Overdose deaths in Kentucky rose 5% in 2019; officials say fentanyl and methamphetamine were drivers of the increase

By Melissa Patrick

Kentucky Health News

Drug-overdose deaths in Kentucky rose 5 percent in 2019, after dropping by nearly 15% from 2017 to 2018, according to the state's latest annual report.

“We believe the increase is due to a rise in illicit fentanyl and its analogs within the drug supply. The problem is also exacerbated by the widespread availability of potent, inexpensive methamphetamine,” Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said in a news release.

The state recorded 1,316 overdose deaths in 2019. That was 69 more than in 2018, when 1,247 were recorded, but 250 fewer than in 2017 when the state recorded its highest number of overdose deaths ever, 1,566.

Toxicology reports show that fentanyl was involved in 759 of the overdose autopsies, or nearly 58% -- down from 61% in 2018, but up from 52% in 2017 and 47% in 2016. Acetylfentanyl, another version of the drug, was found in 419, and 4-ANPP, a controlled substance that is synthesized through a chemical reaction to make fentanyl, was found in 544.

The report says overdose deaths from heroin declined 12% in 2019, and those from alprazolam, an anti-anxiety medicine branded as Xanax, dropped 23%. Heroin-related deaths dropped to 166 in 2019 from 188 in 2018. Deaths involving alprazolam dropped to 165 in 2019 from 214 in 2018. 

Overdose deaths from methamphetamine, oxycodone and gabapentin increased in 2019. 

Methamphetamine, which has long plagued Kentucky, has been found in more overdose cases in each of the past three years: 357 in 2017, 428 in 2018 and 517 in 2019. "Meth, a stimulant, is less likely to kill someone immediately," note Alex Acquisto and Bill Estep of the Lexington Herald-Leader. "Instead, it corrodes the body and central nervous system over time. It’s not uncommon for meth to be cut with fentanyl in order to up its potency."

Oxycodone, another long-popular and troublesome drug in Kentucky, was involved in 54.5% more overdose deaths in 2019, rising to 170 from 110 in 2018. Deaths from gabapentin, which sells under the brand names Neurontin, Gralise and Horizant, and is often taken along with other illicit drugs to enhance their effects, increased 14.5%, to 292 in 2019 from 255 in 2018. 

“There is no doubt that the nationwide opioid crisis is hitting Kentucky at an alarming rate,” Mary Noble, secretary of the state Justice and Public Safety Cabinet, said in the release.

Counties under 20 are shaded yellow
because rates are considered unstable.

To make more useful comparisons with U.S. Centers for Disease Control and Prevention data, this year's report only includes Kentucky residents who died from a drug overdose, regardless of where the death occurred. 

Counties with fewer than 10 deaths are not included in the report's calculation of overdose rates, so the report has rates for only 29 counties. That's up from 2018, when 23 Kentucky counties had 10 or more overdose deaths.

Estill County (Irvine, Ravenna) had the highest rate of fatal overdoses in 2019, followed by Grant (Williamstown, Dry Ridge, Crittenden). Each had fewer than 20 overdose deaths, a level at which the report says the rate is "unstable and should be interpreted with caution."

Boyd (Ashland, Catlettsburg), Madison (Richmond, Berea), and Greenup counties each had more than 20 overdose deaths and ranked third through fifth.

Jefferson County had the largest number of overdose deaths with 319, an increase from 281 in 2018. Counties with significant decreases included Fayette, down 22; Kenton, down 13; and Campbell, down 11.

The age group in which Kentucky overdose deaths are most common continues to be 35 to 44. Next is 45-54, which ranked third in the 2018 report and traded places with the 25-34s in this year's report. 

State and federal efforts

The state and its partners have launched a number of efforts to battle the state's opioid and substance-abuse epidemic, including efforts to widely distribute naloxone, a medication that can reverse an overdose caused by an opioid drug; the KY Help Call Center (1-833-859-4357), which provides information on treatment options and open slots among treatment providers; and an online website that provides similar services called FindHelpNowKY.org.

The Kentucky State Police have launched the Angel Initiative, which allows anyone with a substance-use disorder seeking treatment to visit a KSP post, where they are directed to treatment. The state Department of Corrections has also overhauled the way it addresses substance abuse. 

The General Assembly has passed several opioid-control laws in recent years, including a crackdown on pain clinics, limiting opioid prescriptions for acute pain to a three-day supply (with exemptions), tougher penalties for heroin dealers and more funding for drug treatment and other response efforts.

“As our state plans for the future, the success of our initiatives depends on the involvement and support of grassroots coalitions, local and state agencies, as well as community and faith-based organizations throughout Kentucky,” said Ingram.  

Gov. Andy Beshear said, “I share the concerns of so many that in this battle against covid-19, which we must fight and must win, we cannot take our eyes off the increased risk of substance use and overdose deaths, I'm committed, with the Kentucky Office of Drug Control Policy, to monitor the trends associated with opioid and substance use and their impact on the public's health.”

Already in 2020, Kentucky has seen a surge in overdose encounters among hospitals and ambulance services, especially during the two months after Beshear declared a state of emergency due to the coronavirus pandemic. Researchers say the surge coincided with preliminary data that showed an uptick in overdose deaths during April and May. 

Data for the report were compiled from the Kentucky Office of the Medical Examiner, the Kentucky Injury Prevention & Research Center and the Kentucky Office of Vital Statistics. 

White House puts fewer Ky. counties in 'red zone' and more in 'yellow zone' as Beshear goes counter to its advice on bars

Counties with fewer than 10 total cases are not included in the White House task force alerts.

By Al Cross
Kentucky Health News

The latest weekly White House Coronavirus Task Force report on Kentucky is less red and more yellow, and if that sounds good, it is.

It means that fewer counties (13, down from 18) are in the task force's "red zone," for places where new cases of the virus numbered more than one per thousand residents and the share of residents who tested positive for the virus was higher than 10 percent.

And it means that more counties are in the "yellow zone," for places with new cases numbering between 0.1 and 1 per 1,000 and a positive-test rate of 5% to 10% -- or one of those, with the other in the red zone. Forty counties are in the yellow zone, down from 34 last week.

Overall, the report for Saturday, Aug. 1 through Friday, Aug. 7 shows 53 counties in one of the danger zones, one more than the previous week.

It says Kentucky had 81 new cases per 100,000 people, well under the national average of 114.

The state-by-state reports make recommendations to states. Kentucky has generally followed them, in some cases going farther than advised, but on Monday Gov. Andy Beshear went contrary to two recommendations by reopening bars and increasing restaurants' indoor capacity to 50%.

The report advises, "Keep establishments closed where social distancing and mask use cannot occur, such as bars, nightclubs, and entertainment venues. Continue to limit indoor dining at restaurants to 25% of normal capacity and continue expanded outdoor dining."

Beshear and Dr. Steven Stack, commissioner of the state Department of Public Health, said at a news briefing Monday that it's better to have people drinking in bars that can be regulated than at the alternative many have found: private parties that are impossible to regulate.

The report includes maps that show, in ranges, the new-case rate and the positive-test rate for the week, and the changes from last week, as well as a national map that shows how Kentucky and its counties compare to the rest of the nation in new cases by population last week. For a larger version of any map, click on it.

