Kentucky can soon provide Medicaid coverage to people nearing release from prison or juvenile detention; jails might come later

By Melissa Patrick
Kentucky Health News

Kentucky is one of five additional states that will soon provide Medicaid health coverage for people nearing release from prison or juvenile detention, according to the U.S. Department of Health and Human Services. 

"We've been eagerly anticipating CMS's approval of Kentucky's healthy re-entry demonstration for years now," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

The program started as a demonstration focused on treatment for substance-use disorder during incarceration and "has expanded to focus on putting in place all of the physical and behavioral health treatment, care coordination, and wrap-around supports justice-involved Kentuckians need to successfully return to their communities and thrive," Beauregard said in an email. 

This demonstration program is operated under a partial waiver of the Medicaid program's inmate-exclusion policy, which prohibits paying for services to inmates unless they are admitted to a hospital.

"Providing avenues for greater health outcomes is always the right thing to do, and this program does just that," state Cabinet for Health and Family Services spokesman Brice Mitchell said in an email.

Before the state can start the coverage, it must submit an implementation plan to the Centers for Medicare and Medicaid Services, Mitchell said: "Upon receiving implementation approval from CMS, Kentucky will cover a select set of pre-release health-care services through Medicaid and the Kentucky Children’s Health Insurance Program for up to 60 days before an individual’s expected date of release."

Kentucky didn't take full advantage of the waiver, which allows states to provide coverage up to 90 days before the expected release date. Eligibility is based on income; the limit is 138 percent of the federal poverty level.

Mitchell added, "The individual must be eligible for Medicaid or KCHIP to qualify and must be a state inmate housed in one of Kentucky’s 14 prisons or a post-adjudicated juvenile in the custody of the Department for Juvenile Justice."

Mitchell provided data from the state Department of Corrections, which said "There are 19,220 individuals serving felony convictions in state prisons or jails, as well as an additional 49,700 on active supervision with the Division of Probation and Parole. At least 95% of the state inmate population will be released from incarceration at some point." 

Kentucky's waiver doesn't allow inmates in jails to participate, because its jails are operated by counties, not the state. Beauregard said, "We've advocated for allowing jails to opt in, if they are willing to meet requirements and participate fully." She said the state Department for Medcaid Services "has said they will consider [jails] as a future phase of this project."

Coverage will be available not only to adult prisoners, but incarcerrated youth, under the Children's Health Insurance Program, called KCHIP in Kentucky. Beauregard praised the inclusion of youth in the coverage, which was not part of the original demonstration program for substance-use-disorder treatment and not part of the orignal application for its expansion. 

"Another important expansion from the original waiver is that youth who are in detention facilities will also get these services and wrap-around supports, which has the potential to reduce recidivism," Beauregard said.

 

A July 2 news release from HHS noted that incarcerated people often report higher levels of substance-use disorders, chronic health conditions and other health concerns, and that people transitioning out of jail or prison can experience delays in obtaining access to Medicaid or CHIP. 

HHS Secretary Xavier Becerra said in the release, "For people involved in the justice system, ensuring a successful transition back into the community includes having the health-care supports and services they need."

Kentucky is the first Southern state in the program. The other newly approved states are Illinois, Oregon, Utah and Vermont; California, Massachusetts, Montana and Washington had already been approved.

State and advocates try to keep eligible Kentuckians on Medicaid

State employees staffed a booth at the Kentucky State Fair to help people understand Medicaid changes and how to apply for the program or other coverage. (Ky. Lantern photo by Deborah Yetter)

By Deborah Yetter
Kentucky Lantern

Some patients find out they’ve been dropped from Medicaid when they come in to pick up a prescription. Others, when they arrive for a doctor’s appointment.

And some are struggling to cope with paperwork or documentation required to prove eligibility for Medicaid under new rules that require such information for the first time in three years.

Ashley Shoemaker, director of outreach for the Family Health Centers in Louisville, recalls the relief one man expressed when he was contacted as part of an effort to alert patients about the Medicaid changes.

“He said, ‘I’ve been trying to do this on my own and I don’t know where to start,’” Shoemaker said. “He’s eligible; he just didn’t know where to begin.” Staff helped him complete his application.

But around 70,000 people in Kentucky have been terminated from the health plan for low-income and disabled individuals through June, the latest numbers available from the state.

Mosyt lost coverage for not responding to paperwork, or not properly completing it.

How to renew your Medicaid

What’s going on with the program? If you get health coverage through Medicaid, you may have to resume the annual process of proving you are still eligible for the federal-state health plan for low income and disabled individuals. The requirement was suspended for three years during the Covid-19 pandemic but in Kentucky, resumed in May.

What do I need to do? Watch for a notice in the mail from state Medicaid officials, and be sure to read it and return it with any information requested. If your address has changed in the past three years, make sure the state has your current address either by notifying the state Department for Community Based Services in your county or by calling 1-855-306-8959.

If you have an account through kynect, the state’s online health insurance site, you can log in and update your information and check to see whether you have any messages requiring action. The kynect phone number is 1-855-4kynect (459-6328).

Where can I get help? If you don’t apply by mail or online, you can visit any Department for Community Based Services office; there’s one in every county.

You also can call the kynect hotline listed above to ask help finding a kynector — workers trained to help people get health coverage. They are located at agencies, clinics and other sites.

What if I no longer qualify for Medicaid? Visit the kynect site or meet with a kynector or local insurance agent to look for other options. A number of low-cost health plans are available with federal subsidies that make them affordable.

Health advocates in Kentucky — as well as nationwide — are watching and working to ensure people who are eligible remain insured as states transition back to yearly recertification for Medicaid. The state began sending the first round of notices in May, based on a member's renewal month.

“For three years, people didn’t need to respond to notices they received because their coverage was going to continue,” said Emily Beauregard, executive director of Kentucky Voices for Health, which is closely monitoring the situation.

During the pandemic that began in 2020, the federal government suspended the annual requirement that people prove they are eligible for the coverage which is based largely on income.

Kentucky’s $15 billion-a-year Medicaid program covers 1.6 million people, including adults, children and individuals in nursing homes, with the federal government covering 70% to 80% of the costs.

With the recent decision to lift the federal public health emergency, the states must again begin requiring annual renewal by members.

And that’s proving difficult among people who aren’t used to the annual requirement, may not understand the process or don’t have access to technology required to complete online applications and upload documents, such as income verification, advocates said.

“It’s hard to know if people understand what they need to do and are taking those steps,” Beauregard said.

70,000 Kentuckians terminated through June

Molly Lewis, CEO of the Kentucky Primary Care Association, said she worries that people who have benefited from expanded mental-health and addiction treatment in recent years could suffer if they inadvertently lose Medicaid coverage.

“I am most concerned about all those who have benefited from behavioral-health services,” said Lewis, who represents a network of clinics that see about one million patients a year.

Through June, 70,000 of the around 900,000 Kentucky adults covered by Medicaid have been dropped from the health plan, most losing coverage for “procedural reasons,” such as failing to respond to a renewal notice sent by the state.

Other states are posting similar numbers, with 75% of disenrollments nationwide due to procedural reasons, according to the Kaiser Family Foundation, a non-partisan health policy organization which offers a Medicaid enrollment tracker on its website.

That doesn’t mean all Kentuckians who lose Medicaid lack health coverage.

Eric Friedlander, secretary of the state Cabinet for Health and Family Services, which administers Medicaid, said Kentucky structured its 12-month recertification plan to first target those who are most likely to have obtained other health coverage. That includes up who people 65 and qualify for Medicare, the government plan for older Americans, or who have obtained coverage through employment.

Advocates agree with the approach but still worry that too many people who are eligible are losing coverage for failing to receive or respond to notifications from the state. With only a few months of data available, it’s hard to tell, said Beauregard.

“At this point, it’s too soon to know how many people are walking around uninsured and either don’t know it or think they are not eligible,” she said.

Preliminary numbers show as many as 40% of those losing Medicaid coverage may have obtained other health insurance. And about 3,000 people who lost coverage have been reinstated once they provided applications or documentation, such as proof of income or address, Friedlander said.

