State reports record number of new cases; Beshear holds firm; third inmate dies at Central City prison, where 40% are infected

Updated list of state-involved testing sites; others are available. For a larger version, click on it.

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

By Al Cross and Melissa Patrick
Kentucky Health News

After reporting the largest number of new coronavirus cases yet in one day, Gov. Andy Beshear stuck to his plan for relaxing restrictions against the pandemic.

The new-case total was 625. That included 309 cases from nearly compete testing at a Western Kentucky prison, but and the remainder of 316 was still well overjust short of the previous record of 273322, reported April 19. And there were 14 new deaths, the most in several days.

Beshear said that when recent days are averaged out, the pandemic in the state is "still pretty stable." The seven-day average had reached a previous high of 175 on Friday, and Beshear's gradual reopening of businesses is set to begin Monday, despite federal guidelines that call for a two-week "downward trajectory" in cases or positive test results.

Asked about that, Beshear said, "I believe that we can safely engage in phase one" of reopening, through the rest of the month, and that "If we take all these precautions we can do this safely." He added, "I'm not gonna be afraid to pause things if we believe the situation is dangerous."

He acknowledged that reopening will lead to more cases, and was asked what public-health data modeling tells him will happen. He suggested that the models may not fully reflect the current experience.

"We believe Kentuckians have shown they can follow the rules and regulations," he said. "Your actions have done more to flatten the curve than we ever thought was possible in a pandemic. You have rewritten the rule book. You have rewritten all of the modeling."

He added, "If we see a spike in cases, if we believe we see deaths that are related to work, we’ll be willing to pause and to re-evaluate as we go. Listen, all of this is people doing the best we can, trying to make the best decision we can, and balancing the best rules and restrictions with what people are willing to do and trying to get the maximum compliance out of Kentuckians. They have done an amazing job, but we do need to get some people back to work and I'm trying to do it as safely as I can."

He pleaded for continued compliance. "You’ve been asked a lot, and you're gonna be asked a lot more as we safely transition to healthy at work," he said at the end of his daily briefing. At the start, he recalled sacrifices made by "the greatest generation" in World War II.

Gov. Andy Beshear holds up his mask.

He said that generation of Americans had an enemy “they didn’t know they could defeat; we know that we are gonna come out on top,” but can follow their key qualities: personal responsibility, integrity (including compliance), faithful commitment and work ethic. “It’s about slogging it out even when it’s difficult to get the job done, and that’s about where we are in fighting this virus,” he said. “We are in the challenge of our lifetimes and we have to have the work ethic to complete our task.”

Asked what advice he would give to law enforcers and employers, in light of violence some have faced in other states as they try to enforce restrictions, Beshear didn't answer directly but showed a mask and said, “This is how you make sure your actions don’t kill somebody else. . . . Violence can't be our answers.” He wants people to wear masks in public, especially starting Monday.

Prison issues

Beshear said 400 inmates and employees at Green River Correctional Complex in Central City had tested positive, after 1,029 tests, with 52 results pending. He said the 40 percent infection rate is like those at prisons in other states with outbreaks.

Three inmates have died. J. Michael Brown, Beshear's executive cabinet secretary, said two inmates and two employees are hospitalized, one each in intensive care.

John Cheves of the Lexington Herald-Leader reports inmate Jeffrey Rowland told him Monday in a phone interview, “It’s just insane in here. You’ve got six guys who have tested positive living in my dorm, and they’re exposing ... everyone else.” He said contract kitchen workers for Aramark “are not wearing masks like they’re supposed to. The [corrections] officers wear them when they want to.”

Brown said Monday that inmates are being separated depending on whether they have tested positive or not for the virus, whether they have been exposed to it, and if they are medically vulnerable to it. He said the design of the prison makes that easier than at most.

Beshear was asked if he had acted quickly enough. He said he followed recommendations of public-health officials in Kentucky and other states, and "I took the extra step of asking everybody to be tested, and most governors out there aren’t doing that with prisons."

He said the separation plan "is one a lot of corrections systems wouldn't do," because most inmates at Green River are "serving some pretty significant sentences. When you start moving people . . . into completely different environments, it can be a little dangerous." He noted that Brown, a former justice secretary, knows the Muhlenberg County prison well.

In other covid-19 news Tuesday:

• Deputy Workforce Secretary Joshua Benton said people who are on unemployment and get called back to work next week will be able to not show up for work and still get benefits if they are in certain at-risk categories or cannot find someone to care for their children.
• Beshear said "It’s not fair in the least" to reopen businesses and not child care, but he said the latter would be too risky. He said he is looking at best practices elsewhere, and when child care reopens, it will be "smaller, much more spread out."
• The 14 deaths, which brought the state's death toll to 275, were of a 77-year-old man in Hopkins County, an 89-year-old woman and a 79-year-old man in Boone County, an 85-year-old man in Henderson County, two women in Jackson County, 70 and 59; two men and three woman in Kenton County, 94, 91, 96, 88 and 86; two Jefferson County women, 63 and 69, and a 35-year-old man in Jefferson, who Beshear said is the youngest victim yet.
• Counties reporting more than 10 new cases, other than Muhenberg, were Jefferson, 95; Warren, 42; Kenton, 27; Daviess, 22; Boone, 20; Butler, 14; and Bullitt, 12. Beshear said he would work for continued testing in Warren or an adjoining county.
• In long-term-care facilities, 16 more residents and 10 more employees tested positive, and 13 more deaths were reported, for respective totals of  828, 331, and 152.
• Beshear said everyone in a long-term-care facility will be tested for the virus, and the state will help facilities that want to conduct tests on their own.
• He said on a WKYT-TV special program that there might be "some form of limited visitation" at such facilities this summer.
• Bill Estep of the Herald-Leader tells the story of Michelle Rose Thompson, 58, of Columbia, who volunteered to work on the covid-19 ward at the Summit Manor nursing home in Adair County, a Signature HealthCare facility, and died April 30. She was also noted on the CBS Evening News. Thompson was the second employee at the home, and the second in Kentucky, to die of covid-19, The other was Pamela L. Hughes, who died April 13.
• "Scientists have identified a new strain of the coronavirus that has become dominant worldwide and appears to be more contagious than the versions that spread in the early days of the covid-19 pandemic, according to a new study led by scientists at Los Alamos National Laboratory," the Los Angeles Times reports. "In addition to spreading faster, it may make people vulnerable to a second infection after a first bout with the disease, the report warned. . . . The Los Alamos study does not indicate that the new version of the virus is more lethal than the original," or that it makes victims more likely to be hospitalized.
• "The bold hypothesis, however, was immediately met with skepticism by many infectious-disease experts, and there is no scientific consensus that any of the innumerable mutations in the virus so far have changed the general contagiousness or lethality of covid-19, the disease caused by the coronavirus.," The Washington Post reports. "The paper will now have to survive the intense scrutiny of a research community trying to deliver urgently needed information while remaining scientifically rigorous."
• On the WKYT special, Dr. Mark Daugherty Dougherty of the University of Kentucky Baptist Health said virologists have found that people are most contagious in the first few days after they get the virus and before they show any symptoms, and that the rate of virus shedding through excretions is greater than for any other virus.
• UK said it would dismantle the temporary field hospital it created at its football training center because its medical center has plenty of beds. Beshear said this week that the field hospital at the state fairgrounds in Louisville will remain in place.
• Health Commissioner Steven Stack said Perdue Farms, which Beshear said had not been cooperative enough in dealing with an outbreak of cases at its chicken-processing plant at Cromwell in Ohio County, will test everyone in the plant Wednesday and will work with the state "to come up with mitigation plans." Other meatpackers have closed temporarily for cleaning and re-engineering.
• Beshear said he would "do everything I can to prevent any furloughs or layoffs" of state workers, since "that exacerbates the recession."
• He warned against family travel once school is out, saying "Traveling to other places is still dangerous. . . . People should think very carefully about their vacation plans for the summer."
• Asked about "demonstrations" being planned by Western Kentucky legislators seeking an immediate reopening of businesses in the region, Beshear said such reopenings "would be dangerous," and said any demonstrations should be done safely. Sen. Steve Meredith, R-Leitchfield, told Kentucky Health News that the events are to be a series of press conferences, not demonstrations or "rallies," as his local radio station described them.
• The latest Axios poll found that most Democrats believe the covid-19 death toll is higher than it is, while most Republicans think it is lower, and found that people who rely on Fox News are most likely to believe it is lower than reported. "This may be the most jarring evidence to date about just how deeply partisanship has infected our collective ability to trust institutional sources and agree on science and facts," Axios says. "Trust in government is abstract, but death counts are real."
• Click here to watch a virtual panel discussion, "Outside the Margins: Covid-19, Health Inequities and the Black Community" that examined the broad economic and health impacts of the disease on African Americans. Preliminary data from the Centers for Disease Control and Prevention show 30% of covid-19 patients are black, though African Americans are only 13% of the population, reports UKNow. In Kentucky, 13.2% of the cases and 17.8% of the deaths have been among blacks, while only 8.4% of the state's population is African American. 
• "A trade association for online sellers has filed a lawsuit against Kentucky Attorney General Daniel Cameron that alleges it's unconstituttional to apply state price-gouging statutes to sellers on nationwide digital marketplaces like Amazon," Morgan Eads reports for the Herald-Leader. Cameron's office has an online complaint form to report price gouging. 
• An experimental coronavirus vaccine developed by Pfizer has been administered to patients in the U.S.; the World Health Organization says this is one of eight potential vaccines currently in clinical trials.  
• Becker's Hospital Review breaks down how much funding hospitals in each state got from the latest slice of covid-19 aid. It shows that 542 rural providers in Kentucky got $372.3 million. Every rural hospital will get at least $1 million, and each rural health clinic and community health center will get at least $100,000, says a news release from Sen. Mitch McConnell.
• McConnell made a floor speech in which he said, "We know there is no policy Congress could pass, nor any amount of money we could spend, that could keep the entire economy glued together if these blunt shutdowns continue indefinitely. . . . As we carefully consider what may come in the weeks ahead, we’ll need smart and targeted policies to help jump-start our economic engine, not unrelated ideological wish-list items that would gum it up even further."
• "An Associated Press analysis shows that some states with small populations like these took in an out-sized share of the $150 billion in federal money that was designed to address coronavirus-related expenses, when measured by the number of positive tests," AP reports. "The awards in the relief act passed in late March were based on population, but with a catch: Every state was to receive at least $1.25 billion, regardless of its size. Lawmakers said setting such a minimum was needed to reach a deal in a divided government," and the next bill is likely to have the same provision. Alaska got $3.4 million per positive test; New York got $24.000. West Virginia got just over $1 million; Kentucky got about $300,000, based on current case totals. Its total so far is $1.732 billion, according to Federal Funds Information for States. UPDATE, May 10: New York Gov. Andrew Cuomo says Kentucky's per-case funding was $337,000, indicating that the figures were for cases at the time of the funding.

Pandemic has created divides, socioeconomic and political

A GrubHub delivery is made in Washington, D.C. (Photo by Erik S. Lesser, European Pressphoto Agency)

Former labor secretary Robert Reich, a professor at the University of California, Berkeley, writes for Common Dreams that the pandemic has created four new socioeconomic classes. In The New Yorker, Robin Wright summarizes and elaborates on them:

• “Remotes” are professional, managerial, and technical workers still at their jobs, usually remotely and usually for the same pay.
• “Essentials” include health care, the food-supply chain, police and other first responders, and truck drivers, about 30 percent of workers, many of whom "are putting their lives at risk with limited physical or economic protection," Wright notes.
• “Unpaids” are the growing numbers of the unemployed, the furloughed and personal-services workers whose task can't be done remotely. "So far in this crisis, 43 percent of adults report they or someone in their household has lost jobs or pay, according to the Pew Research Center," Reich notes.
• “Forgottens” are migrant workers, the homeless, Native Americans, the disabled, the elderly, and the imprisoned. "Outbreaks in nursing homes, homeless shelters, and prisons have proved among the most merciless," Wright writes.

Reich concluded, "Not surprisingly, the Essentials, the Unpaid, and the Forgotten are disproportionately poor, black, and Latino. And they are disproportionately becoming infected. An Associated Press breakdown of available state and local data showed close to 33 percent of coronavirus deaths so far are African-American, despite representing only 14 percent of the total population in areas surveyed."

In Kentucky, African Americans have accounted for 18 percent of deaths from covid-19 though they are only 8.3 percent of the state's population, and Latinos have a higher rate of coronavirus cases than their population share.

Black, Latino and poor Americans "aren’t getting what they need to survive this crisis because they don’t have lobbyists and political action committees to do their bidding in Washington or state capitals," Reich argues. "The Remotes among us should be concerned, and not just because of the unfairness of the covid-19 class divide. If the Essentials aren’t sufficiently protected, the Unpaid are forced back to work earlier than is safe, and the Forgotten remain forgotten, no one can be secure. Covid-19 will continue to spread sickness and death for months, if not years to come."

