National report on health-system performance ranks Kentucky low, but disparities among its racial and ethnic groups are also low

Commonwealth Fund graph (click to enlarge) shows Kentucky with low performance but low disparity.

By Melissa Patrick
Kentucky Health News

A new report from The Commonwealth Fund, a New York-based foundation, shows racial and ethnic disparities persist in health-care access, quality, and outcomes in Kentucky and across the nation.

"In every state we find wide disparities in health and health-care experiences for people of different racial and ethnic backgrounds," David Radley, a senior scientist for The Commonwealth Fund, said during an online press conference. "And that health system performance is markedly worse for people of color when compared to the experience of white people." 

The Commonwealth Fund, which says it aims to promote a high-performing health-care system, issued its 2024 State Health Disparities Report on April 18. 

The report used 25 measures to determine health-system performance, evaluating states on health-care access, quality, use of services, and health outcomes for people of different races and ethnicities in each state. It then gave a health-system performance “score” for each racial and ethnic group.

In Kentucky, white people had the highest score,in the 52nd percentile among all population groups nationally, making them about average. Hispanic Kentuckians had the state's lowest health-system performance, scoring in the 22nd percentile. Black Kentuckians scored in the 32nd percentile.

Despite those health disparities, when compared to other states in the Southeast, Kentucky has smaller disparities among its racial and ethnic groups. That's largely because Kentucky's whites rank lower than whites in all states except Wyoming, Arkansas, Oklahoma, West Virginia and bottom-ranking Mississippi.

The report says health disparities are influenced by a number of factors, including a lack of affordable, quality health-care options, and whether a person has health insurance or a primary-care provider. It is also influenced by social determinants, such as whether a person lives in an area of high crime, has access to transportation or lives in poverty. And it is also influenced by whether they have to deal with racism and discrimination in healthcare settings. 

“Where a person lives matters, and this is especially true for people of color,” Radley said. “We also see big differences in people’s abilities to access care. Not only do uninsured rates vary from state to state, we also find big differences within states where we see large coverage gaps between people from different racial and ethnic groups.”

The researchers said their work points out that only looking at how a state performs overall can mask the "profound inequities" that many people experience. 

Dr. Laurie Zephyrin, senior vice president for advancing health equity at The Commonwealth Fund, said improving health equity will require policy action and health system action. 

"One key area is around insurance coverage and affordability. Insurance coverage is a key part of this. It is however the floor in terms of ensuring that everyone has access to health care. And it is really critical," Zephyrin said. "When we look at the data about 25 million people in the United States are still uninsured, and they're disproportionately people of color. And even for people who are insured about a quarter of working age adults are underinsured." 

Kentucky made a big policy decisions to increase access when it expanded Medicaid in 2014 to people with incomes up to 138% of the federal poverty line under the Patient Protection and Affordable Care Act. 

Nevertheless, 28% of Hispanic adults in Kentucky have no health coverage, compared to 8% of Black adults and 6% of white adults. Having no insurance, or having plans that require high out-of-pocket costs relative to a person's income, cause people to not seek care when they need it.

Two of the nine health-outcome measures that the researchers looked at were premature treatable and preventable deaths before the age of 75.

In Kentucky, Blacks had the highest death rate for treatable conditions,171 per 100,000 people. This was followed by Whites with 119 deaths per 100,000, Hispanics with 57 per 100,000, and Asian American, Native Hawaiian and Pacific Islander (AANHPI), with 58 per 100,000.  

Black Kentuckians also led the state for deaths before the age of 75 from preventable causes per 100,000 people, with 402 deaths per 100,000. This was followed by whites, at 328; Hispanics, 173; American Indian and Alaska Native, 111; and AANHPI, 104. 

"Premature preventable mortality rates are higher for both Black and White residents in several Southern and South Central states — Arkansas, Mississippi, Louisiana, Tennessee, Kentucky, and Missouri — compared to most other parts of the country," says the report.  

Compared to other states, Kentucky's health system performance for Black people was better than average, ranking 18th of the 39 states where calculation of a Black rate was statistically reliable. 

 

Kentucky's health-system performance was ranked worse than average for Hispanics, ranking 29th of 47 states.

And with a ranking of 46th of 51 states, Kentucky's health system performance for white people was considered among the worst compared to other states. 

The researchers said the hope is that policymakers, health system leaders and community stakeholders will use this information to inform future policy that will ensure a more equitable health care system in the future. 

The report offered four policy options toward this goal, with detailed suggestions for each of them on how to accomplish them. The policy options would ensure universal, affordable and equitable health coverage; strengthen primary care and improving the delivery of services; reduce inequitable administrative burdens affecting patients and providers; and  invest in social services.

"This analysis will give policymakers and health-care leaders a critical roadmap to enact targeted policies and make the key investments to eliminate disparities and achieve health equity," said Dr. Joseph Betancourt, president of The Commonwealth Fund. "Just as deliberate choices have been made that have put us in the situation, we can now be deliberate about promoting high quality equitable health care for all. This undoubtedly will create healthier, more resilient communities that would ultimately benefit the entire nation." 

Despite waiting list, a shortage of nurses and plenty of money, governor and legislature don't fund new building for KSU nursing

Kentucky State University’s nursing program has outgrown the Betty White Health Center, opened in 1971. Nursing classes are spread in buildings across campus. (Kentucky Lantern photo by Jamie Lucke)

By Sarah Ladd
Kentucky Lantern

Kentucky State University requested $50 million this year to build a nursing school for its growing class of future health care providers. The governor and legislature rejected the request, even though the KSU program has a waiting list and Kentucky suffers from a shortage of nurses but enjoys a record surplus.

“The real tragedy is that we had the money to do it,” Rep. George Brown Jr., a Lexington Democrat, told the Lantern last week. He called the omission “a travesty.” Brown and other lawmakers said the decision is part of a long pattern of neglect and underinvestment in historically Black colleges and universities (HBCUs) — a disparity the Biden administration also has highlighted.

It’s “always been the history,” said House Democratic Floor Leader Derrick Graham, a KSU alum who urged Republican legislative leaders to fund the nursing building.

During House debate, Black lawmakers pointed out that Kentucky’s only public HBCU was being denied $50 million for a project they deem critical to its future, while $125 million was quickly found for Northern Kentucky University and the University of Kentucky to open a biomedical center in downtown Covington, where plans also call for NKU to move its law school.

The Senate added the Covington project to House Bill 1, which moves $2.7 billion from the Budget Reserve Trust Fund into one-time spending over the next two years. HB 1 includes other higher education projects: $60 million for a veterinary tech facility at Murray State University, $25 million for a UofL Health cancer center in Bullitt County and $22 million for a livestock innovation center at a UK research farm.

