Harvard study finds toxin in Juul pods that is known to cause long-term lung damage; highest in flavors not nixed by new FDA ban

By Melissa Patrick
Kentucky Health News

A study at Harvard University found that electronic cigarette products made by Juul Labs had a microbial toxin that can cause long-term lung damage.

CNN image

The researchers from Harvard T.H. Chan School of Public Health found that 46 percent of the 54 Juul pods they analyzed contained detectable levels of glucan, a component of fungal cell walls.

"Chronic exposure to glucan can cause inflammation in the airway and lead to long-term lung damage," David Christiani, a co-author of the study, said in a news release.

The study, published online in the American Journal of Respiratory and Critical Care Medicine, found that pods with menthol and tobacco flavors had the highest levels of glucan: 1,353 and 307 times higher, respectively, than in the company's other flavored products.

Those are the two flavors exempted from the U.S. Food and Drug Administration 's ban on the sale of flavored e-cigarettes.

The ban is for cartridge-based systems, like pods produced by Juul, the leading manufacturer. It does not include flavors in tank systems sold in vape shops. Juul, which leads the e-cigarette market, had already stopped selling its fruit-flavored products, including mint, prior to the ban. It continues to sell products with tobacco and menthol flavors.

The Harvard study follows another study at the school, published in April, that found bacterial and fungal toxins in many popular e-cigarette products. That study was conducted on 37 cartridges and 38 e-liquid products with the highest nicotine content from the 10 top-selling U.S. brands in 2013, which before Juul joined the market in 2015.

The April study found that 17 of the 75 e-cigarette products, or 23%, were contaminated with endotoxin, a microbial agent and a component of the exterior cell wall of certain types of bacteria. It also found that 61, or 81% of the 75 products, were contaminated with glucan. Like the latest study, glucan concentrations were higher in the tobacco- and menthol-flavored e-cigarettes.

Christiani, co-author of the latest study, said the glucan found in Juul pods is not related to the current vaping-related illness in the U.S., which the Centers for Disease Control and Prevention reports has hospitalized over 2,500 patients and killed 55 as of Dec. 27.

In Kentucky, 43 cases are under investigation, with six of them confirmed and 12 of them probable. In 10 of the suspected cases, e-cigarettes have been ruled out as a cause.

The CDC says vitamin E acetate, an additive in some e-cigarette products with THC (the psychoactive ingredient in marijuana), is closely associated with  the vaping-related illness, which is called EVALI, for "E-cigarette or Vaping product use Associated Lung Injury."

Christiani said he’s not sure why Juul’s tobacco- and menthol-flavored pods have such high levels of glucan. He said it could be related to the raw materials used in the products or could be occurring during the production process.

Abby Haglage reports for Yahoo Lifestyle that most of the research so far on the health effects of glucan comes from working environments, and adds that traditional cigarettes have also been shown to contain glucan, "likely at far higher levels than e-cigarettes," she writes.

Greg Conley, president of the American Vaping Association, took issue with the report.

"Microbial contamination is a reality with everything in life, including e-liquids and traditional tobacco products,” Conley told Haglage. “These authors have identified no actual risk, just that some microorganisms were detected, and they are promoting their findings knowing that many will falsely interpret the paper to mean that vaping could be equally or more hazardous than smoking cigarettes.”

The study said its main limitation was that it did not evaluate contamination of aerosols inhaled by users. It called for further research to be conducted with larger representative samples of products. (Despite the term "vaping," many devices do not produce a vapor, which has liquid particles suspended in the air. They produce an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.)

Lexington launches free app for youth to educate them about opioids; promoters hope to roll it out across state this year

Image from the FEND website

By Melissa Patrick
Kentucky Health News

Lexington is offering a new app called FEND, for "Full Energy, No Drugs," to aid in the education and prevention of opioids among Fayette County's 75,000 youth.

Mayor Linda Gorton announced Jan. 6 that the app will be offered through a partnership between the city and Preventum Initiative.  It is funded by private donations, grants and corporate sponsorships.

“Teaching young people about the dangers of addiction, opioids, and prescription drugs better equips them to handle situations, helps arm them with useful tools, and we hope, deters them from the use of illicit or non-prescribed drugs," Gorton said at a news conference.

Dr. Jacquii Burgess, executive director of Preventum Initiative, said FEND gives young people the facts about opioids, prescription drugs, and addiction so they can make informed choices about their health.

“Understanding what an opioid is, why they’re so addictive, and how to recognize and respond to an opioid overdose can potentially save a life,” Burgess said in the news release. 

The app, which is offered for free in Apple and Google Play stores, will reward Fayette County youth for using the app. A news release says the campaign for the app includes a competition between Lexington high schools and will reward youth who use it with gift vouchers, streetwear, concert tickets, athletic events and other rewards.

Burgess told Kentucky Health News that the app can be accessed and opened by all teens across the state, but only those in Fayette County will be able to redeem the localized rewards.

"We are currently working with our partners in the state of Kentucky and hope to roll out the full version of FEND statewide in the coming year," she said in an e-mail.