Wright, after citing Reich's insights, writes of another split: "The most dangerous divide emerging from the pandemic is the oldest in American history—over the rights and duties of the states versus the power of the federal government. We fought a war over the issue a hundred and sixty years ago; it has flared again during the pandemic—and now threatens to tear the nation apart in new ways."

After citing President Trump's Twitter mischief aimed at governors in Michigan and other Democratic-led states, and his mixed signals about federal and state authority and responsibility, Wright warns:

"The impact could outlast the pandemic’s pathogens. The American social contract—based on the “inalienable rights” of “life, liberty and the pursuit of happiness” in the Declaration of Independence—was already eroding; the interpretations were being redefined, a process begun by Reaganism in the 1980s as part of a sustained attack on the role and meaning of government, David Blight, a Yale historian, told me. From the Civil War to the 1970s, government expanded its reach to try to insure the same rights for African-Americans, women, Native Americans, the disabled, veterans, the elderly, and the ill. 

Government grew to fight wars and secure the homeland, improve the economy, advance education, and institute the first environmental protections. “But part of our political culture has never really supported this long and seismic change and done the best to roll it back,” Blight, who grew up in Flint, Michigan, told me. During the pandemic, those opposed to expansive government have decried shelter-in-place orders as excessive and questioned the recommendations of the government’s top health officials. . . .

The existential but conflicting issues spawned by the pandemic—the right to life and physical health versus the right to liberty and economic health—have provided the perfect vector for new fissures in America. The gun-toting protesters may be a minority, but polls show that the President’s positions on the role of the state during the pandemic have solid public backing. In the midst of Trump’s skirmish with (Michigan Gov. Gretchen] Whitmer, his job-approval rating soared by six points, to 49 percent, according to a new Gallup poll released on Thursday. It tied for Trump’s personal best in Gallup’s polling data; 47% disapprove. America is a country evenly and bitterly divided. But Americans should remember, Blight added, “There won’t be any blue or red rooms in heaven.”

As projections warn of resurgence, Beshear talks about how he will deal with 'a very scary virus;' says Ky. will have enough tests

List of testing sites in which the Commonwealth of Kentucky is playing a role; to enlarge, click on it.

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

By Melissa Patrick and Al Cross
Kentucky Health News

As a short list of Kentucky businesses plan to reopen next Monday, Gov. Andy Beshear spoke at length Monday about how he would proceed with a slow, gradual restart, noting that some states were seeing a spike in coronavirus cases and covid-19 deaths as they relaxed restrictions.

Such increases have been projected by the Trump administration, according to internal government documents published by The New York Times, confirming the fears of public-health experts that reopening the economy will cause such spikes.

""Some people see stable numbers and they think it is no longer contagious, and it is," Beshear said at his daily briefing. "People see stable numbers and think it is no longer deadly, it is because we continue to see deaths. So let's remember even as we work at being healthy at work, this is still a very scary virus out there, and I'm using that term intentionally. We have to be gradual, we have to be smart, and we have to make the right decisions, and we need everybody on board."

Beshear showed headlines from other states that are seeing spikes in case numbers, including one that said, "Mississippi governor reconsiders reopening state after its largest spike of covid-19 deaths and cases."

"I want to commend Mississippi's governor; his name is Tate Reeves. We were elected at the same time, that's probably the only thing we have in common and he'd say the same thing," Beshear said. "Governor Reeves was planning this big re-opening, I think starting today, but got a big spike in cases and paused it. All right, that is doing the right thing. It's saying that ultimately the virus is in charge of the timing, and we are going to protect the health and safety of folks. I hope he keeps after that.

"But what we are seeing in a number of places that are opening up or that are more aggressive in their timetable is more cases or major concerns. Listen, I hope all those leaders are trying to do the right things, but I want to learn from others that decide they want to be first. When it's being first at doing something that can risk people's lives, I do admittedly want to watch, because I want to make the best, smartest decision for you. I want to make that decision that protects you and your parents and your kids and I want to do this right. And I know the decisions that I make are going to be the difference between life and death for real people and for Kentuckians.

"So understand that I'm not going to be the fastest. I'm just not going to do that. . . . I think we've got to be the smartest, based on public health, based on a gradual phasing in, where we can protect our population."

Asked about Indiana's faster opening on some fronts, Beshear said he and Gov. Eric Holcomb talk weekly and that he continues to believe, as does Louisville Mayor Greg Fisher, that re-opening at a gradual pace is the best way to proceed. Fisher said on KET's "Kentucky Tonight" that he is trying to work out compromises with mayors across the river.

Asked about the lack of a two-week decline that is called for in federal guidelines for reopening, Beshear reiterated that new cases remain at a plateau of new cases, that the state has increased its testing capacity, and there was federal money available to hire 700 people to trace the contacts of people who have been exposed to people who have been infected or exposed.

On May 11, Kentucky will allow manufacturing, construction, automobile and boat dealers, office-based businesses to reopen at 50 percent capacity. It will also allow horse racing without fans, pet grooming and boarding, and studio photography.

In addition to a list of 10 rules that all businesses must follow to reopen, specific regulations for each of the businesses that are allowed to open next week have been posted on kycovid19.ky.gov under the Healthy at Work tab.

“It’s important that you meet these guidelines, these requirements, because it allows us to be healthy at work,” said La Tasha Buckner, the governor’s chief of staff and general counsel. “That allows us the successful reopening and to make sure we’re making advancements and staying at the plateau level and hopefully declining.”

A second phase of health-care activities, non-urgent outpatient and ambulatory services, such as colonoscopies, will be allowed to resume Wednesday, May 6. Additional business sectors are scheduled to re-open May 20 and May 25.

Beshear has said those reopenings will be delayed if they can't be done safely, and there were signs Monday that the virus remains in control.

The New York Times reported: "As President Trump presses for states to reopen their economies, his administration is privately projecting a steady rise in the number of coronavirus cases and deaths over the next several weeks. The daily death toll will reach about 3,000 on June 1, according to an internal document obtained by The New York Times, nearly double the current number of about 1,750."

The projections by the Federal Emergency Management Agency, based on government modeling, "forecast about 200,000 new cases each day by the end of the month, up from about 25,000 cases now," the Times reported. "The projections confirm the primary fear of public-health experts: that a reopening of the economy will put the nation back where it was in mid-March, when cases were rising so rapidly in some parts of the country that patients were dying on gurneys in hospital hallways as the health care system was overloaded."

The report from FEMA and the Centers for Disease Control and Prevention shows counties with "elevated incidence growth" of cases, as well as "elevated incidence of plateau" and other categories. Compared to its major adjoining states, Kentucky compares favorably, but there are many "elevated" counties in its western half: Ballard, McCracken, Henderson, Daviess, McLean, Simpson, Warren, Allen, Meade and Jefferson. Boone, Kenton, Campbell, Jessamine and Perry are also elevated.