Meanwhile, about half of those targeted each month for Medicaid recertification don’t have to do anything at all. They are deemed eligible through “passive” renewal, in which the state is able to validate information such as income and household size by checking state and federal databases.

And those whose income has increased, making them no longer eligible for Medicaid, may be eligible for low-cost, federally-subsidized private plans through kynect, Kentucky’s online health insurance exchange, Medicaid Commissioner Lisa Lee said: “There really is something for everyone.”

Stakes high for kids

Kentucky's approach means thatg it has avoided cutting children from Medicaid. Advocates have sounded sound the alarm about other states where high numbers of children are losing coverage — most often for procedural reasons.

The tens of thousands of children losing coverage in some states prompted one group that monitors Medicaid to suggest states suspend terminating kids to determine what’s going wrong.

In Idaho, for example, around 23,000 children have been removed for failing to return recertification forms, according to the Idaho Capital Sun. Arkansas also has moved aggressively to cut people, including children, from Medicaid.

“The stakes are high,” said a blog post on the Georgetown University’s Health Policy Institute Center for Children and Families. “Gaps in coverage are problems for anyone — but especially for children, who, while not expensive, are regular users (or should be) of health care.”

Children and adults in rural states including Kentucky are especially dependent on Medicaid for health care, the center reported.

Nationwide, seven rural counties have half or more of their adults covered by Medicaid and six of those counties are in Kentucky, it said.

Around 600,000 Kentucky children have health coverage through Medicaid or the Children’s Health Insurance Program, known as CHIP, a Medicaid program for children whose parents earn too much to qualify but are still considered low-income.

That’s more than half the state’s children.

They will be among the last to be recertified under the 12-month process Kentucky began in May, Friedlander said.

‘Health care is expensive’

Meanwhile, state officials, advocacy groups, community clinics and others are working to alert Medicaid patients to the changes through notices, fliers, mail, phone calls, text messages and other means.

State officials set up an exhibit at the Kentucky State Fair to inform the public about changes, with private booths where state workers helped people apply for or renew coverage.

Advocates are especially concerned about those who might unknowingly lose coverage by not receiving or responding to a notice.

“It is important that individuals have insurance coverage because health care is expensive,” Lewis said. “A medical bill for something that’s not covered can be really debilitating.”

It could also affect community clinics that serve a high percentage of Medicaid patients and operate on tight budgets.

“It definitely can affect us from the bottom-line standpoint,” said Kirstie Matzek, CEO of the Shawnee Christian HealthCare Center, a federally authorized community health service in Louisville.

Matzek said her clinic staff has been attending events such as festivals and church picnics to hand out information. Staff also has been notifying patients about the Medicaid changes, she said.

“I know there’s a level of responsibility for the patient,” Matzek said. “But I think we have a responsibility as well.”

We're all tired of the pandemic, but the latest version of the virus is more contagious, so vigilance is needed, health writers say

President Biden and other top Democrats mingle among a largely unmasked crowd at the Congressional Picnic at the White House on Tuesday. (Getty Images photo by Chip Somodevilla)

By Myah Ward and Joanne Kenen
Politico Nightly

We have entered the “See no virus, Hear no virus, Speak no virus” stage of the coronavirus pandemic.

Midway through Year 3, the denial is pervasive. And it’s no longer coming solely from science-denying, Anthony Fauci-detesting Trump voters. It’s all over the place, including college-educated blue-staters who are weary of the pandemic and have convinced themselves that just because they or their family or their brother-in-law’s colleague didn’t get really sick from Covid, no one will get really sick from Covid.

Yet the BA.5 variant, which looks to be the most adept yet at evading vaccine protection and antibodies from prior infections, is spreading voraciously. “The worst version of the virus” to date, is how Scripps Research virus expert Eric Topol summed it up.

Deaths are mercifully steady, usually running about 300 to 350 a day — though right now it’s above 400, and even the lower numbers are well over the average U.S. daily death toll of breast cancer and prostate cancer combined. Hospitalizations are creeping up. Positivity rates are climbing. The CDC says that most U.S. wastewater surveillance sites show moderate to high viral levels, with 40 percent hitting the highest level since Omicron snuck up on us last Thanksgiving.

Some medical experts think we may hit as many as a million new cases a day, though it’s impossible to tell exactly, since so many people now rely on at-home rapid tests, if they test at all.

Yet, in a New York Times poll last week of registered voters, less than 1 percent placed the pandemic as their top priority.

“People are tired of the pandemic,” University of Minnesota epidemiologist Michael Osterholm said. “So the way of dealing with it is: ‘We’re done.’”

That leaves us feeling like skunks at the garden party — that is, if we had enough friends who didn’t have Covid-19 right now to even have a garden party.

“I already had it,” people tell us. (“YOU CAN GET IT AGAIN — MAYBE IN A MONTH. AND IT MIGHT BE EVEN WORSE,” we want to scream.)

“I’m young and healthy,” they declare. (“BUT THE PERSON STANDING NEXT TO YOUR UNMASKED FACE AT THE GROCERY STORY OR ON THE BUS MAY NOT BE.”)

And when we’re being virus-splained by someone with that particular blend of arrogance and ignorance, we’ve been known to casually drop into conversation, “WHAT DO YOU THINK OF THAT VETERANS’ HEALTH DATA SUGGESTING ELEVATED RISK OF HEART ATTACK AND STROKE AND DIABETES FOR A YEAR AFTER COVID?”

Don’t get us wrong. We’re tired of the pandemic too! And we aren’t saying that things aren’t better. Of course they are, in just about every way we can think of. We go more places and do more things than we did a year ago. We worry less about our older or sicker relatives. We are grateful for the drugs that work, for the shots keeping most of us alive — and the new vaccines in development that might reduce these staggering waves of breakthroughs.

But there’s still plenty of virus to see, hear and speak of. To preserve the progress we’ve made, to keep recovering, we need to dial up our vigilance at certain times. Now is one of those times.

Osterholm said BA.5 is causing a lot more “moderate” disease as opposed to sniffles, sore throats and minor illness. More people are sick — in bed, sick — for two to three weeks. “We don’t see that often with influenza,” he said. “Wherever BA.5 pops up, you can expect to see a major increase in moderately ill people who are going to be off of work, not dealing with life and such for days.”

West Virginia public health commissioner Ayne Amjad said health professionals know a surge when they see one — and they are seeing one right now. But in her outreach to West Virginians, she chooses words with care: “They are tired of hearing about ‘surges.’ It just makes them think about lockdowns and mask mandates.” 

She’s trying to help people understand that the virus is here to stay, that it will ebb and flow, and that people can learn to protect themselves when it’s on the rise. She’s still trying to increase her state’s low vaccination rate. She’s keeping an eye on rising hospitalizations that could take the state’s health system to the breaking point all over again. It’s already too close for comfort.

The Biden administration, still juggling its messages of normalcy and vigilance, is watching the BA.5 numbers climb. Health officials are considering recommending a second booster for everyone — not just older people and the immune-compromised. That’s going to require some high-octane messaging to penetrate the virus malaise, given that only one-third of those eligible have gotten their first booster and a third haven’t even gotten the first series of shots. Boosters don’t require people to see or hear the virus — just to roll up their sleeves.

Booster needed to protect against Omicron variant; infection may provide as much immunity, but doctors say a booster is better

If you haven't gotten a booster shot following your "full vaccination" with the Moderna or Pfizer-BioNTech vaccines against Covid-19, you probably are not protected against getting sick from the Omicron variant of the coronavirus, says a study in the New England Journal of Medicine.

The study found that "Two shots of Covid-19 vaccine without an additional booster offer essentially no lasting protection against infection with Omicron, and a coronavirus infection is as effective as a recent booster shot in preventing a new Omicron-fueled illness," reports Corinne Purtill of the Los Angeles Times.

"At the same time, any immunity to the highly contagious variant, either from infection or vaccination, appears to offer significant and lasting protection against serious illness, hospitalization and death, the researchers found. And if you haven’t had either the virus or the vaccine, doctors urged, it’s better to get the jab."

