State, local governments have great power to fight coronavirus

"Local and state public health officials wield extraordinary powers in emergency situations such as the current coronavirus outbreak," Michael Ollove and Alex Brown report for Stateline. They can close schools and private businesses. They can restrict or shut down mass transit systems. They can cancel concerts, sporting events and political rallies. They can call up the National Guard. They can suspend medical licensing laws and protect doctors from liability claims. And they can quarantine or isolate people who might infect others."

Laws on emergency powers vary in the details, but such laws still give states and municipalities wide latitude to respond to health threats such as the coronavirus disease dubbed covid-19. That generally includes the right to declare a state of emergency, which serves both practical and psychological functions. Governments can slow the spread of disease by restricting movement or quarantining the sick without having to deal with red tape. And declaring a state of emergency may reassure members of the public who are anxious to know that officials are responding, Ollove and Brown write .

Under emergency-declaration laws, authorities can also redirect health care workers to where they're most needed and help hospitals deal with the onslaught of patients. "For instance, they can decide which hospitals should have isolation wards," Ollove and Brown report. "They can order or request hospitals to release patients with lesser health needs to make room for those infected with the virus. They can take properties to create emergency medical centers if hospital space runs out. And they can transfer equipment and supplies from one hospital to another, based on the needs of the moment."

Local public-health officials also play a critical role in informing the public, either directly or through the news media. Providing clear, factual information to the public can slow the spread of disease, reduce panic, and kill rumors, Ollove and Brown write.

Beshear urges employers who don't offer paid sick leave to do so, to keep sick workers at home and prevent spread of coronavirus

Gov. Andy Beshear (Lexington Herald-Leader photo)

Gov. Andy Beshear wants Kentucky employers who don't allow paid sick leave to change that policy, to prevent spread of the coronavirus.

“We have got to make sure that people stay home when they’re feeling sick until we move past this,” Beshear told journalists, adding that it is only a matter of time before Kentucky sees a case of covid-19, the disease caused by the virus.

“I would encourage all those businesses that are out there that don’t currently offer paid sick leave, absolutely consider it for the next several months,” Beshear said.

The Courier Journal reports, "Kentucky sits in a region with some of the lowest rates of access to paid sick leave in the country, according to Jason Bailey, head of the Kentucky Center for Economic Policy, a left-leaning think tank. Some 62% of private sector workers in Kentucky, Tennessee, Alabama and Mississippi receive paid sick days, compared with 91% of workers in the Pacific Northwest, Bailey said. That's partly because Kentucky has a greater number of low-wage employers — factories and retailers."

But it’s also because the 2017 General Assembly banned local governments from imposing sick leave requirements, Bailey told the Louisville newspaper: “Cities like Louisville are actually barred from doing that. So that creates additional risk because a lot of those workers who do not have paid sick days are also the ones who are in those jobs with regular contact with the public. … We have created a situation through that and other policies that increase our risk.”

Live forum about coronavirus on KET Tuesday night

With the spread of the coronavirus around the world, the United States declared a public health emergency at the end of January, and the number of confirmed cases in the U.S. grew significantly in the first week of March.

To help address this health risk, Dr. Wayne Tuckson of KET's "Kentucky Health" will host a special live forum on the network Tuesday, March 10, at 9 p.m ET. "Trusted health experts will share the latest information about the coronavirus, answer viewers’ questions, and discuss how the state and healthcare providers have been preparing," a KET news release says. The panel will include physicians and other professionals:

• Steven Stack, commissioner of the Kentucky Department for Public Health
• Lori Caloia, medical director of the Louisville Department of Public Health and Wellness
• Derek Forster, medical director for infection and prevention control at UK HealthCare
• Staff from the Lexington-Fayette County Health Department

Have a question you’d like answered? You may submit questions in advance via:
• Email: ketforum@ket.org
• Twitter: @KET
• Facebook: facebook.com/KET

Committee approves doctors' bill to regulate lawyers' ads aimed at soliciting clients who take certain prescription drugs

By Melissa Patrick
Kentucky Health News

A bill to regulate plaintiff-lawyer commercials that solicit clients allegedly injured by prescription drugs or medical devices is headed to the state Senate floor.

Sen. Ralph Alvarado explained SB 178 to the Economic
Development, Tourism and Labor Committee. (LRC photo)  

“I’m sure all of you are aware and have seen legal advertisements on television about prescription drugs,” said Sen. Ralph Alvarado, R-Winchester. “They look like an important health alert about the risks associated with a medication, often using the logo of a national health organization like the Food and Drug Administration meant to imply authenticity. . . .  And their goal is simple: It is to alarm the public and lure the consumer into calling a 1-800 number that promises them financial recovery through legal services."