“Kentucky State always seems to suffer and always has to wait,” Brown said March 29 on the House floor. “‘You have to wait your time; it’s not your time.’ … So the question is, when will it be Kentucky State’s time?”

When budget negotiators met in a free conference committee on March 26, Graham asked why KSU’s “top priority” was not included in budget legislation. Graham represents Frankfort where KSU sits on a hill overlooking the capital city. Sen. Chris McDaniel, chairman of the Senate budget committee, said KSU had also revised its budget request by asking for money to deal with failing infrastructure and other maintenance needs.

House Bill 6, the budget bill, sets aside $60 million in bonding for “asset preservation,” described by McDaniel as “cleaning up campus.” House Bill 1 includes $5 million to design a Health Science Center for the nursing program but nothing to build it. McDaniel vowed “full intent” to pay for construction of KSU’s nursing building in the 2026 budget bill. McDaniel’s district includes Covington; he was instrumental in obtaining the $125 million for the downtown project involving NKU.

“We have a great deal of confidence in the new president of Kentucky State,” McDaniel said in the March 26 meeting. He was speaking of Koffi Akakpo, who became KSU’s 19th president last year on July 1. Before that, he was president of Bluegrass Community and Technical College.

HB 6 provides all the public higher-ed institutions with asset preservation funding pools for renovation and maintenance of buildings and other infrastructure.

During the free conference committee meeting, Democratic Senate leaders Gerald Neal of Louisville and Reggie Thomas of Lexington, both of whom are Black, said that expanding KSU’s nursing program is critical to the school’s rebound from recent troubles. The construction delay will cost KSU new students and needed tuition revenue and disrupt Akakpo’s plan for the future, said Neal.

Neal and Thomas urged the budget negotiations to reconsider. Thomas suggested spending less on restoration and maintenance at KSU in this budget to free up $50 million over the next two years to design and build the nursing building.

Senate Republican Floor Leader Damon Thayer of Georgetown responded ​​that KSU was “probably lucky that they get the taxpayer money that they have been getting and continue getting. With the recent numbers and results that have come from K-State, I think we should be dubious moving forward.” He said the “numbers have been pretty embarrassing.”

KSU has faced a series of controversies, including misused funds under a former administration and a 2023 warning from its accreditation body. In 2022, the legislature put KSU under a management improvement plan and provided $23 million to help it recover from a budget deficit.

In an interview with the Lantern last week, Akakpo said he is “grateful” for the $60 million in bonding but that it will “go quickly” as he tackles a list of maintenance needs.

The HVAC system, he said, is “not quite up to par” and the dorms are “in really bad shape.” Sidewalks and entryways need fixing, he said, and “leaky roofs” have caused damage that needs attention. The $60 million does “not quite” cover these needs, he said. “But we will try the best we can.”

A new building for nursing students and money to address maintenance needs were “both equally crucial for us to move forward,” Akakpo told the Lantern.

KSU's 342 nursing students make up 24% of the university's enrollment, and the program is “only going to grow,” said Akakpo. Nursing students study in three separate buildings because no designated building is large enough.

The Betty White Health Center, which is 53 years old, has administrative offices and a learning lab. Students take classes in Bradford Hall, Carver Hall and Hathaway Hall. “The building is needed because the building that is assigned to the nursing program is too small,” Akakpo said. It’s also already full.

Kentucky is thousands of nurses short of what it needs. The state is short 5,391 registered nurses and licensed practical nurses, according to the Kentucky Hospital Association. And, the students going into nursing school aren’t enough to replace those retiring and leaving the workforce.

Brown said KSU’s backlog of maintenance needs stems from historic underinvestment. The historically Black university, he said, is “the redheaded stepchild, if you will” of Kentucky higher education.

The Biden administration last year documented roughly $12 billion in underfunding for HBCUs nationwide when compared with state funding of similar predominantly white institutions.

The study compared land-grant institutions created by Congress in the 19th century, first for white students and later for Black students. KSU and UK are Kentucky’s land-grant universities. In Kentucky the disparity in per student state funding from 1987 to 2020 was $172 million.

U.S. Education Secretary Education Miguel Cardona and Agriculture Secretary Tom Vilsack sent letters to governors, including Kentucky’s, asking for states to right the “historical underinvestment.”

A letter from Cardona to Gov. Andy Beshear cited “unbalanced funding” and “longstanding and ongoing underinvestment” as reasons KSU “has not been able to advance in ways that are on par with University of Kentucky.” It added that “unequitable funding” of KSU put it $172.1 million short of what it would have received in the last 30 years.

The budget Beshear introduced in December did not include money for the KSU nursing building. It did ask lawmakers to allocate about $1.2 million to KSU for nursing and social-work scholarships in 2024-26.

American Heart Month and Black History Month are the same month, and are related; Blacks are likelier to have heart disease

By Dr. Daniel Brunner

In February, we commemorate both American Heart Month and Black History Month, which presents an opportunity for us to raise awareness about cardiovascular health, remember the contributions of African Americans who helped shape the nation and reflect on the continued struggle to overcome disparities. As February ends, I urge everyone to commit to mind the teachings of American Heart Month and Black History Month throughout the year. That’s because a particular disparity that impacts the African American community is heart disease – the leading cause of death for African Americans and all adults across the U.S.

Daniel Brunner, M.D.

According to the Centers for Disease Control and Prevention, more than 20 million U.S. adults — approximately 7% of the U.S. population — have heart disease. The disparity lies in the fact that nearly 48% of African American women and 44% of African American men have some sort of heart disease. This is a lot higher than the 36% of white, non-Hispanic adults in the U.S. who have heart disease. In Kentucky, where heart disease is the commonwealth’s leading cause of death, 11.8% of the African American population has been diagnosed with a cardiovascular disease — higher than the national average of 9%.

While many factors contribute to their increased risk, what matters is that heart disease is killing Black Americans at a higher rate than any other group in the U.S., and the best way to fight this disparity is to successfully treat the risk factors.

Here is what people need to know:

Screening: Getting screened by a medical professional will help identify risk factors for heart disease early enough to treat it. Medical screening will identify if there are genetic risks or if factors such as weight, environment and habits are putting a person at higher risk of disease and death. Getting screened at least once a year is crucial for all adults.

Medication management: It’s not only important for people to take prescribed medication as directed for heart disease and other conditions that cause heart disease (such as diabetes, high cholesterol and high blood pressure), but is also important to communicate with a doctor to help manage conditions and adjust medication when required.

Staying active: Staying physically active reduces and helps manage weight. It may reverse early diabetes and cut cholesterol levels. It can even help control stress and hypertension. All it takes is 30 minutes a day, at least five days a week of exercise that is enjoyable, like walking, running, swimming, cycling, dancing, playing a sport or anything that gets the heart pumping.

