Free webinar, "Shifting the Lens: Covid-19 Policy Lessons for Reducing Kentucky's Health Inequities," Nov. 19; pre-register

Health officials will explore what's behind the inequities that have made African Americans and other people of color disproportionately affected by the novel coronavirus at a webinar hosted by Kentucky Medical Association, the Foundation for a Healthy Kentucky and the University of Kentucky College of Public Health.

According to the Centers for Disease Control and Prevention, covid-19 hospitalization rates among non-Hispanic African-Americans and Hispanic or Latino people are both about 4.7 times the rate of non-Hispanic white people.

Statewide, as of Nov. 6, African Americans accounted for 11% of Kentucky's coronavirus cases and nearly 12% of covid-19 deaths, even though they comprise only 8.5% of the state's population. Hispanics accounted for 9% of cases and 3% of covid-19 deaths, and have nearly 4% of the population.

The webinar, "Shifting the Lens: Covid-19 Policy Lessons for Reducing Kentucky’s Health Inequities" will be held Thursday, Nov. 19 from 1:30-3 p.m. ET.

Presenters will speak to practices and policies that can be put in place, both short- and long-term, to improve health outcomes for persons of color in the commonwealth, says the release.

“We need to fully understand the reasons underlying the more devastating impact that covid has wreaked on our African American community, and implement the policies and practices that will help allow them to reach their best health,” Ben Chandler, president and CEO of the foundation. The program will open with two Black Kentuckians who have had covid-19.

The presentations include: “The Impact of Covid-19 on Racial and Ethnic Minority Groups," presented by Dr. Connie White, deputy commissioner for clinical affairs, state Department for Public Health; “Ensuring that Telemedicine Bridges, Rather than Deepens, the Gulf," by Dr. William C. Thornbury Jr., general family-medicine practitioner from Glasgow; and “Reducing Chronic Disease in African American Communities," by Dr. Karen Krigger, M.D., director of health equity at the University of Louisville School of Medicine.

Dr. Wayne Tuckson, host of "Kentucky Health" on KET, will moderate the program. Click here to register for the free program. 

With 2,318 new cases, Ky. sets a new record; other key metrics are bad too, and more people don't help with contact tracing

Thursday's red-zone ratings are intended to guide behavior for the coming week. (State chart)

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear announced 2,318 new cases of the coronavirus Thursday, setting a record for the highest number of cases found on a single day. 

And though that number may include some backlog from the day after Presidential Election Day, a holiday, Beshear noted that every other metric used to measure the virus's impact on Kentucky -- deaths, positivity rate, hospitalizations, and red-zone counties -- also took a turn for the worse. 

"Today again shows that concerning escalation that means we just need more out of everybody," Beshear said, noting that 80 of the 120 counties are in the state's "red zone," meaning they have averaged at least 25 new cases per 100,000 residents in the last seven days. That's up from 69 last week.

"I will say, I'm seeing more communities coming together on the red-zone recommendations and so I have certainly hope moving forward, but for any community right now that's saying 'Eh, we don't really need to do those recommendations. We just need to say people please wear your mask and wash your hands', that's not enough. It's got to be a concerted community effort everywhere that this virus is out of control."

The governor said two-thirds of counties in the red zone "means virtually the entire state is seeing a significant surge. It means for these red counties, it's dangerous out there. It's dangerous to you personally. It's dangerous to those around you. It's dangerous to especially those the most at risk from this virus."

This is the second week Beshear has asked businesses and individuals in red-zone counties to follow a nine recommendations that, among other things, call on employers to allow people to work from home  and ask individuals to avoid gatherings of any size and stay home as much as possible. Other recommendations call on schools to have remote-only instruction next week, and tell long-term care facilities to further restrict visitation. 

"We know what will work," Beshear said. "We just need everybody, everybody willing to do it."

Asked if it is time to go back to mandates, instead of recommendations, Beshear said, “I don’t think, at this moment, it’s an issue of more mandates. It’s an issue, that's fair to say [of] encouragement and enforcement to get people to wear the darn masks.”

He later said, “If you're not wearing a mask, I really want you to wear a mask. And I’m not trying to tell you to do it because I want to invade your liberty. I’m doing it because I want you to survive this thing and not harm anybody else.” 

The state's case-incidence-rate map, which is updated daily, has 39 counties in the orange zone, with 10 to 25 new daily cases per 100,000 people; only two in the yellow zone, with 1 to 10; and none in the most desirable green zone, with less than one case per 100,000. 

Kentucky Health News graph

More daily numbers: For the second day in a row, Kentucky had record numbers of people in the hospital and intensive care for covid-19, with 1,102 hospitalized, 291 of them in ICUs and 129 of those on ventilators.

And the percentage of Kentuckians who tested positive for the virus in the past seven days has gone up again. It is now 6.5%. 

Beshear announced that 20 more Kentuckians had died from covid-19, bringing the state's death toll to 1,534. 

Dr. Mohammad Jawed

Today, he honored the life of Dr. Mohammad Jawed of Corbin, who died Oct. 31 at age 59 after battling covid-19 for over a month at the University of Kentucky Medical Center. He said Jawed was the loving father to three daughters, a beloved husband and one of our frontline health care workers.  

“He humbly served the southeastern Kentucky community for over 23 years as a well-respected physician,” said Beshear. “He is a true hero, battling multiple myeloma, a cancer that affected his plasma cells, over the last two years while continuing to work as a frontline health care worker, even during covid-19. He dedicated his life to supporting his family and caring for his patients.” 

Contact tracing concerns: Beshear spent a good bit of his daily briefing encouraging Kentuckians to pick up the phone if they are called by a health department employee tracing the contacts of infected people. He said that in the 20-day period that ended Oct. 15, tracers were only able to reach 62% of people who were considered at high risk. 

Asked about those who are reluctant to answer because that would lead to a quarantine that would put them out of work for 14 days, Beshear said employers have been encouraged to provide paid sick leave, and should, because "If you don't, there are some people who are going to make the decision to come to work" when they are sick, spreading the virus to other employees.

To show that paid sick leave is in employers' best interests, he said four people at one workplace were all at work the day the health department informed them they had tested positive for the virus. "There are now dozens of people from that work quarantined," Beshear said. "If you provide that paid leave, if you just do the right thing here, you protect other workers around you."  

Prison report: J. Michael Brown, Beshear's executive cabinet secretary, said there have been 1,255 cases of the coronavirus among inmates in the state's prison system, with 214 currently active and two of those in the hospital. He said there have been 221 staff cases, with 34 of those active. Brown said most of the active cases are at two facilities: Little Sandy Correctional Complex in Elliott County and Bell County Correctional Facility near Pineville. 