Dr. Jeffrey Klausner, an infectious disease specialist at the University of Southern California, “It’s definitely much, much safer to get vaccinated than to get infected. The vaccine is only presenting a small piece of the virus. The whole virus, if you get infected, is going to spread throughout the body, it’s going to cause different symptoms in different body parts and increase your risk for long Covid or a prolonged duration of illness.”

The study shows that we are going to be able to live with Covid-19, said Laith Jamal Abu-Raddad, an infectious-disease epidemiologist at Weill Cornell Medicine-Qatar and a co-author of the study, which was conducted in the small Middle East nation that has just under 3 million people but expatriates from 150 other countries.

“Covid-19 is going to stay with us essentially forever. It’s not really going to disappear,” Abu-Radded said. “But the question will be: Will we be able to live with it somehow? And the initial results we are getting are actually very encouraging.”

The study found that people without booster shots "had essentially no protection against a mild to moderate case of Covid-19," Purtill writes. "Six months after their last shot, they were just as susceptible to a positive test and disease symptoms as anyone else — but still showed strong resistance to severe illness."

Also, "A prior infection was about 46% effective at preventing a symptomatic infection. Being fully vaccinated and boosted was about 52% effective. And having natural immunity from a prior infection as well as immunity from a vaccine and booster was the most effective of all, reducing Covid-19 risk by 77%." That is much less than the initial 94% to 95% effectiveness of vaccines, but as the virus "accumulates mutations, the vaccines become less effective at recognizing the virus and blocking infections," Purtill explains.

“The immune evasion is so much higher” with Omicron, Abu-Raddad said. It is “essentially a new virus.”

Dr. Robert “Chip” Schooley, an infectious disease specialist at the University of California-San Diego, told Purtill that the Qatari researchers have done “a much better job of understanding the decay of the immune response over time than we have” in the U.S.

“Getting Covid right now — if you’re vaccinated up and you’re reasonably healthy — is more of a nuisance than it is a life-threatening event for most people,” Schooley said. “It’s a very different disease from two years ago, when we had a largely non-immune human population, and a virus that was going at you for the first time. Now we have a virus that many of us have either seen through vaccination, or through infection, or a combination of both. The playing field is much more level.”

Trump promotes coronavirus vaccines and booster shots, still opposes Biden's vaccine-or-testing mandates

Trump at an Aug. 21 rally in Cullman, Ala., where he was booed

after encouraging vaccination for the coronavirus. (Photo by Chip

Somodevilla, Getty Images, via The Wall Street Journal)

Kentucky Health News

Former President Trump is promoting coronavirus vaccines, saying he has received a booster shot, but still opposes vaccine-or-test mandates like those President Biden is still trying to get through the courts.

In two interviews this week, Trump endorsed the vaccines and their booster shots, which experts say are key to thwarting widespread illness and death from the highly contagious Omicron variant of the virus.

"Some in and around Trump’s orbit have long pleaded with him to get behind vaccination pushes, if for no other reason than to remind Americans of the scientific achievements that advanced during his presidency," including rapid development of the vaccines, Rick Klein writes for ABC News.

Trump revealed Sunday, Dec. 19, that he had received a booster shot. At the Dallas stop of a speaking tour with Bill O'Reilly, the former talk-show host said they both “are vaxxed” and asked Trump, “Did you get the booster?”

“Yes,” Trump said. O'Reilly replied,  “I got it too,” Mr. O’Reilly said. Many boos were heard, and Trump waved his arms, saying, “Don’t, don’t, don’t, don’t,” and pointing to what he called “a very tiny group over there.”

Shortly before that exchange, Trump said his supporters should get vaccinated "because, he suggested, unwillingness to do so represented a victory for liberals," The New York Times reports. He said, “You're playing right into their hands.”

In a later interview with conservative commentator Candace Owens on the Daily Wire, Trump said the vaccine development “was one of the greatest achievements; we did it in less than nine months. . . . Some people aren't taking it; the ones that get very sick and go to the hospital are the ones that don't take the vaccine, but it's still their choice. And if you take the vaccine, you're protected.”

"This is good news that Donald Trump is delivering this message to his followers," USA Today Washington Bureau Chief Susan Page said Friday night on PBS's "Washington Week." Polls have shown lower vaccination rates in states and counties Trump carried; he beat Biden by 29 percentage points in Kentucky.

Trump spoke about vaccines after Owens cast doubt on them by saying that fewer people died of Covid-19 last year than this year, when they became available. By far, most Covid-19 deaths have been among the unvaccinated, and ABC notes that the vaccines were not "widely available until early spring 2021, after Biden had already assumed the presidency. . . . Other factors such as the end of masking and social distancing mandates in many local jurisdictions, as well as new variants of the virus, have contributed to Covid-19 deaths in 2021."

ABC adds, "Both Trump and Owens expressed their continued opposition to vaccine and mask mandates, and Trump also claimed that prior infection from Covid-19 protects in a similar way to the vaccine. That claim is disputed by medical experts who say that the protection from the vaccine and a booster shot is stronger than protection from prior infection."

Trump "has previously encouraged his supporters to get vaccinated," notes The Wall Street Journal. He was briefly booed at a rally in Alabama in August after urging attendees to get a Covid-19 shot. “You got to do what you have to do, but I recommend: Take the vaccines,” he said. “I did it. It’s good.” In September, he told the Journal that he probably wouldn't get a booster shot. But that was before the Omicron variant appeared.  

Spencer residents with 'country spirit' cite mistrust of government, side effects, links to abortion as reasons they're not vaccinated

Spencer County stands out in an adapted screenshot of the Dept. for Public Health interactive map.

By Melissa Patrick
Kentucky Health News

TAYLORSVILLE, Ky. – In 21 of Kentucky's 120 counties one-fourth or fewer of residents are fully vaccinated against the coronavirus, and at 16.4%, Spencer County ranks last. In the percentage of residents who have received at least one dose of a vaccine, it ties for last with Christian County, at 20%. 

Spencer stands out on the state's vaccination-rate map; every county close to it has a much higher rate. What makes the county of about 20,000 so different?

Several reasons were clear during interviews in the parking lot of Country Mart in Taylorsville, the county's only town, population 1,300.

They included not wanting the government telling them what to do, concerns about potential long-term effects and side effects of the vaccine, and not wanting to take a vaccine that is connected in any way to abortion. 

Sean Lawson, 55, said, "I will not have baby parts injected into me." A 55-year-old businesswoman who would not give her name said likewise, and was one of several who spoke passionately about not trusting government and disliking its instructions. "I don't know who I can trust," she said.

The resistance to government advice is not surprising in a county that has been Kentucky's fastest-growing in the last 40 years because it offers a rural, lightly regulated lifestyle with easy access to the state's largest city. A 20-year-old man who declined to give his name said he thought the independent "country spirit" of local residents played a role.

Though it's in the Louisville metropolitan area, Spencer County's low vaccination rate is more like those of Kentucky's more isolated rural counties, and the reasons people give for that may be reflective of those places, too.

Doubts, beliefs and facts

The mistaken belief about "baby parts" stems from the use of fetal cell lines in the development and manufacture of the coronavirus vaccines. Experts say the cells are not the same thing as fetal tissue, Healthline reports.

According to Dr. Aleena Banerji, a member of the American College of Allergy, Asthma & Immunology Covid-19 Vaccine Task Force, fetal cells were obtained from elective abortions in the 1970s and 1980s and have been grown as cell lines in laboratories for 30 to 40 years. They are used in vaccine research because viruses need human cells in which to replicate.

Banerji said neither Pfizer nor Moderna used fetal cell lines in development or production of its coronavirus vaccines, "so there are no fetal cells in the vaccine," but did use them to make sure the vaccine worked before beginning clinical trials in humans. She said the Johnson & Johnson one-dose vaccine used a fetal cell line in development and manufacturing.

Lawson said he didn't think people wanted a coronavirus vaccine because the county's case numbers were so low and because people aren't worrying about dying from it, since the survival rate is 98%. He also said he doesn't worry about the virus because he "is protected by God."

