State fair won't be public; bars will be allowed to reopen with stricter rules; hospitalizations set record, reflecting July surge

Kentucky Health News chart based on initial daily numbers, which are often slightly revised

By Al Cross
Kentucky Health News

This month's Kentucky State Fair will be only for credentialed participants in competitions, and will be closed to the general public.

Gov. Andy Beshear said he will require masks "until we have significant control over the virus" and will also continue his more recent ban on social gatherings of more than 10 people.

Hospitalizations for covid-19 in Kentucky set a new record, probably reflecting the July surge in cases, but Beshear said new cases this week are on a trend that could give the state its first weekly decrease in six weeks.

And the governor said he is preparing to let restaurants return to 50 percent capacity and allow bars to reopen, but require enforcement to keep patrons seated and discourage mixing.

Those were the big items from Beshear's last scheduled briefing this week, which also touched on the virus in prisons, children's vulnerability to the virus and weekend events that could be transmission sites for it.

State fair: The Kentucky State Fair Board's decision appeared to have been made at the behest of Health Commissioner Steven Stack. Beshear said Wednesday that Stack met recently with Fair Board Chair Steve Wilson and CEO David Beck after making recommendations to them and getting a reply.

Wilson, a recent Beshear appointee, said in response to a question Thursday that the board had not voted on the matter, "but the fair board‘s in complete support of all the efforts the governor’s done to keep our community healthy . . . It’s really impossible to enforce social distancing at a free concert," one of the many events normally held at the fair.

Asked why the board hadn't voted, Wilson replied, "Why would we want somebody to vote against healthy practices? Every single board member is in favor of the action." Asked what he would say to those who will see rides in action at the leased Kentucky Kingdom amusement park that is part of the Louisville fairgrounds, but no midway operating at the fair, he said, "Kentucky Kingdom regulations were enforced before I became chairman."

Wilson said he was happy that the board is able to continue its horse show, even without spectators, and youth livestock competitions. A state law says the board "shall hold an annual fair on the state fairgrounds, for the exhibition of agricultural, mechanical, horticultural, dairy, forestry, poultry, livestock, mineral, and all other industrial interests of the state."

Masks, mandates and numbers: Beshear issued an emergency order July 9 requiring masks to be worn in indoor public spaces, and outdoors when people can't stay six feet apart. He said he would renew it for another 30 days and keep renewing it until the virus is under control in the state and the share of Kentuckians testing positive for it falls below 4 percent. That figure for the last seven days is 5.51%, the same as Wednesday and well above where it stood in June.

“We do believe the facial coverings are having a real impact,” Beshear said. “It’s working, and since we made it mandatory more people are wearing them. . . . If we want to get some things open that we had to pause, if we want to continue to grow our economy, this is the way.”

Beshear noted that new-case numbers this week are running behind last week. He reported 516 new cases Thursday, lowering the seven-day rolling average to 557. Almost two weeks ago, it reached a high of 668.

The governor said he would also continue the 10-person limit on noncommercial gatherings that he imposed on July 27. Noting a street-rods event in Louisville and the U.S. 127 Yard Sale this weekend, Stack said, "Please follow our guidance, wear a mask, stay away from each other."

The state's daily coronavirus report said 701 people were hospitalized with covid-19 at Kentucky hospitals, well above the record of 638 set Tuesday. Intensive-care units had 140 covid patients. Beshear said a surge in hospitalizations “isn’t unexpected, given the large numbers in July but something we ought to be pretty worried about.”

He said some of the hospitalizations are from other states, noting that TriStar Greenview Regional Hospital in Bowling Green has accepted transfers from its sister hospitals in Tennessee, but said out-of-state patients would be less than 10% of the total.

Beshear said 12 of Thursday's new coronavirus cases were children under 5. Referring to false statements President Trump has made this week about children and the virus, he said, “Let’s not listen to anything out there suggesting kids can’t get this; they absolutely can, and they are.”

The state reported eight more covid-19 deaths, bringing the state's toll to 760. The fatalities were a 68-year-old woman from Bell County; an 86-year-old woman from Fayette County; a 94-year-old woman and a 94-year-old man from Franklin County; an 87-year-old man from Graves County; a 78-year-old woman from Jefferson County; a 68-year-old woman from Kenton County; and an 84-year-old woman from Ohio County.

Noting that “deaths follow a large number of cases by a few weeks,” Beshear said the daily death list  is “probably gonna be longer than this in the coming weeks, but I do feel hopeful, and I do feel optimistic, that if we will continue to wear that facial coverings, we will have found a way to stop what was going to be devastating, and hopefully to not just reach a plateau but to get back on the right track.”

Restaurants and bars: Beshear reduced restaurants' indoor capacity to 25% on July 27. He said that when he issues an order letting them go back to 50%, they will need to "prioritize outdoor seating," serve nothing after 10 p.m., and close by 11 p.m. He said the same curfew will apply to bars.

He said bars "can expect to have an enforced seat rule, in which all service will be at tables that will be limited to the people who were initially seated at them. "I know that’s gonna be a different experience, but it’s about the only way that we think we can do it, and do it safely at the moment," he said. "We think this gives us the best opportunity to avoid the mega-spreading events, the super-spreading events, and encourage what we need to see from folks."

He added that patrons shouldn't exchange the late-night bar and restaurant experiences for house parties, which have caused problems in other states.

Prisons: J. Michael Brown, secretary of the governor's Executive Cabinet, said the Kentucky State Reformatory near La Grange has 217 inmates and 19 employees who have tested positive for the virus. He said KSR is "the closest thing we have to a hospital prison," and inmates have been separated according to their status, with meals being delivered to them. He said one dormitory has been converted into a covid-19 recovery unit.

Brown did not mention that the prison "is now linked to deaths of six inmates, the highest number of such fatalities at any of the state's 13 prisons," as Deborah Yetter of the Courier Journal reported Aug. 3. He reported on two other facilities, the Green River Correctional Complex in Central City, saying it had no more active cases, and the Kentucky Correctional Institution for Women at the western tip of Shelby County, near Pewee Valley.

He said 239 inmates and 31 staff members at KCIW had tested positive, and 190 and 22 have recovered, respectively. Overall, he said state correctional facilities have had 844 cases among inmates and 136 among staff, and 560 inmates and 87 staff have recovered, leaving active cases among 284 inmates and 49 staff.

More data: The Kentucky Hospital Association has posted on its website a coronavirus dashboard that emphasizes hospitalizations for covid-19 and puts them in context, with the number of available beds, including intensive-care units. The dashboard's figures before Beshear's update showed that 80 percent of ICU beds were occupied, 11 percent of them by patients suffering from covid-19. Overall, 65 percent of Kentucky beds are occupied, but Beshear said recently that there have been some local shortages.

Kentucky Hospital Association coronavirus dashboard, before new numbers were reported Thursday

Republican state Rep. Kim Moser of Taylor Mill, chair of the House Health and Welfare Committee, said on Facebook that she worked with KHA "to provide accurate information as we reopen and adjust our activities accordingly. The KHA has worked hard to standardize reporting among hospitals statewide to ensure consistency and accuracy."

KHA President Nancy Galvagni said that in response to Moser, "KHA decided that policymakers of all stripes would benefit from having that kind of information, and we worked to produce basic facts that the General Assembly, the Executive Branch and the public could incorporate into their thinking about how best to respond to the pandemic."