Beshear recommends no in-person instruction in schools until Sept. 28; says open, regulated bars better than private parties

Beshear used this graph (adapted by KHN) and chart to say that the pandemic remains at its apex.

The positive rate for the seven-day period ending Aug. 8 was 6.02 percent.

By Al Cross and Melissa Patrick

Kentucky Health News

Saying it's unsafe to have children in classes at the peak of a pandemic, Gov. Andy Beshear recommended Monday that Kentucky schools wait until Sept. 28 to start in-person instruction.

“The concept that we would try to resume in-person classes at our peak instead of during a decline is something that would defy logic, wouldn’t be safe to do,” Behsear said, citing the recent trends in coronavirus cases and the percentage of Kentuckians testing positive for the virus.

The positive-test rate varies widely from county to county, but Beshear said the virus is "spreading everywhere" and "We shouldn't want our kids to be the canaries in the coal mine," an old way to detect deadly gas. He added later, "The risk is just too great."

Decisions about when and how to have school are up to districts, but the state's guidance will be influential. "Various superintendents, including those who lead schools in places like Frankfort and Pikeville, tweeted in the minutes after Beshear's announcement that they would follow the governor's recommendation and have virtual learning until late September," reports Billy Kobin of the Louisville Courier Journal.

Beshear had recommended Monday, July 27 that schools delay in-person instruction until the third week of August. Three days earlier, the state's positive-test rate went over 5 percent, a level that raises more concern among public-health experts. The upward trend continued, and Saturday it hit 6.02%, the highest since testing became widespread. The combined rate for Sunday and Monday was 5.71%.

“We are still in a very difficult, dangerous place with a virus that is spreading so significantly right now,” Beshear said at the start of his daily briefing. He reported only 275 new cases Monday, but said a computer glitch made the report incomplete.

“We can’t just stay where were are,” he said. “We have got to start decreasing our cases, because otherwise we sit in a place where they can skyrocket again very, very quickly.”

He said his other reasons included the increasing number of children with the virus, and the experience of other states, where schools had to close due to outbreaks of the virus.

“It is a myth that kids do not get his virus. It is a myth that kids cannot spread this virus,” he said, adding that they can spread it to adults in the building even if they are not affected by it. “While there are significantly fewer bad outcomes with kids there are still bad outcomes,” he said.

From July 16 to 30, at least 97,078 U.S. children tested positive for the virus, a 40% increase in child cases, and children represent 8.8% of all available cases, says a summary by the American Academy of Pediatrics and the Children's Hospital Association. Deborah Yetter of the Courier Journal reports there are about 4,000 cases in Kentuckians under 19, and about 1,200 are under 10.

Beshear said a delay of six weeks “hopefully gives us enough time to knock this virus down,” gives school officials more clarity for planning and avoids switching from in-person to online instruction, which “might hurt your students even more.”

Also, “If you go back too early a school can possibly create a spike in a community,” he said. “I think just about every other state is gonna end up where we are.”

He suggested that schools should eliminate fall breaks from their calendars, and shorten the Christmas break, to discourage vacations that have proven to be vectors for the virus. “Our families can’t be going on vacation right now if we want to keep those facilities open,” he said.

Beshear did not mention that the Kentucky Education Association, which helped elect him, said Friday that in-person schooling shouldn't resume until the positive-test rate remained below 4 percent statewide and locally. But he did introduce Lt. Gov. Jacqueline Coleman, a former teacher, who reflected the concerns of teachers and administrators: “It is not fair to ask educators to . . . be in a situation where they could be putting their health at risk.”

The Prichard Committee for Academic Excellence endorsed the decision but said Beshear should form an emergency working group to help the estimated 240,000 Kentucky students who lack sufficient internet access.

Bars and restaurants: While Beshear wants schools closed, he and Health Commissioner Steven Stack issued the expected order allowing bars to reopen and restaurants to increase their indoor seating capacity to 50% from 25%, where Beshear lowered it on July 27. They said it's better to have people in bars with rules, such as earlier closing times and enforced seating, than at uncontrolled parties.

The move runs contrary to the guidance in the latest White House Coronavirus Task Force report, which recommends to the state, "Keep establishments closed where social distancing and mask use cannot occur, such as bars, nightclubs, and entertainment venues. Continue to limit indoor dining at restaurants to 25% of normal capacity . . . "

Stack referred to the report, but not those recommendations. However, he implicitly defended the bar decision, saying, "People engage in bad behavior . . . in an unsupervised environment."

New bar and restaurant rules (state graphic; for a larger version click on it)

Beshear acknowledged, “We need to step up the enforcement on our end,” and said likewise of local alcoholic-beverage officers. “We’re gonna have to be brave enough to actually take steps, shot places down and issue fines,” he said.

The University of Kentucky said it received several reports of house and apartment parties over the weekend and announced that it will apply the Student Code of Conduct to those who gather at such events, Rick Childress reports for the Lexington Herald-Leader. Students could be charged with conduct violations covering harm or threat of harm or breaking federal or local laws or UK policy. The first day of class is Aug. 17, Last week, Stack said on a webinar that one of the challenges that comes with 18- to 20-year-olds is that they are adults physiologically, but not psychologically because the part of their brains that controls judgement is still developing. 

Asked why colleges should be able to resume classes while schools shouldn't, Beshear said most college students live away from their more vulnerable parents and grandparents, and online instruction and related issues are easier to manage. Another Herald-Leader article looks at how colleges and universities across the state are handling their re-openings amidst the virus.

Daily numbers: Beshear reported two more covid-19 deaths, of a 60-year-old woman from Graves County and a 98-year-old woman from Lincoln County. They raised the state's toll to 775.

The governor said the daily case numbers for Monday, Tuesday and Wednesday would be revised after the data problem is resolved. Jefferson County had 38 percent of the cases reported Monday, 105. Other counties with more than five were Fayette, 35; Warren, 14; Franklin, 13; Madison, 11; Pulaski, 11; Hardin, 9; Powell, 6; and Taylor, 6. Beshear read from a list that had other counties and larger numbers; that was from Saturday's report.

Asked about people who might have less faith in the figures because of the computer problem, Beshear said, "Continued attempt to disbelieve the numbers, or to say this is just like a flu, is just sticking your head in the sand while something rages through our communities and potentially kills people that you know. . . . Stop disbelieving and just do the steps to battle it."

