Poll: 3 of 4 Kentuckians say they worry about affording health care

Chart from poll report; for a larger version, click on it

By Melissa Patrick
Kentucky Health News

More than half of Kentucky adults struggled to pay for health care in the past year, and three out of four were worried about paying for it in the future, according to a Altarum Healthcare Value Hub survey, done in collaboration with the ThriveKY Campaign.

In the survey of 1,140 Kentucky adults, taken May 8-26, 58 percent said they had experienced one or more health-care affordability burdens in the past year, with 18% reporting they had been uninsured at some point in the prior 12 months and 39% of that group saying they lacked coverage because it was too expensive. 

The reality of those concerns are likely high for many Kentuckians during this record year of unemployment, in which many Kentuckians have also lost their health insurance. 

“More than 233,000 Kentuckians have lost employer-sponsored health insurance along with their jobs,” Emily Beauregard, executive director of Kentucky Voices for Health, said in a news release.

One option for many who have lost their coverage in Kentucky has been Medicaid, the federal-state plan for low-income and disabled people. It was expanded in 2014 under the Patient Protection and Affordable Care Act to include those who earn up to 138% of the federal poverty level and may not have been able to afford the ACA's subsidized marketplace plans.

When the pandemic hit, the state made Medicaid enrollment easier, and Kentucky has led the nation in the rate of people gaining Medicaid coverage during the pandemic, according to a July 24 report by the Kaiser Family Foundation. It found that Kentucky Medicaid, which now covers more than 1.5 million people, grew 7% from March to April.

”Legal-aid offices around the state for years have seen Kentuckian families crushed by debt to the point of bankruptcy, and too often plagued by collection practices," Kentucky Equal Justice Center Director Rich Seckel said in the release. "Medicaid expansion and marketplace plans made a big difference, but families worry that the coverage may end. And many recently lost their employer-sponsored coverage.”

Just over half of those surveyed, 51%, said they had encountered one or more cost-related barrier to getting health care in the past 12 months. Of that group, 30% had delayed going to the doctor or having a procedure done; 29% had skipped needed dental care; and 24% had skipped a recommended medical test or treatment. 

Other delays due to cost were: going to the doctor or having a procedure done altogether, 24%; not filling a prescription, 23%; cutting pills in half or skipping doses of medicine, 20%; and having problems getting mental-health care, 12%. 

And even if they could get health care, 32% of Kentucky adults said they struggled to pay for it. Of this group, 14% said they had been contacted by a collection agency; 9% said they had used up all or most of their savings; 8% said they had been unable to pay for basic necessities; 8% said they had to borrow money or get another mortgage on their home; 7% said they had racked up large amounts of credit-card debt; and 7% said they had been placed on a long-term payment plan.

“Amidst the covid-19 crisis, Kentucky residents are critically concerned about health-care affordability and believe their elected officials should act to address these problems,” said Amanda Hunt, co-deputy director of the Healthcare Value Hub. “We found that even when respondents got the care they needed, one out of three Kentucky adults struggled to pay the resulting bill. Solutions received widespread support across party lines.”

The survey found that 77% of Kentucky adults are concerned about affording health insurance in the future. Their worries included the cost of prescription drugs or dental care; the cost of long-term care or home care, or rising medical cost when they grow old; or the cost of of a serious incident or accident.

And regardless of their coverage type, 61% of the respondents said they were worried or very worried about not being able to afford health insurance in the future. 

The survey found some regional differences in how Kentuckians experience health-care burdens. Eastern Kentucky adults reported the highest level of affordability burden, 68%; and affordability worry, 84%. Northern Kentucky adults reported the least amount of cost burden, 53%; and Louisville Metro reported the least amount of worry over cost, 73%. 

The survey included several questions about the coronavirus. Asked if they were worried about "affording treatment of coronavirus/covid-19 if you need it," 59% said they were worried or very worried. 

They were asked to pick their top three worries regarding covid-19 from a list of 12. Twenty-one percent said they were worried that "you or a family member becoming ill from covid," 11% were worried about job loss and resulting lack of wages, and 9% each were worried about the decreased value of their retirement savings and an inability to get treatment for other health problems. 

Dissatisfaction with the current health-care system was both statewide and bipartisan, with 71% of the respondents agreeing or strongly agreeing that the system needs to change; only 27% said "We have a great health-care system in the U.S." 

Chart from poll report; for a larger version, click on it

And when asked what issues the government should address in the upcoming year, 69% said health care. Some of the top votes on a long list of what the government should work on were: drug companies charging too much money, 74%; hospitals charging too much, 69% and insurance companies charging too much, 65%.

Some of the top strategies to tackle cost, according to the respondents, included expanding health-insurance options so that everyone can afford quality coverage, requiring insurers to provide up-front cost estimates to consumers, and to show what a fair price would be for a specific procedure.

The respondents were also asked about covid-19 policy. The report said, "There was significant diversity in the policies supported, with the front runner, additional federal stimulus payments, closely followed by four almost equally ranked options: more financial help for small businesses, improved public-health emergency preparedness, universal health coverage, and price limits on needed vaccines. The least supported policy was “More financial help for large businesses.”

Ky. campaigning in seven counties to get more of Black and Hispanic populations, hard-hit by covid-19, on Medicaid

Kentucky is launching a "1-2-3 No Cost to Me" campaign to get more Black and Hispanic residents enrolled in health coverage, Deborah Yetter reports for the Louisville Courier Journal. 

Image from Diversity Nursing Blog

The campaign aims to reduce racial disparities in health by adding eligible people to Medicaid, the federal-state plan for low-income or disabled people.

"We're very excited about this campaign," said Jackie Richardson, chief of staff for the state Cabinet for Health and Family Services, said at Louisville Mayor Greg Fisher's Aug. 11 press briefing. "We know that African Americans fall lowest when it comes to health outcomes, and this pandemic is no different." 

Fischer said the coverage could help ease some of the racial disparities highlighted by covid-19. In the Louisville area, 23% of residents are Black but account for about 27% of deaths from the disease, Yetter notes. 

Statewide, as of Aug. 15, Hispanics accounted for 13% of coronavirus cases though they are only 6% of the population. Black residents comprise about 8.5% of the population, but account for 14% of deaths and about 12% of cases.

"Early in the pandemic, when it appeared Black residents were suffering disproportionate rates of death and infection from the coronavirus, Gov. Andy Beshear pledged to try to expand health coverage for residents of color," Yetter notes.

The campaign, launched Friday, will focus on seven counties with the highest concentrations of minority residents: Jefferson, Fayette, Campbell, Christian, Madison, McCracken and Warren. Individuals must be legal residents to qualify for Medicaid, Yetter reports.

The campaign will include public-service advertisements and radio and television ads, billboards, bus stop ads, social-media ads, and notices in Black and Spanish-language newspapers. 

An estimated 20,000 Black and 34,000 Hispanic state residents lack health coverage, Health Secretary Eric Friedlander told Yetter.

Health Watch USA to host 'Covid-19 Vaccines' webinar Aug. 19

Health Watch USA will host a webinar on vaccines for the novel coronavirus at 7 p.m. ET Aug. 19.

"Covid-19 Vaccines" will focus on the current status of advocacy related to the pandemic, with Dr. Henry Chambers offering a presentation titled, "Covid Vaccine Primer." 