In other covid-19 news Thursday:

• Counties with more than five new cases were Jefferson, 148; Fayette, 33; Warren, 21; Madison, 18; Calloway, 15; Hardin, 13; Bell, 11; Graves and Oldham, 10 each; Franklin and Laurel, 9; Boone, 8; Jessamine, Kenton, McCracken, Shelby and Whitley, 7 each; Cumberland, Knox , Washington and Woodford, 6 each.
• A telephone poll taken in Kentucky July 30 through Aug. 3 by Connecticut's Quinnipiac University found that 66 percent of registered voters approved of Beshear's handling of the virus, and 30 percent disapproved. His overall job rating was slightly lower, 63-34, but the poll's error margin was plus or minus 3.3 percentage points for each number. President Trump's rating on the virus was 50-47, virtually the same as his overall job and favorability ratings.
• Asked about teachers complaining that some districts are requiring them to come to school to
  deliver online instruction to students at home, Beshear said the districts should "strongly reconsider." He said, "I know that’s the way things have always been done, but that doesn’t mean it’s a good reason to do it. . . . In the middle of a pandemic we have to do things differently . . . Everybody doesn’t need to be in every single day.”
• Stack reported that the federal inter-agency team that visited Louisville this week to evaluate response in the state's biggest hotspot complimented Kentucky's system of tracing contacts of infected people and asking them to self-isolate, saying it is "one of the best that they've seen."
• Beshear renewed his plea for federal aid to make up state budget losses, saying the money would have one and half times the effect of other aid. "To us, it's not political," he said. "It's a matter of survival."
• The governor said he spoke with Ohio Gov. Mike DeWine, who discovered that he had the virus because he was planning to greet Trump on a visit to the state. Beshear said DeWine told him that he didn't know how he became infected. DeWine doesn’t know how he got the virus, Beshear said. “It’s just an example of how this virus can spread very aggressively.” UPDATE, Aug. 7: DeWine's test turned out to be a false positive; he tested negative twice.
• Misinformation about the virus is proving to be "highly contagious," The Associated Press reports, and "There is seemingly no antidote in sight for the burgeoning outbreak of coronavirus conspiracy theories, hoaxes, anti-mask myths and sham cures. . . . Experts worry the torrent of bad information is dangerously undermining efforts to slow the virus."

Positive-test rate goes above 5.5%, making Beshear consider recommending another delay of in-person schooling

Ky. Health News adaptation of chart shown by Health and Family Service Secretary Eric Friedlander

By Al Cross
Kentucky Health News

More Kentuckians are testing positive for the novel coronavirus, and that could prompt Gov. Andy Beshear to recommend another delay in the start of in-person schooling this month.

Nine days ago, Beshear recommended that schools wait until the third week of August, due to a surge in coronavirus cases in July. Asked Wednesday if schools are in a position to open then, he said, “I’m watching the numbers very carefully this week. If it were today, I would suggest that they delay. We’re still in a very uncertain area and I'd like to see that positivity rate rate lower.”

The governor reported that 5.51 percent of Kentuckians tested for the virus in the last seven days, a noticeable jump from Tuesday, when the state's seven-day rolling average was 5.24%. The previous Wednesday, it hit 5.81%, the highest since testing became widespread in the state. The 5% rate is a generally recognized threshold for greater concern.

Asked if it was possible that he would recommend another delay, Beshear said, “That's certainly possible.” He said some schools that opened early in other states have had to close due to surges in cases. In Kentucky, such decisions are up to local school officials. 

Daily numbers: The governor reported 546 new cases of the virus Wednesday, lowering the state's seven-day rolling average to 577. The three-day average is 523, and Beshear noted that the same Monday-Wednesday period last week had 104 more cases, for an average of 558.

As he gave the daily number, Beshear alluded to much smaller numbers reported a month ago, when the surge began: “It’s hard to believe that that could be good news, and it’s not in so many ways . . . but the trajectory we were going on was terrifying,” he said. “I believe it’s evidence of facial coverings working.” On July 9, he ordered that masks be worn in public indoor spaces, and outdoors when people can't stay six feet apart.

“It looks like we are stopping a very dangerous situation from occurring. We need to keep it up,” Beshear said, adding that it's important for local and state leaders to set good examples by wearing facial coverings: “It shows to other people that we’re willing to walk the walk, and we need leaders at every level that are doing this.”

Noting that 21 children under 5, one 18 days old, were among the day's new cases, Beshear said, “Let’s wear our masks for the 18-day-old. Let’s make sure were protecting one another when it could harm the very youngest among us.”

Only one death from covid-19 was reported Wednesday, "the lowest in a long time," Beshear noted. The death of a 71-year-old woman from Logan County raised the state's toll to 752.

Current hospitalizations for covid-declined to 620, from the record 638 reported Tuesday; 131 of them are in intensive care, a decline of four. Beshear said hospitalizations are counted as covid-19 cases if the admitting physician believes they are; he said the state hopes to differentiate between those suspected cases and those that are confirmed by a test.

State chart, adapted by Ky. Health News; for a larger version click on it.

In nursing homes and other long-term-care facilities, the state is doing a good job thwarting the virus, said Eric Friedlander, secretary of the Cabinet for Health and Family Services. He displayed charts showing that the state's case and death rates are low compared to other states, especially for a state with relatively poor health overall: "When you look at our relative heath status, we have done a very good job."

More than 63% of Kentucky's covid-19 fatalities have been residents of long-term-care facilities. The daily report on those facilities says there are 454 active cases among residents and 208 among employees.

Counties with more than five new cases on the daily report Wednesday were Jefferson, 104; Fayette, 59; Warren, 52; Hardin, 20; Madison, 15; Daviess, 12; Barren, Bullitt and Kenton, 11 each; Jessamine and Scott, 10 each; Franklin and Pike, 9 each; Greenup, 8; Fulton, Logan, Perry, Whitley and Woodford, 7 each; and Boone, Campbell Clark and Knox, 6 each.

Campus concerns: Asked about reopening of the University of Kentucky, which began testing as many as 30,000 students this week, Beshear said the challenge is how to monitor and trace the contacts of infected students and discourage them from "activity we wouldn’t consider reckless on a college campus anytime other than now." Asked how much faith he had in students to make good decisions, Beshear replied:

“That’s a heck of a question . . . I can’t claim I made all the best decisions at 18, 19 and 20, but I also wasn’t in the middle of a worldwide health pandemic . . . We’re asking so much of our young Kentuckians at a time when they’ve been separated from their friends in a way that they never have before, at a time when their emotional and social health is so connected to those interactions, and I hurt for ‘em. . . . We need to reduce the number of places they could go to make bad decisions, and then we need to be consistently talking to them as adults, 'cause we’re asking them to be really responsible adults at a time in their lives where we probably shouldn’t have to ask that.

“Do I have faith in them? Yes; the challenge is, there’s so many of them . . . We need our young adults . . . if they want to be in their university settings, to know it’s probably contingent on the vast majority of them making good decisions.”

In other covid-19 news Wednesday:

• Beshear said he would consult with the White House Coronavirus Task Force before allowing bars to reopen or increasing indoor capacity at restaurants, and if bars open, seating rules will have to be strictly enforced. He said a curfew for bars would also apply to restaurants and would probably be at 10 p.m.
• The state Fair Board appears likely to announce soon tighter restrictions for the state fair, scheduled Aug. 20-30 in Louisville, a hotbed of the virus. Beshear said Health Commissioner Steven Stack met recently with board Chair Steve Wilson and CEO David Beck after health officials made recommendations and Beck replied.
• Asked about college football, Beshear said he waiting to see what conferences decide, suggesting they might further delay the season. As for limiting fans, he said, “If you really thin it out and you do enforcement, then you can do it, [but] we see similar venues across Kentucky not doing enforcement at all, and the result can be really concerning.”
• And the Kentucky Derby, set to run Sept. 5 with Churchill Downs at 60% capacity? "There's a lot of different ways that event could happen," said the governor, who would present the trophy on national television. 
• Beshear said more cases are being reported in county jails, but said he didn't have current information on state prisons.
• Midway Mayor Grayson Vandegrift told his constituents in a monthly covid-19 update that they needed to resist anti-mask peer pressure, which he hopes is not intentional, and find ways to confront it: “Nobody wants to be, so to speak, the wet blanket. . . . I think we need to work on being that person; I think that’s what leadership really is.”
• Carl Hulse, chief congressional correspondent of The New York Times, writes: "Senator Mitch McConnell has put himself in one of the toughest spots of a political life that has seen plenty of them.
  "Up for re-election in the middle of an unforgiving pandemic, the Kentucky Republican and majority leader is caught in a family feud between a group of endangered incumbents in his party who are desperate for pandemic relief legislation that is tied up in slogging negotiations, and a significant portion of Senate Republicans who would rather do nothing at all. He is also up against Democratic leaders who do not see the need to give an inch on their own sweeping coronavirus relief priorities, administration negotiators who badly want a deal that boosts President Trump — even if it ends up being one that most Senate Republicans oppose — and the president himself, who has played his usual role of undercutting the talks at every turn.
  "All that is at stake is the health and economic state of the nation, control of the Senate and Mr. McConnell’s own reputation and future."