Brown said the state would send 50,000 of rapid, point-of-care tests provided by the federal government to prison facilities to test staff. Asked about those tests' high rates of false positive results, and the fact they were not designed to test people without symptoms, Beshear said they were well aware of those limitations. He said they would consider the tests a tool to help monitor the spread of the virus and that anyone who tested  positive on one of them would then get a more accurate laboratory-based test. 

In other covid-19 news Thursday: 

• Counties with 10 or more cases were Jefferson, 444; Fayette, 177; Kenton, 95; Hardin, 82; Boone, 55; Nelson, 52; Boyd, 50; Barren and Campbell, 49 each; Bullitt and Daviess, 47 each; Madison, 44; Floyd, 37; Christian, 35; Laurel and Warren, 34 each; Grayson, 29; Jessamine, 28; Graves and Montgomery, 27 each; Marion, 25; Breckinridge, Greenup, Henderson and McCracken, 24 each; Calloway, 23; Monroe, 22; Oldham,21; Shelby, 20; Hopkins and Perry, 19 each; Marshall and Taylor, 18 each; Pike, 17; Clay, Hart and Whitley, 16 each; Knox, Meade, Mercer and Pulaski, 15 each; Lewis, McLean and Powell, 13 each; Bell, Boyle, Grant, Scott and Woodford, 12 each; Harlan, Ohio and Spencer, 11 each; Adair, Carlisle, Estill, Larue, Muhlenberg, Washington and Wayne, 10 each.
• Today's fatalities were an 81-year-old woman from Boyd County; a 71-year-old man from Breckinridge County; a 52-year-old man from Bullitt County; an 83-year-old man from Carroll County; two women, 86 and 94, from Christian County; a 76-year-old man from Daviess County; a 75-year-old woman from Fayette County; four women, 78, 83, 90 and 102, and three men, 62, 78 and 80, from Jefferson County; a 93-year-old man from Laurel County; an 81-year-old man from Marshall County; an 81-year-old woman and an 83-year-old man from Martin County; and a 71-year-old woman from Muhlenberg County.
• Beshear especially encouraged Kentuckians in red-zone counties to get tested. Click here to find a location near you. 
• In long-term care, 130 new residents and 74 new staff have tested positive for the virus, with 1,098 active cases among residents and 687 among staff. There have been 921 resident deaths and six staff deaths attributed to covid-19.
• As of Nov. 4, the K-12 dashboard says 387 students and 189 staff have tested positive for the virus this week, with 3,163 students and 521 staff quarantined. Click here for the K-12 public health report, which has confirmed cases. 
• The college and university report shows 567 student and 10 employees have tested positive in the past 14 days, with 77 students and one employee reported today. 
• In a story titled "Kentucky county long unscathed by coronavirus suffered deadly spike in October," Bill Estep of the Lexington Herald-Leader tells how Lee County went from being one of the last counties to have a documented case of the virus, and having only 15 cases in early October, to having a rate of 166 per 100,000 residents Oct. 28. The community has also had nine deaths attributed to covid-19. “We exploded,” Judge-Executive Chuck Caudill Jr. told Estep. “One of my worst fears came to fruition.”
• The Lee County Care & Rehabilitation Center has driven the outbreak and accounts for all of the deaths. While it is unclear how the outbreak started in the nursing home, what is clear is that the outbreak increases the risk of spread in the community, since employees live and shop in the area and residents leave the facility for medical appointments, said Scott Lockard, public-health director of the Kentucky River District Health Department.  
• Like the rest of the state, case numbers in Fayette County continue to climb, and contact tracers, who are monitoring 1,000 Lexington residents daily, are being stretched thin, Jeremy Chisenhall and Beth Musgrave report for the Herald-Leader.
• As Thanksgiving approaches, having the holiday like normal is "probably the most dangerous thing" to do in Louisville right now, top Louisville health official Sarah Moyer, told WDRB. Moyer, a physician, said those who choose to travel for the holiday should not rely on a last- minute test to determine if they are free of the virus. "If you really want to be around friends and family, I would start now with quarantining," Moyer said. "Then if you do happen to be in a big gathering and aren't sure if you got exposed afterwards, I'd ask people to quarantine afterwards for two weeks before they came back to work or school or wherever else in the community, especially if they travel."

Beshear rejects Senate leaders' request for private meeting with health commissioner; Stivers criticizes governor's approach

By Al Cross
Kentucky Health News

Gov. Andy Beshear and state Senate President Robert Stivers clashed Thursday over the governor's handling of the novel-coronavirus pandemic and his relationship with the legislature.

Stivers and House Speaker David Osborne have complained about a lack of information and explanation from Beshear, and have talked about limiting the emergency powers he has used against the pandemic.

Asked for an update on that Thursday morning, Stivers said Senate leaders had received no response to a letter they sent Beshear a letter six weeks ago asking for a private meeting with Health Commissioner Steven Stack.

"We need to be very measured in what we do" with emergency powers, Stivers said. "The biggest component of this is having knowledge of what’s being done and why." For example, he said the state has spent $20 million on tracing contacts of infected people, and legislators would like to see what sort of gatherings are most responsible for the spread of the virus.

Stivers said that when legislators have been able to talk "one on one" with members of Beshear's administration and "they’ve been very responsive," but "It seems his internal circle has a bunker mentality."

Stivers became Senate president when Beshear's father, Steve Beshear, was governor. "He is not his dad," Stivers said. "He does not have the ability to communicate or develop relationships like his dad."

Asked about Stivers' request, Beshear chose to reply at his 4 p.m. briefing.

"Doctor Stack has testified in front of legislative committees for the past four or five months; he hasn’t been treated very well for a guy that has left a lucrative practice and given his all, heart and soul, every day," Beshear said. Stack is an emergency physician and a former president of the American Medical Association.

Beshear added that it would be "virtually unprecedented" for a party's entire leadership to meet privately with a member of the administration "without anyone else there with them. It's something I would never ask for one of their employees. We are happy to work with them; it's just got to be in a positive way."

The governor said several other chief health officers in other states have resigned "because of the way they’ve been treated, and I gotta make sure that doesn’t happen here; he is too valuable, he has given too much."

He concluded, "We’re happy to various briefings if they are requested in a positive manner, with individual members of the administration that can provide various responses; non willing to play closed-door meetings where gotcha can be played."

Stivers said earlier that a private meeting with Stack would allow frank discussion of the pandemic without public statements that might alarm people.