New AG vows to fight child abuse (Ky. ranks No. 1 in it); child-advocate groups want changes in state laws to protect children

Kentucky's new attorney general called a press conference to declare his office's commitment to partner with child-advocacy organizations and state and federal prosecutors to prevent child abuse, and to prosecute abusers to the fullest extent of the law.

Atty. Gen. Daniel Cameron spoke at a press conference
about child abuse. (Louisville Courier Journal photo) 

"We are No. 1 in child abuse and neglect, and that has to stop, especially as we move into the new decade," Attorney General Daniel Cameron said at a press conference with Kentucky Youth Advocates in Louisville Jan. 7.

Kentucky has ranked first or second for each of the past six years for child maltreatment and has ranked among the 10 worst states for more than a decade, Deborah Yetter reports for the Louisville Courier Journal.

Yetter reported in August, in a story titled "Tortured and Abused: Why Kentucky can't stop hurting -- and killing -- its children," that federal statistics show Kentucky has the nation's highest rate of child abuse or neglect, with some cases so severe an independent panel has classified them as "torture."

In September, Yetter reported that the number of Kentucky children killed or nearly killed from abuse or neglect is likely even higher than what the state reports to the federal organization that compiles the data. "In some cases, Kentucky social service officials decline to classify the deaths as caused by abuse or neglect, therefore keeping the numbers lower," she wrote.

In 2017, Kentucky reported 16 deaths and 56 near-deaths of children from abuse or neglect. In 2018, 24,066 Kentucky children were victims of abuse or neglect, KYA said in a news release.

Substance abuse and addiction occur in as many as 70 percent of the cases investigated by the Cabinet for Health and Family Services, Yetter reports.

Keith Inman, president of Kosair Charities, asked for the public's help in identifying, reporting and helping prevent child abuse. Six years ago, Kosair founded the Face It Movement to end child abuse in Kentucky, which now includes more than 100 groups, Yetter reports.

Cameron said his office will develop a prosecutor's manual to help commonwealth's and county attorneys statewide better prosecute adults for abuse and neglect of children.

KYA Executive Director Terry Brooks said Face It will seek several changes in state law, including removing the clergy-penitent exemption for child abuse so clergy can report it to the authorities; clarifying rules around mandatory reporting of child abuse, to keep an agency from investigating itself; and tightening the rules for home schooling so that parents suspected of abusing or neglecting children can't remove them from school and claim to be home schooling in order to avoid scrutiny.

KYA would also like to reform the county-coroner system, with more training of the elected officals and standardized systems of investigating and reporting child deaths, Yetter reports.

Learn more about Face It’s 2020 policy priorities at faceitabuse.org/policy/. If you suspect child abuse or neglect, make a report at 1-877-KYSAFE1.

Grayson County newspapers introduce health department's new public health director, who says he's going after human trafficking

Grayson County Public Health Director Joshua Embry
(Photo by Matt Lasley, Grayson County News-Gazette)

By Al Cross
Kentucky Health News

LEITCHFIELD, Ky. – Health departments in Kentucky usually operate in the background, or under the radar of local news organizations, unless a health issue arises. But their work is important, so they deserve more regular attention, and both weekly newspapers in Grayson County did that when it got a new public health director.

Some residents of the west-central Kentucky county may have been startled when they read a headline in the Grayson County News-Gazette saying that Joshua Embry was going to "address human trafficking." He told reporter Matt Lasley, "Based on our clinic services, we know for a fact it is happening in our community. . . It's definitely happening in small, rural towns."

"According to Embry, human trafficking is not solely related to sex, it also includes human labor, and can be drug-related as well," Lasley reports. "In many instances, people are brought into the country and forced to provide unpaid labor to work off a debt to the person who brought them here."

Also, "Underage children can be victims of human trafficking without ever leaving their homes, by being deceived into sharing explicit images of themselves with people online. These images are then widespread, which falls under the umbrella of human trafficking, health department officials say."

January is Human Trafficking Awareness Month, and Embry "is beginning an awareness campaign aimed at educating the community on the issue and how to address it and report it," Lasley writes.

The front-page story in the county's other weekly, The Record, briefly mentioned human trafficking and was more general, reminding readers of the health department's wide range of services and responsibilities, which include "grief counseling services for families who've lost a child."

"People hear 'health department' and they automatically think STD tests" for sexually transmitted diseases, Embry told The Record's Rebecca Morris. "I want to be able to educate the community on all the programs we have. A lot of people just don't understand the great resource the health department is."

Embry, 32, began work last month after almost seven years at Breckinridge Health, which operates Breckinridge Memorial Hospital in Hardinsburg. After a brief teaching career, he started as an emergency-room admittance clerk and ended as coordinator of compliance, emergency preparedness and safety. He told Morris that health care is a "field you definitely have to be called to."

One could say that about the weekly newspaper business, too. I was editor of the News-Gazette (and general manager of a predecessor, The Leitchfield Gazette) before the Louisville Courier Journal hired me away in 1978. One of my successors as editor, Jenny Searcy, started The Record a few years later.

