When health officials talk about strong measures to 'flatten the curve' to fight the coronavirus, this is what they're talking about

Measures that are being called "drastic" and "extreme" are necessary to keep the coronavirus and its covid-19 disease from overwhelming the U.S. health-care system, according to health experts and public officials. This chart roughly illustrates what happens when there is no action against a pandemic, and what happens when interventions flatten the transmission of the virus to a point where the health-care system can cope with it. It shows a somewhat idealistic scenario; The New York Times has an interactive version of this chart, with various scenarios.

Teleconference on Tuesday, March 17, will cover prevention and treatment options for covid-19, the coronavirus disease

The Commonwealth Fund will host a teleconference briefing at 12:30 p.m. ET Tuesday, March 17 for journalists and policymakers to discuss prevention and treatment of the coronavirus disease, covid-19. The call will last about an hour. Register here.

Experts will cover these topics:

• What policy tools do the federal government and states have at their disposal to address the pandemic, and what actions have they taken so far? 
• How can we expand coverage and access to care through Medicaid, and how can we work with insurers so that no one is deterred from seeking needed treatment?
• What role could emergency federal powers play, and where could they fall short?

The call will be conducted by:

• Kevin Lucia, J.D., M.H.P., research professor, Georgetown University Center on Health Insurance Reforms
• Sara Rosenbaum, J.D., Harold and Jane Hirsh Professor of health law and policy, George Washington University Milken Institute School of Public Health
• Moderator: Rachel Nuzum, M.P.H., vice president, federal and state health policy, The Commonwealth Fund

The Commonwealth Fund is a nonprofit dedicated to improving health care and making it more affordable and accessible to all Americans.

Three anti-abortion bills advance in General Assembly

Rep. Joseph Fisher

The Kentucky House of Representatives passed two anti-abortion bills March 10, one to amend the state constitution to say that it grants no right to abortion, and another to expand the power of the Kentucky attorney general to regulate abortion facilities.

House Bill 67, sponsored by Rep. Joseph Fischer, R-Fort Thomas, would have the constitution say, "To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion."

The bill went to the Senate on a vote of 71-21. If approved there and by voters this fall, it would be effective only if the U.S. Supreme Court overturned its 1973 Roe v. Wade decision. He said it would "end the slaughter of unborn children in Kentucky," Joe Sonka reports for the Louisville Courier Journal.

Several Democratic legislators spoke against the bill, reading the testimony of opponents who were cut off by the committee chairman after only seven minutes when the bill was in committee.

Rep. Patti Minter, D-Bowling Green, called Fischer’s bill “blatantly unconstitutional” and a “grave violation of individual liberty.” She noted that the bill has no exceptions for “victims of rape, for those who have survived incest, [or] to save the life of the mother.” To pass such an amendment, she said, is “exceptionally cruel." Fisher said the legislature could provide exceptions by law.

House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, would expand the power of the attorney general to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations. This bill went to the Senate on a 70-23 vote.

Current law only allows the attorney general this power if action is requested by the Cabinet for Health and Family Services, which licenses and inspects health facilities. But for the first time ever, the executive branch is run by Democrats and the attorney general is a Republican: Daniel Cameron, who opposes abortion rights.

Rep. Stan Lee

Lee said his bill “simply allows the attorney general to step in and act as a special prosecutor as his office does all over the state currently in any number of cases.”

Rep. Mary Lou Marzian, D-Louisville, called the bill a “power grab,” saying Kentucky women “do not need a special prosecutor to come at them for myriad reasons that will, in the end, be very political ones . . . not connected to our health,” Alex Acquisto reports for the Lexington Herald-Leader. Lee countered that a special prosecutor was needed to protect the “unborn babies that are killed,” Sonka reports.

The next day, a Senate bill, called the "Born Alive Infant Protection Act," to require health care providers to do everything possible to save the life of a baby who is born alive, was approved by the House Judiciary Committee. It is posted for passage in the full House.

Senate Bill 9, sponsored by Sen. Whitney Westerfield, R-Hopkinsville, would require health-care providers to give "medically appropriate and reasonable life-saving and life-sustaining medical care and treatment" to any infant born alive, including after a failed abortion, and would make not doing so a felony. The bill was amended to remove any reference to research, so it would not inhibit ongoing research.

Sen. Whitney Westerfield

Westerfield said the bill is not specifically tailored to abortion, but Jackie McGranahan of the American Civil Liberties Union of Kentucky said it "does not accurately reflect how abortion works and it's based on false claims. . . . This bill perpetuates stereotypes about abortion, the women who receive abortions and the doctors who care for them."

Rep. Maria Sorolis, D-Louisville, said she was "really troubled" by the bill. "We have laws in this state that prevent killing anything that breathes on its own, they call it murder," she said. "So we don't need this bill; it's already on the books, because the minute a pregnancy ends and a human being is born, they have all the full protections of this state."