Chambers is chief of the Division of Infectious Diseases, at San Francisco General Hospital and director of clinical research services for the Clinical and Translational Science Institute. He is an editor of Antimicrobial Agents and Chemotherapy, a reviewer for numerous medical publications, and a peer reviewer for National Institutes of Health study sections.

The conference code is 7901347097. To participate by phone dial 866-814-9555. To join the meeting via Adobe Connect, go to http://healthwatchusa.adobeconnect.com/aug2020/

Weekly total of coronavirus cases is highest yet, but 7-day rolling average falls; officials note Kentucky has low covid-19 death rate

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear reported 390 new coronavirus cases Saturday, bringing the unadjusted total for the official Monday-Sunday reporting week to 4,492, the most yet. But even with cases on the uptick, the state's top doctor noted that the state's death rate from the disease is much lower than the nation's.

Beshear said in a news release, “The total number of new covid-19 cases has increased this week, which shows the disease is still very active in Kentucky, but on a positive note, it appears that Kentuckians have stopped the exponential growth of the virus. Team Kentucky has again shown that if we socially distance, wear masks and wash our hands, we have a better chance of continuing to reopen our economy safely and get more Kentuckians back to school and work.” 

The reporting week's preliminary figure is 386 cases, or 9.4 percent, than the largest weekly number, 4,106, reported July 27 through Aug. 2, The total number of new cases for the week remained more than 1 per 1,000, one metric that can push a state into the "red zone" of the White House Coronavirus Task Force.  

However, the seven-day rolling average of new daily cases is 642, down a bit from Saturday's 646 and well below the record 670 set Friday.

As usual, Sunday's report did not include some data, including the share of Kentuckians testing positive for the virus in the last seven days. However, it did note a metric not often mentioned. Health Commissioner Steven Stack said Kentucky's mortality rate for deaths related to covid-19 is 2.1%, compared to 3.2% nationally.

“This success is a combination of accomplishments including keeping covid-19 from spreading out of control, excellent health care, and more widespread testing than many other states,” said Stack.

Even so, he urged, “We can’t allow ourselves to forget that this virus spreads rapidly and is very dangerous. Let’s continue to come together as Team Kentucky to keep ourselves, our friends, families and communities as safe as possible.”

Beshear reported three more deaths from covid-19, raising the state's total to 813. The fatalities were all women: a 67-year-old from Fayette County, a 73-year-old from Perry County and a 91-year-old from Franklin County.

Beshear reported that 13 of the newly reported cases were in children age 5 and younger. 

Jefferson County had 41% of the new cases Sunday, with 160. Other counties with more than five new cases include Madison, 26; Fayette, 24; Kenton, 13; Warren, 12; Marion, 11; Bell, 10; Adair, 9; Bullitt, Greenup and Simpson, 6 each; and Boone, Scott and Woodford, 5 each.

In other covid-19 news Sunday:

• After three days on the University of Kentucky campus, Chronicle of Higher Education reporter Lindsay Ellis reports that the prevailing sentiment of students returning in the midst of a pandemic was "This is worth it." She explains, "The moment’s excitement was a result of the university’s intense planning: The hundreds of pages of guidance. The Zoom meetings. The thousands of pieces of furniture taken out of classrooms, dining halls, and lounges, and put in storage to reduce capacity and create distance. The excitement, for a moment, was louder than fears about student behavior, about faculty and staff health, about the wisdom of the togetherness on which the coronavirus thrives."
• "A Deadly Coronavirus Was Inevitable. Why Was No One Ready?" The Wall Street Journal asks, and then explains, in a long story that makes these points, among others: "Governments had ignored clear warnings and underfunded pandemic preparedness. They mostly reacted to outbreaks, instead of viewing new infectious diseases as major threats to national security. And they never developed a strong international system for managing epidemics, even though researchers said the nature of travel and trade would spread infection across borders. . . Officials made mistakes earlier this year when the severity of the outbreak became clear. Some were understandable blunders made during a panic; others were simply blunders. . .  Efforts were weakened by a revolving door of officials, among other distractions and missteps. In May 2018, John Bolton, then President Trump’s national security adviser, dismantled a National Security Council unit that had focused on global health security and biodefense, with staff going to other units. . . . It pushed emerging disease threats down one level in the NSC hierarchy, making pandemics compete for attention with issues such as North Korea, said Beth Cameron, a previous senior director of the unit. . . . Deteriorating relations with China reduced Washington’s activities there just as researchers were becoming more certain of the threat from coronaviruses. The CDC cut personnel in China from 44 to 14 and said it expects to have 10 U.S. and local staff by the end of this year. The agency said it reallocated programs to other countries with greater needs."

Public-health officials defend their data, calling it imperfect but useful, and explain support for Beshear's school recommendation

By Melissa Patrick

Kentucky Health News

A legislative committee meeting to review how the state collects and reports coronavirus data shifted quickly Thursday to Republicans' questions about Democratic Gov. Andy Beshear's recommendation to delay in-person schooling until Sept. 28, and his general handling of the pandemic.

Dr. Steven Stack and Doug Thoroughman
(Photo by Dalton Godbey, posted on Twitter)

"We don't close our schools down for influenza, but we do for covid," said Sen. Danny Carroll of Paducah, after establishing that more children die in Kentucky from the flu (six last season) than have died from covid-19 (one so far).

Carroll's "why" question at the meeting of the Program Review and Investigations Committee, which he co-chairs, was answered by Doug Thoroughman, the acting state epidemiologist.

"If you don't take the measures to reduce transmission and keep it slower, unlike flu, you are going to see eventually, like a New York – if you get the hospitals overwhelmed, you lose a lot of people, because you don't have the ability to care for them," Thoroughman said.

Gov. Andy Beshear regularly points out that while children generally have milder cases of the disease, they can spread it to their teachers, staff and caretakers, who are often grandparents, even if they don't have symptoms. And those people are more likely to die from covid-19 than from the flu.

"Mortality is definitely higher for covid-19" than for flu, Thoroughman said. Kentucky has had 810 deaths from covid-19, starting in March; in the past four years, 767 Kentuckians have died from the flu.

Rep. Lynn Bechler, R-Marion, asked if it is safe to say that 99 percent of the population won't die from covid-19. Health Commissioner Steven Stack said that's true, but it's important to recognize exactly how many deaths 1% would represent, noting that is 10 times greater than the fatality rate for the flu. "One percent of 330 million is 3.3 million people. So 1 percent of a big number is still a big number," he said.

Carroll noted that almost two-thirds of the covid-19 deaths in Kentucky have been nursing-home patients, and questioned whether that warranted delaying in-person classes or shutting down businesses.

Stack, a physician, said there's not much he'd change about what he and Beshear have done, saying the opening of schools in other states to in-person learning has shown that the virus spreads like wildfire. 

"I realize we've got to let things get back in motion, and I think that we're starting to do that more and more as we learn where we can pull back and allow things to go," Stack said, "but I still think we are following the general trend where the majority of public health experts are recommending we go, as we are trying to learn as rapidly as possible." 

Schools were a persistent topic of the meeting, held three days after Beshear recommended that schools delay in-person instruction to Sept. 28. Three days before that, the Kentucky Education Association, one of his major political allies, said in-person classes shouldn't resume until the positive-test rate declined significantly.

Carroll referred to KEA's statement and asked Stack, "Are you aware of any political motivations to change that recommendation so quickly?" Stack replied, "No, my recommendations to the governor are based on public health." 

