the Centers for Disease Control (and Prevention), green leafies accounted for 22 percent of all food-borne illnesses from 1998-2008." (Leafy vegetables also include cabbage, spinach and other kinds of greens.)

Haspel says she loves a good salad as much as anyone, and recognizes that as a filler it has kept her from eating too much calorie-dense food, but she concludes, "As we look for ways to rejigger our food supply to grow crops responsibly and feed people nutritiously, maybe we should stop thinking about salad as a wholesome staple, and start thinking about it as a resource-hungry luxury."

Kentucky's local food movement is booming, but some say home-processing laws places undue burden on qualified entrepreneurs

The local food movement is alive and well in Kentucky, which leads the nation in federally funded local food projects, Janet Patton reports for the Lexington Herald-Leader.

In 2014, "Local food sales topped $11.7 billion, according to the United States Department of Agriculture, which has invested more than $800 million into local food businesses and infrastructure in the last six years," Patton reports. "Kentucky leads the nation in participation in federally funded local food projects, with 1,659 projects including high tunnels that extend the growing season, microloans for smaller farmers, and direct funding for food hubs, farmers' markets and other local food enterprises."

Kentucky's bipartisan nonprofit initative, Shaping Our Appalachian Region, has as one of its initiatives is "to identify local and regional food systems as opportunities to create new jobs and new entrepreneurships" in Kentucky's Appalachian counties, Agriculture Secretary Tom Vilsack noted.

Two communities in Kentucky, Barbourville and Hazard, were chosen to participate last year in the federal "Local Food, Local Places" initiative, which "helps communities develop action plans that use local foods to support healthy families and communities to drive downtown and neighborhood revitalization," says the website.

A second round of funding for this initiative is now available. The application deadline is Sept. 15. Click here for more information.

Kentucky has "73 farmers markets and direct-to-consumer outlets accept SNAP or food stamps now," Patton reports, with "nearly $80,000 in SNAP benefits redeemed at Kentucky's farmers markets last year, according to the USDA."

www.extension.org

But despite this boom in the local food movement, "Kentucky joins Delaware and Rhode Island as the three most restrictive states in the country for cottage food sales," Rachel Hurd Anger reports for LEO Weekly, a Louisville publication.

Cottage foods are produced in a person's home and are considered safe to be prepared in the average kitchen, like jams and jellies, candy, fruit butter, doughnuts, cakes and breads.

Until 2003, it was not legal for Kentuckians to sell home-processed foods, but this changed with the passage of House Bill 391, which allows farmers to grow, harvest and process food products and sell them from their homes and at approved farmers markets and farm stands. The law also requires home-based processors to register for one of two separate processing categories and follow specific kitchen guidelines.

The problem with this law, according to Anger, is that it "restricts the sale of low-risk cottage foods made in common kitchens, unless the homeowner grows the main ingredient themselves," which is "intentionally restricting skilled people from launching businesses."

As the law is written, Kentuckians who do not grow the primary ingredient in the product they wish to sell must get a Commercial Food Manufacturing permit and prepare their product in a "permitted kitchen that meets commercial food manufacturing requirements," according to the University of Kentucky Family and Consumer Sciences Extension website.

Anger also notes that this law does not apply to those who belong to Kentucky Proud, a free state marketing program for agricultural products that farmers must apply for, who "are allowed to produce and sell cottage foods from ingredients grown on their farms or elsewhere."

"Skilled Kentuckians deserve an inclusive cottage food law that allows for legal participation in the marketplace alongside our farmer friends," Anger writes. "Whether our cottage foods come from local harvests or just local hands, many gardeners, bakers, canners and other hobbyists have skills and generations of knowledge they crave to share with the community for a humble profit."

Store holiday leftovers properly for better flavor and food safety

Leftovers are a great way to stretch your food budget, but proper handling of them is important to make sure they maintain their taste and remain bacteria-free, says the Institute of Food Technologists.

In a news release, the institute suggests three keys for handling leftovers safely: proper refrigeration, containers and heating.

Leftovers need to be refrigerated within two hours of cooking (one hour on hot summer days or in warm climates). Modern refrigerators are built to cool hot dishes, and while it is both safe and energy efficient to cool food a bit before you refrigerate it, you don't have to completely cool it. Leftovers need to be just warm to touch, or around 90 to 100 degrees Fahrenheit before placing them in a refrigerator that is maintained at 40 degrees Fahrenheit or lower.

The best containers are thin-walled metal, glass or plastic and no more than 2 inches deep, but bags, foil and plastic wrap also work.

How long are leftovers safe in the refrigerator? It varies:

• Cooked meat can be stored three to four days in the fridge, while uncooked ground meats, poultry and seafood will last only a day or two.
• Raw roasts, steaks and chops (beef, veal, lamp or pork) can be refrigerated for three to five days.
• Casseroles, veggies and similar side dishes, as well as pie, will usually last three to five days.

If you have more food than you can eat within these time frames, Shelke recommends freezing it. Uncooked meats can last eight to 12 months in the freezer, while frozen cooked meats will begin to lose their flavor after three months. Freezer temperature should be at zero F (-18 Celsius).

On the front end, how do you food has been heated to a safe temperature? The best way is to use a thermometer. Most foods, especially meats, should be heated to 165 degrees F in the center. The institute also recommends that you bring sauces, soups and gravies to a boil before serving.

