Respiratory viruses are making many Kentuckians sick and causing schools to close for a few days; will there be a 'tridemic'?

The school boards' group said Nov. 4 that at least 19 of the 171 districts had closed or moved to non-traditional instruction days due to illness. Fayette County later said it would close Nov. 7.

This story has been updated.

By Melissa Patrick
Kentucky Health News

Lots of people are sick and schools are closing these days as cold and flu season has hit Kentucky early, and nearly 750 Kentuckians a day were diagnosed with the flu last week -- and that does not include home tests. 

"Let me just start by saying right now from a health perspective, we're dealing with a lot more than Covid," Gov. Andy Beshear said Thursday at his weekly news conference. "But right now flu, RSV and other illnesses are really hitting our population, especially our children. The report I got earlier this week is that almost every pediatric bed at our three hospitals that have pediatric beds, nearly all of them were full and pediatric ICU beds were completely full."

RSV, or respiratory syncytial virus, is a common respiratory virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults. A spokesperson for UK HealthCare said that on Nov. 3, its hospitals had 31 pediatric patients with RSV. 

Beshear urged Kentuckians to get their annual flu vaccination and the updated Covid-19 booster, and to stay home if they are sick. 

In just three weeks time, Kentucky's flu activity went from sporadic during the week ending Oct. 8 to widespread during the week ending Oct. 22, according to the state Department for Public Health's weekly flu surveillance reports. Flu activity in Kentucky remains widespread in the latest report. 

The health department considers Kentucky's flu level "widespread" when increases in cases are seen in more than half of the state's 16 health regions; that was the case with 16 regions in the latest reporting week.

This surge in flu cases across the state has been so bad that it's shutting some of Kentucky's schools down for a few days. 

On Friday, Nov, 4, the Kentucky School Boards Association said that at least 19 of the state's 171 school districts have announced closures due to illness. The districts include Ballard, McCracken, Crittenden, Owen, Scott, Bourbon, Clark, Madison, Powell, Wolfe, Magoffin, Wayne, Fleming and Carter counties, and the Berea, Jackson, Paris, Raceland and Williamstown independent districts.

Sunday, Nov. 6, Fayette County was added to the list for Monday "due to widespread illness among students and staff," the Lexington Herald-Leader reports.

Kent Koster, director for the Purchase District Health Department, which includes McCracken and Ballard counties, told Jennifer Brown of Hoptown Chronicle that the flu and RSV are affecting school districts the most. 

Koster said the common flu is expected to increase in the coming weeks and that it’s possible people’s immune systems have weakened after multiple winters of wearing masks during the Covid-19 pandemic.

“Since Covid cases have gone down and we are no longer required to wear masks, we can only expect flu cases to go up,” Koster told Brown. 

Jackson Independent Schools Supt. Wayne Sizemore told Grason Passmore of WKYT that students were coming to school with temperatures of 101 and higher and being sent home.

“Anytime we’re below 80 percent, it’s a cause for alarm. We want to make sure we’re looking at the safety of our staff, our students and the safety of our community, as well,” Sizemore said.

The latest flu report for the week ended Oct. 29 showed that Kentucky had 868 new confirmed cases of flu, up from 286 the week prior. The state has recorded 1,260 cases this season and one flu-related death, which was reported as a flu and Covid-19 co-infection.  

One reason "everyone you know is sick right now" is because people have moved away from wearing masks and other precautions to avoid Covid-19 -- efforts that also slowed the spread of flu and RSV, Dylan Scott reports for Vox. Also, people have returned to their pre-pandemic activities, which increases exposure, and because people have largely avoided the flu and RSV for two years, immunity to the viruses has waned. 

Some infectious-disease experts have called the conflation of flu, RSV and Covid-19 that is poised to threaten hospital capacity in some states the "tri-demic." Scott reports that experts are calling for a winter Covid-19 surge based on the pattern of the past two years. 

“We used to worry about a twin-demic. Now some people are worried about a tri-demic: influenza, Covid, and RSV,” William Schaffner, a Vanderbilt University professor and medical director of the National Foundation for Infectious Diseases, told Scott. “Although we worried about this in the past few seasons, people are really anticipating this may be the one where these viruses really gang up on us and together may strain the health care system.”

Experts also told Scott that the hope is that this will not be the new normal because people will get sick and develop immunity to the viruses again, anticipating that this increase in virus infections will last about two years. 

Meanwhile, we already have vaccines for flu and Covid-19 and a new RSV vaccine could be on the horizon. In addition, old-fashioned public health measures like keeping your hands washed, wearing masks, covering coughs and sneezes and staying home when you are sick also work to slow the spread of disease.

Study: Smoking increases risk of viral and respiratory infections, including a coronavirus; supports tobacco control to curb Covid-19

A new study shows that smoking increases the risk of viral infections and respiratory illnesses, including one type of the coronavirus, this supporting efforts to curb tobacco use as a way to thwart Covid-19.  

The University of California, Davis Comprehensive Cancer Center study, published in the Nicotine and Tobacco Research journal, found that current smokers have a 12% increased risk of a laboratory-confirmed viral infection and a 48% increased risk of being diagnosed with respiratory illnesses. These results did not vary by type of virus, including a coronavirus.

“Past research has shown that smoking increases the risk of Covid-19 disease severity, but the risk of infection had been less clear,” UC Davis tobacco researcher and lead author of the study Melanie Dove said in a news release. “Our study findings show smokers have an increased risk of viral infection, including a coronavirus and respiratory illness.”

In combination with past findings, the researchers note that findings from this study support "urgent recommendations to increase tobacco control efforts for countering Covid-19," says the release. 

These findings are especially important to Kentucky, where 23.4% of adults smoke and the state continues to have some of the highest rates of new Covid-19 cases. For help to quit smoking, the state runs a  1-800-QUIT-NOW hotline that offers free tobacco cessation services. 

Data for the study came from a re-analysis of the British Cold Study, a 1986-1989 study that exposed 399 healthy adults to one of five "common cold" viruses, including a strain of the coronavirus that existed prior to the novel coronavirus that causes Covid-19. 

The data showed that current smokers had an increased risk of respiratory viral infection and illness, with no significant difference across the types of viruses. It also showed that the increased association for the mild, common coronavirus that they tested did not reach statistical significance, which the researchers  said was likely due to the small sample size.

"These findings are consistent with known harms caused by smoking to immune and respiratory defenses and some observational evidence of increased Covid-19 infection and disease progression in current smokers. . . . The relative risks from this study can provide an estimate of the strength of associations that can be used to guide tobacco control decisions," says the release. 