Asked what had changed, Stack said the state saw an exponential growth in cases, and Dr. Deborah Birx, the White House Coronavirus Task Force response coordinator, recommended that the state take aggressive steps to tamp down the infections or risk becoming the next Arizona, Texas, South Carolina or Florida. 

Rep. Steve Riley, R-Glasgow, asked if there had been any consideration for the irreparable academic damage that some students will suffer, noting that there is little substitute for in-person instruction, especially in the lower grades. 

Stack said it is "mission critical" to reopen schools, but suggested delaying the start of in-person instruction will allow the state to see what happens in other states that have already reopened, and could convince some mask-reluctant Kentuckians to change their minds. 

"I think there are still a fair amount of people who don't believe in these masks," he said. "There are still a fair amount of people who don't believe in staying six feet apart. I think if they see all the schools shut down in Georgia and in other states that are opening and not following the rules consistently, it may help others to say 'Maybe if I wear a mask and I stay apart that we can open schools better'." 

Sen. Whitney Westerfield, R-Crofton, asked if Stack and Beshear had considered any of the collateral damage that results from closing schools, such as substance abuse. He said it is up, but abuse referrals and behavioral-health referrals, many of which are initiated in schools, are down. 

Stack concluded a long, detailed response by saying, "I think it's fair to say that we have a pretty robust effort to try to be aware of those different trade-offs and considerations." 

Data debate

The first half of the meeting was spent on how the state gathers coronavirus data and reports it, a complicated system with dozens of testing laboratories, multiple reporting mechanisms, daily cleaning of the data and a governor who needs a daily report for his 4 p.m. news briefing.  

"For covid-19, because we do these daily updates, we are compressing about two weeks for a given case of disease into a few hours each day," said Thoroughman, the epidemiologist. 

One metric reported daily is the percentage of Kentuckians who tested positive for the coronavirus over the past seven days. Thoroughman said this metric isn't perfect because some labs don't report their negative results, despite efforts of the Department for Public Health to get them to do so.

State law doesn't require reporting of negative tests, "so that makes it really difficult to get positivity rate," Thoroughman said. 

Carroll asked, "So why would we even report those numbers to the public when they are nowhere near accurate?" 

Thoroughman replied, "Well, because there is a huge clamoring for it." He also said the state has found a need to show more accurate figures than those reported by the federal government, which are generally 2 to 3 percentage points higher because it misses a lot of negative case numbers due to the ways different labs report. (Also, Stack has said the federal numbers include all positive tests for the same person, but the state "de-duplicates" them.)

"It sounds like we are making decisions based on that positivity rate that is totally inaccurate," said Carroll.

Slide from Health Commissioner Steven Stack's presentation to the committee

Stack pushed back, saying that even though the number is not perfect, it's an important number to pay attention to, and shows trends.

"We're making decisions on a lot of data points and this is just one," he said. "I can assure you our decision making is far more complicated and intricate than relying on any single metric, including this one. . . . The data has been, is and will remain imperfect, but we are committed to doing the best we can, but it is not perfect. But it is still very useful."

On another key metric, daily new cases, which can fluctuate widely, he said, "I look at decision making often on a weekly basis, because the day to day variation may be an artifact, and not representative of what is truly happening." He said regardless of when they are reported, all new cases are unique people.

Near the end of the two and a half hour meeting, Carroll's frustration with the Beshear administration bubbled over. 

"The problem we have right now is half of this state doesn't believe anything you all say, and it hinders the effort," Carroll said. "And in my view, all of that could have been avoided from the very beginning had the governor decided to structure things properly, to reach out to the House, to the Senate, to build a consensus, to bring in a panel of experts maybe as a covid commission, to provide advice and everyone stand up united."

He added, "I think there would be a higher level of trust to what is coming out and at this point, honestly sir, I don't believe a lot that comes out. There's just so many holes in so much of it, and politics has taken over and it's a struggle and I wish it were different,  I truly wish I felt differently, but I don't."

Leaders of the Republican majorities in the Senate and House have complained about Beshear's lack of consultation with them. Carroll asked Stack if he thought it could be done better. Stack said that theoretically it could, since most Americans say they want their politicians to work together. He also noted the strong differences of political opinion that exist in Kentucky, and said they didn't just show up in 2020. 

Carroll said, "If there ever was an incident that we need to be united on in recent decades, this is it, and we just missed it. It falls in different areas. I think we got off to a good start, I think the governor got off to a good start, it just didn't last long. It's just sad that this didn't happen, and that's why there is so much division and that's why people are just mad right now, and it's getting worse, and I hope that, it would be my hope, that we could get past that and we could start working together more closely."

Other questions 

Asked why the state hasn't implemented restrictions by ZIP code or county, Stack said the virus has no regard for a map, nor do people who cross county lines for work, school, church and so on. 

Sen. Karen Berg, D-Louisville, asked about the 123 child-care centers that have reported positive cases, saying that she was hearing some refuse to report them for fear of being shut down. 

Stack said he had heard such stories about churches and businesses, and said there is a fine line between citizens' need to know, to keep themselves safe, and personal or business privacy. He assured Berg that they were making every effort to protect privacy so people will participate in the process. 

Sen. Michael Nemes, R-Shepherdsville, asked the average age of death and a covid-19 death in Kentucky, and was told 75.8 and 77.4, respectively. 

Asked about herd immunity, Stack said only about 5% of Kentuckians have been infected with the virus and that 60% to 70% of the population would need to be infected to reach herd immunity. Thoroughman said he thought it would need to be 95%, because the disease is so infectious. He is an epidemiologist; Stack is a former emergency-room doctor who was president of the American Medical Association.

A 95% level of infection would result in a tremendous number of deaths in a short period of time. Stack said that if somehow 100% of Kentuckians were to get infected over the next 12 months, with a mortality rate of 1%, 45,000 Kentuckians would die from it; and even if that rate were cut in half, that would leave 22,500 Kentuckians dead. 

Rep. Rob Rothenburger, R-Shelbyville, asked about supplies of personal protective equipment. Stack said that he also is concerned because of the surges in other parts of the country, and "It's about to get more difficult to get."

Stack said the state had increased its warehouse space by 116% and wants to have a multi-month supply of PPE. He said it has about a six-week supply for hospitals and first responders in case of a major surge, more than other states in our region. He said hospitals are required to have a 14-day supply.

Stack told Bechler that cases in Kentucky appear to be on a second plateau, and avoiding another increase is important to ensure that the state has enough hospital capacity. He said the recent rise in cases in Eastern Kentucky prompted the Appalachian Regional Healthcare to imposed a two-week hold on all elective procedures in its hospitals, which are filling up with covid-19 patients.

State certain to set weekly new-case record Sunday, but positive-test rate for the past week falls to the lowest level in 10 days

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

By Al Cross
Kentucky Health News

Kentucky is certain to have its largest number of new weekly cases of the coronavirus in the reporting week that ends Sunday.

Gov. Andy Beshear reported 638 new cases Saturday, bringing the unadjusted six-day total to 4,102. That preliminary figure is just four cases short of the largest weekly number, 4,106, reported July 27 through Aug. 2.

The current total “unfortunately suggests this is going to be the highest week of total cases that we’ve ever had, though our positivity rate is going down a little bit,” Beshear said in a news release.

The share of Kentuckians testing positive for the coronavirus in the last seven days is 5.45 percent, down from 5.68% the day before. That is the lowest rate since the 5.24% reported Aug. 4, the day before the average began rising to 6.02% on Aug. 8, the highest since testing became widely available.