Alvarado, the bill's sponsor, called Senate Bill 178 a "patient protection bill" and told the  Senate Economic Development, Tourism and Labor Committee members that such ads compromise the doctor-patient relationship and potentially put consumers' health at risk

He said the ads target many common drugs, including blood thinners and treatments for diabetes, heartburn, heart disease and certain cancers.

"Consider a scenario when someone abruptly stops taking a blood thinner, for example. Patients can experience a stroke or a transient ischemic neurological event, residual paralysis and in the worst case, death," said Alvarado, who is a physician. "What we're seeing is people will view these ads and stop taking the medication, despite it being the best course of treatment and despite there not being a medical reason for the person to stop treatment."

He cited studies to support his claim, including one that found 58 percent of physicians reported having patients who stopped taking their medications without consulting their doctors after seeing such ads, and said the American Association of Retired Persons has sent warnings and letters to its members to implore them to not stop taking their medications without talking to their physicians first.

Among other things, SB 178 would require advertisers to warn viewers that it is dangerous to stop taking prescribed medications before consulting with a physician; would prohibit the use of a government agency logo in any way that suggests an affiliation; would prohibit ads that solicit legal business from being labeled a "medical alert" or "health alert"; and would protect personal health information from being sold or transferred to someone for the purpose of  soliciting legal services without the written authorization of the patient.

Sen. Ernie Harris, R-Prospect, asked how enforceable the bill was since most of Kentucky is served by out-of-state TV stations. Cory Meadows, deputy executive vice president and the director of advocacy for the Kentucky Medical Association, said this still has to be worked out, but said Tennessee has a similar law and West Virginia is considering one.

"What this comes down to is protecting patient health and safety as well as preserving that relationship," Meadows said. "There needs to be some regulation and oversight around these ads if we don't want Kentuckians to get hurt or further hurt."

Sen. Wil Schroder, R-Wilder, a lawyer, asked why a violation would be a misdemeanor rather than a civil violation with a financial penalty. Meadows said the original idea was a felony, and was negotiated down. He said some criminal penalty was needed to "put teeth" in the bill.

Jay Vaughn of the Kentucky Justice Association, which represents plaintiffs' lawyers, said the group likes the proposed warning to not stop taking a drug without consulting a physician, but thought the other provisions went too far.

Is the coronavirus causing covid-19 a pandemic? It looks like one, and health officials across the world are treating it like one

By Paige Winfield Cunningham
The Washington Post

Officials have been slow to use the “P” word to refer to the spread of coronavirus.

Yes, that word: “Pandemic.”

. . . The story of covid-19, the disease caused by the virus, isn't the same as a Hollywood thriller. But some health experts are frustrated by the hesitancy of officials to describe it as a pandemic, even though it checks just about every box of criteria.

“Personally, I think we're doing everyone a disservice by continuing this debate,” Lauren Sauer, director of operations for the Johns Hopkins Office of Critical Event Preparedness, told me. “It is creating more panic than just declaring it and moving on.”

A pandemic refers to an infectious disease spreading so rapidly across multiple countries that it can’t be contained. The World Health Organization defines “pandemic” this way: “The worldwide spread of a new disease” that sickens a large number of people because they don’t have immunity to it.

One could argue — and most epidemiologists do — the coronavirus is a pandemic under that definition; cases have been reported in more than 50 countries and on every continent (except Antarctica) and nearly 3,000 people have died from it.

Japan and South Korea have shuttered their schools. China has dramatically scaled back its manufacturing under intensive quarantines. Heck, even the Louvre in Paris is closed.

When officials do use that term, it indicates they’re worried the virus has hit a tipping point where drastic actions such as closing schools, canceling public gatherings and urging people to stay at home are necessary. While containment is the goal under an epidemic — where a disease is spreading only regionally, not globally — mitigation becomes the goal under a pandemic.

There are growing signs that health officials around the world are viewing coronavirus as a pandemic — even if they're not willing to state it yet directly.

• Last Tuesday, the U.S. Defense Department raised its “Risk of Pandemic” warning from “probable crisis” to “imminent crisis,” according to a document obtained by Newsweek. Officials expect the coronavirus will “likely” become a global pandemic within the next 30 days.
• Nancy Messonnier, a top official at the Centers for Disease Control and Prevention, said the following day the coronavirus has met two criteria of a pandemic: causing illness resulting in death and spreading person to person in a sustained way.
  “The world moves closer toward meeting the third criteria — worldwide spread of the new virus,” Messonnier told reporters.
• And yesterday, the WHO director general used the word “pandemic” as he warned “the window of opportunity for containing it is narrowing.”
  “We need to be preparing side by side for a pandemic,” Tedros Adhanom Ghebreyesus told CNBC.