Latest White House report has fewer Kentucky counties in danger zones, drops two points of preventive advice from previous report

Table from White House Coronavirus Task Force report; for a larger version, click on it.

By Al Cross
Kentucky Health News

Kentucky got a better report this week from the White House Coronavirus Task Force.

It has two more counties are in the task force's "red zone" -- for places with more than 100 new cases per 100,000 people, and a positive rate of at least 10 percent in tests for the virus -- but a lot fewer in its "yellow zone," for those with 10 to 100 cases per 100,000 and positive-test rates of 5% to 10%.

And the latest report dropped two recommendations that were in the previous week's report, that Kentucky stop visitation in nursing homes and other long-term-care facilities, and tell people with obesity, diabetes and high blood pressure that they should shelter in place.

The task force sends the report to states with recommendations based on the red and yellow zones. It is dated on Sundays and covers the preceding Saturday through Friday. The Cabinet for Health and Family Services released the report in response to an open-records request from Kentucky Health News, which asked that it be released within one day of receipt from the federal government because it contains time-sensitive material. The request was made on Monday and the cabinet fulfilled it on Tuesday. "We appreciate the prompt response," KHN told the cabinet in an email.

The latest report puts 18 counties in the red zone, two more than in the previous week's report, which but has only 34 counties, down from 58 the week before. Taken together, the number of the state's counties in a danger zone is 52, down from 74.

While the number of red-zone counties didn't change much, the names of the counties did. The latest report added the entire metropolitan areas of Louisville and Evansville, including Owensboro and Henderson. Those additions were expansions from Jefferson and Daviess counties, which were already in the red zone. Jefferson County has seen a major surge in cases the last three weeks.

Chart from White House Coronavirus Task Force report, relabeled by Kentucky Health News

The other red-zone counties, largely in the order listed by the task force, are Warren, Oldham, Graves, Barren, Scott, Laurel, Henderson, Casey, Knox, Adair, Spencer, Henry, Anderson, Metcalfe, Monroe, Cumberland and Fulton. The last three jumped directly into the red zone without having been in the yellow zone, illustrating how quickly the virus can spread.

Shelby and Ohio counties moved from the red zone into the yellow zone. Carroll County, which had been in the red zone, isn't even in the yellow zone in the latest report. Counties that were unlisted in the previous report but are now in the yellow zone are Garrard, Lawrence, Perry, Pulaski and Taylor.

Counties moving out of the yellow zone in the latest report were Allen, Boyle, Butler, Clinton, Fleming, Franklin, Gallatin, Grant, Grayson, Green, Hancock, Harrison, Hart, Hickman, LaRue, Livingston, Martin, Mason, Nicholas, Owsley, Todd, Trigg, Trimble, Union and Washington.

The report says 7.2% of the state's nursing homes had at least one infected resident, an increase of 0.6 percentage points from the previous week.

"The nursing home facilities with more than two confirmed or suspected covid-19 cases are largely in red and yellow zones," the report says. "Preventing further spread in these areas is critical to protect the vulnerable nursing-home population. Protect vulnerable populations in assisted living and long-term care facilities through weekly testing of all workers and requiring masks. In facilities with workers who tested positive, ensure all residents have been promptly tested and appropriate cohorting measures are in place. Conduct on-site inspections to ensure covid-19 safety guidance and considerations are being implemented."

Overall, Kentucky had 95 new cases per 100,000 population in the past week, compared to a national average of 137 per 100,000. That put it just out of the red zone for cases.

The report's statewide recommendations say the state should keep its mask requirement in place and "work with local communities to ensure high usage rates; identify mechanisms to assess compliance with local regulations."

Enforcement of the mask mandate is largely up to businesses. They are supposedly monitored by local health departments, but Gov. Andy Beshear acknowledged July 27 that enforcement needs to improve. His office has not responded to questions from Kentucky Health News about what he has done to improve enforcement and any results from any such actions.

Maps from White House Coronavirus Task Force report for July 25-31; for a larger image, click on it.

Covid-19 cases up and hospitalizations at record high, but Beshear says virus leveling off in Ky.; calls for more federal aid

Chart by Daniel Desrochers of Lexington Herald-Leader shows past month's covid-19 hospitalizations.

By Melissa Patrick and Al Cross

Kentucky Health News

After reporting 700 new cases of the coronavirus and a record-high number of hospitalizations for covid-19, Gov. Andy Beshear said Tuesday that he was still hopeful the state was on a better trajectory.

"While today we have a higher number than we had at this time last week, if you compare Monday and Tuesday of last week, it's just barely higher than Monday and Tuesday of this week," Beshear said at his daily briefing. "What we believe we see is a general leveling off, though today there are more cases than I would like to report." 

Including today's numbers, the seven-day average of daily new cases is 588; the three-day average is 495. Today's positive test rate of 5.24% is slightly up from yesterday's rate of 5.18%. Beshear has said that anything over 5% is considered a danger zone.

Beshear reported that 638 Kentuckians are hospitalized for covid-19, but he did not note that the figure was the highest daily hospital census yet attributed to the disease in Kentucky. It was a 4 percent jump from the 612 reported Monday; covid-19 patients in intensive care numbered 135, down by one.

The state reported seven more deaths from covid-19, raising its toll to 751. Beshear said, “This is probably gonna be a really tough month in Kentucky,” with deaths resulting from the surge of cases in July.

Beshear reported 18 more coronavirus cases in children under five today, with the youngest of them two- months-old. “Britainy and I know as parents how scary it must be," he said, referring to his wife, who preceded him to the lectern to announce a "Coverings for Kids" campaign that will allow Kentuckians to donate facual coverings directly to local schools starting Aug. 11.

Against the backdrop of still-worrisome numbers, Beshear said Kentucky is on a better trajectory than it was just weeks ago when cases increased by 48% one week and 52%, the next, but only 4% and 5% the last two weeks.

He again attributed that to the mask mandate he issued July 9. "We showed in that graph yesterday where we were heading but for our willingness to wear a mask or a facial covering," he said. "The curve that we were on was troubling, but now thankfully we are now headed in a better direction." 

Beshear said Kentuckians can expect to see him continue the mandate, and cautioned that facial coverings will be needed even after the mandate ends -- at least until a vaccine is readily available and the virus has abated.

And he made his daily pitch for masking: "When you wear a facial covering when you are in public you’re passing the test of humanity . . . you’re putting other people’s lives above your basic comfort."

Restaurants, bars and Derby: Asked why restaurant capacity is restricted if the mask mandate is working, Beshear said it will take at least two weeks to see the impact of his week-old order closing bars and decreasing indoor restaurant capacity to 25%, from 50%, and the state must not only stop the escalation of cases, but decrease them and get the positive-test rate below 5%.

He said that to feel more comfortable with relaxing restaurant restrictions, "I would like to see a break in the data this week," and reiterated that if bars are reopened, "It's going to have to look different."