Ky. is in the White House task force's worst zone for coronavirus as cases keep going up; advice already implemented in state

White House Coronavirus Task Force chart; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

Again, Kentucky is in the worst danger zone for its coronavirus case numbers, with the 18th highest rate in the country, according to this week's White House Coronavirus Task Force report. 

Being in the White House red zone for cases means the state has 101 or more new cases per 100,000 residents. Kentucky's cases have been increasing for weeks.

The state had 257 new cases per 100,000 in the latest report, which covers Oct. 24-30. That was up from 185 per 100,000 the prior week, and 158 the week before. The national average is 165 per 100,000.

The report puts 91 of the state's 120 counties into one of the danger zones, down from 93 the previous week. Eight fewer counties, a total of 61, were in the top two danger zones. 

The number of counties in the red zone decreased from 47 to 44; the orange zone decreased from 22 to 17; and the yellow zone grew from 24 to 30. 

The report says 76% of Kentucky counties had a moderate or high level of community transmission, with 37% of them having high levels. 

Gov. Andy Beshear noted that the task force's recommendations to thwart the spread of the virus line up with the steps Kentucky has taken.

"Its recommendations more than ever tell us that we are on the right track and that this White House supports the steps we're taking here in the commonwealth," he said. "That means that we have bipartisan agreement, state and federal as well, with all the health experts pointing to the same things, saying that if we can come together, especially with our red zone recommendations and everything that goes into it, that the White House believes that is our best chance to succeed."

For example, the White House recommendations call for high-visibility, color-coded community action plans; limiting restaurant indoor capacity to less than 50%, and restricting hours until cases and the test positivity rate decrease; and asking people to forgo social gatherings beyond their immediate household. It also recommends that people always wear a mask in public, including teachers and students in K-12 schools.

The report also calls on the state to focus its efforts on finding asymptomatic sources of spread and to prioritize the use of the the Abbott Laboratories BinaxNOW diagnostic test, which is a rapid, point-of-care test, which has been provided by the federal government to determine trend data on where the virus is and as a way to direct mitigation, with a need to use a more accurate lab test confirm any positive test in low-positivity areas. Beshear has said the state has directed most of these tests to congregate settings, such as schools, prisons and nursing homes.

The Food and Drug Administration issued an alert Nov. 3 warning that the rapid antigen tests, like the ones provided by the federal government, can produce incorrect positive results. The alert says problems are more likely in populations with low prevalence of infection, or when the test is improperly performed.

The White House report put the state in the federal orange zone for the percentage of residents testing positive for the virus, indicating a rate between 8 % and 10 %, with the 19th highest rate in the country. The state uses a different data stream than the White House that produces lower rates. On Wednesday, Beshear said the rate was 6.3%.  

The report says, "There is a continued increase in cases, hospitalizations, and fatalities nationally, spreading southward from the coldest climates as the population moves indoors and cases increase exponentially." 

White House Coronavirus Task Force maps; for a larger image, click on it.

Communities in the red zone had positive-test rates higher than 10% and more than 1 new case per 1,000 residents. Those in the orange zone had 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 for the red zone. Yellow-zone communities have new cases between 0.1 and 0.5 cases per 1,000 and a positive-test rate of 5% to 8% -- or one of those, with the other in a higher zone.

Ky. moves above average for nursing-home virus cases and deaths, largely because of community spread, officials say

Kentucky Health News graph; case numbers are from initial, unadjusted daily reports

By Melissa Patrick

Kentucky Health News

 

Gov. Andy Beshear and his lieutenants cited the rising number of nursing-home coronavirus cases and deaths in nursing homes Wednesday in their latest effort to stop the escalation of the pandemic in Kentucky.

"We're seeing an alarming increase in long-term care facilities because we're seeing an alarming increase in community spread," Health Secretary Eric Friedlander said during Beshear's daily briefing. "It's real. I've often reported to you that we've been below the median for the country, in terms of case rate in terms of deaths in facilities. We are just now passing that median, and that is because of community spread." 

As of Oct. 18, a Centers for Medicare and Medicaid Services report shows Kentucky's nursing homes ranked 31st in virus-case rates, with 224.8 cases per 1,000 nursing-home residents, and 26th in deaths, with 42.5 deaths per 1,000.

Friedlander walked through the many protocols and programs the state has implemented to slow the spread of the virus in these facilities, but he said that when the spread is so rampant in communities, it's going to get in.

Health Secretary Friedlander urged mask wearing
to stop the spread of the virus to nursing homes.

"And you know what we can do to stop that?" he asked while holding up a mask. "We can wear one of these. We can wash our hands. We can observe the guidelines that the governor talked about around red counties. It makes a difference. We can protect our seniors. All we have to do, all we have to do is this," he said as he put on his mask. 

On Wednesday, the long-term care daily report showed 1,017 residents and 648 employees had an active case of the virus, with 116 new resident and 75 new staff cases reported today. Beshear said 16 additional deaths can now be attributed to covid-19 in these facilities, for a total of 908 resident and six staff deaths, or 60% of the state's covid-19 deaths.  

Beshear announced 1,653 new cases of the coronavirus on Wednesday, calling the number "way, way too many." 

Asked by Kentucky Health News if he had ruled out taking any further measures to thwart the spread of the virus, Beshear said, "We haven't ruled anything out, but we have not received any public-health advice, either from our federal experts or our state experts, that at this point has suggested any new additional measures beyond the red-zone recommendations."

Those recommendations, which include things such as canceling gatherings and allowing employees to work from home in counties with high case rates, have been in place for three days. Beshear said that he thinks the "vast majority of those counties" in the red zone are working to follow them and that they were working to encourage those that aren't. 

He added that some places that have disagreed with him over other guidelines are following these "because the problem has gotten that significant." 

Beshear renewed for another 30 days his mandate requiring people to wear masks when around other people outside of their homes, and cited the exit poll for Tuesday's election, which found that 51% of Kentucky voters said they strongly favored the mandate and 20% said they somewhat favored it.

The poll also found that 33% of voters said they or someone in their household "lost a job or income because of the coronavirus pandemic."

Health Commissioner Steven Stack pointed out that hospitalizations for covid-19 in Kentucky have doubled since the end of September, and intensive-care use by such patients has more than doubled.

The Kentucky Hospital Association reported Tuesday that 85 percent of the beds in its members' intensive-care units are occupied, 18 percent of them by covid-19 patients. 

Kentucky Hospital Association graphic, updated from time to time at https://www.kyha.com.

“One of the concerns we have related to hospitals is not that we will first run out of bed space but that we may not have enough health-care workers to staff all those beds,” Stack said.

Stack, a physician, urged Kentuckians to follow all public-health guidance, including wearing a mask and social distancing, saying that the more community spread there is, the more likely health-care workers and the general population will become exposed to it. 

Kentucky had record numbers of people in the hospital and in intensive care for covid-19 Wednesday, with 1,066 in the hospital, 286 in ICUs and 125 on ventilators. All of these numbers were up from yesterday. 

Stack added that Kentucky has "an alarmingly large number of red counties" right now, which means they have had at least 25 new daily cases per 100,000 residents in the last seven days. And some counties, he said, are reporting upwards of 91 cases per 100,000. What this means, he said, is that "at that level of transmission, the disease is spreading rapidly and this is a very real threat." 

The percentage of Kentuckians who tested positive for the virus in the past seven days continues to rise. It is now 6.3%. 

Beshear said 11 more Kentuckians had died from covid-19, bringing the state's death toll to 1,514. 

The fatalities were two women, ages 79 and 96, from Hancock County; three women, 60, 81 and 89, and four men, 59, 71, 72 and 72, from Jefferson County; an 82-year-old woman from Knott County; and a 91-year-old woman from McLean County.

In other covid-19 news Wednesday: 

• Counties with 10 or more new cases were Jefferson, 332; Fayette, 159; Kenton and Warren, 64 each; Laurel and McCracken, 56 each; Boone, 46; Campbell, Daviess and Hardin, 38 each; Christian, 34; Floyd, 31; Bullitt, 28; Henderson, 25; Caldwell, 24; Barren and Montgomery, 22 each; Graves, Grayson, Greenup and Shelby, 17 each; Lincoln and Nelson, 16 each; Franklin, 15; Madison, Monroe and Pike, 14 each; Scott, 13; Hart, Marshall, Oldham, Simpson and Spencer, 12 each; and Breckinridge, Pulaski and Woodford, 10 each.
• The K-12 public health report of confirmed cases showed 751 students and 363 staff tested positive for the virus in the last 14 days, with 108 students and 37 staff reported today. Click here for the K-12 dashboard.
• The college and university report shows 554 students and nine staff tested positive for the virus in the last 14 days, with 58 students and two staff being reported today. 
• Beshear signed an executive order to continue allowing pharmacists the ability to dispense 30-day refills.
• Beshear announced a new company is scheduled to open in Paris that will produce medical-grade gloves. The company, U.S. Medical Glove Co. LLC, is expected to help provide Kentucky and other states with its ongoing need for personal protective equipment. 
• Norton Healthcare and Baptist Health Lexington have been chosen as partner sites for a clinical trial of the coronavirus vaccine, WDRB reports. A clinical trial from Janssen is being led by the University of Kentucky's Center for Clinical and Translational Science in Lexington. Anyone interested in volunteering for the trial can click here to fill out a prescreening questionnaire. Officials told WDRB that completing the questionnaire does not obligate the person to participate in the trial and that volunteers will be compensated. 
• Starting Monday, Norton will begin seeing patients at a drive-thru location at the corner of Breckenridge Lane and Taylorsville Road, Lexie Ratterman reports for WDRB. The facility has two drive-thru bays that will offer diagnostics testing, vaccinations and lab work seven days a week with a Norton doctor referral, she reports. The hospital's CEO told WDRB that the idea stemmed from an effort to find innovative ways to keep patients out a waiting rooms, while providing full access to health care.
• A review of 36 published studies on the coronavirus, covering thousands of patients, found that 18% had gastrointestinal symptoms, such as loss of appetite, nausea, vomiting, diarrhea and stomach pain, along with some other more common symptoms, like fever, cough, fatigue and labored breathing. And about 16% of the patients had only gastrointestinal symptoms and nothing else, reports the Lexington Herald-Leader. 
• An analysis of about 400,000 women covid-19 patients, aged 15-44, found that they were more likely than non-pregnant women to be admitted to intensive care, to be put on a ventilator, and to receive extra-corporeal membrane oxygenation, a process by which blood is pumped outside the body to a machine that removes the carbon dioxide and then sends the oxygen-filled blood back to the body, bypassing the heart and lungs, allowing them time to rest and heal. The study also found that the pregnant women had a 70% increased risk of dying, compared to those who were not pregnant, according to a report by the Centers for Disease Control and Prevention. The Herald-Leader reports on this study. 
• The U.S. Food and Drug Administration issued an alert Nov. 3 warning that the rapid antigen test, like the ones provided by the federal government, can produce incorrect positive results. The alert says problems are more likely in populations with low prevalence of infection, or when the test is improperly performed. This comes after Louisiana officials recommend against using the rapid test for asymptomatic people and that anyone who gets one of these tests  be informed of its limitations, Crain's New York Business reports. 
• The U.S. for the first time surpassed 100,000 new coronavirus cases in a single day, The Washington Post reports.

Kentucky exit poll gives Beshear slightly better grades than Trump on handling the pandemic; sharply divided views otherwise

The exit poll of Tuesday's election in Kentucky gave Gov. Andy Beshear a slightly better grade than President Donald Trump for handling the novel-coronavirus pandemic, and found sharply divided opinions about the pandemic between those who voted for Trump or former vice president Joe Biden.

Asked if they approve or disapproved of the way Trump has handled the pandemic, 57% of Kentucky voters said they approved and 42% disapproved, but 15% of those who disapproved still voted for him.

Beshear's ratings on handling the pandemic closely resembled a poll taken Oct. 7-15 and released Oct. 21; 63% in the exit poll said they approved, and 36% said they disapproved. Both categories were about evenly divided between "strongly" and "somewhat." Biden carried Beshear's approvers 53% to 46% and the strong approvers 69% to 30%, while Trump carried the other groups.

Just over half of voters, 55%, said they thought the coronavirus in the U.S. is at least "somewhat under control," and 45% said it's "not at all under control." As might be expected, Trump carried the former group 87% to 10%, while Biden carried the latter group 68% to 30%.

Only 4% of voters said the pandemic is completely under control, while 16% said it is mostly under control and 35% said it is somewhat under control.

The poll asked, "Regardless of whom you support, would you say Joe Biden or Donald Trump is better able to handle the coronavirus pandemic?" Almost half, 48%, chose Trump, while 36% chose Biden; 10% said neither and 4% said both were equally able.

Trump has clashed with the nation's top infectious-disease expert about the pandemic. Voters were asked, "Do you approve or disapprove of the way Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has handled the coronavirus pandemic? Almost two-third, 65%, approved, and 33% disapproved. Among approvers, Biden won 51% to 47% but that was within the poll's error margin of plus or minus 2.2 percentage points.

The poll was conducted for The Associated Press by NORC (formerly the National Opinion Research Center) at the University of Chicago, online and by phone, largely in the days before the election. The Kentucky poll surveyed 2,908 voters. The numbers will be updated as more data becomes available, and will eventually be adjusted to match the actual vote count.

As coronavirus cases escalate, officials warn hospitals could reach capacity; say it's time to aggressively minimize contacts

State Department for Public Health map; for a larger version, click on it.

By Lisa Gillespie
Kentucky Health News

As coronavirus cases continue to escalate in Kentucky, Gov. Andy Beshear said hospitals are beginning to see big increases in the number of patients with covid-19, and warned that if the trend continues they could soon run out of beds for patients.

“If we cannot control the increase, then it is a real possibility that we could face some real concerns with capacity – having enough beds – here in Kentucky,” Beshear said at his daily briefing.

Beshear said 1,037 people were hospitalized with covid-19 in Kentucky on Tuesday, a new record, with 259 in intensive care and 116 on a ventilator. He added that since the time the report was prepared for him, 20 more patients had been admitted to intensive care. He called the increases "very concerning." 

Earlier in the day, Louisville's top health official, Dr. Sarah Moyer said the city's hospitalizations are about three and a half times higher in the first days of November than in early October, and that number is expected to increase rapidly in coming weeks, Kate Stringer reports for WDRB. 

Moyer said it's time for people to cancel events and gatherings, to reduce in-person shopping, to order out instead of dining in, and for employers to allow their employees to work from home if possible. In other words, it's time for Kentuckians to stay home. The recommendations reflect those that the state makes for counties in its "red zone," which includes Jefferson County.

"If we aren't starting to be more aggressive now, our hospitals are going to be over capacity in the next two, three, four weeks," Moyer said. "We have so much covid in our community that the regular risk reduction measures like wearing a mask, washing your hands, staying six feet apart are not enough to curb the spread alone."

Asked about this, Beshear said several hospitals across the state are reporting that they are near capacity, noting that the Barren County Progress reported that the Glasgow hospital is about 80 percent full. 

“We’re seeing, in certain areas, hospital systems becoming taxed,” Beshear said. “And just about every hospital system is reporting to us that the numbers of hospitalized Kentuckians is going up, and it's starting to go up a lot faster.”

He said Kentucky has a plan for how to expand its number of hospital beds if needed, but if the state can't get control the increase in cases, it could end up like Texas, Florida and New York, where hospitals have filled up and patients had to go to temporary field hospitals. 

Beshear commended the state's hospital administrators, saying they have been responsible and proactive in their efforts to ensure adequate capacity. 

“They will start dialing back some of the other activities they engage in to make sure they have the capacity,” Beshear said. “From all of our health care warriors -- from the person doing admissions to the CEO -- we have seen a real commitment when it comes down to do what it takes to defeat this virus.”

Beshear again called on people, institutions and governments in counties in the red zone to follow the state's recommended precautions to slow the spread of the virus, calling this a comprehensive plan that ultimately places the responsibility on individual communities.

"It's not enough for me to stand up here and say, 'We can't be doing that.' It's not," he said. "We need to make sure that when people are thinking about their actions, they're thinking about their neighbors."

Beshear said no matter who wins the election, the covid-19 pandemic will still be surging on Wednesday.

“When you wake up tomorrow, I hope you realize that no matter who wins or who loses, we’re still at war with this virus,” Beshear said. "This virus isn’t going away the day of the election; the day of the election it is continuing to surge. So let’s remember tomorrow, we’re all Americans, we're all  Kentuckians, all of our actions impact everybody else." 

Beshear reported 1,795 new coronavirus cases, the fifth highest day yet. The top four days, and the sixth largest, all occurred last week. (Those rankings do not count a day that a backlog of more than 1,400 cases in Fayette County pushed the daily total above 2,300.)  

Today's case numbers bring the seven-day rolling average to 1,695, also a new record, beating yesterday by two.

The state’s positivity rate – or the share of people who tested positive among all those who received a coronavirus test in the past seven days – was 6.24%. 

Beshear announced 11 new deaths from covid-19, bringing the state's death toll to 1,503. 

"That is a grim milestone," he said. "And it appears that we are going to lose a significant number of additional Kentuckians unless we pick it up, unless we do better." 

In other covid-19 news Tuesday: 

• Today's fatalities were a 71-year-old man from Hardin County; four women, 86, 91, 92 and 94, and a 59-year-old man from Jefferson County; an 88-year-old woman from Monroe County; a 76-year-old man from Montgomery County; an 82-year-old woman and a 71-year-old man from Muhlenberg County; and a 78-year-old man from Ohio County. 
• Counties with 10 or more new cases were Jefferson, 414; Fayette, 107; Warren, 68; Laurel, 67; Boone, 57; Kenton, 50; Campbell, 40; Hardin, 40; Madison, 38; Daviess, 36; Pike, 36; Bullitt, 31; Whitley, 31; Henderson, 25; Nelson, 24; Floyd, 23; Hopkins, 21; Rowan, 21; Jessamine, 20; McCracken, 20; Breckinridge, Christian, Knox and Montgomery,19 each; Boyd, Magoffin and Monroe, 17 each; Barren and Greenup, 16 each; Caldwell and Oldham, 15 each; Franklin, 13; Harlan, Pulaski, Scott and Taylor, 12 each; Bell, Marion and Rockcastle, 11 each; and Graves, Jackson, Marshall, Trigg and Webster, 10 each.
• Beshear said 255 of the 1,795 cases reported to day were in children 18 and under: "We continue to see not only a surge in the virus, but more and more of our kids by percentage getting it." 
• A Nov. 2 report from Deborah Birx, coordinator of the White House Coronavirus Task Force, "sounded alarms Monday about a new and deadly phase" in the pandemic, The Washington Post reports.  “This is not about lockdowns … It’s about an aggressive balanced approach that is not being implemented," says the internal White House report that challenges many of President Trump’s pronouncements, including his claims that the country is "rounding the turn." 
• What is “essential at this time point,” the report said, is “consistent messaging about uniform use of masks, physical distancing and hand washing with profound limitation on indoor gatherings especially with family and friends.” It adds: “This is about empowerment [sic] Americans with the knowledge and data for decision-making to prevent community spread and save lives.”
• The Post says Birx’s report "goes to pains to dispute Trump’s false claims that coronavirus cases are increasing only because of increases in testing," noting that although testing is flat, a rising number of tests are positive, suggesting “community spread is much worse than is evident by current [measurements].”
• The Post reports that officials have described Birx as frustrated with Trump's new medical adviser, Scott Atlas, a neuroradiologist with no infectious-disease experience, who has called for allowing people to return to daily living without restrictions to hasten herd immunity and bolster the economy. They say she has challenged these views in task force meetings, saying this would lead to thousands of deaths. 
• The latest Children and Covid-19 State report, by the American Academy of Pediatrics and the Children's Hospital Association, says that as of Oct. 29, 61,447 new children had been infected by the coronavirus, making up 11% of U.S. cases. -- about 1,134 cases per 100,000 children. The report says this is the highest since the pandemic began. From Oct. 15 to 29, 111,744 new youth cases were reported, a 15% increase. Hospitalizations and deaths remain very low.  As of Oct. 29, the report says 15.7% of Kentucky's cases have been in people under 20, with a rate of 1,421 per 100,000 children. 
• Findings from an ongoing study that includes systematic and daily follow-ups has found that 53% of people living with a person who was infected with the virus contracted it themselves, and that cases can originate from both children and adults. The study, published by the Centers for Disease Control and Prevention, also found that at least 75% of secondary infections occurred within five days of the first person in the home experiencing symptoms. “In the absence of an efficient approach for identification of infections without regard to symptoms, these findings suggest that prompt adoption of isolation measures as soon as a person feels ill might reduce the probability of household transmission,” the researchers said a Vanderbilt University release.

'This week is absolutely critical,' Beshear says in announcing 1,032 new coronavirus cases, a Mon. high; positivity rate 6.25%

State Department for Public Health chart, relabeled by Kentucky Health News; click it to enlarge

One of the slides Gov. Andy Beshear
displayed at his daily briefing Monday

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear announced 1,032 new cases of the novel coronavirus Monday, setting a record for the highest number reported on the day of the week that case numbers are usually low.

Beshear also announced that the share of Kentuckians testing positive for the virus in the last seven days was 6.25 percent, the highest since June 1, and five of the last seven days have set records for single-day case numbers.

State chart, relabeled by Ky. Health News; click to enlarge

And all that after an official Monday-through-Sunday reporting week with the highest number of cases yet, 11,774.

“In America and in Kentucky . . . this is getting increasingly more and more dangerous. The newest numbers are absolutely staggering," Beshear said at his daily briefing, now being held remotely. 

Nationwide, with more than 9 million cases and 231,000 deaths, Beshear said an American tests positive for the virus every 1.2 seconds and dies every minute and 47 seconds from covid-19.  

Hospitalizations for covid-19 also remain high, at 988, with 270 of them in intensive care and 142 of those on a ventilator. Yesterday set the record for the most hospitalized, at 994.

Again, Beshear called on people, institutions and governments in counties averaging at least 25 new cases per 100,000 people to follow the state's recommended precautions to slow the spread of the virus. This week, there are 68 counties in that "red zone."

"Knowing that this week is absolutely critical, and there is the highest chance that you will get covid or that you could potentially bring it back to your family than you have ever seen in your community, if you are in a red-zone county, we need everybody following these recommendations," he said. "Otherwise, this escalation continues to increase." 

Despite the governor's regular urging, two large school districts next to Lexington, Jessamine and Scott counties, are continuing to hold in-person class this week though they are in the red zone, Valerie Honeycutt Spears reports for the Lexington Herald-Leader. Billy Kobin of the Louisville Courier Journal reports on several other red-zone districts that are still holding in-person classes.

Beshear said one reason for the latest surge in cases is a decline in mask wearing. To show how his mask mandate has worked, he showed graphs that compared case and death rates with Tennessee, which leaves mask rules up to counties. Both graphs showed lower rates in Kentucky, though the gap has narrowed recently. (Graph below shows cases; for a larger version, click on it.)

Mask mandates are expected to start affecting case numbers 10 to 14 days after they take effect.

"That shows you graphically what that mask mandate has accomplished thus far," he said. "Now as our line gets closer to their line, we're not wearing our masks as much as we used to. The effectiveness of our mandate is how many people wear them each and every day, so we need everybody to pick it up."

Recent studies in Tennessee and Kansas, comparing counties with and without mask mandates, show that masks slow the spread of the virus, as measured by case numbers in Kansas and hospitalizations in Tennessee.

Beshear reported three more deaths from covid-19 on Monday, bringing the state's death toll to 1,492: an 82-year-old man from Hardin County, a 93-year-old man from Jessamine County and a 59-year-old man from Whitley County, who was a health-care worker. 

In other covid-19 news Monday: 

• Counties with 10 or more new cases of the virus are Jefferson, 200; Fayette, 147; Warren, 31; McCracken, 30; Kenton, 29; Bullitt, 28; Boone, 24; Floyd, Hardin and Whitley, 22 each; Daviess, 21; Hopkins, 19; Calloway, 16; Campbell, 15; Carter, Graves, Madison, Mercer and Shelby, 12 each; Hart and Pike, 11 each; and Boyle, Jackson and Lewis, 10 each. 
• In long-term care facilities, 57 more residents and 39 more staff have tested positive or the virus, with 1,109 active resident cases and 641 active staff cases. There have been 892 resident deaths and six staff deaths attributed to covid-19. 
• The college and university report shows 608 new student and eight new staff cases in the last 14 days, with 203 of the student cases and one staff case reported today. 
• The K-12 schools report, which includes only confirmed cases, shows 785 students and 383 staff tested positive for the virus in the past 14 days, with 183 students and 77 staff cases reported today. Two staff have died from covid-19. The K-12 dashboard was last updated Oct. 30. 
• Beshear said he has designated $15 million in CARES Act funding for the Healthy at Home Utility Relief Fund, which can assist households that have suffered financially due to the pandemic, covering up to $500 for past-due utility bills. For a limited number of households with income up to double the federal poverty level, the fund can pay up to $200 for past-due electric or natural-gas bills, up to twice. Kentuckians can apply at their local Community Action office; for locations, call 800-456-3452 or go to www.capky.org.
• Sarah Ladd of the Courier Journal reports how to vote if you tested positive for the virus a few days before the election. "A voter who did not request an absentee ballot prior to Oct. 9 can still do so in case of 'medical emergency,' which includes this situation," Secretary of State Michael Adams tweeted Thursday. "We have a way to get you that ballot. You will need to contact your county clerk."

Coronavirus vaccine will come with challenges and cautions, and we'll still need to be careful while it proves itself, experts say

By Melissa Patrick

Kentucky Health News

Even after a vaccine is approved for the novel coronavirus and is widely distributed, it will still be important to follow public-health recommendations to thwart the spread of the virus, including basic hand hygiene, social distancing and wearing a mask. 

Dr. Kevin Kavanagh

That's partly because the vaccine only has to be 50 percent effective at preventing covid-19, and the immunity it provides could last only a few months, says Dr. Kevin Kavanagh, a retired Somerset physician who heads Health Watch USA, which focuses on infection control. 

Because the vaccine will have been approved through an emergency-use authorization, which involves a less rigorous approval process than that of the U.S. Food and Drug Administration, Kavanagh said there will still be some unknowns about the vaccine, like what the degree or the length of its protection will be or what its long-term effects will be, especially among high-risk populations, such as those who are pregnant or immuno-suppressed.

"Emergency-use authorizations, because they're not as rigorous in evaluation, will not guarantee effectiveness or even safety compared to what a full approval process does," Kavanagh said in an intreview. "So even if you get the vaccine, you still need to wear a mask and you still need to social distance." 

Kavanagh wrote in Infection Control Today about some of the vaccine concerns that were voiced by health officials at an Oct. 22 FDA meeting, and discussed many of them with Kentucky Health News.

Some concerns are about vaccine storage and administration. Two of the vaccines that appear to be the furthest along in the development require "ultra-cold storage." Some vaccines will require two doses, and will not be interchangeable, so patients will have to make sure they receive the same vaccine for each dose.

The vaccines needing ultra-cold storage "are going to be problematic," he said. "Just manufacturing the dry ice, getting the types of glass containers that won't break, keeping them ultra-cold . . . There's just a number of problems that have to be overcome; and overcoming them doesn't mean we have to develop new technologies to do it, it's just that they don't have enough of the products. . . . There's just a lot of coordination which needs to be done."

Other concerns have to do with safety, Kavanagh said. The final phase of the accelerated vaccine trials only have 3,000 participants, 1,500 who are getting the vaccine and 1,500 who serve as the control group.

Also, the protocol for the trial requires only a minimum of two months of follow-up with participants to ensure long-term safety. Kavanagh said in his article that an FDA-approved vaccine would require an average of 30 months each for its two final phases.

While a two-month follow-up will capture the vast majority of complications from the vaccine, later complications can occur. He noted the suggestion of Dr. Marcus Schabackler, CEO of ECRI, who said a trial should last at least six months and get data from every patient who receives the vaccine.

In his article, Kavanagh pointed out that many who provided public comment on the vaccine-evaluation plan said  the two-month follow-up period was too short and that 3,000 study participants were too few to detect adverse reactions among racial minorities, pregnant women and other high-risk groups. He said surveillance programs will be available for patients, and they will be important for gathering long-term information about the safety and efficacy of the vaccine. 

Kavanagh said the health officials also voiced concerns about the vaccine's effectiveness. The minimum acceptable vaccine efficacy was set at 50 percent, so this may result in a "very minimally effective vaccine," Kavanagh said.

Other concerns included the view that the number of "severe" patients required in the control group was too few; that the criteria for being a severe patient was set too low; that minority populations may be under-represented in the vaccine trials; and the fact that the vaccine is only required to prevent covid-19, with no requirements that it also prevent hospitalizations, disability or death. 

"There's concerns that this vaccine may not give lasting immunity because it's only going to be followed for two months, and it may not be totally effective because the bar is very low, 50 percent improvement in prevention of covid, which could just be preventing a cough," Kavanagh said. "You could still get covid-19. So even if you get the vaccine, you still need to wear a mask and you still need to social distance."

That could be a big pitfall. Kavanagh said if "everybody stops wearing masks and socially distancing, you may actually have an increase in covid-19 cases. So the key is you still need to follow public-health advice" and pay attention to the continued monitoring to know if you are protected long-term or not. 

And there's a chance that the coronavirus will mutate so much, like flu viruses, that new versions of the vaccine will be needed, perhaps for the foreseeable future.

"One of the greatest fears that I have is that the virus will either mutate or that your immunity will rapidly decrease," Kavanagh said. "It's fine to do the vaccine. It will help us get through this pandemic, but it is unlikely to do it by itself. We need to follow public-health measures."  

Kavanagh's article also voiced concerns about public acceptance of a vaccine, noting that a recent Harris Poll found that 80% of the respondents worried about how safe the vaccine would be if it was quickly approved, and only 58% said they would get the vaccine as soon as it was available. 

Kavanagh concluded his article: "The overall cost for society is far too high for a flawed and relaxed vaccine approval process. If the vaccine has low effectivity and primarily prevents mild disease, it will offer little protection to society and may cause inconceivable harm. To paraphrase Peter Luri, MD, MPH, from the Center for Science in Public Interest: The benefits of a minimally effective vaccine can be negated if the public relaxes wearing masks and social distancing. But even worse, if the vaccine is ineffective, it will further fuel the antivaccine movement for decades to come." 

All that said, Kavanagh said if you are at high risk for covid-19 or a frontline worker, it may be in your best interests to get the vaccine, after weighing the risks and benefits. As for the rest of the population, the months-long wait for universal distribution will give time for more research, he said: "By that time, there'll be a lot more safety data, and data on the vaccine's effectiveness."

Last week of the coronavirus in Ky. breaks old record, by far

Department for Public Health map, relabeled by Kentucky Health News; click on it to enlarge.

By Al Cross
Kentucky Health News

Kentucky added more new cases of the novel coronavirus in its latest official Monday-through-Sunday reporting week than any other since the beginning of the pandemic, Gov. Andy Beshear said.

The 1,423 cases reported Sunday made a weekly total of 11,774, based on unadjusted daily reports. The previous week's unadjusted total was 9,433. The only bright spot: Last Sunday's number was slightly higher, 1,462.

“If you’re not alarmed by these record numbers . . . you should be,” Beshear said in a press release. “I know we’re tired, but if we do not get the spread of this disease under control, we risk a darker, more deadly period this winter than we ever experienced in the spring.”

Hospitalizations for covid-19 in Kentucky again set a record, at 994, with 250 of them in intensive care, and 136 of those were on ventilators.

Health Commissioner Steven Stack said in the release that the statistics are “telling us what we’d hoped to avoid: Kentucky is in a critical situation. The spread of covid-19 is accelerating at a dangerous pace.”

The share of Kentuckians testing positive for the virus in the last seven days is 6.14 percent, about the same as the last three days. The seven-day rolling average of new cases is 1,682.

Counties with more than 10 new cases were Jefferson, 301; Fayette, 163; Kenton, 60; Johnson, 50; McCracken, 47; Bell, 42; Warren, 38; Bullitt, 36; Hardin, 35; Barren, 33; Boone, 32; Nelson, 31; Christian, 29; Daviess, 27; Henderson, 26; Campbell, 23; Floyd, 21; Graves, 16; Madison, 15; Jessamine and Magoffin, 12 each; and Grayson, Marion, Scott and Webster, 11 each.