The researchers note that one of the  main limitations of this study is that the mild common coronavirus that they tested may have different biological and health effects than other coronaviruses, including the one that causes Covid-19, which means the the findings may not be generalizable to other coronaviruses.

“These findings may have implications for addressing tobacco use at the population level as a strategy for preventing Covid-19 infection,” Elisa Tong, senior author and UC Davis internal medicine professor, says in the release.

Cases up, but Beshear says State Fair is on and businesses can soon increase capacity to 50%; ACLU wants all inmates tested

Kentucky Health News chart shows the two-week trendline tilting about the same as the day before.

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

The number of coronavirus cases in Kentucky jumped again Tuesday, to 245, after two days of the lowest numbers the state had seen in some time, but Gov. Andy Beshear announced another relaxation of restrictions and gave the state fair a mostly green light.

"Today's numbers again show the virus is still out there," Beshear said at his daily briefing. " They are above yesterday's number, but below what we've seen a couple of days before that."

Beshear announced that restaurants, retail stores and others that have been operating at 33 percent capacity can increase to 50% capacity one month after they were allowed to reopen because “we have gotten the practices in” to expand. It appears that retail will be able to increase its capacity by June 20 and restaurants by June 22.

Asked if the recent upward trend is worrisome as expansion looms, Beshear said, "Our concern would be if the number of cases continues to escalate and escalate, especially with a multiplier. When we had to take the steps we took at being healthy at home, we were seeing it double every week."

He said if the numbers "can stay within a range," such as the rate of positive test results, "We believe that we still can handle the reopening and do it safely."

Beshear said at least 287,597 tests have been conducted in the state. The 245 new cases brought the state's total to 11,709, a 4.1 percent positive rate overall; more recent rates have been below 3 percent, he said Monday. At least 3,365 people have recovered from the virus, he said.

The governor said the Kentucky State Fair submitted a good plan and will be allowed to proceed "as long as we continue to have a handle on this virus." He said agricultural competitions will be allowed, but the fair will have fewer vendors and fewer activities, and most will take place outdoors. "It will look very different," he said.

Beshear said the portion of the Kentucky Exposition Center that has been converted to a field hospital will remain intact, because the state must continue to be ready for a surge of cases that could overwhelm the health care system, a current threat in states such as Arizona.

The governor reported five more deaths, bringing the state's toll to 477. The fatalities were a 95-year-old man from Warren County, a 53-year-old woman from McCracken County, a 58-year-old man from Shelby County, an 82-year-old man from Barren County, and a 69-year-old woman from Jefferson County.

Testing and tracing: Beshear continued to encourage Kentuckians to get tested, saying it provides data that we need to track the spread of the virus. He also encouraged Kentuckians to "answer the call" if a contact tracer calls them and be willing to work with them.

"If we can do that, if we can continue testing at a high capacity, and people are willing to work with the contact tracers, it means if there is a significant spike that we can approach it surgically . . . whether it's the area of the state or the potential industry, that we can approach it in a fashion where we don't have to pause anything else," he said.

WHO: Asked about the comment by a World Health Organization official, since walked back, that people who have the virus but no symptoms very rarely transmit the virus, Beshear referred the question to Health Commissioner Steven Stack, who said, "That was a premature statement."

Stack added, "The jury is still out, and I say that because that is the current state of understanding. Some modeling has shown up to 40 to 40-plus percent transmission from asymptomatic people; we just don't know yet for sure."

What we do know, Stack said, is that many people with the virus but without symptoms "are out in the communities and that they are at risk for spreading the disease. So I would not take one data point, one news story and allow that to be expanded to mislead folks that this is not a dangerous disease that does not spread from person to person because the evidence suggest that it does."

Health inequality: Monday, Beshear committed to an effort to get every black Kentuckian covered by some form of  health insurance in an effort to eliminate the health inequality that has been made more evident by the pandemic, with 15.3% of Kentucky deaths from covid-19 among African Americans, though they make up only 8.4% of the state's population.

"Eventually we want to get to make sure that everybody who doesn't have coverage, has coverage," he said, "but we have an obligation, right here and right now to do what we can for a group that has been subjected to racial inequality in health care." About 5.6 percent of Kentuckians have no health insurance; among the state's African Americans, the share is 5.8%.

In other covid-19 news Tuesday:

• Beshear said 525 covid-19 patients are in Kentucky hospitals, with 75 in intensive care. Click here for the state's detailed daily update.  
• Counties with the most new cases Tuesday were Jefferson, 91; Warren, 29; Fayette, 18; Shelby, 14 and Allen, 11. All have had elevated numbers recently. 
• In long-term care facilities, 10 more residents and 26 more staff members have tested positive for the virus, bringing the respective totals to 1,463 and 699, Beshear said. He said there have been 15 more deaths among residents, all but two of whom had already been included in the statewide death toll. In all, there have been 304 resident deaths and three staff deaths; the total of 307 is 64.4 percent of the state's covid-19 deaths. Click here for details. 
• In-home child-care programs were allowed to reopen Monday, and larger daycares can open next Monday, "but the path forward looks murky for many," Liz Moomey reports for the Lexington Herald-Leader. She reports that the centers are struggling with how to stay afloat under a reopening model that will generate less operating revenue because of limits on the number of children in each classroom, laid-off staff that have moved on to other jobs, and nervous parents. A recent survey found that 11% to 15% of Kentucky child-care providers say they may have to permanently close due to the pandemic. 
• The American Civil Liberties Union sent Beshear a letter, dated June 5, demanding that all of the 11,383 inmates in every state prison be tested for the virus, and either release or place on home confinement those who would be medically vulnerable to the virus. ACLU Legal Director Corey Shapiro said the ACLU is "receiving concerning reports about potential exposure to the pandemic at the Kentucky Correctional Institution for Women and Luther Luckett Correctional Complex, and therefore believe the Department of Corrections must act now to prevent further tragedy and loss of life." They have called for immediate action, and asked for a response by June 12.
• Nearly 900 people who participated in Louisville protests against police brutality and racial injustice over the past two weeks were tested for the coronavirus over the weekend at two free sites, reports the Louisville Courier Journal. 

Coronavirus cases continue to rise in Kentucky; governor touches on many topics: testing, politics, schools, health disparities, etc.

State map, labeled by Kentucky Health News, shows rates through June 3. Click on it to enlarge.