Further, she said the bill doesn't account for palliative care and would strip away the rights of parents to make difficult palliative decisions when they are told that their infant will not live or will not have quality of life. "I am appalled that you would try to do this to an infant," she said.

Asked why he didn't think our current laws were sufficient, Westerfield said this bill wasn't about whether such a situation has ever happened, but about its possibility. He said a constituent told him they had to argue with their physician to have their premature child cared for.

Sorolis asked what the parameters of the bill were, noting that the bill doesn't define care.

"This bill doesn't just provide food, water, the things that are basic human needs. This provides that the parents totally lose their right to make a decision about what is best for their child," she said. "And how do we extrapolate that when we have parents, for example, who refuse medical care based on religious principles? How do we decide for them that the state gets to usurp your religious convictions and require that you do these extreme measures?"

Westerfield said he didn't think his bill strips parents of their rights, "except to the extent that they can't have their child killed." He said the bill does not change the standard of care, but only requires that care be provided. It cleared the committee 16-4, with two members passing.

As covid-19 cases grow, Beshear tells those over 60 not to fly or take cruises; health chief gives advice on when to see a doctor

Kentucky Department for Public Health chart; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

Kentucky has confirmed two more cases of covid-19, the disease caused by the new coronavirus, bringing the state's total to six. All of the patients are in isolation, Gov. Andy Beshear said.

"As time goes on, we will have more cases," Beshear said. "We need to expect that."

Three cases are in Harrison County, where the first case was confirmed Saturday. Two are in Fayette County and one is in Jefferson County. A March 9 news release says that Kentucky has done 34 tests, with 28 of them coming back negative.The figures are updated at kycovid19.ky.gov, along with other information about the virus.

Saturday, the U.S. Centers for Disease Control and Prevention recommended that all Americans over 60 or those with heart, lung or kidney disease avoid public gatherings. Monday evening, Beshear also advised those 60 and older against flying or taking cruises.

Dr. Steven Stack, Kentucky's public health commissioner, offered some advice on when a person should go to the doctor at a morning news conference.

He said if you are "worried, but well," do not go to a hospital, emergency room or doctor's office -- stay home. If you are feeling ill, but otherwise would not have sought out medical care, do not seek care at an ER, hospital or doctor's office. If you need advice, call the state hotline at 1-800-722-5725 or call your local health care provider. If you are sick and feel you have an emergency, call your doctor or seek medical care.

“For 80 percent or more of people who get infected, you are going to be just fine. You’ll probably either have cold symptoms or no symptoms,” said Stack.

Beshear said in the news release, “I know many people are concerned, but I want Kentuckians to know the risk remains low and there is no need to panic. Everyone can help protect themselves, their loved ones and their communities by taking simple measures to reduce their risk.”

Those measures include: washing your hands with soap and warm 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; do not visit with seniors or people with chronic health conditions if you are sick; cover your cough or sneeze with a tissue and then throw it away; get a flu shot; and clean and disinfect frequently touched objects and surfaces. It is also suggested to engage in social distancing, which means trying to stay six feet apart.

At a Monday news conference, Dr. Nancy Messonnier, director of the CDC National Center for Immunization and Respiratory Diseases, emphasized that older Americans are at the highest risk for a serious infection of the coronavirus, and that so far only about 2 percent of infected patients were people younger than 19. She was using data from China that analyzed more than 70,000 cases of covid-19.

"This seems to be a disease that affects adults," she said.

She said the study found 80% of those infected had a mild case of covid-19 and recovered, and 15 to 20% had a serious illness, with those 60 and older and those with underlying health conditions at the greatest risk of serious illness. She said the greatest risk of serious illness and death was among those 80 and older.

The state has not recommended that schools or public gatherings close at this time, though schools can make that decision.

Harrison County has decided to close through at least March 13, while Fayette and Jefferson counties have decided to stay open. A Jefferson County Public Schools tweet said Monday, "Dr. Sarah Moyer -- health department director -- says several factors would have to be present before @LouMetroHealth would recommend closing schools, the biggest being wide spread of virus between children."

Beshear said the first covid-19 patient in Kentucky is an employee at the Walmart in Cynthiana. Crystal Miller, the county's public health director, said that six other employees have self-isolated, but have not shown any symptoms. Beshear said there was no reason not to visit the Cynthiana Walmart "right now." .

WLEX-TV published a statement from Wal-Mart Stores Inc. that says, in part, "Upon learning about the case from health officials we reinforced our cleaning and sanitizing protocols with guidance from Walmart’s chief medical officer."

To make sure factual information about covid-19 reached all of its citizens, The Cynthiana Democrat worked through the weekend to be able to send a special edition today to every mailbox in Harrison County.

