Health-care leaders urge Kentuckians to act now to secure 'life-changing' insurance coverage before it's too late; help available

By Dr. Lori Caloia, Dr. Jason Smith and Dr. James Frazier

Access to health-care services, doctors, vaccines, medications, therapies and guidance can have life-changing consequences. Health-care coverage is not a "nice to have." It’s a must-have. And it’s available for Kentuckians of all ages. And for those enrolled in Medicaid, action is required to stay covered.

During the pandemic, the federal government enacted a Public Health Emergency, which meant that individuals covered by Medicaid were allowed to stay in the program regardless of whether their eligibility had changed. This was to prevent coverage gaps during the health crisis. But renewals have now restarted, and people covered by Medicaid must act to keep coverage or find a new health plan.

Action must be taken to ensure coverage

Medicaid renewals in Kentucky began again last April, and 1.6 million Kentuckians – 37% of our state’s population – are being asked to show their eligibility for Medicaid and the Children’s Health Insurance Program.

Acting now is critical. Many people are unaware that their coverage may be ending, or may have already ended. Data from Kentucky and across the country shows that millions have lost Medicaid coverage but have not transitioned to other health insurance plans through an employer or Kynect, Kentucky’s state Health Benefit Exchange. Of course, going without health insurance is dangerous medically and financially, and it’s unnecessary when Affordable Care Act plans are available for as little as $0.

Take steps now to make sure you have coverage. Even if you’re not enrolled in Medicaid, affordable health insurance for you and your family is available.

What to know about renewing and enrolling in health-care coverage

Many resources have been made available to help Americans understand and take advantage of options to stay covered. In fact, the Commonwealth of Kentucky and Anthem Blue Cross and Blue Shield in Kentucky both offer tools and resources to help people easily understand their options and access the coverage that meets their needs. Anthem offers MyHealthBenefitFinder.com, a self-service tool allowing anyone to answer a few, simple questions, and get information that helps them understand the types of health coverage they may be eligible for. The tool then provides clear steps on how to access that coverage. Anthem also offers a dedicated call center for those who have questions about navigating the Medicaid renewal process. Call 1-855-690-7784 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m.  

The Kentucky Health Benefit Exchange, at khbe.ky.gov, is full of information, resources, agents, and health coverage guides called Kynectors who can answer questions and help you understand your coverage options. HealthCare.gov is another warehouse of information, quick start guides as well as connections to healthcare navigators and brokers in each community.

Affordable, accessible coverage is available for people of all ages and most circumstances. It just takes action to secure that coverage. That’s why Anthem is urging Kentuckians to start the new year by spending time following up on where they, their loved ones, and acquaintances stand with their healthcare coverage. If help is needed, take advantage of the resources that are available. Taking just a few minutes could make a life-changing difference.

Dr. Lori Caloia is the medical director for Anthem Blue Cross and Blue Shield in Kentucky. Dr. James Frazier is chief medical officer at Norton Healthcare. Dr. Jason Smith is chief medical officer at University of Louisville Health and p rofessor at the University of Louisville.

Physician-in-chief at Kentucky Children's Hospital says state can do better by its kids; it ranks 40th in well-being of children

Dr. Scottie B. Day (UK photo)

By Dr. Scottie B. Day

University of Kentucky

A recent report by the 2023 Kids Count Data Book studied how economic well-being, education, health and family support impacts a child’s overall well-being, and how those impacts vary from state to state. So how does Kentucky rank? Are parents able to find secure employment, with wages that keep pace with inflation and cost of living? Are the kids doing well in school, meeting education benchmarks and graduating on time? Do they have access to health care, especially mental health resources? How do we fare compared to other states?

Kentucky ranks 40th in children’s overall well-being. This is unacceptable, and we can do better.

Our kids are in crisis. 22% of Kentucky’s kids live in poverty. Without access to affordable, quality childcare and preschool programs, those kids fall behind their peers in developmental and educational benchmarks. More than 41% of children between the ages of 10-17 are overweight or obese. Children who struggle with their weight are at higher risk for heart disease, diabetes and cancer later in life. Sixty percent of children and adolescents with major depression receive no mental health care. Since 2019, suicide deaths in individuals ages 10 to 19 increased by almost 70%.

The pattern is clear; how we provide kids now informs their futures, as well as the future of the entire commonwealth.

This is not to suggest that as children transition to adulthood, they aren’t capable of change and have the knowledge to make better decisions for themselves and their children. But shouldn’t they have the best possible start to begin with? Shouldn’t we utilize every resource to ensure that every child in Kentucky grows up to be a healthy adult?

We need to help families offset the cost of child care and support child-care workers. Strengthen preschool programs accessibility so kids can build the skills they need to be successful in school. But most importantly, we must invest in kids’ physical and mental health. The stress of poverty, exposure to violence, substance abuse and lack of access to primary care, preventive screenings and proper nutrition are just a few of the factors that adversely affect a child’s physical, mental, and emotional well-being. Adversity doesn’t “build character;” it influences every aspect of a child’s life and continues to inform patterns of behavior for generations.

If we only do what we can do, we will never be more than we are now. Let’s plant the tree now and let the roots take hold to build a stable foundation. Even though we may not see the fruit for years, we can take comfort in knowing that future generations of Kentuckians will be strong and well-nourished.

Scottie B. Day, M.D., is physician-in-chief at Kentucky Children’s Hospital and chair of the University of Kentucky College of Medicine’s Department of Pediatrics.

Opinion: Gender dysphoria may have a basis in human biology

By Kimberly Kennedy

Most of us witnessed with horror the passage of anti-transgender bill SB150 by legislators who ignored overwhelming opposition. Since Gov. Andy Beshear is expected to veto it, our only recourse is to convince legislators not to override that veto.