In some regards, it doesn't matter much whether officials say they're dealing with a pandemic or not. Global authorities are already responding to the novel coronavirus as though it’s the highest-level health threat, regardless of the terms used to describe its spread. . . .

WHO no longer uses “pandemic” as a term to classify the threat of infectious diseases. The agency changed its classification system after calling the 2009 swine flu outbreak a “pandemic.” At the time, it was accused of exaggerating the alarm for an illness that turned out milder than initially expected.

But the agency has already given coronavirus its highest threat level — dubbing it a “Public Health Emergency of International Concern” — and its leaders have been wary of using the term pandemic casually.

“Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems,” Ghebreyesus said last week.  But WHO spokesman Tarik Jasarevic told me this morning “we are at a critical juncture in the outbreak.”

“While we must continue efforts to contain Covid-19 — focusing on strengthening surveillance, conducting thorough outbreak investigations to identify contacts and applying appropriate measures to prevent further spread — countries should also use this time to prepare for the possibility of wider transmission,” Jasarevic wrote in an email.

In public, top Trump administration officials are staying away from the term “pandemic” as they try to reassure Americans the threat of getting the virus is still low and do damage control after reports suggested the administration's response has been internally chaotic.

Pence said on CNN's “State of the Union” that the Trump administration is leading an aggressive, coordinated response, keeping the threat of the flulike illness at a low level for the average person.

“The good news is, of the 22 Americans that have contracted the coronavirus, more than half of them are almost fully recovered,” Pence said. “And I think it’s all a reflection of the fact that early on in this crisis, the president took the unprecedented step of suspending all travel from China and establishing a quarantining effect.” 

Risk of Americans getting the new coronavirus remains low, but a top expert cautions that this is an evolving situation

The new coronavirus (Centers for Disease Control)

By Melissa Patrick
Kentucky Health News

Kentucky health officials have been monitoring more than 100 people for the novel coronavirus, all of whom agreed to voluntary isolation after recent travel to mainland China, but as of Sunday there had been no confirmed cases in Kentucky.

The state has tested one person for the virus, and that test came back negative, Gov. Andy Beshear said at a Feb. 27 press conference. State public-health officials have offered a list of several steps you can take to protect yourself and those around you:

• Wash hands with soap and water for at least 20 seconds; only use alcohol-based hand sanitizer if soap and water are not available.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home if you are sick.
• Cover your cough or sneeze with a tissue and then throw it away.
• Clean and disinfect frequently touched objects and surfaces.
• Get a flu shot.

Why get a flu shot when it won't work against the coronavirus, which causes a disease that has been named covid-19? The U.S. surgeon general says fewer flu patients equals more resources to combat covid-19; and the Kentucky Medical Association says having the flu weakens the immune system, leaving unvaccinated people more susceptible to contracting other illnesses. In the great majority of covid-19 deaths there has been an underlying medical condition.

At this time there are no recommendations for individuals who are well to wear a face mask, despite there being a rush to buy them. The Centers for Disease Control and Prevention says it "does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases, including covid-19. Facemasks should be used by people who show symptoms of covid-19 to help prevent the spread of the disease to others. The use of face masks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health-care facility)."

On Saturday, the surgeon general concured, saying on Twitter that Americans should stop buying masks because They won't prevent the general public from catching the virus, "but if health-care providers can’t get them to care for sick patients, it puts them and our communities at risk!"

Facts about the virus

Covid-19 is a respiratory illness that can spread from person to person. The CDC says it is transmitted by tiny droplets from sneezes and coughs and can spread to people as much as six feet away. And while it may be spread from contact with infected surfaces or objects, "this is not thought to be the main way the virus is spread," the CDC says.

The virus was first identified in China. The CDC says it is not spreading throughout the United States. Two deaths from the virus were reported Saturday and Sunday in Washington state.

As of Feb. 29, the CDC reported there had been 22 confirmed and presumptive positive cases in the U.S., plus 47 confirmed positive cases among people who have been repatriated to the U.S.: three from Wuhan, China, and 44 from the Diamond Princess cruise ship, which had been docked in Yokohama, Japan.

The World Health Organization reported on Feb. 28 that there are more than 83,000 cases worldwide, with more than 2,800 deaths.

The risk of getting covid-19 in the U.S. is currently low, but Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said at a White House press conference Saturday that it's important to remember that "this is an evolving situation."