Cynthiana Mayor James Smith told The Rural Blog he thought this was a good idea because ""Not everyone, especially in a rural county like Harrison County, has internet connection; not everybody is on Facebook; not everybody listens to the local radio," and some watch TV stations based in Cincinnati, not Lexington. "Some people in the county didn't even know we had a case in the county."

Beshear said that two of the Harrison County patients were linked and that a travel history was found in only one of the individuals.  He added that they believe that  Kentucky is experiencing some "community spreading."  People can get the virus and display no symptoms, and can pass it along for days without showing symptoms

“We believe, and this seems to be the case nationally, that this is community spreading, spreading from person to person,” he said. “Again that has been expected, we are ready for it, it is what we always thought that we would see with this novel coronavirus.”

Beshear issued an executive order Monday to waive all cost-sharing, including co-payments, coinsurance, and deductibles for screening and testing for covid-19, to waive any prior authorization requirements for screening and diagnostic testing for covid-19, and to allow insured individuals to obtain refills of their prescriptions early, with approval of the provider. It also requires insurers to ensure that provider networks are adequate to handle an increase in the need for care, including by offering access to out-of-network services where appropriate. The order applies to both private and state insurers, and will remain in effect for the duration of the state of emergency.

The governor has also removed any impediments, like prior authorizations,  for treatment of Medicaid patients for anything related to coronavirus.

He has also issued an executive order to prohibit price gouging. If Kentuckians have information regarding possible price gouging call the attorney general's consumer protection hotline at 888-432-9257.

Two days after state's first covid-19 case is confirmed there, weekly paper sends a special edition to everyone in its county

The four-page edition was printed on thicker,
whiter paper for easier handling and retention.

By Al Cross
Kentucky Health News

A weekly newspaper in Kentucky is setting a great example for the rest of the nation of how to deliver reliable information about the new coronavirus.

After working through the weekend, The Cynthiana Democrat sent a special edition today to every postal patron in Harrison County, where the first case of covid-19, the disease caused by the coronavirus, was confirmed Saturday. Another was announced Sunday.

The idea arose as Editor Becky Barnes rode with Cynthiana Mayor James Smith and County Judge-Executive Alex Barnett from a state Capitol press conference Gov. Andy Beshear held Saturday to announce the first case.

"I said, there's just so much information that needs to get out there," Barnes recalled, "because there's so much misinformation."

Barnett said he told Barnes and Smith, "Let's get it in every mailbox in the county and we’ll come up with a way to pay for it."

Smith said, "We talked about what should be in there, and decided how it should go to every household in the county," which has 18,000 people and "probably 6,000 households."

Becky Barnes, in 44th year at the paper

Smith said he thought it was a good idea because "Not everyone, especially in a rural county like Harrison County, has internet connection; not everybody is on Facebook; not everybody listens to the local radio," and some watch TV stations based in Cincinnati, not Lexington. "Some people in the county didn't even know we had a case in the county."

Newspapers can reach everyone in their home counties quickly because postal regulations allow them mail up to 10 percent of their annual circulation in their home county to non-subscribers at subscriber rates. It's a way to build and maintain print circulation, but many papers don't take advantage of it.

Harrison County (Wikipedia map)

Barnes was familiar with the idea, because The Cynthiana Democrat published a sample-copy edition after a 1997 flood in Harrison County. Her paper is owned by Landmark Community Newspapers, which regularly uses sample copying, and has a press in Cynthiana. That made it easier to print on Sunday and mail as soon as possible.

This is an example for the whole country. Printed community newspapers have a high level of trust with their readers, and are ideal vehicles to circulate reliable information on a topic that has become the subject of false or misleading online information and political talking points.

To make sure it reached everyone in the county, Barnes said, the paper went beyond the usual sample copying, sending (at extra cost) papers to patrons of post offices that are in other counties but serve Harrison County residents. It also provided copies to Harrison Memorial Hospital, which first treated the first patient found to have the disease and draws patients from adjoining counties.

So, who's paying for the printing and mailing of the special edition? Local officials are looking into funding sources, but say they will come up with the money if they have to. "We asked the postmaster if he could bill us later," Smith said. "We told Becky that, as a city, if the money doesn't come from other sources, the county and the city would figure out how to pay."

Smith concluded, "Hopefully, we're setting some examples for other communities."

Editorial: suicides a growing health threat in Hardin County, but many are reticent to seek help

Suicide is an increasing phenomenon in Hardin County, and such deaths are more than statistics, writes the editorial board of The News-Enterprise in Elizabethtown: "Our neighbors are hurting. Mental illness, depression, sub­stance abuse, desperation, whatever the cause, these are real issues which, without proper attention, can become a preventable death. Some people need medication. Others counseling or another form of professional treatment. In many cases, support groups have help people find ways to cope with their personal demons."