If you’re dubious, hear me out: We’ve left critical information out of the conversation, namely the growing evidence that gender dysphoria (GD) has a basis in biology. Skeptical that would work? Well, research shows that when people understand this, their support for trans people increases.

Kimberly Kennedy

Many in the trans community bristle at the idea of discussing GD as if it were a defect. But I believe we can be sensitive; and I take inspiration from researcher Dr. J. Graham Theisen of Augusta University, who describes it as a “variant,” like blue eyes or brown hair, that doesn’t cause disease but makes us individuals.

Plus, we must meet the opposition where they are, if we hope to bridge the gap. I’ve heard awful comments about trans people; but I look for common threads, like the belief it’s a choice or lifestyle, or that it ignores what God intended. Evidence of a biological basis discounts these arguments and might persuade more legislators to push the pause button on anti-trans legislation.

So here’s a sample: First, research has confirmed that male and female brains are different. Second, during fetal development, hormones influence the gender of the external and internal sex organs during the first trimester; hormones program gender development in the brain, where gender identity is experienced, later in the pregnancy.

Research in the Netherlands from 2014 found that in some cases, physical development in utero was subject to a hormonal mismatch from brain development, “so that the body was masculinized and the brain was feminized, or the other way around.” This corresponds with transgender people’s reported experience of their gender identity, which occurs before age seven for three-fourths of the population.

In 2018, an Australian study comparing transgender women and cisgender men (both born male) found statistically different variations in four genes. In 2020, a U.S. and a U.K. meta-analysis (compilation of multiple studies) found that “people with gender dysphoria have a brain structure more comparable to the gender to which they identify” rather than to the sex assigned at birth. Yet a 2020 German study found that the brain structure of trans women was different from both cisgender males and females. In view of this, researchers suggest that we view gender as a “spectrum” rather than a binary construct.

Theisen clarifies that “once someone has a male or female brain, they have it and you are not going to change it. The goal of treatments like hormone therapy and surgery is to help their body more closely match where their brain already is.”

Proof of transgender biology indicates that SB 150 will invite a civil-rights lawsuit. Thus Kentucky taxpayers will pay to defend legislation that 71% of Kentuckians don’t want — potentially costing hundreds of thousands or even millions of dollars; just ask Floridians about the price tag for defending controversial legislation.

Contact all legislators who voted "yes" in the House and Senate. Write to your own representative or senator, or call the Legislative Research Commission comment line at 1-800-372-7181. We have until Tuesday, March 28, to make a difference for our families and friends.

Kimberly Kennedy of Villa Hills is a freelance writer, former educator and parenting-magazine editor, and parent of an LGBTQ+ young adult. Her degrees are a BFA in art education and a BA in art history from the University of Cincinnati. This article was originally published in Forward Kentucky.

Opinion: Covid-19 vaccine effectiveness declines rapidly; seniors need to keep up their immunity, and we need a better vaccine

Covid-Net graph, adapted; gray area may have some delayed reporting and does not indicate trends.

Kevin Kavanagh, M.D.

By Kevin Kavanagh for Infection Control Today

I am at high risk for severe Covid-19, being 65 years or older, with additional health problems. I received my bivalent booster as soon as possible and am approaching my 6-month anniversary. I, thus, watched the CDC’s last Advisory Committee on Immunization Practices meeting with great interest regarding their recommendations for when to obtain my next booster.

Reuters reported that the committee concluded, “There is not sufficient evidence to recommend more than 1 Covid-19 booster shot a year for older people and those with weakened immune systems,” but the committee did voice some flexibility. It needs to be stressed that there was an absence or lack of data—rather than a presence of data—indicating the durability of vaccine immunity, justifying annual boosters.

There was no vote regarding the timing of booster doses, but there was nowhere near a unanimous consensus. Michael Hogue of the American Pharmacists Association said, “We want those clinicians to be able to make good decisions for the individual patient based upon their comfort and desire as long as we have safety in mind, and it is clear that we do have a very safe vaccine with our bivalent vaccine. So, I feel that flexibility needs to be put into this some way, with both older adults and people with immunocompromising conditions.”

I did not hear calls for approving a more frequent administration schedule. One committee member said those over 65 should be allowed to discuss off-label use with their physician in order to receive the booster sooner. Almost all the discussion centered on messenger-RNA vaccines, with little mention of Novavax or the urgent need for newer, more durable vaccines.

Vaccine effectiveness is an important point. Although much of the younger population received a get-out-of-hospital free card for the latest variant, senior citizens were in its crosshairs. Since May 2022, those over 75 had a higher rate of hospitalization than in the Delta surge; those 65 to 75 had about the same. Both age groups continue to be at high risk for death and disability.

However, when I saw data on effectiveness of the monovalent vaccines, the two-dose-or-more immunization that preceded the bivalent vaccine, I felt foreboding. The data showed that for those 65 years and older, the effectiveness of two or more monovalent doses at preventing hospitalizations fell to 28% in less than a year.

Among younger people, the monovalent vaccines were only 19% effective. This finding may seem paradoxical, but could be explained by the elderly leading a safer lifestyle and the possibility that immunity produced by previous infections may not have been as durable. Neither explanation bodes well for vaccine effectiveness lasting a year.

For the bivalent booster, effectiveness against hospitalization fell rapidly, from 52% at a median of 32 days to 31% at a median of 74 days (67-85 days) after the last dose. It should be noted that this effectiveness is on top of some residual immunity from the monovalent vaccine, since the monovalent vaccine was used as the reference.

Let’s face it. The results are dismal, with little durability from an immunity boost from a bivalent booster after an individual has had a monovalent vaccine. The benefit from the bivalent booster rapidly diminishes, and its efficacy in preventing hospitalizations two months after receiving the booster is poor and would be expected to be poorer in the elderly.