He said of restaurants, "It's not fair that they have to bear a lot of the brunt of this, but what the White House is saying is that this can make the biggest impact on getting our cases back under control and we hope we don't have to do it again." He said state data shows "a significant number of clusters that have occurred in restaurants," 18% of all clusters at one point.  

Asked if there had been talk about limiting fans at the Sept. 5 Kentucky Derby, since the Indianapolis 500 has decided to run without fans Aug. 23, Beshear said Churchill Downs CEO Bill Carstanjen had called him hours earlier. 

"We are both carefully watching the numbers," he said. "He assured me that he wants Churchill and the Derby to be safe. We are going to talk early next week after we see the trends going on this week."

He later added that if the case numbers were the same as today, he would want to see tighter capacity limits than the 60% now planned, and significant enforcement. "Do I believe that if done right, there can be some fans? . . . I do think that there can be some, and the level will really depend on where we are with the virus." 

A plea for federal aid: As negotiations on the latest coronavirus relief bill dragged on, Beshear stressed the need for Congress to help states and localities make up big pandemic-caused losses in their budgets.

"It shouldn't be this hard," he said. "I get that things are really hard in D.C.; everything seems hard in D.C., but we are in the middle of an international health pandemic where people are dying, where it is out of control in so many states, where we are much higher than I want us to be, where we are in the midst of a significant recession because of it, and . . . what they pass may be the difference in us being in the midst of this recession for a long time or us being able to bounce back."

He added, "We are looking at the largest single-year budget cuts in the history of Kentucky in the midst of coronavirus. Congress can't let that happen. That is malpractice. That is refusing to step up and do your duty. And again, I guess horsetrading occurs all the time in D.C., but I wish we were at a place where at least something like this could shake us out of that and just get us to do the right thing."

Earlier, asked what the state is doing for school districts, he said, "What we are also working on for our school districts is pushing Congress for budget stabilization, without which schools might have money to buy PPE, but they won't have the amount of funding in the next budget they need just to keep the doors open." 

He also endorsed continuation of the extra $600 a week in unemployment benefits, which expired last week and "is of significant help to our economy right now and will make the difference in how long we want this recession to last." The two sides are "miles apart" on the issue, a House Democratic leader said.

Senate Majority Leader Mitch McConnell said Tuesday that he'd support whatever agreement the Trump administration and Democrats reach, even if he has "some problems with certain parts of it," Roll Call reports. Trump said Tuesday that poorly run states shouldn't get a bailout. 

In other covid-19 news Tuesday: 

• The seven fatalities were a 53-year-old man from Calloway County; a 70-year-old man from Daviess County; a 50-year-old man from Kenton County; a 95-year-old woman from Ohio County; and three from Jefferson County: two women 45 and 69, and an 81-year-old man. Beshear said the 45-year-old victim had some other medical conditions, but "This is one of the youngest groups that I've had to read."
• Jefferson County accounted for 30 percent of the day's new cases, 212, on the state's daily report. Other counties with more than five new cases were Fayette, 47; Warren, 35; Kenton, 29; Boone, 27; Laurel, 18; Campbell, 17; Scott, 16; Knox and Madison, 15 each; Graves and Hardin, 11 each; McCracken, 10; Hopkins and Shelby, 9 each; Barren, Daviess and Jessamine, 8 each; Grant, Magoffin, Nelson and Oldham, 7 each; and Clark, Henry, Meade and Muhlenberg, 6 each.
• Daily reports going back to June 1 are now archived at https://chfs.ky.gov/Pages/cvdaily.aspx.
• In long-term-care facilities, 13 more residents and 25 more employees tested positive for the virus, five more facilities had at least one case, and three more deaths were attributed to covid-19. The state is now reporting active cases: 444 among residents, 123 among employees. 
• In child care. six more facilities were associated with a case, for a total of 110. The cases involve 84 employees and 75 children.
• Jessamine County School Supt. Matt Moore overruled the 3-2 vote of the school-board decision to allow both in-person and online "non-traditional instruction." Moore said schools would only start virtually, WKYT reports. In a letter to parents, he said in part, "Covid-19 cases have recently spiked in our community, as a result, and to safeguard our students and staff, I have made the decision to exercise my authority to utilize our extended NTI plan."
• The president now supports the use of face coverings to thwart the virus, even asking his base to wear them. The Lexington Herald-Leader reports that an e-mail his re-election campaign sent to supporters Monday said “We have nothing to lose, and possibly everything to gain” by wearing masks. He added, “We are all in this together, and while I know there has been some confusion surrounding the usage of face masks, I think it’s something we should all try to do when we are not able to be socially distanced from others,” the president said. “I don’t love wearing them either. Masks may be good, they may just be OK, or they may be great.”
• Covid-19 at the Kentucky State Reformatory in LaGrange is now linked to deaths in six inmates, the highest number of such fatalities at any of the state's 13 prisons, Deborah Yetter reports for the Louisville Courier Journal. The state has reported that nine inmates from the reformatory were hospitalized as of last Thursday. 
• Kentucky Youth Advocates hosted a forum to discuss challenges that youth and families connected to the child welfare system are facing because of the covid-19 pandemic, along with solutions moving forward. Click here for a full report titled: "Covid-19 Impacts on the Kentucky Child Welfare Community: A Public Health Crisis Meets a Vulnerable System," click here for the presentations of the findings and click here for a recording of the forum.

Beshear: Drop in virus cases lines up with mask mandate, and 200,000 more in Ky. would follow it if Trump wore one routinely

Health Commissioner Steven Stack used this graph to compare states. For a larger image, click on it.

By Melissa Patrick and Al Cross

Kentucky Health News

The state's top doctor said Monday that from a medical standpoint, Kentucky has done "a pretty good job" dealing with coronavirus, but Gov. Andy Beshear said the state would be doing better if President Trump set a better example by wearing a facial covering.

Asked to grade Trump's efforts against the virus, Beshear declined, except to say, "I have mentioned that we really need the president to wear a mask, that if the president would routinely wear a mask, then there’s probably a couple hundred thousand Kentuckians that would wear one too, and would better protect them."

Health Commissioner Steven Stack praised Kentuckians' efforts to do what has been asked of them to keep the disease at bay, most importantly wearing facial coverings and and practicing social distancing.

“I think we have a lot to be proud of in Kentucky. It’s been hard. It's taken a real toll on us and I never want to be dismissive of that,” Stack said. “I think that the evidence so far is showing we've done a pretty good job steering us through this in Kentucky from a medical standpoint.”

Beshear reported 323 new cases on Monday. The seven-day average is 564; the three-day average is 453. He reported 612 Kentuckians in the hospital with the virus, and 136 of them in intensive care. The state's positive test rate is 5.18%.

The positive-test rate that Kentucky reports is lower than those in federal and other reports because the state removes duplicates, Stack said. Beshear said some days have seen as many as 22 duplicates, reflecting multiple tests of the same infected person.

While Kentucky had its largest number of overall positive cases in July, Beshear said there is reason to be hopeful, "because what the numbers are telling us is that facial coverings and masks are working."

Blue bars are cases per week, June 8 to Aug. 2. Dotted line projects numbers
if the trend of July 13-19 had continued. For a larger graphic, click on it.

He showed a graph of cases per week that showed a 48% increase in the week of July 6-12, a 52% jump July 13-19, a 4% increase July 20-26, and a 5% increase July 27-Aug. 2. The mask mandate went into effect July 10, and the incubation period for the virus can be two weeks or longer.

"This shows you how important wearing that facial covering is and its impact that it can have pretty quickly," the governor said. 

Beshear projected that if Kentucky did not have a  mask mandate, it would have continued seeing exponential growth,  as high as 1,000 new cases every day, like Oklahoma, Mississippi and so many other states have had. "That is the trajectory that we were on," he said. 