Grayson may be the only county in the U.S. with weekly newspapers operated by competing chains, which usually don't buy papers with less than $1 million in annual revenue, and certainly not in competitive markets. But Landmark Community Newspapers of Shelbyville bought The Record to give advertisers in its Elizabethtown daily, The News-Enterprise, an opportunity to buy combination ads. It ran a circulation campaign, managed by Searcy, that won it the local circulation lead and thus the public-notice ads. The News-Gazette went through several owners and is now owned by Paxton Media Group of Paducah, which bought in a 2017 package deal with two other nearby papers and moved it from twice-weekly to weekly publication. The county of 27,000 also has an AM-FM radio station with an active news department, WMTL-WKHG in Leitchfield, a town of about 7,000.

FDA bans sale of most flavors in cartridge-based e-cigarettes; menthol flavor still allowed, against health advocates' advice

By Melissa Patrick
Kentucky Health News

The Trump administration has announced a ban on the sale of flavored e-cigarettes except for menthol and tobacco-flavored products for cartridge-based systems, like pods produced by Juul, the leading manufacturer. The ban does not include flavors in tank systems sold in vape shops.

Science News photo

The U.S. Food and Drug Administration said in a news release that it made these concessions to support adults who use e-cigarettes as a quit-aide for traditional cigarettes.

“By prioritizing enforcement against the products that are most widely used by children, our action today seeks to strike the right public health balance by maintaining e-cigarettes as a potential off-ramp for adults using combustibles tobacco while ensuring these products don’t provide an on-ramp to nicotine addiction for our youth. We will not stand idly by as this crisis among America’s youth grows and evolves, and we will continue monitoring the situation and take further actions as necessary," Department of Health and Human Services Secretary Alex Azar said in a news release.

The FDA has not approved any e-cigarette product as a smoking cessation method and the smokefree.gov website says, "So far, the research shows there is limited evidence that e-cigarettes are effective for helping smokers quit."

President Trump suggested in September that his administration would ban all flavors from the market except for tobacco, but backed off after protests from users, retailers and manufacturers.

On Dec. 31, two days before the policy announcement, Trump told reporters that the the new policy would protect both families and the industry,

"We're going to protect our families, we're going to protect our children and we're going to protect the industry. It's become a very big industry. We're going to take care of the industry," said Trump, adding that some products could "very quickly" return to the market.

Trump was referring to an FDA review process that requires manufacturers of new tobacco products put on the market since Aug. 8, 2016, to submit pre-marketing authorization applications by May 12, 2020 for their review. This process could allow some of the products that fall under the enforcement action of this policy to be approved and re-enter the market, including flavors.

Vaping advocates have said a full ban on flavored e-cigs would put vape shops out of business, and hurt adults who are trying to use the devices to quit.

Health advocates are more concerned about the public health impacts of these products, especially related to the surge in teen use which has been driven by the flavors. They have urged the Trump administration to take all flavored products, including menthol, off the market.

The FDA release says it didn't ban menthol because a 2019 federal survey found that fruit and mint flavors were the two most popular e-cigarette flavors among teens, with menthol least favored.

The 2019 "Monitoring the Future" study found that menthol was among the least popular flavors among students, at less than 2.3% for eighth graders, less than 3% for 10th graders, and less than 6% for high-school seniors.

However, public-health officials worry that the absence of other flavors will result in a shift toward menthol products, citing the National Youth Tobacco Survey, which shows that youth use of mint and menthol e-cigarettes increased in 2019 after Juul restricted its other flavors.

More than 6 million U.S. middle and high school students are current users of tobacco products, and 5.3 million of them, or 85 percent, are using e-cigarettes, according to the latest annual National Youth Tobacco Survey.

The latest data for e-cigarette use by Kentucky teens, from 2018, shows e-cig use had nearly doubled from 2016, with more than one in four high-school seniors and one of seven eighth-graders reporting they used the devices, the Kentucky Incentives for Prevention study found.

In an analysis of the FDA's industry "guidance" document, Stanton Glantz, director of University of California, San Francisco's Center for Tobacco Control Research and Education, pointed out that it has nothing to keep e-cig companies from simply re-labeling mint-flavored e-cigs as menthol. "After all, menthol is derived from mint," he writes.

The American Medical Association called the policy a step in the right direction, but added that it didn't go far enough.

“If we are serious about tackling this epidemic and keeping these harmful products out of the hands of young people,” the association said in a statement, “a total ban on all flavored e-cigarettes — in all forms and at all locations — is prudent and urgently needed,” adding that it was “disappointed that menthol flavors — one of the most popular — will still be allowed.”

A statement from the Campaign for Tobacco-Free Kids said the policy "falls woefully short of the bold action the administration promised" to address the youth e-cigarette epidemic. Further, it called the policy a win for the e-cigarette industry, saying the Trump administration had sided with "Juul, Altria, [which owns 35% of Juul], the vape shops and other e-cigarette interest over our kids."