In other covid-19 news Monday:

• The state's daily report said 641 people were hospitalized in Kentucky for covid-19, and 155 of them were in intensive care.
• Beshear said nine more child-care facilities reported positive tests of employees or children, raising the total to 123.
• Louisville officials continue to say there aren't enough coronavirus test for everyone to get tested and to only get one if you've been exposed or have symptoms, while Gov. Andy Beshear regularly urges Kentuckians to get tested whether they think they have the virus or not, Yetter and Grace Schneider report for the Courier Journal. They write, "The mixed messages may seem minor. But the patchwork of pandemic policies, guidelines and mandates from President Donald Trump, governors and mayors isn't helpful."
• Beshear said President Trump's executive order on unemployment benefits is "not workable in its current form" and Congress needs to pass another aid package.
• Health Secretary Eric Friedlander said only 200 of the 22,000 health-care providers in Kentucky have applied for special financial aid from the latest federal coronavirus relief bill, and the deadline is Aug. 28. "We all know our health-care providers need this additional support," he said. 
• Two studies from Germany, published in JAMA Cardiology, suggest that in many patients, covid-19 could presage heart failure, Elizabeth Cooney reports for Stat. Both “suggest that being infected with covid-19 carries a high likelihood of having some involvement of the heart. If not answering questions, [they] prompt important questions about what the cardiac aftermath is,” Matthew Tomey, a cardiologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Health System in New York, told Cooney. “The question now is how long these changes persist. Are these going to become chronic effects upon the heart or are these — we hope — temporary effects on cardiac function that will gradually improve over time?”
• The U.S. now has more than 5 million confirmed cases of the coronavirus, by far the most of any country, and health officials believe the actual number is perhaps 10 times higher, or closer to 50 million, given testing limitations and the fact that as many as 40% of all those who are infected have no symptoms, The Associated Press reports. 

Herald-Leader busts seven prevalent myths about covid-19

By Daniel Desrochers

Lexington Herald-Leader

It has been five months since Kentucky announced its first case of covid-19. As the coronavirus has spread rapidly through the country, infecting more than 34,500 Kentuckians and more than 4.5 million Americans, disinformation about the virus has spread almost as quickly. 

Almost daily, the Herald-Leader gets messages and emails from people questioning the basic facts that have caused our lives to be completely upended. 

Here’s the truth about some of the most frequent covid-19 myths. 

'Covid-19 is just like the flu' 

There are similarities between the flu and covid-19, which are two separate viruses. Both are respiratory illnesses that can cause mild to severe illness. With both, you can spread it at least one day before you start showing symptoms, according to the Centers for Disease Control and Prevention. 

But even with the government imposing measures to limit the spread of the novel coronavirus, more than 158,000 Americans have died from covid-19 this year. In comparison, between October 1, 2019 and April 4, 2020, the centers for disease control estimated between 24,000 and 62,000 flu deaths. Scientists estimate that the mortality rate for the flu is around 0.1 percent. In Kentucky, 2.21 percent of people with known cases of covid-19 have died. 

Scientists expect that percentage to continue decreasing as testing expands and treatments improve, but even a 1 percent mortality rate would be 10 times the death rate of flu. 

Covid-19 seems to affect the body in different ways than other respiratory illnesses, said Dr. Kathleen Winter, an assistant professor of epidemiology at the University of Kentucky. 

“Even though some of the clinical symptoms are the same, there are a myriad of ways that covid-19 affects the body that we’re still learning about,” Winter said. 

There is another really big difference between covid-19 and the flu — covid-19 is new. That means not as many people have been exposed to it. It means scientists are still learning about the virus as we navigate the pandemic. It means there has been no time to develop a treatment or a vaccine. 

“Truly, we are learning more and more about this virus every week and we still don’t have great treatment,” Winter said. 

'Cases are only increasing because we're testing more'

Kentucky has increased its testing capacity. In the month of July, 224,925 Kentuckians were tested, the most of any month in the pandemic. That coincided with 14,527 cases, also the highest of any month since the pandemic began. 

But scientists have a metric to determine if the frequency of cases is increasing, even when there are more people being tested. It’s called the positivity rate. The positivity rate takes the total number of people who tested positive and divides it by the total number of people who were tested. 

In using that metric, scientists are able to take out the variability of how many people are being tested and instead focus on what percentage of tests are coming back positive. In the month of July, 6.46 percent of tests in Kentucky came back positive, nearly double the 3.42 percent of tests that came back positive in June. 

Scientists look at more than just the positivity rate when making decisions about what to shut down, but Kentucky’s rate was a factor in causing Beshear to issue an order making masks mandatory when around other people and to shut down bars and lower capacity at restaurants for two weeks. 

'The number of cases is inflated because they count people multiple times'

They’re not counting people multiple times. 

When Beshear reads out the daily number of new positive cases, he’s reading out numbers that have been “de-duplicated,” a process where the public health department goes through and eliminates anyone who has already tested positive for the virus.

“When we tell you how many new positives are today, we have de-duplicated those numbers,” said Dr. Steven Stack, the state commissioner of public health. “So if we tell you there are 300 positives today and 200 positives tomorrow, those are five hundred different people.” 

Don’t believe the state? How about your local health department? Kentucky’s 61 local health departments track cases at the county level because they’re responsible for contact tracing and monitoring the spread of the virus. When added up, local health departments have consistently reported a higher number of cases than Beshear, in part because of the way the governor collects his data.

'Covid-19 deaths are inflated because they count unrelated deaths'

A death from covid-19 is only counted in the state’s total when the virus causes the death or is a contributing factor, Winter said. When there’s confusion about whether the virus played a role in the death, it’s sent to a state review committee that determines whether it should be counted. 

“If you’re in a car accident and you have covid are we going to say you’re a covid death?” Stack said on July 22. “The answer is no, your death will be categorized as an automobile accident.” 

 While many of the people who have died from the virus have had underlying health conditions, that doesn’t mean they would have died on that particular day, and maybe not for several years, had they not contracted covid-19. 

 Winter said she is baffled by the myth that death numbers are inflated. She said the hospitalization rate consistently goes along with the fatality rate. 

“What seems so absurd to me is that it’s so not what my experiences are with reality,” Winter said.

'Only old people are dying so only they need to be careful'

Older people are disproportionately dying from the virus, but they’re often catching it from someone younger. 

In Kentucky, around 50 percent of the covid-19 deaths have been people who are older than 80, even though they only make up around 5.5 percent of cases. Of the people older than 80 who have caught the virus, about 20 percent died. That death rate drops with age. About 8% of Kentuckians in their 70s who have caught the virus have died. It’s about 3.5% for Kentuckians in their 60s. 

It is also true that a majority of Kentucky’s covid-19 deaths have been associated with nursing homes. As of Wednesday, about 64 percent of Kentucky’s covid-19 deaths were nursing home related. 

Many of those deaths came when the state was on lockdown and with visitors barred from nursing homes. As nursing home residents generally aren’t traveling much, that means the virus was brought into the nursing homes by staff who weren’t showing symptoms. 

Those staffers go home everyday, so any spread in the community can get into the nursing homes. 

Dr. Deborah Birx, a top adviser on the White House’s coronavirus task force, noted that Kentucky is seeing a growth in cases in people between the ages of 20-39. Birx warned that is dangerous, because younger people can pass it on to their parents or grandparents, who may be more vulnerable. 

The virus can also affect people in more ways than just dying. Many who have recovered say they still feel lingering effects of the virus. “There’s a lot of bad between getting infected and dying that we need to consider,” Winter said. 

'Kids can't get it or transmit it'

More than 4,000 Kentuckians under the age of 19 have tested positive for covid-19. That includes more than 1,000 children younger than 9. More than 100 childcare facilities in Kentucky have experienced cases affecting 75 children. 

While children tend to be spared the more severe symptoms of the disease, they are susceptible to pediatric multisystem inflammatory syndrome, a serious condition that sometimes comes after the child has recovered from covid-19 and can result in hospitalization or death. 