Common signs and symptoms of covid-19 include cough, other respiratory symptoms, fever, shortness of breath and breathing difficulty. Symptoms may appear in as few as two days or as long as 14 days after exposure.

Preliminary information shows that older people and people with underlying health conditions may be at increased risk for a severe case of the virus. Most cases of the virus are mild, but that is one thing that makes it harder to deal with.

An insidious disease

Because covid-19 is generally not life-threatening, it is harder to identify and isolate, Dr. James Hamblin writes for The Atlantic: "It is deadly, but not too deadly. It makes people sick, but not in predictable, uniquely identifiable ways. Last week, 14 Americans tested positive on a cruise ship in Japan despite feeling fine. The new virus may be most dangerous because, it seems, it may sometimes cause no symptoms at all."

Marc Lipsitch, a Harvard University epidemiology professor, told Hamblin, “I think the likely outcome is that it will ultimately not be containable.”

Hamblin writes, "Testing people who are already extremely sick is an imperfect strategy if people can spread the virus without even feeling bad enough to stay home from work." 

That's what happened to Carl Goldman, who got the virus while on the quarantined Diamond Princess.

Goldman, who is in his late 60s, tells his story in The Washington Post, writing that his only symptoms are that this chest feels tight and he has coughing spells. He writes that he has no chills, no body aches, breathes easily and has no stuffy nose.

"If I were at home with similar symptoms, I probably would have gone to work as usual," he writes.

His treatment has largely been preventive IV care, "gallons and gallons of Gatorade, and when my fever rose just above 100 degrees, some ibuprofen. . . . It’s surreal to see everyone panic — news conferences, the stock market falling, school closures — about a disease I have. It does seem likely that coronavirus will spread in the United States, but it won’t help anybody if we all panic."

Robert Redfield, the CDC director, said at Feb. 27 press conference, "At this stage, the risk is low we need to go on with our normal lives."

Is our political system properly serving our public-health system?

The president and vice president watched Dr. Anthony Fauci Feb. 29. (Photo: Andrew Harnik, Associated Press)

By F. Douglas Scutchfield and Al Cross

The new viral disease, covid-19, began in China, which continues to report new cases even as the coronavirus spreads to several nations around the world. This suggests that we are likely to have a disease outbreak comparable to the 2009 pandemic of “swine flu” caused by the H1N1 influenza virus. Health experts say the current best way to handle covid-19 is to manage this emerging disease as we managed that emerging disease.

The disease is very much like influenza, which we have managed over the years with varying success. In the absence of a vaccine, we need common-sense steps: wash your hands frequently and thoroughly; keep your hands away from your face; avoid those who have disease; and if you get sick, don’t go to work or school, since you will infect others. Sneeze or cough should be controlled and covered with a tissue which is then discarded.

We are likely to develop a vaccine for this virus, but that will take 12 to 18 months, and given Americans’ poor track record of flu immunization, even if we had a vaccine, would they take it? As for current prevention efforts, we worry that again, our public-health system is not being well served by our political system.

President Trump’s Feb. 26 press conference on this potential pandemic reflected a lack of knowledge and understanding of the subject, and created more misunderstanding. He did better on Feb. 29, giving the lectern to experts such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The president and his point man on the issue, Vice President Mike Pence, can play a major role in educating people about the development of this epidemic, but they need to stick to the facts and stay on message.

The president did not do those things in a public meeting with an African American group, when he said the virus will eventually disappear “like a miracle,” or earlier, when he said a vaccine is being developed “fairly rapidly,” which to many people means weeks, not months. He also disputed the federal Centers for Disease Control and Prevention’s warning that outbreaks of the disease in the U.S. are inevitable, and then said Democrats and the news media are making too much of the matter, even using the word “hoax.” He seemed to be more concerned with the political impact of the virus than helping people control it. Likewise, Vice President Pence does not inspire high confidence in such matters, given his mismanagement of an outbreak of HIV among intravenous drug users in Southern Indiana. It took him too long to take experts’ advice.

Americans deserve better and should demand better. We need a voice of reason, backed by the best scientific minds in government such as Dr. Fauci, to reassure the nation that the public-health system knows what is happening, is able to predict what is likely to happen, and knows how to deal with the problem – all the while being driven by calm knowledge, concern and commitment, giving the nation a calming voice, not a political rant.

In Kentucky, past policymakers have neglected our local and state health departments. When we don’t provide adequate funding, we shouldn’t be surprised that they need additional resources in a crisis. When the crisis passes, we allow them to slowly lose that funding and are again surprised at their inability to deal with new problems. Several health departments in Kentucky are at the edge of closing their doors, due to the state pension crisis, and we seem little concerned about their ability to protect the public’s health. Perhaps concern about the new coronavirus will change that, if politicians behave properly.

