Messaging campaign to encourage back to school vaccines is underway; Kentucky vaccination rates are below U.S. average

Lexington-Fayette County Health Department graphic

By Melissa Patrick

Kentucky Health News

With just weeks left before school starts, it's time to make sure your school-aged children are up to date on required immunizations.  

Toward this effort, the Kentucky Association of Health Plans, the trade group for health insurers in the state, and Kentucky Voices for Health, a coalition of health advocacy groups, have partnered to roll out a messaging campaign to help educate families and improve student immunization rates. The partnership involves a 3-year, $360,000 grant from KAHP to be used toward building a stronger safety net in Kentucky.

"This back-to-school season is the perfect opportunity to talk to a provider and ensure that your family is caught up on recommended immunizations. If you or someone in your family has fallen behind, trust me, you are not alone," Kelly Taulbee, director of communications and development at KVH, said at a press conference to announce the partnership. " We encourage families today to work with providers and get the additional resources and an immunization schedule that's right for you and your children." 

Taulbee said the messaging campaign will involve TV commercials, radio ads and occasionally print. Asked if they would be targeting any certain region of the state, Taulbee said, " It's a relatively equal approach across the board as far as how we're messaging." 

Many Kentucky children are still catching up with routine vaccinations that were missed during the pandemic. The state's vaccination rates remain below the national average. 

"That puts our children at unnecessary risk and it strains our healthcare system," Tom  Stephens, president and CEO of KAHP, said at a press conference. 

Stephens noted that the recent outbreak of whooping cough in Lexington "underscored the urgency of this issue."  Last week, the state Department for Public Health reported 138 cases of whooping cough, known medically as pertussis, and said this level of infection had not been seen in Kentucky since 2016-17. 

"This outbreak is a stark reminder of what can happen when immunization rates fall," Stephens said. "It's not just about individual protection. It's about community immunity."

"Community immunity" occurs when enough people have been immunized against a disease to protect others who are not immunized. Some can't get vaccinations because their immune systems are too weak to allow them to get vaccinated, or because they are too young. 

Children can get their routine vaccinations at health clinics, health departments, pharmacies and doctor's offices, but it's important to make those appointments soon because school typically starts in August and students are required to provide up-to-date immunization records at the beginning of each school year, unless exempted for religious or medical reasons.

Taulbee noted that a law passed during the last legislative session allows pharmacists to continue administering immunizations down to the age of 5. "It's such a simpler access point that we want families to keep in mind," she said. 

Families can find a provider, including those that offer free immunizations through the Vaccines for Children program, by calling the Kentucky Infectious Disease & Vaccine Call Center at 855-598-2246, Monday-Friday, 8 a.m. to 5 p.m. ET 

Asked about vaccine hesitancy, which has been fueled by the Covid-19 vaccine, Taulbee and Stephens both encouraged families to talk to their provider if they have any questions or concerns about immunizations. 

A recent Pew Research Center survey of more than 10,000 adults found that 88% of Americans believe the overall benefits of the measles, mumps and rubella vaccine outweighs the risks, compared to 62% who believed the Covid-19 vaccine benefits outweigh the risks. Further, the survey found a drop in support for vaccine requirements for healthy children in schools, with 70% of those surveyed supporting the requirement, down from 82% in 2019 and 2016. 

Data from the School Immunizations Survey dashboard, which includes data for each school, show that during the 2023-24 school year, nearly 85% of kindergartners were up to date with all vaccines, 80% of seventh graders were, and nearly 54% of 11th graders were. 

The KAHP-KVH partnership will also focus on keeping children signed up for Medicaid as Medicaid renewals resume for them.  

"The renewal process is going to begin soon for the first time in four years for our children," Taulbee noted. "We encourage families to take this very seriously. Check your mail, watch and make sure you understand eligibility standards and keep your children covered." 

State's health chief urges parents to get kids vaccinated against measles, the most contagious disease, which can do great harm

By Melissa Patrick
Kentucky Health News

A highly contagious childhood disease that was declared eliminated in the United States in the year 2000 is making a comeback, largely driven by a declining vaccination rate in the country.  