There is no scientific evidence that children do not spread the disease. There was a recent study that showed children under 10 do not spread the disease as easily as adults, but can still spread it, and that those between 10 and 19 spread the disease just as easily as adults. 

Winter also pointed out that children are less likely to have symptoms and are therefore less likely to get tested. 

 'We need herd immunity. It's a hoax. People are just going to die.'

Public officials have imposed social distancing guidelines in order to minimize the number of people who die from the virus before a vaccine or effective treatment is developed. 

Ditching those guidelines for the sake of herd immunity — the idea that if you just let the virus run its course enough people will get it and recover so it won’t transmit so easily — both underestimates the amount of people who would have to get the virus and assumes that any immunity someone gets against the virus will last. 

In order to achieve herd immunity, scientists say at least 70 percent of the population would have to be infected. That would be around 229.7 million Americans. According to Johns Hopkins University, 5 million Americans have been infected with the virus, leading to 162,938 deaths. If you were to take the current death rate, which might be an underestimate since hospitals would almost certainly be overwhelmed, and apply it to 229.7 million cases, around 7.5 million Americans would die. That’s more than the population of Los Angeles and Chicago combined. In 2018, a total of 2.8 million Americans died, according to the CDC. 

Scientists are still trying to figure out how long immunity lasts, but there are some studies that indicate it might only last two to three months. 

“We’re all dying, some just more quickly than others,” Stack said at one of Beshear’s daily press conferences. “I am not here to separate you from your death. I would just like to delay it as long as I reasonably can.”

Kentucky's covid-19 report has good and bad news in it today; Beshear says he will talk about schools tomorrow

Kentucky Health News chart; daily numbers are often adjusted slightly after initial report.

By Melissa Patrick
Kentucky Health News

The good news is that Kentucky had fewer coronavirus cases in the reporting week that ended Sunday, Gov. Andy Beshear said. The bad news, he said, is that the percentage of Kentuckians testing positive for the virus keeps rising. 

Gov. Andy Beshear in his Facebook video Sunday

"We're ending the week with about 300-and-change less cases that we had last week," Beshear said in a Facebook post on Sunday's covid-19 report. "That's directly attributable to people wearing their facial coverings or mask. Please, keep it up, wear them even more, especially when you are inside."

Then he said, "On the bad side, our positivity rate, which won't be official until tomorrow for this week, will be higher, meaning that the virus continues to spread aggressively." 

Saturday's positive test rate was 6.02 percent, the highest it's been since May, when the state tested the entire Green River Correctional Complex in Central City. Health experts consider rates above 5% cause for concern. 

Beshear reported 425 new cases of the virus on Sunday, about 375 fewer than yesterday, but higher than a typical report on a Sunday, when fewer testing labs report to the state. The seven-day rolling average fell a bit to 555; it has been between 528 and 592 for the past week. The three-day average is 600.

Beshear pointed out that nine counties had 10 or more new cases Sunday, and Health Commissioner Steven Stack said all but five counties saw rising case counts last week. 

Jefferson County had nearly 32% of Sunday's new cases, at 135. Other counties with more than 10 were Fayette, 47; Pulaski and Taylor, with 19 each; Hardin and Madison, with 13 each; Casey and Warren, with 12 each; and Wayne, 11. 

“Covid-19 is still out there and it’s still a threat,” Stack said in a news release. "We are encouraged, though, by the many Kentuckians taking this seriously and taking steps to keep themselves and others safer, including wearing a mask.”

The state's top doctor called on Kentuckians to continue to do the things that are known to mitigate the risk of getting or spreading the virus.

“Every time we take steps, such as wearing masks and social distancing, it impacts how many Kentuckians will test positive, how many businesses, schools and other places where we gather can remain open, and how many Kentuckians will get hurt,” Stack said. 

He also reminded Kentuckians to limit their outings and to make sure to wear a mask, social distance and practice good hand hygiene when you do go out: “When you and your household members leave your home, be aware that it increases your risk of exposure.”

In addition, he called on Kentuckians to practice good, old-fashioned public-health precautions, offering a longer list than usual:

“Continue to wear a mask. When possible, walk or bike to your destination or take your own vehicle. Avoid interacting closely with people and unnecessarily touching things. Keep disinfecting wipes or hand sanitizer with you. Wash your hands frequently. If you sneeze, sneeze into your elbow. If you sneeze into a cloth mask, wash your mask when you get home.” 

The state reported one more covid-19 death Sunday, raising its toll to 773. The fatality was s a 71-year-old man from Pulaski County. The daily report did not provide today's covid-19 hospitalization data. 

Beshear said he would talk Monday about a possible recommendation about schools at tomorrow's 4 p.m. press conference.

"We certainly need to get control of this virus to protect our teachers and our students," he said. 

Beshear said Wednesday that a continued high positive-test rate might prompt him to recommend again that in-person schooling be delayed. On July 27, he recommended that it not begin until the third week of August, but those decisions are up to local school officials. 

The Kentucky Education Association, the statewide teachers' union and a major Beshear ally, said Friday, "In-person instruction should not resume until, at a minimum, the infection rate in Kentucky statewide and the infection in the county in which the school district is located both fall below 4% and both remain below 4% for 21 consecutive days as measured by a 7-day rolling average."

Health chief tells businesses that masks are key; lawyer tells how to enforce mandate; local health dept. official says they can help

By Melissa Patrick

Kentucky Health News

The state's top physician often says that basic public-health measures – like washing our hands, staying six feet apart and wearing a mask – are all we have right now to thwart the spread of the novel coronavirus until we get a vaccine. But masks are the most important, he indicated Friday.

Dr. Steven Stack

"That single measure is felt to be really a linchpin in us keeping things open and minimizing the spread of the disease," Health Commissioner Steven Stack said Aug. 7 during a Kentucky Chamber of Commerce "Restart Kentucky" webinar.

Gov. Andy Beshear's mask mandate, first issued on July 9 and reinstated Aug. 6 for at least 30 days, requires masks to be worn in indoor public spaces, and outdoors when people can't stay six feet apart. It includes several exemptions, including children who are 5 or younger and any person with a disability or a physical or mental impairment that impairs them from safely wearing a face covering, 

The burden of enforcing the mandate falls largely on businesses, and they still have a lot of questions about what is expected of them, with both their employees and customers, said Wesley Duke, general counsel for the Cabinet for Health and Family Services. He answered some of their most frequently asked questions on the webinar. 

"We expect business owners and management to do as much as they can to encourage the wearing of mask," he said. 

He said employers need to broadly document the names and reasons any of their employees fall under an exemption. For example, he said those with a medical exemption simply need to state that as their reason, with no further details. That said, he then encouraged such employees to instead wear a face shield or to move to a job that allows for social distancing whenever possible. 

As for customers, Duke said the expectation is for businesses to encourage every customer who enters their establishment to wear a mask, and if at all possible to provide a mask to them if they don't have one – and if the customer doesn't have a facial covering or refuses to put one on, ask them to leave. 