Spencer County's rate of new cases over the last seven days is not low, compared to the rest of Kentucky. It is 5.3 per 100,000 people, slightly higher than the statewide rate of 4.5.

Overall, however, the county's rate has been lower than the state's. It has had 1,636 cases, 0.36% of the state's total, and 25 of the state's 7,077 deaths, or 0.35%; the county has 0.45% of the state's population.

While most of the people interviewed did not want to share their name, no one turned down the opportunity to say why they thought the county's vaccine rate was so low and why they are part of that.

Some said they had not gotten vaccinated because they had already had the virus, which gives them natural immunity. (Just how much immunity, and how long its lasts, are unknown.) Others in this group said they were suffering lasting symptoms, even though they began several months ago, and that had made them nervous about getting a shot.

Various reasons

Several said they thought people weren't getting vaccinated because of how fast the vaccines were developed, and because it was too new. 

"It's not old enough for me yet," said a 37-year-old woman who said she had other health conditions to consider. "I'm not against vaccines and I don't think anybody is against vaccines; I just think it is such a new vaccine." 

Pinkston said he has had the virus, and "I have no faith at all in a vaccine developed in six months."

He offered many other reasons, including this: "Biblically, it is just a step away from the mark of the Beast," the Antichrist figure in the New Testament book of Revelation. "When they start talking about how they wanted to identify people somehow once they've had it, with a chip or whatever. . . . It's not there now, but it's a step away."

The vaccines do not contain microchips or other such devices, and Gov. Andy Beshear has said the state will not require proof of vaccination.

One 48-year-old man said he and his family had planned on getting the Johnson & Johnson vaccine, but after it was temporarily halted because one or two in a million recipients, all women of child-bearing age, developed a peculiar type of blood clot, they decided "to give it some more time."

Several people said they had gotten a vaccine and wish everyone else would too. "I tell everybody, get vaccinated as soon as you possibly can because people are still getting infected and people are still dying every single day," said Clarence E Keith Jr., 71.

Spencer County is in the North Central District Health Department, which also includes Shelby, Henry and Trimble counties. In an effort to learn why people in the district are not getting vaccinated, the department is conducting an anonymous six question survey on its Facebook page. Results from the survey will be shared on social media, said Stephanie Lokits, the agency's nursing director. 

Nearly all of those interviewed in Taylorsville said the county's low vaccination rate had nothing to do with a lack of access. 

Spencer County has at least four places to get a free coronavirus vaccine, including the health department, a community health center and two pharmacies.  The health department has also hosted a drive-through clinic and Taylorsville Community Health Center is hosting one on June 12 from 8 a.m. to 3 p.m. The vaccines are free for anyone 12 and older, and no appointment is needed. 

John Shindlebower, longtime editor of The Spencer Magnet, said vaccination has not been a hot issue for his readers. He said that even after the paper published several stories about the county's low vaccination rate, it only got one letter urging people to get vaccinated. 

"We've not heard a lot of opinion one way or the other about the vaccine," he said. 

Nearby Franklin and Woodford counties have the highest rates of fully vaccinated people, with half of their populations fully vaccinated and 60% or more of them with at least one dose of a vaccine.  Statewide, 46.7% of Kentuckians have received at least one shot, 57% of adults have had at least one, and 38.7% are fully vaccinated.

Lokits said the health department keeps trying to find ways to encourage vaccination. Most recently, it did clinics at all the county's public schools. It is also offering on-site vaccine clinics for groups and businesses and have distributed yard signs with fact-based messaging to quell misinformation. 

Anti-misinformation signs are in English and Spanish

"We're continuing to share information on social media about vaccinations, just trying to get the information out there to folks," she said. "You know, there's so many myths out there about the vaccine, and so many things that people really don't understand." 

One of those myths is that the vaccines are not safe. Lokits said it's important for people to know that the health department has given over 13,000 doses of the vaccine and not one person has had a reaction that required hospitalization. 

Lokits said they also give vaccines on Thursdays to anyone who signs up for one, but only about five people show up each week. She said some people may be getting their shots in Jefferson County, since that's where most Spencer County residents work.

Vaccines going unused

Cassandra Yates, charge nurse at the Taylorsville Community Health Center, said it offers the vaccine to all of their patients, but has only given about 70 vaccine doses in the last three weeks and has no one on its waiting list. "People just don't want to get it," she said.

Yates said that when they offer the vaccine, younger patients have been less likely to take it than older ones, and those who refuse usually don't want a flu shot either. 

She said she thinks one reason people refuse is because they don't have a mindset to get preventive vaccinations once they become adults: "They are just not going to do it."  

Yates added that the recent lifting of the state mask mandate, and plans to drop all restrictions June 11, sent a message that the pandemic is over, which makes some people less likely to get a vaccine. 

Alex Shields, a pharmacist at Hometown Pharmacy, said they are giving about 10 shots a week, 515 in all, and have more than 200 doses available. "I think a lot of people in our community have made their mind up to not get it," she said.

The Centers for Disease Control and Prevention vaccination report that ranks Spencer County last for full vaccination only includes people for whom a county of residence is listed. Kentucky has 116,288  vaccinated residents without a county of residence listed. The report says 93% of the state's fully vaccinated residents are accounted for. 

The pace of vaccinations is slowing; in Kentucky, the daily figure is below 10,000 and the last seven days saw 44% fewer shots than the week before.

The New York Times reports that at the current rate of vaccination, it will take Kentucky about two months to get 70% of its adults vaccinated with at least one dose of a vaccine. That's about average among the states, but vaccination rates are lower in states to the south, and health experts worry that more contagious or deadly variants could develop in the region.

Click here for information about what medical and public-health experts say about some of the reason's given for Covid-19 vaccine hesitancy. Click here for the CDC's information regarding myths and facts about the Covid-19 vaccine. Click here for vaccine facts on the health department's Facebook page.

Busting myths and verifying facts about coronavirus vaccines

By Mallory Olson
University of Kentucky

Over the past year, a novel, highly contagious virus has spread across the world. Scientists and researchers have worked quickly to respond with vaccine development, two of which have been approved by the U.S. Food and Drug Administration for emergency use. Others will likely follow.

Vince Venditto in the College of Pharmacy building

As the vaccine rollout continues through priority phases, a University of Kentucky pharmacy professor is helping separate fact from fiction with regard to the safety and efficacy of the vaccines.

Vince Venditto, an assistant professor in the Department of Pharmaceutical Science, has extensive expertise in vaccine design. He was trained in organic synthesis and vaccine development. He is currently working on a clinical trial with community pharmacies to understand the prevalence of the novel coronavirus in Kentucky.

Here are some vaccine beliefs and what Venditto has to say about them:

The vaccine has been rushed, so it cannot be safe. Fiction. While the timeline from the start of the pandemic to the approval of the vaccine has been faster than any other vaccine, the technology has been in development for many years. Messenger RNA, the technology behind Pfizer and Moderna’s vaccines, were touted as a quick and efficient method to produce vaccines at unprecedented speed, and this proved true for SARS-CoV-2, the novel coronavirus. Pfizer and Moderna have been working in this space for many years and it was because of their strong foundation in this technology that they were able to generate a vaccine in less than a year.

There has not been enough testing. Fiction. The Covid-19 vaccines, like all drugs that are approved for human use, undergo significant scrutiny from various independent evaluators to ensure efficacy and safety during the clinical trials, and then by the FDA for approval. After FDA approval, safety and efficacy continue to be monitored for adverse events. Some of the Covid-19 vaccines being tested in clinical trials were halted because of a serious illness in a few people, but the illnesses were not associated with the vaccine. Pausing a clinical trial is a very common event and indicates that the independent safety monitoring boards are ensuring that only safe vaccines are approved for use.

Since approval, there have been a few reports of a rare, but serious, allergic response in a small number of patients, and the safety monitoring boards continue to evaluate these events to ensure the safety of those who receive the vaccine.