"By leaving menthol flavored e-cigarettes widely available and totally exempting liquid flavored products, this policy will not stop the youth e-cigarette epidemic," said the organization's president, Mathew L. Myers. "It is a capitulation to both Juul and vape shops and gives a green light to the e-cigarette industry to continue to target and addict kids with flavored products."

Glantz also expressed concern that a product called Suorin, an e-cig that is highly popular with kids that is sold empty and has refillable pods, would be exempted. Further, he noted that the industry guidance states that "self-contained, disposable products," like the Puff Bar e-cigarette, which is also popular with teens, would be exempt. The Campaign for Tobacco-Free Kids adds that the Smok product, which is an open-pod, refillable system used by teens, would also be exempt.

Glantz called for localities and cites to keep passing laws to end the sale of all flavored tobacco products, but this is not possible in Kentucky because state law preempts local laws on sale, use and distribution of tobacco products.

On Dec. 20, Trump also signed, as part of the year-end spending bill, a measure that prohibits the sale of tobacco products to anyone under the age of 21. The FDA issued a statement on the same day saying the new age limit went into place immediately.

New legal age of 21 to buy tobacco products surprises some; anti-smoking leaders say it won't thwart teenagers' use of e-cigarettes

By Melissa Patrick
Kentucky Health News

The minimum age to buy tobacco products, including electronic cigarettes, is now 21.

Legislation to raise the age from 18 passed Congress as part of the year-end spending bill and was signed into law by President Trump Dec. 20.

The "Tobacco 21" legislation, co-sponsored by Senate Majority Leader Mitch McConnell, R-Ky., and Sen. Tim Kaine, D-Va., gave the federal government up to nine months to develop and implement the regulation, but the U.S. Food and Drug Administration issued a statement on its website the same day the bill was signed into law to make the new age threshold effective immediately.

The statement said, "It is now illegal for a retailer to sell any tobacco product – including cigarettes, cigars and e-cigarettes – to anyone under 21. FDA will provide additional details on this issue as they become available." Dr. Stephen M. Hahn, the FDA commissioner, tweeted that "more details will be forthcoming as we update our regulations to carry out this provision of law."

Some health advocates have praised the change as a way to reverse the surge in teen use of e-cigarettes, but others say it's an important move that doesn't go far enough. They say tobacco companies supported it to avoid heavier restrictions on e-cigarettes, the use if which is epidemic among teenagers.

Ellen Hahn, a University of Kentucky nursing professor and the longtime leader in Kentucky tobacco-prevention efforts, and Audrey Darville, a tobacco treatment specialist at UK, told Kentucky Health News in an e-mail, "Raising the minimum age of legal sale of tobacco products to 21 years is a step in the right direction, but without also prohibiting all flavored tobacco products, the Tobacco-21 law will not stop the youth e-cigarette epidemic."

They added later, "Keep in mind that the tobacco industry wants to do all they can to avoid FDA regulation for new products, so agreeing to Tobacco-21 (without flavor restrictions) is a pro-industry, not a pro-public health strategy."

On Jan. 2, the FDA announced a ban on the sale of flavored e-cigaretttes except menthol and tobacco-flavored products for closed systems, like Juul pods. The ban does not include flavors in tank systems sold in vape shops; the FDA says this concession was made to support adults who use e-cigarettes as a aid to quit traditional cigarettes.

Health and Human Services Secretary Alex Azar said in a news release that HHS "seeks to strike the right public health balance by maintaining e-cigarettes as a potential off-ramp for adults using combustible tobacco while ensuring these products don’t provide an on-ramp to nicotine addiction for our youth."

The key word in that sentence is "potential." The FDA has not approved any e-cigarette product as a smoking-cessation aid, and the smokefree.gov website says, "So far, the research shows there is limited evidence that e-cigarettes are effective for helping smokers quit."

Quick change surprises many

Several national organizations weren't happy with the abrupt change and sent the FDA a letter Dec. 27 stating the challenges it presents to retailers and consumers. The letter asked that the new threshold not be enforced until the FDA updates its regulations and offers clear direction.

On Jan. 2, one of the groups that signed the letter, the National Association of Convenience Stores, urged compliance with the new threshold, despite questions about its implementation.

"While there are unanswered questions about when FDA plans to enforce this requirement and whether the agency can legally enforce it before updating its regulations, retailers should be aware that FDA views any sale to a person younger than 21 as a violation of the new law," the association said in its newsletter..

A manager at a tobacco shop in Owensboro said the change has upset some of her customers, Trey Crumbie reports for the Messenger-Inquirer.

Elizabeth Leary, manager of River's Edge Tobacco Outlet, told Crumbie that 20 to 30 percent of her clientele is in the 18-to-20-year-old range. The outlet sells both traditional tobacco products and vaping products.

Leary added that while she hated to see young people smoking, she didn't think raising the age of purchase to 21 would curtail vaping among teens.

"They're going to find a way," she told Crumbie. "You can change the laws all you want but people find a way to get what they want, one way or another. And what the scary part is if they can't come here and get something that's legit, they'll go in the back alleys and get the stuff that's been causing people to get sick."