Diet: It is extremely important to watch your diet to help maintain a healthy weight and heart. Certain ethnic food or diets and sugar-sweetened beverages are widely embraced in many communities. Some diets may be associated with a significantly increased risk of heart disease. With risk factors as high as they are, it is critical to be diligent with limiting foods that are rich in sugar, fat, calories and sodium.

Lifestyle choices: While it is not possible to change genes that are inherited, it is possible to make lifestyle changes that can influence heart health. Cutting smoking, getting six to eight hours of quality sleep at night and refraining from overeating could make a positive difference in heart health. Also important is cutting stress, since stress can increase hormones that elevate blood pressure. If stress continues long-term, it can lead to permanent hypertension, an irregular heart rhythm or a permanent heart condition.

Fighting back against heart disease doesn’t have to be undertaken alone. It’s obvious that people need their doctors to help, but in many cases, people can also turn to their health insurer for support. Many health plans offer special assistance in the form of case managers who work with patients and providers to determine a course of action that best serves a patient’s needs.

Accessing no-cost screenings, managing medication, and utilizing benefits designed to help members stay active or access diet programs are key to ensuring a healthy life. Reach out to your health plan to manage the thing that is most important – your health.

Daniel Brunner, M.D., is medical director for Anthem Blue Cross and Shield Medicaid in Kentucky. He is an emergency medicine physician based in Northern Kentucky.

Black Kentuckians need more information about colon cancer screening, especially the availability of in-home tests, study finds

Most focus-group participants in Louisville said they had not
been offered stool-based testing as an option for colorectal
cancer screening, stressing the need for more community-
based outreach. (Photo by fizkes, iStock/Getty Images Plus)

By Elizabeth Chapin

University of Kentucky

A recent study at the University of Kentucky's Markey Cancer Center highlights the need for increased outreach and education to reduce colorectal cancer screening disparities in Black communities.

According to the study, published in the Journal of Cancer Education, people in Kentucky’s Black communities may not be aware of all of the colorectal-cancer screening options available to them, particularly stool-based tests.

Black communities are disproportionately affected by colorectal cancer. In Kentucky, Blacks who have colorectal cancer are more likely to die from the disease than whites.

Since about half of the racial gap can be explained by differences in screening rates, educating Black communities about screening options can save lives, says Markey Cancer Center researcher Aaron Kruse-Diehr, the study’s principal investigator.

“In the colorectal-cancer screening world, we like to say ‘the best test is the one a patient completes’ — and giving people multiple options has been shown in previous studies to increase their likelihood of completing screening,” said Kruse-Diehr, who is an associate professor in the UK College of Medicine. “To reduce the Black-white colorectal cancer mortality rate, we need to make sure Black people of screening age are being provided all available options.”

Regular screening, beginning at age 45 is the key to preventing colorectal cancer and finding it early. Two types of tests are recommended by the U.S. Preventive Services Task Force: visual exams (primarily colonoscopies) and tests that check a stool sample for signs of cancer. Stool-based tests are less invasive and, for many, more accessible since they can be done at home.

Kruse-Diehr said, “Home tests can reduce a number of both individual-level and structural barriers that often exist for many people with respect to completing colonoscopy, such as needing to take time off work, finding an individual to drive the person to/from the procedure, and travel distance to a provider who can perform colonoscopy.”

The research team partnered with five Black churches in Louisville, which has bihg racial differences in screening, to conduct focus groups exploring screening barriers and facilitators for cancer education and outreach.

While focus-group participants overwhelmingly recognized the importance of being up to date with screening, nearly all reported that they had never heard about stool-based tests or heard health-care providers offer them as an option.

To address this knowledge gap, participants stressed community-based outreach and communication from trusted individuals, such as local Black medical providers and colorectal cancer survivors.

Kruse-Diehr led the study with Elizabeth Holtsclaw, cancer support strategic partnerships manager at the American Cancer Society. Two of the study’s co-authors, College of Public Health undergraduates Carlee Combs and Rose Wood, helped analyze the data and write the results as part of an independent-study course.

The research team is now planning to pilot a church-based screening program with one of the partner churches, with hopes of eventually expanding the program across Kentucky.

“These study results are informing outreach efforts that we hope will make a huge dent in the death rates from colorectal cancer among Black Kentuckians,” said Kruse-Diehr.

Too many pregnant Kentuckians and babies in 'maternity deserts' and Ky. has no birthing centers; midwives say they could help

Laura Browning, an Eastern Kentucky doula and midwife student, with her four children in a selfie.

By Sarah Ladd
Kentucky Lantern

During three of her four pregnancies, Laura Browning drove three hours round-trip past hospitals to get prenatal care from midwives in Lexington, the only place that offered what she needed.

She even made the trip while in labor with her first baby, feeling that “the care that I was receiving” from midwives “was worth that risk” of birthing in her car.

As deaths from pregnancy rise in the United States, Browning and other advocates say Kentucky could fill gaps in prenatal care by educating and certifying more midwives, attracting more to the doula profession and encouraging the creation of freestanding birth centers in the state.

The shortage of care for pregnant people is documented in a recent March of Dimes report, “Nowhere To Go: Maternity Care Deserts Across the U.S.”

More than 2 million Americans, most of them rural, live in “maternity care deserts,” defined in the report as having “no hospitals providing obstetric care, no birth centers, no obstetrician/gynecologist and no certified nurse midwives.”

In 2021, 14.2 percent of mothers received inadequate prenatal care, says the March of Dimes, which gave Kentucky an F on its annual report card this year, making it one of just nine states (plus Puerto Rico) to get a failing rating.

Almost half of Kentucky’s 120 counties — 48% — are maternity-care deserts, according to the March of Dimes study.

Prenatal care provided by midwives has been shown to prevent costly complications in mothers and babies, including cesarean deliveries and low birth weights. The March of Dimes reports that “midwifery care has been associated with an increased chance of having a low-intervention birth and lower cost of care due to significantly lower odds of medical intervention.”

Yet only about 8% of births in the U.S. are attended by midwives. In Kentucky, 700 to 800 babies are born every year outside hospitals, and are usually delivered with midwives present. There were 51,688 live births in Kentucky in 2020.

Certified nurse-midwives and certified midwives are accredited by the Accreditation Commission for Midwifery Education and pass national exams after graduate-level studies, according to the American College of Nurse Midwives.

The midwives and midwifery students who spoke with the Kentucky Lantern expressed passion for serving their communities and reported low rates of transfer to hospitals, easing the burden of hospital staff shortages.

Mary Harman

Also, midwives can provide important inclusive services to people who are “beyond the binary,” said Mary Harman, the only midwife within a two-hour drive from Pike County who travels that far for clients.