There is an advantage to having multiple vaccines, not just one that works. Fact. While one vaccine is a significant achievement, it is critical that multiple vaccines, based on different technologies, are approved for use. There are several reasons. First, the number of doses necessary to immunize the whole U.S. and the entire world is not practical using one vaccine, given the different reagents necessary to produce the vaccines. Approval of multiple effective vaccines will reduce the burden on a single manufacturer to ensure that everyone across the world can have access to a vaccine in a timely manner.

Second, not all vaccines work well in all populations. Historically, there are examples of vaccines that are more effective in specific ethnic populations for reasons that are not well understood. Because of this, multiple vaccines will ensure that everyone has access to an effective vaccine.

We do not know what is in the vaccine. Fiction. We know exactly what is in the vaccine. This varies from vaccine to vaccine, based on the company’s specific design, but the first two approved vaccines from Pfizer and Moderna contain oil droplets with genetic materials to express non-infectious pieces of the virus.

We do not know anything about the side effects. Fiction. Each of the clinical trials are being conducted in more than 30,000 people from around the world, and all subjects are monitored for side effects. Half of the subjects get placebos, and half get the vaccine. In general, they report soreness and swelling at the injection site, as well as fever, chills, tiredness and headache, which go away after a few days. This is exactly what you want to happen because it means your immune system is active and doing its job.

The subjects in the clinical trials continue to be followed for any additional side effects and none have been observed. Everyone who receives the vaccine in the trial or after approval will continue to be monitored for side effects to ensure continued safety in different populations and conditions.

Covid-19 will eventually go away on its own. Fiction. It is unlikely that SARS-CoV-2 will go away on its own. Just like the common cold – which is also a coronavirus – it continues to make kids sick every year, but as we age and continue to be exposed, we generate an immune response that prevents us from getting sick. The vaccine helps to accelerate this process to protect us. However, we are only a year into this pandemic and scientists will continue to monitor how many people are infected each year.

Receiving an mRNA vaccine will not affect your DNA/genetics. Fact. The mRNA vaccine is fantastic technology because it has no way to get into your DNA but can still induce a strong immune response. It does so by generating pieces of the virus for our immune systems to respond to. Once the mRNA is used by our cells, it is destroyed and has no long-term effects on our cells.

The vaccines are just placebos. Fiction. Clinical trials require vaccine groups and placebo groups to show that the vaccine is effective. Once a proper comparison between these groups can be made, all vaccines administered will contain the active ingredients to induce an effective immune response.

There is a chip or marker in the vaccine used to track you. Fiction. This is simply not true.

Being outdoors doesn't mean you're safe from the coronavirus

White House Rose Garden ceremony (Photo: Chip Somodevilla, Getty Images)

By Thomas A. Russo
Professor and Chief, Infectious Disease, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York

If you think you’re safe from the coronavirus just because you’re outdoors, think again.

While the wind and the large volume of air make the outdoors less risky than being indoors, circumstances matter.

Someone who is infectious can cough or sneeze, or just talk and, if you happen to inhale those respiratory droplets or they plop into your eye, you can get infected. If you shake hands with an infected person and then touch your eyes, nose or mouth, you also run a chance of getting infected. You don’t have to be inhaling an infected person’s air for very long. What matters is the dose.

As an infectious disease doctor, I get a lot of questions from patients about COVID-19 risks. Here are some answers about the risks outdoors.

Doesn’t wind make outside safer than inside? It’s true that the wind helps disperse respiratory droplets that can carry viruses. When you’re indoors, one of the big concerns about how the coronavirus spreads is aerosols – tiny, light droplets people emit along with larger droplets when they breathe. These particles can linger in the air, and the concentration can build up in enclosed, poorly ventilated spaces.

There’s less of a risk in open outdoor settings because of the sheer volume of air and available space to physically distance. At least one study, not yet peer reviewed, found covid-19 patients were nearly 20 times more likely to have been infected indoors than outdoors.

But that doesn’t mean you’re in a protective bubble when outdoors.

What behaviors could put you at risk outside? To get a sense of how easy it is to put yourself at risk outdoors, look at crowd photos from the White House Rose Garden event on Sept. 26. About 200 people attended that ceremony, and at least 12 tested positive for the virus within days, including President Donald Trump and two senators.

When and where each person was infected isn’t known, but several behaviors at the Rose Garden ceremony raised the risk of getting or sharing the virus.

The first problem with this scene: Very few people were wearing face masks. With no mask, infectious people can be shedding the virus when they talk and there is nothing to stop the respiratory droplets. For people not yet infected, no mask means the virus has several ways to enter their bodies – nose and mouth as well as eyes.

The lack of masks also raises the risk of getting a larger dose, and a higher viral load may mean a higher likelihood of severe disease.

People were also seated close together. And before and after the ceremony, they mingled – indoors and outdoors – shaking hands, leaning in for close conversations and hugging each other.

Remember that just breathing expels respiratory droplets, and loud, animated speech like laughing or shouting expels more. We don’t yet know how much virus is needed to trigger symptoms, but those doses add up. So, you might get a small dose from a person sitting next to you, but if that person later gives you a big hug or shakes your hand, they could give you another dose. Or you might talk to someone else who is infectious for several minutes and inhale more virus particles.

All it takes is one person in the peak infectious period – the 24 to 48 hours before and after symptoms start – to spark a superspreader event.

When do I have to wear a mask outdoors? Face masks lower your risk of getting infected, and they also reduce the amount of virus you’re spreading if you’re infected.

If you’re running or walking, carry a mask with you. When you’re near other people, put it on. If you’re sitting at an outdoor café, try to mask up between bites and sips, especially if your age or health or weight make you vulnerable to severe covid-19.

The likelihood of a passing interaction from someone walking by a table is small, but it’s still possible. The safest spot when eating outdoors is a table away from high-traffic areas and upwind of everyone else.

Is six feet of social distancing enough? Depending on where you are, maximize the distance between yourself and others. There’s nothing magic about staying six feet apart. Particles generated by sneezes can travel a lot farther than that.

Twelve or 15 feet is safer. It’s all about minimizing risk. You can never drive that risk to zero when you’re in public.

Can I still have people over for an outside party? Think of the coronavirus like a sexually transmitted disease – everyone claims to behave safely, but do you really know where they’ve been? It just takes one infected person. Rapid covid-19 tests aren’t 100% accurate, either, and are presently unavailable for most people.

To keep things safe for an outdoor gathering, set up tables for each social bubble – a family, for example. Keep the tables at least 15 to 20 feet apart. Set up food on individual plates in a central location and have people or each bubble go up separately. Don’t share utensils or food or glasses. Wear masks as much as possible, and don’t forget physical distancing.

There is a lot we still don’t know about the coronavirus, including what the long-term damage is. Regardless of how old you are or how healthy, do what you can to avoid the virus until there’s a vaccine. Even if you get over the illness quickly, we don’t know what the long-term consequences will be.

This article is from The Conversation, a site for journalism by academics.

906 new coronavirus cases make for state's third highest day, pushing total above 50,000; 10 more deaths bring toll to 976

Kentucky Health News chart, based on initial daily reports, which are adjusted slightly downward

By Mary Meehan
Kentucky Health News

As Kentucky saw more than 900 new coronavirus cases Thursday and double-digit death tolls for the fourth straight day, state officials cautioned that a vaccine is unlikely until 2021 and said advances in testing are less dramatic than they may appear.

Gov. Andy Beshear announced 906 new cases and 10 additional deaths during his daily briefing, bringing the death toll since Monday to 46.

The new-case number was the third highest of the pandemic. “Nine hundred and six cases used to be unfathomable here in Kentucky,” Beshear said. The seven-day rolling average jumped to 713, the highest yet.

In one bit of good news, the share of Kentuckians testing positive in the last seven days dropped to 4.53%, from 4.7% Wednesday.

Thursday saw the state pass a grim milestone, passing 50,000 cases; there have been 50,885. That means about 2.5% of the state's population has been identified as infected. The death toll is approaching 1,000; it stands at 976.