More than 6 million U.S. middle and high school students are current users of tobacco products, and 5.3 million of them, or 85 percent, are using e-cigarettes, according to the latest annual National Youth Tobacco Survey.

The latest data for e-cigarette use by Kentucky teens, from 2018, shows e-cig use had nearly doubled since 2016, with more than one in four high-school seniors and one out of seven eighth-graders reporting they used the devices, the Kentucky Incentives for Prevention study found.

The state legislature, which convenes Jan. 7, will need to change state law to comply with the federal statute. Sen. Ralph Alvarado, R-Winchester has already prefiled a bill to do so.

Kentucky's weekly flu chart looks like a ski jump, as spread of the disease accelerates; some hospitals restrict visitation

Kentucky Health News

Influenza kept spreading faster in Kentucky in the week ended Dec. 21, the last week for which the federal Centers for Disease Control and Prevention and the state Department for Public Health have issued a weekly flu report.

The report said 1,339 new cases of flu were reported that week, another big jump from the 814 new cases reported the week before. During this flu season, 3,775 cases have been confirmed in Kentucky. No additional deaths from flu were reported during the week, but 30 of the 120 counties did not report.

The CDC recommends that everyone over 6 months of age get a flu vaccination each year. There is still plenty of time to protect yourself from the disease; flu season usually runs into May.

The spread of flu is prompting hospitals to restrict visitation. Twin Lakes Regional Medical Center in Leitchfield bans visitors under 16 and people with flu-like symptoms (fever, cough, and sore throat); allows no more than two visitors in a room at one time, and allows "no visitors other than immediate family or other significant persons defined by the patient," wrote Krissy Logsdon, the hospital's director of infection prevention and employee health. "Exceptions to these restrictions may be made for cases involving critically ill patients and end of life situations."

Perry County remained Kentucky's flu hotbed in mid-December, with 94 new cases during the week for a total of 404 this season. That was 1.5 percent of its estimated population. In adjoining counties, Breathitt had 24 new cases for a total of 59; Knott had 18 more for a total of 119; Leslie had 20 more for a total of 129; and Letcher had 24 more, for a total of 82.

Barren County and adjoining Monroe and Warren counties had big jumps during the week; Barren had 69 new cases for a total of 139, and Monroe had 29 more for a total of 58. Warren, which is much more populous, had 37 new cases for a total of 84.

Bullitt County more than doubled its number of cases, adding 113 for a total of 224. Its infection rate was nearly 0.3 percent; in adjoining and much more populous Jefferson County (which had 684 new cases during the week for a total of 1,582) the rate was 0.2 percent. The statewide rate based on county reports was 0.08 percent, but the actual rate was higher because one-fourth of counties (most of them small) did not report.

For a larger version of this map from the report, with more legible numbers, click on it.

Beshear cancels, re-bids $8 billion in manged-care contracts Bevin awarded; Lisa Lee returns as Medicaid commissioner

Gov. Andy Beshear (Photo from Kentucky Today)

Gov. Andy Beshear has cancelled, and ordered rebidding of, $8 billion in Medicaid managed-care contracts that then-Gov. Matt Bevin awarded to five insurance companies 24 days after Beshear defeated him and 11 days before Beshear took office.

Beshear offered several reasons for his actions at a Dec. 23 news conference, Jack Brammer reported for the Lexington Herald-Leader. He noted that the original request for proposals included provisions from Bevin's plan to change Medicaid, which Beshear recently rescinded.

Bevin's proposal would have required "able-bodied" adults without dependents to work or participate in approved "community engagement" activities 80 hours a month and pay small, income-based premiums monthly to stay covered by Medicaid.

The original proposal projected that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it, largely because of non-compliance with its requirements, including monthly reporting. Bevin's plan had been twice blocked by a federal judge in Washington, D.C., and was awaiting the decision of an appeals court.

Beshear also noted that members of the legislature's Government Contract Review Committee, which has only advisory powers, unanimously voted to reject the contracts on Dec. 9 "and that Bevin had shown bias against one of the unsuccessful bidders -- Passport Health of Louisville -- by criticizing the company," Brammer noted.

Passport and Anthem Inc., which both have managed-care contracts, were not included among those awarded for the fiscal year beginning July 1, 2020, which the Bevin administration announced Nov. 27. The contracts went to Aetna Better Health of Kentucky, Humana Health Plan and Wellcare Health Insurance of Kentucky, all of which have contracts with the state, and two newcomers, United Healthcare and Molina Health Care.

Passport and Anthem had promised to appeal the awards; Beshear's cancellation of them could create a cause of legal action for the other companies.

About 1.2 million of the 1.3 million low-income and disabled Kentuckians in Medicaid are covered by the managed-care system, in which the companies deal with patients much like private insurance plans.

Beshear said the state would rebid the contracts on an accelerated time schedule, with a request for proposal target date of Jan. 10; responses due Feb. 7; and a goal of selecting providers in April.