“Not every person needs an OB-GYN,” Harman said, but they cannot accept insurance or Medicaid, which is another barrier to their practice, Canary Nest Midwifery.

Research also suggests that freestanding birth centers, which are staffed by midwives and offer holistic birthing options for people who qualify, reduce the cost of care while producing higher patient satisfaction.

Kentucky is in the minority of states that have no freestanding birth centers. The American Association of Birthing Centers reports that more than 384 freestanding birthing centers are operating in 37 states and the District of Columbia, a 97 % increase since 2010.

Advocates attribute the lack of birthing centers to the difficulty of obtaining the state-required certificate of need in the face of opposition from hospitals that can mount costly legal battles, such as the one waged by three hospitals against a retired Army officer who tried to open a birthing center in Elizabethtown.

She prevailed in Franklin Circuit Court, which overturned a hearing officer’s denial of a certificate of need, but was forced to give up in 2017 when the hospitals won on appeal.

Rep. Jason Nemes, R-Louisville, has sponsored legislation in the past to remove the certificate-of-need requirement for birthing centers and will continue to support them. He has called the law mandating the certificate “very cumbersome.”

In 2019, the legislature did take action aimed at licensing more certified professional midwives, after the Kentucky Hospital Association and Kentucky Medical Association dropped their years of opposition.

The results have been underwhelming. In the almost four years since the law was enacted, the number of certified nurse-midwives and certified midwives in Kentucky has increased by only 12 — to 131 providers, reports the American Midwifery Certification Board.

Some hospitals have doula and midwife programs, such as the University of Kentucky’s midwife clinic and Norton Healthcare’s doula program.

Among the barriers to increasing midwifery care in Kentucky is the $1,000 cost of renewing a Certified Professional Midwife license. Compare that with $110 in Tennessee, $200 in California or $322 in New York.

Earlier this year, Kentucky took advantage of an opportunity in the American Rescue Act Plan to put in place one of the March of Dimes recommendations by increasing postpartum care under Medicaid from 60 days to 12 months. The change will allow an estimated 10,000 Kentucky mothers to maintain their health coverage for one year after giving birth.

Stark racial disparities in maternal mortality

The March of Dimes reports that deaths from pregnancy are increasing in the United States, which already has one of the highest maternal death rates among high-income countries.

About 900 women in the U.S. died from pregnancy-related issues in 2020, up 14% from 2019 and up a whopping 30% from 2018. Sixty-three percent of pregnancy-related fatalities are preventable, says the report. In Kentucky, preterm births increased in 2021 to 12%, up from 11% in 2020.

Pregnancy is especially dangerous for Black Americans, who are three times more likely to die from pregnancy than their white counterparts. Conversely, white women are more likely to have access to good prenatal care than Native, Black, Pacific Islander, Asian and Hispanic women. 

Those stark disparities are not lost on the expectant mothers who turn to doulas to guide them through their pregnancies and births. Doulas provide moral, physical or other support to pregnant people throughout pregnancy, delivery and postpartum.

Meka Kpoh, a doula in Louisville, founded the nonprofit Black Birth Justice to help mothers and babies get off to a healthy start all the way through the critical postpartum period. She has been in birth work long enough that the March of Dimes report wasn’t news to her.

She said these gaps in care should be taken seriously.

“The maternity care deserts aren’t going to just erase themselves,” said Kpoh, who is also in training to be a midwife. “It’s not going to be like next year there’s going to be a new hospital and every community has a hospital at least 30 to 40 minutes away. That’s not going to happen, at least not anytime soon. So it’s really important for there to be options for families like licensed certified home birth midwives.”

Kpoh said many of the clients she sees are driving hours from rural areas. “It’s really insane to me,” she said, “that we are their only option.”

In addition to more doulas and midwives, she said Kentucky needs freestanding birthing centers.

“Pregnant people are driving three hours just to get prenatal care, just to give birth, just to have postpartum appointments,” she said. “It’s ridiculous.”

To get the kind of care they want, Kpoh said many pregnant people end up facing a difficult choice: “Either they drive three hours to a hospital or they catch their baby by (themselves),” she said, adding: “I don’t recommend that for anyone.” 

Renee Basham, a doula, founded the nonprofit community doula program Hope’s Embrace to help pregnant people who are often cut off from help. Basham and her 30 doulas serve those who are unhoused and those with drug addictions.

“You’re not necessarily treated well if you are by yourself,” said Basham. “And so having people … vouch for you, or speak up for you or remind you to speak up for yourself … all of that … contributes to better outcomes.”

 
The stigma of going against the norm

Anihhya Trumbo, a doula who serves the Lexington area, said there remains a stigma about birth outside a hospital.

“Kentucky is a state where it’s always been preached that doctors know best,” she said. “It’s a bit of a taboo if you go outside of what is … considered the norm here.” 

Doula and midwife-assisted birth isn’t a new thing, either, she said.

“This is something that’s been going around since the beginning of time,” said Trumbo, who is also a military veteran. “We just got Western medicine and that’s what changed the norm but home birth and having the natural birth — that’s how we got here.”

Browning was so committed to midwifery care for herself that from six weeks gestation to birth, she drove three hours for her prenatal appointments. She’s now living in Laurel County but lived in Estill at the time of that first pregnancy.

Already a doula, Browning told the Kentucky Lantern that she is in midwifery school herself now “because women should not have to drive that far for care.”

“It’s definitely a need that we have here.”

Building trust in public health for the next time: 'If a pandemic can’t bring us together around the common purpose, what can?'

Protest at state Capitol against pandemic restrictions, Aug. 28, 2021 (Photo by Jon Cherry, Getty Images)

By Sarah Ladd
Kentucky Lantern

Even as Kentucky reels and recovers from Covid-19 in what some have touted as the “new normal,” experts say there are systemic steps we could take now to prepare for the next big health crisis.

Chief of all, experts told the Kentucky Lantern, is building trust between the general public and health officials, the shortage of which during this pandemic has led to a myriad of misinformation spread through social media and otherwise.

At the 100-year anniversary of the 1918 flu pandemic, the Centers for Disease Control and Prevention issued a report examining gaps in pandemic preparedness. Those gaps included scarce surveillance of birds and pigs, not enough access to ventilators, worries that the health care system would be overrun in a flu-like pandemic, lack of a universal vaccine, shortage of pandemic plans in many countries, and more.

Two years later, when the Covid-19 pandemic hit, those predictions held true.

Though vaccines were produced relatively quickly, roughly 2,000 Kentuckians died from the virus before the lifesaving shots came out in late 2020. Even after they arrived, many Kentuckians were reluctant to roll up their sleeves. Covid-19 deaths in Kentucky as of last week totaled 17,555 people.