He stressed that employees should never put themselves into a dangerous situation when asking customers to wear a mask: "We do not expect confrontation, and we would caution against confrontation, but to do everything to that point to encourage the customer to wear that mask and to let them know that they should not enter that premises without one."

Duke noted that he had heard "through the grapevine" that there are businesses that have told their local health departments that every single employee in their business has a medical reason that exempts them from wearing a mask. 

"I don't know what the odds are of that happening. I don't mean to question anyone's honesty," he said. "However, if that's their position and they documented it and they are taking that position, then I don't think there is much to, really, that we can do beyond that. We can't demand medical records and it's a very fine line [to] bump up against."

Stack was not so polite in asking Kentuckians to stop trying to find excuses to avoid doing things that are proven to slow the spread of the virus.

If the public "keeps trying to find ways to avoid the tools that work, we are going to have all the misery we currently have, and we're going to have added to it more people getting sick and more people who have bad outcomes from health care," Stack said.

"So this is not a time for us to look for the excuse to avoid doing the right thing; we need all of us, and leadership, and that certainly includes the business community . . . it requires all of us to be consistent on this message: Wear a mask and socially distance, that's how we get through this until we get a vaccine, hopefully in early 2021." 

Stack noted that at least 34 states some version of a mask mandate, including the bordering states of Indiana, Ohio and West Virginia, and the top recommendation in the latest White House Coronavirus Task Force report is for Kentucky to keep its mandate and work with local communities to ensure higher usage rates.

Duke said it's important for businesses to post signage that clearly states their expectations about the mask mandate and to educate their employees and others about why it is important.  

As for enforcement, the emergency administrative regulation, which is part of Beshear's executive order, provides for warnings and fines for those who refuse to wear masks, as well as for businesses that don't enforce its provisions. Duke said the first offense, which is a warning, is an opportunity to educate about why the mandate is so important. 

Overall, Duke said the business community has "been overall very, very helpful" with enforcing the mask mandate, especially businesses that are part of large corporate groups, compared to the mom-and-pop type of businesses where some of the issues are coming from.   

He said the Kentucky Labor Cabinet's KYSAFER hotline was getting fewer calls reporting poor compliance with the mask mandate.  "I'm hoping that that is because people are wearing them," he said. 

Beshear has acknowledged the need for better enforcement, but has not responded to questions from Kentucky Health News about what he is doing to improve it.

He has said the mask mandate seems to be working, as shown by the state's recent plateau in case numbers over the past two weeks.

When he extended the mandate, Beshear said he would keep renewing it until the virus is under "significant control" and the share of Kentuckians testing positive for it falls below 4 percent. The latest figure for that measure is 6.01%, the highest rate since testing became widely available in May. 

Testing is not ideal

Stack said that while testing for the virus has improved, "It's still not as effortless as we would like." 

Ideally, he said, anyone who would like a test should be able to get one at a cost that doesn't burden them or their employer.  The federal CARES Act requires insurers to pay for testing only of people who have symptoms or are at high risk of exposure. At this point, work-related testing is not paid for by the health-insurance system. 

"We have to continue to find better ways to help support industry and employers so they have effortless access to testing," Stack said. "But like many other occupational health needs, this is one of those things employers have a role to play and so we keep working on that." 

Stack discouraged business owners from investing in antibody testing unless they partner with a properly trained provider who understands their use and limitations. "You will otherwise, you could waste money, get the wrong results, reach the wrong conclusions, and not help yourself and perhaps reach the wrong course of action," he said. 

Health departments offer help 

Dr. Lynne Sadler, director of health at the Northern Kentucky Health Department, encouraged businesses to call their local health department if they have employees who have tested positive. 

"One of the things that we hear most often from employers is that they are afraid that we are going to shut them down and that is not at all what our intention is," Sadler said. "So many of the employers that we've worked with have been pleasantly surprised at their interaction with the health department, how helpful it is, how reassuring it is and that we haven't shut them down, we haven't made all of their workers go home."

She explained, "We have some pretty specific criteria about who is considered a close contact that would need to go into quarantine and we really do want to work with employers so that they maintain a safe work place and that we can stop the spread in the community."  

Sadler added that health departments often have resources to help businesses, noting that hers offers a Covid-19 Business Toolkit on its website. She also encouraged businesses to print, laminate and post instructions on what to do if they have a positive case in their business. 

"When in doubt, call the health department and let us help you sort through the situations so that we can figure out what's the best plan of action for you as the employer," she said. 

Sadler also stressed the importance of signage and educating employees and the public about why wearing masks is important. "Let people know what the expectation is, and I think that's where enforcement starts," she said.

She later added, "Businesses are such key partners in controlling the spread of covid and so we try to approach this as much as possible as let's work together because if we all chose to do the right thing consistently, we've got this. We can lick this." 

Schools reopening

Stack said that when schools reopen, it will be difficult to control all of the variables needed to keep students safe, like social distancing and mask compliance, but thought it would be possible in the primary grades because they are in highly supervised environments.  "I think we can control a lot of the variables well enough to reduce the risk reasonably and tolerably," he said, but added that the proof will come afterward.

As for colleges and universities, he noted that one of the challenges is that while 18- to 20-year-olds are adults physiologically adults, but not psychologically because the part of their brains that controls judgment is still developing.

"Their frontal lobes aren't fully developed until they are in their mid-20s, and so that whole appreciation of the longer-term consequences of their actions sort of gets lost on them, right? That's just part of their developmental stage in life." 

He said he is already hearing stories about college students who have chosen poorly, adding, "This is truly an instance, this disease, where we are all heavily dependent on the decisions other people make."

New coronavirus cases above 800 and positive-test rate over 6%; Beshear calls it a 'tough day,' says 'We simply need to do better'

Kentucky Health News chart; daily figures may be revised slightly after initial report

By Melissa Patrick

Kentucky Health News

After nearly two weeks of coronavirus case numbers on a rough plateau in Kentucky, they jumped to 801 Saturday, and perhaps more worrisome, the seven-day average of Kentuckians testing positive rose to 6.02 percent, from 5.57% the day before 

"Today is a tough day in our fight against covid-19," Gov. Andy Beshear said in a press release and a Facebook video. "I know we are slowing the growth of this virus in Kentucky, but it's still aggressive." He said, "We simply need to do better."

The 801 new cases was the third largest daily number, behind the 979 and 836 reported on July 19 and 25. On the latter day, the state's seven-day rolling average was 668, the highest it has been. Saturday, it increased to 560, and the three-day rolling average rose to 630.

And likely of greater concern, the share of Kentuckians testing positive for the virus has crept up as this week has progressed, increasing from 5.18% on Monday to Saturday's rate of 6.02%, the highest it's been since May, when the state tested the entire Green River Correctional Facility in Central City, Beshear said. Rates above 5% are considered cause for concern.

"Folks, we need your help," Beshear said. "This is the time where we must buckle down and do what it takes to get this virus under control. With this increase in positivity rate, we'll talk next week about what that means for school and in-person classes. We've got to make sure that it's safe for our students and for our teachers."

Beshear spoke in a Facebook video.

Beshear said Wednesday that a continued high positive-test rate might prompt him to recommend again that in-person schooling be delayed. On July 27, he recommended that it not begin until the third week of August, but those decisions are up to local school officials.