"Unfortunately, as the measles vaccination rate has decreased, it's just one of those things where folks are opting out of vaccination more often, we're starting to see the increase of measles in the United States," Dr. Steven Stack, commissioner of the Kentucky Department for Public Health, said at a Feb. 29 press conference. 

In Kentucky, about 90% of the state's kindergarteners are vaccinated for measles, mumps, and rubella "and that has to be 95% or higher to stop transmission," said Stack. 

Stack spent the bulk of his time talking about a disease that he said most people in our country, including health-care providers, have never seen. Further, he said, it is a disease that is "virtually, entirely vaccine-preventable." 

"If you are vaccinated, you almost certainly will get no symptoms from measles," he said. "In fact, the vaccine is so effective, you won't get sick at all and you don't transmit the virus." 

Stack said symptoms of measles include a cough, congestion, fever that may go up to 104 degrees, and a full-body rash. The Centers for Disease Control and Prevention also mentions sore, red eyes that may be sensitive to light; watery or swollen eyes; small greyish-white spots in the mouth, and a loss of appetite. 

"You feel miserable," said Stack, adding, "In the unlucky ones, the complications are pneumonia, diarrhea, ear infections, and even sometimes brain swelling that can lead to things like seizures, developmental disabilities and other permanent brain damage."

Among the unvaccinated population, Stack said more than one in five measles victims are hospitalized and one in 20 get pneumonia, which is the most common cause of death. 

"The most common age of death is under 5,  those are the individuals hurt the most by this disease if you're unvaccinated," he said. "And for the really unlucky, one in one thousand can get a permanent brain injury from the brain swelling that I talked about." 

Dr. Steven Stack with Gov. Andy Beshear (File photo)

Because measles is a highly contagious virus that is spread through the air, with an incubation period of 10 to 12 days, it is easy to spread it unknowingly. Stack said a person is contagious for four days before the rash and four days after the rash, which is why it is recommended for anyone who has been exposed to measles or who has it to stay at home for 21 days to avoid spreading the disease. 

"Measles is probably the most contagious viral disease on planet Earth at present. The only thing that could maybe compete with it is Covid," he said. "In this room, all of us in this press conference for a period of 40 to 60 minutes, if one person had measles in this room and we were unvaccinated, nine out of 10 of us would become infected with measles in about 10 to 12 days." 

As of Feb. 29, the CDC reported there had been 41 measles cases reported in 16 states, none in Kentucky.  

"This is becoming more common and because people travel a lot and are portable in ways that weren't possible . . . in the prior century, it spreads too easily and can cause too many problems," said Stack. "Everybody please go get yourselves and your children vaccinated if you are not already vaccinated."

Florida, with its many airports and a regular vacation spot for many Kentuckians, is one of the states with a recent outbreak. Of concern to public health officials is a letter issued by the Florida State Health Department that does not urge parents of unvaccinated children at that school to get vaccinated or to quarantine. Instead, it leaves these decisions up to parents.

These recommendations go against well-established public health guidelines that call for unvaccinated people or those with no prior immunity to isolate for 21 days after exposure and for unvaccinated children to get vaccinated within 72 hours of exposure, which allows them to return to school as long as they don't develop symptoms,  Katelyn Jetelina and Dr. Kristen Panthagani, write in their Your Local Epidemiologist newsletter.

Asked about what precautions Kentuckians should take if they are traveling through the Florida airports or spending time in the state, Brice Mitchell, spokesperson for DPH said a person's level of concern should be determined by whether they are vaccinated or not.  

"If you are vaccinated for measles, there are no special precautions necessary. If you are unvaccinated for measles, the Kentucky Department for Public Health urges that you get vaccinated," he said in an email. "For further information, please review the Centers for Disease Control and Prevention guidance." 

Dr. Sean McTigue, interim chief of infectious disease at Kentucky Children's Hospital agreed.

"Anyone who is up to date with this vaccine is protected against measles infection and would not need to take any additional precautions when traveling to Florida or through Florida airports," McTigue said in an email. "If planning a trip to Florida and one or more travelers are not already up to date with MMR vaccine, then now would be an excellent time to be vaccinated." 

Two doses of measles, mumps and rubella (MMR) vaccine are recommended to children starting at 12 months. Adults can also be vaccinated. 

