State tells local health departments how to enforce Beshear's new restrictions; second highest day yet for coronavirus cases

Diagram illustrates possible misconceptions about vulnerability during gatherings.

By Al Cross
Kentucky Health News

As Kentucky reported the second-highest daily number of coronavirus cases Saturday, state officials scrambled to get local health departments to enforce Gov. Andy Beshear's new restrictions on businesses.

Beshear said in a news release and Facebook video that the 3,711 new cases are an escalating threat to “the health-care capacity in this state. That’s why we’re taking action and that's why we’re fighting back.”

The number of covid-19 patients under intensive care in Kentucky hospitals, and the number of those on ventilators, set new records, at 370 and 202, respectively. Total hospitalizations dropped by 40, to 1,514.

"We're worried we'll reach the point where there aren't enough doctors and nurses to help those who are sick," Beshear said. His office noted that the St. Elizabeth Health Care hospital in Fort Thomas is at capacity and moving intensive-care patients to other St. Elizabeth facilities.

To thwart the surge in cases, now in its sixth week, Beshear banned in-person schooling and indoor service in restaurants and bars, limited indoor gyms and recreation facilities to one-third capacity and limited sizes of gatherings, and requested that churches stop in-person worship.

“I know these steps are hard, but I want to thank the vast, vast, vast majority of individuals out there, and businesses out there – many that are hurt the most by these steps we’re taking – that are stepping up, agreeing and doing it right, knowing that the future of so many lives depends on it,” Beshear said.

“And there’s a light at the end of the tunnel, two effective vaccines; we’ve just got to get there. Let’s make sure that we work hard to protect one another, make sure our most vulnerable are there to get the vaccine. So mask up, follow these steps we’re taking the next three weeks and let’s stop this growth of the coronavirus.”

Some restaurants said they would defy Beshear's order. One was in Marshall County, where others said they might follow suit. During a special meeting of the county health board Saturday morning, officials said they unsure of their authority to enforce the order and had not received guidance they had requested from state officials, and expected to get it next week.

However, Beshear Communications Director Crystal Staley told Kentucky Health News in an email, "The Kentucky Department for Public Health issued enforcement guidance to the Marshall County Health Department this morning before the Board of Health meeting. We have communicated with two restaurants in Marshall County that had been open, but will now close."

Staley said the guidance was sent to all health departments.

Earlier, when asked if there would be enforcement action against a Grant County restaurant that was remaining open, Staley indicated that was up to local officials: "We thank the thousands of establishments that are following the orders to save lives and defeat this virus. . . . If an establishment violates the order, it is violating the rule of law, and all levels of government have a duty to take action."

The guidance says that when a health department receives a complaint about violation of an establishment it regulates, a staffer should visit the site to verify the complaint, and if valid, explain the requirements of the order. If compliance is not forthcoming, the establishment is to be given a "Notice to Cease Operation," and if it does not comply, the department should "proceed to suspend their food service permit" under a state regulation on public health hazards.

The Traveler's Lantern and Cafe in Trenton, in Todd County, also defied the order. County Health Director Jennifer Harris told the Todd County Standard, "I don't feel like we have a choice but to enforce. There is a process we are going to have to go through."

Richard Hayhoe, owner of Bean's Cafe in Dry Ridge, told Cincinnati's WCPO-TV that the order against restaurants was unfair, and customers should be able to dine inside if they think that is best for them: "Please, Frankfort, you don't need to tell everybody what they must and must not do."

Staley noted research that shows restaurants are major sources of virus transmission, and restrictions imposed by governors in other states.

Health Commissioner Steven Stack, a physician, said in the news release, “Kentucky, and much of the nation, is in a dangerous place right now. Stay home. Stay home with only your own household as much as possible. If you must leave your home, wear a mask every time you are in public and stay as physically far away from others as possible. This is necessary for you, your loved ones and the most vulnerable Kentuckians who depend on us all.”

Beshear reported 21 more deaths from covid-19, raising the state's toll to 1,783. He said one, a 58-year-old man in Barren County, worked in a long-term-care facility.

The other fatalities were three Jefferson County men, ages 43, 72 and 83; two Jefferson County women, 67 and 73; a Bullitt County man, 79; a Carter County man, 80; a Monroe County woman, 79; three Pike County women, 73, 75 and 90; an 80-year-old Pike County man; a 76-year-old and 91-year-old from Madison County, genders unspecified; two Jessamine County man, 86 and 90; a Lewis County man, 75; two McCracken County man, 87 and 92; and McLean County woman, 94.

Beshear took note of the high number of new cases, 171, in Oldham County, and may have had Marshall County on his mind, noting the 27 new cases there, much fewer than the others he noted.