For a larger version of the map, click on it.

Counties at elevated plateaus (again, from west to east) include Marshall, Calloway, Webster, Muhlenberg, Barren, Grayson, Hardin, Bullitt, Nelson, Oldham, Shelby, Fayette and Floyd. Some counties are showing a "sustained decline": Graves, Christian, Hopkins, Ohio, Butler, Adair, Pulaski and Jackson.

The Times noted that Scott Gottlieb, who was President Trump’s commissioner of food and drugs, said Sunday on CBS, “We expected that we would start seeing more significant declines in new cases and deaths around the nation at this point. And we’re just not seeing that.”

In other covid-19 news Monday:

• Beshear announced 163 new cases of the coronavirus, bringing the state total to 5,245. Click here for a daily summary of covid-19 cases, deaths and other related data. 
• There have been eight more deaths, for a total of 261. The latest were of six Jefferson County residents, men aged 69, 74, 86, and women 86, 89 and 98; a 79-year-old woman from Hopkins County, and 66-year-old woman from Hardin County.
• Beshear said the state expects to be able to test more than 2 percent of the state's population, which would be around 88,000 people, and that it can possibly do more. He said that would meet federal guidelines.
• Kentucky will offer 17 drive-through testing sites this week. Beshear also announced a new partnership with St. Elizabeth Hospital in Northern Kentucky that will open next week, by appointment only. Click here to find a location.
• A federal judge ordered Beshear from enforcing interstate travel bans that Beshear has acknowledged are difficult to enforce. Judge William O. Bertelsman wrote, “The restrictions infringe on the basic right of citizens to engage in interstate travel, and they carry with them criminal penalties.”
• In long-term care facilities, there have been 17 new cases among residents, one of an employee, and seven more deaths. In all, 812 residents and 321 staffers have tested positive and 137 residents and two staffers have died from it, in 76 facilities. Click here for a list. 
• The Lexington Herald-Leader reports that there have been more than 158 active cases of covid-19 among inmates and staff at the Green River Correctional Complex in Central City, according to the Muhlenberg County Health Department, while 17 people have recovered and at least two people have died from it. J. Michael Brown, Beshear's executive cabinet secretary, said all inmates and staff have been tested in this facility, but results won't be release until all are in. "We think this will be used as a model" for other prisons, he said. 
• Brown said that in addition to practicing good hygiene,  providing masks for everyone and doing daily temperature checks, the prison will separate inmates into four buildings: one for those who test positive, one for those who test negative, but have had exposure; one for those who test negative and have had no exposure; and one for inmates who are medically vulnerable to the disease.
• The Kentucky Chamber of Commerce and the Kentucky Distillers Association have partnered to get personal protective equipment and hand sanitizer to small businesses. Masks can be purchased for $1 each at kychamber.com/maskorderform. Businesses in need of sanitizer can visit kyhandsanitizer.com to put in an order for purchase. 
• Beshear said that of the 23,078 March unemployment insurance claims that were left to process, only 900 did not involve employer-separation issues, which are being worked on. 
• Louisville's chamber of commerce has called on the governors of Kentucky and Indiana to align their "disjointed reopening plans." Greater Louisville Inc. President and CEO Sarah Davasher-Wisdom wrote, "Our families, workers and businesses need consistency for this regional economy and do not view the Ohio River as the line we are being asked to stay behind." She asked that Gov. Andy Beshear and Indiana Gov. Eric Holcomb "identify coordinated solutions" to ensure the region is "best positioned for reopening, Ben Tobin reports for the Louisville Courier Journal. 
• Beshear has removed a member of the state Board of Emergency Medical Services, saying Robbie Smither of Shelbyville "publicly promoted violent action against law enforcement" on social media, the Lexington Herald-Leader reports. WHAS-TV reported last week that Smither criticized the arrest of a Louisville woman for repeatedly violating a quarantine order. “This is tyranny,” Smither posted on Facebook. “I wish this lady would have used deadly force against these tyrants and then a jury nullify the case.” 
• The University of Kentucky Cooperative Extension Service has stepped up efforts across the state to make isolation gowns, N95 mask covers and surgical caps, Carol Lea Spence reports for UKNow.
• The U.S. Food and Drug Administration is allowing emergency use of an experimental drug that appears to help some coronavirus patients, reports Modern Healthcare. Preliminary results from a government-sponsored study of 1,063 patients showed that remdesvir shortened recovery time by 31 percent, or about four days on average, for seriously ill covid-19 patients.
• The FDA says coronavirus antibody tests, which identify people who may have had the virus, including those with no symptoms, must meet standards for quality and accuracy. This comes after the agency allowed more than 100 such test on the market without review, The Washington Post reports. Officials told the Post that “unscrupulous actors” have been “marketing fraudulent test kits and using the pandemic as an opportunity to take advantage of Americans’ anxiety.”
• An opinion piece in The New York Times goes into detail about what natural herd immunity for the coronavirus may look like, noting that there would be nothing "quick or painless" in this process without a vaccine, because it would result in millions of deaths. 
• Doctors have found that some covid-19 patients have dangerously low blood-oxygen levels -- levels that usually lead to unconsciousness or even death -- but are able to breathe normally. Doctors are trying to figure out if home monitoring using pulse oximeters, a device that measures oxygen levels through your finger, will help. 
• A report by the left-leaning Center on Budget and Policy Priorities says "The severe and unprecedented size of the health, human, and economic crisis caused by covid-19 should determine the size of the legislative response — not arbitrary dollar comparisons to stimulus in prior recessions, the level of debt, or the debt ratio." 
• As meatpackers anticipate supply disruptions due to coronavirus infections among their employees, Costco has joined some other grocers and is allowing only three meat purchases per Costco member, reports the Lexington Herald-Leader.
• Former President George W. Bush issued a video calling for national unity in the pandemic, saying "In the final analysis, we are not partisan combatants. We are human beings, equally vulnerable and equally wonderful in the sight of God. We rise or fall together, and we are determined to rise." President Trump tweeted, "I appreciate the message from former President Bush, but where was he during impeachment, calling for putting partisanship aside?"

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

By Melissa Patrick
Kentucky Health News

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

Image from Alcohol.org

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

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

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

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

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

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

Virus creates perfect storm for relapse 

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

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

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

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

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

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

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

Drug use continues

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

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

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

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

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

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

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

Help is still available.

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

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

Beshear pleads for testing sign-ups and show-ups; protesting safely; wearing masks; and taking some time off, as he did

Gov. Andy Beshear showed Hardesty Photography's view of the Nelson County Courthouse.