McTigue called this measles outbreak and others a "wake-up call" for those who are not protected and provides an opportunity for parents to protect their children against measles. 

"Because the MMR also protects against mumps and rubella, it is also an excellent way to protect against mumps which can cause testicular infection and sterility in males and against rubella which can cause severe birth defects if a pregnant woman is infected during her pregnancy," he said. 

Stack also pointed to the protections provided by the vaccine, saying in a news release, "Two doses of MMR vaccine are 97% effective at preventing measles and provides lifelong protection if exposed to the virus. Even if exposed to measles, vaccinated persons may continue routine activities.”

The CDC says that while detectable antibodies generally appear within just a few days after getting the measles vaccination, it takes about two or three weeks to be fully protected. Ideally, the CDC says a person should be fully vaccinated at least two weeks before they travel.

More information can be found in a Los Angeles Cedars-Sinai Hospital blog post, "Measles Makes a Comeback: What Parents Need to Know." It says measles cases worldwide increased 79% in 2023, according to the World Health Organization. In 2022, the WHO estimated that measles killed more than 130,000—most of them children.

“Measles is a huge concern and directly related to declining measles vaccination rates,” said Dr. Priya Soni, a pediatric infectious-disease specialist with Cedars-Sinai Guerin Children’s Hospital. “Vaccine hesitancy, fueled during the pandemic by the anti-vaccine movement, has affected vaccination rates nationwide. In addition, because children were quarantined during the pandemic, many missed out on well-child visits and didn’t catch up on their vaccines. That has meant 61 million fewer doses distributed nationwide between 2020 and 2022.”

Although the first dose of the MMR vaccine is traditionally given to infants 12-15 months of age, and the second around a child’s fifth or sixth birthday, Soni said infants as young as 6 months can receive the first vaccine if they are traveling to areas where the measles infection rate is high.

CDC keeps urging health-care providers to recommend and offer vaccines; flu, Covid-19 and RSV rates are elevated in Kentucky

State Department for Public Health graphs, adapted by Ky. Health News

By Melissa Patrick
Kentucky Health News

The Centers for Disease Control and Prevention continues to encourage health-care providers to get their patients immunized against flu, Covid-19 and respiratory syncitial virus, noting that a recent poll shows that many Americans who have not yet been immunized report being open to vaccination.

"Strong provider recommendations for, and offers of, vaccination could increase influenza, Covid-19 and RSV vaccination coverage," says the CDC's Dec. 22 Morbidity and Mortality Weekly Report. 

The survey sample was drawn from a random-digit-dialed cellular telephone survey that included adults in every state.

It found that between Sept. 24 and Dec. 9, an estimated 40% of Kentucky adults reported they had gotten a flu shot; 15% had received an updated 2023-24 Covid-19 vaccine, and 23% of adults 60 and older had received a vaccine for RSV, which poses the greatest risk for seniors and infants. 

Kentucky's flu and updated Covid-19 vaccination rates are lower than the estimated national rates of 42% for flu and 18% for Covid-19, but higher than the national seniors rate for RSV, 17%. 

The state Department for Public Health's latest weekly respiratory-illness report shows that Covid-19, RSV and flu activity is elevated, and hospitalizations for RSV and flu are increasing. 

In the week ended Dec. 16, emergency-department visits for respiratory illness increased for yet another week, to 3,921, up from 3,670 the week prior. 

Of the latest week's cases, 2,072 were for flu, up from 1,720 the week prior; 1,073 were for Covid-19, down from 1,134; and 776 for RSV, down from 816. 

Among children 4 and younger, emergency-department visits due to respiratory illness increased slightly, to 1,303, up from 1,265 the week prior. Of those, 604 were for flu, up from 507; 570 were for RSV, down from 594; and 129 were for Covid-19, down from 164. 

Among children 5 to 17, emergency-department visits due to respiratory illness increased to 810, up from 653 the week before. Of those, 653 were for flu, up from 498. Covid-19 and RSV numbers stayed about the same as the week before, at 86 and 71, respectively. 

In that same week, hospital admissions for respiratory illness dropped a bit, to 617, down from 639 in the prior week. Of those, 310 were for Covid-19, down from 345; 171 were for RSV, down from 191; and 136 were for flu, up from 103. 