To further promote the effectiveness of wearing a mask, Beshear launched a new statewide public service campaign called MaskUpKY that will be released over the next couple of months. The message is "Don't put it off. Put it on."

“We know that if we can get the majority of Kentuckians to wear a mask when you go in public, we can make a major difference,” Beshear said. “If we want to get our kids back in school, reopen our economy, keep each other safe and get to a new normal, we need every Kentuckian to wear a mask or facial covering. It’s that simple.”

Beshear and Stack said it is still too early to see the impact of the week-old order closing bars and decreasing indoor restaurant capacity to 25%, from 50%.

Beshear said he hoped to provide additional capacity for restaurants next week. "On bars, we hope that we can have better, stronger guidelines," he said. "We may also have to consider a curfew, a closing time, because that appears to be at least semi-effective in other states."

Labeled screenshot of New York Times interactive map,
which also has estimates for schools of 100 and 1,000.

Schools: How risky will or would it be to open schools to in-person instruction in the middle of a pandemic? Researchers at the University of Texas estimated the risk on the basis of current infection rates in each county, and The New York Times created an interactive map with their data. Kentucky's risk is relatively low, but some counties are especially risky.

For example, in Warren, Barren, Monroe and Cumberland counties, a school with 500 people would be expected to have five people arriving infected with the virus in the first week of in-person classes. That is the near middle of the estimated range of three to nine.

Bell and Harlan counties are even higher, at seven, with ranges of four to 14 and four to 13, respectively. Counties with an estimate of four, and their estimates' ranges, are Boyle (3 to 8), Casey (2-7), Fulton (3-8), Graves (2-8), Metcalfe (2-7), Ohio (2-7), Oldham (2-7) and Scott (4-8). Jefferson and Fayette counties both have estimates of three, with ranges of two to seven. They have decided to begin instruction online.

In other covid-19 news Monday:

• The state reported two more deaths from covid-19 on Monday, bringing its toll to 744. The fatalities were a 99-year-old man from Calloway County and a 75-year-old man from Floyd County. 
• Counties with 10 or more new cases were Jefferson, 75; Fayette, 30; Warren, 24; Oldham, 20; Madison, 13; and Jessamine, 10. 
• Twelve of the new cases were in children under the age of five, with two of them three months old. 
• In long-term care facilities, Beshear reported nine more residents and  seven more staff tested positive for the virus, and attributed three more deaths to the disease, for a total  of 475. The state began reporting only active cases at the facilities: 417 residents and 201 employees. 
• Beshear's travel advisory, asking people to avoid traveling to states with positive-test rates of 15% and to self-quarantine if they do, now applies to fewer states: Alabama, Arizona, Florida, Idaho, Kansas, Mississippi, Nevada and South Carolina. Alabama and Mississippi have the highest rates, 21.55% and 21.12%. 
• Beshear followed the White House task force's advice while Tennessee Gov. Bill Lee did not, refusing to close bars or require masks, the Courier Journal notes in its weekly covid-19 roundup. It also notes that New York has added Kentucky to the list of 30 states whose citizens should quarantine for two weeks if they come to the Empire State, due to Kentucky's higher positive-test rate.
• A federal response team of four to six people will be in Louisville this week to evaluate the city's response to the pandemic because of Jefferson County's rising case numbers and positive-test rates. Some recommendations are expected, said Eric Friedlander, secretary of the Cabinet for Health and Family Services.
• Kroger Co. has moved its testing to its in-store clinics, but Beshear said more than 225 testing sites can be found at kycovid19.ky.gov.
• Free drive-through testing sites will be offered in Louisville at three locations starting Aug. 5; call 502-588-0414 to sign up. In Northern Kentucky, new drive-thru testing will begin Aug. 6 at the Atlantic Corporate Center in Erlanger. The testing is free, but by appointment only. Beshear said he would announce a new site in Lexington in the next few days. 
• "Seven young podcasters are telling the stories of the pandemic’s impact in Eastern Kentucky," reports Liz Moomey of the Lexington Herald-Leader. The interns with the Appalachian Media Institute, part of Appalshop in Whitesburg, premiered “A Mask on the Mountains”  July 23 on WMMT-FM, available online. "They focus on covid-19’s effect on life in the region, addressing a range of topics like foster care, health care disparities and canceled festivals," Moomey reports.
• "The mask is the simplest and among the most effective weapons against the coronavirus in the public health arsenal. Yet from the start, America’s relationship with face coverings has been deeply fraught," The Washington Post reports. "Faulty guidance from health authorities, a cultural aversion to masks and a deeply polarized politics have all contributed." New York Times columnist Paul Krugman writes, "The cult of selfishness is killing America."
• Some families are creating "pandemic pods" to provide supplemental learning or to complete at-home coursework together and to be able to socialize, others are looking to form "microschools" by hiring someone to teach their children, and others are participating in home-school co-operatives. Some have suggested that public schools should explore similar models, especially to help high-risk and high-need students and others have strongly cautioned that these models represent an inequitable model that will further widen the achievement gaps in education based on class, race and ability, Billy Kobin reports for the Courier Journal. 
•  WDRB reports on challenges for the state's contact-tracing system, provided to the state by Deloitte under a $4.27 million contract. Key among the challenges is an inability for health departments to have quick access to the data. “We just don’t have a quick way yet to get it out, to get that information out to the public in an accurate manner,” said Dr. Sarah Moyer, Louisville's public-health director.  
•  Ed Yong of The Atlantic offers an in-depth analysis, "How the Pandemic Defeated America." Yong opens his story by writing, "How did it come to this? A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom."
• The Kaiser Family Foundation offers a report that answers key questions about nursing-home oversight and explains how federal policy has changed in light of covid-19.

UK student maps planting and use of blackberries in Grow Appalachia program; store-bought berries too expensive for many

Lucinda Smith with blackberries (Photo via UK)

By Katie Pratt
University of Kentucky

A University of Kentucky student is contributing to nutrition research that could lead to healthier habits and fewer negative health outcomes in her native region.

“I have always wanted to give back to Eastern Kentucky,” said Lucinda Smith, a senior human-nutrition major from Corbin who is working working with Dawn Brewer, an assistant professor in the Department of Dietetics and Human Nutrition in UK's College of Agriculture, Food and Environment.

Brewer is leader of the Community Engagement Core of UK’s Superfund Research Center, which is funded by the National Institutes of Environmental Health Sciences. The core seeks to help people near hazardous waste find ways they can use nutrition to improve their health and reduce their risks of negative health impacts associated with exposure to pollutants from the sites.

This summer, Smith received undergraduate research funds from the college and department that allowed her to map the location of blackberry bushes distributed through the community engagement core and Berea College’s Grow Appalachia program earlier this year by the Cowan Community Center in Letcher County and the Red Bird Mission Community Outreach Clinic in Clay County. Each participant received six to eight bushes and growing supplies.

“In an earlier survey, many people in the project said they loved blackberries, but they were often too expensive for them to purchase,” Smith said. “Blackberries are also a plant that grows well in Kentucky and are easy to plant and maintain. They contain phytonutrients and antioxidants, which help reduce oxidation and inflammation.”

Smith's project is measuring the amount of fruit each family harvests and how they use it, and mapping where the bushes and the demographic data of the 89 project participants. She collaborated with Josh Knight, UK senior extension associate with the Center for Crop Diversification, to make the maps and received location data from Grow Appalachia.

“Lucinda’s work gives a nice visual to share with our current and potential sponsors so they can see the reach of our program, particularly throughout Eastern Kentucky,” Brewer said.

Along with the maps, Smith has helped develop supplemental material for the BerryCare Extension curriculum, which was Brewer developed to teach people the health benefits of blackberries and ways to incorporate them into their diets.

Smith says she wants to become a family doctor and hopes to practice in Eastern Kentucky, and has developed a better understanding about the connections between nutrition and health.