Meanwhile, the managed-care program will operate under the current contracts, which Beshear said may require extensions to prevent any loss of coverage.

He told reporters that his decision “has nothing to do with who won or lost in the initial process. The rebidding will be fair. No one is guaranteed a contract."

Lisa Lee

On Jan. 3, Beshear announced that Lisa Lee, who was Medicaid commissioner in the final years of the governorship of his father, Steve Beshear, will return to the job. In her 16 years in the Cabinet for Health and Family Services, she had been a member services representative, director of provider services, a policy analyst and deputy commissioner before becoming commissioner.

“During my time in Medicaid, I saw firsthand how important this program is to Kentucky – from the members it serves to the providers who treat them,” Lee, a native of Hazard, said in a press release. “I am excited to return to Medicaid and assist this administration in developing policies aimed at improving the health of all Kentuckians.”

Flu cases reported at increasing rate; 6 deaths in Ky. this season

Kentucky Health News

Kentuckians are getting the flu at an increasing rate, and more are dying from it.

In the week ended Dec. 14, there were two deaths, bringing the statewide total for the flu season to six, according to the state Department for Public Health.

During that week, 814 new cases of the flu were confirmed by laboratory testing. Five of the deaths were people 18 or older and one was under 18. Twelve of the state's 17 health regions reported increased flu activity during the week.

The federal Centers for Disease Control and Prevention estimates that the flu has killed between 12,000 and 61,000 Americans each year since 2010. It recommends that everyone over 6 months of age get an annual flu vaccination.

Dr. Angela Dearinger, Kentucky's health commissioner, says is especially important for children and high-risk adults to get vaccinated, since they are at higher risk of complications and negative consequences, including death. She also encouraged anyone with flu to stay home and avoid contact with others.

It's also important to practice good hygiene, covering your cough and making sure you are washing your hands with soap and water for at least 20 seconds -- or the time it takes to sing "Happy Birthday" twice. The CDC recommends washing hands with soap and water whenever possible, and if not, to use a hand sanitizer with at least 60 percent alcohol.

Because flu germs linger on surfaces, it's also important to wash your hands after coughing, touching a door knob or handrail, or shaking hands. One regional health official has even advised Kentuckians to avoid handshaking during the flu season, calling it "the worst thing you can do."

For a larger version of this map, with more legible numbers, click on it.

Gov. Beshear rescinds Bevin's Medicaid waiver plan but asks federal government to let Kentucky keep four parts of it

By Melissa Patrick
Kentucky Health News

As he promised in his campaign, Democratic Gov. Andy Beshear rescinded defeated Republican predecessor Matt Bevin's Medicaid plan, which included highly controversial work requirements. But Beshear said he also wants to keep using four parts of it.

Beshear signs executive order on Medicaid. (Melissa Patrick photo)

"We were convinced that the only way to address this waiver initially was to fully rescind it and then move forward on addressing or creating those programs that might be beneficial inside of it," he said at a Dec. 16 news conference, where he signed an order rescinding Bevin's request for a waiver of federal rules to implement the plan.

The plan would have required "able-bodied" adults on Medicaid to work or participate in approved "community engagement" activities 80 hours a month and pay small, income-based premiums monthly to stay covered.

Bevin's original proposal projected that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it, largely because of non-compliance with its requirements, including monthly reporting.

"My faith teaches me that rescinding this waiver is not only the right thing to do, it is the moral, faith-driven thing to do," Beshear said. " I believe health care is a basic human right."

"That's spot on," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "That's what I was always taught Jesus Christ was about, is about including people and giving them a hand up when and where you could. And that's what this is and I think it's a great thing."

Chandler noted that the foundation had committed to helping the state keep people from losing coverage under the waiver, and could now use those resources for other efforts.

"We had been concerned about the hundred thousand or so people who were predicted to ultimately lose their coverage had the waiver been implemented." Chandler told Kentucky Health News.

Bevin's proposal had already been struck down twice by a federal judge in Washington, D.C., and was awaiting the decision of an appeals court. Beshear told reporters that by ending the waiver, Kentucky would no longer be involved in that lawsuit. Arkansas, which implemented a similar plan before being sued, will remain in the suit.

Beshear's office hinted in a news release that he might use his order as partial grounds for also rescinding "the $8 billion in Medicaid managed care contracts that the previous administration awarded with just 11 days left in the administration. Those contracts were awarded based on the waiver." Legislators in both parties have objected to the awards.

Two days after signing the executive order, Beshear's administration sent a "clarification" letter to the Centers for Medicaid & Medicare Services saying his request did not apply to four provisions in the waiver.

Two of those provisions involve substance use disorder. One allows non-emergency medical transportation for methadone treatment for most people on Medicaid; the other involves the substance-use disorder program that is available to all Kentucky Medicaid beneficiaries.

The third involves a provision that extends Medicaid coverage to former foster-care youth who were the responsibility of another state before moving into Kentucky; the fourth allows a family to coordinate its annual Medicaid re-determination with an open-enrollment period for an employer-sponsored insurance plan. It would include any children who are enrolled in Medicaid or in the Children's Health Insurance Program and are covered by a parent or caretaker's plan.