The high numbers come as the Centers for Disease Control and Prevention is asking states to be ready to distribute vaccine as early as Nov. 1. Beshear said there will be no vaccine until 2021.

“We’re going to make sure that we do the work to distribute the vaccine as soon as it is safe,” he said, but “We still don't see any path for there to be a vaccine that's gone through steps that it needs to before the beginning of the year.”

Health Commissioner Steven Stack echoed the message.

“I'll say it again, there will not be a vaccine for virtually everybody this calendar year,” said Stack, a physician. “I know that there's a press to make these timelines suggest we're going to have vaccine going out the door to people in October and November.” The presidential election is Nov. 3.

“There are some corners that cannot be cut,” Stack said. “You have to ensure that you are not going to take a healthy person and hurt them.”

Stack also cautioned that while progress is being made, there are few affordable rapid-response tests that are accurate and easy to process.

The Food and Drug Administration last week approved a 15-minute test from Abbott Laboratories in the form of a chip card that will sell for $5. The FDA also recently approved a saliva test from Yale University.

“Both tests have limitations, and neither can be done at home,” The Washington Post reported. “Abbott’s new test still requires a nasal swab by a health worker, like most older coronavirus tests. The Yale saliva test eliminates the need for a swab but can only be run at high-grade laboratories.”

Stack said that with the saliva test, getting enough spit in the tube is a challenge. Also, the tube has to be shipped to a lab, and because saliva is sticky, each test must be processed manually or machines will malfunction. “They still have to run it in a high-complexity lab,” he said. “So, it's not a $5 or $15 test; someone in the laboratory with expensive machines still has to run the test.”

Stack said he understands why people are eager for rapid, widely available testing, but accurate, affordable testing, just like vaccines, will take time. “None of this is intended to discourage us from finding innovative ways to try to manage the disease and get us back to work faster and keep people safe,” he said.

As they have all week, Stack and Beshear said the record-setting levels of new cases mean that this Labor Day weekend is no time to abandon the steps that curb the spread of disease. Beshear stressed the need to keep gatherings under 10 people and practice social distancing especially with the rescheduled running of the Kentucky Derby on Saturday and The Kentucky Oaks on Friday. 

 “Do everything a little different this year,” he said. “Do it safely.”

In other covid-19 news Thursday:

• Counties with more than 10 new cases were: Jefferson, 192; Warren, 89; Fayette, 68; Madison, 66;  Daviess, 25; Green, 21; Henderson and Kenton, 20 each; Pulaski, 19; Union, 18; Franklin, 17; Hardin, 16; Jackson and Logan, 15 each; McCracken and Oldham, 12 each; Bell, Calloway, Campbell and Scott, 11 each; and Barren, 10.
• The 10 fatalities were a 52-year-old man from Barren County; five women, 60, 72, 72, 79 and 85, and two men, 70 and 73, from Jefferson County; and an 88-year-old woman and 76-year-old man from Lewis County.
• Of the 906 newly infected Kentuckians, 124 were under 18. There were 67 new cases of students and 22 new staff in K-12 schools. There are 273 active student cases and 102 active staff cases in K-12. 
• Colleges and universities added 69 students and two staff members, resulting in 675 active student cases and 23 active employee cases. Beshear urged people to check the state’s covid-19 website for updates at schools or universities in their communities. He also said the state is working to improve how quickly individual cases are reported. 
• Covid-19 hospitalizations in Kentucky totaled 568, with 132 of them in intensive care.
• Long-term-care facilities had 28 new resident and 26 new staff cases, and five more deaths. There are 582 active cases among long-term residents and 379 active cases in staff.
• WKYT reports that Thursday morning, Fayette County School Supt. Manny Caulk and other school officials participated in the Lexington Forum to address concerns over virtual learning. Caulk said the situation was less than ideal. “We have to do something that is less than ideal in order to maintain the safety, the health, safety, and welfare of our children,” he said. “We have to pivot based on the scientific data and evidence that’s before us, based on what’s the community spread right here in Fayette County.” He concluded with this: “I would say this, I would rather have a loss of learning than the loss of life.”
• The Lexington Herald-Leader reports that as one Northern Kentucky school district decided against fall sports, others around the state are developing limits on fan attendance with games set to begin Monday. Erlanger/Elsmere Supt. Chad Molley announced in a letter dated Tuesday that his district would not participate in high-contact fall sports until it could do so safely. That district’s high school is Lloyd Memorial.
• Herald-Leader reporters Valarie Honeycutt Spears and Jared Peck explain that in Fayette County, information on who can come to games next week has trickled out to some of its athletic teams, but the district’s full policies have not been released. Communications to soccer parents at Bryan Station, Paul Laurence Dunbar and Tates Creek high schools indicate Fayette County will limit players to four or five family members each, and attendees must be submitted for an entry list this week and remain the same throughout the season. The communications indicate those fans will be the only ones allowed at games.
• Other districts, including Scott County, are also placing limits on football attendance. The Kentucky High School Athletic Association’s draft guidance for covid-19 issues did not mandate limits. Beshear said plans for football had been approved for University of Louisville and several other Kentucky universities. He said capacity, across the board, will be limited to about 20 percent of a stadium’s capacity and family groups would have distance from one another.

Reopenings may not fit guidelines, but Beshear says plateau and other states' trends forecast a decline in May; public data limited

State's "epidemic curve" notes, and Kentucky Health News arrow emphasizes, that coronavirus cases with first symptoms in the last two weeks may not appear. The later the date, the more that is likely.

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 and Al Cross
Kentucky Health News

Kentucky's coronavirus cases remain at a plateau, and Gov. Andy Beshear said they may not show the two-week decline that federal guidelines say should precede reopening of some businesses -- which he has scheduled to start in less than two weeks, on May 11.

Beshear's first benchmark for reopening is "14 days where cases are decreasing," but he has said that doesn't mean a decline each day. His benchmarks follow the federal guidelines, which call for "Downward trajectory of documented cases within a 14-day period" or "Downward trajectory of positive tests as a percent of total tests within a 14-day period." He gives new case numbers daily -- there were 174 yesterday -- but not the positive-test percentage.

Asked at his daily briefing Thursday if the state would see "a two-week decline" by May 11, he said, "The answer is maybe. We believe that we've been holding steady on overall numbers despite there being more testing, and that is with us now testing more people in populations such as long-term care facilities," where cases are more prevalent.

"What I believe is that by doing a very gradual and phased re-opening with strict guidelines, that we can do it safely at a time that we know where the contagion isn't increasing, that we are not on the increase," he said. "And I believe that we will see that we are on the decrease in May."

Beshear has generally scheduled reopenings for several days in May, while reserving the right to change the schedule. He indicated that his decisions are based in part on watching trends in other states.

"We have now been plateaued for about three weeks, and if we are running a couple of weeks behind other places, I think that they are seeing their numbers changing, changing gradually," he said. "Again, we wouldn't be doing it if we didn't think it was safe -- and everything is dependent on the virus."

The only time-related graph the state has on its kycovid19.ky.gov website is an epidemic curve, showing the first onset of symptoms among people who have tested positive for the virus, and it notes, "Illnesses that began within the last two weeks may not be reported," because of delays in reporting by laboratories.

The graph shows a peak of 177 cases on April 16, followed by 85, 59, 95 and 69 cases April 17-21. After that, the numbers are quite low; the virus has an incubation period as long as two weeks, so the more recent the daily number, the more likely it is to change.

Apparently referring to case numbers, Beshear said, “For about the past three weeks, we’ve been in generally the same area. That is good news when we look at something that would otherwise spread more quickly.”

But to limit the spread as normal activities resume, he said every business that plans to reopen must open in phases, allow for social distancing, make daily onsite temperature checks, enforce mask wearing, provide access to personal protection equipment, and make special accommodations for those who need it.

"These are things that allow us to start re-opening our economy, even in a time where we are facing a worldwide pandemic," he said. "These are things that keep us healthy. Let's buy into them, let's not push back on them, let's say that this is what it takes to make sure we can go back to work and not cause a spike in this virus, and that's what we ought to want to do."

