State reports 790 new coronavirus cases, lower positive-test rate

Kentucky Health News graph, based on initial daily reports, which are adjusted slightly downward

By Al Cross
Kentucky Health News

After four days with more than 800 new coronavirus cases each day, Kentucky finally dipped below that figure, but not by much. Saturday's case count was 790.

That brought the seven-day rolling average down by five, to 710. Gov. Andy Beshear said 98 of the infections are in Kentuckians 18 and younger.

“It is critical that Kentuckians take the steps necessary to slow the spread of covid-19,” Beshear said in a press release. “We need everyone to keep gatherings to less than 10 people, wash your hands frequently, social distance and wear a mask.” 

Beshear did not attend the Kentucky Derby, where attendance was largely limited to people with connections to horses on the day's race card. “This Derby Day is very different for many reasons,” he said. “Kentuckians are battling inequities, injustice and a global health pandemic brought on by covid-19. For those who make your voice heard today, we are continuing to listen. For Kentuckians gathering today or over the holiday weekend, I ask you to please do so safely.”

The state's daily report said the share of Kentuckians testing positive for the virus dropped almost half a percentage point, to 4.22 percent.

The state Department for Public Health reported six more deaths from covid-19, raising its official death toll to 993. "Reporting from local health departments indicates the state already passed 1,000 deaths, reaching a total of at least 1,051 by Thursday," the Lexington Herald-Leader reported.

Beshear said, “Please light your homes and places of business up green tonight to show compassion for these Kentuckians and their families.”

The fatalities were 77-year-old man from Bell County; a 67-year-old man from Madison County; a 68-year-old woman from Marion County; a 72-year-old man from Nelson County; an 80-year-old man from Scott County; and a 59-year-old man from Todd County.

Counties with more than 10 new cases were Jefferson, 198; Warren, 99; Fayette, 73; Madison, 33; Daviess, 16; Kenton, 15; Laurel, 14; Hardin, 13; Boone, Lewis, Nelson, Oldham and Union, 12 each; Greenup and McCracken, 11 each; and Boyd and Henderson, 10 each.

The state reported 24 more coronavirus cases each among students and employees in K-12 schools, making for 324 active cases in students and 133 in employees. At colleges and universities, the official state list, which lags several days behind local reports, had were 52 more in students and nine in staff, making for active-case totals of 749 and 36, respectively.

In other covid-19 news Saturday:

• As Kentucky nears its 1,000th official covid-19 death, Bill Estep and Jack Brammer of the Lexington Herald-Leader report on the pain suffered by families of victims.
  
• The Nelson County Jail has had an outbreak of covid-19 cases. As of Aug. 29, last Saturday, 35 of the 119 inmates and 10 deputies had tested positive; most have been asymptomatic, Jailer Buck Snellen told the county Fiscal Court, reports The Kentucky Standard.
• Bardstown Independent Schools will begin in-person classes Tuesday, while offering the option of online learning. Supt. Ryan Clark cited "an encouraging decline" in coronavirus cases, The Kentucky Standard reports. Nelson County Schools still plan to start in-person classes Sept. 28.
• The Beechmont Neighborhood Association in Louisville is using a a $31,000 Community Challenge grant from AARP to create a more pedestrian-friendly main street, public-space seating and street lighting" to adapt to the pandemic, Nadia Ramlagan of Public News Service reports in KyForward. "In Lexington, residents and urban planners are also working to tailor the city’s open spaces for a pandemic future, and held a public webinar last week to discuss plans for local parks, trails and other public areas. . . . According to recommendations from the Centers for Disease Control and Prevention, outdoor spaces that allow people to remain six feet apart combined with mask-wearing is the most effective way to curb spread of the coronavirus."

'Prostate cancer is to men as breast cancer is to women,' survivor writes for National Prostate Cancer Awareness Month

By Steve Ranson

Prostate cancer is to men as breast cancer is to women.

The second-leading cause of cancer deaths in men comes from a small gland located between the bladder and the penis. If not monitored or treated, prostate can be a killer. Likewise, the No. 2 cause of cancer deaths in women is breast cancer. So what’s the difference? Over the years, more awareness has been directed at breast cancer screening than with the prostate gland. Therefore, with September being Prostate Awareness Month, let’s put the spotlight on this type of cancer.

I’m one of those statistical males where prostate cancer will affect one out of nine men in their 60s. I began screening about every 18 months to two years when I was in my 50s, and then about every year to 18 months after I entered my 60s.

An abnormal PSA or prostate-specific antigen found in the blood alerts physicians that prostate cancer may exist. During the past six years, my PSA slowly climbed from a 3.18 in 2014 to 6.36 in 2017. In 2019, the PSA more than doubled to 16.57, causing my general practitioner to refer me to an urologist. Other warning signs began to develop during the first seven months. I had frequent urges to urinate, but the stream was weak. Occasionally, blood would appear in my urine. Sometimes, I would stand over the toilet, straining to empty the bladder.

My urologist Dr. Brian Montgomery saw me in late August 2019 and quickly re-ordered another PSA. It returned with a score shy of 17.

“The higher the PSA, the more likely prostate cancer,” he said, reviewing the latest result with me.

A month later, Dr. Montgomery completed a core biopsy of the prostate by taking samples from 12 areas. When he presented the results to me two weeks later, I had the presence of cancer in two quadrants, the left base and left lateral apex. Dr. Montgomery’s attention focused on the left later apex, which measured the adenocarcinoma — cancer forming in mucus-secreting glands —up to 16 mm in its greatest dimension and occupying 95% of the surface area.

Furthermore, Dr. Montgomery said the pathologist issued a Gleason grading score of 8, which means I have a high-grade legion than can spread more quickly than scores half that.

The left base showed adenocarcinoma took up only 5%, but the Gleason score came in at 6. Based on my PSA, however, Dr. Montgomery said he expected to see the adenocarcinoma in more than two quadrants.

“It’s all statistics with many different results,” he said.

One test remained before Dr. Montgomery offered his final decision on treatment. A bone scan using criteria based on National Comprehensive Cancer Network guidelines determined if the cancer had spread beyond the prostate to another organ or the bones.

“If you’re metastatic, that basically means high risk,” he pointed out, “but your imagining shows it has not spread.”

Dr. Montgomery said I was very fortunate not to have the cancer in more than two quadrants. Statistically, he said the prognosis shows I have a good chance to beat this disease and there’s an 80% chance I will not have a reoccurrence of prostate cancer.

The treatment: Based on all the tests and the Gleason scores, I was deemed a good patient for receiving radiation treatments instead of having a radical prostatectomy where the prostate and surrounding tissues are removed.

The next step: Dr. Montgomery implanted three radioactive seeds into my prostate that would accurately guide radiation beams to not only the affected quadrants but also the entire prostate.

Dr. Gary E. Campbell, a radiation oncologist with more than 37 years experiences, oversaw the next step with me receiving 43 radiation treatments over three months. The last session on June 1 ended the numerous 128-mile round-trip journeys from my hometown to the center. Willing to answer any questions thrown at him, Dr. Campbell works with his team to develop a tailored plan for each patient.

“We want to take away the fear. It’s scary. Anybody would be scared,” Dr. Campbell said of patients facing radiation treatment.

As the treatments progress, patients begin to feel more relaxed and confident. Seeing and talking to the staff on each arrival seemed like the beginning of the popular television sitcom Cheers … where everyone know your name.

The 43 radiation treatments I received give a higher percentage of killing most cancer cells. Dr. Campbell said statistically, out of hundreds and hundreds of patients, he can tell how they will do with their treatment plans. Chemotherapy, however, is used for advanced prostate cancer and administered on the center’s main floor.

Dr. Campbell also said radiation will work on both the prostate and the tissues associated with the prostatectomy, and since The Carson Tahoe Cancer Center is an affiliate of Huntsman Cancer Institute at the University of Utah, he can access their physicians and findings to assist him developing a treatment plan on answering questions.

Based on his 30-plus years as an oncologist, he said the technology has improved, and the treatments are better tolerated by the patients and more successful because of the center’s multi-million dollar treatment machines.

“It’s kind of like the latest and greatest, and it’s very precise. We are able to push the radiation doses which is important,” he said.

With each 20- to 25-minute treatment, Dr. Campbell said his technicians shoot external radiation beams to the area that’s being treated.

Radiology technician Ellen Plewacki said every patient is treated according to information downloaded from a chart to a computer. For every session, the prostate cancer patient like me lies down on a table, and at a computer outside the treatment room, a technician guides the rays at different angles — nine to be exact — at both the affected quadrants and entire prostate.

“Most of the patients have the same setup and procedure,” she said. “It takes about 2 to 3 minutes to identify the internal anatomy needing treatment.”

Based on dose escalation studies, Dr. Campbell said a higher dose provides the best opportunity to eradicate the cancer.

With the end of radiation treatments almost three months ago, I have encountered side effects from swelling in the legs and ankles, urination and bowel-movement problems, restless nights and some tiredness — they should go away. In order to keep the prostate small and to fight any cancerous cells that may be lingering, I receive a Lupron shot every three months. My main complaint with the shot is how it causes hot and cold flashes and mood swings.

Both doctors, however, have repeatedly said the best indicator of how treatments worked is with another PSA … and with a score of 2 or below.

“I would anticipate your PSA will be extremely low,” Dr. Campbell predicted after I finished the treatments.

My first three-month checkup with Dr. Montgomery occurred in late August, and I had the opportunity to see my first PSA result. Bingo! The result came back as a negative .02, meaning there is no traceable sign of cancer left in the prostate.

“Just what I hoped for,” Dr. Montgomery said.

Steve Ranson is editor emeritus of the Lahontan Valley News in Fallon, Nev. He is a former president of the Nevada Press Association and the International Society of Weekly Newspaper Editors.

Study finds using electronic cigarettes can lead to 'substantially increased risk' for teens and young adults of developing covid-19

Getty Images

By Melissa Patrick

Kentucky Health News

Electronic cigarettes are linked to a "substantially increased risk" of covid-19 among teens and young adults, a new study says. 

“This study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and it’s not just a small increase in risk; it’s a big one,” the lead researcher, Dr. Shivani Mathur Gaiha, a postdoctoral researcher at Stanford University, said in a news release.

The study, published in the Journal of Adolescent Health, found that people from 13 to 24 who use e-cigarettes have a “substantially increased” risk of becoming infected with the coronavirus and exhibiting symptoms of covid-19, such as coughing, fever, tiredness, and difficulty breathing.

The researchers found that among young people who were tested for the coronavirus, those who used e-cigarettes were five to seven times more likely to be infected than those who did not. 

In Kentucky, 26.1 percent of high-school students use e-cigarettes frequently (on 20 or more of the 30 days before the survey) and 8.7% use e-cigs daily, according to the 2019 Youth Risk Behavior Survey. 

The findings prompted two Illinois Democrats, Senate Minority Whip Dick Durbin and Rep. Raja Krishnamoorthi, chair of the U.S. House Oversight and Reform Committee’s consumer subcommittee, to urge the Centers for Disease Control and Prevention to encourage college campuses to go tobacco-free, and that all such policies should include e-cigarettes, Beth Wang reports for Inside Health Policy. 

 

“College-age tobacco users are at heightened risk of contracting the virus, and they will spread it,” the legislators wrote. “Young people are increasingly driving the spread of covid-19, and that will only increase with reopened college campuses if appropriate public health precautions are not strictly implemented.”

The latest Kentucky report shows 710 college and university students and 27 staff have active cases of the virus and that 1,417 students and 60 staff have ever testing positive for it. Those numbers are almost certainly under-reported.

The legislators noted that most college students are already unable to legally purchase tobacco products, since Congress raised the tobacco-purchasing age from 18 to 21 in December, Wang reports. 

In a letter to state Health Commissioner Steven Stack, the Coalition for a Smoke-Free Tomorrow walks through the known risks from covid-19 associated with smoking. 

The letter says the CDC has identified smokers as a group of people at higher risk for severe illness from covid-19 if they contract the disease, and the World Health Organization has found that "smokers are more likely to develop severe disease with covid-10, compared to non-smokers." 

The letter expands on how smoking harms the lungs, how tobacco weakens the immune system, how smoking is the major cause of a list of underlying health conditions, like heart disease and diabetes, and that a growing body of evidence shows that vaping can harm lung health. 

"While it is not yet clear if smoking can increase the likelihood of contracting the disease, evidence confirms that smokers are more susceptible to severe symptoms if they do contract covid-19," says the letter, signed by Ben Chandler, the coalition's chair and CEO of the Foundation for a Healthy Kentucky.

Kentucky adults who want to quit smoking can call the state's free quit-tobacco line, 1-800-QUIT-NOW (784-8669).

Teens who want to quit vaping can use a program called "My Life, My Quit," a free service for minors. The program includes live support by phone, text or online chat. 

Participants can join by texting START MY QUIT to 855-891-9989 or going to MyLifeMyQuit.com. Teens are eligible for up to five calls with an experienced and trained Quit Coach. The program does not provide nicotine replacement therapy. 

Here are other resources for teens looking to quit: 

• Truth Initiative text message program: Text DITCHJUUL to 88709 or visit https://truthinitiative.org/research-resources/quitting-smoking-vaping/quitting-e-cigarettes 
• Not On Tobacco (NOT), a 10-week, voluntary program for small groups of teens aged 14-19: https://www.lung.org/quit-smoking/helping-teens-quit/not-on-tobacco 
• Become a Smoke-Free Teen: Quit Vaping explains tools to help you quit and how to use them, from the U.S. Department of Health and Human Services: https://teen.smokefree.gov/

Coronavirus cases top 800 for 4th straight day; as another surge threatens, Beshear urges people to follow the rules and be careful

Department for Public Health map, labeled by KHN; for a larger version, click on it. Get update here.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear announced 809 new cases of the novel coronavirus Friday, the first time Kentucky has seen four days in a row with more than 800 new cases each day. And his announcement of 11 more deaths made this week's death count the highest yet, 66 since Sunday. 

Beshear again implored Kentuckians to keep their social gatherings small and follow public-health guidelines as the state heads into the Labor Day weekend and the running of the 146th Kentucky Derby -- without fans at Churchill Downs, but perhaps at many Derby parties. 

Kentucky has been on an elevated, rough plateau of cases for several weeks, and it got there following a surge after the last big holiday, July 4.

“I know this is a big weekend: Derby weekend, even though it’s September, and Labor Day weekend,” Beshear said in a news release. “Traditionally, we’d get together with a lot of people over this weekend. This year, I need you to do it a little differently. Just this one time, probably in your entire life, please keep your gatherings small, 10 people or fewer.”

Today's new cases created new records. The state's unadjusted seven-day total of daily new cases is 5,006, the first seven-day period above 5,000 cases. The seven-day rolling average is 715. 

The good news continues to be that the share of Kentuckians testing positive in the last seven days continues to be under 5 percent, a key threshold for suppressing the virus. Today's positive test rate is 4.70%. It has remained under 5% for 10 days. 

Of today's new cases, Beshear reported that 98 are age 18 and younger, and of those, eight were 5 and under. The youngest was a 2-month-old baby from Jefferson County.

“We’re trying to keep our businesses open and get our economy to bounce back,” said Beshear. “We’re going to get our kids back in school later this month. We’re trying to get high school sports up and going and keep them going. So we really need you to help us on all the other things like wearing a mask, washing your hands frequently and social distancing.”

Friday's deaths were a 61-year-old man from Barren County; an 88-year-old woman from Carroll County; an 82-year-old man from Clinton County; an 82-year-old woman from Hardin County; two men, 72 and 77, from Jefferson County; a 77-year-old woman from Kenton County; a 67-year-old woman from Marion County; a 75-year-old man from Owsley County; a 79-year-old woman from Rockcastle County; and a 64-year-old woman from Warren County.

“I know how much we all want to see our families and friends for this holiday, but for one year, we need to prioritize making sure every person we care about is around to celebrate with us next year,” said Beshear. “We have already lost so many Kentuckians, and I don’t want that loss to be even greater. It will be if we have a spike in cases.”

Beshear extended several health-related executive orders, including his mask mandate and an order that allows pharmacists to dispense 30-day refills. 

Counties with more than 10 new cases Friday were Jefferson, 249; Fayette, 56; Pulaski, 36; Daviess, 26; Madison, 23; Warren, 22; Union, 21; Henderson, 20; Laurel, 16; Boone, 15; Greenup, 14; Kenton, 14; Grayson, 13; Bullitt, 12; Nelson, 12; Hardin, 11; and Shelby, 11.

Hospitalizations for covid-19 in Kentucky remained stable, at 574, with 132 of them in intensive care. Each figure was up six from Thursday.

In long-term-care facilities, 51 more residents and four more employees were found to be infected. At least 310 facilities statewide have had at least one case, and there active cases among 585 residents and 352 employees.

In K-12 schools, the daily report showed 27 new cases among students, raising the active-case total to 300. Seven more employees were added to the case list, making 109 active cases. The total cases reported so far are 459 students and 128 employees.

Kentucky Kernel graph, labeled by Ky. Health News; click it to enlarge

At Kentucky colleges and universities, the state added 51 more students and four more employees to its list, making active-case totals of 710 and 27, respectively. The report was incomplete, or not up to date, or both; for example, no new cases were reported at the University of Kentucky, but the Lexington-Fayette County Health Department, which reports on a different schedule, reported 111 new cases, 50 of them at UK. The state report said UK has 390 active cases, but UK's own site, which had date through Tuesday, Sept. 1, said it had 459 active cases.

UK has started testing dormitories' wastewater to detect infection by the virus. "Increasing levels in wastewater could be an early indicator of an outbreak or increased prevalence," UK President Eli Capilouto said in a campus-wide email.

In other covid-19 news Friday:

• The Christian County Board of Education voted 4-1 to approve Supt. Chris Brentzel's recommendation that in-person classes begin Tuesday, while allowing students to opt out, Hoptown Chronicle reports: "Elementary school students will be on a traditional schedule and attend in-person classes five days a week. Middle- and high-schoolers will be on a hybrid schedule. They will be in class two days and have virtual learning the remainder of the week."
• "The pandemic has heightened stress and upset routines" so much that "physicians and researchers are seeing signs it is doing deep damage to people’s sleep," The Washington Post reports. “Coronasomnia,” as some experts call it, could "have profound public-health ramifications — creating a massive new population of chronic insomniacs grappling with declines in productivity, shorter fuses and increased risks of hypertension, depression and other health problems."
• The Louisville Courier Journal reports on what happens to public health when a city has "uncontrolled spread" of the coronavirus. Dr. Sarah Moyer, the city's chief health officer, told Grace Schneider that like a wildfire, extinguishing the spread is nearly impossible "after we have the wildfire going." Louisville Metro's public health officials encourage people who have tested positive for the virus to go ahead and do their own contact tracing by alerting those they were within six feet of for at least 15 minutes in the days before they began to feel symptoms. 
• The Courier Journal's Deborah Yetter tells the story of covid-19 from the perspective of people who have recovered: the administrator of a nursing home that had a big covid-19 outbreak in May that resulted in the loss of 16 residents and one staff member to the disease; a nurse who works on a covid-19 ward; and a physician. Dr. Briones-Prior of U of L Health told Yetter that she is seeing whole families affected by the disease, instead of just the frail and elderly: "It gets into the household, and the whole household gets it."
• University of Louisville Physicians offer tips on how to increase your activity during the pandemic, saying that adding an extra 2,000 steps a day and reducing calories by 100 a day will help you achieve an energy balance that can stop weight gain. 

Hospitals invest in interventions and public education to fight heart disease, which is the number-one killer of Kentuckians

https://www.lanereport.com/130324/2020/09/hospital-tech-takes-on-kentuckys-top-killer/?utm_source=Faster%20Lane%20Newsletter&utm_medium=Email&utm_campaign=

906 new coronavirus cases make for state's third highest day, pushing total above 50,000; 10 more deaths bring toll to 976

Kentucky Health News chart, based on initial daily reports, which are adjusted slightly downward

By Mary Meehan
Kentucky Health News

As Kentucky saw more than 900 new coronavirus cases Thursday and double-digit death tolls for the fourth straight day, state officials cautioned that a vaccine is unlikely until 2021 and said advances in testing are less dramatic than they may appear.

Gov. Andy Beshear announced 906 new cases and 10 additional deaths during his daily briefing, bringing the death toll since Monday to 46.

The new-case number was the third highest of the pandemic. “Nine hundred and six cases used to be unfathomable here in Kentucky,” Beshear said. The seven-day rolling average jumped to 713, the highest yet.

In one bit of good news, the share of Kentuckians testing positive in the last seven days dropped to 4.53%, from 4.7% Wednesday.

Thursday saw the state pass a grim milestone, passing 50,000 cases; there have been 50,885. That means about 2.5% of the state's population has been identified as infected. The death toll is approaching 1,000; it stands at 976.

The high numbers come as the Centers for Disease Control and Prevention is asking states to be ready to distribute vaccine as early as Nov. 1. Beshear said there will be no vaccine until 2021.

“We’re going to make sure that we do the work to distribute the vaccine as soon as it is safe,” he said, but “We still don't see any path for there to be a vaccine that's gone through steps that it needs to before the beginning of the year.”

Health Commissioner Steven Stack echoed the message.

“I'll say it again, there will not be a vaccine for virtually everybody this calendar year,” said Stack, a physician. “I know that there's a press to make these timelines suggest we're going to have vaccine going out the door to people in October and November.” The presidential election is Nov. 3.

“There are some corners that cannot be cut,” Stack said. “You have to ensure that you are not going to take a healthy person and hurt them.”

Stack also cautioned that while progress is being made, there are few affordable rapid-response tests that are accurate and easy to process.

The Food and Drug Administration last week approved a 15-minute test from Abbott Laboratories in the form of a chip card that will sell for $5. The FDA also recently approved a saliva test from Yale University.

“Both tests have limitations, and neither can be done at home,” The Washington Post reported. “Abbott’s new test still requires a nasal swab by a health worker, like most older coronavirus tests. The Yale saliva test eliminates the need for a swab but can only be run at high-grade laboratories.”

Stack said that with the saliva test, getting enough spit in the tube is a challenge. Also, the tube has to be shipped to a lab, and because saliva is sticky, each test must be processed manually or machines will malfunction. “They still have to run it in a high-complexity lab,” he said. “So, it's not a $5 or $15 test; someone in the laboratory with expensive machines still has to run the test.”

Stack said he understands why people are eager for rapid, widely available testing, but accurate, affordable testing, just like vaccines, will take time. “None of this is intended to discourage us from finding innovative ways to try to manage the disease and get us back to work faster and keep people safe,” he said.

As they have all week, Stack and Beshear said the record-setting levels of new cases mean that this Labor Day weekend is no time to abandon the steps that curb the spread of disease. Beshear stressed the need to keep gatherings under 10 people and practice social distancing especially with the rescheduled running of the Kentucky Derby on Saturday and The Kentucky Oaks on Friday. 

 “Do everything a little different this year,” he said. “Do it safely.”

In other covid-19 news Thursday:

• Counties with more than 10 new cases were: Jefferson, 192; Warren, 89; Fayette, 68; Madison, 66;  Daviess, 25; Green, 21; Henderson and Kenton, 20 each; Pulaski, 19; Union, 18; Franklin, 17; Hardin, 16; Jackson and Logan, 15 each; McCracken and Oldham, 12 each; Bell, Calloway, Campbell and Scott, 11 each; and Barren, 10.
• The 10 fatalities were a 52-year-old man from Barren County; five women, 60, 72, 72, 79 and 85, and two men, 70 and 73, from Jefferson County; and an 88-year-old woman and 76-year-old man from Lewis County.
• Of the 906 newly infected Kentuckians, 124 were under 18. There were 67 new cases of students and 22 new staff in K-12 schools. There are 273 active student cases and 102 active staff cases in K-12. 
• Colleges and universities added 69 students and two staff members, resulting in 675 active student cases and 23 active employee cases. Beshear urged people to check the state’s covid-19 website for updates at schools or universities in their communities. He also said the state is working to improve how quickly individual cases are reported. 
• Covid-19 hospitalizations in Kentucky totaled 568, with 132 of them in intensive care.
• Long-term-care facilities had 28 new resident and 26 new staff cases, and five more deaths. There are 582 active cases among long-term residents and 379 active cases in staff.
• WKYT reports that Thursday morning, Fayette County School Supt. Manny Caulk and other school officials participated in the Lexington Forum to address concerns over virtual learning. Caulk said the situation was less than ideal. “We have to do something that is less than ideal in order to maintain the safety, the health, safety, and welfare of our children,” he said. “We have to pivot based on the scientific data and evidence that’s before us, based on what’s the community spread right here in Fayette County.” He concluded with this: “I would say this, I would rather have a loss of learning than the loss of life.”
• The Lexington Herald-Leader reports that as one Northern Kentucky school district decided against fall sports, others around the state are developing limits on fan attendance with games set to begin Monday. Erlanger/Elsmere Supt. Chad Molley announced in a letter dated Tuesday that his district would not participate in high-contact fall sports until it could do so safely. That district’s high school is Lloyd Memorial.
• Herald-Leader reporters Valarie Honeycutt Spears and Jared Peck explain that in Fayette County, information on who can come to games next week has trickled out to some of its athletic teams, but the district’s full policies have not been released. Communications to soccer parents at Bryan Station, Paul Laurence Dunbar and Tates Creek high schools indicate Fayette County will limit players to four or five family members each, and attendees must be submitted for an entry list this week and remain the same throughout the season. The communications indicate those fans will be the only ones allowed at games.
• Other districts, including Scott County, are also placing limits on football attendance. The Kentucky High School Athletic Association’s draft guidance for covid-19 issues did not mandate limits. Beshear said plans for football had been approved for University of Louisville and several other Kentucky universities. He said capacity, across the board, will be limited to about 20 percent of a stadium’s capacity and family groups would have distance from one another.

Stigma, a big obstacle to fighting drug abuse, is often reinforced by health-care providers, and in the pandemic is more problematic

By Nora D. Volkow
Director, National Institute on Drug Abuse
Republished from Scientific American magazine

Untreated drug and alcohol use contributes to tens of thousands of deaths every year and affects the lives of many more people. We have effective treatments, including medications for opioid and alcohol use disorders, that could prevent a significant number of these deaths, but they are not being utilized widely enough, and people who could benefit often do not even seek them out. One important reason is the stigma around those with addiction.

Nora D. Volkow, M.D.

Stigma is a problem for people with health conditions ranging from cancer and HIV to a variety of mental illnesses, but it is especially powerful in the context of substance use disorders. Even though medicine long ago reached the consensus that addiction is a complex brain disorder, those with addiction continue to be blamed for their condition. The public, as well as many people working in health care and in the justice system, continues to view addiction as a result of moral weakness and flawed character.

Stigma on the part of health care providers who see patients' drug or alcohol problems as their own fault can lead to substandard care or even to the rejection of individuals seeking treatment. Staff in emergency departments, for instance, may be dismissive of addicted people because they do not view treating drug problems as part of their job. As a result, those showing signs of acute intoxication or withdrawal symptoms are sometimes expelled from the ER by staff who are fearful of their behavior or who assume they are only seeking drugs. People with addiction can internalize this stigma, feeling shame and refusing to seek treatment.

During a visit to Puerto Rico several years ago, I visited a “shooting gallery”—a makeshift injection site—in San Juan, where I met a man who was injecting heroin into his leg. It was severely infected, and I urged him to visit an ER, but he had been treated horribly on previous occasions and preferred risking his life, or probable amputation, to the prospect of repeating his humiliation.

Beyond just impeding the provision or seeking of care, stigma may actually drive addicted people to continue using drugs. Research by Marco Venniro of the National Institute on Drug Abuse has shown that drug-dependent rodents choose social interaction over the drug when given the choice, but when the social choice is punished, the animals revert to drug use. Humans, too, are social beings, and some of us respond to both social and physical punishments by turning to substances to alleviate our pain. The humiliating rejection experienced by those who are stigmatized for their drug use acts as a powerful social punishment, driving them to continue and perhaps intensify their drug taking.

The stigmatization of people with substance use disorders may be even more problematic in the current covid-19 crisis. In addition to the greater risk associated with homelessness and with drug use itself, the legitimate fear around contagion may mean that bystanders or even first responders will be reluctant to administer lifesaving naloxone to people who have overdosed. And there is a danger that overtaxed hospitals will pass over those with obvious drug problems when making difficult decisions about where to direct limited personnel and resources.

Alleviating stigma is not easy, in part because the rejection of people with addiction or mental illness arises from unease over their violations of social norms. Even health care workers may be at a loss as to how to interact with someone acting threateningly because of withdrawal or because of the effects of certain drugs (for example, PCP) if they have not received training in caring for people with substance use disorders. It is crucial that health care personnel, from staff in emergency departments to physicians, nurses and physician assistants, be trained in caring competently for people with substance use disorders. Treating patients with dignity and compassion is the first step.

There must be wider recognition that susceptibility to the brain changes in addiction is substantially influenced by factors outside an individual's control, such as genetics and the environment in which one is born and raised, and that medical care is often necessary to facilitate recovery as well as to avert the worst outcomes, such as overdose. When people with addiction are stigmatized and rejected, especially by those in health care, it only contributes to the vicious cycle that makes their disease so entrenched.

Over 800 new cases for second day, 18 deaths; Beshear says Ky. is in a 'dangerous place' as another holiday weekend approaches

Kentucky Health News chart based on initial daily reports, which are adjusted slightly downward

By Al Cross
Kentucky Health News

For the second day in a row, Kentucky reported more than 800 new cases of the novel coronavirus, and its seven-day average of new cases set a record. The state reported 18 deaths from covid-19, a near record. And the share of Kentuckians testing positive for the virus also went in the wrong direction.

“Tough report all the way around,” Gov. Andy Beshear said as he began giving the numbers, starting with 816 new cases, following 807 on Tuesday. "Not many days that we've had more than 800 back to back." Actually, it's the first time.

Beshear said he thought only two other days have had death tolls larger than 18. “Sadly, I think we’re gonna have a lot more days like today,” he said, because nearly 2 percent of Kentuckians who have tested positive for the virus have died of its disease. The last three days have seen 36 deaths.

Kentucky Health News chart

The share of Kentuckians testing positive in the last seven days rose to 4.71%, up from 4.4% Tuesday.

“We’re in a dangerous place, no question,” Beshear said, noting that the state is nearing a weekend that will include a rescheduled Kentucky Derby and Labor Day. Cases surged after the Memorial Day and July 4 holidays.

The Derby will have no fans, due to the pandemic, but Derby parties are a tradition in much of the state, and officials are warning about them.

“This weekend I need you to keep your gatherings small,” said the governor, noting his emergency order limiting noncommercial gatherings to 10 people. “Let’s not look back and say that something as special as what this weekend can be turned into the time when this virus got out of control.”

Beshear has also ordered that facial coverings be worn in indoor public spaces, and outdoors when people can't stay six feet apart. “It’s gonna be more important than ever that we wear them,” he said of masks. “We’re about to do a lot more, especially as we come near the end of September,” when he has recommended that schools resume in-person classes.

“If we want to protect business, if we want to get our kids back in school, if we want to save lives, the number-one thing we need to do is wear a mask, and the number-two thing we need to do is stay six feet apart,” he said. “So if you love Kentucky, you love all three of those things, you love America, wear a mask.”

Earlier, referring to the politicization of the topic, he said, “It baffles me about how this has become any type of argument . . . I’ve got a document from the White House telling me that we need a mask mandate . . . and it’s working.”

The governor urged Kentuckians to trust public-health professionals: “Let’s remember that these people have dedicated their lives to this. They have the knowledge for it, and let’s listen to them.”

He added later, “The goofy conspiracy theories out there, you just can’t listen to. It’s not going away after an election, it’s not related to an election at all . . . This battle’s gonna go on until that vaccine is safe and until it can get out there to everybody… so we need you to have your game faces on, we need to continue to do the right things.”

Asked about the recent order that students wear masks in schools even when they are six feet apart, Beshear said Kentucky has learned from other states, where students congregated outside classrooms, and from schools that have had cases but not as many as might have been expected because students are wearing masks. 

“I think this is a smart move,” he said. “It’s a little more stringent but we’ve got to sacrifice if we want to get our kids back to in-person learning.”

In other covid-19 news Wednesday:

• The day's total of new coronavirus cases raised the state's total to 49,991. The 18 deaths raised its covid-19 toll to 966.
• Beshear said several deaths came from "a single facility" and noted that the 18 fatalities included a 43-year-old man from Oldham County. Others were an 82-year-old man from Ballard County; a 79-year-old woman from Bell County; a 67-year-old man and a 91-year-old woman from Casey County; an 87-year-old woman from Christian County; two women, 65 and 79, from Fayette County; a 97-year-old woman from Lincoln County; a 77-year-old man from Martin County; a 91-year-old woman from Perry County; four women, 62, 78, 78 and 81, and an 83-year-old man from Todd County; and two women, ages 96 and 99, from Warren County.
  
• Counties with more than 10 new cases were Jefferson, 215; Fayette, 59; Warren, 45; Kenton, 35; Nelson, 29; Madison, 22; Scott, 17; Boone, 15; Greenup, 14; Daviess, 13; Jackson, 12; and  Pulaski, 12.
• Beshear said 116 of the 816 new cases were people 18 and under, and said Warren County had 12 of them, all from ages 11 to 18. He has often singled out the county, a coronavirus hotspot that is one of about 30 counties having in-person classes.
• Evictions for most renters will be barred for the rest of the year by an order from the Centers for Disease Control and Prevention, on grounds that eviction might spread the virus by putting more people in cramped quarters or shelters. To qualify, tenants must attest to a substantial loss of income, inability to pay full rent and best efforts to pay partial rent, and stipulate that eviction would be likely to leave them homeless or force them to live with others at close quarters. Forms will be available on the CDC website when the order is published in the Federal Register. Beshear indicated that would be Friday. “We think that’s gonna answer the question in Kentucky” about evictions, which are the subject of a lawsuit. He said he would stuck to his plan of providing federal relief money to landlords.
• The University of Kentucky said in a news release that it had expanded its dashboard that tracks the impact of the virus on the campus, including active cases, new cases, number of students in isolation, and the percentage of students and employees who have completed a required daily screening. It doesn't give the positive-test rate, but the total number of tests (26,426) and positive results (575), which can be used to calculate the positive rate (2.1%). The dashboard says, "Based on active cases and daily attestation numbers, UK's positivity rate remains below 2%."
• "Use of inexpensive, readily available steroid drugs to treat people hospitalized with covid-19 reduced the risk of death by one-third, according to an analysis encompassing seven different clinical trials conducted by the World Health Organization and published Wednesday in the Journal of the American Medical Association," Stat reports.
• The National Institutes of Health says there is not enough data to recommend for or against use of convalescent plasma as treatment for covid-19, despite the Food and Drug Administration's recent, emergency authorization of it.

Dale Toney is new president of Kentucky Medical Association

Dale Toney, M.D.

Dr. Dale Toney, a Lexington internist, is the new president of the Kentucky Medical Association. He was elected last weekend at the organization’s annual meeting, which was held virtually due to the pandemic.

Also elected were President-Elect Neal Moser of Crestview Hills, Vice President Michael Kuduk of Winchester and Secretary-Treasurer Jiapeng Huang of Louisville.

Toney is a board-certified specialist in internal medicine at the University of Kentucky hospital, an associate professor in UK's College of Medicine, and interim chief of the General Internal Medicine and Women’s Health division. He was President of the Lexington Medical Society in 2004 and a member of the Kentucky Board of Medical Licensure from 2016 to 2019.

Toney said his goals for the year included the promotion of the “Be Well. Stay Well.” campaign, which encourages Kentuckians to take simple steps to protect and improve their health. The campaign began in August with the launch of the “Raise Your Guard, KY” initiative, which is a partnership with the Foundation for a Healthy Kentucky and Anthem Blue Cross and Blue Shield.

Contact tracer at UK describes how the process works

University of Kentucky contact tracers work in the Boone Center, the former faculty club, which has been closed. (UK photo by Pete Camparoni)

By Lindsey Piercy
University of Kentucky

It’s 8 a.m., and it’s time for Eryn Clayton to pick up the phone and begin dialing.

There’s a pause as the call connects.

A University of Kentucky student is on the other end. Clayton smiles sympathetically as she introduces herself; she will be the first to inform them they have tested positive for covid-19.

“That call can be really hard for some to receive, and expected for others,” says Clayton, part of Health Corps, UK's main tool for keeping the pandemic from closing the campus again.

Clayton is trying to keep the mood light — not because the call isn’t serious. In fact, it’s just the opposite, and getting a stranger to trust you is a monumental task.

“I have to be ready throughout the day to have open conversations, provide guidance as best I can and ultimately make sure the person on the other end, and their friends and families, are safe,” she says.

As the conversation continues, Clayton works to educate the patient — inform them of what their test result means, and provide them with important resources. She details symptoms, high-risk pre-existing medical conditions, what to do if more severe symptoms develop, and helps to create an isolation plan. (Those who test positive are in isolation; those who come into close contact with a positive case are quarantined to prevent the spread of the virus in case they have contracted it.)

Who gets a call and who doesn’t?

Then comes the contact tracing. Clayton tries find out where they’ve been, and more specifically, who they’ve been around. With each interaction, the web widens.

Clayton picks up the phone again, explaining, “We start reaching out to the UK-affiliated contacts and inform them they came into close contact with someone who tested positive for covid-19.”

All students, faculty and staff at UK are considered a contact when they have high-risk exposure (close contact) with a positive case. The Centers for Disease Control and Prevention defines "close contact" as within six feet for more than 15 minutes, “but there are also various extensions of this, as you can imagine the multitude of circumstances where respiratory droplets could pass from one person to another,” Clayton says. “As a basis though, this is how we determine who is a contact and who is not.”

If the infected person has contacts who are not members of the UK community, Health Corps sends those names to the individual’s local health department, which reaches out to them about testing and isolation.

Those who get a call from any contact tracer are not told the name of the person they came into contact with; that information remains confidential.

“The difficult part is that so much of this is a waiting game — but it’s powerful,” Clayton says. “It’s difficult in the scenario where a contact can feel perfectly healthy but must quarantine for a full 14 days. A negative test result following close contact does not mean someone is free from developing the virus within that 14-day period. But if a person in quarantine does develop the virus due to their close contact, then they won’t be able to spread it.”

Everyone Clayton contacts will receive documentation that they have been asked to isolate or quarantine, and they may use that dated material to make the necessary arrangements. In addition, Health Corps ensures every student has a plan to quarantine or isolate safely — regardless of whether a student lives on or off campus. Through this process, UK is offering students a unique level of support and options that non-university-goers may not have.

What happens after the initial conversation?

Following their conversation with a contact tracer, those who test positive will receive a call from a wellness connector.

If symptoms are mild, the individual will be asked to continue communicating with their local health department. If concerns are noted, the patient receives immediate follow-up depending on needs.

The health department where the individual is isolating will provide the written release from isolation to those who tested positive. That documentation must be sent to Health Corps. Once that document has been received, a team member will respond through email with a final release.

While not required, Clayton says she encourages those who test positive to have conversations with those who might be affected — such as roommates, professors or bosses.

Contact tracers will only notify those who were within close contact to a positive case and are at the highest risk of spreading the virus. “That being said, we are not reporting to faculty that someone will not be in class due to testing positive," Clayton says. "That is the responsibility of the student.”

While each day is never quite the same, one goal remains constant — to keep the UK community as safe as possible.

“I love that as a contact tracer, I get to talk to students one-on-one every day,” Clayton says. “UK is a big school, but every person who tests positive gets a call from someone who wants to help and understand how their feeling. Personal interaction, individual care and education is what ultimately makes a huge impact here.”

Beshear voices worry about increased coronavirus cases in kids; 7-day average of new Ky. cases sets a record; 15 more deaths

New York Times graphic; for a larger, clearer version, click on it.

By Mary Meehan

Kentucky Health News

 

Gov. Andy Beshear expressed concern Tuesday at the rising number of young Kentuckians testing positive for the novel coronavirus, a trend following some recent school openings and a worrying sign for others that are planning to have students in class before the governor’s Sept. 28 recommendation. 

During his daily press briefing, Beshear also urged people to wear masks and take precautions during the upcoming Labor Day weekend, and said he would not present the winner’s trophy at the Kentucky Derby at Churchill Downs this Saturday in order to model responsible behavior. Since other spectators can’t be at the track, he said, he would present the trophy virtually. 

“What we want to see from other people that are out there, small groups of 10 or less for Labor Day,” he said. “Two, we need people to be careful. Remember the Fourth of July? Remember Memorial Day? Those led to more cases. Let's make sure we don't do that right now when people want to do high school sports, and we want to get our kids back in school.” 

Beshear said the trend showing more youth testing positive must change. 

“We think that's two things,” he said. “Younger Kentuckians are getting out more, we're doing more, and then they're getting tested more.” But, to his main point: “The virus is certainly spreading more in and through our kids." 

An American Academy of Pediatrics report shows the share of positive coronavirus cases among children has increased in every state since spring, and nearly doubled from 5 percent in May to over 9% mid-August, The Hill reports. In Kentucky, the report shows that as of Aug. 27, 13.5% of cases were in people under 20. 

Of the 807 new cases of the coronavirus Beshear reported Tuesday, 150 were in Kentuckians under 18, said a release from Beshear's office. He said 50 were 17 or 18.

The daily total of 807 was the sixth highest of the pandemic. More importantly, it raised the seven-day rolling average, a key metric, to 677, a record.

In more bad news, Beshear reported 15 deaths from covid-19, the highest number in a single day since May. That raised the state's toll to 939.

Health Commissioner Steven Stack said the state is having about 150 new daily cases per million people in the state. “We're operating really kind of hot, meaning that there's a lot of disease spread widely throughout the state,” he said. “It's absolutely imperative that you wear your masks, you watch your space and [are] social distancing more than six feet, and that you wash or sanitize your hands often.” 

Stack said there is good news in that the rate of Kentuckians who have tested positive for the virus in the past seven days remains below the danger level of 5%. It was 4.4% Tuesday and has been under 5% for a week.

The daily K-12 report shows 15 new students and 9 new school staff tested positive for the virus and 174 students and 68 employees have active cases. This report has been updated with data for individual schools.

The daily report for colleges and universities shows 410 more students and two more employees testing positive, and 647 students and 19 staff with active cases. Most new cases, 372, are at the University of Kentucky.

The editor of UK's student newspaper, the Kentucky Kernel, put together a detailed "data explainer" regarding coronavirus cases at UK. Natalie Parks writes, "Positive cases among UK's student body are on the rise, but the actual data on the number of cases can be confusing." 

Beshear urged universities to continue to work on contingency plans if there is an outbreak on campus.

“There is a debate right now . . . even in public health, about . . . whether the kids go home or stay, and I just don't think it can be as simple as go or stay, which is what we hear,” he said. “Everything seems to be oversimplified right now.” 

One concern is that students might carry the virus into their home community, putting vulnerable friends and family at risk. 

Asked about a school district requiring parents to sign a waiver of liability for coronavirus infection, Beshear was incredulous: “I don't see how we make a family sign a waiver to go to a public school which is theirs to go to by right, not by privilege. I just, I don't think you can make somebody sign a waiver of liability to attend a public school.” 

He had an equally strong response when asked about a high-risk teacher feeling forced to return to the classroom. “That's just plain awful,” he said. “Let's not put hard-working public servants in harm's way when we know they are at risk. He added later, “We want to get back to in-person learning and classes. We can't be putting people in situations where they might die.” 

Stack stressed that Kentuckians should get tested for the virus. “If you have symptoms, [or a]very high risk exposure, you should get tested. That's still very, very important.” 

The Centers for Disease Control and Prevention last week issued guidance that downplayed the need for testing but quickly walked it back. 

“In my dialogues with the state health officials around the country, I think it's fair to say that there's universal frustration, that the way that the guidance was changed,” he said. 

Stack, a physician, cautioned that our actions have consequences when it comes to the spread of the virus. 

“So, enjoy Labor Day weekend, but wash your hands, watch your distance and wear a mask,” he said. “This is important because after these other holidays, we've seen explosions of this disease so what you choose to do this weekend could have impacts for months to come.”

Beshear echoed those sentiments near the end of his briefing, in which he had noted that he had read an article about a group of legislators a public meeting where few wore masks.

In other covid-19 news Tuesday:

• Tuesday's fatalities were a 78-year-old woman from Calloway County; two women, ages 71 and 85, and two men, ages 87 and 88, from Campbell County; a 73-year-old man from Fayette County; a 55-year-old woman from Grayson County; a 70-year-old man from Harlan County; a 77-year-old woman and an 83-year-old man from Jefferson County; two men, ages 73 and 81, from Lincoln County; a 79-year-old woman from Monroe County; a 67-year-old man from Owen County; and an 80-year-old woman from Pulaski County.
• Beshear said, “We've known that we're going to see these numbers and we're going to continue to see numbers like this, because even with a 1.9% mortality rate, if you have over 4,000 cases a week, we're losing people we care about.” He said people who continue to believe only the elderly should pay attention to the death of a 55-year-old.
• State data shows 552 people are hospitalized in Kentucky with covid-19 and 138 of them are in intensive care.
• In long-term care, six new residents and 13 new staff have tested positive for the virus and 610 residents and 354 staff have active cases of it. Four more resident deaths can be attributed to covid-19, Beshear said. 
• Counties with more than 10 new cases were Jefferson, 155; Fayette, 74; Madison, 65; Warren, 39; Hardin, 22: Laurel, 19; Daviess, Jackson and Oldham, 17 each; Franklin, 15; Scott, 14; McCracken, 13; Boone, Greenup, Pulaski, and Russell, 11 each.
• Deputy Labor Cabinet Secretary Amy Cubbage said the state had extended its contract with the Ernst & Young accounting firm to help with about 70,000 disputed unemployment claims awaiting adjudication. She said the new contract is worth about $4.9 million and will continue until the end of the year. Cubbage said the original contract and extensions are funded through Coronavirus Aid, Relief and Economic Security (CARES) Act and would not affect the state’s normal budget. 
• The Louisville Courier Journal reports that Norton Healthcare will open specialized clinics for adults and children to provide post-covid-19 care and “evaluate patients’ ongoing symptoms and develop treatment plans.”  An estimated 87% of adult survivors, even those who weren't hospitalized, deal with ongoing health problems — chief among them are chronic lung issues, Grace Schneider reports. Another 20% have long-term heart conditions, as well as neurological, vascular and renal medical distress. Less is known about long-term effects on children. 
• World Health Organization Director General Tedros Adhanom Ghebreyesus has urged people to continue taking steps to prevent the vulnerable from contracting the virus, while condemning those who dismiss the loss of life among the elderly. Ghebreyesus said Monday that dismissing the loss of life was “a moral bankruptcy,” adding that the virus was a real threat to society and that when elderly people die, “it’s not fine.” The Washington Post notes that Tony Abbott, the former Australian prime minister, said in a Tuesday speech to the Policy Exchange think tank in London that not enough politicians were posing “uncomfortable questions about the level of deaths we might have to live with," particularly among the elderly.
• The Kentucky Board of Education sent a letter to the Kentucky High School Athletic Association urging it to consider expanding covid-19 guidance for student athletes, Jason Frakes reports for the Courier Journal. High school sports competition is scheduled to begin next Monday in cross country, field hockey, soccer and volleyball and in football on Sept. 11. 
• More than 40 people at the Nelson County Detention Center have tested positive for the coronavirus, according to the judge-executive, Dalton Godbey reports for WDRB.
• Paige Noel of WYMT provides a list of coronavirus cases and new deaths from health departments in Eastern Kentucky. 
• Each day this week WKYT is presenting a series about misinformation, including falsehoods about the pandemic. Click here to see Part I, Misinformation overload: It's everywhere. Why?" Click here to see Part II, "Combating common coronavirus myths." Part III, on Wednesday, will be "Parsing political misinformation;" Part IV, on Thursday, is "Lies about covid and kids;" and Part V, on Friday, will be "Separating fact from fiction." 
• The United States Department of Agriculture has extended the school food waivers until the end of 2020, according to a news release from Senate Majority Leader Mitch McConnell. The waivers allow flexibility in how school nutrition programs can be delivered to students in need during the pandemic.

Baptist Health completes purchase of E'town hospital, which it has managed for 20+ years; changes name to Baptist Health Hardin

A new sign graces the grounds on Dixie Highway (US 31-W). (Photo by Mary Alford, News-Enterprise)

Baptist Health, which has managed Hardin Memorial Hospital in Elizabethtown for more than 20 years, has completed a long-delayed purchase of the 300-bed facility and given it a new name: Baptist Health Hardin. It is the ninth hospital in the Baptist Health system.

"The transaction includes $361.4 million in payments and future investments," a Baptist Health press release said. "The closing came about three years after the Hardin Memorial Hospital Board of Trustees signed a letter of intent to pursue the sale," and five years after they started seeking a buyer. The release said they received "about three dozen proposals."

“This is a great day in the history of this community and our health system,” said Hardin County Judge-Executive Harry Berry, who was the hospital board's chair. “The hospital board sought the best solution to continue providing the excellent healthcare that our community -- and 10-county service area -- have come to expect. We found that solution in Baptist Health, which has helped guide us so successfully for more than 20 years.”

Baptist Health CEO Gerard Colman said, “You can expect the same quality healthcare you’ve come to know from familiar faces. You can also expect groundbreaking ceremonies, ribbon cuttings and announcements about new providers in the future as Baptist Health delivers on its promises to invest in the health of this community.”

In the purchase agreement, Baptist Health promised $235 million in investments over 10 years in operating and capital investments. The release said it would invest a minimum of $150 million in the first five years for new facilities, recruit more physicians and upgrade equipment and information technology.

At closing, Baptist paid the county $60 million, less the amount used in July to fully fund the Hardin Memorial defined benefit pension plan for current employees and retirees, plus another $66.4 million over 25 years. It will provide up to $150,000 per year for 25 years for health-care services historically provided to inmates of the county jail.

"President Dennis Johnson and other senior leaders have been retained," the release said. "Employment was offered to all employees at their current pay."