Is the bivalent booster worth taking? Yes, definitely. However, this differs from the booster or vaccine we need to navigate this pandemic. We need another warp-speed initiative for vaccine development—a vaccine that is more durable and can reduce spread. The risk of continuing to use a vaccine with reduced effectiveness is shown when the vaccine was seemingly less effective in the young. When vaccinated, many view themselves as invincible and can increase risky behavior far beyond the vaccine's benefits.

It is critical for the elderly to keep their immunity as high as possible. Monoclonal antibodies are no longer effective with the new variants, and far too many cannot receive Paxlovid because of drug interactions. Molnupiravir is often not prescribed since it works by creating viral mutations and has been implicated in speeding variant evolution.

At the conclusion of the CDC committee meeting, my primary impression was that we senior citizens might be viewed as expendable. Far too few policymakers are concerned about our well-being and willing to make the hard decisions that must be made to assure our safety during this pandemic. After looking at the data, I will consult my physician about receiving a booster on an accelerated schedule, possibly at six months.

Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA. This is an edited version of his original article, which was first published in Infection Control Today.

May is not just Nurses Month; it's Kentucky Nurses Suicide Prevention Month, writers say; nurse suicide rates keep rising

OPINION by Julie Marfell, Paul Norrod and Lee Anne Walmsley
    
Nurses are the backbone of health care, supporting and protecting their patients. During the Covid-19 pandemic, nurses have soldiered through an increased workload, short staffing, fear of becoming sick or worse exposing their families to sickness and very ill patients, many of whom died with a nurse by their side and no family members. The load nurses have carried over the past two years is consistently heavy and, with no relief in sight, the backbone is feeling the strain. As nurses continue to move forward, we must find ways to lift this burden. The high price for the burden is losing nurses to suicide.

Lee Anne Walmsley, Julie Marfell and Paul Norrod 

Suicide is the 11th leading cause of death in the United States. Nurse suicide rates continue to rise with female nurses experiencing higher suicide mortality compared to other occupations. By contrast, male and female nurses are more likely to experience job problems and mental health challenges than the general population which increases the risk of suicide. In Kentucky, approximately 58 nurses have died by suicide since 2016; one is too many.

Nurses need continued support to thrive as a profession. In January, the Kentucky Board of Nursing mandated that all nurses must complete nurse suicide-prevention continuing education. The Kentucky Nurses Action Coalition, with the support of the Kentucky Nurses Association, developed an educational video and program to address suicide prevention for nurses. Visit kentucky-nurses.org for more information. This program teaches nurses how to identify signs of overwhelming stress and hopelessness in themselves and others that are risk factors for dying by suicide. It also emphasizes the importance of self-care to reduce stress and reaching out for help to carry the load and relieve some of the burden.

An increased awareness of the risk for suicide is crucial for the health of the nursing workforce. To remain strong, nurses need to support in all aspects of their work and everyday lives. This includes encouraging and providing opportunities to maintain healthy lifestyles, training in suicide prevention and removing the stigma attached to mental health illnesses. We all must develop an understanding that just like other illnesses, we can prevent mental health problems and treat them with lifestyle changes and medications.

National Nurses Month affords us the opportunity to show our appreciation for nurses and we appreciate the accolades; however, it’s important to remember to thank nurses every day, 365 days a year. If you have a friend or relative who is a nurse, check in with them, and when you ask them how they are doing. please listen. Hear what they are saying and support them. Help them get the help they need to be well. We all need to take care of nurses for without a strong backbone we cannot stand tall.

The National Suicide Prevention hotline is 1-800-273-8255. Text HOME to 741741 to speak anonymously with a crisis counselor. Kentucky Community Mental Health Centers are listed at https://dbhdid.ky.gov/crisisnos.aspx

Julie Marfell, DNP, FNP-BC, FAANP, is president of the Kentucky Nurses Action Coalition and an associate professor in the University of Kentucky College of Nursing; Paul Norrod, DrPH, M.Div., MA-C, RN, is a member of the coalition and an instructor in the College of Nursing; LeeAnne Walmsley, PhD, EdS, MSN, RN, is an assistant professor in the college.

Fentanyl-driven addiction crisis requires more investment in prevention and treatment, says president of treatment company

OPINION By Tim Robinson

Every day in the United States, more than 270 people die from drug overdoses. That’s one person roughly every five minutes.

Behind these staggering statistics are real people—mothers, fathers, sons, daughters, colleagues, friends—and their loved ones whose lives have been forever changed. With more than 2,300 Kentucky lives lost to overdoses just last year, our communities here at home have certainly felt the impacts firsthand.

In recent years, fentanyl has become an unprecedented and driving force of overdose fatalities, accounting for the deaths of more than 79,000 adults ages 18 to 45 and becoming the leading cause of death for Americans in that age range. Officials in Kentucky have also linked fentanyl to increases in drug overdose deaths.

If you take a look at headlines from across the country, you’ll find heartbreaking story after heartbreaking story of the individuals behind these facts and figures—many of whom are shockingly young. Between 2019 and 2020, drug deaths among children ages 10 to 14 more than tripled. Researchers estimate that adolescents and young adults have lost 1.2 million years of life due to unintentional drug overdoses over a five-year period.

As a result, more conversations are happening at the state and federal levels about the road ahead. In February, lawmakers in Washington, D.C., released a bipartisan report outlining strategies to address our nationwide fentanyl problem and reduce the number of overdose deaths, which include increasing prevention resources and access to treatment.

Much like the comprehensive public health response to the HIV/AIDS epidemic back in the 1980s, the addiction crisis requires an all-hands-on-deck approach. This is a problem that’s worse today than it was just a couple years ago. To start moving in the right direction, we must invest in education, prevention, treatment and recovery—and without delay.