Supplies like personal protective equipment, ventilators and masks were in short supply in the early months. Hospitals were overrun with sick people, field hospitals went up to handle overflow, and National Guard members were deployed to help stretched medical staff.

During all this, Kentucky contended with a nursing shortage exacerbated by pandemic-induced burnout.

“One of the difficult lessons that we have learned in this pandemic is that the public-health infrastructure of this country has been under tremendous stress and they have suffered, I think, through this pandemic, in a number of different ways,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky.

Kentucky is also vulnerable to pandemics because of our high rates of comorbidities, when two or more diseases or medical conditions are present in a patient at the same time, Chandler added. The state ranks high for risk factors such as diabetes, kidney disease and cancer, and “all of those things cause people to be much more vulnerable to viruses.”

Pandemic politics  

In addition to a lack of resources early on in the pandemic, Chandler added, public-health experts had to battle constant misinformation and distrust.

“When you have a pandemic, it’s a pandemic generally because whatever you’re facing is novel, it’s new,” Chandler explained. “And there will always be questions and uncertainties about exactly how to handle it. It’s not always clear what the right thing is because the science isn’t yet entirely clear on what the society is dealing with.”

Ben Chandler

Partisan politics added to the problem, said Chandler, a Democrat who served in Congress in 2004-12 and was Kentucky's attorney general in 1996-2004.

“We have sort of … retreated to armed camps,” he said. “And we’ve got to somehow figure out how to bridge those gaps, and I don’t know what it will take because you would think that if anything could cause you to bridge the gaps and have people come together, it’d be a pandemic. If a pandemic can’t bring us together around the common purpose, what can?”

Jennifer Hancock, president and CEO of Volunteers of America Mid-States, agreed. “By design, public health is political,” she said. But, there’s a need going forward, she added, to make sure those decisions are transparent and all voices have a chance to sit at the decision-making tables.

“If you feel like you’re not at the table, then you’re on the menu,” Hancock said. “Then, it immediately promotes defensiveness and mistrust.” (Republicans who run the legislature criticized Democratic Gov. Andy Beshear for not consulting them about his anti-pandemic measures.)

Historical racism has also exacerbated mistrust of the medical community. Oluwasegun Abe, a member of the Kentucky Nurses Association who works in Louisville as a hospitalist, said “the first thing” we need to work on “is to repair the distrust between the health-care system and the different races.”

Abe spent more than a year of the pandemic volunteering with the Louisville Metro Department of Health and Wellness. As he vaccinated people all over the city, he repeatedly heard people’s mistrust, much of it based on the notorious study in which medical researchers and providers withheld treatment from about 400 Black men in Tuskegee, Alabama, from 1932 to 1972 in order to study the course of untreated syphilis.

“We continue to just distrust each other,” Abe said. One solution to that distrust is investing in more diversity, he said, so people can see themselves represented in health-care professions.

Delanor Manson

Delanor Manson, CEO of the Kentucky Nurses Association, said, “What we’ve learned over the last three years is that the community must trust the professionals that are providing the information” in order for it to be effective. That means showing up for people, listening to their concerns and answering the hard questions.

“I think a lot of the ways to build that trust include being present,” said Manson. “And what I mean by that is being present when there isn’t a pandemic, when there isn’t an epidemic, but being present in the community to establish the relationship that there is support, caring, and we have that all the time, not just when there’s a problem.”

She added: ‘If you’re not there when things are stable, then you don’t have that relationship to build on when things are not going well.”

Fear breeds distrust

“My experience has been: whether it’s someone in Eastern Kentucky or someone in West Louisville,” mistrust is “really based in fear,” Hancock said.

Manson said another way to build trust, particularly when thinking about vaccinations, is to normalize that in childhood, a job that often falls to parents.

Hancock, who required vaccines for VOA workers early in the pandemic, said the model of internal quick and clear communication about the shots and the risk factors of Covid-19 can be of use for employers in the future.

“The fear and anxiety we had regarding people being pushed out of our organization or feeling pushed out of our organization because of that decision (to require vaccines) was never realized,” Hancock said, pointing out her 95% employee-retention rate.

Manson said Kentucky must also prioritize not just recruiting nurses to fix the current shortage but also strive to retain staff. Nurse retention starts with including nurses in the decision-making process, from the shifts they work to the laws that impact them, she added.

“What most nurses want more than anything else,” Manson, herself a nurse, said: “They want to be heard.”

Hancock said authentic conversations are a must.

“If we have that same spirit and approach where we are really seeking to have the most inclusive table where all voices get to be respected and represented, then it diffuses some of the rhetoric that otherwise gets the headlines,” she said. “And that’s what we’ll continue to do. And we’re very, very committed to that.”

As overdoses among Blacks in Kentucky more than double, UK researchers explore their relations with drug-treatment providers

By Amanda Nelson
University of Kentucky

Black adults share about their experiences in drug treatment in a new University of Kentucky study published in the Journal of Substance Abuse Treatment.

Until now, few studies have included the voices of Black people and their experiences with treatment providers. Study authors hope it will inform changes to promote successful recovery and healing.

The study was conducted among 39 African Americans in Kentucky, where opioid-related deaths recently more than doubled among Blacks. All the interviewees had used opioids within the past six months.

Researchers found three primary themes influenced interviewees’ perceptions about treatment for substance-use disorder, centering on:

• Readiness for change, influenced by whether the treatment was mandated by an external entity such as the legal/justice system, or individuals were able to decide for themselves they were ready for help;
• Characteristics of their treatment provider (race, gender, the provider’s personal substance-use history, as well as their ability to build rapport, maintain confidentiality, and seem motivated to help);
• Relational support from people in the interviewees’ lives, such as partners and family members.

Danielle Stevens-Watkins (UK photo by Mark Cornelison)

Exploring factors likely to impact the experiences of Black adults in treatment is an important step to being able to culturally adapt treatment strategies and integrate approaches that will have more meaningful effects among this underserved population, said Danelle Stevens-Watkins, professor of counseling psychology in the UK College of Education Department of Educational, School and Counseling Psychology and UK’s associate vice president for research in diversity and inclusion.

The paper is the first to be published from a $3.2 million National Institute on Drug Abuse project led by Stevens-Watkins, now in its second year. The project will include interviews with 800 African Americans who misuse prescription and illicit opioids, filling a need for data on this under-served group.

Readiness for change

Research conducted among primarily white participants has found that time in substance-use treatment tended to increase readiness to change, regardless of whether it was mandated by the legal system. But that was not true among African Americans in the study.

“The men and women in our study reported less success in their experiences with treatment when it was mandated, versus something they sought out because they wanted it for themselves,” said Candice Hargons, associate professor of counseling psychology and interim chair of the Department of Educational, School and Counseling Psychology.