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

By Al Cross
Kentucky Health News

Gov. Andy Beshear made several pleas Sunday: Sign up for coronavirus testing; if you sign up, don't fail to show up; if you disagree with his policies, do it safely, unlike some protesters Saturday; wear a mask in public; and take some time off and tune out news about the pandemic.

Returning to the briefing podium after his first day off in eight weeks, Beshear said Kentucky had no reported deaths for the first day in many weeks, but said that was probably because of delayed reporting on the weekend. "I already know of at least one that will be reported tomorrow," he said.

Beshear said five deaths were reported Saturday, along with 173 new confirmed infections of the virus, for a death toll of 253 and case total of 5,130. He said the rates are "very stable" even though the state is doing more testing, much of it at potential hotspots such as prisons and nursing homes.

His first plea was for Kentuckians to fill open slots next week at Kroger-sponsored testing sites in Louisville, Lexington, Bowling Green and Ashland, a new site where hundreds of slots remain open and there has been relatively little testing.

Beshear also pleaded for people who sign up to show up, saying about 50 per site have not kept their appointments. “To sign up to take that test and not show up, you can’t be doing that,” he said, noting that anyone can spread the virus without knowing they have it.

He said testing will become more important as restrictions are gradually lifted and the virus has more opportunity to spread. He said much testing has targeted vulnerable populations, but “We also have to test the general public because so many people can be asymptomatic," meaning they have the virus but no symptoms. “You ought to treat yourself like you have it.”

That wasn't the case with hundreds of people who came to the state Capitol Saturday afternoon to protest Beshear's anti-virus policies and demand that he allow businesses to reopen. The rally's master of ceremonies asked those who did wear masks to take them off.

Beshear said he had also heard that other speakers, including state legislators, had made the same request, "told people that social distancing is optional, and one even said she wouldn't take a vaccine" for the virus if one is developed.

"That’s just reckless," he said. “It's O.K. to disagree, but if you are a leader people listen to, be responsible in how you do it. . . . Whether you agree or disagree with me, I want you to be safe.”

The vaccine comment, by state Rep. Savannah Maddox of Dry Ridge, wasn't as extreme as Beshear described, according to a reporter who quoted her as saying that she wouldn't be forced to get a vaccination, and asked Beshear for his reaction. He said, “This is a highly infectious virus, that if it gets to the wrong person, could be devastating,” shook his head and asked for the next question.

Asked if any action would be taken against anyone at the rally, Beshear said, “We’ll see about steps that are gonna be taken.”

Beshear reiterated that he won't take action against people who refuse to wear masks in public, but pleaded with them to do so. “At the end of the day, it’s your decision, but it’s one that impacts the lives around you," he said. “Your refusal to wear a mask could result in somebody dying. . . . If you believe we’re supposed to love our neighbor as yourself, and you may be carrying a virus that could potentially harm people, why would you not be willing to do this?”

Beshear began his briefing by noting he didn't have one Saturday, and repeated a plea he has made before. “I was trying to live out what I’ve asked everybody else to do, be in a good place with your mental, physical and emotional health” and have resilience, he said.

Nursing homes: Acting Health Secretary Eric Friedlander gave an update on long-term-care facilities, which have accounted for 122 of the state's deaths, or 48 percent, four newly reported. “As I've looked across the country, I think we've been leaders here,” he said.

He said the state is paying nursing homes more quickly, because their business has been hurt by lack of elective surgeries that send them patients for rehabilitation. “We're making sure we take care of that industry so that industry can take care of people in their care,” he said.

Friedlander also said the state is paying the homes more to treat patients with covid-19, as an incentive for the facilities to get the patients tested. Beshear said he would like to have everyone in nursing homes tested, but “We're gonna have to triage it a little bit. … We want to make sure the most fragile are being tested as early as possible.”

Beshear said 43 more residents of long-term-care facilities had tested positive, plus nine staff members, for totals of 795 and 320, respectively.

Friedlander's cabinet is also in charge of inspecting nursing homes, and a story in the Lexington Herald-Leader Friday noted that it rarely labeled lack of infection control a serious violation from April 2016 to December 2019, when the Beshear administration began.

Friedlander said the cabinet is now making infection control a priority, but has "fewer eyes" looking for violations because it has limited inspections, for fear inspectors could carry the virus. He said it is a shared responsibility: “This is a time when this industry and us can demonstrate that we're gonna be faithful stewards for those people in their care.”

On another nursing-home point, Beshear said, “We’ve gotta expect there’s not gonna be visitation in the near future. We’ve got to take every single step to protect those in these facilities.”

Asked if visitation might be allowed for patients who don't have the virus, or to those who are in critical care, Beshear said that would not happen in long-term-care facilities because of their vulnerable populations. He noted that there are exceptions for those who are at the end of their lives.

In other covid-19 news Sunday:

• Beshear said Saturday's five deaths were of a 79-year-old woman in Logan County; two women in Adair County, 81 and 90; and a 90-year-old man and a 99-year-old woman in Jefferson County.
• Asked his goals for the week, Beshear said he would like to issue rules for retail businesses and houses of worship by Friday, to give them guidance more than a week in advance of their scheduled openings. Also, he said, "We're gonna continue to try to ramp up testing."
• Beshear said Perdue Farms, which he said Saturday was not being as helpful as it should be in addressing cases at its plant at Cromwell in Ohio County, called Health Commissioner Steven Stack and "had a productive dialogue. They repeated their commitment to collaborate … but what I'm gonna need to see is action." He noted that other meatpackers with outbreaks had closed their plants for cleaning and re-engineering, and JBS Foods is still working with Louisville officials on its outbreak and hasn't shut down, contrary to what he said Friday.
• He said he agreed with the federal appeals-court decision not to exempt churches from his order against mass gatherings, but said Maryville Baptist Church of Hillview “somehow convinced the court that we hadn't allowed them to do a drive-up” service, resulting in the court issuing a ban on enforcing an order that never existed. The church claimed people participating by drive-up were given quarantine notices on Easter, just like those who attended the in-person service. Beshear said no one in drive-up should have gotten a notice. He reiterated that the church is the only one he knows of that is not obeying his order.
• Friedlander said the state is continuing to pay certain closed child-care centers, the 17 percent who are part of a federal program, to keep them from closing permanently "We have to make sure we don’t lose capacity," he said. "We know we need more."
• Lexington Herald-Leader opinion-page editor Linda Blackford writes about problems caused by Beshear's delay in reopening day-care centers: "What if you are a single mother with no daycare and your employer opens? What are you supposed to do? Do you lose your unemployment because your office is open, but you can’t go? It’s not as if you can depend on elderly grandparents anymore." Beshear has said opening the centers would spread the virus, but Blackford notes that centers open for children of health-care workers and first responders haven't had outbreaks, "amid strict protocols." Blackford also noted that day-care owners have been unable to get their insurers to pay business-interruption claims "because there was not enough testing" for the virus when Beshear closed them in March. She suggested that Attorney General Daniel Cameron take up their cause.
• The Herald-Leader published a 12-page special section about a wide range of front-line workers doing special duty in the pandemic. The printed stories are appearing online gradually: one about a nurse cut off from her son; another nurse-and-son story, the latter a University of Kentucky football player; and an introduction to the series, with other examples.
• Senate Majority Leader Mitch McConnell announced that Kentucky received $15,121,392 "to respond to the public health and safety effects" of the pandemic, including "nearly $8.3 million to strengthen testing, containment and treatment as well as to help Kentucky make progress toward safely re-opening the economy. The U.S. Department of Justice Coronavirus Emergency Supplemental Fund delivered $6.8 million to Kentucky to help state and local governments respond the virus’ spread."
• National columnist Salena Zito contrasts the situation in Bristol, a city bisected by the Virginia-Tennessee border; one side of State Street is pretty much open, and the other is largely closed.