Another key metric, the seven-day rolling average of new daily cases, fell to 646 from the record 670 set on Friday. However, the total new cases in the period remained more than 1 per 1,000, one metric that can push a state into the "red zone" of the White House Coronavirus Task Force. The other metric is the positive-test rate, which will leave Kentucky in the "yellow zone."

“Folks, this thing is real,” Beshear said. “We are at war with it, and we are going to have to be the strong, resilient and also patient Kentuckians that we are to make sure that we prevent loss of life, that we promote health, and that we protect our children, that we should never, ever experiment with.” 

Beshear has been defending his recommendation that schools not begin in-person instruction until Sept. 28, and using his news briefings to call out school districts that aren't cooperating or thinking about not cooperating. His release said 17 of Saturday's 638 new cases were in children 5 and younger.

He also noted how more school-age children are testing positive, especially in the state's hot spots. “When you look at how hard children are being hit now,” he said in the release, “322 people under the age of 18 have tested positive since the beginning of this in Warren County alone.”

The Warren County Board of Education is to decide Monday whether to proceed with its plan to start in-person classes Aug. 24. Friday, the Bowling Green Independent Board of Education voted to still start that day, but gave parents "the option to either send their children to school on a hybrid, A/B schedule or attend the district’s virtual academy, which requires a one-semester commitment," Aaron Mudd reports for the Bowling Green Daily News.

Beshear's release also quoted Health Commissioner Steven Stack, who said, “Now, more than ever, we have to renew our commitment to work together to protect ourselves, our friends, our families, and our communities. This week outpaced the number of new cases last week and, if we become complacent, our hard-fought containment of the coronavirus could slip from our grasp.” 

Stack added, “Every person who avoids crowds, wears a face covering in public, maintains a social distance of at least six feet, and frequently washes their hands makes essential and invaluable contributions to our ability to fight this pandemic. If we all do these things consistently, we can suppress covid-19 enough to more safely open schools and engage in many activities so important to our lives.”

The state reported six more deaths from covid-19 Saturday, raising its total to 810. The fatalities were two men from Jefferson County, 71 and 85; a Jefferson County woman, 57; a Graves County man, 74; a Nicholas County man, 72; and a McCracken County man, 89. 

Jefferson County had 32 percent of the new cases Saturday, 205. Other counties reporting more than five new cases were Fayette, 45; Warren, 36; Daviess, 17; Kenton, 17; Pike, 17; Calloway, 16; Shelby, 15; Hardin, 13; Oldham, 10; Greenup and Pulaski, 9 each; Barren and Montgomery, 8 each; Boone, Campbell, Clark, Madison and Simpson, 7 each; and Bourbon, Graves, Jessamine, Marshall and Nelson, 6 each.

State chart, adapted by Kentucky Health News; for a larger version, click on it. Updates are here.

7-day case average new high; Beshear prepares mask citations, calls out another school district; election-rules deal announced

By Al Cross
Kentucky Health News

Kentucky reached a new peak in the coronavirus pandemic Friday, as 679 new cases raised the state's seven-day rolling average to 670, the highest yet.

Meanwhile, the state health department took the first concrete step toward enforcing Gov. Andy Beshear's mask mandate, and the governor and Secretary of State Michael Adams announced an agreement for voting procedures for the Nov. 3 election.

The seven-day average of daily new cases smooths out the highs and lows in daily new cases and shows the recent trend. It has risen for the last three days, driven mainly by the record 1,163 cases the state recorded Wednesday. The new high of 670 is just above the previous record of 668, set July 19-25.

Beshear, who has recently highlighted data by calendar weeks, said this week's total is likely to exceed last week's, but by less than 10 percent. "At least we are at a plateau, due to people's wearing facial coverings," he said. "We still need more time to reach a decline."

The White House Coronavirus Task Force uses Saturday-through-Friday weeks to put states in danger zones, and Kentucky has now exceeded a criterion for the task force's "red zone": more than 1 new case per 1,000 people in the week. The total for the last seven days was 4,690; the state's estimated population on July 1, 2019, the last estimate available, was 4.468 million.

Kentucky probably won't be in the red zone, though. The other task-force metric is the percentage of residents testing positive for the virus during the week. By the state's figuring, that was 5.68%; the task-force number is always somewhat higher, state officials say, because it counts multiple tests of the same person. The "yellow zone" for the metric is 5% to 10%.

Beshear said he was glad to see the figure below 6%, where it was Aug, 5, "but we have got to get that lower." He said the task force says for "regular reopening," a state's rate should be below 5%.

The rate needs to be below 4% for three weeks statewide and in a school's county before it resumes in-person instruction, the Kentucky Education Association, the statewide teachers' union, said last Friday. On Monday, Beshear recommended that schools delay in-person classes until Sept. 28. 

Today, he called out another school district that so far is not following his recommendation. Noting that 77 of the 679 new cases were in children, he said three were in Barren County, and they "presumably would be in schools under current plans."

He also mentioned Hardin County, where the school board voted Wednesday to start in-person instruction Aug, 24. He said the new cases included another three school-age children in Hardin County, making nine in the last two days.

Image from WKYT-TV

Citations ready: The state Department for Public Health sent county and district health departments citations to issue businesses that don't enforce Beshear's July 10 order that Kentuckians wear masks in indoor public spaces and outdoors when they can't stay six feet apart.

"The first offense is just a warning, but after that businesses will be ordered to pay fines of $50 for a second offense, $75 for a third offense, and $100 for fourth and subsequent offenses," Phil Pendleton of WKYT-TV reports.

Beshear did not mention the topic at his news conference, and wasn't asked about it. He has not responded to written questions from Kentucky Health News about what he was doing to improve enforcement of his order.

Asked what guidance was sent with the citation forms, Cabinet for Health and Family Services spokeswoman Susan Dunlap said in an email, "District and local health departments were provided mask mandate guidelines a few weeks ago. . . . The forms allow the health departments to deliver the citations in a way that is easier to track. The system is in place, and the expectation is that it needs to be enforced."

Election agreement: Beshear and Adams' plan for the Nov. 3 election is much like their arrangements for the primary, which Beshear moved to June 23 due to the pandemic. That made for some hurried arrangements, and Adams said those issues are resolved in the new plan.

Absentee voting will be available to anyone who says they are concerned about contracting or spreading the virus through in-person voting, and their statement won't be questioned. Applications can be made through an online portal that will open by Friday, Aug. 21. It will close Oct. 9, farther in advance of the election than for the primary, to give county clerks time to get ballots in the mail to voters.

No-excuse early voting at clerks' offices or alternate locations will be more extensive, running from Oct. 13 through Nov. 2, including at least four hours on Saturdays, another change from the primary. Photo identifications will not be required if a voter has a non-photo ID and signs a statement that they couldn't get a photo ID due to fear of the virus or closure of offices that issue the IDs.

Counties can limit the number of polling places on Election Day with the approval of Beshear, Adams and the State Board of Elections, and every county will have at least one site with ballots for all precincts. Adams said that would help people who might go to the wrong polling location.

Another major change is that absentee ballots will not be counted if received after Friday, Nov. 6. Adams said the biggest complaint about the primary, other than the shortage of polling places, was the week-long delay in getting results. He said counties will be required to report on election night all votes received by then, and "I expect we’ll have the vast, vast majority of the vote in."