Among children 4 and under, hospitalizations for respiratory illness increased to 130, up from 105 the week prior. Of those, 101 were for RSV, up from 94; 19 were for flu, up from 7; and 10 were for Covid-19, up from 7. 

Among children 5 to 17, hospitalizations due to respiratory illness increased to 17, up from 10 the week prior. Of those, 13 were for flu, up from 4; 3 were for RSV, down from 4; and 1 was for Covid-19, the same as the week prior. 

A CDC report for the week ended Dec. 16 showed that Covid-19 hospitalization rates in 11 Kentucky counties were above 2 hospitalizations per 10,000 residents, which the CDC considers high. 

The leading county remains Letcher, with a rate of 2.3 hospitalizations per 100. The other high counties, with rates of 2.05 to 2.12, were all in northeastern Kentucky: Lewis, Greenup, Boyd, Carter, Rowan, Menifee, Morgan, Elliott, Lawrence and Martin. 

Deaths: Since Oct. 1, the state health department has attributed 118 deaths to Covid-19 and six to flu. One Covid-19 death was reported during the week ended Dec. 9.

Respiratory-related deaths for flu and Covid-19 on the state's weekly dashboard are reported according to when they occur, which sometimes leads to a delay between the actual date of death and the submission to the department.

Kentucky Association of Health Plans is offering free rides at Kentucky State Fair to people who get vaccinated at its site there

The Kentucky Association of Health Plans is hosting its third annual vaccination pop-up clinic at the Kentucky State Fair and while supplies last, will give away free, unlimited ride wristbands to those who get vaccinated, as well as the opportunity for other incentives. 

KAHP is the trade association representing commercial health insurers and Medicaid managed-care organizations in the commonwealth. 

From Aug. 17 to 27, KAHP is giving away a free unlimited ride wristband (while supplies last) when State Fair attendees go to the Health Horizons Pavilion in South Wing B to receive a vaccination. Hours are 10 a.m. to 5 p.m. daily.

In addition, those receiving a vaccine will be able to spin the wheel for a chance to win prizes like a bonus ride pass, food voucher, or $25 gift card. Medicaid members may also be eligible to receive an incentive offered by their health plan in addition to the KAHP giveaway. KAHP also has a kid-friendly zone with coloring books and life-size “Max the Vax” and “Maxine the Vaccine” cut-outs.

Vaccines offered include measles-mumps-rubella (MMR), tetanus-diphtheria-pertussis (Tdap) and influenza.

“The recent outbreak of whooping cough (pertussis) in Lexington is something that should concern us all,” Tom Stephens, KAHP president and CEO, said in a news release. “Children, pregnant women, newborns, and those around other medically vulnerable people are most at risk. It is vaccine-preventable, so we are urging folks to stay up to date on their shots. We have seen an alarming trend with fewer Kentucky children receiving Tdap vaccines, which protect against tetanus, diphtheria and pertussis." 

Another study shows that wearing a mask lowers the odds of getting Covid-19, and that the type of mask you wear matters

Centers for Disease Control and Prevention chart

By Melissa Patrick
Kentucky Health News

Two years into the pandemic, many people still refuse to wear a face mask as part of a holistic approach to slow the spread of a virus that has killed more than 13,000 Kentuckians, despite public-health officials begging them to do so – and a wealth of research that supports their pleas. 

On Friday, another such study was released by the Centers for Disease Control and Prevention, showing real-world evidence that masks work, and that the type of masks you wear matters. 

“In addition to being up to date with recommended Covid-19 vaccinations, consistently wearing a comfortable, well-fitting face mask or respirator in indoor public settings protects against acquisition of [Covid-19] infection; a respirator offers the most protection,” says the early release report. 

The researchers said their study has limitations, but the results are consistent with previous research showing that masks prevent the spread of the virus.

The study assessed face-mask or respirator use among 652 people who tested positive for the virus and 1,176 who tested negative from Feb. 18 to Dec. 1, 2021 and self-reported being in indoor public settings during the two weeks preceding their test, with no known contact with any confirmed or suspected Covid-19 infection. The samples were randomly selected residents of California.