F. Douglas Scutchfield, M.D., is the Peter P. Bosomworth Professor Emeritus in the Department of Health Management and Policy in the University of Kentucky College of Public Health. Al Cross is a journalism professor at UK, director of its Institute for Rural Journalism and Community Issues, and editor and publisher of Kentucky Health News.

Legislators repeat myths about flu vaccines, get subtly corrected by a colleague who is a doctor; disease remains a threat in Ky.

By Melissa Patrick
Kentucky Health News

With all the people who come through the state Capitol, and all of the handshaking that goes on there, especially when the Kentucky General Assembly is in session, it's no wonder the House opened Monday's session with a call for members to keep in mind the many who were absent due to illness, or that the flu was mentioned several times in the Senate.

But some senators demonstrated how politics and public health don't always match up.

Sen. Dennis Parrett, a Democrat from Elizabethtown, while recording votes that he missed while out with the flu, told his colleagues -- and everyone watching Kentucky Educational Television -- that the last two times he got a flu shot, he soon after got the flu, including this last time.

Parrett insinuated that the vaccine gave him the flu, but medical experts say that doesn't happen.

No one contradicted Parrett, and his remark prompted Senate President Robert Stivers, a Manchester Republican, to say from the dais, "I've never taken the flu shot, and I've never gotten the flu."

Sen. Ralph Alvarado (file photo from LRC Public Information)

Several moments passed before Sen. Ralph Alvarado, R-Winchester, a physician, stood up and said, "I'd like to encourage everyone if they have not gotten their flu vaccination to get one."

He noted that the flu has been particularly virulent this year and stressed that flu is one of the most preventable diseases because of the vaccine. "So people who are watching at home, please go out and get your vaccination," he said.

And to laughter all around, Stivers uttered the line typically used when routine announcements are made: "Members, please take note."

Flu myths and misconceptions

On the surface, what Parrett and Stivers said about the flu is no big deal. But from a public-health perspective, their comments repeated several persistent myths about flu vaccines, which have long been proven to be the best defense against this often serious disease. So far, flu has killed 80 Kentuckians during this season, which runs through May.

The federal Centers for Disease Control and Prevention says that unequivocally that a flu shot cannot give you the disease. The vaccines are produced in two ways, with an "inactivated" or killed flu virus, or by using only part of a flu virus. In other words, there is nothing in a flu vaccine that can infect you.

And while nasal-spray flu vaccines do have live influenza viruses, the CDC says they are weakened, and will not cause a person to get the flu.

One reason for this persistent myth is because the flu virus is constantly changing – which creates confusion and distrust of the vaccine – and some years the vaccine doesn't cover the most prevalent strain of the virus.

Another reason for this persistent myth is because the flu shot does not offer protection immediately, and takes at least two weeks to kick in. So when someone says they got the flu right after having a shot, it means they were exposed to the virus before they developed immunity. Or, someone may have been exposed to a flu virus different from the viruses that the vaccine is designed to protect against.

That said, some people do report a mild reaction to flu vaccinations. The most common reactions are soreness, redness, tenderness or swelling where the shot was given, but some report low-grade fever, headache and muscle aches.

The bottom line: The vaccine is about reducing your risk, not eliminating it. And even if you get the flu after getting a shot, chances are that your symptoms will be less bothersome than if you didn't get it.

And while Stivers has never had the flu, despite never getting a shot, that doesn't mean he isn't at risk of getting it in the future. Also, it's possible to be infected with the flu virus but have no symptoms.

And its not about Stivers or any other individual. Adults need vaccination to provide "herd immunity" for those who can't be vaccinated like babies and those who are immuno-compromised.

The CDC notes that the flu is highly contagious and can spread to people as much as six feet away, largely through the tiny droplets made when coughing, sneezing or even talking.

As Alvarado said, the best way to protect yourself from the flu is to get a yearly vaccine, and it's not too late, since the season usually runs through May. It is recommended that everyone over 6 months old get an annual flu vaccination.

Kentucky has a lot of room to improve its flu vaccination rates, especially among adults. The CDC reports that only 45 percent of Kentucky adults and 65% of the state's children got a flu shot last season.

Besides vaccination, there are other, simpler ways to protect yourself from the flu, a cold, or even the novel coronavirus.

Washing your hands properly is one of the most important ways you can keep from getting sick and spreading germs to others. It is recommended that you scrub your hands with soap and water for at least 20 seconds, or the length of time it takes to sing "Happy Birthday" twice.