Asked about fresh concerns about the ability of the U.S. Postal Service to get all ballots delivered on time, the Democratic governor said, "I believe that the Postal Service can handle this. … While there are some worries right now, I think this is just caught up in national politics." He also said, "If people overwhelmingly choose to vote by mail, it's set up to get them to do it early." Adams said voters should mail in their ballot when they make up their mind.

Adams, a Republican, noted a report that the Postal Service had told 46 states, including Kentucky, that it might have difficulty delivering election mail on time. “I haven’t got that letter,” he said. “Maybe it’s in the mail somewhere.”

In other covid-19 news Friday:

• The state reported eight more covid-19 deaths Friday, raising its toll 804. All were women: two from Franklin County, 82 and 92; two 85-year-olds from Bell and Casey counties; a 63-year-old from Christian County; a 75-year-old from Hopkins County; an 83-year-old from Jefferson County; and a 77-year-old from Lewis County.
• Lewis County, where a nursing home had an outbreak, stood out on the list of new cases because it had 30 and has a population of only 13,000. Other counties reporting more than five new cases were Jefferson, 193; Fayette, 44; Warren, 30; Hardin, 26; Madison, 21; Barren, 18; Kenton, 18; Boone, 17; Harlan, 14; Clark, 12; Bullitt, 10; Laurel, 10; Pulaski, 10; Bell, 8; Franklin, 8; Jessamine, Johnson McCracken and Scott, 7 each; and Carroll, Oldham, Rockcastle and Russell, 6 each.
• Beshear said 656 people are hospitalized in Kentucky for covid-19, with 147 of them in intensive care and 97 of those on ventilators.
• Attorney General Daniel Cameron said in a press release that his office “has seen an alarming increase of up to 300% in monthly reporting of scam activity, since the onset of covid-19. . . . We urge every Kentuckian to continue to be vigilant and cautious, to be wary of any communication that asks for personal information, and to report scams to our Consumer Protection Hotline at 1-888-432-9257 or online at ag.ky.gov/scams.”
• U.S. Sen. Rand Paul, R-Ky., said in an interview with a libertarian economist that authorities should, as summarized by the Lexington Herald-Leader, "put kids in school and let young adults work and play while reserving masks and other restrictions for older, at-risk populations."

Beshear tries to jawbone uncooperative school districts into following his recommendation, noting 785 new cases today

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

By Melissa Patrick and Al Cross 

Kentucky Health News

Even after reporting a record number of cases yesterday, and an above-average number today, Gov. Andy Beshear said the addition of 785 more cases likely won't push the state into an exponential increase this week, similar to what the state was seeing just a few weeks ago. 

"It means that wearing a facial covering is working, other steps are working," Beshear said. "But we need you to stick with it, and we cannot make decisions that are ultimately going to cause a significant spread right now because that's going to make everything we want to do that much harder."

Beshear spoke as some school districts are beginning in-person instruction, contrary to his recommendation that they delay it until Sept. 28, and he called out some of them.

More than once, he pointed to Warren County, a coronavirus hotspot, where the county and Bowling Green districts are planning to open schools Aug. 24. The districts' boards are to meet Friday and Monday, respectively. Aaron Mudd reports for the Bowling Green Daily News.

Beshear pointed out that school-aged children accounted for six of the 29 new cases in Warren County today, and in the last three weeks, 86 children in the county had tested positive, though children aren't tested as often as adults.

"That is incredibly concerning, and I hope that in making decisions we would see that county . . . ultimately reach good decisions where we are patient enough to make those good plans to reopen our schools work at a time when they can work."

Beshear noted that the White House Coronavirus Task Force considers Warren the second hottest county in Kentucky for uncontrolled spread of the virus, with a positive-test rate of 10% or more.

He also pointed to Hardin County, where six of 21 new cases today were school-aged children. The county school board voted 4-1 in Elizabethtown Wednesday evening to allow in-person instruction to resume starting Aug. 24, Shellie Sylvestri reports for Louisville's WAVE-TV. The schools will also offer online learning. 

Lexington Christian Academy, a private school in Fayette County with more than 1,100 students, also plans to open with in-person learning next week, Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

Parents in Madison County said in a poll that they wanted schools to open on schedule, but after an "emergency" session with state officials, the school board voted Thursday night to delay opening until Sept. 2 and no mandate in-person instruction until Sept. 28, WKYT-TV reports: "School board members said after an emergency meeting with officials of the Kentucky Department of Education, they felt like their hands were tied."

Beshear said many more Kentucky children could be positive for the virus since young people are often not tested. "We are seeing an explosion of positive tests amongst our young people," he said. "Let's make sure that the decisions we make set us up for actual success and don't set us back as a state, and as I've said before let's not experiment with the health of our children." 

About 40 percent of people with coronavirus infections have no symptoms, but can still spread the virus. Beshear mentioned a report that shows nationwide, about 100,000 children tested positive for the virus during the last couple weeks of July. 

And to those who say that the virus only harms people of a certain age, making it safe to send children back to school, Beshear stressed that children can spread the disease to their teachers, staff and caretakers, who are often grandparents. Also, he said, the greater the exposure, the more opportunity kids have for a bad outcome, and the long-term ramifications of the virus are still unknown.

Some school superintendents said this week that they don't have access to county-level positivity rates to help them make re-opening decisions. Asked about that, Beshear said county-level rates in many small counties would have a large margin of error due to lack of testing, but acknowledged that a regional look, using data from several adjoining counties, might work.

However, he added that Dr. Deborah Birx, the task force's response coordinator, told him during her recent visit to Kentucky that because the state had half its counties in the task force's danger zones, this was a statewide problem that needed statewide steps. The latest report shows that 13 counties are in the red zone and 34 are in the yellow zone.

"I believe overall where we are in the state right now," he said, "just about any school district is going to have a real challenge."

Health Commissioner Steven Stack displayed a graph of Georgia's and Kentucky's cases over time, which he said shows how Kentucky's "measured and phased" approach has allowed Kentucky to flatten its case curve, compared to the exponential increase in cases in Georgia, which nevertheless opened schools this month.

Chart from divoc-91.com website, displayed by Health Commissioner Stack

“I think what we see is that the mask mandate is what impacted and has hopefully flattened that curve, and we'll see as this week ends where our totals fall," Stack said, adding that there has much debate about masks in Georgia and "I think they are seeing the consequences of not following that simple public health guidance, to use these masks." 

He displayed several slides of news coverage about schools in Georgia, showing rapid case escalation during the first week of re-opening in one school; another school that had 59 new cases, resulting in a two week quarantine for 925 students and staff; and another that had to close because of the virus. He then shared similar stories from a charter school in Louisiana and another in Indiana. 

"So just to avoid any lack of certainty, I very much support the decision that the governor made," Stack said. "I also am cognizant of the many trade-offs that there are with delaying schools. We need to get the kids back to school, but we need to get kids back to school safely." 

He stressed that the state's case numbers are still at an all-time high, and that the White House guidance is to take aggressive action to reduce the risk of transmission -- and unfortunately schools are places with a high risk of transmission. 

"I am hopeful as we have done along this journey, we will learn lessons from these other places that have done this earlier than us," Stack said.

CNN reports that over 2,000 students and teachers have been placed under quarantine in the few reopened districts in several states. Of those, there are at least 230 positive cases. The governor has asked Kentucky schools to hold off opening for another month to learn from the mistakes of  other states that have already moved forward with reopening their schools to in-person learning.