“Through my human nutrition classes, I have been able to learn about the importance of a good diet, and by working with the Community Engagement Core, I have learned more about the effects of nutrition on the body,” Smith said. “I have also had the opportunity to shadow a family doctor who specializes in chronic care to see how diet has contributed to her patients’ chronic diseases.”

Almost half of counties still lack syringe exchanges, including 20 of those most vulnerable to drug-related disease outbreaks

By Melissa Patrick

Kentucky Health News

Most Kentucky counties now have harm-reduction programs to fight drug abuse, but the coronavirus pandemic has slowed their expansion and complicated the work of their syringe exchanges.

Still, they've all continued to offer some level of service during the pandemic. Sixty-three counties have harm-reduction programs, and one more is in the works, but that will still leave 56 of the 120 counties without one. 

Tony Cox, director of the Bracken County Health Department, which has the newest program, encouraged those counties to be open-minded.

"Communities are hesitant, and we do understand their concerns, but I would encourage any and all communities to educate themselves, along with their policymakers and even the citizens in the community, to find out exactly what a harm reduction/syringe exchange program is really all about," he said. "It is about getting dirty needles off the street and off of our playgrounds and off of the places we go, certainly that's a huge part of it. But it is also a program that is about helping the people in our community as well that need help because they are addicted to drugs. Be open minded and get educated." 

Such programs have been able to stay open through the pandemic because the Department of Public Health designated them an essential service.

"To ensure public safety, programs adopted strategies including face coverings, moving to outside stations, creating distance in their spaces, some appointment-only programs, limiting hours/days and decreasing number of infectious-disease testing times," the department said in an e-mail.

Harm-reduction programs are designed to prevent outbreaks of HIV and hepatitis C, which are commonly spread by the needle sharing among intravenous drug users. They also provide health screenings and vaccines, and connect drug users to treatment. 

They were approved in Kentucky under a 2015 law that requires approval by the county health board, the fiscal court and the city where the exchange is to be located.

Five added since last round-up

Kentucky has 74 operational syringe exchange locations in 63 of its 120 counties. Since mid-July 2019, when Kentucky Health News did its last syringe exchange roundup, five more counties have been marked on the state Cabinet for Health and Family Services map of exchanges and the counties deemed most vulnerable to HIV and hepatitis C outbreaks.

Besides Bracken, the new counties are Christian, LaRue, Marion and Martin.

Bracken County Health Department photo on Facebook

Christian County's program is the latest to be approved, but is not yet operational. Bracken County's exchange is still marked as not yet operational on the state's map, but it started operating July 8. 

Among the 54 Kentucky counties that the U.S. Centers for Disease Control and Prevention has identified as being most vulnerable to outbreaks of HIV and hepatitis C among IV drug users, 34 have operational exchanges.

The vulnerable counties that have not approved an exchange include Bell and Clinton, which rank sixth and 11th on the national list of 220 vulnerable counties; Cumberland, Casey, Edmonson, Harlan, Johnson, Lawrence, Lewis, Menifee, Monroe, Rockcastle and Wayne, also in Appalachian Kentucky; and eight in the rest of the state: Carroll, Gallatin, Green, Breckinridge, Grayson, Green, Allen and Hickman.

Harm reduction and the pandemic

Christie Green, public health director of the Cumberland Valley District Health Department, said their program saw a brief dip in participation in March and April, and it has since increased. Early in the pandemic they only offered services every two weeks as a way to limit interactions, she said, but have since gone back to their weekly schedule. 

"As restrictions were lifted," she said. "most of our participants preferred to come every week."

Green said they also increased usage of their mobile harm-reduction unit in Clay and Jackson counties. "So, instead of bringing them into the van, which is set up kind of like a little lab on the inside, we shifted it all to outside, under a canopy with a table beside the van," she said. "If someone wants a test, then we mask them and bring them inside." 

Scott Lockard, public health director of the Kentucky River District Heath Department, which has a program in each of the seven counties in the district, said its use has held steady or better. 

"People are still thankfully coming in and getting the supplies they need, because the last thing we would have wanted to see was a big uptick in HIV or hep C right now too," he said. "Our services are being utilized more than ever."

John Moses, harm-reduction team leader at the Lexington-Fayette County Health Department, said it has seen a steady increase in participation, with record numbers in the last month.

"The good thing about our program is that we were able to continue all of our services through the syringe exchange with really minimal interruption because of covid," he said. "We simply moved our program outside and are using our mobile unit to see our clients."

Jamey Whaley, harm-reduction and peer-support specialist with the Buffalo Trace District Health Department, said that one of the biggest changes he's seen in its program since the beginning of the pandemic is a shift from methamphetamine to heroin, because limited meth supply has driven its price up.

"So I have seen more people who have gone in the direction of heroin, which is a little unsettling because of the risk of potential overdose," Whaley said. He added that he has seen some of the program's former participants relapse since the pandemic hit, and that he has added a good number of new participants. 

Whaley said Buffalo Trace shut down its program down for six weeks at the beginning of the pandemic and re-opened in mid-May. Since then, "I've been very busy, especially the last month I have really been steady." 

Only a few in the works

Logan County has received approval from its Board of Health for a syringe exchange program, but still needs the approval of the Russellville City Council and the county Fiscal Court. 

Alexis Bigham, who was the public-health educator at the Barren River District Health Department when interviewed, and now works on harm reduction in Edmonson County through the University of Kentucky, said two of the district's eight counties (Warren and Barren) have exchanges.

The agency wants Logan to be next "because we have a lot of people traveling from Logan County to here in our Warren County program." she said. But the pandemic has put that push on the back burner because everyone at the health department has been working on covid-19.

The Lincoln Trail District Health Department is based in Hardin County, but its efforts to start a program there haven't been successful. In the meantime, Marion and LaRue counties have joined adjoining Nelson County in the program, largely due to local support, said Melissa Phillips, a harm-reduction specialist.

"You really need both pieces, you need your buy-in from your policymakers, and data is usually what sells them, and knowing that there is no cost associated with it," she said. "And when you have a local champion, it makes the process so much smoother. They really do a lot of the leg work for us."

She said the need in Hardin County is supported by data on drug arrests, HIV and hepatitis C, but the pandemic has slowed the effort, largely because they aren't able to participate in face-to-face meetings with policymakers and the community, which she said is an essential part of the process.

July 26 federal report said that in most of Ky., nursing-home visits should stop, and obese, diabetics, hypertensive should stay home

Chart from White House report, adapted by Kentucky Health News; for a larger version, click on it.

This story has been updated.

By Al Cross
Kentucky Health News

The latest weekly report to states from the White House Coronavirus Task Force contains many recommendations for state and local officials that Kentucky officials have not implemented or even revealed.

For example, it recommends that the state prohibit visitation at long-term-care facilities in most Kentucky counties, those in the red and yellow danger zones as defined by the task force.

It recommends that people with obesity, diabetes and high blood pressure in those counties shelter in place, much as Gov. Andy Beshear ordered Kentuckians to do from late March to early May.

Beshear spokeswoman Crystal Staley told Kentucky Health News Monday morning that Beshear met with Dr. Deborah Birx, the task force's response coordinator, "to gather recommendations directly, and the actions taken by Gov. Beshear follow her advice. She would agree that too many Kentucky counties are in danger and that action was needed statewide."

Still, the recommendation to stop visitation at long-term-care facilities will be at the top of the agenda for Tuesday's meeting of the task force that the state has assembled to help the facilities get through the pandemic, task-force coordinator Keith Knapp said Monday morning.

The White House report also recommends that public officials "Ensure that all business retailers and personal services require masks," something that is not being done in much of the state, if anecdotal reports of limited mask wearing and enforcement in many businesses are indicative.

Beshear has acknowledged the need for better enforcement by businesses, and backup enforcement by health departments. "There's not been enough enforcement out there; we can admit to that," he said July 27.