Flu in Kentucky

For the last two months, Kentucky has seen about 2,000 new cases of flu a week, and the number of deaths from it continues to rise, with 14 more adults in the state reported to have died from the flu in the week that ended Feb. 22. That brought the state's total to 80 for the season. Four victims were under the age of 18, according to the state Department for Public Health.

The latest weekly report shows that in the week ending Feb. 22, Kentucky counted 1,943 new cases. During the flu season, 21,000 cases have been reported in Kentucky. The actual number of cases is higher, because not all flu cases are counted; flu does not have to be reported, and three counties did not contribute to the latest report. Here are the new cases recorded each week:

1,943 in week ended Feb. 22
1,854 in week ended Feb. 15
2,101 in week ended Feb. 8
1,815 in week ended Feb. 1
1,739 in week ended Jan. 25
1,544 in week ended Jan. 18
1,898 in week ended Jan. 11
2,213 in week ended Dec. 28
1,339 in week ended Dec. 21
814 in week ended Dec. 14
511 in week ended Dec. 7

Hotspots continue around the state, including: Barren County with 94 new cases, for a total of 1,147; Bullitt with 47, for at total of 842; Fayette with 53, for a total of 513; Floyd with 52, for a total of 248; Franklin with 49, for a total of 457; Greenup with 47, for a total of 296; Hardin with 44, for a total of 317; Jefferson with 679, for a total of 7,486; Knott with 52, for a total of 374; Oldham with 55, for a total of 508; Perry with 48, for a total of 1,056; Pike with 61, for a total of 1,111; and Warren with 55, for a total of 761.

MMWR = Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention

House passes bill to loan money to struggling rural hospitals; funding is still in the works, but sponsor appears confident

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Spurred to action when the hospital in his county said it was closing, state Rep. Danny Bentley filed a bill to create a loan program for financially distressed rural hospitals. It went from the House to the Senate without dissent Feb. 28, and Bentley voiced confidence that it will be funded.

Rep. Danny Bentley

House Bill 387 would allow the state Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available.

Loans could run 20 years and would be available to hospitals in counties with fewer than 50,000 people.

Bentley, R-Russell, said more than 60 hospitals would qualify for the loans, and 13 of them are vulnerable to closure. One is already closing: Our Lady of Bellefonte Hospital in his home town, a Greenup County suburb of Ashland.

Most questions about the bill dealt with funding. Bentley told Kentucky Health News that it will be funded. The next day, he said that while funding details are still in the works, "Let's put it this way: It's too important not to be funded."

The bill has a powerful co-sponsor, House Speaker David Osborne, R-Prospect. He told The Associated Press that funding could come from state bonds.

“It's the goal to help turnarounds when turnarounds are possible," Osborne told reporters. “That doesn't mean that we can save every hospital that is failing, just like we can't save every business that's failing. But there are some, when given the opportunity, that can succeed, and that's our goal ... to help those that can."

Osborne told the AP that the idea stems from discussions about the state's proposed $35 million loan to the University of Louisville to help it buy Jewish Hospital and other KentuckyOne Health facilities that were at risk of closing. He said concerns were voiced about how the state could also help struggling rural hospitals. The House has passed HB 99, which would approve the loan.

On the House floor, Bentley pointed to the closing of the only hospital in his county as an example of how devastating the loss of a rural hospital can be. Our Lady of Bellefonte will close on April 30, according to a press release from the Catholic group that owns it.

Bentley said that will kill about 1,000 jobs and about $700,000 in annual tax revenue, and make care less accessible. He added, "If they close a rural hospital on us, they will never re-open them. So we've got to be concerned."

If passed and signed into law, HB 387 would take effect immediately. Many rural hospitals in Kentucky are struggling to keep their doors open.

Kentucky Health News reported in October that a Navigant Consulting Inc. study concluded that 16 of Kentucky's rural hospitals, or about one-fourth of the total, are at high risk of closing unless their finances improve. Another study at the University of North Carolina said eight rural Kentucky hospitals are at high risk of financial distress and 23 more are considered to have mid-high risk. The Kentucky Hospital Association, using 2017-18 data, concluded that 35 of the 70 hospitals it considers to be rural are in poor financial health, with 14 of them "very vulnerable." The numbers vary because the studies measure financial distress differently.

Five rural Kentucky hospitals have closed since 2009, four of them since 2014, according to a UNC report.

Bentley said one reason rural hospitals struggle to make ends meet is because most of their patients are on Medicare or Medicaid, which pay less than the full cost of care.