Stack said it's especially important to get an influenza vaccination now, to limit the number of hospital beds used by flu victims at a time when they may be needed by covid-19 patients. He added that the guidelines for preventing the spread of both viruses are the same.

Beshear, asked about Black activists in Louisville saying that it would be inappropriate and insensitive to hold the Kentucky Derby while Attorney General Daniel Cameron's investigation of the police killing of Breonna Taylor is pending, Beshear said, "It's been 150 days. Surely there will be a resolution by that point." The race has been reset for Sept. 5. 

Beshear said he hoped that the activists and organizers of Derby events could work together "to convey the right message." Asked if he will attend the race and present its trophy, he said he has to see Churchill Downs' specific plan for him before making a decision.

Asked if he had the power to order businesses to not accept money from customers who are not wearing masks, Beshear did not answer directly, but said his various executive orders effectively require businesses to do that, and that is what they should do: refuse service to the unmasked. 

Daily numbers: The 785 new cases reported today raises the seven-day rolling average to 654, second only to the 668 recorded July 19-25. 

The share of Kentuckians testing positive for the coronavirus over the last seven days was 5.67 percent, slightly under the average for the week. "We need to see a significant reduction in that rate," Beshear said. 

The state reported six more deaths from covid-19, raising the toll to 785. The fatalities were a 56-year-old man from Carter County, a 74-year-old man from Taylor County, an 80-year-old woman from Fayette County, and from Jefferson County, two women 82 and 89, and a man, 92. 

In other covid-19 news Thursday:

• Counties with more than five new cases were Jefferson, 189; Fayette, 61; Warren, 29; Kenton, 25; Clay, 23; Barren, Hardin and Madison, 21 each; Pulaski, 20; Bullitt, 18; Nelson, 16; Franklin and McCracken, 15 each; Calloway, 13; Daviess and Green, 12 each; Logan and Shelby, 11 each; Campbell, 10; Boone, Floyd, Graves, Laurel and Owen, 9 each; Knox, Magoffin and Scott, 8 each; Christian, Johnson Russell and Spencer, 7 each; and McCreary and Taylor, 6 each. 
• Beshear noted the relatively high number of new cases in Green, a county of 11,000 people. With that population, it takes only 11 cases in a week to get into the "red zone" of the White House Coronavirus Task Force, and it had more than that in one day. 
• Hospitalizations in Kentucky for covid-19 declined slightly, to 658, with 140 of those in intensive care and 98 of the ICU patients on ventilators. Beshear recently began giving the ventilator count, which is not part of the state's daily report. 
• Beshear reported that seven more child-care facilities had at least one coronavirus case among staff or children, raising the total to 131. Most cases, 102, are among staffers; 87 are among children. 
• On Monday, Beshear reported 123 child-care facilities have disclosed coronavirus infections for 96 staff and 82 children. John Cheves of the Herald-Leader lists them. The state provides a frequently asked question page for childcare centers on kycovid19.ky.gov.
• Asked about President Trump's objections to financial aid for the Postal Service in the next relief bill, Beshear said it was "not just silly but dangerous" to discuss "defunding the post office" in the midst of an election. Trump said Democrats want the money to facilitate mail-in balloting, which he claims (without evidence) will be subject to fraud.
• Buddy Forbes reports for Hazard's WYMT-TV a story in Johnson County about Darrell McCoy who said he thought covid-19 was a hoax and all about politics, and had been going about his business without a mask, shaking hands and holding in-person meetings. That changed after he was diagnosed with the virus, and his new message is to encourage everyone to wear a mask. “I was the one that, you know, was like 90 percent of the people in the mountains here. I refused to wear a mask; I wasn’t gonna change my way of life. I thought that it was all a hoax,” he said. “But I’m telling you, guys. This thing is real. And if you think that it can’t touch your family, just wait.”  
• In new guidance released Thursday, the American Academy of Pediatrics advised that face coverings can be worn safely by children over the age of 2, including the vast majority of children with underlying health conditions, with rare exceptions. "Just like children understand that they must wear bicycle helmets and buckle into their car seats, they will come to learn to wear masks routinely when necessary," AAP President Dr. Sally Goza said in a news release. She added, "As parents prepare to send their children to school and into childcare settings, cloth face coverings should be part of their new normal." New guidance from the White House for schools only encourages the use of masks when social distancing is not possible. 
• Looking for a coronavirus test in Lexington? Karla Ward of the Herald-Leader provides a list of sites, along with hours of operation and whether an appointment is necessary. Kycovid19.ky.gov also provides a list of 243 testing locations across the state that can be located by county.
• One way to make your home safer from the coronavirus is to crack a window and to be even more effective, put a box fan in that window, Mitchell Willetts reports for McClatchy. “The safest indoor space is one that constantly has lots of outside air replacing the stale air inside,” Shelly Miller, mechanical engineering professor at the University of Colorado, wrote in an essay for The Conversation. “Simply put, the more fresh, outside air inside a building, the better. Bringing in this air dilutes any contaminant in a building, whether a virus or a something else, and reduces the exposure of anyone inside.”
• "Across the United States, at least 200,000 more people have died than usual since March, according to a New York Times analysis of estimates from the CDC. This is about 60,000 higher than the number of deaths that have been directly linked to the coronavirus," Denise Lu reports. During the pandemic, Lu reports, Kentucky's excess deaths peaked during the week of July 5. 
• During late June, a CDC report found that 40.9% of U.S. adults reported struggling with mental health or substance use associated with covid-19. 

A cautionary tale: Hopkinsville journalist was surprised when she got covid-19, because she had been so careful

Jennifer P. Brown

The coronavirus pandemic hit unexpectedly close to home recently for Jennifer P. Brown, founder and editor of digital startup The Hoptown Chronicle in Hopkinsville.

Brown, former editor of Hopkinsville's daily newspaper, the Kentucky New Era, writes that she tested positive for covid-19 in July despite taking every precaution: "I was motivated to avoid an illness that could put me in the hospital and maybe on a ventilator. I am 58 years old, the same age my mother was when she died on a ventilator. That awful fate didn’t seem like a remote possibility to me."

She tested positive in early July after feeling exhausted for days. The fatigue and brain fog were her worst symptoms, though she writes that she was also more sensitive to heat and humidity, and it took her much longer to feel back to normal than she expected. She notes that covid-19 doesn't always present the classic symptoms; she only ran a fever for one night and never had the extreme respiratory distress many patients report.

She writes, "I’m writing about this now because it’s important to know that the coronavirus can reach almost anyone — including people who try hard to avoid it. Also, it seems odd for me to keep writing news stories about all the ways the pandemic is affecting my hometown without acknowledging that it has also affected me. In community journalism, there are fewer degrees of separation between reporters and the stories they cover than there are in large media markets. Often it feels like there are zero degrees of separation, especially when the news happens to a reporter."

Brown writes that, for example, the Christian County Health Department and the Jennie Stuart Medical Center are both major information sources about the local impact of the pandemic for the Chronicle, but both also gave her care and information. She shares other examples where her dual identities as a journalist and as a covid-19 patient (or potential patient) gave her conflicting perspectives on local health providers and agencies, public policy, and personal freedom. Read more here.

Brown is the programming co-chair of the national advisory board of the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.

State reports record number of new coronavirus cases in one day; Beshear defends his recommendation to delay in-person classes

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear reported 1,163 new coronavirus cases in Kentucky on Wednesday, the highest number yet in a single day – another reason, he said, to support his increasingly controversial recommendation to schools to delay in-person instruction until Sept. 28.