Protesters gather at Capitol; federal prison reports cases; federal appeals court declines to exempt church from ban on gatherings

State Rep. David Hale, R-Wellington, spoke to the rally, (Lexington Herald-Leader photo by Ryan Hermens)

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

Protesters gathered at the state Capitol Saturday afternoon to demand that Gov. Andy Beshear ease his restrictions on economic activity in the pandemic.

“It’s not time to open Kentucky next week, or tomorrow or this evening. Open Kentucky now,” said Republican state Rep. Savannah Maddox of Dry Ridge, one of six legislators who spoke at a rally advertised by the Central Kentucky Tea Party. Attendance estimates varied wildly; the Lexington Herald-Leader said "around 200 attended," but the Louisville Courier Journal put the number at "around 1,000."

Few wore masks, and the master of ceremonies, Lee Watts, asked those who did to take them off. "An X-ray technician wearing scrubs and a mask stood in silent protest of the gathering," the CJ reports. "Several attendees holding signs moved to block her as speeches began, while others screamed insults at her."

Beshear, who recently moved his daily briefings from the Capitol to the state Emergency Operations Center at the Frankfort airport, did not hold a briefing Saturday for the first day in eight weeks. He said he needed a break.

In other covid-19 news Saturday:

Read more here: https://www.kentucky.com/news/state/article242436221.html#storylink=cpy

• At least 33 inmates and one employee at the Federal Medical Center on Leestown Pike in Lexington have tested positive for the coronavirus, the Lexington Herald-Leader reports. It's part of a national problem, The Washington Post reports.
• "The U.S. Court of Appeals for Sixth Circuit ruled Saturday that Gov. Andy Beshear and other state officials cannot prevent Maryville Baptist Church from holding drive-in worship services during the coronavirus pandemic," the Louisville Courier Journal reports. "But the three-judge panel declined to extend the injunction to in-person services at the Bullitt County church, noting it was not comfortable doing so after being given the case 24 hours earlier." Beshear has encouraged drive-in services, but the church claimed that state police gave quarantine notices to drive-in worshipers at the church on Easter Sunday, and the court noted that his order banning mass gatherings did not provide a drive-in exception.
• Kroger Co. said Friday it will limit purchases of ground beef and fresh pork at some stores due to concerns over meat shortages from supply disruptions caused by coronavirus outbreaks in the meatpacking industry. It did not identify the stores. Walmart said it does not expect to limit purchases, CNN reports, but "Other large grocers say they expect to be out of stock on different types of cuts very soon."
• Janet Patton of the Herald-Leader writes, "Where can you go if the big stores don’t have the meat you’re looking for? In Kentucky, at least, you have tons of options, many with locally grown proteins. She names them.
• The Herald-Leader's Linda Blackford previews a special section in Sunday's print edition about everyday heroes who have kept working and adopted new routines to help others: "Family resources coordinators try to break down barriers to learning, so they spend long weeks finding clothes or therapists or food. . . . Like the cafeteria workers who feed students during the week, the sanitation workers who pick up our trash or grocery workers who keep us nourished, they’ve been there all along. It’s just taken a crisis to reveal how important they are."
  
  Read more here: https://www.kentucky.com/news/coronavirus/article242154701.html#storylink=cpy
  
  Read more here: https://www.kentucky.com/lexgoeat/food/article242430071.html#storylink=cpy

Governor and health commissioner say they look at data models to guide their decisions, but 'don't have something to share'

Graphs from the rt.live website show the likeliest transmission rate of the coronavirus, within estimated ranges. A rate of 1 is an estimate that one infected person will infect one other person, and so on.

By Dalton Stokes and Al Cross
The (Frankfort) State Journal and Kentucky Health News

State-by-state by state figures have been revised to reflect an adjustment by the estimators.

Gov. Andy Beshear said this Wednesday about his slow, gradual steps to reopen the state: “If it proves that we can't do any of them safely, it is always subject to pause.”

But the weekly rolling average of new coronavirus cases hit a new high Friday. How will he know when to pull the plug?

In some other states, governors give considerable attention to two statistical models used to track the spread of the virus, but Beshear and Health Commissioner Steven Stack are keeping to themselves whatever models they are using.

Epidemiologists measure reproduction of a virus with a figure called R0, or “R naught.” It represents the number of infections, on average, that stem from a single infection.

A related number, called Rt, for transmission, uses statistical adjustments to create a more current estimate of how fast a disease is spreading, or what epidemiologists call the effective reproduction number of a virus.

Asked at Beshear’s briefing Wednesday if the state Department of Public Health calculates those figures, and if so, what they are, Stack said: “Yes, we do try to calculate those numbers, but I don’t have any great confidence in them,” because they depend on so many varying factors.

“We do look at those things,” Stack said, “but I don’t have something to share.”

A website created by the co-founders of Instagram estimates the virus’ Rt value in each state daily. Natalie E. Dean, an assistant professor of biostatistics at the University of Florida, told Vox that the model, as well as the data behind it, seem sound.

The site estimates the likeliest rate within a range of possibilities. It reckons that Kentucky’s Rt on April 25 was 0.88, just about in the middle among the states. The estimate for April 26 was 0.84, after the site revised its methodology, adjusting most states' figures downward.