But that's just part of the problem. The Navigant report pointed to other issues, including: a shift from inpatient to outpatient care, which has left hospitals overstaffed and underused; shrinking populations that tend to be older and poorer, meaning that there are more Medicaid and Medicare patients; and not enough money in their budgets to invest in updated, innovative technology.

The hospital association also says changes in federal reimbursement policies have also hurt Kentucky hospitals. It supports Bentley's bill.

KHA President Nancy Galvagni said in an e-mail. "We do not expect HB 387 to be a panacea for the challenges facing some rural hospitals, but it will be an important support for both the hospitals and for our rural communities." She added, "Kentucky’s hospitals are not just buildings where people seek health care; they are also crucial economic players in our communities across the commonwealth."

Study: Rural women with ovarian cancer are more likely to be diagnosed later, but not because of greater distance to doctors

Rural women who have ovarian cancer are more likely to find out about it when it's already at stage IV than women who live in metropolitan areas, according to a study just published in The Journal of Rural Health.

That matters, because early detection makes survival more likely. From 2000 to 2015, the five-year survival rate of stage IV ovarian cancer was only 29 percent. The American Cancer Society estimates that 23,000 women were diagnosed with ovarian cancer in 2019, and about 14,000 died or will die from it. That includes 280 new cases in Kentucky, and 190 deaths.

Researchers at the University of Iowa and the Centers for Disease Control and Prevention studied about 1,000 women in Iowa, Kansas and Missouri who had been diagnosed with ovarian cancer in 2011-12. At the time they were diagnosed, 111 had stage IV and 889 had stages I-III. Stage IV patients were more likely to be older, rural, and have other health problems.

It is tempting to attribute that difference to poverty, or to difficulty in accessing care, but the study controlled for those factors. Rural women were more likely to be diagnosed with late-stage ovarian cancer regardless of the socioeconomic status of their census tract or the distance to their primary-care provider.

This disparity also isn't likely related to lifestyle factors such as smoking, obesity, or lack of physical activity; though such factors are more prevalent in rural areas, they aren't prominent risk factors for ovarian cancer. And though such lifestyle factors could create a higher incidence of cancer, they aren't likely to create geographic-survival or diagnostic disparities, researchers said.

Rural cancer patients generally have poorer outcomes than non-rural patients, including a lower survival rate. That's true of rural ovarian-cancer patients too, probably because of less access to specialty care and treatment after diagnosis.

The researchers suggest that if rural women had better access to gynecological specialists in urban areas, it could make a difference, since those doctors are highly trained and may be able to recognize the symptoms of ovarian cancer sooner than other health-care providers.

State House passes 25% tax on electronic cigarettes

By Melissa Patrick

Kentucky Health News

FRANKFORT, Ky. -- A bill aimed at reducing teen use of electronic cigarettes by increasing their price passed the state House 75-17 and went to the Senate Feb. 26. The bill would place a 25 percent wholesale tax on the products.

State Rep. Jerry Miller

The bill's sponsor, Rep. Jerry Miler, R-Louisville, told the House that youth use of e-cigarettes is "creating a crisis" and "The most effective way to attack underage use is through raising the price."

The Kentucky Incentives Prevention Survey found that from 2016 to 2018, Kentucky teenagers nearly doubled their e-cigarette use, with more than one in four high-school seniors and one in seven eighth-graders reporting use in 2018.

House Bill 32 would also raise the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigarettes to that list. It would also double the per-unit tax on chewable and non-smokable products, but does not increase the tax on traditional cigarettes.

Gov. Andy Beshear proposed a 10-cent-per-pack hike in the cigarette tax, estimated to raise nearly $40 million for the next two-year state budget.

Miller said his bill is projected to bring in nearly $50 million. He said the amounts were increases "that a large manufacturer" said it could live with without opposing the bill.

The original bill called for a 27.5% wholesale tax on e-cigarettes, which are the only tobacco products in Kentucky that does not have an excise tax. That would be equivalent to the current tax in cigarettes.

Terry Brooks, executive director of Kentucky Youth Advocates, applauded the bill's passage, but asked that the Senate go to 27.5%, "to make a real impact for young people." 

"E-cigarettes put our young people at risk of nicotine addiction, serious lung injury or disease, and other harmful outcomes," Brooks said in a prepared statement. "A tax on e-cigarettes equivalent to that on cigarettes is a proven way to prevent usage among youth and can reduce future healthcare costs and provide additional revenue for the state budget."

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said the 25% tax was close enough to the cigarette tax to reduce youth use of the products. Chandler noted that after the state raised the cigarette tax 50 cents a pack, to $1.10, in 2018, annual sales dropped 36 million packs.