The Kentucky Education Association, the state teachers' union, said Friday that "In-person instruction should not resume until, at a minimum, the infection rate in Kentucky statewide and the infection in the county in which the school district is located both fall below 4% and both remain below 4% for 21 consecutive days as measured by a 7-day rolling average."

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told Lawrence Smith of Louisville's WDRB that Kentucky's rising percentage of positive tests puts the state in danger of becoming a covid-19 hotspot, but he said there is time to turn things around. 

"That has been, in our experience, a sure-fire predictor that if you don't do something different than what you're already doing, those little upticks -- as small and insignificant as they may seem -- don't turn around spontaneously by themselves," Fauci told Smith. "You got to do something different."

"We are not powerless" against the virus, Dr. Steven Stack, commissioner of the state Department of Public Health, said in the news release. 

“We have shown repeatedly that our individual actions will determine our future," Stack said. "Will you continue to wear a face covering? Are you keeping at least six feet distance between yourself and others? Are you washing your hands frequently? And, if you receive a call from a contact tracer, will you answer? If each of us answers ‘Yes!’ through our actions, we can keep Kentuckians safe and keep Kentucky open. Together, Team Kentucky can contain the coronavirus.”

On Saturday, 93 of the state's 120 counties reported at least one new case and 28 of them were in children under five. 

Beshear said, "This is spreading all over the state and we simply need to do better, keeping our social distance, not having people, more than 10, over to our homes, making sure we reduce our contacts and not traveling to the beach because we are seeing so much spread from people who continue to travel to states with high positivity rates." 

Beshear didn't mention his mask mandate, which he reinstated for another 30 days Thursday. On Friday, Stack said wearing a mask is the linchpin to keeping Kentucky's economy open and minimizing the spread of disease. He was speaking at a Kentucky Chamber of Commerce "Restart Kentucky" webinar. 

The state's daily report shows that 653 people were hospitalized for covid-19 Saturday, down from 717 Friday, with 149 of them in intensive care, up from 136 on Friday.

Jefferson County had nearly 25% of the new cases, at 197. Other counties with more than 10 were Fayette, 80; Warren, 35; Hardin, 32; Oldham, 29; Madison, 28; Boone, 21; Kenton, 20; Graves and Pike, 17 each; Daviess, 15; Whitley, 13; Pulaski, 12; Campbell, 11; and Casey, 10. 

The state reported eight more covid-19 deaths Saturday, raising its toll to 772. The fatalities were a 64-year-old woman from Fulton County; a 56-year-old woman from Kenton County; a 68-year-old man from Bell County; a 93-year-old man from Christian County; a 97-year-old woman, also from Christian County; a 66-year-old woman from Pulaski County; an 82-year-old woman from Clinton County, and a 73-year-old woman from Muhlenberg County. 

In other covid-19 news Saturday:

• Fauci told Louisville radio personality Terry Meiners Friday that if people do attend the Kentucky Derby, they should wear mask and social distance, Sarah Ladd reports for the Louisville Courier Journal. "The good news is that it's outdoor, as opposed to indoor," Fauci said on WHAS. "If you can physically separate yourself, and the organizers keep people six feet apart and you wear a mask or a facial covering, you are much better off than if you didn't do that."
• John Cheves reports for the Lexington Herald-Leader that Kentucky's child care system has been in decline for years because of inadequate funding, but faced with covid-19 is "now collapsing"  “With most centers, it’s always been a struggle to break even, let alone make a profit,”Cindy McGaha, professor of child development at Berea College, told Cheves. “So when we start doing things like restricting the number of children that we can care for and the number of adults that can be with the children during the day, that increases the costs dramatically. So you’ve got these centers that always struggled, and now they’re in the red and they just cannot provide that care. They cannot stay open any longer.”
• Coronavirus outbreaks at the Fayette County Detention Center increased to 44 inmates and two employees, Karla Ward reports for the Herald-Leader. A news release said that so far, 93 inmates had been tested and that test results for 32 of the inmates were pending; 17 tested negative. 

'Vigilance and protective measures are essential to save lives' from overdoses in pandemic, state health secretary writes

By Eric Friedlander
Secretary, Kentucky Cabinet for Health and Family Services

"Together, we are stronger than opioids."

It’s a uniting mantra we use as part of the Kentucky Opioid Response Effort to guide our purpose, affirm our hope and call upon our greatest asset in this commonwealth: one another.

Eric Friedlander

Together, we are building a system of care to reduce harms associated with opioid use and prevent misuse, connect more people with evidence-based treatment, including medications for opioid use disorder and expand recovery programs and services.

When covid-19 hit, new norms were called for: distancing from each other, working from home or not at all; and loss of child care and at-home schooling led to some people experiencing frequent and long bouts of isolation. We were fortunate in the Commonwealth to act quickly and decisively, united as the new Team Kentucky, flattening the curve together.

While we resolved to stop the spread of a dangerous virus, the stressors and anxieties took their toll on our mental and behavioral health.

It wasn’t long before we started hearing reports nationally and locally from first responders and health departments. Emergency service calls were up. Orders for Narcan – the opioid overdose reversal drug – increased.

Treatment providers voiced concern, wanting to safely keep people in treatment. Individuals in remission and recovery started to lose vital in-person connection and support, despite recovery groups’ creativity to provide virtual meeting spaces and other recovery initiatives. Overdoses in April were the highest reported since 2017 when the opioid crisis was at its peak. These reports coalesced to confirm what service providers have been concerned about since the pandemic began.

Vigilance and protective measures are essential to save lives right now and each of us can take action. Similar to CPR training, we urge Kentuckians to be trained and to carry Narcan. The website odcp.ky.gov/Stop-Overdoses/ can help connect individuals with pharmacies and harm-reduction programs ready to supply the live-saving medication.

We also encourage everyone to become familiar with the state’s online provider locator, findhelpnowky.org, to help those in need to find treatment. Identify mutual-aid groups for family and friends who are supporting those struggling with substance use.

At the state level, we continue to advance telemedicine, and have adopted policy changes to support its use.

We suspended the requirement for prior authorizations for behavioral and substance-use services in Medicaid. We’re also committed to ensuring access to health coverage so payment will not be a barrier.

Just 12 months ago, we were encouraged by a 15 percent reduction in overdose deaths. We knew our work was far from over, but this was an indicator of progress. More people were getting access to prevention, harm-reduction services, and more treatment providers were prescribing medications for opioid use disorder and providing evidence-based practices. The stigma around substance use was beginning to change.

This point in time has created new challenges to maintaining progress. It also has reminded us our recovery as a commonwealth is a work in progress, just as an individual’s recovery, because addiction is a chronic, complex disease. Let’s use these challenges as opportunities for change and advocacy.

We have long been aware of the resilience of individuals and families affected by substance-use disorder. We have watched so many adapt to these uncertain times and access services differently, ask for assistance with accessing technology and other resources, and go to any length to participate in their treatment and recovery, many of them doing so while caring for children and working or navigating loss of employment and other financial challenges.

We owe it to our fellow Kentuckians to not give up, not be discouraged, and not stop believing change and recovery are possible. Let’s acknowledge the challenges we are facing and commit to overcoming them – together. Because that is how we are stronger than opioids.