He reiterated that day-care centers could not re-open and showed graphics of how doing so would greatly increase the numbers of contacts each person would have if they were allowed to, which he said greatly increases the risk of spreading the virus. Here are the graphics, in succession, also showing workplace interactions (click on them to enlarge):

Health Commissioner Steven Stack said it will not be possible to open public swimming pools in the early part of summer, and beyond that, it's too early to say. Beshear added that this includes any communal pools, such as those in apartment complexes.

"There is just almost no way you can put together a whole bunch of kids and people at a public pool and not have folks socializing and violating the social distancing rules of greater than six feet," he said.

The state's quarterly budget report shows that due to the economic impact of the pandemic, Kentucky is facing a budget shortfall of upwards of $319 million to $496 million, and a Road Fund shortfall of up to $195 million, for the fiscal year that ends June 30. Beshear said all governors have urged Congress to provide relief to both states and local governments, and he discussed "some of the numbers" Thursday with Senate Majority Leader Mitch McConnell, who first rejected "revenue replacement" for states but now seems to have opened the door to it.

Beshear said, "He said he understood, and that there were more discussions going on in Washington D.C., but he heard me out."

In other covid-19 news Thursday:

• The 174 new cases brought the state's total to 4,708. Beshear said there had been five more deaths, for a total of 240. They were of a 77-year-old man from Bath County, a 93-year-old woman from Daviess County, a 71-year-old woman from Jefferson County and a 97-year-old woman and a 66-year-old man from Grayson County.
• The counties with the highest number of new cases are Jefferson, with 27; Kenton, with 27; Warren, with 19; and Boone, with 13. 
• Two deaths were reported in the state's nursing homes, bringing that total up to 121 resident deaths and one staff death. Deaths in long-term-care facilities now account for 51 percent of the state's total. In all, 727 residents and 307 staffers in nursing homes have tested positive for the virus in 74 facilities. Click here for a list of the affected facilities with the number of residents and staffers affected in each of them.
• Rosedale Green nursing home in Covington is a covid-19 hotspot. Julia Fair of the Cincinnati Enquirer reports in detail on what health departments and St. Elizabeth Healthcare are doing to reduce coronavirus infections, including a plan to separate residents based on exposure and symptoms, increased testing, additional clinical supports, more personal protective equipment and doing a deep clean. As of Wednesday, the facility had reported 54 residents and 22 staff who had tested positive, and 14 resident deaths. 
• Beshear said everyone in the Green River Correctional Complex in Central City would be tested by Friday. The Lexington Herald-Leader reports that there have been 64 confirmed cases of the virus in the facility and two people have died from it, according to the Muhlenberg County Health Department.
• Josh Benton, deputy secretary of the Cabinet for Education and Workforce Development, said e-mails will be sent today or tomorrow to 9,000 Kentuckians who need to submit identity documents to get their unemployment benefits. He said some of the nearly 28,000 March claims that have not been processed yet have to do with employer-separation issues. 
• Beshear urged people to sign up for open slots at testing sites, and added one to the list: Jessamine County, next Tuesday through Friday. Click here for a list of all of the state's drive-through testing sites.
• The Kentucky National Guard will do a statewide flyover on Friday to honor health-care workers and essential personnel, part of a nationwide event called Operation American Resolve. It will touch Frankfort, Lexington, Pikeville, Bowling Green, Owensboro and Louisville. The Courier Journal has the schedule.
• Stack announced that Kentucky's hospitals will now use the Battelle Critical Care Decontamination System that uses "vapor phase hydrogen peroxide" to decominate N95 respirator asks for up to 20 reuses without degrading filter performance.
• Norton Healthcare specialists are researching experimental therapies to treat patients with covid-19, including medications to kill the virus or prevent it from growing; to help stop the body's immune response that results in increased damage to otherwise healthy organs; and to improve immunity; and research that looks at the benefits of "convalescent plasma" in treating covid-19 patients, according to a hospital news release.
• The release says 21 critically ill Norton patients have received convalescent plasma, which comes from a fully recovered covid-19 patient, and researchers say they are seeing "very encouraging results," with six patients having recovered and gone home. Click here to learn more about how to donate blood plasma.
• As part of a pilot program, Beshear announced that the more than 600,000 Kentuckians who participate in the Supplemental Nutrition Assistance Program, formerly called food stamps, will now be able to use their benefit cards online via Amazon and Walmart. 
• Big cities and major urban areas have seen the greatest number of coronavirus deaths, but a new Kaiser Family Foundation analysis finds the growth rate is now higher in rural areas. The report includes an interactive map that shows the per-capita number of coronavirus cases and deaths across metropolitan and non-metro counties. 
• The KFF analysis found that in the two-weeks ending April 27, non-metro counties saw a 125% increase in coronavirus cases (from 51 to 115 per 100,000 people) and a 169% increase in deaths (from 1.6 to 4.4 deaths per 100,000). Metro counties saw a 68% increase in cases (from 195 to 328 per 100,000) and a 113% increase in deaths (from 8 to 17 deaths per 100,000). 
• The Medicaid and CHIP Payment and Access Commission, a non-partisan group that analyzes policy and data makes recommendations, again told Health and Human Services Secretary Alex Azar that funds from the Coronavirus Aid Relief and Economic Security (CARES) Act are not providing sufficient help to health-care providers who serve Medicaid beneficiaries, and thus could do permanent damage to the nation's health-care safety net. Click here to see the letter. 
• Housing authorities in more than 100 Kentucky towns will get about $12.6 million from the CARES Act, says a news release from Senate Majority Leader Mitch McConnell, which lists the recipients and says the money "will be used to support prevention and preparation services for their residents, for responding to the coronavirus pandemic in public housing, and supporting the health and safety of assisted individuals and families." 
• A long list of African American faith and civil-rights leaders in Kentucky joined a statement issued by such leaders around the nation "encouraging communities to stay at home in states where stay at home orders are being lifted until there is evidence that it is safe." African Americans have been disproportionately affected by covid-19; their death rate from it in Kentucky is about double their share of population in the state. 
• The Kentucky Distillers’ Association and the Kentucky Chamber of Commerce are partnering to help business make sure they have enough hand sanitizer needed to protect Kentuckians as businesses, a chamber news release says. Click here if you are a Kentucky business in need of hand sanitizer, to find out where to get it.

• A Versailles-area winery is "putting the words of the man who told them to partially shut down to good use," John McGary reports for The Woodford Sun. Wildside Winery's first varietal is named Six Feet Petite, and bears Beshear’s familiar admonition “Y’all can’t be doing that” under an illustration of male and female silhouettes separated by a two-way arrow. Co-owner Elisha Holt told McGary that most buyers get two bottles, one to save for conversation pieces in the future. The wine "came out of the barrel last week, and Monday Holt said they’d already sold a third of it," McGary writes.
• The University of Kentucky's Chinese partners have donated 15,000 pieces of personal protective equipment to the university, says a UK news release.

Trump says he has power, political if not actual, to 'open up the states'; but Beshear says, 'In this state, the buck stops with me'

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.

By Melissa Patrick and Al Cross
Kentucky Health News

President Trump, eager to restart the economy amid the covid-19 pandemic, said yesterday that it will be his decision, not governors', to "open up the states" by relaxing safeguards against the coronavirus. Gov. Andy Beshear sees it somewhat differently.

Asked at his daily briefing how much sway Trump would have on his decisions, Beshear said, "I think we're all anxious to move past this, and I think we all want to give voice to that at different times. I can understand that. I do think that the president, when looking at the data, looking at how important social distancing is, when looking at what is happening in Japan right now and [how] we may see a resurgence of this in China, will ultimately determine that May 1st is probably not a realistic date." That is the date the current federal recommendations will expire.

Noting that Trump "was aiming for Easter," but changed his mind "when the data was different," Beshear said, "It could be that his motivation is to keep us all very interested and engaged, wanting to know that there is a light at the end of the tunnel; I can't quite speak to that. But I have confidence in, whether it is working with the different groups that we do, that ultimately where we are in the data at that point will guide his recommendations."