All people struggling with suicidal ideation need support and encouragement, but many are reticent to seek help, so we must be on watch for unusual behavior and care enough to reach out to our friends, family and neighbors, the board writes.

The National Suicide Prevention Lifeline is 1-800-273-8255.

Nearly 2/3 of Ky. adults with guns at home keep them loaded and unlocked; 15% with children have loaded, unlocked guns in them

Kentuckians increasingly keep their guns loaded, and almost two-thirds who keep them loaded are not locking them up, according to a recent survey.

Kentucky Health Issues Poll chart; for a larger version, click on it

The Kentucky Health Issues Poll, taken Oct. 15-Dec. 6, found that 55 percent of Kentucky adults keep guns in or around their homes. Almost half of that group, 48%, said they were loaded, compared to 35% in 2011.

Among adults who live in a home with a child, the percentage with guns was virtually the same, 56%, but only 28% said their firearms were loaded. But 15% of those with children at home said their gun was both loaded and unlocked.

Those numbers haven't changed since 2016, says the report. And the number of Kentucky adults who reported they kept loaded and unlocked guns in their homes, 64%, is also nearly the same as the KHIP results in both 2011 and 2016, when the same questions were asked. "Neither the proportion of homes with unlocked, loaded guns nor the percentage of such homes occupied by children has improved since 2011," said a news release from the Foundation for a Healthy Kentucky, co-sponsor of the poll. Safety and health experts recommend keeping guns and ammunition in separate locations.

"We're not making any progress in the most basic step that gun owners can take to protect against tragic and often deadly accidents," Ben Chandler, president and CEO of the foundation. "Locking up your guns and keeping the ammunition in a separate place is recommended by multiple child-health and safety organizations to keep them out of the hands of kids who are either just curious or seriously considering harming themselves or others."

Kentucky law neither requires guns to be locked nor imposes criminal liability for negligent firearm storage, even if a child gains access to the firearm and causes an injury or death, according to the Kaiser Family Foundation.

The share of Kentucky adults with guns at home is higher than the national average of 42% that was reported by a 2017 Pew Research Center poll.

Responses to this question in the Kentucky poll varied by region, with adults in more rural areas of the state more likely to report having a gun. In Eastern and Western Kentucky, respectively, 67% and 63% reported having a firearm in or around their home. The figure was 52% in the Lexington area, 48% in Northern Kentucky and 40% in the Louisville area.

Men were more likely than women to report having a firearm in or around their home: 65% and 47%, respectively.

The poll was funded by the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,559 Kentucky adults via landlines and cell phones. The margin of error for statewide results is plus or minus 2.5 percentage points.

In 2018, the Centers for Disease Control and Prevention reported that 762 Kentuckians died because of a firearm, including suicides, homicides and unintentional injuries. That was a rate of 16.9 deaths per 100,000 people, 13th highest in the nation.

Centers for Disease Control and Prevention chart; click on it for a larger version

Three anti-abortion bills advance out of legislative committees

Three abortion bills advanced in the legislature last week, one to give the state's attorney general more power to enforce abortion laws, one to require fetal remains to be buried or cremated after the procedure, and one to give the state auditor power to audit reports about abortions.

Abortion-rights supporters dressed as characters from "The
Handmaid's Tale" at the  March 4 House Judiciary committee,
which passed two abortion bills. (Photo by Melissa Patrick) 

House Bill 370, sponsored by Rep. Nancy Tate, R-Brandenburg, would require abortion providers to either cremate or bury aborted fetuses in a licensed funeral facility. Parents could also decide the final disposition of the fetal remains.

“The abortion provider currently has to provide for the disposal. This is merely directing respectful disposal as opposed to being incinerated with other medical waste,” Cathie Humbarger, an abortion opponent with Northeast Indiana Right To Life, told the House Judiciary Committee March 4.

HB 370 is similar to a 2016 Indiana law that was upheld by the U.S. Supreme Court last year.

No one spoke against the bills, though abortion-rights activists sat in the audience wearing white bonnets and red robes like characters from "The Handmaid's Tale," the dystopian novel and award-winning Hulu show in which women are treated as property of the state and forced to bear children. 

The committee also approved House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, would expand the power of Attorney General Daniel Cameron, an anti-abortion Republican, to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations.

Current law only allows the attorney general this power if it requested by the Cabinet for Health and Family Services, which licenses and inspects health facilities.

"Several committee members expressed concern about expanding these powers, with Rep. Maria Solaris, D-Louisville, asking about the potential for a "rogue attorney general." Lee said the courts could handle such problems," Deborah Yetter reports for the Louisville Courier Journal. 