Eric Friedlander can be reached at 502-564-7042.

Positive-test rate up again, to 5.57%; KEA says in-person school should wait until state and local rates are under 4% for 3 weeks

By Al Cross and Melissa Patrick

Kentucky Health News

As covid-19 hospitalizations again set a record, and more Kentuckians tested positive for the coronavirus, the Kentucky Education Association said Friday that in-person schooling shouldn't resume until the infection rate falls to where it was before the July surge began.

The KEA is the biggest political ally of Gov. Andy Beshear, who said Wednesday that a rise in the infection rate could prompt him to recommend another delay in in-person instruction. Nine days earlier, he had suggested that it be delayed until the third week of August. Such decisions are up to local school officials, and they have been going both ways lately.

The infection rate – the share of Kentuckians testing positive for the virus in the last seven days – was 5.51 percent on Wednesday and Thursday. On Friday, Beshear reported that it was 5.57%, the highest since testing became widespread in May, except on July 29 and 30.

“What it suggests is that we are still in a very dangerous place where this virus could easily get out of control,” he said in a press release. As usual for a Friday, he did not hold a news conference. Federal health officials have recommend that schools not reopen if the rate is above 5%.

More than two hours before the release, KEA issued a statement saying, "In-person instruction should not resume until, at a minimum, the infection rate in Kentucky statewide and the infection in the county in which the school district is located both fall below 4% and both remain below 4% for 21 consecutive days as measured by a 7-day rolling average."

The statement began, "By every objective measure, and without public schools being open at all the last few months, the coronavirus situation in Kentucky at this moment is far worse than it was in March," when schools moved to online instruction. "If we all believed it wasn't safe to operate schools then, how can it possibly be safe to reopen now?"

When schools were closed, health experts had not yet recommended that people wear masks to thwart the virus, because the effectiveness of masks was uncertain and there was a need to save them for health-care workers, first responders and other priority users. Since then, supplies have become adequate, research has shown the effectiveness of masks and Beshear has ordered them to be worn.

But KEA said it "believes the choice, based on scientific evidence, is clear: Kentucky's public schools should not open to in-person instruction at this time." In addition to the infection-rate standard it suggested, the teachers' union said school districts must "consider other factors unique to their own communities, such as the infection rate among school-aged children and whether the Department of Public Health supports their reopening plan."

Of the 144 school districts that had responded to a state Department of Education survey as of Thursday, 109 had chosen a "blended" model in which parents and students can choose in-person or online instruction; 26 "indicated they will only have virtual learning to start the year, and nine districts said they are using the 'hybrid' or 'A/B' model for classes," reports Billy Kobin of the Louisville Courier Journal.

Beshear reported Friday that 717 people are hospitalized in Kentucky for covid-19, an increase of 20 percent in the last seven days, and 136 are in intensive care. When the previous record of 701 was set Thursday, he said it wasn't surprising because of the big surge in cases during July. 

The governor reported 573 new cases of the coronavirus Friday, leaving the state on the plateau it has seen for almost two weeks. The seven-day rolling average of daily new cases dropped to 528; two weeks ago, it was at a record 668. Friday’s new cases included 21 children under 5.

Jefferson County had 33 percent of the new cases, with 187. Other counties with more than 10 new cases on the state's daily report were Fayette, 37; Warren, 19; Oldham, 16; Franklin, Jessamine and Kenton, 14 each; Bullitt and Hardin, 13; and Boone, 12.

The state reported four more covid-19 deaths Friday, raising its toll to 764. The fatalities were a 53-year-old man from Pulaski County, a 62-year-old woman from Graves County, a 73-year-old woman from Jefferson County, and a 91-year-old man from Laurel County.

In other covid-19 news Friday:

• Beshear said he would issue his new orders for bars and restaurants Monday, as he described them Thursday.
• A Centers for Disease Control and Prevention report on rates of children hospitalized with covid-19 found that the rate was low (8 per 100,000 population) when compared to adults (164.5 per 100,000); one in three hospitalized children were put in intensive care. Hispanic and Black children had the highest rates of hospitalizations associated with covid-19. 
• "From the bus stop to dismissal," Fayette County schools have a plan for when students return to in-person instruction, Valerie Honeycutt Spears reports for the Lexington Herald-Leader. In a separate article, she writes about the rules around the use of Plexiglas barriers in schools. 
• The Courier Journal reports on key details from the Southeastern Conference for coronavirus testing, masks and quarantine, including required tests at least twice a week for players and masks for coaches on the sidelines.  
• A recent Commonwealth Fund survey finds that Americans are faring much worse mentally and financially in the pandemic than citizens in other high-income countries, Dennis Thompson reports for MedicineNet. "Data from our research demonstrates that U.S. adults, when compared to people in eight other high-income countries, face greater mental-health and financial consequences from the covid-19 pandemic," said Reginald Williams II, a vice president at the private foundation, which studies health issues. "It is also notable that few U.S. adults believe that national leadership has done a good job of managing the pandemic when compared to other countries." Click here for the report. 
• The Kentucky Supreme Court will hear oral arguments Sept. 17 in a Boone County case about the legality of Beshear's emergency orders, Deborah Yetter reports for the Courier Journal.

Telehealth is improving access to health care; digital interactions emerge as a silver lining to the pandemic’s dark cloud

By Shannon Clinton

The Lane Report

Amy Coyne noticed her 9-year-old son Max wasn’t feeling well and booked a doctor’s visit a week after his Georgetown school closed due to the coronavirus outbreak. The exam not only produced a diabetes diagnosis, but Max spent two nights in the intensive-care unit of the University of Kentucky Hospital.

A diabetes educator said Max needed a follow-up visit within days, but by that time the pandemic outbreak was dominating the headlines, and the Coyne family feared venturing back to Lexington and the main facility treating covid-19 patients in the region.

Max Coyne does telehealth. (Photo provided to UK)

So, for the first time, the Coynes tried a new way of connecting with health-care professionals — a video visit with a diabetes-education professional. And it enabled the whole family, including out-of-state grandparents, to be updated about Max’s new health needs.

Health-care systems have had to quickly increase their use of telehealth options for patients like Max to keep both staff and patients safe in the pandemic.

The U.S. Centers for Disease Control and Prevention touts telehealth as the best method when in-person visits aren’t necessary. It also helps patients who may lack reliable transportation or who live in rural areas with limited health care provider options, particularly specialists.

The U.S. Centers for Medicare and Medicaid Services and state officials greatly facilitated telehealth by issuing waivers expanding how it may be used and paid for.

The Coynes sought care for Max at UK's Barnstable Brown Diabetes Center, where Shawn Crouch is administrator. He and Dr. Carol Steltenkamp, a pediatrician, have led efforts to scale up UK’s use of telehealth in the pandemic. Steltenkamp has been a leader in the implementation of electronic health record systems in Kentucky.

Steltenkamp said UK Healthcare had about 100 telehealth visits in April 2019, and 25,000 in April 2020. By June, there were fewer than 20,000, and about the same in early July, when in-person care visit numbers had begun to rebound, Crouch said.