As frontline treatment providers, our organization is constantly working to identify and reduce barriers to recovery. When an individual decides to seek help, our transportation team will pick them up, wherever they are, and bring them to treatment. Addiction Recovery Care’s team of community liaisons serves as our boots on the ground throughout the state, working to connect with some of our most vulnerable community members and the hospitals, doctors and corrections facilities that routinely interact with them. Our ARC Anywhere program takes advantage of advances in telehealth and broadband to offer services via phone and computer.

While accessible treatment is a critical part of the equation, equally important is prevention, especially among our younger community members who still have so much of their lives ahead of them.

In Kentucky, we’re fortunate to have partners like Operation UNITE that have led the way on prevention since the earliest days of the addiction crisis. Operation UNITE has consistently been ahead of the curve with their programs that educate children and teens on the dangers of substance use. And while prevention alone won’t stop addiction in its tracks, I know that many teens and adults who are struggling with addiction today would have benefited from learning about substance use from a younger age and being equipped with the proper tools and information.

At the end of the day, treatment and prevention are two sides of the same coin. That’s why we also work hand-in-hand with Operation UNITE to ensure that anyone who wants treatment services can receive them, regardless of their ability to pay. Operation UNITE’s Treatment Voucher Program provides financial assistance to low-income Kentuckians pursuing long-term residential treatment for a substance use disorder. Over a 15-year period, Operation UNITE has provided more than $18.6 million in vouchers for treatment.

With so many lives lost already—and many more at risk—we must continue to invest and expand thoughtful, comprehensive prevention initiatives and programming throughout our schools, communities and workplaces, not just in Kentucky, but nationwide.

No American wants to live in a world where more than 270 lives are lost to drug overdoses each day. That’s certainly not the reality I want for my children, grandchildren and future generations. By prioritizing both treatment and prevention, we can forge a path that leaves our communities in better shape for future generations—but the work has to happen today.

Tim Robinson is president and CEO of Addiction Recovery Care (ARC), which offers treatment and recovery services throughout Kentucky.

Opinion: Legislature is moving bill that would restrict abortion rights while ignoring several filed to help babies and mothers

This opinion was originally published in the Lexington Herald-Leader.

By Linda Blackford

Herald-Leader Opinion Editor

Why bother writing about abortion access in Kentucky? The die is cast, as it were, with superdupermajorities in the state House and Senate who can legislate however they want. It’s very possible that in the near future, the Supreme Court will strike down the constitutional right to an abortion, and Kentucky will become once again home to back alleys and wire hangers. We already have a trigger law in place outlawing the practice in Kentucky as soon as the Supreme Court rules.

On Tuesday, March 1, the House Veterans, Military Affairs and Public Protection Committee, which for some strange reason now hears abortion bills instead of the Health and Family Services Committee (because Health members might be too touchy-feely?), approved House Bill 3, the new omnibus bill that does all kinds of things to make it even harder to get an abortion here. The bill takes special aim at MAB, medication that can cause an abortion very early on in a pregnancy, and is so safe and effective that it accounts for half of all abortions in Kentucky and was recently approved by the Food and Drug Administration to be sent through the mail directly to people’s homes.

Photo illustration from Deamstime

So why shout into the wind (again)? Well, I think it’s worth pointing out that Republicans are not the only ones who care about mothers and babies. The Kentucky House Democratic Women’s Caucus (again) has crafted a slate of maternal health bills, not one of which has been even assigned to committee.

They range from a sales tax exemption for breast pumps to bereavement leave in the case of a child’s death to Medicaid coverage for doulas. House Bill 37 would try to stem Kentucky’s horrific maternal mortality rates, including the fact that Black women die at more than double the rate of white women. According to the 2020 Maternal Mortality Report for Kentucky, in 2017, roughly 76 percent of all maternal deaths were preventable.

One exception is House Bill 174, which would extend Medicaid to new mothers for up to a year, which passed the House, and of course there are some Republicans, like Sen. Julie Raque Adams of Louisville, who have worked hard on issues affecting families.

But 16 bills from House Democrats would also address getting new mothers on Medicaid, postpartum depression, parental leave, and new rights for pregnant inmates. In other words, they are all trying to help the lives of mothers and babies in this state — actual people who are already here — in humane and holistic ways.

And let me say this again: None of these bills has been assigned to committee, which tells us that the majority party is not really that interested in doing anything but score political points.

There are two more bills that sit ignored in the Committee on Committees: House Bills 299 and 300 would require health-care plans to cover birth control before and immediately after a pregnancy. If I were worried about unwanted pregnancies, I’d be very interested in getting birth control to more people, but that is both logical and consistent, two words that don’t abound in Frankfort.

Despite what Republicans tell you, no one thinks abortion is grand or wonderful, but as many doctors will tell you, it can be an important part of women’s healthcare that should be between those women and their doctors. The fundamental hypocrisy of the GOP caring only about the unborn is alive and well. Sadly, it will probably be even more on display in the years to come. 

Linda Blackford writes columns and commentary for the Lexington Herald-Leader. She has covered K-12, higher education and other topics for the newspaper for the last 20 years.

UnitedHealthcare, nation's largest insurance company, posts record profit for an insurer; growth comes mainly from taxpayers

UnitedHealth Group's headquarters is in Minnetonka, Minnesota, near Minneapolis.

NEWS ANALYSIS by Wendell Potter

Just days after a Commonwealth Fund report showed that American families are sending health insurance companies more and more of their income every year even as their deductibles skyrocket, the country’s biggest insurer reported massive 2021 profits and told investors to expect even higher profits in 2022.

UnitedHealth on Wednesday reported 2021 profits of $24 billion on revenue of $287.6 billion. Executives told Wall Street they expect United will be the first insurer to take in more than $300 billion from its customers this year.

Instead of giving its health-plan customers relief from ever-increasing out-of-pocket requirements, United spent $5 billion last year buying back its own shares of stock, a gimmick that boosts the value of shares and makes shareholders richer. United also paid shareholders $5.3 billion in dividends in 2021.

No insurer has ever made that kind of money in U.S. history. It’s even more notable when you consider that United is not growing by attracting substantially more new customers.

At the end of 2021, United had about 26.6 million people enrolled in its commercial (individual and employer-sponsored) health plans. That’s just 700,000 more than the 25.9 million the company had 10 years ago. Most of United’s membership and revenue growth now comes from the company’s Medicare Advantage plans and the state Medicaid programs it manages. In other words, from us as taxpayers. United and other insurers are padding their top and bottom lines by charging their existing commercial customers higher and higher premiums every year.

Consider this: an employer-sponsored family policy that cost an average of $15,073 in 2011 cost $22,221 in 2021, a 47% increase, according to the Kaiser Family Foundation. And during that time, insurers have forced their health plan enrollees to pay more and more out of their own pockets through ever-increasing deductibles, copayments and coinsurance. Most Americans now have to pay on average twice as much out of their own pockets as they did 10 years ago.

That Commonwealth Fund report shows that with the relentless increase in both premiums and out-of-pockets, Americans are shelling out far more of their household income for health insurance and to cover out-of-pockets than a decade ago. Premiums and deductibles now take up more than 10% of median income in 37 states, up from just 10 in 2010.

Insurers argue that high deductibles are necessary to control premium increases. Unfortunately, most employers and policymakers seem to have bought that argument. But when you look at the research from both the Commonwealth Fund and Kaiser Family Foundation – and then the record profits United and other insurers are reporting – that talking point just doesn’t hold up.

Editor's note: UnitedHealthcare's parent firm, UnitedHealth Group, is the world's eighth largest company by revenue and second-largest health-care company behind CVS Health by revenue, and the largest insurance company by net premiums, according to Wikipedia. Wendell Potter is a former reporter Tennessee and Washington who spent more than two decades in the health insurance industry, first at Humana and then at Cigna as head of corporate communications. He has written three books: Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans (a New York Times bestseller and winner of the Ridenhour Book Prize in 2011); Obamacare: What’s In It for Me/What Everyone Needs to Know about the Affordable Care Act (an ebook); and Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It. His nonprofit corporation, To Be Fair, publishes news and commentaries on money in politics, propaganda, health care and other topics.

Somerset doctor says spread, strength of Delta variant mean it's too late to 'vax it or mask it'; both needed in high-spread areas

By Kevin Kavanagh

Republished from Infection Control Today

Dr. Jerome Adams, surgeon general in the Trump administration, said this month that the guidelines the Centers for Disease Control and Prevention issued in May on removing of masks were “premature” and “wrong.” Two years ago, most would not believe such a statement, but after the last year and a half, Adams’s statement is viewed by many as just another instance of misguided policy from the CDC. At issue was the May 14 policy reversal of no longer requiring vaccinated individuals to wear masks. The CDC stated it was based solely on science. However, many felt that this would open the door for no one to wear masks. Unfortunately, this is what appears to have happened.

Then came the Delta variant, virus which is up to 2.25 times as infectious as the wild type virus and has a higher replication rate producing 1,000 times more virons. In addition, it appears to be able to evade immunity. Israel reports vaccine efficacy has dropped to 64% in preventing symptomatic disease, down approximately 30 percentage points. Thus, there is concern that even vaccinated individuals can develop symptomatic diseases and may spread the virus. Most agree that the vaccines are effective in preventing deaths and hospitalizations, but even mild to moderate disease carries the risks of long Covid-19.

Thus, neither masks nor vaccinations will truly afford safety in areas where there is high viral spread. Each is a layer of armor and all need to do both until this virus dissipates.

The CDC and our federal response cause concern. In 2020, advisements on masking were reversed once asymptomatic spread was identified. In the public’s eye, this was held by many to be a sign of incompetence rather than evolving science. But since then, there have been a number of missteps in dealing with the coronavirus, SARS-CoV-2.

The rapidity of viral spread around the world, along with case reports from choirs, restaurants, and hospitals made an extremely strong case for aerosolization of SARS-CoV-2 -- so strong that 239 international scientists asked the World Health Organization and other public-health organizations on July 6, 2020, to recognize aerosolized spread of the virus. The National Academies of Science issued an expensive report on SARS-CoV-2 airborne transmission in October 2020. On Feb. 15, 2021, warnings were sent to the White House, CDC and the National Institutes of Health regarding SARS-CoV-2 aerosolization by 12 prominent infectious-disease authorities. Their letter called for strengthening of CDC guidelines for small-droplet spread with attention to the provision of respirators (N-95 masks) to workers and those exposed to SARS-CoV-2 aerosols.

But it took until May 6 for the CDC to recognize that airborne transmission can be a major spread of the virus. Ironically, a week later the CDC removed the masking requirement for those who are vaccinated, making the need for N-95 masks much less. Others are starting to follow former Surgeon General Adams’ advice. On July 19, 2021, the American Academy of Pediatrics recommended that all children over the age of 2, regardless of vaccination status, wear masks in schools this fall.

One of the safeguards which was present in 2020 was the presence of civilian scientists on the White House Coronavirus Task Force. However, on January 20, President Biden dissolved his Covid-19 transition task force, removing non-governmental employees, including some who later signed the Feb. 15 letter.

Needless-to-say, early recognition of aerosolization would require the use of N-95 masks and make upgrading ventilation systems an imperative. Proper interventions require infrastructure changes and allocation of significant resources. We also need to implement a comprehensive system of genomic sequencing of viral specimens to track community spread. Throughout this pandemic testing has been woefully inadequate in the United States, unless of course you are a member of a professional sports team.

All of these advisements tend to mitigate the seriousness of SARS-CoV-2 and lessen the need for interventions. We need to have a paradigm shift in the way we view this virus, planning and implementing strategies to allow us to live with an endemic pathogen. We need to treat respiratory pathogens with the same vigor and diligence we put forth to prevent water, surface and foodborne disease.

The advice that you’re safe if you “vax it OR mask it” no longer holds with the Delta variant. We must do both. We also need to be taking this virus seriously. We need to remember that many civilizations in the past have been brought down by infectious disease, and species have gone extinct. What separates mankind from the rest of the biosphere is our intelligence and ability to leverage science. If we do not do this, we are in no better position than a tadpole. Unfortunately, almost all of our leaders appear to be hoping the virus will miraculously disappear. This did not work last year, and it will not work in 2021.

Kevin Kavanagh of Somerset is a retired physician and founder of Health Watch USA.

Writer recalls what it was like to visit her unvaccinated relatives

By Teri Carter

Seven of us are crowded around a table for six in a packed Missouri restaurant called The Southerner, waiting for entrees that are taking forever to arrive. “Aw, they can’t help it, that’s for sure,” Dad says. “Nobody wants to work.”

I take a sip of Diet Coke and ask what I’ve been wanting to ask since we got here: “So, are all of you guys vaccinated?”

My brother Chuck is sitting across from me. “Hell, no,” he says. I ask why not. “Because it’s bull, that’s why,” he says (but more profanely). “These vaccines ain’t even approved, and coronavirus ain’t new. They ain’t sticking that thing in me. Who knows what’s in it.”

Map on Cape Girardeau floodwall

I am visiting my hometown of Cape Girardeau, Mo., having dinner with my family. I know Dad is vaccinated but have no idea about anyone else. My brothers and I were separated by divorce when we were little — I went with Mom, they went with Dad — and we are far from close. At 55, I’m the oldest. Butch, 53, and his family aren’t here. This is the first time I’ve seen Chuck, 48, since our grandfather’s 2011 funeral, where we did not sit together. Tonight, Chuck has brought his new girlfriend, his 19-year-old daughter and his 25-year-old daughter and her husband.

I look to the girlfriend next. “Oh, I am,” she says, holding up both hands. “But not by choice. My former employer made us.”

A busboy arrives to refill our water glasses. At the other end of the table, my nieces shake their heads no, and my niece’s husband says to me: “I’m not an anti-vaxxer or anything. I get a flu shot every year. This is just stupid and there’s no science. It’s all politics.” Then he turns to the whole table: “Hey, is this where we get to talk about how Biden’s not the real president?”

“Don’t start,” Dad says, and soon enough the waitress arrives with an armful of plates to put us out of our misery.

It is June 24. A day before, The Associated Press had published a story reporting: “Missouri is becoming a cautionary tale for the rest of the country: It is seeing an alarming rise in cases because of a combination of the fast-spreading delta variant and stubborn resistance among many people to getting vaccinated. Intensive care beds are filling up with surprisingly young, unvaccinated patients, and staff members are getting burned out fighting a battle that was supposed to be in its final throes.”

I live in rural Kentucky, so Covid denial and vaccine refusal are no surprise. But other than my husband, I have no family in Kentucky. Which means we have no required gatherings there. If I go to a restaurant, I go by choice and with people I know, and those people are vaccinated.

When I arrived in Missouri, I’d thought my dad and I were having dinner alone, just the two of us. After all, it was the first time I’ve been home — the first time I’ve seen him — since November 2019. He would meet me at The Southerner, he had said, next to my hotel. It wasn’t until I arrived at the restaurant that I saw the reservation was for seven — Dad being our dad, hoping not-for-the-first-time that getting us in the same room might miraculously fix us.

Sadly, on top of our already fractured and dyspeptic personal history, my family has added Trumpism and a global pandemic to the long-standing influence of local-boy-done-good Rush Limbaugh — dead now but lionized here in our shared hometown — who spent decades sowing falsehoods, selling victimhood and convincing southeast Missourians like my family that Democrats are big-government, baby-killing socialists who can’t be trusted. And now their president wants us to take a brand-new vaccine?

My family should be eager to take the shot: Missouri reportedly had the highest share in the nation of the new delta variant among its coronavirus cases late last month. But in Cape Girardeau County, another stat may be more relevant: Trump won Missouri with about 57 percent of the vote last November, but he got almost 72 percent in the county.

That was no surprise. I recall the time in 1999 that I flew home from Minnesota, where I was living then. My luggage got lost. I woke up in my hotel and went straight to the beauty supply store across the highway to get some basic toiletries. Limbaugh’s radio show was playing loud behind the counter. As she checked me out, the clerk swooned, “Don’t you just love Rush? I could listen to him all day. He says everything I think.”

The Southerner restaurant

As our family dinner at The Southerner comes to a close, everyone stands, and Dad nudges me with his knuckles: “Come with me a sec. I found one of your scrapbooks.” On the way out, Chuck says, “We’ll see y’all Saturday.”

It is 90 degrees, and a hard, hot wind whips at us the instant we step outside. In the full parking lot, we stand behind Dad’s truck, and I wait while he struggles with a tiny lighter to light his Marlboro. When it finally catches, he takes a long draw, and I ask what Chuck meant. I thought my dad and I were driving over to Illinois on our own to see more family. But it turns out Butch and his wife Donna are coming, too, and Dad thinks we should ride with them for the 90-minute drive each way.

I haven’t seen or heard from them in about a decade, so it seems like that would be weird. But I have another question: “Are they vaccinated?”

The hot wind continues to blow in all directions. We are both sweating. I have to keep pushing my hair out of my face. Dad flicks his ashes at the parking lot.

They’re not vaccinated, he explains, because they already had it, and so did one of their kids — back in September, Dad thinks. But they didn’t get all that sick.

I tell him I wouldn’t choose to get together in a big crowd of unvaccinated people, even though I’m vaccinated myself. Dad shrugs, flicks his cigarette into the wind and lights another. I am trying not to cry. We continue to stand in the full parking lot, cars pulling in and out, him smoking, me stewing. We are silent. I wonder if it sounds petty that I don’t want to share meals or ride in a car for three hours with a brother and sister-in-law whom I barely know anymore and who refused to be vaccinated.

Of course it sounds petty. Because it is petty.

But then I think about the 14 months that my cancer-surviving husband and I took the virus seriously, followed guidelines, stayed home, never ate at a restaurant (even outside), refused invitations from good friends, missed every holiday and birthday with our kids and two baby grandsons. I think about how we struggled online to get vaccine appointments and how I stood in that long line, twice, to get shots. I think about how excited we were to finally get out in the world again, to get on with our lives.

Until today, until this family dinner, I did not realize the depth and breadth of the envy and resentment I still hold for those like my own brothers and their families — the Covid deniers, the willfully unvaccinated, who spent those same 14 months going happily and carelessly about their lives as 600,000 died.

Even as I understand the toxic and steady influence of professional prevaricators like Donald Trump and Rush Limbaugh, I want to place blame on the familiar. I wonder when we will get past all this. And if.

“All right, kiddo,” Dad says, taking his last drag, hugging me with one arm, and climbing into his truck. Through the window he hands me my scrapbook, which looks to be from about eighth grade. “Good God,” I exclaim, “where’d you find this?”

Teri Carter

He asks me if I remember that time I was in college and my car wouldn’t start, so he had to come meet me at the crack of dawn to help me get to class.

I do not remember, but I say yes anyway. “Come on over Saturday,” he says, pulling away, “and we’ll figure all this out.”

Teri Carter lives in Anderson County. This was first published in The Washington Post.

Louisville-based columnist for Washington Post includes Beshear and two other governors among list of heroes of the pandemic

Govs. Andy Beshear, Mike DeWine (Ohio) and Jay Inslee (Wash.)

By Perry Bacon
The Washington Post

I was relieved in 2019 when voters in Kentucky, where I live, rejected giving then-incumbent Gov. Matt Bevin (R) a second term. Unlike Bevin, who spent his time in office on Trump-like attacks on the press, judiciary, teachers and other institutions, his opponent Andy Beshear was at least a small d-democrat. My worry was that Beshear was also a big-D Democrat — the kind of blah, status-quo figure the party often churns out, who isn’t particularly good at politics or governing. After all, the main reason he won was that people in Kentucky disliked Bevin and had good memories of Steve Beshear, the former governor and Andy’s dad.

I was totally wrong about Andy Beshear. As Covid-19 struck, the usually mild-mannered governor was aggressive early, emphatically emphasizing the dangers of the virus in ways that helped get people in the state to take it seriously sooner than we might have otherwise. He issued a stay-at-home order and required business closures before many other states did — a bold move, considering the Republicans who hold most of the power in this bright-red state wanted to take their cues from President Donald Trump. In his almost-daily news conferences, Beshear was reassuring and optimistic about how the state could limit sickness and fatalities if we all followed public health guidance. It was a moment of real leadership — and it saved lives.

Beshear, of course, isn’t the only person who rose to the occasion. So here is my list of some of the people who provided outstanding service to the country during the worst stages of the pandemic. I consulted with journalists, government officials, policy experts and others, but these are solely my choices. It no doubt leaves out many who did important work. I also do not mean to minimize the failures of government and society more broadly that could have prevented more death and suffering. Nor do I want to suggest that the fight is over — deaths from Covid-19 are way down, but 370 died of the virus Wednesday.

A lot of governors were consistently supportive of mask-wearing and other policies advocated by health experts to stop the spread of the virus. And the nation’s governors as a group deserve a lot of credit for managing what my colleague Max Boot has rightly described as one of the most important achievements of U.S. governance — of American adults getting coronavirus vaccines over the past six months.

But it was easier to take aggressive steps if you were a governor (Democrat or Republican) in a blue state. In Ohio, Mike DeWine (R), like Beshear, had to navigate around a lot of conservatives mimicking Trump’s dismissive attitude toward the virus. DeWine’s innovative move to start a lottery to encourage people to take the vaccines became a model for other states and the federal government. Under Jay Inslee (D), Washington was the first state with a major covid-19 outbreak, but the worst of it was stamped out fairly quickly thanks to the leadership of Inslee and other key figures there.

Public health leaders: With the federal government often both downplaying the virus and taking a hands-off approach when Trump was in office, city and state public health directors had to make hard and politically fraught decisions. That led to intense criticism of these officials, including threats of violence, and a wave of resignations or outright ousters. But these local officials took actions that saved lives during the heat of the pandemic. It would be impossible here to list every standout official, but I will single out Ohio’s Amy Acton, Santa Clara County’s (Calif.) Sara Cody, Michigan’s Joneigh Khaldun, the Cherokee Nation’s Lisa Pivec and Maine’s Nirav Shah for their exemplary work fighting the pandemic in their communities and states.

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases: The doctor hasn’t been perfect — he made some comments that turned out to be inaccurate and at times prioritized placating Trump over candor with the public. That said, when Trump was in office, Fauci seemed to be the top U.S. official taking the pandemic seriously. That was an extremely important role. It’s hard to imagine all of the mask-wearing, closures and other mitigation efforts that happened before Biden became president without Fauci repeatedly delivering a message that was essentially: “Ignore what the Leader of the Free World says, and take this virus really seriously."