Cameron is the first Republican to hold the office since 1947, and "many of his staff members worked in former Republican Gov. Matt Bevin's legal team, defending abortion restrictions in several high-profile legal battles and attempting to close the state's only abortion facility," Ryland Barton reports for Louisville's WFPL.

Since taking office in December, Democratic Gov. Andy Beshear has ended the state's licensure battle with abortion providers and allowed Planned Parenthood of Indiana and Kentucky to offer abortions in Louisville.

Tamarra Wieder of Planned Parenthood told Yetter that the group chose to remain silent after members were cut off from speaking at a recent hearing on another abortion bill, with the chairman saying the committee was out of time.

"Today was a statement about how we've been treated in the past," said Wieder, the organization's public affairs and policy director. "It's a statement on the power grabs that are taking place around Kentucky on reproductive health."

Kate Miller, with the American Civil Liberties Union of Kentucky, told Yetter afterward that her organization also opposes both bills as "a continuing effort to force every Kentuckian to stay pregnant against their will."

State Auditor Mike Harmon and Rep. Stan Lee present Lee's
bill to let the auditor audit abortion reports. (Melissa Patrick photo) 

House Bill 391, also sponsored by Lee, would  expand the state auditor's powers to audit reports about abortions, including audits of whether facilities that perform abortions are following state requirements to report all abortions to the state Office of Vital Statistics.

It was approved March 5 by the House Health and Family Services Committee.

Yetter reports in a separate article that the bill prompted "heated debate, largely along party lines, about it's true purpose."

"Rep. Tom Burch, D-Louisville, questioned whether the measure is a Republican "method of harassing providers" by the party of Ronald Reagan, the president who argued for smaller government.

Lee said it is to ensure abortion statistics are being reported accurately, citing Reagan's famous "'trust but verify' comment about nuclear disarmament with the former Soviet Union," Yetter writes. Lee said, "I would like to think that this piece of legislation is verifying abortion providers who are taking the lives of unborn babies are complying with the law."

Several Democratic women on the committee questioned why abortion clinics, already regulated by the health cabinet, would fall under the purview of the state auditor; one questioned why the auditor, whose main role is to ensure proper use of public funds, was being called to audit facilities that get no state money; another asked Lee and state Auditor Mike Harmon what other private entities his office investigates, and got no direct answer.

Yetter writes, "State law requires any facility where an abortion is performed to report information including the age, race and state of residence of the patient; age in weeks of the fetus; and the type of abortion, such as surgical or by medication. It does not include reporting any identifying information regarding the patient."

An annual report required by law shows that 3,203 abortions were reported in Kentucky in 2018, 18 of them at hospitals and the rest at EMW Women's Surgical Center in Louisville, the state's only abortion clinic.

Jackie McGranahan of ACLU-Kentucky, spoke against the bill, saying she believed it was part of an effort "to make abortions inaccessible to all Kentuckians."

This prompted Rep. Robert Goforth, R-East Bernstadt, to suggest strongly that McGranahan violated the oath she took to tell the truth before testifying. When McGranahan tried to reply, Goforth cut her off more than once before saying "That's your opinion."

Tamarra Wieder of Planned Parenthood, told Yetter that the bill is part of an ongoing effort by the legislature to erode reproductive rights and to expand authority over abortion. "It is a chilling prospect for the future of abortion in Kentucky," she said. At least eight anti-abortion bills are being considered in this legislative session.

First Ky. case of coronavirus disease found; clinicians suspected it, but patient didn't qualify for testing when testing was hard to get

Crystal Miller, head of the health department serving Harrison County, at a press conference Saturday. Others, L to R:  Gov. Andy Beshear; Health Commissioner Steven Stack; Harrison County Judge-Executive Alex Barnett; Cynthiana Mayor James Smith; and Mark Newman, head of UK HealthCare.

This story was updated at 8 p.m. Sunday.

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky found its first case of the new coronavirus, in Harrison County, on Saturday, and Gov. Andy Beshear advised residents of the county to avoid crowds. Sunday, he announced that the county had another case, and that Louisville and Lexington each had one.

Beshear's advice came on the same day that the U.S. Centers for Disease Control and Prevention recommended that all Americans over 60 or those with heart, lung or kidney disease avoid public gatherings. Seniors and people with underlying medical conditions are more vulnerable to the virus.

The governor said the patient had been treated at Harrison Memorial Hospital in Cynthiana, and the University of Kentucky said the patient is now in isolation at UK Chandler Hospital. Beshear said the patient was in serious condition but is improving. "There is no cause for fear at this time," he said.

The hospital said the patient was treated for "flu-like symptoms" and when those didn't subside, the patient was tested further but the state Department for Public Health "determined the patient did not qualify for testing" for the coronavirus. However, "due to the patient's condition," hospital clinicians admitted the patient "into a negative-pressure isolation room," to prevent spread of any viruses. "From there, the patient was transferred to a tertiary care facility," meaning UK.