It also recommends that you never reheat leftovers in crock pots, slow cookers or chafing dishes, and only reheat foods to a rare center if they were initially cooked properly.

Raw milk suspected as cause of bacterial infections among four children in Hardin County and one in Oldham County

Five children in the Louisville region were recently hospitalized with E. coli bacterial infections, and all had consumed unpasteurized milk, state health agencies found. Investigators have not yet proven that raw milk caused the infections, but "found raw milk was the only common factor among the sick children," Forrest Berkshire reports for The Kentucky Standard in Bardstown and The News-Enterprise of Elizabethtown.

Four of the children are from Hardin County, and one is from Oldham. All went to a hospital to be treated for complications of E. coli, which attacked their red blood cells and affected their kidneys. The Lincoln Trail District Health Department said tests of milk from the suspected dairy and distributors were negative for E. coli, a bacterium common to the intestinal tracts of mammals.

"Pasteurization is the process of heating a liquid such as milk to a high enough temperature to destroy disease-causing microorganisms," Berkshire explains. "It also increases the shelf life of milk by destroying spoilage microorganisms and enzymes."

The state Department for Public Health said, "DPH is stressing the dangers of unpasteurized milk after learning all the affected children had consumed it and because it is a known source of E. coli bacteria, as well as numerous other pathogens that can lead to illness."

Selling raw milk is illegal in Kentucky, but is available through a "herd share," which allows members to buy an interest in a cow that allows them to take the milk home. "Northern Kentucky U.S. Rep. Thomas Massie, a Republican, introduced two bills earlier this year he characterized as 'milk freedom legislation' and would strip the U.S. Food and Drug Administration of its authority to police raw milk sales," Berkshire writes. Supporters of raw milk say it helps people resist disease and promotes better growth, stronger teeth and better behavior.

However, the federal Centers for Disease Control and Prevention conducted a study over a decade that found "the risk of outbreaks caused by raw milk is at least 150 times greater than the risk of outbreaks caused by pasteurized milk," Berkshire reports.

Kentucky law requires milk must be pasteurized, and officials encourage buyers to check labels to make sure it is, and throw it out if pasteurization cannot be confirmed. "Even negative tests do not guarantee that raw milk is safe to drink," the CDC says on its "Raw Milk Questions and Answers" webpage. "People have become very sick from drinking raw milk that came from farms that regularly tested their milk for bacteria and whose owners were sure that their milk was safe." (Read more)

Storm victims need to be vigilant about avoiding tetanus and mold, and protecting food safety

As storm and and flood cleanup continues, Kentuckians need to be vigilant about tetanus, mold and food safety, the state Department for Public Health warns.

Regarding tetanus, the DPH recommends avoiding contact with flood waters, which can be a risk for contracting the disease for people who have open wounds.

Mold can develop in homes that have been flooded, but air conditioners or dehumidifiers can help prevent mold growth, the DPH advises. When cleaning affected areas, wear safety goggles, rubber boots and waterproof gloves. In areas of heavy mold growth, a respirator or suitable mask is advised.

The DPH recommends removing all items that have been wet for more than 48 hours and cannot be dried or cleaned. Mold can be removed from hard surfaces using cleaners, soap and water or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Severe cases should be cleaned by experts.

When it comes to food safety, a full freezer will keep its temperature for 48 hours. A freezer that is half full will maintain its temperature for 24 hours. Refrigerated foods are safe as long as the power is not out for more than four hours. Any perishable food that has been above 40 degree for more than two hours should be discarded.

Freezer and refrigerators should be cleaned with a solution of 2 tablespoons baking soda dissolved in 1 quart of warm water. (Read more)

Kentucky gets an 'F' for how it handles food-borne illnesses

Kentucky is one of 13 states to receive an "F" for the way it handles food-borne illnesses, the Lexington Herald-Leader's Mary Meehan reports.

The Center for Science in the Public Interest report looked at data from the Centers for Disease and Prevention from 1998 to 2007. Ironically, the report gave the highest letter grades to the states that had the highest incidences of food-borne illness. "Those states are the most likely to have robust detection and reporting systems," the CSPI concluded.

"States that aggressively investigate outbreaks and report them to CDC can help nail down the foods that are responsible for making people sick," said CSPI Food Safety Director Caroline Smith DeWaal. "But when states aren't detecting outbreaks, interviewing victims, identifying suspect food sources, or connecting with federal officials, outbreaks can grow larger and more frequent."

During the period of study, Kentucky only reported 25 outbreaks, resulting in 193 people getting ill. Of those outbreaks, 75 percent involved 26 to 50 people, Meehan reports.

Dr. William Hacker, commissioner of the Kentucky Department for Public Health, said sizable changes have been made in the past five years, including hiring 18 epidemiologists to help prevent and study outbreaks. "I believe the report doesn't actively reflect what is happening in Kentucky," he said.

Seven states, including Florida, Hawaii, Maryland, Minnesota, Oregon, Washington and Wyoming, were given "A" grades. Kentucky, Arizona, Arkansas, Louisiana, Mississippi, Missouri, Nebraska, New Mexico, Oklahoma, South Carolina, Texas and West Virginia all received failing grades. The study noted the states with the lowest grades are in climates "conducive to pathogen growth." (Read more)

For a fact sheet on new legislation that addresses gaps in outbreak reporting, click here.