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

The number of new, daily coronavirus cases in Kentucky continues to creep up, hitting a seven-day high of 295 on Thursday.

Beshear called the number "pretty high . . . elevated from where we were going for more than a week," but said it is "a little too early" to say the trend has reversed and is on an upward trajectory.

"Again, it's not enough data to say that I am concerned or to raise a high level of concern," he said, pointing to other metrics: "We have a lot of tests that are out there. We are testing more asymptomatic people than ever. Our ICU current beds are really low."

Kentucky briefly celebrated a two-week downward trajectory in new cases just last week, but starting May 28 the number jumped to 283, and for five of the last seven days the case numbers have been over 213.

Kentucky Health News chart shows cases for last two weeks and trendline for the period.

Of the 295 new cases, most of them, 149, were in Jefferson County. No one asked Beshear or Health Commissioner Steve Stack about that, and neither of them offered any comment on the unusual figure. Other leading counties were Kenton and Warren, 14 each; Boone, 13; and Clark, nine.

Beshear reported an adjusted total of 10,705 cases in the state, with at least 3,303 of them having recovered. He said 518 people are hospitalized with covid-19, including 67 in intensive care. So far, the state has had 262,714 tests.

Beshear said Kentuckians should expect to see more positive tests as the state continues to ramp up its testing and as people's contacts begin to increase with the economy reopening.

"Now, I hope that they are lower than this, but we're going to have more," he said. "We're going to watch the numbers as we continue."

Stack noted that the state's testing capacity is well above the federal guidance to test 2 percent of the population each month.

He said another way to reach this guideline is to test until the number of people testing positive for the virus is less than 3%, which indicates that enough people are being tested to find the positive cases. Kentucky is currently at 4.07%, reports the Lexington Herald-Leader.

While the state has more than enough testing capacity, Beshear said he remains worried about "testing fatigue," noting that the sign-ups in the free Kroger-sponsored sites have been slowing. He called on employers to get their employees tested regularly.

"If you are running a business, you ought to want your employees to continue to go to get tested so that someone who is asymptomatic doesn't spread it throughout the office or the factory or the environment that they work in," he said. An estimated one-fourth to one-half of the people with the virus have no symptoms but still spread it without knowing.

Deaths and classifications: Beshear announced that eight more Kentuckians have died of covid-19, bringing the state's death toll to 458.

The new dead were an 87-year-old woman from Boone County, a 72-year-old man from Franklin County, an 82-year-old man from Grayson County, a 92-year-old man from Kenton County, a 71-year old woman and 91- and 92-year-old men from Jefferson County and an 86-year-old woman from Metcalfe County.

Asked it he would consider doing a separate count of people who have died from multiple issues, he said that could be counterproductive.

"Almost everyone that has died from the coronavirus has underlying health conditions and many of them are serious and significant health conditions," he said. "I don't want to over-complicate in our numbers what this virus does. Yes, there are other causes, but without this virus in most cases, we do not believe that the death would be there.

"And there may be some that say, 'Oh, well, that's conflating it.' No, this is killing people and if we don't take it seriously, again if we pull out our numbers in different ways that let us rationalize that it is not a problem, then we don't do what is necessary to defeat it."

Politics: Asked about Attorney General Daniel Cameron's suggestion to a legislative panel that the governor's executive authority during such emergencies should be limited, Beshear referred to his presentation the day before defending his orders and noting three studies showing they "saved thousands of lives."

"It's after we've blunted the curve and crushed the curve that politics comes back into it," he said. "But, if a future governor did not have the power to take urgent action when it is needed, it would have resulted in significant additional death. . . . Every action that I've taken is for the life and the safety of our Kentuckians."

Schools: Asked about schools reopening, Beshear said he hopes there will be a regular reopening, but cautioned that school will look much different than it currently does.

He pointed to recent testimony at a legislative hearing that objected to public-health suggestions for social distancing, wearing masks and keeping one group of students together all day, while teachers move from class to class. 

"If schools don't do things differently, they have an outbreak, you shut down that school," Beshear said. "I think we've seen that in France and in some other places. My hope is that we can start school normally in the fall, but those schools that are willing to embrace the things you need to do to prevent the spread are likely going to be able to continue and not have interruption." 

He said state officials are still working on guidance for schools and this will be influenced by what happens with the virus over the next few months. 

Disparities: Beshear said he would announce actions that his administration will take to address disparities in health care and other areas among "communities of color." on Monday. North Carolina Gov. Ray Cooper signed an executive order Friday establishing a task force to address the issue, ensure that relief funds have been fairly distributed and giving minority-owned businesses access to more opportunities and resources. Beshear said he wants to change the situation, not just come up with recommendations.

For additional information, including up-to-date lists of positive cases and deaths, as well as breakdowns of coronavirus infections by county, race and ethnicity, click here.

In other covid-19 news Thursday:

• "Less than a year after Kentucky celebrated its first decline in overdose deaths in five years, evidence is building that the covid-19 pandemic and its fallout have fueled a rise in drug relapses and fatal and nonfatal overdoses in parts of Kentucky," Chris Kenning reports for the Louisville Courier Journal. 
• The long-term-care facility webpage has been updated to an easier-to-read format. It shows that 1,384 residents and 639 staff have ever tested positive for the virus, with 411 residents and 141 staff currently with it; 283 residents and two staff have died of covid-19. 
• Six Eastern Kentucky counties are among the 25 U.S. counties with the highest overall food-insecurity rates, and the covid-19 pandemic is making it worse, Liz Moomey reports for the Lexington Herald-Leader. Michael Halligan, the chief executive officer of God's Pantry Food Bank, told her that the region had never quite bounced back from the 2008 financial crisis. She writes that many food banks are just beginning to reopen. 
• Beshear announced that Nascar would be allowed to race at the Kentucky Speedway July 9-12 without fans and more information on this would be coming Monday. He said betting parlors for "historic horse racing" can open Monday, June 8, at 33% capacity. 
• Also opening Monday are in-home childcare, libraries, horse shows, and educational and cultural activities. The Kentucky Horse Park and state park campgrounds can open June 11.

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

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

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In other covid-19 news Wednesday:

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

Plans are in the works to open schools in fall, despite some superintendents' concerns that guidelines make it impossible

By Melissa Patrick
Kentucky Health News

Some Kentucky school superintendents say they wouldn't be able to re-open schools under suggested state guidelines that require social distancing on school buses, rely on children to wear masks and will disrupt the normal class structure of upper grades.