State Health Commissioner Steven Stack said in an email to the Louisville Courier Journal Saturday night, “Like other states, Kentucky has been following the CDC guidelines for who and when to test. This individual was tested when CDC guidelines and clinician judgment determined testing was medically indicated.”

The Washington Post reports, "Even where test kits are available, many states are following strict criteria for who should be tested to avoid overwhelming their labs."

Stack said earlier Saturday, "The state of Kentucky has all the test kits it needs to test everyone we need to test at this time." With commercial laboratories soon doing tests, "We hope that very soon people will be able to seek routine medical care and get a test . . . just like they would for the flu."

Harrison County (Wikipedia map)

State and local officials said they expect Harrison County to have more cases, and Beshear said the county's schools would close for "at least a portion of a week if not a full week," as health officials had recommended. "We would advise that public gatherings be delayed," and that nursing homes be closed to visitors, he said.

"We are not advising the closing of any business," Beshear said. "What we are suggesting is engaging on social distancing, trying to stay six feet apart, and then practicing good hygiene, practicing really, really good hygiene: washing your hands, washing them well, washing them a whole lot more than you might have a month ago, and making sure that if you are sick, anywhere in Kentucky but especially in Harrison County, do not go to work."

The virus causes a disease that has been named covid-19, for "coronavirus disease 2019." Symptoms may include fever, cough or shortness of breath, and may appear in as few as two days or as long as 14 days after exposure.

Health officials continue to stress that washing hands with soap and warm water for at least 20 seconds is the best way to prevent transmission of the virus because it is mainly transmitted by tiny droplets from sneezes and coughs. Other suggestions include:

• 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; especially do not visit with seniors or people with chronic health conditions if you are sick. 
• Cover your cough or sneeze with a tissue and then throw it away. 
• Get a flu shot. There is no vaccine for the new coronavirus, but the flu vaccine can boost resistance to it.
• Clean and disinfect frequently touched objects and surfaces.

The U.S. Environmental Protection Agency has released a list of EPA-registered disinfectant products for use against the coronavirus. The EPA's news release says coronaviruses are one of the easiest types of viruses to kill with the right disinfectant.

Beshear said that the threat posed by the virus is still low, but that he declared a state of emergency Friday to make sure the state has access to all of the resources available to it. He and other officials advised calm.

"We've gotten through this just like this, or even worse, in the past," said Dr. Steven Stack, commissioner of public health. He advised against general use of face masks, or hoarding them, which could leave health care short.

Role players include consumers, employers, Congress

At UK HealthCare, “Supplies of personal protective equipment are exceedingly low, and many items are on back order,” UK Executive Vice President for Medical Affairs Dr. Mark Newman told employees, asking them, "Please be frugal."

Beshear said he has invoked, for preventive and related items, the state law against price gouging, and has asked Attorney General Daniel Cameron to enforce it. Cameron issued a call for residents to report cases of price gouging by calling his office's consumer protection hotline, 1-888-432-9257.

Dr. Crystal Miller, director of the WEDCO District Health Department, based in Cynthiana, said employers should take preventive measures: "I urge you to be flexible in everything that you do; be creative," she said. "If your employees are sick, please be flexible with them."

Beshear has urged employers who don't offer sick leave to grant it, to limit the spread of the virus. He said Saturday that the state will offer its employees more sick leave than they have accumulated.

The state recently started doing its own testing for the virus, with four positive results out of the 21 tests done through midafternoon Sunday. The figures are updated at kycovid19.ky.gov.

U.S. Sen. Mitch McConnell announced Friday that Kentucky would receive at least $7 million to fight the coronavirus. This money is part of a special $8.3 billion appropriations bill President Trump signed that day. McConnell's news release said the funding "will be provided to state officials who will determine how the resources will be distributed."

Asked Thursday if any of the money could be used by  health departments to help fund their efforts in controlling the virus, Beshear said, "I am committed before this legislature ends or through any other powers that I have in making sure that we have sufficient funding to meet the threat. . . . This shows how important our local health departments are, doesn't it? We haven't appreciated those as a state in far too long and I think this serves as a reminder about how absolutely critical they are."

"The number of public health workers in Kentucky fell from 3,449 in 2012 to 2,269 last year," Chris Kenning of the Courier Journal reports, citing the Kentucky Center for Economic Policy. "The strain is particularly acute in small, rural health departments."

Medicaid beneficiaries, take note

Beshear said the state will not require pre-authorization for treatment of Medicaid patients "for anything related to coronavirus." On Friday, he said Kentucky is fortunate to have expanded Medicaid, something it did during the administration of his father, Steve Beshear.