Miller is also the sponsor of House Bill 69, which would add a long list of regulations to e-cigarettes. It passed out of committee on Feb. 12, but has not yet been called up for a House vote.

Representatives from the Kentucky Smoke Free Association, which represents about 400 independent vape shops statewide, told lawmakers at the bill's committee hearing that while they support the added regulations in HB 69 because they address teen-access issues, they did not support the tax because it would hurt their businesses and would discourage adults from using their products as a smoking cessation device.

A recent U.S. Department of Health and Human Services report says more research is needed before it can be concluded that e-cigarettes help people stop smoking.

Bill to help people with addictions get medication-assisted treatments moves; advocates say insurers killed the last one

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to help people with opioid and alcohol addictions to get prescription drugs to treat their substance-use disorders -- the recognized standard of drug treatment -- passed unanimously out of committee Thursday and now heads to the full House.

Kimi Banta, Rep. Kim Moser, Dr. Shawn Ryan in committee

House Bill 389, sponsored by Rep. Kim Moser, R-Taylor Mill, would ban the requirement of "prior authorization" for any prescription drug that is used in the treatment of alcoholism or opioid-use disorder that contains methadone, buprenorphine or naltrexone, which are the recommended first courses of treatment for most patients.

Under prior authorization, insurance companies require health-care providers to get the insurer's approval for certain drugs and procedures before they can be administered.

"Your treatment could be delayed anywhere from several hours to several weeks because of the prior authorization rules that insurance companies have in place," Moser told the House Banking and Insurance Committee. "Ultimately, your health-care provider knows what is best for you . . . but unfortunately, they are not always the ones to make the final decision."

Starting Jan. 1, a law passed during the last legislative session gave insurers five days or less to give or deny approval of a drug, allowing some maintenance drugs used to treat chronic conditions to be approved for up to a year.

Moser, whose main job between 2014 and 2018 was Northern Kentucky director of the state Office of Drug Control Policy, talked about the dangers such delays have for people with addictions, often resulting in relapse or death from overdose.

She also said immediate access to these "life-saving treatments" is imperative because the window for when a person is ready and willing to seek treatment for addiction is often very short.

"The evidence is clear, treatment works," she said. "It helps keep people out of jail, it helps them stay in jobs, it helps them be productive members of society and family members, but most importantly, it saves lives."

This claim is well supported. Most recently, a study published Feb. 5 in JAMA Network Open compared six treatment plans for nearly 41,000 adults with opioid-use disorder between 2015 and 2017 and found that patients who were treated with buprenorphine or methadone were 76 percent less likely to overdose within three months and 59% less likely in 12 months, compared to those who did not get these drugs but participated in other types of treatment.

The same patients were 32% less likely to go to the emergency room or be admitted to the hospital in three months, and 26% less likely in 12 months.

Only 12.5% of the patients in the study were prescribed buprenorphine or methadone, citing a lack of access to doctors who can prescribe those drugs; high co-payments; prior-authorization requirements; "and other restrictions on use," the study said.

Kimi Banta of Louisville told the committee that as an alcoholic and an addict in recovery, "Medically assisted treatment has saved my life."

She said "after years and years of failed attempts to stop my drug use," she was prescribed Suboxone, which is a combination of buprenorphine and naloxone, a drug that reverses an opioid overdose, and that has allowed her to stay sober for two years and rebuild her life.

"I am a changed person and Suboxone bought me the time to do it all," she said. "More Kentuckians deserve this opportunity and should not have to jump through hoops to get medication that can change their life and their families life. This bill will save lives."

Moser, who chairs the House health committee, said the bill is supported by American Medical Association, the Kentucky Medical Association, the American Society of Addiction Medicine, the Kentucky Society of Addiction Medicine and treatment providers everywhere.

KMA President Dr. Brent Wright said in a news release, "This legislation will remove a critical barrier to ending Kentucky’s ongoing overdose and death epidemic. We support this bill because it will save lives."

A similar measure passed the House 97-0 last year, but was not given a hearing in a Senate committee. The joint  KMA and AMA news release says last year's bill "was ultimately defeated by opposition from health-insurance companies."

Kentucky's Medicaid program and some insurance companies have voluntarily lifted prior authorization for some medication-assisted treatments. Moser said her bill would codify this requirement for all three drugs in the Medicaid system and with private insurers.

Moser told Kentucky Health News, "There are patients who when they are ready for treatment for their addiction, they need these medications right away so that they don't go back out and use and overdose and die -- and we are seeing that. That's why [this bill] is so critical."