They voiced their concerns to public-health officials and the state education commissioner in an online meeting May 26, and were told that opening under the guidelines would be difficult but possible.

"I do believe we can do this. I believe it is going to be a heavy lift," Interim Education Commissioner Kevin Brown said.

Kentucky schools have been closed to in-person classes since mid-March because of the novel coronavirus. Students finished out the year at home.

Dr. Steven Stack, commissioner of public health, told the superintendents that because there will be no vaccine this year, and no treatment is likely to be widely used before school is fully underway, schools will have to rely on social distancing and other public-health measures to reduce the risk of infection.

He warned them that the virus is so contagious that without intervention, every person who has it will infect three more. He reminded them that while children who get the virus generally have mild cases of covid-19, they can pass it on to those who are more vulnerable, and even those who don't develop the disease can be contagious.

Deputy Health Commissioner Connie White said, “Children can frequently have no symptoms and spread the infection so easily, if they are wearing a mask, it helps keep the infection to them and keeps it away from others.”

Stack said, "So, the challenge we all face is substantial. I don't say these things to undermine our confidence that we will find ways to overcome them, but I do say them at least to be sobering in the sense that it is a big challenge."

He said he had seen no "real good solutions yet for these trade-offs, between bringing large numbers of children back together where they can infect each other and then take infection back home, relative to the other cost to society . . . having all these children not getting their education, perhaps falling behind and their parents unable to work as reliably because their children are not in school. . . . They are very real and very serious trade-offs.”

The guidance, among other things, includes recommendations for social distancing, not only in  classrooms, but also in the hallways and school buses; to keep the same group of students together all day, while teachers move from class to class; daily temperature checks, for those who are able to wear a mask all day; enhanced hand hygiene and surface cleaning; and for those who are sick or who have been exposed, home quarantine for at least 14 days, the incubation period for the virus.

Buses: The guidance calls for keeping students and staff six feet away from each other, even on buses, where guidance from the CDC calls for one student to a seat, with a seat between them.

"We can't transport like that, and if we don't transport, we can't have school. Is there any realistic guidance for school buses?" one superintendent asked.

Stack called this is "an enormous challenge" and said he didn't have an easy answer.

"If you put them all too close together, they end up spreading infection, and even if we tell all the children to wear masks, we see how successful we are with adults, unfortunately, and children aren't likely to be much better," he said "If anything they are likely to be less compliant."

Masks: The superintendents also asked many questions about who would and would not be required to wear a mask. Stack stressed that anyone who is not able to wear a mask would not be required to wear one, but said everyone else would need to wear one.

"The masks are likely to remain part of our future for quite a while, and I don't have any relief to offer on that," Stack said. "That's just one of the simplest and easiest things we can do to try to minimize the spread of infection."

The superintendents asked if schools would be required to provide cloth masks to students, then voiced concerns that if they did provide them, the students wouldn't bring them back from day to day.

One solution to this problem was to ask community volunteers to make masks. The Hardin County Schools website has already posted such a request, saying masks will be accepted only from provided materials, because students will only be allowed to wear colors designated for their grade level.

Hardin County students will receive masks when they get to school or when they get on the bus in the morning. Masks will be collected at the end of the day to be washed, dried and sanitized so that they can be passed out again the next day.

Classes: The state guidance also calls for grouping students in such a way that they stay together in one classroom all day, with teachers rotating in and out. This is meant to minimize the number the number of personal contacts throughout the day.

That will create a major challenge in the upper grades, where teachers are usually certified to teach in one subject area. Superintendents said finding ways to group students appropriately to accommodate a full day of classes will be difficult. Health officials urged them to be creative.

White explained the science: "If we've got a group of students that stay together, then if one of them gets sick, then we are only having to deal with looking and caring for a smaller group, as opposed to if one kid gets sick and they've been intermingling with 250 kids in the high school."

Money: White also acknowledged that telling students to stay home when they have no symptoms but have been exposed to the virus "really hits your bottom line," since state funding is based on average daily attendance.

Superintendents asked if it wouldn't be best to just go ahead and plan for nontraditional instruction, or NTI, in the fall.

Brown said schools need to have a playbook that includes both in-person instruction and NTI, as well as a hybrid approach that uses both, and recognize that the playbook probably won't be executed exactly as planned. He said it must allow schools to pivot quickly and efficiently from one scenario to the next.

He said schools would be allowed NTI days in the fall, through Gov. Andy Beshear's emergency powers, and “Even if we did not do it through that authority, I am confident that the General Assembly would have gone back and made that retroactive when they meet in January.”

After superintendents repeated their concerns about reopening under the guidelines, Stack said, "I wish I had more reassurance . . . but the challenges are significant, and it doesn't mean we won't let school open up; and it may mean we have to accept that when school opens up. that there are more kids together than we would prefer because the counterbalancing trade-offs of having them fall further behind in education, of having parents who can't be at work, that those things are so substantial that we have to try to figure out a way to navigate the trade-offs. I think it is premature for us to reach the conclusion that we can't have school yet in the fall."

Politicians' views and legal issues

Beshear often says at his daily briefings that his two main goals in dealing with the virus are to open the economy and to reopen schools this fall.

"I want to get our kids back to school. We know that distance learning isn't the same, we know that our kids fall behind when they do it, we know as parents how hard it is to step in," he said at his May 15 briefing. That was the same day the  Kentucky Department of Education released its 16-page document, meant to serve as a starting point for schools and districts as they work toward reopening.

Resumption of school is a broadly accepted goal. U.S. Senate Majority Leader Mitch McConnell said in a recent visit to Owensboro that most people are comfortable with getting back to normal, and that one of the most important aspects in doing so would be having children return to school, Katie Pickens reports for the The Owensboro Times.

“K-12 and college-age kids need to be back in school,” McConnell said. “There are consequences for being cooped up at home. You’ve seen the results of these studies indicating suicide is up, spousal abuse is up, child abuse is up. There are health-related consequences as well. So, clearly, that needs to come to an end.”

McConnell has also called for schools to be legally protected from lawsuits that could arise due to resuming classes amid the pandemic, Newsweek reports.

Asked if school districts are setting themselves up for a lawsuit since each would have a separate plan for opening, Commissioner Brown reminded the superintendents that districts are sued regularly, with or without covid-19, and when they are sued for negligence, the standard defense is reasonableness.