"I do believe that we are in a better place to address this  than many states because of expanded Medicaid," he said. "I don't mention that because of my belief in expanded Medicaid, but it does mean that there is more access out there, that people will have less barriers to get service."

Beshear said Kentuckians should be wary of scammers and con artists claiming to have a cure or a vaccine for the virus, and to be wary of e-mails pretending to be the CDC or other public-health organizations, and people claiming to raise money to develop a coronavirus vaccine or to help victims.

Newman said most patients with covid-19 will be treated in local hospitals or at home. Officials have voiced concern that the disease and the flu will overload hospitals, and that people congregating in clinics could spread the virus.

"If you are sick, try to use the telephone first," Stack said, adding that people with a fever and a cough should "take Tylenol and stay home and rest." He said those who are concerned but not sick should call the state's covid-19 hotline, 1-800-722-5725.

Senate bill to address surprise medical billing now in House

By Jim Hannah
Legislative Research Commission

FRANKFORT, Ky. – Legislation to offer patients some protection from surprise medical bills passed the state Senate Friday.

“There are many factors that contribute to surprise billing,” said Sen. Ralph Alvarado, R-Winchester. “Some will place the blame on insurance companies. Some will place the blame on providers. It all depends on whom you ask. But while we are trying to figure out who to blame, patients are stuck in the middle of the problem – often with large medical bills.”

Alvarado's Senate Bill 150 seeks to stop the practice by requiring insurers to cover surprise billing, sometimes called balanced billing. It happens when a patient receives medical care – often unwittingly – outside of their insurer's network. Subsequently, the doctor or hospital bills the patient for the amount insurance didn't cover.

Alvarado characterized SB 150 as a consumer protection bill. He said surprise billing was a dubious exercise of cost shifting from insurers to patients.

A second provision of SB 150 would require the state insurance commissioner to establish a database of billed health-care service charges. A final provision would provide a dispute resolution program for medical insurers and providers to work out their differences over these out-of-network charges.

Sen. Rick Girdler, R-Somerset, spoke against the bill. He cited a fiscal impact estimate that SB 150 would increase individual premiums for health benefit plans by up to $9 per month.

Sen. Tom Buford, R-Nicholasville, said he voted for the bill because the He noted the self-funded Kentucky Employees’ Health Plan already covers surprise billing for its nearly 265,000 members.

“If we are going to enjoy that benefit, the citizens of Kentucky should share the same,” he said.

Sen. Wil Schroder, R-Wilder, who voted no, said what is needed more is broader reform to empower health-care consumers through such measures as transparent pricing of procedures and drugs.

“Today I filed Senate Bill 265 that I believe offers a better solution in the context mentioned,” Schroder said. The bill has been assigned to the Senate Banking and Insurance committee.

Alvarado said SB 150 wasn’t a hastily drafted bill, but the result of three years of investigation.

“I wish to remind the members of the Senate that a successful bill for surprise billing should only make one group happy – and that is the patients we are trying to protect,” he said. “If other stakeholders are a bit uncomfortable, then we have a good compromise on this issue.”

SB 150 went to the House on a vote of 30-3. Sen. John Schickel, R-Union, cast the only other "no" vote.

Flu slacked a bit in last week of Feb.; season runs through May, vaccine still useful and is best defense; may help with covid-19

In the last week of February, Kentucky reported fewer new cases of influenza and fewer deaths from it than it did the week before.

The latest weekly report from the state Department for Public Health shows that in the week ending Feb. 29, Kentucky counted 1,591 new cases, down from 1,943 new cases the previous week. Five flu deaths were reported in the state, down from 14 the previous week and 16 the week before that. During the flu season, the state has reported 22,591 cases of flu and 85 deaths, four of children.

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 last report.

Nationwide, the Centers for Disease Control and Prevention estimates that so far this season, at least 34 million people have had the flu, causing 350,000 hospitalizations and 20,000 deaths. Of those, 136 were children.

Health officials recommend that everyone over 6 months old get an annual flu vaccination. It is not too late, since the season usually runs through May.

Measures to protect yourself from the flu could also provide limited protection from covid-19, the respiratory disease caused by the new coronavirus, for which there is no vaccine. They are:

• 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.

Flu hotspots continue around the state, including Barren County, with 107 new cases, for a total of 1254; Bullitt with 71 new, for a total of 913; Carter with 41, for a total of 235; Fayette with 78, for a total of 591; Floyd with 59, for a total of 307; Franklin with 91, for a total of 548; Greenup with 42, for a total of 338; Hardin with 49, for a total of 366; Jefferson with 278, for a total of 7,764; Knott with 52, for a total of 426; Knox with 37, for a total of 162; Perry with 79, for a total of 1,135; Pike with 84, for a total of 1,195; and Warren with 55, for a total of 816.