When Beshear issued his “healthy at home” order March 26, Kentucky’s adjusted Rt was 1.28, the website estimates. It dropped to 1.0 on April 8, and settled at 0.84 on April 19.

Among the states bordering Kentucky, most have lower Rt estimates; Illinois has about the same, and only Indiana has seen a resurgence. Its estimate fell to 0.95 in early April, then rose to 1.02 on April 15. Its latest estimates have been just below 1.

“You want it to be less than 1, which means it’s decreasing; if it’s over 1, it’s increasing, and if it gets too high, it increases very rapidly,” Stack said.

New York Gov. Andrew Cuomo said Tuesday that his plan uses Rt as a “circuit breaker,” set to 1.1. If the state jumps to 1.1, or higher, his reopening efforts will be reversed. New York's latest estimate is 0.83, but New York City has been a hotspot that could easily have a resurgence. 

Dean told Vox that the accuracy of the R0 and Rt estimates hinges on the amount of testing in a state. If states don’t increase testing proportionate to the growth of the virus, they will report the same relative number of new cases each day, even if there are actually more.

While Stack wouldn’t say what numbers he and Beshear are using, he said the difference in the Rt estimate and the basic R0 number for the coronavirus shows the effectiveness of the measures they have taken.

“The R0 for this disease is ... closer to 3 when it’s unchecked,” he said. The number means that if no measures had been taken to contain the virus, each infected person would have infected three other people, and those three would have infected nine more, and so on.

“We are trying to do the best we can,” Stack said, “to balance the societal need to resume activities that are so important to society, but to keep people safe.”

Chart by rt.live, last updated 11:23 a.m. Saturday, May 2

Beshear has said for two weeks that the state's daily number of new cases is at a plateau, or relatively so, but the rt.live chart for new cases shows the seven-day rolling average has slowly increased over that time, and reached a new high Friday. A seven-day average is used to smooth out daily differences, which can be driven by laboratory reporting schedules, testing patterns and other factors.

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

Nursing homes had problems controlling infections before all this

Jackson Manor, one of Signature HealthCare's 42 facilities in the state, had a major outbreak.

"Many Kentucky nursing homes failed at infection prevention and control even before the novel coronavirus blazed through them over the last two months, infecting more than 1,000 of their residents and staff as of Friday and killing more than 120," John Cheves reports for the Lexington Herald-Leader, after checking the homes' inspection records from April 2016 to December 2019.

"Among the places cited for errors as routine as a lack of hand-washing are seven of the 10 long-term care facilities now hardest hit by covid-19, such as Rivers Edge Nursing and Rehabilitation Center in Jefferson County, Signature HealthCare at Summit Manor in Adair County and Signature HealthCare at Jackson Manor in Jackson County."

But people who were looking for a nursing home for themselves or a loved one in the last year would have to dig deep, like Cheves did: "State regulators almost never issued a serious penalty for infection control violations, so they seldom resulted in fines or affected the federal government’s five-star rating system that the public uses to compare the quality of nursing homes."

Cheves examined the 333 infection-control citations issued to Kentucky nursing homes from April 2016 to December 2019. He summarizes with examples: "Nursing home employees failed to wash their hands, change gloves and disinfect equipment and supplies while walking from room to room among elderly and ailing residents, even when they handled urine and feces and cared for infectious patients in isolation, according to its own citations. . . . Aides passed out food, drinks and pills to residents with their unwashed bare hands while also touching their own faces, hair and communal objects such as light switches and refrigerator door handles, according to inspection reports. Feces-stained bed sheets were put on residents’ bed tables where personal items were kept. Residents’ surgical wounds were not properly cleaned and dressed."

Yet, the state Cabinet for Health and Services "nearly always determined there was 'minimal harm'," a key to keeping the violations from being considered serious and resulting in fines. Infection-control citations are among the most commonly issued to nursing homes, as well as among the least penalized, Cheves was told by Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, which lobbies for better care for the elderly and disabled.

“We have a lot of nursing homes that get cited for infection control deficiencies year after year, and for really basic stuff like nursing aides not washing their hands between rooms. But our regulatory system is pretty toothless, so we haven’t been solving the problem,” Edelman said. “Unfortunately, at a time like this, during a pandemic, we’re all seeing the results.”

The health cabinet "declined to say whether the state did enough in the past to enforce infection control at nursing homes or whether it would take more aggressive steps in the future," Cheves writes. A cabinet official told him that it follows U.S. Centers for Disease Control and Prevention-recommended protocols for infection control.

“Awareness of confirmed cases of COVID-19 in our commonwealth and in long-term care settings has resulted in the escalation of safety and infection control protocols and expanded emergency-scenario planning,” spokeswoman Susan Dunlap wrote. “Long-term care facilities are anticipating changes to CDC guidelines with respect to safety and infection prevention based on new learnings from combating the novel coronavirus. When these are issued, CHFS will follow them.”

Cheves reports, The U.S. Centers for Medicare & Medicaid Services sent a team of inspectors to the country’s hardest-hit nursing homes. They found that in 36 percent of the facilities, staff were not following proper hand-washing guidelines, and in 25 percent, staff failed to properly use personal protective equipment, such as masks, gloves and gowns, even when they had it."

Beshear calls out Perdue Farms for being uncooperative after virus outbreak at plant; restaurants say they're being ignored

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

Restaurants are unhappy with Gov. Andy Beshear, and he is unhappy with Perdue Farms.

Kentucky restaurateurs voiced their ire at not being included in Beshear's first round of reopenings scheduled for this month, and Beshear said Friday that Perdue "has not been as helpful and as responsive" as other meatpackers that have had coronavirus outbreaks.

The Louisville Courier Journal reported Tuesday that 31 of the approximately 1,000 employees at the Perdue plant at Cromwell in Ohio County had come down with covid-19, the disease caused by the virus. The Tyson Foods plant at Robards, in Henderson County, reported 71 cases and shut down through Saturday for cleaning.

Kentucky has 26 meat plants that are inspected by the U.S. Department of Agriculture. Asked Friday whether he had considered forcing a shutdown of operations at those with outbreaks, Beshear said the JBS Foods plant in Louisville had also agreed to shut down temporarily for cleeaning.

"Perdue has not been as helpful and as responsive, but we’re going to continue to try work with them to get the right things done," Beshear said. "We can't ask people to walk into a very dangerous situation if we and and an employer aren't doing everything they can to make it safe, so we're gonna continue to take steps, we'll do what it takes to make sure that we can make those facilities as safe as we can."

Then he issued what appeared to be a veiled threat: "I continue to believe that if you have to shut down for three days, but it means that you can create a safe, healthy environment, that may help you from having to shut down for multiple weeks or even a month. I hope those that need to hear that hear that."