Adam Silver: On the night of March 11, 2020, Trump announced a 30-day ban on people from Europe traveling to the United States to stop the spread of the virus. But in my view, what really convinced Americans that Covid-19 was a super-serious threat was the National Basketball Association deciding that same night to suspend its season. Sports are one of America’s most influential institutions. So when league commissioner Adam Silver was seen to take the virus more seriously than even most elected officials, it had a huge impact, forcing a national conversation and resulting in cancellations and closures across a number of sectors.

President Biden and Ron Klain: Biden entered office with exactly the right approach — making covid-19 the highest priority of his administration. Klain, the White House chief of staff who also managed the U.S. government’s response to Ebola during the Obama administration, has led the implementation of that approach, both communicating that strategy in a calm and reassuring manner and executing it.

Vaccine scientists: Having vaccines rolled out so quickly was a critical success and a huge credit to the scientists and companies who worked on them, both those working in government agencies such as the National Institutes of Health and at companies such as Johnson & Johnson, Moderna and Pfizer. Barney Graham and Kizzmekia Corbett of NIH were among the key figures in the vaccine development process.

Health-care workers: More than 3,600 health-care workers died of Covid-19 over the past year, according to an analysis done by The Guardian and Kaiser Health News. That is significantly larger than the number of U.S. military deaths — about 2,300 — in Afghanistan since 2001. This was a kind of war, and health-care workers were our front-line troops, risking their lives for us all.

The American people: Millions of Americans stayed home for much of the past year, wore masks, supervised online schooling for their children, stopped seeing friends and family, and took newly developed vaccines. We needed leaders such as Beshear and Fauci, but we also needed Americans to become health leaders in their individual circles. America’s covid-19 year was terrible in so many ways. But it also showed that there are a multitude of great leaders among us.

'Only in our anti-truth hellscape could Dr. Anthony Fauci become a super-villain,' says headline on Washington Post column

By Margaret Sullivan
The Washington Post

Right-wing commentators are pretending that thousands of newly released emails from Dr. Anthony S. Fauci represent some kind of smoking gun against the government’s top infectious-disease expert, whom they have recently decided to try to destroy.

I haven’t been nearly as excited by the emails, which are mostly full of mundane correspondence. But there’s at least one line in them that stands out.

“I genuflect to no one but science and always, always speak my mind when it comes to public health,” the normally even-tempered scientist wrote in March of last year, to an epidemiologist who had accused a number of public health officials of appeasing the science-challenged President Donald Trump.

Dr. Anthony Fauci

At 80, Fauci has served in Republican and Democratic administrations since the Reagan era. And until recently, he has garnered widespread respect. The reason is in that email: He’s really not a political animal, but someone who is all about the science. For decades, that has served him well. But not anymore.

These days, the director of the National Institute of Allergy and Infectious Diseases is the right’s latest excuse for outrage-mongering.

Rep. Elise Stefanik of New York wants Fauci fired immediately. Sen. Josh Hawley of Missouri expressed shock at the supposed revelations in Fauci’s emails and called for a full congressional investigation. Tucker Carlson wants a criminal investigation. His Fox News colleague Steve Hilton claimed last weekend that Fauci lied to Congress about ties between a Chinese lab and the Obama administration. And the fringe Gateway Pundit website published a story blaming Fauci for millions of deaths. It featured a deranged headline that recalled the fake miracle cures for covid-19 that Trump used to tout: “They CONSPIRED to Disqualify Hydroxychloroquine as a Covid treatment.” (Editor's note: Sen. Rand Paul has also been a leading public critic of Fauci, going back months. Rep. Thomas Massie has co-sponsored the "Fire Fauci Act" and accused him of hiding and skewing data.)

But the campaign against Fauci has dramatically intensified recently — especially since BuzzFeed and the Post released his email trove last week.

And in a twisted way, it makes sense. After all, today’s right-wing politics and media require a villain. With solid approval ratings and an apparently indelible reputation as a moderate, President Biden isn’t turning out to be much of one. Vice President Harris? A little more promising given how much some trolls enjoy race-baiting, but still a less-than-ideal target.

But Fauci is a different story. He established himself as an annoyance to Trump early in the pandemic, when he was forced to publicly correct the president’s many dangerous assertions about the disease.

In a right-wing culture so often opposed to verifiable reality, who better to target than a person who stands for science and facts?

“During the Trump administration, many on the right unfortunately learned the lesson that they could make up almost anything and people would believe it,” said Laura Helmuth, editor in chief of Scientific American (and a former colleague of mine at the Post). “But science is a challenge to that.”

Which makes someone like Fauci, who genuflects only to science, a real problem and an ideal target. At times, he has been left vulnerable by his devotion to the scientific data at hand, which is never perfect or complete.

Fauci was wrong when he advised against routine mask-wearing early in the pandemic. And he may prove to be wrong about his belief that the virus originally spread to humans from a wild animal, rather than because of a Chinese government lab leak. He says he’s keeping an open mind — waiting for more data.

But let’s be clear. There’s very little in the released emails that’s shocking, other than the immense patience with which Fauci politely and helpfully responded to thousands of emails, many from strangers.

When CNN’s John Berman brought up his errant guidance on mask-wearing, Fauci said that he did the best he could with the limited knowledge he had. Would he have offered different advice given what we now know about asymptomatic transmission of the virus and about the effectiveness of masks?

“Of course,” he responded, with a touch of exasperation. “That’s so obvious.”

Is it entirely logical, in a culture intent on rejecting facts, that a career public servant devoted to science should be under vicious attack?

Of course. That’s obvious, too.