Beshear has gone farther than the recommendations in at least one case, limiting social gatherings to 10 people -- something the task force recommended by done only in red zones.

The latest White House report, dated July 26, was sent to state officials. It was obtained and published by The New York Times. Kentucky officials have not responded to requests for a copy of the report; one of Beshear's emergency pandemic orders gives custodians of public records 10 days to respond to requests for records instead of the usual three.

Here are the recommendations to red and yellow zones in Kentucky in the July 26 report. Most are the same for both zones; this list notes major differences.

Public Messaging
Wear a mask at all times outside the home and maintain physical distance
Limit social gatherings to 25 people or fewer (10 in red zones)
Do not go to bars or nightclubs
Use takeout, outdoor dining (indoor dining in yellow zones when strict social distancing can be maintained)
Protect anyone with serious medical conditions at home by social distancing at home and using high levels of personal hygiene (in red zones, handwashing and surface cleaning are emphasized)
Reduce your public interactions and activities to 50% of your normal activity (25% in red zones)
Public Officials
Limit gyms to 25% occupancy and close bars until percent positive rates are under 3; create outdoor dining opportunities with pedestrian areas (gyms in red zones should be closed)
Institute routine weekly testing of all workers in assisted living and long-term care facilities; require masks for all staff and prohibit visitors
Ensure that all business retailers and personal services require masks and can safely social distance Increase messaging on the risk of serious disease for individuals in all age groups with pre-existing obesity, hypertension and diabetes, and recommend to shelter in place
Work with local community groups to provide targeted, tailored messaging to communities with high case rates, and increase community-level testing
Recruit more contact tracers as community outreach workers to ensure all cases are contacted and all positive households are individually tested within 24 hours
Provide isolation facilities outside of households if positive individuals can't quarantine successfully
Testing
Move to community-led neighborhood testing and work with local community groups to increase access to testing (in red zones, increase community-level testing)
Surge testing and contact-tracing resources to neighborhoods and ZIP codes with highest case rates
Diagnostic pooling: Laboratories should use pooling of samples to increase testing access and reduce turnaround times to under 12 hours; consider pools of three to five individuals
Surveillance pooling: For family and cohabiting households, screen entire households in a single test by pooling specimens of all members into single collection device

The report also includes, for each state, four maps showing new cases, positive-test rates and the change in each from week to week. Here are Kentucky's maps from the July 26 report, comparing the week of July 18-24 with the previous week, July 11-17. For a larger version of the image, click on it.

Limited Sunday report keeps the coronavirus in Ky. on a plateau

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

By Al Cross
Kentucky Health News

Kentucky reported 463 new cases of the novel coronavirus Sunday, a little more evidence that the state has settled into another plateau, but one much higher than the one it was on a month ago.

“We appear to be seeing what we all hope is a plateau in the alarming growth of coronavirus cases in the commonwealth,” Gov. Andy Beshear said in a press release. “It shows that wearing a mask, social distancing and not traveling to virus hot spots is working. We need to see this trend continue to avoid having to make more hard choices and sacrifices.”

Beshear has also cited a decline in the percentage of Kentuckians testing positive for the virus. He did not report on testing or hospitalizations Sunday.

Reports are limited on Sundays, when fewer testing laboratories report to the state, and numbers are typically lower. But the record number of daily new cases, 979, was set on a Sunday, July 19.

Health Commissioner Steven Stack said in the news release that he was “cautiously optimistic we have blunted our steep covid-19 escalation with the mask requirement, restriction of gatherings to 10 or fewer people, bar closings and restaurant capacity restrictions. This is a prolonged challenge, though.”

The state reported two more deaths from covid-19 Sunday, a 56-year-old man from Oldham County and a 70-year-old woman from Muhlenberg County.

Counties with five or more new cases on Sunday's daily report were Jefferson, 91; Fayette, 80; Warren, 23; Kenton, 20; Pulaski, 19; Calloway, 14; Daviess, 13; Boone and Jessamine, 12 each; Oldham, nine; Graves, seven; Campbell, six; and Boyd, Casey, Franklin, Russell, Scott and Shelby, five each.

On the national level, the response coordinator of the White House Corinavirus Task Force warned that the virus is now widespread across the nation. She said, "To everybody who lives in a rural area, you are not immune or protected from this virus."

Pandemic calls for local leadership and trusted voices

By Al Cross

Kentucky Health News

This was originally published as a column in KyForward.com.

Norman Chaffins and Donnie Keeton probably never expected to see their name in a column about Kentucky politics. But they’re elected officials who have done the right thing when it comes to the coronavirus, and they and their kind should be exalted.

Chaffins, a Republican, is the sheriff of Grayson County, in west-central Kentucky. Keeton, a Democrat, is a magistrate in Morgan County, in Eastern Kentucky. They both got the virus, and they went above and beyond the call of duty, telling others about it.

And they think we should all be wearing masks, probably the biggest single thing we can do to thwart the virus and its covid-19 disease – but something that has become way too controversial and politicized, just like so much else about the pandemic.

After recounting his covid horrors in a Facebook post, Chaffins, 51, wrote, “I’m telling you this because I want you to wear your mask. Not because I am the sheriff, not because the governor said so, and not because the business tells you to. I want you to wear a mask because I do not want anyone to have to go through what I went through. I want you to wear a mask because I don’t want my kids or grandbabies to get sick. I want you to wear a mask because it’s just the right thing to do. It may not 100% guarantee that you won’t contract it, but wearing a mask will certainly reduce your chances. Please understand this: I am not telling you to wear a mask. We are not going to fine you or insist that you wear a mask. As your friend, I am asking you to wear a mask when you are around others and when you go out into public at least until there is a vaccine.”

Chaffins, a former state trooper, published 929 words on July 12. Keeton, a disabled heavy-equipment operator, kept his July 16 post simple, but in white type on a red background: “For those who don’t think covid-19 is real, it is. I tested positive. . . . Sue hasn’t got her results yet.” (His wife tested negative.)

Yes, Keeton knew people who didn’t think the virus was real, he told me: “They think it’s all about the election, or it’s going to be over after the election.”

That’s what happens when a president politicizes public health, downplays a deadly pandemic and uses Twitter to peddle conspiracy theories and quack medicine, apparently in an effort to so confuse Americans that they don’t know what to believe.

Keeton, 52, told me he voted for Trump because “It’s kind of hard to go with the national Democratic Party right now,” but he had the president’s words in mind when he told his local newspaper, the Licking Valley Courier, “It’s not a hoax and it’s probably not going away anytime soon.”

Trump implied Feb. 28 that the pandemic, or Democrats’ criticism of his response to it, was Democrats’ “new hoax” after their failed impeachment of him. He walked that back, but Keeton told me that the phrase probably gave a lot of people the wrong idea.

Trump was elected partly because a lot of Americans, especially in rural areas, thought they were being left behind and disregarded by the urban elite. Many if not most of those people have never liked elites and experts telling them what to do (remember the debates about seat belts?), and Trump appealed to their resentment.

That approach turned dangerous when Trump started contradicting public-health experts and scientists, but he was operating in a friendly environment, as the unchallenged boss of a political party that has fueled and capitalized on skepticism about science, primarily the evidence of climate change. But it is also a friendly place for skepticism about vaccines, which could be the long-term obstacle in quashing the coronavirus.

That’s why it’s more important than ever for public officials at all levels to set good examples. Chaffins told me he has tested negative for the virus, and doesn’t think government should mandate masks, but he wears one to be “a good role model.”

And in an age where social media have more sway than news media, it’s important to hear covid-19 stories from authoritative victims. Chaffins said his nurse practitioner told him his post was helpful because “a lot of people don’t know anybody who’s had this and had a bad case of it.”