Schools advised to be creative but observant 

White told the superintendents that the guidance is based in science, but as the Centers for Disease Control and Prevention says, "You have to look at feasibility, accessibility, and you have to tailor that to your particular community. The closer you can get to these, the less likely there will be issues." She encouraged the superintendents to be creative

"We don't have a covid police," White said. "Nobody is going to be coming with a six-foot measure and measuring and citing people We feel like that if we give you the information you need, then you are going to come up with those creative situations to make the best possible things happen for your students."

Brown said local schools are obliged to follow state guidelines: "Everyone needs to act in good faith. Local school districts are state actors; even though they are locally controlled, they are arms of the state. And I think we all want to act in good faith, and we don't want to have a situation where these practices are not followed."

Pike County Supt. Reed Adkins told the Appalachian News-Express, “We plan to follow all of the state’s guidelines to protect our students, but we haven’t received enough guidance yet to make a decision on reopening.”

Adkins "said the situation is still changing and there are many questions that have been left unanswered, which has caused him to hesitate," Nicole Ziege reports. Adkins told her, “The health and safety of our students is our top priority.

Virus creates perfect storm for those with substance-use disorder, but opens the door to online recovery tools that could persist

By Melissa Patrick
Kentucky Health News

Economic struggles and social isolation are well-known triggers for people with substance-use disorders, so the coronavirus pandemic has created a perfect storm for them. But the isolation has prompted an influx of online recovery services that addiction experts hope will continue long after the virus subsides.

Image from Alcohol.org

"Some really great things that are going to come out of this situation is that for folks who really face transportation barriers, especially out in those rural communities, if we allow, continue to have this space for virtual connection, we can really create some better connections with those people to get them the supports that they need," Tara Moseley, program manager at Young People in Recovery said on "Coronavirus: A Kentucky Update," a weekly Kentucky Education Television program hosted by Dr. Wayne Tuckson.

The shift to online care is an opportunity for those who are seeking recovery, but are hesitant to attend an in-person meeting, said Sarah Bell, lead peer specialist at Beyond Birth, a University of Kentucky outpatient substance-use-disorder recovery program serving mothers in recovery.

"I think it is a great time to for anyone who might be exploring getting sober, but they don't want to walk into a meeting in their town," Bell told KET. "There are all these virtual meetings now, which I think is really helping to break down the stigma of people who feel like they might want to stop using a substance."

Addiction experts have long called for more access to online addiction treatment, including the ability to prescribe medications online for opioid-use disorder. About 40 percent of U.S. counties don't have a health-care who is approved to prescribe buprenorphine, an active ingredient in Suboxone, the preferred drug in medication-assisted treatment for substance-use disorder, according to a federal report.

Online prescribing is possible only because the pandemic prompted the federal government to suspend a law that required patients to have an in-person visit with a physician before such a prescription, Phil Galewitz reports for Kaiser Health News. 

The new rules also allow people who are in treatment for addiction and are considered “stable” to take home a 28-day supply of methadone, and those "less than stable" to have a 14-day supply. Beforehand, methadone could only be administered in an opioid treatment program. Advocates say compliance with the new guidelines has been inconsistent, reports Stat, the medicine-and-science publication of The Boston Globe.

Virus creates perfect storm for relapse 

Since mid-March, all non-life-sustaining, in-person businesses in Kentucky have been closed, public schools have ceased all in-person classes, and Kentuckians have been asked to practice social distancing and be "healthy at home" to slow the spread of the coronavirus. Such measures, while saving lives, have wreaked havoc on the economy and thrown people with addictions into a tailspin as in-person recovery supports have shuttered.

"Research shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide," according to a recent poll for the Kaiser Family Foundation, which notes, "A broad body of research links social isolation and loneliness to both poor mental and physical health."

The poll found that 45 percent of U.S. adults said their mental health has been hurt by worry and stress over the virus.

A U.S. Department of Labor report shows that Kentucky (except tourism-dependent Hawaii) leads the nation in percentage of workforce that has claimed unemployment benefits. The Louisville Courier Journal reports that about 590,000 Kentuckians, or about 29% of the state's workforce, have submitted new jobless claims in the past six weeks.

"Quarantine and stuff, it causes anxiety, and anxiety is a trigger for a lot of people," Rebekah Bowman, women's group leader at Celebrate Recovery, a faith-driven, 12-step recovery program, said on the KET show.  "And sometimes the alienation, that's a trigger for some people. And the hopelessness of it, some people just get to feeling like it's never going to end."

Alex Acquisto of the Lexington Herald-Leader has reported in detail on this topic, telling the stories of Kentuckians who are working to stay sober while being asked to isolate. One is Jaden Korse, 23, who told her that he normally attends at least three recovery meetings a week.

“For a lot of people, me included, prior to relapse, isolation is sort of a trait you’ll see,” Korse said.  “It’s weird to forcibly be put into that, [since] it was something many of us would do in active addiction.”

Drug use continues

Rob Sanders, commonwealth's attorney in Kenton County, told columnist Salena Zito that even though arrests are down dramatically in his county, he didn't think drug use was.

“I would estimate that we normally would get 20 to 30 felony drug-possession arrests per week in this county,” he said. “Right now we’re averaging five or six, maybe. Short of crashing into a police car, you are very hard-pressed to get yourself arrested for drug possession . . . I don’t think the drug users have stopped using just because of the coronavirus. I suspect there’s a lot of rampant drug use right now and there’s just a lot less police intervention. I’m not faulting the police, because I wouldn’t want them to have any more interaction with strangers than they absolutely had to, but their proactive policing is way down.”

Sanders isn't likely far off in his assumption, since illicit drugs continue to flood into the state, news reports in the past month indicate.

In the past month: WKYT reported May 2 about nine straight days of methamphetamine seizures in Whitley County; WYMT reported April 9 about a meth bust in Johnson County; The Daily Independent of Ashland reported April 7 about a seizure of more than a pound of heroin in Boyd County, an amount the sheriff said was almost unheard of locally.

Meanwhile, drugs continued to reach users. The Richmond Register reported April 24 that the Madison County EMS saw 75% more overdose calls April 1-23 than during the same period 2019.

Paul Brethen, co-founder of SoberBuddy and a certified addiction specialist for more than 20 years, told Dawne Gee of Louisville's WAVE-TV that he believes the supply and distribution of most drugs was being altered because borders closed because of the pandemic: "Drug dealers to keep business going are cutting the heroin and cocaine with fentanyl," which could lead to more overdoses.