The study concluded, "Always using a face mask or respirator in indoor public settings was associated with lower adjusted odds of a positive test result, compared with never wearing a face mask or respirator in these settings."

Among the 534 study participants who reported the type of mask they used, cloth masks offered 56% more protection against the virus than wearing no mask indoors; surgical masks offered 66% more; and respirator mask, such as N95 or KN95, offered the most additional protection, 83%. 

"These data from real-world settings reinforce the importance of consistently wearing face masks or respirators to reduce the risk of acquisition of infection among the general public in indoor community settings," the report says. 

CDC guidance says that N95 masks, when they fit well and are worn correctly, provide the highest level of protection, while also maintaining that "any mask is better than no mask." Last month, the federal government began distributing 400 million free N95 masks through pharmacies and community health centers. 

State officials have long urged Kentuckians to wear masks in indoor spaces and especially in schools, but in September the legislature took away Gov. Andy Behsear's power to impose mask mandates.

A Kaiser Family Foundation survey taken mid-January found that most American adults (54%) say they wear a mask every time in an indoor, crowded space. The rate was highest among among vaccinated people (62%; unvaccinated 28%). It was also higher among Democrats (77%), followed by independents (50%) and Republicans (31%). 

Reports of anti-vaccine preachers spur weekly newspaper to use its 'bully pulpit' and forswear 'neutrality in times of moral crisis'

Many Kentucky newspapers are making extra efforts to increase vaccination against the coronavirus, by fighting misinformation with the facts, and Kentucky Health News plans to continue highlighting them. Chris Evans, the editor and publisher of the only paper in Crittenden County, pop. 9,000, on the Ohio River in Western Kentucky, reported on what he and his wife Allison have done:

"The Crittenden Press has published a first-person article from a local M.D. encouraging vaccines; an article about a nurse practitioner whose husband was hospitalized and unvaccinated and she changed her tune on the vaccine in a hurry; and we have had a couple of recent op-ed pieces, too. Allison wrote a very well-received column a couple of weeks ago comparing it to smallpox and polio." (See below.)

The Press spotlighted the Covid-19 deaths of a local couple.

"Last week, we began a front-page feature where businesses and/or agencies, including local government, are encouraged to tell us how many of their folks are vaccinated. Then we publish what they tell us. City council went first. We have had good response to that so far. Today I attended the funeral of a husband and wife, both unvaccinated, who died last week. The wife previously worked for us for several years."

Evans concludes, "If Covid hasn’t hit your doorstep yet, it’s coming, and we have heard about pastors preaching against the vaccine from the pulpit. I told Allison today, they may have a big audience, but ours is bigger. You probably know that I am a church-going conservative, but it’s time to use my bully pulpit. I have been somewhat reluctant until now to stick my nose squarely into the middle of this, but I think it is time. I am reminded of the phrase in Dante’s Furnace that 'The darkest places of hell are reserved for those who maintain their neutrality in times of moral crisis.'"

Here is the column by Allison Evans, headlined "Polio to Covid."

   Hopefully one day our grandchildren will have to Google-search 'Covid-19' to find a definition.
   If they do, this virus will have come to pass.
   Obviously that’s everyone’s daily prayer, that it will disappear from our society like polio, a disease I’ve tried to learn more about lately – more specifically the country’s reaction to the polio vaccine.
   Unlike the Covid-19 vaccine, apparently there was a greater public acceptance of and willingness to receive the polio inoculation.
   Some of today’s Marion residents were in elementary school back in 1955 when the polio vaccine was distributed. Talked to one recently who remembers walking as a group from school to the second-floor health office on East Carlisle Street. After climbing the stairs, students were given the vaccine, which was contained in a chewable sugar cube.