Beshear added, "Now, I don't know about the authority question that they asked; they've issued recommendations, we've issued orders, and our orders are a state deal; and I will want to collaborate with the federal government as much as possible, but at the end of the day in this state, the buck stops with me, and I'm going to protect our people."

Trump, at his daily briefing that started later and ran longer than Beshear's, said “If some states refuse to open, I’d like to see that person run for election.” Beshear, a Democrat who can seek re-election in 2023, has said that he is acting without regard to political consequences.

Trump, a Republican who is running for re-election, said on Twitter Monday morning: “For the purpose of creating conflict and confusion, some in the Fake News Media are saying that it is the Governors decision to open up the states, not that of the President of the United States & the Federal Government. Let it be fully understood that this is incorrect. It is the decision of the President, and for many good reasons. With that being said, the Administration and I are working closely with the Governors, and this will continue. A decision by me, in conjunction with the Governors and input from others, will be made shortly!”

State Senate Majority Floor Leader Damon Thayer said Monday night that Beshear has done a good job with the crisis, but Kentuckians are getting impatient and “I think they want him to multi-task a little bit” and talk about “gradual re-engagement.”

Specifically, Thayer said he wishes Beshear would lift the ban he placed on elective surgeries, because Kentucky hospitals are losing $20 million a day. "We’re not maxing out the need for beds, and we need a return to normalcy right away," Thayer said, adding later, "Their main cash flow comes from these elective procedures."

In other covid-19 news Monday:

• Kentucky has 87 new coronavirus cases, making a corrected total of 2,048. Of those, at least 673 have been hospitalized and at least 299 are currently hospitalized, with 136 in the intensive care. He said at least 629 of the 2,048 have recovered. (Many have no symptoms but have to self-quarantine for 14 days after testing positive.) 
• Kentucky reported seven new deaths today, for a total of 104. Beshear again encouraged people to light up their homes green to let the families know they are not alone, and announced an extra step: "Now that we've lost 100 people here in the commonwealth, starting tomorrow morning we are going to fly our flags at the Capitol at half mast," for the next week.
• The deaths were a 70-year-old man from Laurel County; an 81-year-old woman from Muhlenberg County; an 81-year-old-man from Jefferson County; and women 67, 70, 81 and 84 from Jefferson. 
• Beshear said there had been five more deaths in long-term-care facilities, raising the toll to 30.  
• As Kentucky heads toward the peak of hospitalizations and deaths, Beshear reminded Kentuckians that it's even more important than ever to keep your hands washed. 
• Asked about churches violating his order against mass gatherings, Beshear said they have not been singled out, and noted that 18 businesses had been cited for violation of closure orders. He said that while news media have focused on the few violators, it is more important to recognize that most have chosen not to gather. "That means that we have been able and committed to doing the right thing at a level that I have never seen before." He ended his response by saying, "I'm not going to give any more oxygen to those that aren't doing it right. I'm going to celebrate all of those that are."
• Showing a graph from a Kaiser Family Foundation site that compares states' coronavirus cases and covid-19 deaths, with Kentucky ranking low, Beshear said, "Kentucky, you are flattening the curve. What that means is you are reducing the number of cases we have right now. You are making sure we have the health-care capacity to care for the people that need it; you are saving lives." He acknowledged that the graph does not account for the amount of testing done in each state. 
• Kroger tested 97 people in its first day of drive-through testing in Frankfort, with the hopes of eventually testing up to 20,000 people with symptoms in multiple locations across the state. Beshear said testing would start in Kenton County on Wednesday. To make an appointment, go to thelittleclinic.com/drivethru-testing or call 888-852-256 and select option 1, then option 3 to see if you qualify. Beshear said testing has been opened up to all people with symptoms in contiguous counties. 
• Beshear said getting personal protective equipment continues to be a challenge, but many across the state have provided significant donations of masks and gloves. Major donors he named included Ford Motor Co., 50,000 surgical masks, Old Kentucky Chocolates, 25,000 pairs of gloves, GE Appliances, 100,000 surgical masks and 100,000 pairs of gloves; and Toyota and UPS, which each gave 10,000 N95 masks. 
• Beshear said he hoped the legislators returning to Frankfort on Tuesday will do only what they need to do, and do it as quickly as possible, so that they don't spread or contract the virus.
• Eleanor Klibanoff of the Kentucky Center for Investigative Reporting reports in detail about the state's crisis standards of care plan, which was sent to hospitals on March 30 with a letter from state Health Commissioner Steven Stack. "The 54-page plan lays out how hospitals respond to 'ethical challenges as a result of scarce critical resources,' in an effort to minimize illness, death and adverse effects on social order and economic stability," Klibanoff reports. The American Association of People with Disabilities has asked the state to issue guidance to all hospitals reminding them of the federal law banning discrimination against people with disabilities.
• The United States now has the world's deadliest outbreak, with a death toll surpassing Italy's. As of 8 a.m ET Monday, the unofficial number of U.S. cases was at 557,590, with 22,109 deaths, reports Medpage Today.
• The World Health Organization says covid-19 immunity is still an unknown and that the virus is "10 times deadlier" than the 2009 influenza, NPR reports.
• The Washington Post reports that at least 41 grocery workers have died of covid-19 and thousands more have tested positive. “Grocery workers are risking their safety, often for poverty-level wages, so the rest of us can shelter in place,” said John Logan, director of labor and employment studies at San Francisco State University. “The only way the rest of us are able to stay home is because they’re willing to go to work.”
• The Post also reports, "Education leaders across the country have concluded that millions of children’s learning will be severely stunted, and are planning unprecedented steps to help them catch up." The Lexington Herald-Leader reports on how some school districts are adjusting.
• Alex Acquisto of the Lexington Herald-Leader reports on the challenges people with addictions face in seeking treatment. “Coronavirus is scary for all of us, but people with substance use disorders are really vulnerable,” Dr. Amanda Fallin-Bennett, co-founder of the Lexington recovery support center Voices for Hope, said. “Recovery support services rely on connection," especially during the outbreak.
• The Louisville Courier-Journal tells the stories of some who have died of covid-19.
• Two Democratic members of Congress have requested details about the sensitivity and specificity data the U.S. Food and Drug Administration has received from makers of coronavirus tests, how the FDA is handling that data and which labs are meeting regulatory guidelines, Modern Healthcare reports."While it is imperative that testing becomes widespread, FDA needs to do its part to ensure people are getting accurate results, as well as address any mistakes that have been made to date," said Rep. Rosa DeLauro, D-Conn.
• Kentuckians with diabetes still need care and education amid the pandemic, and UK HealthCare's Barnstable Brown Diabetes Center is working to meet those needs through TeleCare, says a UKNow news release. Diabetes diagnoses have sharply declined during the pandmeic, and more type 1 patients are going into diabetic ketoacidosis, which can be deadly, because they are avoiding hospitals, the center says.
• Tom Frieden, director of the Centers for Disease Control and Prevention under President Obama, notes that the last CDC public briefing was March 9 and says the U.S. is "less safe" from the coronavirus because the agency is not communicating regularly with the public, Stat reports. Frieden, president and CEO of the cardiovascular advocacy group Resolve to Save Lives, calls for a four-step approach to end the national lockdown: widespread diagnostic testing to detect the virus; the ability to safely isolate all infected people; the ability to find all people who have been exposed, and quarantining them.
• The latest Kaiser Family Foundation poll, March 25-30, found that 72 percent of Americans say their lives have been disrupted "a lot" or "some" by the outbreak, up 32% from the last poll, taken two weeks earlier. It also found that partisan differences on the question have largely been erased and three-fourths of those polled said "the worst is yet to come."
• The Medicaid and CHIP Payment and Access Commission urged the Center for Medicare and Medicaid Services to prioritize safety-net providers in distributing the remaining $70 billion for health-care providers from the $2.1 trillion CARES Act. The first $30 billion was distributed based on Medicare reimbursements, not covid-19 burdens. That "one-size-fits-all approach" has created a furor, Kaiser Health News reports.