Drug shortages can also lead to overdoses, because users will substitute drugs they’re less familiar with, or change their habits, making dosing less reliable and potentially causing a spike in overdoses,
Daniel Ciccarone, a medical professor at the University of California-San Francisco, told Lois Parshley of National Geographic. Ciccarone fears that the pandemic may usher in a fifth wave of the opioid crisis.

Help is still available.

"A big part of recovery is telling on yourself; you are going to always have thoughts about picking up a drink or a drug," Bell, of Beyond Birth, said on KET. "If you say it out loud, and talk to someone else about it, it's going to take a lot of that power away. The more you kind of try to sit in isolation and stuff it and stop thinking about it, or think that you're wrong or guilty for thinking about it, it's going to be a lot tougher to  kind of make it through that craving."

Here is a list of free online meeting options, as well as platforms where individuals can interact virtually with others in recovery, provided to Operation Unite by James Carroll, director of the White House Office of National Drug Control Policy. Kentucky also offers a website to connect Kentuckians to addiction treatment, findhelpnowky.org.

46% of Ky. covid-19 deaths in long-term-care facilities, higher than other states; protective gear, testing and staffing are concerns

Long-term-care facilities have largely confined residents to
rooms to protect them from the virus, but they play games
via hallways. (Photo via The News Courier, Athens, Ala.)

By Melissa Patrick
Kentucky Health News

With 46 percent of Kentucky's covid-19 deaths occurring in long-term-care facilities, up from 32% just a week ago, nursing homes continue to be a tinderbox for the coronavirus. That has prompted state officials to ramp up testing and to create a Long-Term Care Task Force charged with finding ways to slow down the spread of the virus inside these facilities.

Gov. Andy Beshear said the state has increased testing for the virus in these facilities, and more resources than ever are available for them to fight it, but he cautioned that as he begins to reopen the state's economy, it will be even more important to protect some of Kentucky's most vulnerable people.

"As we make these new decisions, as we try to ease restrictions, we've got to make sure that we don't increase the exposure," he said at his Sunday briefing. "Listen, this is what has happened in these facilities when we've had everything shut down . . . So, we've got to be really careful when we start expanding our opportunities that we're not allowing additional access to these facilities."

As of Sunday, Kentucky reported that 610 residents and 280 employees in 60 long-term-care facilities had tested positive for the virus. Ninety-five residents and one employee have died of covid-19. In Kentucky overall, there have been 4,074 confirmed cases and 208 deaths.

In several of Kentucky's surrounding states, long-term-care facilities account for a smaller share of covid-19 deaths, the Kaiser Family Foundation reports: Tennessee had 37 deaths, or 22% of its total; Illinois had 284, or 18%; and Virginia had 78, or 22%. West Virginia, Missouri, Indiana and Ohio are not among the 23 states that have reported their long-term-care deaths yet.

The overall rate among those states is 27%. LTCs accounted for over half of covid-19 deaths in six states: Delaware, Massachusetts, Oregon, Pennsylvania, Colorado and Utah. The Centers for Medicare and Medicaid Services told all nursing homes April 19 to report cases to the Centers for Disease Control and Prevention, but the data is not yet available.

Kentucky's higher rate could partly result from differences in how states define a covid-19 death. In Kentucky, any person who dies having tested positive is counted, regardless of other conditions. Some states have narrower definitions.

The dangers are very real for residents of nursing homes, personal-care homes, family-care homes and assisted-living facilities, given their group living conditions and their many underlying health conditions.

The challenges for protecting them include finding ways to isolate, in buildings that often have few single rooms, those who have been infected; and ways to protect staff who care for this most vulnerable population – especially when basic supplies, like gowns, masks, and gloves, otherwise known as personal protective equipment, is so scarce.

"Staffing, PPE and testing are the common themes of everybody who is really concerned about what do we do next if this goes south on us," said Keith Knapp, the state official and former long-term-care administrator who acts as convener of the task force.

One task-force member is Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington. She said there are about 315 Kentucky nursing homes, with about 28,000 residents, and about 206 personal-care and family-care homes, with about 7,400 residents.

Personal protective equipment

PPE is needed to not only protect vulnerable residents, but to also protect staff, and nursing homes were running short of these supplies long before the pandemic hit, said Betty Shiels, director of Kentucky Emergency Preparedness for Aging and Long Term Care, a public-private coalition.

“They were running short on PPE because they were using so much of it up because they were being hard hit by the flu," she said.

Dr. Muhammad Babar with PPE donated by the
Association of Physicians of Pakistani descent
in North America (Image from governor's briefing)

In an interview, Dr. Muhammad Babar, a geriatrician and independent physician who is on the task force, called the PPE shortages in these facilities "big" and spoke to some of the challenges around procuring it.

"That really limited our facilities, which are still struggling with PPE," he said. "The cost has increased tremendously, and as we all know our states are competing with each other."

Babar is regional hub medical director for Signature HealthCare, which has 42 nursing homes in Kentucky, more than any other operator; the medical director of four of them in Louisville, an assistant clinical professor at the University of Louisville, and the founder of Doctors for Healthy Communities Inc. and Muslim Americans for Compassion.

Beshear speaks almost daily about the challenges of procuring enough PPE for health-care providers in the state, and often pleads for donations, which can be made at any of the 16 state police posts, or can be arranged by calling 1-833-GIVE-PPE or going to givePPE.ky.gov.

Adding to the challenge, the federal government requires the state to make daily reports of its PPE stock in order to be eligible to make a request for additional PPE, and that requires daily reporting from all of the state's health-care providers, including long-term-care facilities.

Shiels, who is also on the task force, said the facilities have been doing everything they can to follow the CDC guidelines, given the PPE supplies that were made available from the strategic national stockpile, which are now depleted. She recognized that long-term care facilities took second priority to hospitals for PPE supplies, but said that was largely because hospitals have higher acuity patients.

Since then, she said, PPE has been "trickling in" and nursing facilities are doing the best they can with what they have available. “I'd say there is varying available supply of PPE for nursing homes right now," she said.

Culp encouraged facilities to keep reaching out to public health for PPE because "this is an evolving situation."

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the long-term-care industry's trade group, said her association's main focus has been to secure PPE and testing for members and residents. “It's not been easy,” she said, “and I wouldn't say we've had a great deal of success.”

Testing

Testing capacity is finally picking up in Kentucky, but Johnson said it is still "iffy" and "I do know that we were not prioritized for testing, either." She said the association's stance is that testing needs to be a priority in these facilities.

"In order to protect our residents, we have to prioritize testing for skilled nursing facilities – all residents, all staff, all the time – to ensure that we know what is going on in that building," she said. "You can be asymptomatic and still be shedding the virus."