The state reported four more covid-19 deaths, raising its toll to 1,489: a 72-year-old Bullitt County man, a 64-year-old Jefferson County man, a 74-year-old Jessamine County man and a 64-year-old Madison County woman.

Beshear's release said red counties on the state's case-incidence map should follow nine recommendations to slow the spread of the virus, and all counties should consider adopting some of those measures to help them avoid the red zone, the category for counties averaging 25 new daily cases per 100,000 people in the last seven days.

In another danger sign, Stack noted that several adjoining counties in Eastern Kentucky entered the red zone last week at the same time they reported cases of influenza. With the arrival of cold weather, the heart of flu season has begun, and many symptoms of the flu and covid-19 are the same.

“Having multiple viruses actively circulating at the same time makes the situation even more difficult, but we have effective defenses that work for these and other viruses,” said Stack, who is a physician.

“Avoid gatherings,” he advised. “If you’re around people, remain at least six feet apart from those not in your household. Wear a face mask. Wash your hands thoroughly. Avoid touching your eyes and mouth. And clean surfaces with sanitizing wipes or a chlorine bleach solution. It’s a highly effective killer of germs of all sorts.”

Tennessee and Kansas studies show masks slow spread of virus

Vanderbilt Hospital graphic: The hospitals were grouped into
four categories: fewer than 25% of patients from Tennessee
counties with mask mandates; 26-50%; 51-75%; over 75%.

As coronavirus cases and covid-19 hospitalizations rise in Kentucky and the nation, a study in Kansas shows that mask mandates reduce new-case numbers, and a Tennessee study shows they prevent hospitalizations.

The Tennessee study, at Vanderbilt University, compared hospitalizations from counties with mask requirements and those without. Tennessee has left mask mandates up to county governments.

The study found that in hospitals where at least 75 percent of patients came from counties that were subject to a local mask requirement, covid-19 hospitalizations were at about the same level in October as they were on July 1.

In hospitals where fewer than 25% of covid-19 patients were subject to a mask mandate, hospitalizations were more than 200% higher than their July 1 levels.

That said, the researchers note that masking is not a "silver bullet," since early October every region of the state has seen a growth in hospitalizations.

"Again, however, this growth has been most dramatic in hospitals that draw a large percentage of patients from areas without mask requirements," says the study report. Further, it says, "This “flattening” of the hospitalization curve is what public health authorities mean when they discuss the role of behavior change and non-pharmaceutical interventions in limiting the impact of covid-19 on the health care sector until new therapeutics and a vaccine are available."

 

University of Kansas chart, with internal labels added by Kentucky Health News

The Kansas study, by the University of Kansas Institute for Policy and Social Research, also found that masks work to slow the spread of the virus, reports The Wichita Eagle.

This study compared the seven-day rolling average of daily cases in counties that did not opt out of the statewide mask mandate with counties that did. Data for the study was collected between March and October.

The researchers found that the counties with a mask mandate saw a decrease in virus cases starting 14 days after the mandate, and their case numbers have remained on a rough plateau. 

The counties that opted out of the mandate have seen a steady increase of cases, and in September, those counties started seeing higher rates compared to the counties with a mask mandate. 

"We found a 50% reduction in the spread of covid-19 in counties that had a mask mandate compared to those without," Donna K. Ginther, director of the institute, said in a video presenting the study's findings.

Fauci and former FDA boss pan Trump's virus work, statements

President Trump and Dr. Anthony Fauci in March
(Photo by Jabin Botsford, The Washington Post)

The nation's top infectious-disease expert and a man who ran the Food and Drug Administration for President Trump are openly taking issue with his handling of the pandemic.

Dr. Anthony Fauci and other health experts told The Washington Post that the White House and its virus task force have concentrated on production of a vaccine and not on encouraging practices that limit the spread of the virus.

“Right now, the public health aspect of the task force has diminished greatly,” said Fauci, director of the National Institute for Allergy and Infectious Diseases. At another point, he said, “We’re in for a whole lot of hurt. . . . All the stars are aligned in the wrong place as you go into the fall and winter season, with people congregating at home indoors. You could not possibly be positioned more poorly.”

In the interview with Josh Dawsey and Yasmeen Abutaleb, Fauci "also lamented that Scott Atlas, a neuroradiologist and Trump’s favored pandemic adviser, who advocates letting the virus spread among young healthy people and reopening the country without restrictions, is the only medical adviser the president regularly meets with," they write.

“I have real problems with that guy,” Fauci said. “He’s a smart guy who’s talking about things that I believe he doesn’t have any real insight or knowledge or experience in. He keeps talking about that when you dissect it out and parse it out, it doesn’t make any sense.”

Fauci said he appreciated White House Chief of Staff Mark Meadows saying last weekend that the pandemic was not going to be controlled. “I tip my hat to him for admitting the strategy,” he said. “He is straightforward in telling you what’s on his mind. I commend him for that.”

Fauci said Democrat Joe Biden’s campaign “is taking it seriously from a public health perspective,” while Trump is “looking at it from a different perspective . . .the economy and reopening the country.”

White House spokesman Judd Deere told the Post, “It’s unacceptable and breaking with all norms for Dr. Fauci . . . to choose three days before an election to play politics,” Deere said.

Sunday night, at Trump’s Sunday night campaign rally in Florida, chants of “Fire Fauci” broke out, The Washington Post reports. Trump replied, “Don’t tell anybody, but let me wait until a little bit after the election.” Politico notes, "While Fauci has civil service protections that would prevent his abrupt firing, Trump has pushed to weaken those protections across government."

Meanwhile, Dr. Scott Gottlieb, a former FDA commissioner, said on CBS's "Face the Nation" that Trump is wrong to say that the country is "rounding the corner" on the pandemic,

"No, things are getting worse around the country," Gottlieb said. "I think the facts are going to overtake any political dialogue rather quickly . . . We're gonna have to start taking some tough steps." But he said that would not be state-level lockdowns because "I don't think the political support is there for it, even at the state level."

Gottlieb said "Thanksgiving will be the inflection point" and predicted, "The hospital systems are going to become pressed again. . . . December is probably going to be our toughest month." By that time, the presidential election will likely have been decided, and Gottlieb alluded to the role that Trump could play.

"The bully pulpit is very important, the national leadership, trying to galvanize collective action," he said.

Gottlieb said Trump was also wrong to say that "Our doctors get more money if someone does from covid." He said the CARES Act has a 20 percent bonus for documented covid pneumonia because hospitals were "bleeding money" when Congress passed the law in May.