In other words, stories about people you know always have greater impact. Licking Valley Courier Editor Miranda Cantrell put a note at the end of her story about Keeton asking other victims to tell their stories, because locals wonder “whether the effects are as severe as mainstream media outlets have reported.”

Yes, they can be that severe, but many don’t trust those outlets – especially after four years of “fake news” bashing from a president who has uttered more than 20,000 falsehoods. Local news media are more trusted, so they need to step up, tell these stories and help their audiences understand how to deal with the pandemic. The politicians can only go so far.

New coronavirus case numbers and 7-day average drop below 600; positive-test rate declines for third day but remains above 5%

Kentucky Health News chart

By Al Cross
Kentucky Health News

Kentucky's coronavirus numbers were almost all improved Saturday.

The number of new cases, 572, was more than 200 less than Friday's fourth-highest figure of 778. The latest report lowered the seven-day rolling average to of daily new cases to 571. The three-day average dropped from 685 to 670.

The number of Kentuckians hospitalized with covid-19 increased slightly, to 602 from Friday's total of 597, but the number in intensive care dropped substantially, to 128 from 150.

The strongest trend line at the moment is the percentage of Kentuckians who have tested positive for the virus in the last seven days: 5.22 percent, the third straight day of decline from a recent high of 5.81% on Wednesday.

Since July 24, the rate has been above 5 percent, which the White House Coronavirus Task Force says is a "danger zone." That and the surge of cases in July prompted Gov. Andy Beshear to close bars, tighten restaurants' indoor capacity and advise school districts not to start in-person classes until the third week of August.

In a news release, Beshear urged obedience of the mask mandate he issued July 9, days after the July surge began. "Facial coverings work," he said. "They are our best chance of saving lives and protecting the health of our people, ensuring our economy can stay open, and getting our kids back in school."

Health Commissioner Steven Stack reminded Kentuckians of another order, one that depends more on public cooperation because it is harder to enforce.

“Gatherings should be limited to 10 or fewer guests, especially informal ones going on in backyards, parks, lakes and similar settings,” Stack said. “The commonly more personal, informal social behavior in these situations is a big risk. If you and your guests are not keeping at least a six-foot social distance and if you’re not wearing masks, this spreads the disease. It places the people you care about most at risk and it endangers others if they spread the disease throughout the community.”

Stack added, “I don’t want to sound like an alarmist, but a big part of this is about the decisions made and behaviors practiced by every one of us as individuals. Public gatherings and social activities can be tinderboxes for covid-19 transmission. Until we get a vaccine or cure to neutralize this threat, we all must continue practicing social distancing and wearing masks.”

The state's covid-19 death toll rose to 740 with five more fatalities, including three men in Oldham County, aged 55, 61 and 67. The others were an 81-year-old man from Jefferson County and an 84-year-old woman from Simpson County. Beshear's office did not immediately respond to a question asking if the Oldham County deaths were connected to the three state correctional facilities in thatg county, at least one of which has had an outbreak of covid-19.

Most county fairs in Kentucky appear to have been canceled, but the Oldham County Fair is planning to open Tuesday, despite advice to the contrary from the county health department, the Louisville Courier Journal reports. The fair plans to screen attendees and require masks, but County Judge-Executive David Vogele voiced doubt about the fair's ability to enforce mask wearing and keep up with necessary cleaning of surfaces over five days. The fair has the same midway as the state fair, Kissel Entertainment.

Counties with more than five new cases Saturday were Jefferson, 152; Fayette, 43; Warren, 32; Kenton, 28; Campbell, 23; Boone, 22; Whitley, 19; Jessamine, 14; Bullitt, 11; Daviess and Madison, 10 each; Barren, 9; Fulton, Graves, Hopkins Perry, Pike and Scott, 7 each; and Hardin, Knox and Laurel, 6 each.

As cases surge in southeastern Ky., public-health and local officials join forces to combat it and tamp down the politics

Like much of the nation, stopping the spread of the novel coronavirus in Appalachia isn't just a public-health effort, but also involves convincing its citizens that it isn't a political issue, Chris Kenning reports for the Louisville Courier Journal. 

The Bell County Health Department's Leighann Baker brings groceries
to Alan Smith, who is quarantined. (Photo by Pat McDonogh, Courier Journal)

Kenning went to Bell and Harlan counties in the southeast corner of Kentucky, which recently recorded some of the state's highest increases in average daily cases per person.

"Bell went from 20 cases to more than 200 in two weeks. Harlan saw 85 in a single week, twice as many as it had over four months. Bell, Clay, Knox and Harlan counties combined, for example, saw deaths more than triple to 18 in the month ending July 30," he reports. 

“We were one of the last counties to see any cases," Trissa Wilder, nurse supervisor for the Bell County Health Department, told Kenning. "We got lax, feeling that we were safe and secure” because of Central Appalachia’s geographic isolation.

Officials across several Kentucky Appalachian counties told Kenning that the virus first spread from "Carolina beach trips, Fourth of July parties, weddings, football practices, a four-day church revival — and even an illegal Clay County cockfight," he reports.

Health officials have voiced concern that covid-19 will have a disproportionate impact on Appalachia because it has fewer hospitals and intensive-care beds, high rates of poverty and conditions such as diabetes and heart and lung disease that make people more vulnerable to the virus.

"All that has meant special challenges for health departments hollowed out by budget cuts, such as those in Bell County, which battle distance, poverty, spotty cellphone coverage, neglected health, difficulty getting some residents to testing and distrust amid the growing politicization of public health," Kenning reports. 

In addition to their ongoing daily work to keep a community safe, public health departments have been stretched even thinner as they have increased their their contact-tracing efforts to identify those who have been infected, then tracking down everyone they have come into contact with and asking them to self-quarantine. 

The state has provided some relief on this front by expanding the number of tracers with federal coroanavirus money, "even as the effort's effectiveness wanes as cases increase," Kenning reports. The state says it recently added 455 tracers to the 431 who were already doing this job, and so far, the tracing is keeping up with the demand.

That added help is critical, Kenning reports, since the number of public-health workers in Kentucky has fallen 34% since 2012, according to the Kentucky Center for Economic Policy. 

"We’ve got a small health department, and we did get a little overwhelmed," Harlan County Judge-Executive Albey Brock told Kenning. "Contact tracing is no joke. It’s laborious. They keep daily communication. If we have 104 active cases, they each have to be called every day. That’s on top of having to track down people they've had contact with, getting them a letter, let them know to quarantine. 

Judge-Executive Albey Brock

"And then you run into the knuckleheads who don't want to stay quarantined because they’re not positive . . . Some of them don’t want to cooperate." 

And then there's the politics. Kenning writes from the Bell County seat of Pineville, "The area remains a conservative place, where every elected official but one constable is Republican. When cases were slow to materialize, some found it easy to dismiss alarms over the coronavirus as a Democratic plot to make President Donald Trump look bad or infringe on rights by requiring masks, local residents and officials said." 

In Harlan, about 30 miles up the Cumberland River from Pineville, Brock, a Republican, told Kenning that he has attempted to depoliticize the pandemic by sending public-health messages via social media and radio and having stern talks. 

“We’ve tried real hard locally to stamp that down. If you want to fight with Trump or Biden, have at it. Just wear a mask,” he said, adding jokingly, “Some believe we never walked on the moon, so I can’t help them.” 

Since Gov. Andy Beshear mandated masks and Walmart required face coverings, mask use has “gone up dramatically,” which has been “a pleasant surprise,” Ben Barnett, Bell County’s Emergency Management director, told Kenning.

Christie Green, public health director for the Cumberland Valley District Health Department. which overs Clay, Jackson and Rockcastle counties, told Kenning that contact tracing has thwarted the spread of the virus in several cases. "But she's still fighting distrust of public health fueled by national politics." She said, "People don’t know what to trust or believe. . . . How do you parse out all the soundbites you get?"