UK plans to ensure that telehealth visits remain an option. While there aren’t many silver linings attributable to the pandemic, Steltenkamp said, “The fact that this really ignited enthusiasm around telehealth is definitely a plus.”

Stressors abound during the pandemic. Aside from those actually battling the virus, along with their worried families, there's unemployment; homeschooling children, often while juggling at-home work responsibilities; and the widespread fears of contracting covid-19 while adjusting to sweeping new safety regulations.

Tack onto that society’s existing mental-health challenges, and the importance of maintaining mental health care access, even in a pandemic, is obvious.

Kentucky Medicaid, which covers almost 1.5 million people, began covering mental health via telehealth last year and piloted it at Lexington-based New Vista, which has a staff of about 2,000 in 25 locations to provide care for mental health and substance-use disorder.

Before the pandemic, in-person visits were overwhelmingly the norm at New Vista, said Don Rogers, its chief clinical officer. The transition to video visits took four or five days and has gone smoothly, Rogers said. Moving forward, he expects a 50-50 mix of in-person and video visits. For now, treatment staff still work from home and in-office on a rotating basis.

Natasha Painter, a New Vista outpatient clinician and telehealth provider, said telehealth has decreased cancellations of appointments by removing barriers such as transportation and child care and enabling treatment within the comforts of home.

“Clients who have transportation issues have definitely been able to come to appointments more often than they had in the past because they’re just a phone call away,” she said.

As virtual visits become more commonplace, patients will be able to contact doctors at times that are most convenient for them, using familiar technology, says Dr. Thomas Coburn, a family physician in Wilmore who’s also medical director of application and information technology for the ambulatory market of CHI St. Joseph Health Lexington.

While telehealth may never replace having a physical exam or the desire to shake a physician’s hand in-office, Coburn said he hopes Medicare, insurance and others will continue reimbursing virtual visits as they become a fixture in American health care.

“There’s a learning curve, and we’re in the middle of that learning curve, but I do see that this will be the wave of the future for health care,” he said.

Coburn said he had used Zoom for internal videoconferencing for years, but not for seeing patients. Covid-19 necessitated exploring that option, which was rolled out in about five days at St. Joseph. They’ve even helped providers in other markets in Tennessee begin providing video visits.

During the height of covid-19 concerns this past spring, about 65% of visits were virtual. That figure has since dipped to between 15% and 20%, which Coburn says is sustainable for the future.

He said patients who want a virtual visit, or are recommended to have one, receive a link to click at their appointment time, then wait in a virtual waiting room until time to video chat with a physician.

Afterward, prescription orders can be sent in electronically, and follow-up visits scheduled as needed. If a physician realizes during a video visit that an in-person appointment is warranted, one will be set up. If it’s on the same day, Coburn said, a patient is charged for only one visit.

Health-care providers are also experimenting with technology that enables them to listen to a patient’s heart with a stethoscope that transmits the heartbeat sounds online to a cardiologist, he said.

Even now, Coburn said, if he has concerns about a patient who he knows also sees a cardiologist, “I can actually consult with the cardiologist in my office through Zoom and they can see the patient while they’re in my office.”

Brent Baldwin, chief information officer for Lexington Clinic, said patient feedback about telehealth has been positive, and he believes it will remain a long-term option.

“The telemedicine genie is out of the bottle,” he said. “Regardless of whether [a vaccine] comes out, we’re going to have to meet the patient’s needs.”

Nick Sarantis, system director for digital health at Louisville-based Baptist Health, agrees. “I think it’s going to be hard for people to just put (telehealth) away” and go back to the way things were before, he said.

There’s been more of a learning curve for some providers, he said, as digital health care delivery isn’t typically taught in medical school. But patients seem to be embracing the changes. “As consumers, we’ve been going down a digital path in our lives for a long time,” he said.

Sarantis predicts telemedicine will be routine in three to five years, and investors will pour money into digital health companies, startups and new products. He said that in about six weeks, Baptist Health advanced its time frame for implementing telehealth by five years.

Much like retail companies such as Amazon have thrived by making access to merchandise easier for customers, Sarantis said, health care will be able to identify what gaps prevent patients from accessing health care and use telehealth methods as part of the solution, especially now that more patients and providers have been exposed to this new way of care.

The Coynes’ telehealth experience continues to expand, as other follow-up visits have been done by telehealth. Amy Coyne said she’s glad to have the option, and now even sends in Max’s blood glucose numbers remotely to his physician.

“Overall it was a really great experience,” she said, “and we were really grateful that we could do it that way.”

This is a condensation of a story that originally appeared in The Lane Report. The full story is at https://www.lanereport.com/129106/2020/07/telehealth-is-improving-access-to-health-care/.

Attorney general has online form to report Medicaid fraud, abuse

Kentuckians have a new tool for reporting suspected Medicaid fraud and patient abuse to the Office of the Attorney General. They can now electronically report abuse, neglect, and exploitation by completing an online complaint form located at ag.ky.gov/medicaidfraud.

“Providers who fraudulently bill Medicaid for healthcare goods and services steal taxpayers dollars and can endanger the health and welfare of beneficiaries,” Attorney General Daniel Cameron said in a news release. “We want to ensure our seniors are treated with dignity and respect by making it easier for Kentuckians to report suspected fraud and abuse.”

The new form allows Kentuckians to submit complaints from electronic devices, including smart phones, computers, and tablets. It allows users to mark their complaint as related to Medicaid fraud, patient abuse, or both, and prompts them to provide information such as the facility, the health-care provider’s information, the patient’s name, and the suspected abuser’s name.

"While Kentuckians are encouraged to report as many details as possible when completing a complaint, the Medicaid fraud and abuse form allows the reporting party to choose to include their name or to remain anonymous," the release said.

"In addition to the newly developed online form, Kentuckians may also report suspected Medicaid fraud and abuse by calling the Attorney General’s Medicaid Fraud and Abuse Hotline at 1-877-ABUSE TIP (1-877-228-7384). Kentucky law requires any person who knows or has reasonable cause to believe that Medicaid fraud or abuse is being committed to report it to the Medicaid Fraud and Abuse Hotline. Any person who reports the offenses of another in good faith is given immunity from civil or criminal action. Moreover, any person who makes a good-faith report is protected from discharge, discrimination, or retaliation in the workplace."

Six substance-abuse treatment programs get $1 million grants

Six Kentucky programs for treating substance-use disorder in "high-risk rural communities" got $6 million in competitive federal grants, Senate Majority Leader Mitch McConnell announced Friday.

The grants are from the Health Resources and Services Administration, which McConnell contacted in support of the grant applications, a press release from his office said.

Getting $1 million each are the Purchase District Health Department, the Northeast Kentucky Regional Health Information Organization (based in West Liberty), Baptist Health Foundation Corbin, Morehead's St. Claire Medical Center, Richmond-based Kentucky River Foothills Development Council and the Lake Cumberland Community Action Agency.

The programs will use the federal funds for a range of recovery activities, including medication assisted treatment, transitional housing and workforce readiness programs, the release said.

For example, Kentucky River Foothills Development Council said the money will enable the Madison Opioid Response and Empowerment (MORE) Consortium to strengthen substance-use prevention, treatment and recovery services in Madison County.