Allison Mick-Evans

   I’ve been wondering whether there was apprehension about the polio vaccine. Was the country divided about its validity, its efficacy? Were people reluctant to have their children vaccinated, were they on the phone talking about their neighbors’ willingness or unwillingness to accept an inoculation to prevent a horrible, debilitating disease that was affecting children at alarming rates?
   Here’s what I found. Surprisingly, it took 47 years from the time polio was identified until a vaccine was distributed. Because of limited technology at the time, scientists and medical professionals started from scratch to develop the vaccine. Since the 1980s, more than 90 percent of school-age children have been vaccinated for polio.
   The quick development of three Covid-19 vaccines was the result of years and years of research in the scientific archives on SARS vaccines. Because Covid and SARS are both coronaviruses diseases, scientists has a head start on dealing with the new strain, which led to the relatively quick creation of a Covid-19 vaccine.
   When it became available in 1955, people couldn’t get the polio vaccine fast enough. One of the reasons, historians say, was that Americans had a deep respect for science. A chorus of social media opinions did not exist back then to confuse the public. A campaign of disinformation and skepticism about the Covid vaccine has clearly created pockets of deep-rooted resistance, doubt and insecurity.
   Polio attacked children. Nearly 60,000 children in 1952 were infected and more than 3,000 died. By comparison, a year’s worth of Covid-19 data show 32 million cases in the U.S. and more than 573,000 deaths. Yet serious Covid illness, so far, is rare among children.
   Years worth of efforts by door-to-door volunteers acting on behalf of the March of Dimes helped Americans feel like they were helping toward the effort to eradicate polio. These are the individuals whose lives were greatly impacted by World War II and many were involved in the war effort not too many years earlier.
   By the time the polio vaccine was available in 1955, parents understood and accepted that the risks of contracting polio were a much greater threat than the risks of the vaccine.
   Sound familiar?
   We’re beginning to understand that about Covid, too. Even though individuals vaccinated for Covid-19 can contract and, unfortunately spread the virus, the risks of serious illness requiring hospitalization are lessened. A study in Georgia released last weekend pointed out that almost 90 percent of Covid hospitalizations were among the unvaccinated. Other data are bearing that out across the country.
   A friend in Louisville who works in the medical industry shared a conversation he recently had with a doctor. Standing outside one of Louisville’s largest hospitals, he pointed to the upper floors and said there were 100 seriously ill Covid patients up there. None of them were vaccinated.
  I’m always one to avoid uncomfortable topics or create controversy. I know there are varying opinions on the Covid-19 vaccine, but I think we’re beginning to see the life-threatening or life-altering effects of not being vaccinated.
   I understand the fear of the unknown. It’s a weakness I share. Being fearful of making the wrong decision is what creates hesitancy, sometimes with serious consequences.
   But we trusted scientists in the 50s to protect our children from polio. Science worked. And now it’s time to let science protect us again.
   The rollout of a life-saving vaccine is something we might only see once or twice in our lifetime. Hopefully no more.
   Folks in the '50s who trusted the process of eradicating polio should be our guide. It’s time we do the same so our kids and grandkids won’t live with Covid-19, but instead will need to Google it.
   Allison Evans is a third-generation owner of The Crittenden Press newspaper. She can be reached at allison@the-press.com.

State opens priority vaccinations to ages 50-59, aims for all 16 and up by April 12; audit found 604 missing deaths from Covid-19

Sen. Rand Paul and Dr. Anthony Fauci argued about
masks at a Senate hearing. See below. (NBC image)

By Bruce Maples and Al Cross
Kentucky Health News

Gov. Andy Beshear announced expansions of the state's Covid-19 vaccination program, both in age priorities and availability, and said bars and restaurants could stay open an hour later because the share of Kentuckians testing positive for the novel coronavirus has fallen sharply, especially Thursday.

He also announced that an audit of deaths had found that the state had missed 604 Covid-19 fatalities during the biggest surge of the pandemic, from mid-November to late January, and said the state would keep looking.

Vaccination expansion: As Kentucky pushes vaccines to thwart more contagious strains of the virus, Beshear said the priority vaccination group would be expanded Monday to anyone 50 or older. People can sign up now, and if sites have slots available this weekend, they can sign up for those as well.

“Kentuckians deemed most vulnerable should still get priority, and they will, but we can’t have these vaccines sitting in a freezer,” Beshear said. “We are in a race against the Covid-19 variants and we’ve got to get it out fast.”

Beshear said that his goal is to have the vaccine program fully open to everyone 16 and older by April 12. That depends on supply, but he said that he is confident the state will not only meet that goal, but beat it.