"Today we’ve set a record that we didn't want to set, and we never wanted to get over 1,000 cases,"  Beshear said at a news conference, adding later, "Covid is hot as a firecracker in Kentucky."

The share of Kentuckians testing positive for the virus in the last seven days dropped a bit, to 5.62 percent, "a rate that we need to get much, much lower," Beshear said. "It makes it unsafe in the current environment, we think, to engage in certain activities." The rate was 5.87% Tuesday and 5.71% Monday; it hit 6.02% Saturday, the highest since testing became widely available.

The new-case number broke the record of 979, set July 19, the peak of a surge that put Kentucky on a much higher level of daily new cases. Beshear said some cases in today's count should have been reported on Monday or Tuesday, but weren't because of a glitch in the reporting system. He said they decided to add them to today's count because ultimately the result would have been similar – a record number of cases either today or 1,090 on Monday.

He also suggested that it's more important to keep an eye on the state's weekly average, and that those numbers indicate that his mask mandate is working because they are not exponentially increasing. The seven-day rolling average of new cases is 616, a level not seen since July. The record for that figure is 668, set July 19-25. 

Beshear spent a good bit of his news conference defending his recommendation to schools, which superseded his original recommendation that they wait until Aug. 24, and quashing notions that he could order them to close by executive order.

"I'm trying to make the best recommendation, and that's what it is. I'm not shutting any school system down that doesn't agree with it, unless of course they have a massive outbreak and they aren't doing the right things and the local health department doesn't do it," he said.

His comments about not shutting schools down was in response to Interim Education Commissioner Kevin Brown's comment, during an online meeting with superintendents Tuesday, that Beshear could issue an executive order requiring school closure. 

He acknowledged that the delay in getting back to school is hard on everyone, including his family. 

"It's tough because as a parent I desperately want to get my kids back in class," he said. "Distance learning is not the same. My kids are of the age where they are losing out on important developmental opportunities, where not going to school impacts their emotional health. I'm sure that they've fallen behind on many of their classes."

But with cases and the positive-test rate so high, he said, "The idea that we would take this step at a time when we are at our peak is simply not a smart move." He added later, "We will get our kids back in school if it's humanly possible, but we're gonna do it safely without our kids being guinea pigs."

Beshear said part of his strategy was to let Kentucky learn from mistakes of other states, and said schools that choose to have in-person instruction sooner could make mistakes causing risks to students, teachers and families of students – many of whom live with their grandparents, whose age makes them more vulnerable to the virus. He said Kentucky has the nation's highest rate of children raised by grandparents.

"I don't believe that we gamble or experiment with our kids," he said, adding later, "All we're asking right now is one month not to make mistakes with the health of our children, their  parents or their teachers. . . . This is sending your kids out in the height of a lightning storm, at the moment." 

Beshear voiced particular concern about counties that have been talking about opening their schools to in-person learning soon that are in the "red zone" of the White House Coronavirus Task Force, which indicates 10% or higher positive-test rates and a weekly infection rate of more than one person per 1,000 population; or the "yellow zone," with a positivity rate of 5% to 10% and an infection rate of 0.1 to 1 per 1,000. 

Leaders of the Republican majority in the state Senate published a statement saying that Beshear's statewide approach isn't best. 

"We support districts deciding on their own to start in-person, virtually, or through a hybrid methods. We cannot apply a one size fits all model for our school districts, as what is best for Jefferson County may not be the same for Adair County," they wrote in an op-ed in the Lexington Herald-Leader. 

Roman Catholic schools in Kentucky have decided to not follow Beshear's recommendation and will start in-person instruction next week, and at least two Christian schools, in Somerset and Danville, are starting in-person learning this week, Valarie Honeycutt Spears reports for the Herald-Leader. She reports in a separate article that the Williamstown school board voted 3-2 to open school as planned, allowing parents the choice of in-person or virutal learning.

Asked about the Catholic schools, Beshear said, "I don't believe it's safe. . . . I'm convinced that it’s going to be hard this week and next week to do it very successfully." As for the opt-out approach, he said "It doesn’t opt out the employees of that school," as well as families and local businesses that might be hurt by an outbreak.

To those who might say that if it's OK for fans to go to the Derby, then it should be OK to send children to school, he said, "This is one of those false equivalencies . . . Churchill Downs will be down to less than 15 percent occupancy" on Derby Day, Sept. 5, with most people "being moved outside and spread out significantly." 

Jefferson County had 45% of Wednesday's new cases, at 526. Other counties listed in the daily report with more than 10 cases were Fayette, 57; Warren, 34; Madison, 31; Hardin; 29; Daviess, 24; Kenton, Pulaski and Scott, each with 19; Bullitt, 18; Perry, 15; Graves, 14; Christian, 12; Boone, Greenup, Knox, Lewis, each with 11; and Campbell, Floyd and Nelson, each with 10.

Ninety-eight of the state's 120 counties had at least one new case. Beshear again noted that the state continues to see a surge of new cases in young people, reporting today that 39 more children under five have tested positive, the youngest one three months old.

The state reported seven more covid-19 deaths, bringing the state's death toll from the disease to 790. The fatalities include a 71-year-old man from Barren County; a 73-year-old woman from Christian County; a 75-year-old woman from Fayette County; two women, ages 85 and 87, from Jefferson County; a 71-year-old man from Meade County; and an 80-year-old man from Oldham County.

Photos displayed by Beshear

“I really want us to remember that these are people, and by now, they’re people that you know … and that we care about," Beshear said.

He shared the story of William "Curtiss" Ice, 72, of Bardstown, who died from covid-19 and is survived by his wife of 49 years, Wanda; three children, seven grandchildren and 10 siblings. Ice served in the National Guard, was a manufacturing engineer with General Electric and a farmer. "Above all else," he said, "Curtiss was proud of his family and loved helping serve people in need."

Beshear said Ice's family was initially reluctant to offer him as an example of a covid-19 victim "because of the stigma that may come with covid" but wanted to honor him, "and I hope that serves as an example of the fact that we cannot allow those that suffer from this, or who have lost from this, to suffer from any form of stigma." 

In other covid-19 news Wednesday: 

• Beshear updated the list of states on Kentucky's travel-advisory list. He has asked Kentuckians to not travel to states with a positive test rate of 15% or greater, and if they do to self-quarantine for 14 days when they return. The list includes one state that is approaching that rate. They include: Washington, Florida, Nevada, Mississippi, Idaho, South Carolina, Texas, Alabama and Arizona.
• Beshear said 683 Kentuckians are hospitalized with covid-19, with 143 of them in intensive care and 95 of those on ventilators.  
• In long-term-care facilities, the governor reported 21 more residents and seven more staff have tested positive for the virus. There are now 389 residents and 246 staff with active cases of the virus.  He attributed one more death to the facilities, bringing that total up to 495.
• Beshear said he was meeting with Secretary of State Michael Adams about how to manage voting in the Nov. 3 election, and that they were very close to an agreement.

If you're obese, a coronavirus vaccine is probably less likely to immunize you, so now's a good time to start losing weight

Illustration by Lynne Shallcross, Kaiser Health News (Getty Images)

Looking forward to getting a vaccine for the novel coronavirus when it becomes available? If you're carrying around way too many pounds, it would be a good idea to lose some.

"Vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness," Sarah Varney writes for Kaiser Health News. "There is little reason to believe, obesity researchers say, that covid-19 vaccines will be any different."