The judge's rulings against the waiver had no effect on those four elements, as the letter to CMS notes. It also points out that the four have operated without interruption in Kentucky during the suit.

"I am glad Governor Beshear sees the importance of keeping these positive policy changes," Marcie Timmerman, executive director for Mental Health America of Kentucky, told Kentucky Health News in an e-mail. "Mental health and substance use disorders affect people from every race, class, ethnicity, and orientation. The commitment of Kentucky to help our citizens have access to substance use disorder recovery is something we can all build on."

Kristen Arant of Newport, who receives coverage through expanded Medicaid, told reporters at the news conference that it had saved her life, allowing her to receive treatment for her substance-abuse disorder. She's now a college graduate and a social worker.

“Health care is not a luxury," she said.  “It is not a commodity. It is a God-given right. People who do not feel well have the right to feel well. People who need medications have the right to have access to those medications."

The expansion has increased by more than a 500% the number in Medicaid beneficiaries receiving treatment for a substance-use disorder, said Emily Beauregard, director of Kentucky Voices for Health. She called Beshear's order a tremendous victory for the 16 plaintiffs who challenged Bevin's plan in federal lawsuits.

The Kentucky Equal Justice Center, which was largely behind the lawsuits that kept the plan from taking effect, are "real heroes in this," Chandler said.

Center Director Richard Seckel diverted his appreciation to the 16 plaintiffs, calling them courageous. "We do hope that as this suit goes on with Arkansas that there will be findings that this waiver never should have been approved in the first place," he said.

Kentucky's Medicaid program covers about 1.3 million people; about 600,000 of them are children, and nearly 450,000 of the total are covered the expansion. Each month, tens of thousands of Kentuckians go on and off the program as they gain or lose eligibility.

"On any given day, most Kentuckians are simply a lost job, reduced work hours, a new baby, an accident or an illness away from qualifying for programs like Medicaid," Beauregard said. "That's why we call it a safety net."

Ky. legislative leaders talk favorably of taxing electronic cigarettes

By Al Cross
Kentucky Health News

Electronic cigarettes, which escaped taxation in the General Assembly last year and were then labeled an epidemic among teenagers, are in line to get taxed when the legislature convenes Jan. 7.

That was clear from statements by legislative leaders at the Kentucky Chamber of Commerce's legislative preview Dec. 16.

"There does appear to be some pretty solid support behind the vaping taxes," House Speaker David Osborne said, using the common term for use of electronic cigarettes. Many don't produce a vapor, which has liquid particles suspended in the air, but an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.

Senate President Robert Stivers said the health effects of e-cigarettes make it easy "to have a two-fold conversation -- health and revenue -- so I think there's interest" in extending the state's tobacco excise tax to e-cigs. Afterward, he said, "I'm very much interested in it."

Chamber of Commerce President Ashli Watts said later that some legislative observers have said that revenue from taxing e-cigarettes "would be a pretty good start on school safety," a law the legislature passed last year but did not fund.

In an earlier session, Senate Majority Floor Leader Damon Thayer said, "On the vaping tax, I think that's something we probably need to consider. I don't favor it being as high as a cigarette tax, but I think there's probably a happy medium that we can find."

In the 2019 legislative session, Rep. Jerry T. Miller, R-Louisville, unsuccessfully sponsored an e-cig tax bill that would have dedicated the estimated revenue of $35 million a year to the state's unfunded pension liability. His latest version doesn't do that, on the advice of Osborne, who said the lack of earmarking would get the bill more support, Miller said in July.

In 2018, an e-cigarette tax was included in legislation that raised the tax on traditional cigarettes, but the e-cig tax was removed in the Senate, just before final passage and after lobbying by Altria Group, the largest tobacco company and 35 percent owner of Juul Labs, the largest e-cig company.

Sen. Chris McDaniel, chair of the Senate Appropriations and Revenue Committee, said in July that he wasn't sure what happened, but thought that a staff member may have raised "a definitional problem" that couldn't be resolved at the last minute.

Stivers has said he couldn't recall what happened, but in an interview after his appearance he said he did not recall Altria lobbying him on the e-cig tax. Altria's top lobbyist came to Frankfort in the final days of the 2018 session, but Stivers said the company may have done that in an effort to revive a bill that would have raised the legal age to but tobacco and e-cig products to 21 from 18.

Teenagers' use of e-cigarettes soared in 2019, increasing to more than 5 million in 2019 from 3.6 million in 2018, a 39 percent jump, according to the latest annual National Youth Tobacco Survey. The devices are increasingly being used with marijuana and other cannabis products, the National Institute on Drug Abuse reported Dec. 18.

Other legislative issues

Gov. Andy Beshear campaigned on the idea of legalizing and taxing medical marijuana, but McDaniel threw cold water on that idea. He said the legislature's decision on medical cannabis would be driven by policy, and if it is deemed to be "a pharmaceutical, we don't tax pharmaceuticals in this state, and we're not going to start." Prescription drugs are exempt from the sales tax.