Asked about anecdotal reports that some vaccination sites are taking adults of any age, and whether that indicates a problem with vaccine hesitancy, Beshear said, "We don't think it's happening on a huge scale." But he also said, "As more people get vaccinated, we'll reach people that want more information. I think as we open up new categories, we'll see more of that hesitancy."

The state will open three big vaccination sites over the next few weeks. The largest, a partnership with U of L Health, will be at Cardinal Stadium. It will have 24 lanes for drive-through vaccinations, with a goal of 4,000 shots a day. Appointments can be made starting March 31, for shots beginning April 12. 

In a push to care for an under-served community, a regional site will open at Whitney Young Elementary School in west Louisville. It will be able to deliver 400 to 500 doses per day, and will have evening hours. 

A regional site will open Wednesday, March 24 at Kentucky Dam Village State Resort Park, in partnership with the University of Kentucky, Wild Health, and the Marshall County Health Department. It will include testing as well as vaccinations and be open 8 a.m.to 7 p.m. seven days a week.

Details on these sites, as well as the other 563 sites across the state, are available at vaccine.ky.gov.

Bars, restaurants and numbers: Due to the continuing decline in the pandemic statistics in the state, Beshear said, bars and restaurants will be able to serve until midnight beginning this Friday, with closing extended to 1 a.m. The capacity limit is still at 60%, and masks and social distancing are still required.

The percentage of Kentuckians testing positive for the virus in the last seven days fell to 3.23%, 0.5 point lower than the day before and the lowest percentage since July 2. It has declined steadily since late January.

The state reported 785 new cases, lowering the seven-day rolling average by 61, to 721. That's the lowest average since Sept. 24.

Audit of deaths: As Beshear explained in an earlier update, the normal death reporting process broke down to some extent during the surge around the holidays. He ordered an audit of death records, which several other states have done, and reported Thursday that 604 more deaths had been found.

The governor said the deaths will be itemized over the next few days. Today's death report included 417 of them, including 200 who lived long-term-care facilities. The average age of the 417 fatalities was 79.9.

Of the 417, Jefferson County had 103, or 24.7% of the total; its share of all deaths has been 17.9%. McCracken County had 16 (3.8%, of the audit total and more than double its overall share of 1.8%); Boyle and Bullitt counties each had 12 (2.9% of the audit total and well above their overall shares of 1% and 1.2%, respectively); Knox and Whitley each had 10 (2.4% of the audit total, far above their overall respective shares of 0.4% and 0.7%).

Other counties with more than five deaths among the 417 were Boyd, Kenton and Madison, 9 each; Fayette and Greenup, 8 each; Barren, Estill, Floyd and Hardin, 7 each; Campbell, Christian, Laurel, Pike and Warren, 6 each. Seventy other counties had five or fewer, for a total of 90 counties with at least one death found through the audit and reported Thursday, with 187 left to be itemized.

Beshear noted that audits in Ohio and Indiana found about 4,000 and 1,500 missing deaths, respectively.

The audit, and 31 deaths added to the list through the normal review process, brought the state's death toll to 5,504, 4,987 of them confirmed and 517 probable.

Asked why the Centers for Disease Control and Prevention reports 6,483 Covid-19 deaths in Kentucky, based on death certificates, Beshear said his administration follows a more rigorous process. He said a certificate might list Covid-19 as a cause of death, but the state's review process may find no positive test to prove it; and even if does, the test may not be close enough to the date of death to be listed as a cause. He noted that death certificates can list multiple causes.

"We'll try to be as transparent about the process as we can," Beshear said. Earlier, he said:

"Our commitment is to know the full devastation of this virus. This won't be the last audit that we do; it won't be the last time that we discover additional people who have passed away. . . . We still have, from this audit, a number of records that we still need to get to determine whether additional Covid deaths occurred. What we will do is we will update when we get the information to make sure that everybody's loss is counted. And that as we move out of this, that we're able to process the total toll that it's taken, and the grief that is has created. No unknown soldiers; everybody counts."

Update on variant: Health Commissioner Steven Stack explained more about a new variant of the virus that had been found in a nursing home, apparently in Morehead. He said the genomic sequencing that found the variant was conducted because several residents had Covid-19 despite being vaccinated.