She quotes Raz Shaikh, an associate professor of nutrition at the University of North Carolina, Chapel Hill: “Will we have a covid vaccine next year tailored to the obese? No way. Will it still work in the obese? Our prediction is no.”

Obese people are already among those more vulnerable to developing severe covid-19 from the virus, and that probably means they are also more vulnerable to dying from it.

"In March, still early in the global pandemic, a little-noticed study from China found that heavier Chinese patients afflicted with covid-19 were more likely to die than leaner ones," Varney writes. Then U.S. health officials said people with a body mass index of 30 or more were at increased risk." That description applies to 42.4% of American adults and about half of Kentucky adults, since the state's adult population is the fifth most obese in the nation.

"People with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results," but the current trials for a coronavirus vaccine "include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health," Varney reports. "Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants’ BMI will be documented and results evaluated."

And even if the vaccine isn't as effective in obese people, it's still safer for them to get vaccinated than not, experts told Varney.

“The influenza vaccine still works in patients with obesity, but just not as well,” said Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama. “We still want them to get vaccinated.”

Beshear says he had 'a lot the symptoms that can suggest covid-19' but tested negative, and felt empathy as he waited for results

Gov. Andy Beshear reported by video after feeling ill and testing negative for the novel coronavirus.

By Al Cross
Kentucky Health News

Gov. Andy Beshear reported 562 new coronavirus cases in Kentucky on Tuesday, but most of his remarks dealt with cases that didn't happen, in his own household.

"My family and I are OK. We tested negative for covid-19 after a real scare," Beshear said in a video that took the place of a scheduled daily press conference after he and his wife "started feeling bad" late in the morning, "with a lot of the symptoms that can suggest covid-19."

He said they immediately isolated themselves and canceled afternoon events, then got tested. "Even the short wait that I had to endure gives me newfound empathy for those that are having to wait even just a couple of days to get their tests returns back, knowing that they may be separated from their family and wondering what their immediate future is going to be."

Delays in testing have plagued some states, but Beshear has said that isn't a big problem in Kentucky. He said he would "continue to try to lead with that empathy, and hopefully it makes me a better governor in addressing this virus."

He added later, "While my family ended up negative today, I know there's a lot of families out there that are positive. We send you our love; we want you to get better; we want to make sure that we're not spreading this to any other family that has to endure any of that hardship."

Beshear said the share of Kentuckians testing positive for the virus in the last seven days rose to 5.87 percent, from 5.71% Monday. "That is a number that is simply too high for a lot of things we want to do," he said. "I'm committed to getting our kids back in school in a safe manner, and we're gonna work towards that."

Monday, Beshear recommended that schools delay in-person instruction until Sept. 28, citing recent increases in the positive-test rate and daily cases. Several school districts have since decided to begin classes online.

Beshear said Tuesday, "We're gonna make sure we wear our masks, and we're gonna make sure that we follow social distancing, and we are gonna work really hard in the weeks now that we have to get there to make sure that we can reduce this positivity rate, reduce our number of cases, to protect our kids and our teachers."

He said Monday that the case numbers for that day, Tuesday and Wednesday would have to be revised because a computer problem is leaving them incomplete. The 562 cases reported Tuesday were near the seven-day rolling averages of the past week.

The governor said 18 of the new cases reported were in children under 5, one of them only 18 days old, in Hardin County. The list also included a 1-month-old from Rowan County and a 3-month-old from Lincoln County.

Counties with more than five new cases on the incomplete list were Jefferson, 104; Fayette, 34; Madison, 30; Warren, 29; Hardin, 26; Laurel, 20; Johnson and Kenton, 16 each; Scott, 12; Barren and Lincoln, 11 each; Campbell and Pulaski, 10 each; Calloway and Christian, 9 each; Boone, Bullitt, Franklin, Henry and Knox, 8 each; Henderson and Hopkins, 7 each; and Bell, Jessamine, Logan and Perry, 6.

Beshear reported eight more covid-19 deaths, noting that one was a 54-year-old woman from Louisville. The others were two women, 65 and 84, and two men, 75 and 93, from Jefferson County; an 86-year-old man from Grant County; a 79-year-old woman from Hopkins County; and a 60-year-old man from Ohio County. They raised the state's death toll from the disease to 783.

In other covid-19 news Tuesday:

• "An exhausted, exasperated nation is suffering from the effects of a pandemic that has upended society on a scale and duration without parallel in living memory," report Joel Achenbach, Brady Dennis and Jeremy Duda of The Washington Post. "The metaphor of a marathon doesn’t capture the wearisome, confounding, terrifying and yet somehow dull and drab nature of this ordeal for many Americans, who have watched leaders fumble the pandemic response from the start. Marathons have a defined conclusion, but 2020 feels like an endless slog — uphill, in mud."
• They add, "Recent opinion polls hint at the deepening despair. A Gallup survey in mid-July showed 73 percent of adults viewed the pandemic as growing worse — the highest level of pessimism recorded since Gallup began tracking that assessment in early April. Another Gallup Poll, published Aug. 4, found only 13 percent of adults are satisfied with the way things are going overall in the country, the lowest in nine years. A July Kaiser Family Foundation poll echoed that, finding that a majority of adults think the worst is yet to come; 53% said the crisis has harmed their mental health."
• A study in the journal Science may explain why some individuals exposed to the virus have modest reactions, Michael Wilner reports for the Lexington Herald-Leader. "The study found that the immune systems of roughly half of its subjects appeared to remember past exposure to other, prevalent coronaviruses, including variants of the common cold, equipping them to respond more quickly to a covid-19 infection once it appeared. The findings also offer new insights that could help in developing a vaccine by looking at T cells, which help fight the virus."
• "Health-care workers of color were more likely to care for patients with suspected or confirmed covid-19, more likely to report using inadequate or reused protective gear, and nearly twice as likely as white colleagues to test positive for the coronavirus, a new study from Harvard Medical School researchers found, Kaiser Health News reports. The study also showed that health-care workers are at least three times more likely than the general public to test positive for the virus, "with risks rising for workers treating covid patients."
• "Senate Majority Leader Mitch McConnell has said he supports President Donald Trump’s recent executive orders targeting coronavirus relief. Sen. Rand Paul, though, has some reservations," Lucas Aulbach reports for the Courier Journal. Beshear says Trump's executive orders aren't adequate, and Congress needs to pass another aid package.
• A Washington Post story by Tony Romm says some of McConnell's constituents are growing unhappy with the lack of a new federal relief bill, which "In more than two dozen interviews, out-of-work residents, struggling restaurant owners and other business leaders, as well as a cadre of annoyed food-, housing- and labor-rights groups, all said they are in dire need of more support from Congress — the likes of which McConnell has not been able to provide." Jason Bailey, executive director of the left-leaning Kentucky Center for Economic Policy, told Romm: “I can’t imagine a state that needs additional relief more than Kentucky does.”
• Republican U.S. Rep. Thomas Massie of Kentucky's Fourth District "said he has tested positive for coronavirus antibodies," the Louisville Courier Journal reports. Massie said Friday on the Glenn Beck show that he thinks he had the virus in January, before it was known to be spreading in the U.S., would donate blood plasma for treatment of covid-19 patients.
• Facebook "says it has taken down 7 million posts for spreading coronavirus misinformation," The Washington Post reports. "The company also labeled 98 million posts with warning notices about coronavirus misinformation between April and June."