Acting Health Secretary Eric Friedlander said last week that the health cabinet has been testing all residents of some facilities, starting with those that need the most help, and that it is working with all facilities that have a positive case.

Beshear said Sunday that nursing homes are classified by red, yellow and green categories, based on several factors, and the state is testing the red group first.

He said for a nursing home to qualify for testing by the state, it must "be working with our Department of Public Health, it's got to collaborate on its established process on how it deals with potential infection and its response, and it's got to comply with a facility plan we put out there of best practices."

He added, "I don't want to sugar-coat it, the coronavirus is deadly in these settings. It's why we cut all visitors at a time when people maybe didn't understand why we were doing it, and so this is a setting where it is a matter of life and death, and we are doing the best we can in a very difficult circumstance with a virus that comes for those that are already vulnerable."

Health officials have called for "sentinel surveillance," which involves rigorous, frequent testing to find hidden carriers of the virus, isolate them limit its spread.

Staffing

Staffing has been an issue for nursing homes for decades. They have successfully lobbied against laws or regulations to require certain staffing levels. Johnson said her members have trouble finding and keeping staff because unemployment rates have been low and they have a non-competitive wage scale because of low payments from Medicaid, the program that pays the bill for most residents.

“I think this covid-19 pandemic has allowed us to really highlight the fact that our skilled nursing facilities simply need more support," she said. "We need support from our policymakers in government. We need support from our communities. We need support from the media."

Culp noted that while the federal CMS agency normally keeps a tally of staffing at these facilities, it has removed this requirement during the pandemic. "That really concerns me, that when this is all over, we will not have a good picture of how the short staffing may have played into this," she said.

CMS has a site, https://www.medicare.gov/nursinghomecompare/search.html, that ranks nursing homes on staffing, health inspections and quality of care. A tabulation of deficiencies in Kentucky nursing homes during the three years through mid-2019 is available from the nonprofit investigative newsroom ProPublica at https://projects.propublica.org/nursing-homes/state/KY.

The state has several measures to help facilities with staffing issues, including the Medical Reserve Corps, which can be used to improve emergency response capabilities and the creation of a rapid response team of providers who can be deployed as needed. Knapp said the state is also working on a "strike force" of health-care professionals to help facilities deal with immediate crises.

An advertisement in the The Messenger newspaper in Madisonville shows that the state is paying registered nurses $65 an hour, licensed practical nurses $50 an hour, and certified nursing assistants $32.50 an hour to work for the state's covid-19 crisis teams for seven days on and seven days off in long-term care facilities.

The state has temporarily waived certain training requirements for nursing aides, who provide most of the hands-on care for residents, to allow for temporary covid-19 personal-care attendants. These new hires would not be allowed to provide care for residents in covid-19 isolation areas.

The state has also partnered with Norton Healthcare to set up a 24-hour hotline staffed by health-care professionals to help long-term-care facilities manage complex infection-control issues and see if they need more support.

"Mostly they need to know that someone is out there willing to help, willing to support," Friedlander said last week. "And we've found that on many calls, that is what is most needed."

Many who work with nursing-home employees are quick to point out their dedication to their jobs. "There are a lot of dedicated people who are working in long-term care," Culp said.

"They are good people," Babar said. "They represent our society. They do their best every day in this broken healthcare system. They are doing a good job."

Johnson said, "This group of people are the most dedicated. They are just hard workers who really want to do the right thing, with very little support."

Visitation restrictions will remain in place

As restrictions are eased elsewhere in the coming months, Beshear has said, “Visitation is going to be extremely, extremely restricted” at long-term-care facilities, a decision that both Babar and Johnson support.

“I think we still need to make the sacrifices of not visiting our loved ones in the facilities, we need to protect them from the outside world and that visitation should be the last thing allowed,” Babar said.

He praised Inspector General Adam Mather's decision to restrict visitation in long-term-care facilities, saying it saved lives.

"We were one of the very first states to stop visitation in our facilities, because of his leadership," Babar said. "He has done a marvelous job because of the base of his knowledge."

Prior to becoming inspector general, Mather was regional operations vice president for Signature, and some criticized his appointment because of his ties to the industry.

Johnson, whose mother is in a nursing home, said, "I haven’t seen Mom since the beginning of March, but I fully support that decision by both the federal and state government. We have to keep these elders safe. It is hard; it's been hard on my family, but hopefully we'll get through this and we'll keep our elders safe at the same time.”

Culp said most of her calls right now are about the visitation restrictions and a need to know if their loved ones facility has been infected with the coronavirus.

The state recently started posting a daily update on Kentucky facilities that have coronavirus cases, listing the number of residents and staff testing positive and the number of covid-19 deaths. It is at https://chfs.ky.gov/agencies/dph/covid19/LTCupdate.pdf.

Infection Control

Shiels, who does emergency preparedness training for nursing homes, said they are fully prepared to control infections, because that's what they do everyday. She said the challenge with covid-19 is that it is so contagious and PPE is in short supply. "Everybody has been doing the very best they can under extreme circumstances," she said.

Inspectors have stopped routine visits to nursing homes during the pandemic, with a short list of reasons for investigation, including serious allegations and targeted infection control.

The Long-term Care Task Force's guidance is posted on the state's covid-19 website, kycovid19.ky.gov. It recommends that residents be screened for fever and respiratory symptoms at least daily, including daily use of blood-oxygen meters, since "long-term care residents with confirmed covid-19 infections may be less likely to show signs of fever and respiratory signs, and symptoms may be subtle." Research has shown many people infected with the virus have low oxygen levels without recognizing it or any other symptoms.

"There are a lot of moving parts to this," said Knapp, a newcomer to state government. Speaking later about the efforts of the health cabinet, he said, "This Team Kentucky thing, it's more than a slogan, it permeates the place."

4 new test sites announced; legislature drops business bill that raised Beshear's ire; state Chamber sets 'what next' webinars

An intubation box, similar to one shown by Dr. Steven Stack at the governor's daily briefing, is used
to limit health-care workers' exposure to the coronavirus when intubating a patient. (WDRB image)  

As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

Gov. Andy Beshear announced four more sites to test Kentuckians for the coronavirus, and deferred most comment on President Trump's plan for relaxing restrictions to fight it, at his daily briefing Thursday.