Possible reasons that participants felt this way about mandated treatment were tied to the culture and climate of mandated-treatment settings.

The study authors suggest that assessing Blacks for readiness and motivation is important, especially when treatment is mandated. They said helping them reduce feelings of loss of control in treatment could increase desire to engage in the process. This could be accomplished, for instance, through developing a collaborative experience, where clients have a role in defining their needs.

While the interviewees understood that personal investment in the treatment process was necessary for recovery, some may have overestimated that wanting it for yourself was the predominant driver in the recovery journey, the study authors wrote.

“Many of the people who talked to us for this study felt someone can simply ‘will’ themselves into recovery,” said postdoctoral fellow Brittany Miller-Roenigk. “Having a personal investment in the process is important, but you also must consider the biological aspects of recovery and the ways treatment helps to address those. It really takes both a readiness for change and a supportive therapeutic environment along the way.” 

Provider characteristics

The study’s look into the lived experiences of Black men and women who use opioids also highlighted how provider characteristics can largely influence the treatment process. Many expressed a difficulty in trusting others, complicated by a lack of racial similarity with providers.

“There is a great need to recruit more Black therapists,” said Natalie Malone, Ph.D. student in counseling psychology. “Many of the participants in this study had never or rarely encountered a provider of color. Several talked about needing to feel the therapist will understand them when talking about experiences of racism, discrimination and microaggressions.”

A few said that race did not matter, if the provider had the ability to build rapport, avoid a judgmental tone and maintain confidentiality.

While most participants felt they could best express themselves to a race-matched provider, opinions were mixed on participants’ preference for providers who had experienced addiction. Some felt providers who were in recovery could better understand them. A few said they preferred providers who had never experienced addiction because they did not trust their providers’ sobriety, meaning it would be difficult to confide in someone that may have questionable time clean from substances.

Study participants also discussed differences in quality between mandated programs, compared to treatment programs available through insurance or direct payment. Some thought treatment facilities more likely to have Black patients had therapists with less education and training than those serving predominantly white patients. Participants also suggested that providers in mandated programs may have been facing burnout and lacked investment in the treatment process, too.

Relational support

Partners and family members were primary sources of support networks among the individuals in the study. Partners undergoing treatment simultaneously were most likely to provide support. Nobody in the study said their partners were a barrier to treatment.

For those with family members aware of their drug use, several identified their family as a primary source of support. Some family members were unsupportive of treatment due to their own personal substance use.

The researchers found a third theme they refer to as “absent support,” which had a negative impact but not a negative intent. This happened among participants’ families that spend time together socially but have a culture of not becoming involved in the personal affairs of others. Absent support was most often related to maintaining privacy, which is consistent in the literature among African Americans, the authors said.

When possible, the study authors suggest integrating peers, family members or partners into treatment may be a useful resource for reducing opioid use among African Americans.

The study authors are sharing these initial findings to highlight aspects of treatment that could be addressed to most likely influence success.

“It is important to take a deeper look into the lived experience of Black men and women who use opioids so that researchers, clinicians and those who influence programs that support recovery and healing have a better understanding of the factors that can make a true difference in their success,” said Destin Mizelle, a Ph.D. student in counseling psychology.

This is a critical time for Black individuals who use opioids, said Jovonna Atkinson, a master's-degree student in the College of Social Work.

Stevens-Watkins noted, “Overdose-related deaths are on the rise and Black men and women are more likely to face similar and sometimes harsher consequences than their white counterparts, including higher likelihood for criminal convictions, longer incarcerations, higher unemployment rates and increased mental health risks. The more data we can gather to inform culturally-tailored interventions, the greater chance we have to reduce the adverse social, legal and fatal consequences associated with opioid use among Black populations.”

Foundation gives $20,000 to spur vaccination in low-vax counties

State Department for Public Health vaccination-rate map, adapted by Kentucky Health News

The Foundation for a Healthy Kentucky has awarded grants totaling $20,000 to increase uptake of the Covid-19 vaccines in counties with the lowest vaccination rates. They are "intended for rapid deployment" for new or expanded vaccination efforts, the foundation said in a news release.

Two grants are aimed at Christian County, which has the state's second-lowest percentage of residents who have received at least one dose of vaccine, 34.2%. The rate may be depressed by the presence of Fort Campbell, but the county also has a big population of African Americans, who nationally have a low vaccination rate. The money will go to the the Hopkinsville-Christian County Branch, NAACP, and the Christian County Health Department.

Other recipients, targeted counties and vaccination rates are:

• The school district in Clinton County, which has an at-least-one-dose vaccination rate of 40.9%. 
• The Lake Cumberland Community Action Agency and the Lake Cumberland District Health Department, for Clinton, Casey (36.8%), Cumberland (42.1%), McCreary (42.7%) counties.
• Pennyrile Area Development District, for Crittenden County, 40.9%.
• Barren River District Health Department, for Edmonson (37.4%), Hart (36%) and Metcalfe (39.3%) counties.
• Grace Community Health Center, for Knox County, 36.3%.
• Lewis County Health Department, 37.6%.
• Buffalo Trace District Health Department, for Robertson County, 37.3%.
• Todd County Health Department, 41.8%.
• Green River District Health Department, for Union County, 40.5%. The statewide rate is 62%. 

“These organizations are on the front line of the effort to get more Kentuckians vaccinated against Covid-19,” foundation President and CEO Ben Chandler said. “We are proud to support their hard work to protect our citizens against serious injury or death from the virus.”

"The organizations will employ various efforts such as videos and graphics to be posted on social media, as well as radio, television and print advertisements, school-based outreach, a 24-hour information hotline, bilingual efforts, and other outreach, especially to vulnerable populations," the news release said. "The foundation also has a number of resources on its website to assist organizations, health care providers, family and friends in sharing the truth about COVID-19 and the vaccines. This includes public service announcement videos, a fact sheet, and links to the CDC and Kentucky Covid-19 dashboard."

As vaccines go begging, Beshear says doses need to go where people are, and local leaders need to urge folks to get a shot

State table shows how supply of vaccines has exceeded demand for vaccinations recently.

By Melissa Patrick
Kentucky Health News

Almost every coronavirus-related question at Gov. Andy Beshear's news briefing Thursday ended with a call from him to get vaccinated, and that came after repeated pleas in his relatively short presentation for Kentuckians to sign up for one of the thousands of open vaccination slots across the state.

"While we vaccinated 125,210 new Kentuckians this last week, we received about 214,000 doses. So what that means is there are open appointments . . . not because we're not vaccinating still at a steady pace, but because we're getting more vaccine," Beshear said, "so we need people to get out there and to sign up." 