Opioid epidemic keeps shadowing Ky. policy, as Senate removes opioids from list of drugs physician assistants could prescribe

By Melissa Patrick
Kentucky Health News

A House bill to let physician assistants prescribe some highly regulated drugs is moving through the Senate, but without application to some highly addictive drugs like oxycodone and hydrocodone, showing how the opioid epidemic continues to influence state health policy.

Rep. Steve Sheldon presents House Bill 135 at the March 3
meeting of the Senate licensing and occupations committee.
(Photo: Legislative Research Commission Public Information)

As amended by a Senate committee March 3, House Bill 135, sponsored by Rep. Steve Sheldon, R- Bowling Green, would allow physician assistants "modified prescriptive authority" for controlled substances in federal Schedules III, IV, and V after the PAs have practiced for a year.

The Senate Licensing, Occupations and Administrative Regulations Committee removed Schedule II drugs, which include a long list of narcotics used for pain management as well as several psycho-stimulants that are used to treat attention deficit hyperactivity disorder, or ADHD -- a condition for which Kentucky has the highest rate in the nation.

Sen. Chris McDaniel, R-Taylor Mill, told the committee that he would not have voted for the bill if the Schedule II drugs had not been removed. He warned, "Know if we come back for Schedule II next year, I will oppose it as vigorously as possible."

McDaniel acknowledged that only a few PAs would likely abuse their Schedule II prescriptive authority, but said that isn't worth the risk because it was only a small percentage of physicians that not so long ago flooded the state with pain pills.

"The damage that they did was monstrous and we're still working to overcome it," McDaniel said. "The fact is, one step toward where we were, for me, is a step too many."

Majority Floor Leader Damon Thayer said likewise: "I thought the bill that came flying out of the House was a bridge too far, and going to Schedule II is not going to fly in the Senate right now, and I hope you don't come back and try it again next year; it won't be received very well by this body."

Andrew Rutherford, vice-president of the Kentucky Academy of Physician Assistants, told the committee that the PAs would keep seeing Schedule II authority.

"Our ultimate goal is always to provide the best patient care we can to our patients, that includes allowing us to practice to our full scope of practice," he said.

Rutherford told the committee that Kentucky is losing its PAs to other states because it does not allow them to practice at their full scope of care. Kentucky is the only state in the nation that does not allow PAs to prescribe any controlled substances.

The bill passed the House 91-1 on Feb. 6, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it's gained any traction.

Sen. Michael Nemes, R-Shepherdsville, noted that the Kentucky Medical Association, which has opposed this bill in the past, isn't necessarily for the bill but is "not fighting it."

Asked about its stance on the bill, the KMA told Kentucky Health News in an e-mail that it "continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants on House Bill 135 with two objectives in mind – promoting public safety and preserving the 'physician-led team model.' KMA will monitor the progress of this bill and urge that principles such as these be included as the legislative process continues."

Adam Haley, government-affairs coordinator for KAPA, told Kentucky Health News that PAs were still working with lawmakers to try to carve out the Schedule II drugs that are used to treat ADHD.

"We obviously heard loud and clear from our members of Senate leadership in committee that there are strong reservations about some of the opioids in Schedule II, and while we believe the gold standard of care does include full Schedule II authority, we're sensitive to those concerns and are working with those legislators on addressing the issue of some of the psycho-stimulants in Schedule II and whether or not those can be broken out separately," Haley said.

Sheldon, the bill's prime sponsor, noted that 49 states allow full prescriptive authority for PAs and Kentucky would become the sixth state to place restrictions on Schedule II if this bill were to become law.

The KAPA's Rutherford said, "Changing this legislation will allow Kentucky to be more attractive for PA practice and will hopefully keep many of those PAs from going to practice in neighboring states. This would allow for more providers in Kentucky, which we all know is much needed."

The bill includes several restrictions on how PAs can prescribe drugs, and new continuing-education requirements, including a number of required hours related to controlled substances. It also leads to a more accurate account of who actually prescribes drugs; now, all scheduled drugs prescribed by a PA are attributed to the supervising physician.

Under the regulation, PAs would still have to work under the supervision of a physician who would be allowed to limit which controlled substances they can prescribe.

Sen. Paul Hornback, R-Shelbyville, said he supported the bill as a way to increase access to care in rural Kentucky and that he hoped the House bill to expand the scope of practice for nurse practitioners would also pass.

Nurse practitioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. HB 286, a bipartisan bill sponsored by Rep. Russell Webber, R-Shepherdsville, would allow them to do that without a supervising physician after four years, if their license is in good standing. The General Assembly approved similar authority in 2014 for non-scheduled drugs. This bill is posted in the House Licensing, Occupations and Administrative Regulation Committee.