Beshear said the Kroger-sponsored sites will be open in Paducah, Madisonville, Somerset and Pikeville Tuesday through Thursday, with a goal of testing 1,000 people apiece. He said they will be open to people in the respective regions, not just the counties of the testing sites or adjoining counties, the practice for the first two sites, in Franklin and Kenton counties. The Kenton location is open through Saturday. To schedule a test at one of the Kroger sites, go to thelittleclinic.com/drive-thru-testing. "Let's not leave one test unused," he said.

Beshear said he had seen a "high-level summary" of Trump's plan, and heard it discussed on a call for governors, but would reserve specific comments on it until Friday because "I think he ought to be able to present it."

"It is just a recommendation that states take certain steps," he said. "A lot of them are the guidelines that we’re thinking about and would have been talking about tomorrow," when he had already planned to discuss the topic.

He said that on Friday, he will give his analysis of the plan and “our additional metrics . . . and maybe where we are on some of those metrics. . . . It's gonna take significant amounts of testing and then contact tracing.” The plan included no guidance for states on those points.

Beshear reiterated that easing of restrictions will be gradual, and differential. “The new normal is going to be different than our old normal,” he said, adding, “Our seniors and vulnerable populations are still gonna be very very much at risk from this virus.”

Also, he said, “We believe we are still on an upward trajectory” in cases and deaths. He announced 159 new cases, for a corrected total of 2,429, and said “We believe tomorrow is gonna be one of the highest numbers we’ve seen because many reports have been delayed. “What we really need to look at are the averages over these days,” he said.

One of the new cases was a 10-day-old baby in Lincoln County. “This is a family that just had a miracle occur and is probably living through a nightmare,” Beshear said.

In other covid-19 news Thursday:

• Showing a social-media comment that nothing can be done about people dying from covid-19, Beshear said, "There is something that everybody can do about this coronavirus. It's following those 10 steps. If you stay healthy at home, then you prevent people from dying. If you engage in social distancing, then you can stop people from dying. If you make sure that you follow our 10 rules . . . that is how we do everything it takes to beat this virus. It is in each and everyone of our hands."  
• Beshear announced that seven more Kentuckians had died from covid-19, bringing the state's total to 129. The most recent deaths were a 79 year-old man and 68- and 92-year old women from Jefferson County; an 85-year-old man from Jackson County; a 78-year-old woman from Adair County; a 69-year-old woman from Shelby County; and a 67-year-old female from Graves County. 
• The General Assembly did not pass a last-day bill that would have directed trade groups and licensing boards to give Beshear a plan for safely reopening certain businesses. Senate Bill 136 passed the House 86-3, but got no action in the Senate. WLKY-TV reports, "A spokesperson for Senate Republicans said the bill had technical flaws, and there was not time to get it redrafted." Beshear, who had objected to the idea, could have vetoed the bill without fear of a legislative override.
• The legislature overrode a vetoed section of the budget bill prohibiting Beshear from spending unbudgeted funds without legislative approval, but added language to a rural-hospital bill allowing unbudgeted restricted funds to be used for personal protective equipment during the state of emergency.  
• The governor said Western State Hospital in Hopkinsville saw five new cases and Green River Correctional Complex in Central City saw two new cases, one inmate and one staffer.  
• The state's long-term care facilities had 27 new cases and one new death. Eleven of the new cases were among staff. In all, 283 residents and 148 staff have tested positive for the virus , and 37 residents and one staffer have died.  
• Kentucky, Wisconsin, Illinois, Minnesota, Michigan, Indiana and Ohio have joined to closely coordinate plans to repoen their economies, Beshear said. Asked what would be needed to partner with Tennessee, he said Tennessee had taken a different approach and had not reached out to Kentucky, "and I guess given some of my comments I can understand that." When Tennessee had relatively lax rules and a higher rate of cases, Beshear compared the two states' performances.
• Health Commissioner Steven Stack showed a plexiglass intubation box made by First Build, a subsidiary of General Electric, to place around heads of covid-19 patients to help protect health-care workers from exposure to the virus when they place breathing tubes in the patients. He said First Build has made 500 boxes to be distributed across the state.
• Beshear said the state will offer non-congregate shelter for persons needing isolation at Lake Barkley and Lake Cumberland state resort parks, beginning Sunday, April 19. Placement will be by referral only from public health and clinicians, for people who are sick or have been exposed to the virus and cannot safely go home and have nowhere else to go. They will get meals, basic first aid, TV and internet access. He said other parks will be used as needed. The program will help relieve pressure on hospitals as well as to prevent the spread of the virus, he said.
• The Lexington Herald-Leader reports on how Kentuckians who have lost health insurance because of covid-19 can apply for Medicaid.
• The Kentucky Chamber of Commerce is hosting two webinars in response to the covid-19 pandemic. The first, "How Can Business Re-Open and Protect Public Health?" will be at 1 p.m. Tuesday, April 21. Click here to register. The second, "How Does Kentucky's Economy Rebound From Covid-19?" will be at 2 p.m. Thursday, April 23. Click here to register.
• UK Now tells the story of how staff and volunteers with the Cooperative Extension Service are assembling face shields and sewing masks for the state's health-care industry. 
• Stat, in collaboration with the Center on Rural Innovation and Applied XL, created an interactive dashboard that examines every U.S. county's covid-19 preparedness level. 
• With a 30 percent false-negative rate, largely because of difficulty getting a proper sample, many are concerned that using some current covid-19 tests to see who can go back to work is not reliable. Stat reports that China has used a chest CT scans to diagnose infections, which one study found to be 97% reliable.  
• The Associated Press reports that the federal government is under pressure to publicly track nursing-home outbreaks and deaths. "This is basic public health — you track this, you study it, and you learn from it," said David Grabowski, who specializes in health-care policy at Harvard Medical School. He told the AP that it's difficult to have confidence in officials' ability to contain the virus if they aren't tracking where it has struck and why.
• Since April 14, the Centers for Disease Control and Prevention has included probable cases and deaths from covid-19, in addition to confirmed cases and deaths. The Washington Post reports that there is great variance among states in how they tally covid-19 case and death, making it difficult to compare one state to another. Kentucky attributes to covid-19 the death of any person found to have the virus, including in tests after death, which some states don't do.
• "Clinicians around the world are seeing evidence that suggests the virus also may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems," the Post reports. "That development has complicated the treatment of the most severe cases of covid-19."
• The Post reports, with a graphic, that covid-19 is rapidly becoming America's leading cause of death.

Graphic from The Washington Post shows causes of death in U.S. April 6-12. To enlarge, click on it.