Beshear again listed regional vaccine sites with thousands of slots available next week, including U of L Health at Cardinal Stadium, with more than 11,000 slots open; Kroger Health at Greenwood Mall in Bowling Green (2,000); and the Kentucky Horse Park in Lexington (1,800); Baptist Health Corbin; the Christian County Health Department (1,000); and Pikeville Medical Center (1,000). 

He pleaded with Kentuckians to take whatever vaccine is available, and not wait for the single-dose Johnson & Johnson vaccine, saying Kentucky only got 7,800 doses of that vaccine this week, a drop from 65,000 last week, and state officials don't know how many it will get in the upcoming weeks. 

State table of variants by county; for a larger version, click on it.

He said if people "wait on the Johnson & Johnson vaccine, we might not win the race against the variants" of the virus that are more contagious and "It's going to take us longer to be able to fully ease the restrictions that we all want to get rid of. So come on, get out there, get your vaccine."

Beshear said so far, the state has detected 113 cases with "variants of concern" in Kentucky. All but two were the highly contagious B.1.1.7, which was first found in the United Kingdom. The Centers for Disease Control and Prevention website says 1,085 cases in Kentucky have undergone genomic testing to detect variants.

More than 1.5 million Kentuckians have received at least one dose of a vaccine, about 33% of the population. 

Reluctance to get the vaccine has been reported to be more common among rural whites, especially evangelicals, and urban Blacks.

Sarah Ladd and Chris Kenning of the Louisville Courier Journal report that the real reason vaccinations have lagged among Kentucky Blacks are lack of access, including things like "little or no transportation, no internet access, few if any nearby pharmacies and struggles trying to sign up online." 

Kentucky Health News asked Beshear if these are some of the reasons rural whites have been slow to get vaccinated, or if it had to do more with politics. Beshear said that while there are some similarities between rural and urban areas, there are also other nuances that must be recognized. 

He said some parts of the state have shown some higher hesitancy, naming Western Kentucky as one. 

He suggested it is time to try some new strategies, like programs that offer incentives for vaccination and getting more doses into places people regularly go to, such as pharmacies and grocery stores. 

The politics can be local, he said: "Some of the areas where we see the least amount of people taking vaccines are ones where we saw local leaders push back against what we were doing to protect people" earlier in the pandemic. "If you see enough of that, and someone is beating that drum beat long enough, again, it's going to make it harder to then convince people to get vaccinated. And so we're going to need help, both from those that have disagreed with us as we've gone along and those that have agreed with us to get it done."

Beshear suggested that on Monday, he would give Kentuckians a broad incentive to get a shot: set a vaccination level at which he would remove capacity restrictions, even for events of up to 1,000 people. 

"We still may be needing to wear masks, whether it's our restaurants, our bars, our offices and the rest, [but] we can get back to that 100 percent capacity," he said, "and it's all dependent on how quickly and how many people we can vaccinate."

Beshear said he thought if done safely and masking is strictly enforced, it will be safe to attend the Kentucky Derby on May 1, and he plans on being there. He also encouraged people to go ahead and get vaccinated now if they plan on being there, or anywhere that involves large crowds. 

"That ought to be on anybody's checklist who is planning on going," he said. 

Beshear said the state is tailoring some of its efforts toward young people, who he said weren't necessarily vaccine-hesitant, but more likely indifferent because the virus has not affected their age group as harshly. He noted that young people in other states have been hospitalized with variants.

Asked about a study, published in The Lancet Psychiatry journal, that shows one in three people who have had Covid-19 have suffered a neurological or psychiatric disorder within six months of infection with the virus, Beshear said he was still looking at the study, and that he expects there will be many more like it. He  also noted that Health Commissioner Steven Stack has warned all along that we don't know the long-term effects of having Covid-19. 

"Again, it has real health impacts. So get vaccinated, continue to wear your mask until we get to the end. And don't be cavalier, because while you may think that it's not going to hurt you the person you could spread it to could be could be suffering from this," he said.

Daily numbers: Beshear reported 645 new cases of the virus, bringing the state's seven-day average to 529, the lowest it's been since Aug. 11, when it was 528.

The share of Kentuckians testing positive for the virus in the past seven days was 2.81%, almost equal to the recent low of 2.8% on March 26 and 27. 

In long-term care, Beshear reported no new Covid-19 deaths, and only six new cases, five of them among employees. "That is the power of vaccinations," he said, referring to the fact that significantly more residents than employees have been vaccinated.

The state added 16 deaths to its list of Covid-19 fatalities. The state's death toll from the disease is 6,214. The 14-day average of regularly reported deaths is 11.6 a day, half what it was two and a half weeks ago.

The state said all 16 deaths were from regular health-department reports and none from the death-certificate audit. However, 10 of them were from 2020, with two dated in July. UPDATE, April 11: The Cabinet for Health and Family Services said nine of the 16 deaths were actually from the audit, which recently went farther back into 2020. "The first of these cases were incorrectly classified Thursday as regular rather than audit deaths because of the pathway through which they were submitted," cabinet spokeswoman Susan Dunlap said in an email.

The July fatalities were both from Jefferson County: a 64-year-old man and a 59-year-old woman. Later in 2020 were three Jefferson County women, 73, 80 and 87; two Jefferson County men, 61 and 72; a Laurel County woman, 77; an Oldham County man, 45; and a Carroll County man, 41.

All the 2021 fatalities on the daily death report were listed as occurring after March 19. They were a Christian County man, 68; a Daviess County man, 54; two Hopkins County women, 73 and 88; a Hopkins County man, 62; an an Ohio County man, 76.  

Unemployment: The state Labor Cabinet said it would shut the state's unemployment system for four days, starting at midnight Thursday to fight a "massive amount of fraud" that is affecting unemployment systems across the nation.

"We hate that we have to do this, to make things more difficult, but these criminals are relentless; they will not stop," said Amy Cubbage, Beshear's general counsel. 

During the shutdown, no new claims can be filed and claimants will be unable to request benefits. Staff will continue to work on existing claims. 

Cubbage said there have been attempts to change 300,000 personal identification numbers on claimants' accounts, not all of them current accounts.  

Claimants will need to set up new accounts next week with a new eight-digit PIN  that they will receive in by U.S. mail, as well as a new 12-digit password. Cubbage said active claimants will not need to file new claims.

In other pandemic news Thursday:

• The state's daily new-case rate over the past seven days was 9.67 per 100,000 residents, 0.1 less than Wednesday. Its rate ranked 34th among the states, according to The New York Times.
• Counties with rates more than double the statewide rate were Simpson, 43.8; Harlan, 29.1; McCreary, 28.2; Bracken, 27.5; Whitley, 27.2; Powell, 26.6; Floyd, 22.5; Knox, 22; Menifee, 22; Robertson, 20.3; Allen, 20.1; Mason, 20.1; Lawrence, 19.6; and Casey, 19.4.
• Counties with 10 more more new cases on the state's daily report were: Jefferson, 125; Fayette, 43; Clark, 23; Warren, 19; Boone, 18; McCracken, 16; Kenton, 14; Letcher, 14; Hardin, 13; Christian, 12; Harlan, 12; Floyd, Logan, Madison and Simpson, 11; and Allen, Daviess and Powell, 10.
• Kentucky hospitals reported 377 Covid-19 patients, six fewer than Wednesday, with 102 of them in intensive care (down 10) and 53 of those on ventilators (down 13).