The Kentucky Restaurant Association told the Courier Journal that it had submitted a proposal for reopening restaurants April 24, but hadn't heard back from Beshear. "We're just not being paid attention to," KRA President and CEO Stacy Roof told The Courier Journal on Wednesday. "And our members are fed up.” She said she had expected Beshear to let them begin reopening in late May.

Asked about that Thursday, Beshear said, "We're trying to reopen an economy, which takes a little time. . . . They're supposed to push, but I think a whole lot of owners of restaurants out there, while they are in a difficult place, know the challenge of doing this safely. I think the worst thing that any restaurant would want is to be the cause of an outbreak of covid-19. I think that's not just a temporary shutdown — that causes a permanent (shutdown) to a facility."

Beshear noted that Ohio Gov. Mike DeWine has not set a date for reopening restaurants. Tennessee Gov. Bill Lee allowed restaurants to reopen at 50% occupancy capacity this week. Indiana is doing likewise, and Beshear was asked what he would say to Kentuckians crossing the Ohio River to dine.

"We’re asking you, stay healthy at home," he said, not mentioning his order that requires Kentuckians to quarantine themselves for two weeks after making unnecessary trips to other states. He said earlier, "We hope phase two will begin in June and can include significantly more activities."

Beshear said he is still coordinating with Indiana, Ohio and Illinois, and said they all hope to learn from states that go first on various reopenings. He was implicitly critical of Georgia, which had the most aggressive reopening.

"We’re starting to see some numbers from Georgia that may suggest their decisions were wrong . . . a thousand new cases overnight," he said, adding later, "It might just be a one-day thing."

Beshear said he would not hold a briefing Saturday, the first break he has taken since starting the daily sessions March 7. He urged Kentuckians to do likewise and even avoid checking social media coronavirus news. “Turn everything off for a little while, invest in your mental and emotional health.” he said. “I’m going to do it too.” The Central Kentucky Tea Party has scheduled a protest of Beshear's policies at the Capitol Saturday.

In other covid-19 news Friday:

• Beshear announced 177 more confirmed cases of the coronavirius, bringing the state's adjusted total to 4,879. He said the number of new cases in the state continues to "hold steady." He said 334 people are in the hospital, with 178 of those in intensive care. At least 1,752 have recovered.
• Counties with the highest number of new cases include: Jefferson, with 41; Butler, with 25; Warren, with 13; and Kenton, with 11. 
• Beshear announced eight more deaths, bringing the state's total to 248. One was the second employee at a nursing home to die of covid-19; the 58-year-old woman was from Adair County, just like the first one. Six deaths were reported in long-term-care facilities, which have accounted for 51 percent of the state's total deaths.
• The other deaths were of a 90-year-old woman in Graves County; an 86-year-old woman in Marshall County; an 80-year-old woman in Butler County; a 67-year-old woman in Jackson County; a 93-year-old man in Carlisle County; and two from Jefferson County, an 81-year-old woman and a 42-year-old man -- the same age as Beshear, the governor noted, to point out that the virus can kill younger people, too.
• Beshear said 25 more residents and four more staffers in long-term-care facilities had tested positive for the virus. In all, 752 residents and 311 staffers have tested positive, in 75 facilities. Click here for a list with data on each of them. 
• Beshear said 1,200 tests of prisoners and employees had been completed at the Green River Correctional Complex in Central City, and results are expected back early next week. 
• He said the state continues to add testing capacity, with hopes of getting close to 30,000 test a week.
• The first week of Kroger-sponsored testing in Louisville, Lexington, Bowling Green and Owensboro resulted in 5,128 people getting tested. Beshear asked those who have signed up to show up, noting that there were nearly 400 no-shows in these locations. "It is really important that we use every one of these tests, so if you sign up, please make sure you go and get tested," he said. "Remember, there is not enough testing nationwide; we are ramping up ours to get it into a place that we need to. Every test is so important; it can teach us so much and it can make sure that you are safe and healthy." Click here to see all of the testing locations in the state. 
• The pandemic is likely to last as long as two years and won’t be controlled until about two-thirds of the world’s population is immune, says a report from the Center for Infectious Disease Research and Policy at the University of Minnesota. "Because of its ability to spread from people who don’t appear to be ill, the virus may be harder to control than influenza, the cause of most pandemics in recent history," Bloomberg News reports."People may actually be at their most infectious before symptoms appear, according to the report."
• University of Kentucky President Eli Capilouto said he plans to reopen the campus to in-person classes in August; UK HealthCare, researchers and facilities management are working on a restart plan; and UK Athletics is creating an "operations Plan" with the rest of the SEC, Rick Childress reports for the Lexington Herald-Leader.
• Pregnant women among first without covid-19 symptoms to be tested in Kentucky, Alex Acquisto reports for the Herald-Leader. She writes that Norton HealthCare in Louisville has already started the practice, and that UK HealthCare, Baptist Health and CHI Saint Joseph will begin universally testing certain groups of patients, including expectant moms admitted for delivery. Health experts say more testing is needed to determine how widespread the virus is.
• The Centers for Disease Control and Prevention is offering a "Coronavirus Self-Checker" to help you make decisions about seeking appropriate medical care.
• Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg that it would be "extremely unusual" if recovered patients didn't develop antibodies, though the World Health Organization has said it is still unclear. "Before anybody tells me that there is no antibody, I want to make sure that it was measured with a validated test," Fauci said, noting that many antibody tests haven't been approved by the FDA.
• Terry DeMio of the Cincinnati Enquirer reports that nearly 30,000 counterfeit or unapproved covid-19 test kits have been shipped through the mail system and seized at the DHL Express hub near the Cincinnati-Northern Kentucky International Airport, officials said Friday.
• Kentucky moved up to 13th from 16th among states for estimated percentage  of residents filling out the census, Beshear said. Everyday he asks Kentuckians to do this, saying, for example, "We're looking at a future where every federal dollar is going to be absolutely critical, probably more so than at any time in my lifetime. Everybody that signs up, everybody that fills out their census, it will take two minutes at most, will help us in the rebuilding effort." 
• Southwest, Delta, American, Frontier, JetBlue and Alaska airlines are among the companies with a face mask policy for customers, the Herald-Leader reports.
• Beshear said there were 24,840 March unemployment insurance claims still left to process. He said 8,000 of had identity-verification issues, and e-mails had been sent to this group; and the rest of them had substantive issues to work through.
• Other than the tourism-dependent state of Hawaii, Kentucky leads the nation in the percentage of its workforce that has filed for unemployment benefits, according to the U.S. Department of Labor. Here's the top of a chart from The Washington Post: