Beshear asks coaches to put student health first, urges schools in 'red zones' to follow guidance; positive-test rate jumps to 4.52%

White House Coronavirus Task force table; for a larger version, click on it.

By Lisa Gillespie and Melissa Patrick
Kentucky Health News

With at least five Kentucky high school football games canceled due to the novel coronavirus only 11 days after the start of a delayed season, Gov. Andy Beshear said coaches are almost in a sacred position to protect the health of their student athletes. 

“If I was running a high-school program, I would want my team to be getting tested on some [regular] basis,” Beshear said at his daily briefing. “I would really want to talk about a partnership with my parents, ensuring that I always know how my athletes are feeling.” 

The governor noted that college athletes are regularly tested for covid-19, but Kentucky’s school teams aren’t even required to be tested once a week. He said it’s critical that coaches make sure student athletes know their health is a priority. 

“I [would] want to make sure I communicated to them that their health is most important to me, because their futures are big and bright, whether they include athletics or not,” he said. “Don't try to come to a practice just because either it's your senior year, or ‘We really need you.’ I think that that dialogue needs to be there.” 

The Lexington Herald-Leader reports that at least five Kentucky high schools have cancelled football games due to covid-19.

Kentucky school districts in "red zones" – where the prevalence of covid-19 is considered ‘critical’ – have been advised to cancel athletics, Beshear noted.

“There's a lot of anticipation and people look forward to it,” he said, “but I think [we need to be] really clear on the expectations of putting the student athlete first.” 

He said football, soccer and volleyball teams have all had new cases of the virus, and two of the five football teams in quarantine because of exposure, Franklin County and Woodford County, played each other recently.

Franklin County's soccer teams are out of play and practice for 14 days after a male football player and the head girls' soccer coach tested positive for the virus, The State Journal reports: "The boys' soccer team hasn’t had any positive cases, but some members of the team play football and have to quarantine because of contact with the student who tested positive." 

Beshear pointed out that the state and the White House use different calculations to determine the coronavirus safety zones for counties, with Kentucky’s map showing nine counties in the red zone, meaning they have 25 or more cases per 100,000 people daily, and the White House listing 17. 

“It ought to tell you that we’re trying to put together a really fair system. . . . in that the White House would have more counties in the red zone,” he said. He stressed that when a county is in the red zone  – like Warren County, which he said has been in the red zone in every single White House report – it means it is in a difficult place and needs to take appropriate actions. 

Beshear often points to Warren County, which was one of the first to start in-person schooling. The latest state guidance calls for red-zone counties to offer remote learning only until they get back into a yellow zone, which means they have 1 to 10 cases per 100,000 people daily. 

The White House report for the week of Sept. 12-18 has 20 Kentucky counties in the newly added orange zone and 30 in the yellow zone. Altogether, 56% of the state’s counties have moderate or high levels of community transmission, with 14% of them having high levels of transmission. 

Communities in the White House red zone have weekly positive-test rates higher than 10% and more than one new case per 1,000 residents. Those in the newly added orange zone have 0.51 to 1 new cases per 1,000, and a weekly positive-test rate of 8 to 10%, or one of those two conditions and one condition qualifying as being in the red zone. Yellow-zone communities have new cases between 0.1 and 0.5 case per 1,000 and a positive-test rate of 5% to 8% -- or one of those, with the other in the a higher zone. 

Statewide, the White House report puts Kentucky in the orange zone for cases, with the 19th highest rate in the nation. It is in the yellow zone for its test positivity rate, the 14th highest. 

Beshear said of the 824 new positive cases of the coronavirus in the state Tuesday, 134 are under age 18, providing stark implications for in-person schooling. 

“Whether it’s safe for our kids to be in school doesn’t depend on me, it depends on the virus,” he said. “And what we can do to stop the virus is wearing a mask and limiting your contacts. It’s your patriotic duty as an American and a Kentuckian.” 

Seven new deaths were reported, bringing the state’s total to 1,119 of the more than 200,000 that have died nationwide. Beshear again urged Kentuckians to wear masks and social distance, calling the pandemic a war. 

“This is a major challenge of our lifetimes: we’ll be judged by how many Kentuckians and Americans we let die,” the governor said. “While we can’t save everybody, we can save a lot of people. Wear a mask. Follow the rules that are out there. If you see crowds that are gathered, don’t go to the crowd.” 

Beshear also noted that the state’s positivity rate had jumped up again, after being below 4 percent for a week. The share of Kentuckians testing positive for the virus in the last seven days is 4.52%.

With the Centers for Disease Control and Prevention issuing guidance to states earlier this month on how to prepare for covid-19 vaccine distribution, Besehar said he’s created a group that’s working on a plan. 

“When we look at all the different steps, the first is what we’ll get and when we will get it, but then we need to think about storage, physical distribution, the fact that it’ll be two separate shots over 21 days that have to be from the same manufacturer when there might be three or four different vaccines, that means it’s the same provider giving them to you,” he said. 

The group is also looking at who will get first priority and the overall safety of a vaccine. Beshear said he’d have to feel comfortable getting vaccinated himself before releasing it to the public.

In other covid-19 news Tuesday:

• The deaths reported Tuesday were of an 87-year-old man from Hardin County; a 79-year-old man from Jefferson County; a 56-year-old woman from Marion County; a 69-year-old woman and two men, 79 and 90, from McCracken County; and a 92-year-old man from Taylor County.
• Jefferson County had the most new cases on the state's daily report, 129. Other counties in the daily report with more than five were Fayette, 110; Christian, 78; Madison, 37; Warren, 35; Laurel, 28;Hardin, 24; Boone, 18; Whitely, 18; Daviess, 13; Montgomery, 13; Campbell, Clay and Henderson and Muhlenberg, 12 each; Calloway, Kenton, Oldham, 10 each; Nelson, 9; Franklin, 8; Boyd, Boyle, Bullitt, Hopkins, Knott, McCracken, Shelby, 7 each; Pulaski, Rockcastle and Scott, 6 each; and Allen, Barren, Caldwell and Jackson, 5 each.
• Beshear said 511 people were hospitalized with covid-19 in the state, 133 of them in intensive care, and 73 of those on ventilators.
• In long-term care facilities, Beshear said 31 more residents and 50 more staff have tested positive for the virus. The daily report shows 588 residents and 393 staff have active cases. Beshear said four more deaths can be attributed to covid-19 from these facilities, bringing that total up to 622 residents and 5 staff. 
• A "cluster" of coronavirus cases in one unit at the University of Kentucky's Good Samaritan Hospital "has forced covid-19 testing of roughly 100 employees, according to a video of a Zoom staff meeting," Jeremy Chisenhall reports for the Herald-Leader. "Every patient in the unit was to be tested," and employees were admonished not to congregate in the break room. A UK spokeswoman said Monday that there were eight cases.
• A closed pharmacy being used as a virus testing site in Lexington was "vandalized with phrases that appear to question the validity of testing," Morgan Eads reports for the Herald-Leader. "Graffiti had been painted in large red letters."
• The Centers for Disease Control and Prevention is discouraging door-to-door trick-or-treating and costume masks and parties. "Many traditional Halloween activities can be high-risk for spreading viruses," the agency said. It listed several "moderate-risk activities," including "one-way trick-or-treating where individually wrapped goodie bags are lined up for families to grab and go while continuing to social distance (such as at the end of a driveway or at the edge of a yard). If you are preparing goodie bags, wash your hands with soap and water for at least 20 second before and after preparing the bags."
• Beshear also said the state doesn’t yet have guidance on Halloween yet, although parties for children or adults will be strongly discouraged. As for trick-or-treating, “our guidance will try to give our kids that experience but in the safest way possible.”

Kentucky records 2nd highest number of virus cases in a week, but positive-test rate remains under 4 percent for a seventh day

State chart, labeled by Kentucky Health News; final-week figure remains subject to revision.

State chart, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

The reporting week that ended Sunday had the second highest number of new coronavirus cases in Kentucky, nearly 4,600. At the expected 1 percent mortality rate, 46 of those people will die, Gov. Andy Beshear noted Monday.

"This is the tough news . . . but there is some positive news," Beshear said at his daily briefing. He said the share of Kentuckians testing positive for the virus in the last seven days is 3.77%, completing a full week under 4 percent. It was 3.62% on Sunday.

He noted that when the rate hit 6 percent in early August, he recommended that schools delay in-person instruction until next Monday, Sept. 28. Many school districts have started in-person classes, and “It’s gonna be a real challenge for us to keep this positivity rate low” when all of them are in, Beshear said.

The governor didn't mention it, but the Kentucky Education Association, perhaps his biggest political ally, said Aug. 7 that the rate should be below 4 percent statewide statewide and in a locality before in-person classes are resumed. However, the state-issued, color-coded guidance for school districts is based on the number of cases per population in a county, unless the statewide positive-test rate is above 6%.

State case-incidence map; click it for a larger version

Beshear said the state has published a case-incidence map to guide school districts' decisions, partly because local officials asked for it, but some who are counties in the most dangerous category, coded red, “are now trying to argue their way around it.” He said, “If you are in red, do not try to argue your way out of red.”

Asked if Kentucky is ready to have in-person schooling statewide, Beshear said “I believe the answer is yes, in some form or fashion.” He said counties coded orange should probably use hybrid systems, “bringing kids in a few times a week,” for example. “We are ready for a majority of the districts to be in.”

Pamela D. Harris

At Fort Knox, which began in-person classes in August but switched to remote schooling early this month, a school counselor has died after being diagnosed with the virus, Defense Department officials told The Associated Press. Pamela D. Harris, 60, of Radcliff, was being treated at a local hospital when she died Tuesday.

The Federal Education Association, which represents educators and support professionals at schools on Army posts, said it had repeatedly warned about the dangers of starting in-person classes. Fort Knox switched "only after Harris and several other school employees reported covid symptoms," AP reports.

Beshear reported 406 new coronavirus cases – typically low for a Monday, following less laboratory work on weekends – and only one death, a 77-year-old woman in Scott County.

Showing photos of people enjoying activities while wearing masks, he said, “It’s one of the main things that’s going to determine how many people die.”

He drove home the revised advice on testing from the Centers for Disease Control and Prevention, saying that anyone in contact with an infected person should be tested, and calling "strange" and "contradictory" the CDC's previous advice that people who had been exposed to an infected person but didn't have symptoms didn't have to be tested.

“About 40 percent of all the transmission occurs with people with no symptoms,” Beshear said. “It’s not rocket science to say that if you want to stop that spread you gotta test those individuals.” He added that “Kentucky, unlike other states, is still performing significant testing . . . There is a location everywhere.”

The CDC's work, or interference with it by higher authorities, came into question again yesterday. "New language acknowledging that the virus that causes covid-19 spreads more easily than once believed disappeared from [a CDC] website Monday just days after being published, replaced with a message saying the previously uploaded information was a mistakenly posted 'draft version of proposed changes'," Time magazine reports.

"The now-missing language, which was posted Friday to a page titled 'How Covid-19 Spreads,' cited small droplets called aerosols as the most common method of viral spread—reversing the agency’s previous stance that the virus was mostly spread by larger droplets that typically don’t travel as far. The move was lauded by scientists who have for months argued that aerosols account for a significant share of coronavirus transmission."

Al Tompkins of The Poynter Institute wrote, "If this guidance re-emerges, and significant scientists say it should, it could launch big changes in the way we think about covid safety as we move indoors for the winter."

In other covid-19 news Monday:

• Fayette County had the most new cases on the state's daily report, 134. Other counties with more than five were Jefferson, 57; Madison, 17; Warren, 14; Knott, 11; Grayson, 10; McCracken, 9; Henderson, 7; Hopkins, 7; Bullitt, 6; Pulaski, 6; and Allen, Boone, Daviess, Kenton, Marshall, Pike and Whitley, 5 each.
• Beshear said 474 people were hospitalized with covid-19 in the state, 108 of them in intensive care, and 64 of those on ventilators.
• Health Secretary Eric Friedlander said Kentucky would largely mirror the new federal rules for nursing-home visitation, but would allow a patient's pet into the facility. “Sometimes, those pets, we all know, can really make somebody’s day,” he said, adding that and transmission by pets is “very, very rare.”
• Beshear said it's all the more important to get a flu shot during the pandemic. “We do not want to be dealing with covid-19 and a widespread flu outbreak this season,” he said, adding that if you don’t get a flu shot and have symptoms, many of which the diseases share, “It can disrupt a lot of lives around you.”
• Beshear announced that the state has applied for federal funding of three more weeks of additional unemployment benefits, for the weeks ending Aug. 22 and 29 and Sept 5. If funded, the $400 checks would issued separately for each week.
• The U.S. recorded its 200,000th death from covid-19.

Ky. efforts at farmer suicide prevention are a national model, UK professor says; Farmer Suicide Prevention Day is Wed., Sept. 23

By Melissa Patrick
Kentucky Health News

Kentucky farmers, like those across the nation, work tirelessly to stay afloat amid plummeting farm incomes, market instabilities, extreme weather conditions, few safety nets and now, a global pandemic. And sometimes those stressors add up, leading some to consider suicide, and others to die by it.

To bring awareness to this issue, the General Assembly passed House Bill 59, sponsored by Rep. Brandon Reed, R-Hodgenville, during the last legislative session to designate the Wednesday of National Farm Safety and Health Week, which is the third week of September, as "Farmer Suicide Prevention Day." This year that date falls on Sept. 23.   

Photo from Talk Business & Politics

"There are significant stress factors across rural America and it's important to know that it's okay for farmers to ask for help," said state Agriculture Commissioner Ryan Quarles. "And one of the more unfortunate issues here is that the farm community is one of the last communities to reach out for help and so we've got to make sure that farmers know that there are resources available if they need to talk with someone."

Quarles pointed to several stressors that are unique to the farming community, including the extended stress that comes with only getting one or two paychecks a year, working under risky market conditions, and not having access to benefits or health insurance through an employer.   

Farmers also worry about losing the family farm, said University of Kentucky professor Joan Mazur. She is deputy director of the Southeast Center for Agricultural Health and Injury Prevention, which has received a $48,000 federal grant to work on suicide prevention.

"No farmer wants to be the person that loses the multi-generational farm, sometimes in the family for decades and decades," Mazur said. "And that can cause huge depression. . . .  Nobody would want  to lose their home, but the additional burden on a farm family ... really can be catastrophic. "

Deborah Reed, a professor of nursing and agricultural health at UK, added that she knows anecdotally and through her own research that farmers also feel "very unappreciated and persecuted by the public."  

One goal of suicide awareness is to reduce the stigma of asking for help, Mazur said: "We know it's hard to ask for help. People talk about physical complaints all the time but it's very difficult for them to talk about any mental health issues that they are having." 

But even though it's hard, she urged anyone thinking about suicide to seek help. 

"Suicide is preventable, it's not inevitable," Mazur said. "That message has to get out to the general public and it has to get out to the farming community as well, and to  farm families so that people can get the help that they need. That's the point of the USDA grant that we have." 

She added, "We can't keep ignoring this. Stress, mental health, depression, suicide are real issues nationwide, and in particular in our farming community, which is our focus." 

2018 Farm Bill spurs action

Mazur said the 2018 Farm Bill has been instrumental to addressing mental health in agriculture, because for the first time it had money included to address the issue. The bill appropriated $50 million over five years for mental-health work with people in agriculture-related occupations, but the impact went beyond money.

"It said to all the farming community, this is a conversation we can have," she said. "You can't overstate enough how important it was that there were mental health components in that 2018 Farm Bill. That was huge." 

Kentucky has also appropriated $500,000 from its Tobacco Settlement Fund for a mental-health and suicide-prevention program. The pilot program brings together a wide range of agencies to focus on increasing awareness of resources, increasing behavioral health care providers in rural areas, increasing  intervention training in communities, and increasing surveillance. It will also create and disseminate a Kentucky farmer cultural humility training for healthcare providers. 

"The concerted effort in Kentucky is remarkable," Mazur said, adding later, "This is really unprecedented nationally to have a state that is so committed to this kind of an issue, to preventing farmer suicide and farmer mental health issues. . . . It's really a model, a national model for how to address an issue."  

Farmer suicide prevention in Kentucky

With its Farm and Ranch Stress Assistance Network grant, Mazur said, the center has created a pilot program to provide suicide-prevention training to a diverse group of community members who largely interact with farmers, such as people from Farm Credit, ministers, Extension agents and their families. The trained community members then go back into their communities and train others. 

The training is called QPR, which stands for "question, persuade, refer," and is designed to teach people how to recognize the warning signs of suicide, how to offer hope and how to get help and save a life. 

Joan Mazur (UK photo)

Mazur said they have enhanced the QPR program with information specific to the culture of farming to help people understand the stressors unique to farmers, their families and their workers. 

As of Aug. 1, she said in the center's annual report, 18 people had completed the training and made a commitment to deliver at least two trainings. She said they expect 100 people to be trained by mid-November.

Mazur said the center is also working with the Suicide Prevention Hotline to help its workers better understand the culture of farming. 

For example, she said, if someone calls the hotline and says it's been a rainy spring and they couldn't plant their crops, the person on the other end of that hotline needs to understand the full implications of what that means to a farmer: "That can be financially devastating and provoke the kinds of situations that cause depression and stress and lead to, that are run-ups to suicide."

Quarles also spoke to the importance of making sure hotline workers understand the "lingo of agriculture" since a farmer's message may get lost in the translation. 

Reed said it's also a problem when health-care providers don't understand farming, because that is who a farmer is likely to see first, given the poor access to mental-health care in most rural areas. 

Reed said farmers have told her "over and over again" that when they actually decide to seek help for their depression or anxiety or mental-health issue, the provider doesn't understand their world: They can't take medicine that makes them sleepy and also work on farm equipment, and can't take time off for therapy. Mazur said efforts are in motion to also work on educating providers about farm culture. 

Prior to the pandemic, Reed said she offered evidence-based community theater programs across Kentucky that focused on health and agriculture safety, including mental health. 

"We're trying to start to move the conversations to where the farm communities themselves will talk about this issue. I think we're having some success," she said, noting that farmers showing up at Extension events that focus on stress, and she is often asked to talk to farm groups about it. 

"What I've seen working with our farmers across the nation, and particularly ones in Kentucky, is they have become much more receptive," she said. "They will attend programs on stress and how to manage their behavioral or mental stress, if you will, now where before they they would not have done that." 

Reed also noted the value of letting farmers know they are appreciated, pointing to the "Heart to Heart Program" at UK where students write letters to farmers expressing their gratitude for what they do. 

"We hear farmers actually say, 'Well, I'd like to get one of those letters,'" she said. "Everybody wants to be thanked so that's an easy step that everyone can do."

"We're really a lot more active on this issue than we have been in years past and I think that is a good thing," said Quarles. 

More data needed

Another challenge is the need for more information about farmer suicides. 

"We don't really understand what the baseline is, that we still are trying to better understand exactly what Kentucky's farmers in rural areas are experiencing right now," Quarles said. 

Mazur said farm suicides are often listed as an accident on death certificates, and reporting systems differ among states. She said through the grant, a doctoral student is working to get better data, including possible factors that contributed to suicide, to guide intervention.  

"We do know that suicide rates have increased among working-age people from 2000 to 2016 by 34 percent," she said. "And rural areas in states with high agricultural populations and small farms like Kentucky are over-represented in that sample."

A 2020 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention looked at 2016 suicide rates by industry and occupation in 32 states and found that the suicide rate among male farmers and ranchers was 43.2 per 100,000, compared to 27.4 per 100,000 among working-age men in all occupations. 

Ty Borders, director of the Rural and Underserved Health Research Center, along with fellow University of Kentucky faculty member Kathi Harp, recently published a study that found, nationwide, rural residents experienced suicide ideation, planning and attempts at a higher rate than those in urban areas.

The study also found that the risk of dying by suicide is greater among lesser educated farmers and at times of economic depression, especially in rural areas that are heavily dependent on a single industry, like farming. Death by suicide is also higher among men.

Borders said that when worked at the federal level on this issue, it became clear that for decades, the national government has needed a better plan to address rural suicide because most suicide-prevention programs have been designed for urban communities and may not be applicable to rural communities. 

The Borders-Harp study calls for new suicide prevention interventions targeted to the unique needs of rural residents.  

Suicide is the 11th leading cause of death in Kentucky, with an average of one person dying by suicide every 12 hours in the state, according to the American Foundation for Suicide Prevention. 

Kentucky is home to about 76,000 farms, and most are small. The average farm in Kentucky has 171 acres, much smaller than the national average of 444 acres. In Kentucky, the industry is dominated by small family farms and about 50,000, or two-thirds, have annual sales of less than $10,000.

If you’re thinking about suicide, are worried about a friend or loved one, or would like support, the Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255.

Cases still on rough plateau; officials urge caution in nice weather; Clinton Co. schools go remote; overweight, not just obese, at risk

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

By Al Cross
Kentucky Health News

State officials announced 439 more cases of the novel coronavirus in Kentucky on Sunday, leaving the seven-day rolling average of new cases about where it was almost two months ago: 668 on July 25. Since then, the figure has been on a very rough plateau, going as high as 715 on Sept. 4 and as low as 528 on Aug. 7 and 11, but the trendline has been slightly upward, worrying officials.

“I hope everyone is enjoying this beautiful weather as we enter fall, but with this pandemic as deadly as ever and flu season beginning please take the essential steps to protect you, your loved ones and your community,” Gov. Andy Beshear said in a press release. “As we saw Saturday, with more than 1,000 cases, covid-19 remains highly infectious, and we must be vigilant to prevent a spike that will claim even more Kentuckians.”

In the release, Health Commissioner Steven Stack encouraged Kentuckians to enjoy the nice weather, but he urged hosts to limit gatherings to 10 or fewer people, insist that invitees stay home if they don't feel well, require facial coverings, try to spend as much time as possible outside, and seat guests at least six feet apart.

“Remember, you’re the host, and you set the rules,” Stack said. “We’re not just preventing the spread of covid-19. We’re also preventing the spread of the common cold, the flu and other viruses, which is very important, since they can easily be confused with covid-19.”

Beshear announced three more deaths from covid-19 on Sunday, bringing the state's death toll from the disease to 1,111. The fatalities were a 66-year-old man and a 92-year-old woman from Lexington, and a 91-year-old man from Boyd County.

Counties with five or more new cases on the state's daily report were Jefferson, 81; Fayette, 74; Calloway, 17; Warren, 17; Madison, 14; Greenup, 13; Pulaski, 11; Barren, 10; Daviess, 9; Hardin, 9; Boone, Boyd, Kenton, Knott, Knox and Marshall, 8 each; Henderson and Leslie, 7 each; Bullitt, Campbell and Pike, 6 each; and Clinton and Graves, 5 each.

Case numbers tend to be lower on Sundays because of limited testing and/or reporting by laboratories. Beshear's release said 68 of the new case were in Kentuckians 18 or younger. As usual for a Sunday, the report did not include hospitalization or institutional data, or the share of Kentuckians testing positive for the virus in the last seven days.

In other covid-19 news:

• Schools in Clinton County, where the Tennessee border intersects the edge of the Cumberland Plateau, shifted to remote instruction Wednesday after the state said the county had a "critical spread" of the virus. “School is not part of the problem yet, but as those numbers go up and we keep having school, it’s inevitable that it would be a problem,” Supt. Tim Parsons told the Clinton County News. He said in-person schooling, which began Aug. 31, won't resume until Oct. 12 because a break is scheduled the week before.
• "Since the pandemic began, dozens of studies have reported that many of the sickest covid-19 patients have been people with obesity," Meredith Wadman reports for Science magazine. "In recent weeks, that link has come into sharper focus as large new population studies have cemented the association and demonstrated that even people who are merely overweight are at higher risk."
• "The country’s extraordinarily high case load — more than 6.5 million so far — and death count have translated into steadily growing acceptance of the preventive steps scientists recommend: hand-washing, social distancing, wearing face coverings," The Washington Post reports. The story, reported from several rural and urban locales, tells how covid-19 deaths woke communities up to the reality of the pandemic.
• Asked on CBS's "Face the Nation" if President Trump is correct in saying that the nation is "rounding the corner" to quashing the virus, his former Food and Drug Administration commissioner, Scott Gottlieb, said, "We have at least one more cycle with this virus heading into the fall and winter," in which cases will increase. "There's a lot of virus left to go in this country."
• Gottlieb said he did not think a coronavirus vaccine would be available until "probably the end of the second quarter of 2021 and maybe into the third quarter," similar to the forecast of Centers for Disease Control and Prevention Director Robert Redfield, which Trump disputed. He said emergency authorization could be given to "very select groups on a very limited basis."

Two weeks after the Derby, held on a Labor Day weekend, Kentucky has its second highest number of coronavirus cases

Kentucky reported 1,002 new cases of the novel coronavirus Saturday, the largest one-day total yet, except for the 1,163 new cases reported Aug. 12.

“Today's report shows that when we let our guard down, this virus truly spreads,” Gov. Andy Beshear said in a press release. “This is everywhere, and we must keep our guard up. The only positive news in today's report is our positivity rate is still under 4 percent.”

The share of Kentuckians testing positive for the virus in the last seven days is 3.82%. It has spent most of the week under 4%, a level it last reached more than two months ago. A rate of 5% or more puts a state or locality in a federal danger zone.

Emma Austin of the Courier Journal notes, "The high case count comes two weeks after the Kentucky Derby and Labor Day weekend, about the length of time health officials said it would take for the state to know if the holiday would result in another spike — similar to what was seen after Memorial Day and the Fourth of July."

Saturday's cases brought the state's total to 61,106. Of the newly reported cases, 145 were in Kentuckians 18 and younger.

“Remember, high number of cases lead to a higher number of deaths several weeks down the line,” Beshear said. “Now that our kids are going to be going back to school in many places in some form or fashion, now that we have more sports, let’s make sure that we cut our contacts, wear our masks and socially distance. Let’s do better – everyone around us is depending on it.”

Beshear reported seven more deaths Saturday, bringing the state's toll to 1,108.

The fatalities were an 82-year-old woman from Lincoln County; a 78-year-old woman from Warren County; an 89-year-old woman from Boyd County; a 76-year-old woman from Martin County; a 66-year-old woman from Mercer County; and a 71-year-old woman and a 91-year-old man from Jefferson County.

Health Commissioner Steven Stack said in the release, “The first official day of fall is fast approaching, and the weather that has descended this weekend over Kentucky will cause a lot of us to want to spend time outdoors. If you get outside, please keep following the same advice we’ve given since the pandemic began. Stay at least six feet from others, wear a mask and wash your hands often. As we prepare to begin a new season, let’s recommit to our efforts to prevent further spread of covid-19. Let’s start the fall season off right, Team Kentucky.”        

In other covid-19 news Saturday:

• Counties with more than 10 new cases: Jefferson, 187; Fayette, 140; Madison, 64; Warren, 39; Union, 31; Christian, 27; Henderson, 27; Estill, 24; Boone, 23; Oldham, 23; Kenton, 21; Daviess, 20; Clay, 18; Hardin, 16; Campbell, 14; McCracken, 14; Greenup, 13; Knott, 12; Laurel 11 1.10 Pulaski 11
• The state's daily report said 496 people were hospitalized for covid-19 in Kentucky, 114 of them in intensive care.
• Young adults are spreading the virus—but not mainly because of parties and bars," National Geographic reports. They "are blamed for the pandemic’s spread, but also face the brunt of the transmission risk that comes with keeping the economy going."
• Natalie Compton of The Washington Post reports how to enjoy fall activities despite the pandemic, including leaf viewing and visits to farmers' markets, orchards and pumpkin patches.

Men, get your prostate checked; early detection is the key to beating cancer, but pandemic is making people put off checkups

By Steve and Heather French Henry, Kristy Young and Melissa Karrer

Cancer screenings save lives among men. But with the ongoing covid-19 pandemic, too many Kentuckians are forgoing or delaying their annual health exams and cancer screenings. By putting off these important doctor appointments, we risk trading one public-health crisis for another. We cannot risk more late-stage cancer diagnoses when most cancers can be found and treated with an early screening measure.

September is National Prostate Cancer Awareness Month. And fortunately, our elected leaders in the Kentucky General Assembly also recognize the importance of these potentially life-saving cancer screenings. During the 2020 legislative session, the General Assembly voted to designate September as Prostate Cancer Awareness Month to encourage early prostate screenings for Kentuckians. The message they intended to send is now more important than ever.

Prostate cancer is one of the leading causes of cancer deaths in the United States. Right here in the commonwealth, 2,681 Kentuckians will be diagnosed with prostate cancer this year alone and 385 men will lose their battle to this life-threatening disease, according to the National Cancer Institute.

Because prostate cancer grows slowly, it is likely to be found in an early stage through a screening test, such as a simple blood test called prostate-specific antigen (PSA) test or digital rectal exam. And the good news is that when caught early, individuals have a 90% chance of survival.

Unfortunately, data shows that urologists are diagnosing prostate cancer at far more advanced stages compared to the last five years. And this means the treatment options become more aggressive and survival rates significantly decrease.

That’s why early detection is key to finding prostate cancer in its earliest and most treatable stage. Even during a health crisis like the one we are currently in, it is important to make sure to take care of your health and talk to your physician about when you should be tested.

The truth is cancer doesn’t stop because of a pandemic. We’re already heading down a dangerous road, as data from the JAMA Network shows a steep reduction in new cancer diagnoses this year compared to last, which means we can expect to see a rise in late-stage cancer.

This is not the time to wait until you have symptoms to visit your doctor. It is safe to do so. And the minimal risk outweighs the potential harm. Early detection is key to beating cancer and saving lives. When we raise awareness about early prostate detection, we are giving more men the opportunity to live long, healthy, cancer-free lives.

Let’s all encourage our fathers, brothers, husbands, family, friends and all Kentuckians to schedule a time to talk to their health care providers about if they should get a prostate cancer test and be screened for other cancers. Their lives could depend on it.

Steve Henry is a physician and former lieutenant governor. Heather French Henry was Miss America 2000. They are with the Kentucky Prostate Cancer Coalition. Kristy Young is with the Kentucky chapter of the American Cancer Society Cancer Action Network, and Melissa Karrer is with the Kentucky Cancer Link.

Ashland hospital says surge in covid-19 cases has it full; feds allow indoor visitation at nursing homes without recent cases

King's Daughters Hospital has 465 beds, making it one of Kentucky's largest hospitals.

By Al Cross
Kentucky Health News

As a smaller share of Kentuckians tested positive for the coronavirus, the hospital in Ashland reported that it had filled up from a surge of covid-19 cases. 

Gov. Andy Beshear announced in a press release that 3.6 percent of Kentuckians who were tested for the virus in the last seven days turned up positive, “our lowest rate in months. When we asked for people to push off in-person classes in our schools until Sept. 28, it was so we could get our positivity rate down to a safer level.” A rate of 5% of more puts a state or locality in an official danger zone.

Beshear announced 777 more cases of the virus in the state, pushing the known total to 60,128. He said eight more Kentuckians had died of covid-19. “This is tough news today,” he said in the release. “It only took ten days for us to go from 1,000 deaths to over 1,100. This is why we’re working so hard to keep our case numbers down.”

In the Ashland area, "Covid is intensely surging in our communities," Kristie Whitlatch, president and CEO of King's Daughters Hospital, said in a Facebook post. "No longer can we say it is primarily impacting those with underlying health conditions or nursing-home residents. It is attacking babies, children, and healthy, active men and women who have no idea how they were exposed. We are also seeing difficult recoveries, many taking months to fully recover and some who have yet to fully recover and may see the impact for the rest of their lives. Our infectious-disease specialists and other medical professionals are very concerned."

Whitlatch said the hospital has had 22 deaths related to covid-19, and this week discovered more than 120 new cases. "Our hospital is at capacity," she wrote. "We are working to open a third nursing unit to care for covid patients. Multiple nursing units dedicated to one virus are unprecedented in our 120-year history. Many of these patients are very ill and many of our physicians, nurses and support team have been struck by the virus. I understand people have differing opinions, but we know for a fact it is dangerous and deadly because we live it every day. We must take this seriously."

After advising the usual precautions, and telling people to "Stay at home as much as possible," Whitlatch wrote, "I also ask for your prayers and/or words of encouragement for our heroes behind the masks. However, today I would add these heroes are not just our team members or other medical professionals. If you are wearing your mask and following the other guidelines you are our heroes too."

Whitlatch did not say exactly how many covid-19 patients are in the hospital. The area has 214 fewer hospital beds than it did at the start of the pandemic, due to the April closure of Our Lady of Bellefonte Hospital in Russell.

Statewide, 500 people were hospitalized with covid-19, and 144 of them were in intensive care, according to the state's daily report.

Nursing-home visits: The federal Centers for Medicare and Medicaid Services relaxed its covid-19 guidelines for long-term-care facilities, allowing visits at those that have gone 14 days without a case among residents or employees. Kentucky has been following a 28-day standard.

"Most nursing homes can allow indoor visits as long as there have been no new covid-19 infections in the past two weeks and the infection rate in the surrounding county is no more than 10%," NPR reports. "But CMS recommends that nursing homes limit how many visitors a resident can have at one time, as well as limiting the number of visitors that can be in the facility at once." The new rules also allow social activities and communal dining by residents, with social distancing and and mask wearing.

"Since March, family members have only been allowed to visit their loved ones for so-called compassionate care," NPR reports. "This was interpreted strictly by many nursing homes to mean end-of-life situations. The new guidance from CMS expands the criteria to include residents who were living with their family before admission to the nursing home and are now struggling with the change in environment, residents who need family members to provide encouragement with eating or drinking, and residents experiencing emotional distress or crying more frequently. The guidance says this should not be regarded as an exhaustive list."

In other related news Friday:

• Of the 777 new coronavirus cases, 97 were in Kentuckians 18 or younger. Counties with more than 10 new cases were Jefferson, 146; Fayette, 116; Madison, 36; Daviess, 33; Warren, 30; Oldham, 26; Boone, 20; Union, 19; Hardin, 16; Henderson, 16; Laurel, 15; Kenton, 12; and Barren, Boyd and Mercer, 11 each.
• Friday's fatalities were an 85-year-old man from Bell County; a 96-year-old man from Christian County; a 96-year-old man from Fayette County; a 90-year-old woman from Greenup County; a 53-year-old man from Hopkins County; a 73-year-old woman from Laurel County; a 78-year-old woman from Pulaski County; and a 91-year-old woman from Scott County.
• K-12 schools reported seven more cases, three students and four employees, raising the active-case totals to 340 and 165, respectively.
• Colleges and universities reported 119 new cases among students, making for 1,098 active cases.
• The University of Kentucky said it would randomly test students for the virus, following "a productive dialogue in which senior leaders engaged earlier in the week with Dr. Deborah Birx, the national coronavirus response coordinator," who visited the campus and praised UK's response. The tests will be free and will continue through the semester, which ends Nov. 24. Spokesman Jay Blanton said in an email that UK plans to test about 400 students in a first round of tests that it expects to be done by Wednesday. "We will follow up with students who do not comply and ask them to test," he said. "If there is not compliance, ultimately, they are subject to sanctions in the student code, which generally range from education all the way to expulsion. But we have found that the vast majority of students have worked to comply with our testing and public-health protocols."
• UK also said it would require retesting of students living in residence halls, "as directed by the data" from sampling of dormitory wastewater for the virus.
• The federal Centers for Disease Control and Prevention "reversed a heavily criticized guidance it issued last month about who should be tested for the novel coronavirus," The Washington Post reports. "The agency updated its recommendation to call for testing anyone — including people without symptoms — who has been in close contact with someone diagnosed with covid-19, the disease caused by the virus."
• Beshear, his wife Britainy and their children, Will, 11 and Lila, 10, got their flu shots this week, along with Lt. Gov. Jacqueline Coleman, Health Commissioner Steven Stack and American Sign Language interpreter Virginia Moore. He "emphasized the importance of getting a flu shot this year to blunt the potential for what the medical community fears could be a 'twindemic' if seasonal flu outbreaks overwhelm health care systems already stretched thin by covid-19," a press release said.

Kentucky hospitals say pandemic has cost them $1.34 billion, net

By Lisa Gillespie
Kentucky Health News

Kentucky hospitals say they have had collective financial losses of $1.34 billion due to the covid-19 pandemic, with the biggest hit from elective procedures that were canceled or postponed.

In a new report, the Kentucky Hospital Association tracks the hits hospitals have taken and the federal assistance they got to stay afloat. They say federal relief money, not counting almost that much in loans from Medicare, reduced their losses by $1.03 billion, and they reduced their expenses by $200 million.

“While it sounds like we've gotten a lot of money, which of course we have, the losses are much greater than that,” KHA President Nancy Galvagni said.

The report says the losses came mainly from fewer patients seeking care not related to covid-19, new limits on hospital capacity in case of a local outbreak, and stockpiling supplies like personal protective equipment.

Elective procedures were put on hold during the three months Kentucky was in lockdown mode. Galvagni said the procedures include anything that could wait without a patient deteriorating or dying, such as knee replacements and preventive services.

“There are procedures that hospitals are able to make a margin on, and they subsidize all the money-losing services that hospitals provide,” Galvagni said. “That period of time when we didn't have that volume, we're never going to recoup those losses. That's just money out the door.”

The pandemic has added other burdens. Hospitals must have 30 percent of their beds at stand-by in case of a local outbreak, and treatment of a covid-19 patient is much more expensive than other patients. KHA cited research indicating that hospitals lose between $1,200 to $8,000 per day on covid-patient care that won’t be paid by insurers.

Another big question that’s weighing on hospitals is the money they owe the federal government. Hospitals were able to request six months of advance payments from Medicare, but at some point Medicare will have to recoup  that money. KHA is asking Congress to forgive the loans.

Galvagni said she didn't know many hospitals had received those advance payments. A Medicare report said Kentucky hospitals and other health-care facilities got $1.16 billion; nationally, hospitals got almost 85% of the money; if that percentage held true in Kentucky, the state's hospitals were advanced about $950 million.

The KHA report says the pandemic has put rural hospitals at higher risk of closure. Kentucky has 68 rural hospitals, which compose 56% of hospitals in the state, employing more than 24,000 people.

“Those hospitals that were already struggling, could be even more struggling,” Galvagni said.

Most rural-hospital patients are covered by Medicaid, the federal-state program that covers people with incomes up to 138% of the federal poverty level. These hospitals already operate under tight margins because Medicaid typically pays less than commercial insurance, Galvagni said: “It's really a reflection of the payer mix of our hospitals in those areas where they’re serving a vulnerable population.”

In the report, KHA asks the Kentucky legislature to not increase a health-provider tax that would mean hospitals give more money to the state to help fund Medicaid.

A Kentucky example shows how CDC's slow, cautious approach to the pandemic contributed to its spread, especially in rural areas

Harrison County Judge-Executive Alex Barnett, Magistrate Dwayne Florence and Treasurer Melody McClure said the pledge of allegiance at a Fiscal Court meeting. Barnett told USA Today, "I am no expert in health ... I am an expert on growing cattle and tobacco. I rely on the CDC." (Photo by Jack Gruber)

A bombshell USA Today package details how the Centers for Disease Control and Prevention failed to effectively respond to the growing pandemic, adding to its spread across the U.S.—especially in small towns and rural areas.

"Reporters reviewed 42,000 pages of emails and memos obtained from health departments and interviewed more than 100 community leaders and public health experts, including current and former CDC officials," Brett Murphy and Letitia Stein report. "The agency has received widespread scrutiny for yielding to political pressure from the White House. These interviews and records provide the most extensive look yet at how the CDC, paralyzed by bureaucracy, failed to consistently perform its most basic job: giving public-health authorities the guidance needed to save American lives during a pandemic."

State and local authorities sought help and guidance from the CDC starting in January, but the CDC ignored questions, gave conflicting advice, brushed off calls to take the pandemic more seriously, and as late as April, continued to downplay the potential harm of the coronavirus, USA Today reports.

"In the most extreme cases, the CDC undermined health officials advocating a more aggressive approach to control the spread," Murphy and Stein report. "The agency went so far as to edit a government science journal in late March to remove a Washington state epidemiologist’s call for testing throughout senior assisted-living facilities. 'I would be careful promoting widespread testing,' the CDC editor noted."

Julia Donohue (USA Today photo by Jack Gruber)

The story highlights how the CDC's missteps hurt small towns such as Cynthiana, a Kentucky town of 6,400 that took the agency's advice to continue life as normal, Murphy and Stein report. In early March, Cynthiana resident Julia Donohue got covid-19, the first confirmed case in the state. But the local hospital she went to had received no urgent warnings about community spread, and the more than 50 hospital workers who came into close contact with her did not wear masks or other protective gear that was in short supply. Cynthiana became the epicenter of a statewide outbreak.

Harrison County Judge-Executive Alex Barnett told USA Today that heeded the CDC's advice that it wasn't that big of a threat. He spent the next two weeks posting pictures on Facebook of himself and his wife eating lunch at different local restaurants, hoping to convince others that it was safe. "For the two weeks from when Donohue fell ill until the governor shut down the state, Barnett said he did not realize how much the small city of Cynthiana was at risk," Murphy and Stein report. 

"I am no expert in health when it comes down to it. I am a farmer," Barnett told USA Today. "I am an expert on growing cattle and tobacco. I rely on the CDC for guidance." However, Barnett did try to help the local newspaper inform Cynthiana residents. Two days after Donohue's test came back positive, Barnett agreed to fund delivery to every mailbox in the county of a special edition of The Cynthiana Democrat explaining the best known facts about the coronavirus. 

Editor Becky Barnes, who won the 2020 Al Smith Award for public service through community journalism by a Kentuckian, said she proposed the extra because people needed to know the facts, and not everyone had access to the internet. Meanwhile, Kentucky health officials were getting impractical advice from the CDC, if they received any replies to questions at all, Murphy and Stein report.

As lawyers and protesters argue about his powers, Beshear says he'll see how in-person classes go before relaxing capacity rules

Solicitor General Chad Meredith argued for Attorney General Daniel Cameron before the Kentucky Supreme Court Thursday. At left is Latasha Buckner, Gov. Andy Beshear's general counsel and chief of staff. (Photo by Ryan C. Hermens, Lexington Herald-Leader)

By Al Cross
Kentucky Health News

As lawyers and protesters argued about his emergency powers, Gov. Andy Beshear said he is unlikely to relax any of his restrictions on business and venue capacity until most students and teachers are in schools for a while.

Beshear said person-to-person contacts are "going up significantly" as schools have resumed athletic events and some have restarted in-person classes. “Because of that we are not likely to increase capacity in different areas” until the state can ensure that relaxed rules would pose no increased risk for students and teachers, he said.

Beshear has recommended that in-person schooling not resume until Sept. 28, and has issued a guide to help local school officials make decisions about classes and athletic events, based on the prevalence of coronavirus cases in their county.

The governor announced 628 more cases of the virus in Kentucky, 76 of them in people 18 and younger. He said that was less than on recent Thursdays, but noted that the mortality rate of the covid-19 disease caused by the virus means that several of those people will die. He announced 11 more covid-19 deaths.

The share of Kentuckians testing positive for the virus remained under 4 percent, at 3.82%. "It’s not because we are testing folks that we do better, it’s because of our actions," he said. "We believe that mask mandate is working, and without it, our positivity rate would go up."

Beshear's July 9 order that masks be worn in public, and a host of other orders, was issued under the state of emergency that a law allows him to declare to protect the public from a long list of "major hazards," including ētiological hazards, which cause disease. The Kentucky Supreme Court heard arguments Thursday in cases challenging the legality and constitutionality of his orders.

Attorney General Daniel Cameron's case against Beshear was argued by Solicitor General Chad Meredith, who said he didn't think the emergency law "was intended to deal with general disease control; we have an entire statute that deals with that . . . The emergency powers are to allow for immediate response. . . . We're now dealing with a more general disease control," which would require Beshear to issue administrative regulations after public comment.

Beshear's general counsel and chief of staff, LaTasha Buckner, said Meredith was arguing "form over substance" because a general law allows Beshear to issue emergency regulations without a comment period or legislative review, as long as they are "rationally based."

Meredith said, "Process is what separates the rule of law from the despotic rule of one man," Meredith said, adding later, "It's the seriousness of this matter that counsels in favor of using a more deliberative process." He twice quoted Health Commissioner Steven Stack's description of the orders as having "breathtaking scope and implication."

The seven justices did not indicate when they would rule. "The hearing comes after the high court took control of two challenges in lower courts where judges ruled against Beshear's orders, but Thursday's hearing involved only a decision from Boone Circuit Court," the only one in which a judge has issued a final order," reports Deborah Yetter of the Courier Journal.

Protesters at State Capitol (CJ photo by Deborah Yetter)

"The hearing began as a noisy crowd gathered outside on the Capitol lawn, few wearing masks and some toting firearms, protesting such executive orders and demanding freedom," Yetter reports. "They had mostly dispersed by the end of the 90-minute hearing." The speakers included legislators and candidates.

Few if any protesters wore masks or practiced social distancing. Beshear said that refuted his critics' argument that "there doesn’t have to be a mandate. … Without intending to, they showed how important it is." He said protesting is fine, but “Do what’s necessary to protect the person who’s right beside you; do what’s necessary to protect the parent of the person who’s gonna go home."

Beshear said of the court case, "I still can't believe that these rules and restrictions have been challenged," because they are "supported by the White House, by public-health experts at every level with almost 100 percent agreement," and "just about every governor" has taken similar actions. "They’re the difference in how fast the virus spreads and how many people die."

As for the argument that his emergency powers have gone on too long, he said, “I can’t stop a worldwide health pandemic.”

Cameron told journalists, "Even in the midst of a pandemic, the constitution is not suspended."

Election update: Secretary of State Michael Adams appeared at the briefing to remind Kentuckians of election deadlines: Oct. 5 to register to vote, and Oct. 9 to apply for an absentee ballot. In-person, no-excuse, no-appointment voting begins under emergency regulations Oct. 13.

"This is going to be the most convenient election Kentucky has ever had," Adams said. "You can vote on Saturdays." He encouraged voters to vote early. Absentee ballots must be postmarked by Election Day, Nov. 3, and received by Nov. 6.

State Board of Elections Director Jared Dearing explained the absentee-ballot process and warned that misinformation about voting is circulating. The video of the news briefing is on Beshear's Facebook page; Dearing starts about 12 minutes into the video, after Lt. Gov. Jacqueline Coleman and Adams.

Beshear complimented Adams, Dearing and the election board: "Both these gentlemen are a credit to the Commonwealth, and I appreciate their work."

In other covid-19 news Thursday:

• The 11 fatalities from covid-19 were a 70-year-old woman and a 78-year-old man from Daviess County; three men, 75, 83 and 93, from Fayette County; an 84-year-old man from Franklin County; a 76-year-old woman from Jackson County; an 82-year-old woman from Jefferson County; two women, 77 and 90, from Madison County; and an 83-year-old woman from Webster County.
• Counties with 10 or more new cases were Jefferson, 89; Christian, 54; Fayette, 52; Warren, 34; Madison, 33; Daviess, 28; Union, 18; Ohio, 16; Hardin and McCracken, 15 each; Laurel, 14; Henderson. 12; Calloway, 11; and Barren, 10.
• In long-term-care facilities, the state reported 56 more cases among residents and 31 among employees, making the active-case totals 578 and 377, respectively, and three more deaths. Noting the staff cases, Beshear said, “I’m proud of them; it’s incredibly brave, and we appreciate them.” Asked if the facilities are a challenge, he said, “By and large the long-term-care facilities have been responsive when there's been a problem.”
  
• The state's daily report said 515 people were hospitalized with covid-19 in Kentucky, 113 of them in intensive care.
• Beshear said the second tranche of additional $400 a week in unemployment benefits was going out Thursday night and the last one will go out "in the next several days."
• Mary Harville, the newly appointed CEO of the Kentucky Lottery, said was doing well during the pandemic because casinos have been shut down. She said it ended the fiscal year June 30 "very well, with another record-breaking year."
  
• Coleman said three regions of the state "have pots of money waiting" for applicants to the Team Kentucky Fund, created to help people who have suffered financially due to the pandemic. “They are the Owensboro area, the counties that surround Louisville and the Big Sandy area,” Coleman said. Go to teamkyfund.ky.gov to apply.
• CVS announced it would open 19 new sites in Kentucky to offer free self-swab tests for the virus, in addition to seven it has already. The new ones will be in Benton, Bowling Green, Columbia, Crestwood, Danville, Franklin, Harlan, Harrodsburg, Hazard, Lexington (2000 Harrodsburg Rd.), London, Louisville (13900 Shelbyville Rd., 3997 Seventh St. Rd. and 5300 S. Third St.), Mayfield, Mount Sterling, Owensboro, Somerset and South Williamson. Patients must schedule in advance at CVS.com.
• A study reported by the Centers for Disease Control and Prevention in late June found that "U.S. adults reported considerably elevated adverse mental health conditions associated with covid-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use," and more contemplation of suicide. The CDC recommended that health agencies "increase intervention and prevention efforts to address associated mental health conditions."
• The Kentucky School Boards Association donated 80,000 cloth masks to the Family Youth Resource and Service Centers in local school systems.

Indiana Univ. professor explains why covid-19 will be with us well into 2021: 'We need to accept this reality and take steps to meet it'

Photo: MedpageToday

Aaron E. Carroll writes in an opinion piece for The New York Times that Americans need to stop expecting life to go back to normal next year, and shows why. 

Carroll opens by reminding us that Dr. Anthony Fauci, the director of the National Institute of  Allergy and Infectious Diseases, warned last week that covid-19 is likely to be hanging over our lives well into 2021. 

"We need to accept this reality and take steps to meet it rather than deny his message," Carroll writes. "Many Americans are resistant to this possibility . . . Unfortunately, their resolve is weakening right when we need it to harden. This could cost us dearly."  

He says this "unrealistic optimism" stems in part from the hope of a medical breakthrough --like Remdesivir or convalescent plasma or antibody treatments, but "most cases don’t benefit from these treatments. Further, none of these therapies can prevent infections or hospitalizations on a broad scale."

He reminds us that concerns about an unflattened curve isn't just about death, but is also about overwhelming the health-care system, which would lead to a situation where people would not have access to care for other life-threatening conditions. That is more of a threat in the flu season to come.

He says Americans are overestimating what a vaccine might do, cautioning that while it seems likely a vaccine will be approved this fall that will be "effective . . .  it’s very unlikely that this vaccine will be a game changer." 

He explains that while some vaccines provide nearly lifelong benefits, like the measles-mumps-rubella vaccine, the flu vaccine and others have to be taken every year -- and we still don't know what type the coronavirus vaccine is. He also points out that we still don't know what type of immunity it will provide, or if it will be more beneficial to certain populations than others. 

"Because of all these unknowns, we will need to continue to be exceedingly careful," using masks, social distance and restraint. "Too many of us won’t," he writes. "Too many will believe that the vaccine has saved them, and they will throw themselves back into more normal activities. That could lead to big outbreaks, just as winter hits at its hardest."

"We still need to figure out how to live in this new world, now, and that means embracing, finally, all the strategies for fighting the virus that many of us have resisted," he writes. "It’s not too late to invest in testing both symptomatic and asymptomatic people." 

 

He says the nation has failed to provide adequate testing and because it let shelter-in-place strategies go to early, "we can no longer rely on just symptomatic testing and contact tracing." 

He calls for more than a million tests a week and says the only way to do this is through "ubiquitous, cheap, fast tests that can be distributed widely to identify those at risk who don’t even know it." 

Further, he writes, "Those who are infected need to isolate, and their close contacts need to quarantine," noting that this is a challenge for many " because they need to work, or their housing is inadequate, or they need food and supplies delivered to them. We have failed to address these gaps."

He adds, "Those who need the most assistance are often those at highest risk for getting and spreading the coronavirus and for having the worst outcomes, and our government has not provided for them."

Carroll expresses doubt that the vaccine can be distributed widely and quickly, that "most people will get it (many won’t) and that we will succeed in prioritizing distribution so that those most at risk will get it first (flying in the face of decades of disparities in the way health care is distributed)." 

Further, he writes that the vaccine is just the beginning of a real coronavirus response and likely won't be the end" "Those who think that we have just a few more months of pain to endure will need to adjust their expectations." 

He also writes about the importance of masks. " We need to normalize mask-wearing. It’s a tragedy that this has become politicized and that this simple, safe and effective measure is in dispute. It’s about protecting others even more than ourselves. That such an action is now viewed as weakness is horrific."

And finally, he says, "We need a functioning scientific infrastructure to provide detailed and specific plans on how schools, businesses and institutions can open and operate safely. We also need a functioning Congress to fund whatever it takes to put those plans into practice."

'Don't be a jerk,' governor lectures, defending health departments; health commissioner 'brings the fire'' about need to wear masks

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear and two of his lieutenants unloaded today in defense of the state's public-health workers and stressed the need for Kentuckians to wear masks if they want the economy and schools to stay open.  

Early in his daily briefing, Beshear shared a quote from Centers for Disease Control and Prevention Director Robert Redfield who, after President Trump again questioned the efficacy of masks, told a congressional committee, "Wearing a mask remains the most important powerful public health tool we have," that it might offer more protection from the virus than a vaccine, and "If we did it for six, eight, ten, twelve weeks, we'd bring this pandemic under control." Trump said much more on the town hall; The Washington Post's Fact Checker gave him "four Pinocchios, over and over again."

Beshear, a Democrat governing a Republican state, highlighted Redfield's words to stress, again, that wearing a mask is not a political statement. 

"It's not a Republican thing. It's not a Democratic thing," he said. "It's a science thing that we know works. It's a public-health thing that we know works. It is a fact: wearing one of these helps protect the people around you."

Health commissioner holds a mask as he speaks at briefing

Near the end of the briefing, Beshear said Health Commissioner Steven Stack "brought the fire" when he let loose on those who still refuse to mask.

Stack, a physician, prefaced his remarks by saying surgeons wear masks for 10 to 12 hours at a time, so "I have a real difficult time understanding when grown adults are saying they can't breathe through a mask. I think they have misunderstood inconvenience with inability," he said. "It's just sort of like when you talk to your child and you say, 'I think you have your needs and your wants confused.' We have got to get over this inconvenience somehow being an infringement that is offensive to us." 

He added later, "And whether you are a Democrat or Republican, you're seeing that the White House folks, the Beshear folks, we're all saying the same thing. Whether it's Trump or Beshear, the science experts are delivering this same message." 

Mark Carter, who oversees the tracing of people who have had contact with Kentuckians who are infected with the coronavirus, spoke up for the many health department employees who are being criticized for their efforts to thwart the spread of the disease and report to the public about it.

Carter referred to recent news reports about health departments being criticized on social media; he was likely referring to the Lexington Herald-Leader's report that the Grayson County Health Department stopped posting covid-19 updates on social media because of "offensive and explicit comments," some of them accusing the department of "fear-mongering" as well as threats of violence. Other health departments told reporter Alex Acquisto that they had caught similar flak on social media. 

Carter, who once headed Louisville-based Passport Health Plan,said,  "I just have to tell you, having worked with these folks now since mid-May, these are local heroes. These folks, they're not politicians; they're . . . public-health experts who work tirelessly for their community." 

Carter reported that his contact-tracing program now has 1,240 staff working to trace the spread of the virus. He said with rare exceptions, the state has been able to keep up with contact-tracing demands.

Beshear also came to health departments' defense: "If you are threatening a local health department worker, if you are hiring a attorney to threaten them because you don't think somebody should have to be quarantined, if you are blowing them up and calling them a liar on Facebook, you're being a jerk. It's pure and simple. Don't be a jerk." 

He added, "If a crisis shows who we really are, it's showing they're really special, amazing people. If you're one of the people threatening them or treating them badly, you ought to think about what that says about you. The crisis is still going. So there's time. Let's make sure that we do things right." 

Asked about the mask mandate, Beshear said he would renew it. 

Daily numbers: Beshear announced 776 new cases of the coronavirus on Wednesday. He said 91 were age 18 and under. His news release said 13 were 5 or younger. 

“We continue to see this trend, where more and more kids are testing positive," Beshear said. He attributed the rise to increased testing and increased activities. Beshear cautioned that when making decisions, people should remember "kids can transmit this virus as easily as anybody else." 

The percentage of Kentuckians testing positive for the virus in the last seven days was 3.89 percent, which was under 4% for second day in a row. The rate through Tuesday was 3.97%. 

Beshear noted that the White House Coronavirus Task Force report shows Kentucky is heading in the right direction, especially in the positive-test rate. The report for Sept. 5-11 put fewer counties in the danger zones and only one metropolitan area, Bowling Green, in the more dangerous "red zone."

Other good news in the report is that Jefferson and Fayette counties are no longer in the red zone for the first time ever, having moved to the yellow zone. 

Communities in the red zone have weekly positive-test rates higher than 10 percent and more than one new case per thousand residents. Yellow-zone communities have new cases between 0.1 and 1 case per 1,000 and a positive-test rate of 5% to 10% -- or one of those, with the other in the red zone.

The state has classified Fayette County's covid-19 spread over the last seven days as "accelerated," not "critical," largely because the state's data, which lags the county's actual numbers, makes conditions look better than they are, Jeremy Chisenhall reports for the Lexington Herald-Leader.

 

State numbers show Fayette County had 16 new cases per 100,000 residents, placing it in the second-worst classification for incidence rate, but the Lexington-Fayette County Health Department counts 35.2 cases per 100,000. The discrepancies in county and state data have been prevalent throughout the pandemic, Chisenhall reports.

Beshear reported eight new deaths from covid-19 Wednesday, bringing the state's death toll to 1,082. Six deaths were attributed to long-term-care facilities. 

In other covid-19 news Wednesday:

• Today's fatalities were a 49-year-old woman and a 76-year-old man from Christian County; a 66-year-old man from Fayette County; an 84-year-old woman from Greenup County; a 74-year-old man from Jackson County; two men, 68 and 83, from Montgomery County; and an 88-year-old man from Union County.
• The state's daily report said 565 people were hospitalized in Kentucky with covid-19 and 125 of them were in intensive care. Beshear said 75 were on a ventilator. 
• Counties with 10 or more new cases were Jefferson, 137; Warren, 37; Madison, 33; Bullitt and Fayette, 28 each; Oldham, 25; Hardin, 22; Daviess, 21; Estill, 18; Campbell, Christian, and Logan, 16 each; McCracken, 15; Caldwell and Laurel, 14 each; Barren and Whitley, 13 each; Boone, 11; and Greenup, Henderson, Hopkins, Martin and Muhlenberg, 10 each. 
• In long-term care, Beshear reported 18 more residents and 22 more employees had tested positive for the virus and 526 residents and 352 employees have an active case. The long-term care daily report shows 606 residents and five employees have died from the virus.
• The K-12 school report shows 41 more students and six more employees have tested positive for the virus and 349 students and 162 employees have active cases. 
• The college and university report shows four more students have tested positive for the virus and active cases in 1,088 students and 49 employees. 
• Kentucky High School Athletic Association Commissioner Julian Tackett said at the group's Board of Control meeting that two schools in south-central Kentucky are reportedly disregarding the mask mandate, and across the state there are problems with spectators. They did well at first, he said, but “as the game went on, they didn’t necessarily do so well” and “they’re gonna jeopardize” future games being played or their ability to attend them. Tackett said there was another reported case in which coach knowingly let a positive-test student play, Dave Baker of WKYT reports.
• Thousands more Americans than usual have died of dementia since the pandemic began, suggesting that “the very strategy of isolation that’s supposed to protect” such people is killing them, The Washington Post reports: “Doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years. Social and mental stimulation are among the few tools that can slow the march of dementia. Yet even as U.S. leaders have rushed to reopen universities, bowling alleys and malls, nursing homes say they continue begging in vain for sufficient testing, protective equipment and help.”