More broadly, the 2020 legislative session will be like none other: a governor of one party dealing with a legislature controlled by the other party -- and more powerful than it was in 1967-71, when Republican Louie Nunn was governor and pushed a sales-tax increase and other programs through a relatively weak legislature controlled by Democrats.

Stivers told the crowd that Gov. Andy Beshear "surely realizes" that his election wasn't a mandate, since the average Republican vote margin was 213,000, except for "one anomaly race," Beshear's defeat of unpopular Republican incumbent Matt Bevin. Later, he said "The governor needs to be careful what he says and does" with helping Democrats seeking GOP-held legislative seats because trying to unseat Republicans and failing "would weaken him tremendously."

Osborne said Republicans "sometimes" worked well with Bevin but "had a really productive relationship" with the governor's father, Steve Beshear, who was chief executive in 2007-2015, before Republicans gained a majority in the House. "I think you will see people anxious to work cooperatively," Osborne said.

Osborne said he is "a little bit hesitant" about senators' idea to limit the governor's pardon power with a constitutional amendment in the wake of controversial pardons and commutations Bevin issued on his way out of office. Stivers said he agreed that the legislature needs to move carefully, but "The shock value of what happened has created quite a bipartisan atmosphere" about addressing the issue.

Stivers said the legislature needs to do more to help the economy in Kentucky's rural areas, many of which are falling farther behind the rest of the state and are "donee regions" to the commonwealth. He said 87 percent of admissions at the University of Kentucky's main hospital come from outside Fayette County.

Kentucky hospitals have benefited greatly from the 2014 expansion of Medicaid, which was initially covered by the federal government under the 2010 Patient Protection and Affordable Care Act. In 2017-19, the state has paid 5, 6 and 8 percent, respectively; in 2020 it will begin paying the reform law's limit of 10 percent. "We know Medicaid costs are going to dramatically increase," Osborne said.

Information for this story was also gathered by Kentucky Health News reporter Melissa Patrick.

Health officials warn outbreak of drug-resistant bacteria is likely coming from petting puppies in pet stores; 3 of 30 cases are in Ky.

By Melissa Patrick
Kentucky Health News

Getting a puppy for Christmas? Keep clean and take it to a vet. At least 30 people in 13 states have been sickened by a drug-resistant bacteria that federal health officials say was likely picked up from puppies in pet stores, three of them in Kentucky.

Getty Images photo, via WJW-TV, Fox 8 Cleveland

The infection is from a multi-drug-resistant strain of the bacterium Campylobacter jejuni. The outbreak has caused four hospitalizations, the federal Centers for Disease Control and Prevention said in a news release.

The CDC noted that the hospitalized ranged in age from 8 months to 70 years old.

Among 24 people with infections who were interviewed, 21 said they had recently touched a puppy and 15 of those said they did so in a pet store. All of the cases were reported between January and November.

"Campylobacter bacteria can spread to people through contact with poop of infected animals and contaminated food or water," says the release.

Infection from the Campylobacter bacteria is one of the most common causes of diarrheal illness in the United States, infecting more than 1.5 million people every year, says the CDC. Most cases are not part of a recognized outbreak.

The release notes that a single, common supplier of puppies has not been identified. However, 12 of those who had contact with a puppy did so at a Petland store, and five of the 12 were Petland employees. Petland has two locations in Kentucky, in Florence and Ashland.

The CDC adds that the strain of Campylobacter in this outbreak appears to be related to a strain that caused a similar outbreak of puppy-related human illness in 2016.

In a statement, Petland said that just like a 2016 outbreak, this specific Campylobacter strain has not originated at any specific Petland store. The company said it implemented all recommended protocols from federal and state officials to prevent human and dog illness after that outbreak.

Campylobacter jejuni oubreak as of Dec. 11, 2019

"For perspective, more than 12 million guests visit our stores annually, and during this specific time period, Petland estimates more than 2.4 million customer socializations of Petland puppies," says the statement.

Illnesses have been reported in Connecticut, Florida, Georgia, Illinois, Kentucky, Maryland, Minnesota, Nevada, Ohio, South Carolina, Tennessee, Utah and Wyoming.

Symptoms of Campylobacter infection include diarrhea, fever and stomach cramps that begin two to five days after being exposed to the bacteria. The illness usually lasts about a week and most people recover without antibiotics. Antibiotics are needed for patients who are very ill or those with severely weakened immune systems.

The CDC encourages people to make sure they take a new puppy or dog to a veterinarian for a checkup within a few days after getting it because puppies and dogs can carry the Campylobacter germs even while appearing healthy and clean.

The agency also advises people to always wash their hands thoroughly with soap and water after touching a puppy or dog, after handling their food and after cleaning up after them. Also, don't let dogs lick around your mouth and face, open wounds, or areas with broken skin.

The release says the CDC the investigation is ongoing and the agency will provide updates when more information is available.