Whenever someone who has been vaccinated still contracts the virus, their infection is gene-sequenced to see if it is a "variant of concern" that is already known. If not, more the variant is compared with larger datasets to see if it is similar to other less-concerning variants around. He said that analysis is still ongoing, but it has not been identified as a variants of concern.

Mask debate: U.S. Sen. Rand Paul had another dust-up with Dr. Anthony Fauci, President Biden's chief medical adviser and director of the National Institute of Allergy and Infectious Diseases. At a Senate committee hearing, Paul accused Fauci of wearing a mask "for show" after being vaccinated, CNN and Fox News report. Fauci replied, "Here we go again with the theater. Let's get to the facts."

"Fauci stressed that vaccines and natural immunity did not protect against Covid-19 variants," Fox reports. "Fauci pointed to a South African study by Johnson & Johnson that found those who had been infected with the 'wild-type' Covid-19, meaning the original strain, had 'no protection' when exposed to variants." Paul, an ophthalmologist, said, "There is no evidence that there are significant reinfections after vaccine."

UPDATE, March 19, 2 p.m.: Aaron Blake's analysis of Paul's "amateur epidemiology" is the most-viewed story on The Washington Post site.

In other pandemic news Thursday:

• The 31 fatalities listed through the normal process today were nine Boone County women, aged 80, 81, 83, 90, 90, 91, 94, 94 and 103; three Boone County men, 80, 86 and 90; two Campbell County women, 84 and 90; a Harlan County woman, 73; a Henry County woman, 94; a Henry County woman, 77; a Hopkins County woman, 69; a Jefferson County woman, 97; a Kenton County woman, 98; a Kenton County man, 72; a LaRue County woman, 86; a Laurel County woman, 69; a McCracken County woman, 67; a McCreary County man, 80; a Marshall County woman, 93; an Ohio County man, 67; a Pike County man, 57; a Pulaski County man, 79; a Shelby County man, 79; and a Trimble County man, 75.
• Kentucky's rate of new cases ranks 17th, according to The New York Times, which shows that Lyon County, site of virus outbreaks at state prisons, still has by far the nation's highest rate. The state reports that rate to be 277 cases per 100,000 population. Other counties with rates more than double the statewide rate of 12.05 are Simpson, 63.1; Knox, 41.7; Clay, 34.5; Hopkins, 28.1; Carroll, 26.9; Laurel, 26.3; Butler, 25.5; and Estill, 24.3.
• Counties with 10 or more new cases were Jefferson, 150; Fayette, 48; Simpson, 37; Warren, 28; Boone, 27; Hardin, 25; Madison, 21; Kenton, 16; McCracken, 16; Clark, Daviess, Hopkins, Knox and Laurel, 14; Christian and Whitley, 13; Campbell and Oldham, 12; and Montgomery and Pulaski, 10.
• Kentucky hospitals reported 449 Covid-19 patients, eight more than Wednesday; 110 of those were in intensive care, up 1; and 57 of those were on ventilators, down 3.
• The new login screen and new home screen for the state's unemployment system goes live on Friday, as part of continuing improvement to the user experience. It will require every user to create a new login for their account, with stronger passwords. A tutorial for the new system will is available tonight.
• A new law allows the state to waive some of the overpayments made through federal relief programs. Persons who have been asked to pay back an overpayment must first file an appeal; if that appeal is denied, or the person never got a chance to appeal, they can then apply for a waiver, said Amy Cubbage, Beshear's general counsel.
• Dr. Anthony Fauci said on “Morning Joe” on MSNBC, “We’ve really got to be careful that we don’t claim victory and pull back on all the public-health measures that we know work in keeping the lid on these surging of infections. So although there is good news in the sense of the vaccine continues to get rolled out … if all of a sudden we declare victory, we can risk a surge.”
• Fauci also stressed the need to “get the overwhelming proportion of the population vaccinated.” Without that, he said, “You’re still going to have the virus have the capability of circulating in society because there are so many vulnerable people. So the approach we are taking is to try and reach out and explain to people and ask what are the issues that make them hesitant about getting vaccinated and try to address them with good, solid, scientific facts.”