Blacks and whites traded places in Ky. coronavirus statistics as the pandemic became less urban and more rural

Graph by Bruce Maples (click to enlarge); dashed lines show races' share of state population.

By Bruce Maples

Kentucky Health News

As the coronavirus pandemic took off, there was a striking anomaly in the data: African Americans were being infected, and dying, at a rate much greater than their share of the population.

The difference was so great, and so striking, that it drew frequent comment from Gov. Andy Beshear in his daily press conferences. A month into the pandemic, on April 11, he announced that Kentucky Blacks were dying of Covid-19 at a rate two and a half times their 8.4% population share; they were 21% of the deaths in which the person's race was known (81% of cases at the time).

Graph by Bruce Maples; dashed lines are races' share of state's population.

Over the past year, however, the proportion of Blacks in the daily case and death numbers have steadily declined, to the point that they are now roughly the same, or less than, their share of the population.

At the same time, white Kentuckians' shares of Covid-19 deaths have steadily climbed and are now greater than their share of the state's population. Whites' share of cases also rose.

Meanwhile, Asian Americans' share of Covid-19 deaths in Kentucky is now less than their share of the population, reversing the pattern from early in the pandemic, when they were affected by some of the same factors as African Americans, one health expert said.

Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness, said many persons of color are "essential workers," often in customer-facing industries such as restaurants and grocery stores, and thus could not work from home. So in the early days, while many people were able to be "healthy at home," the Black and Asian populations in the state had to go into work, and thus were more at risk.

But as things began opening up, white institutions have been more aggressive about doing so, Moyer said: "More white churches went to in-person services. Black churches tended to stay remote. More whites started traveling. And, it's been largely white-majority schools that have pushed to get back into the classroom.

"And, it's just anecdotal, but it seems to me that whites are more willing to take risks."

State's latest report on cases and deaths by race and ethnicity

Donna Arnett, dean of public health at the University of Kentucky, said she suspects the early infection rate among people of color led to some "acquired immunity."

"I don't want to use the term 'herd immunity,' because we aren't clear on just where that line is," Arnett said. "But I do think that the large number of infections could have led to acquired immunity in that population."

She added, "An Indiana study showed that for every reported case, there are about 10 more cases that are not reported and not counted. So, that early spike we see on the graphs actually represents an even larger spike of cases, which may have affected later infections."

In Louisville, Moyer noted most of the people under 60 who are dying of Covid who are under 60 are Black or Hispanic.

One thing that has seemed clear over the past few months is that the rate of infection has dropped in the urban areas in the state, and increased in the rural areas.

The pandemic was later in getting to rural areas, but when it did, it found a vulnerable population that was sicker, older, and has less access to health care, several reports have noted.

WFPL graph shows higher rates of new coronavirus cases in rural counties and one health district.

For example, Louisville's WFPL reported Dec. 23 that the November death rate in the Kentucky River Health District was 107% higher than the statewide rate, so deaths there were 4% of the state total though the district has only 2% of the state's population. Out of 120 counties in Kentucky, only 18 had higher death rates in November than those comprising the Kentucky River district, based in Hazard.

Daily Yonder graph

This trend is national. The Daily Yonder does a weekly look at coronavirus cases and Covid-19 deaths in the rural U.S. Its latest graph clearly shows that the pandemic went from being an urban issue to a rural issue in August of last year, and that the divergence only grew as time went on, until recently.

Now vaccines are widely available, but public-health experts worry that rural residents will be more hesitant to get them, or outright resistant to the idea. They say the same sort of targeted communication that has been directed at communities of color needs to be designed to overcome rural reluctance.

Positive-test rate rises; state has more new cases than last Sun.

State Department for Public Health map, relabeled by Kentucky Health News; click it to enlarge

By Al Cross

Kentucky Health News

The waning of the pandemic slowed in Kentucky Sunday, illustrating public-health experts' worries of another surge before the novel coronavirus is beaten.

The percentage of Kentuckians testing positive for the virus is the last seven days rose, the number of new cases was higher than the previous Sunday, and Kentucky's new-case ranking among the states rose two notches.

The positive-test rate is 4.12%. It was 4% Saturday, after dropping for all but one of the previous 16 days and generally falling for almost two months.

The state reported 526 new cases of the virus; the number last Sunday was 509. The seven-day rolling average of new cases fell by 21, to 874, but the state's new-case rate is 14th in the nation after falling to 16th on Saturday, according to the daily compilation by The New York Times.

Hospitalizations in Kentucky for Covid-19 fell by 33, to 558, and the number in intensive-care units fell by 15, to 156. But the number of ICU patients on ventilators rose to 82, or 53%; Saturday they numbered 72, or 42%.

Pressure on ICU beds in the Lake Cumberland hospital readiness region eased; 82% were in use, after weeks in which the figure was near or above 90%. The easternmost region, from Lee to Pike counties, was the only other one above 80%; 87% of its ICU beds are in use, but only 12% for Covid-19 patients.

The state listed 13 more deaths from Covid-19, all confirmed after review, raising Kentucky's pandemic toll to 4,819. In the last 14 days, the state has averaged 26.6 deaths per day, a figure that has varied little the last two weeks.

The state's daily report shows that Black Kentuckians' proportions of cases and deaths have declined to 8% and 8.2% of the totals, respectively, less than their 8.5% share of the state's population. For months, the rates were near or above double African Americans' population share.

Lyon County, site of many cases in state prisons, leads the nation in the rate of new cases over the last seven days, according to The Washington Post. The state's report says Lyon's rate is 358 cases per 100,000 residents and the statewide rate is 15.2. Other counties with rates more than twice the statewide rate were Rowan, 39.1; Owsley, 38.8; Clay, 35.2; Knox, 34.9; Simpson, 33.1; McCreary, 32.3; and Clinton, 32.2.

Counties with more than five new cases Sunday were: Jefferson, 106; Fayette, 59; Lyon, 30; Kenton, 16; Warren, 16; Daviess, 15; Scott, 14; Franklin, 11; Jessamine, 11; Boone, Bullitt, Hardin and Laurel, 10; Oldham, 9; Campbell, 8; Bell, Clay, McCracken and Nelson, 7; and Logan, 6.