All but three of the 120 counties were in the state's "red zone," because they have had more than 25 daily cases per 100,000 people over the past seven days. Two of the three counties had rates almost that high: Allen at 24.1 and Rockcastle at 24. Menifee County's rate was 15.5. The rate is 27 in Marshall County, 54.7 in Grant County and 77.4 in Oldham County.

Counties with more than 10 new cases on the state's daily report were: Jefferson, 573; Fayette, 268; Oldham, 171; Boyd, 159; Hardin, 139; Kenton, 118; Boone, 109; McCracken, 94; Warren, 86; Lee, 76; Campbell, 74; Nelson, 67; Christian, 62; Daviess, 55; Bullitt, 54; Madison, 53; Graves, 50; Calloway, 42; Logan, 40; Jessamine, 38; Shelby, 38; Clark, 37; Marion, 36; Pike, 36; Henderson, 34; Floyd, 33; Greenup, 33; Perry, 28; Marshall, 27; Hopkins, 26; Carter, 25; Knox, 25; Barren, 24; Boyle, 24; Franklin, Laurel, Pendleton, Powell, Pulaski and Taylor, 23 each; Grayson, 22; Green, Letcher, Mason, Muhlenberg and Simpson, 20; Whitley, 19; Hart and Ohio, 18 each; Magoffin, Montgomery and Woodford, 17; Grant and Harlan, 16; Fleming, LaRue and Rowan, 15 each; Meade, 14; Clay, Edmonson, Garrard, Johnson, Knott, Morgan and Union, 13; and Bath, Bell, Butler, Estill, Henry, McLean, Metcalfe, Washington and Wolfe, 11 each.

The percentage of Kentuckians testing positive for the coronavirus in the last seven days was 9.14 percent, the average for the last five days.

In other coronavirus news:

• In Lexington, "While a number of congregations are complying with Gov. Andy Beshear’s request to halt in-person worship services through Dec. 13, others are reluctant to return to having only virtual services," Karla Ward reports for the Lexington Herald-Leader.
• Kentucky Chief Justice John Minton limited state courts to remote proceedings conducted by computer video, postponed jury trials until at least Feb. 1 and said grand juries will be conducted remotely or suspended for the duration, after "some judges were still holding in-person proceedings in 'red zone' counties," John Cheves reports for the Herald-Leader. He notes "a covid-19 outbreak among Boyle County courthouse employees and infected Daviess County deputy court clerks."

Sen. Rand Paul makes inaccurate remarks about virus, vaccines and 'naturally acquired' covid-19 disease, FactCheck finds

U.S. Sen. Rand Paul's Nov. 17 tweet

U.S. Sen. Rand Paul of Kentucky is being taken to task for a series of remarks he has made about the novel coronavirus, vaccines and immunity. FactCheck.org, a nonpartisan, independent unit of the Annenberg School of Communication at the University of Pennsylvania, found several inaccuracies in his statements.

Paul, an ophthalmologist, suggested on Twitter that “naturally acquired” immunity to the virus was better than that from a vaccine.

"But it’s not known how immunity from the two sources compares — and the entire point of a vaccine is to offer immunity without the risk of getting sick," Jessica McDonald reports for Fact Check. She writes:

Paul made his claim in a Nov. 17 tweet in which he listed interim efficacy figures from two ongoing vaccine clinical trials and then provided his own calculation of the “effectiveness” of natural infection with the coronavirus.

In a follow-up tweet, the Kentucky Republican shared a link to a New York Times article about a new unpublished study that found evidence of some immunity to the coronavirus in most people for at least six months. He commented: “Why does the left accept immune theory when it comes to vaccines, but not when discussing naturally acquired immunity?”

Paul, who has previously spread misinformation about childhood vaccines, has inaccurately argued during the covid-19 pandemic that parts of the U.S. have reached herd, or community, immunity because of pre-existing immunity to other coronaviruses. Herd immunity is when enough people in a population are immune to prevent spread of the disease.

Public-health experts, however, have said that threshold is still a ways off — and that allowing the virus to spread uncontrolled would lead to many needless deaths. A better approach, they say, is to stave off the spread of the virus until a vaccine is widely available.

A Paul spokesperson told us that the senator was not suggesting that immunity through natural infection with covid-19 is better than getting immunity from a vaccine, but rather, “highlighting research that says immunity is real.”

We were directed to subsequent tweets, including one in which Paul said he was not “arguing against vaccines” but that covid-19 patients “can celebrate immunity if lucky enough to survive,” as well as Paul’s support for alternative options to speed along access to covid-19 vaccines.

Still, the efficacy figure Paul provides for natural covid-19 infection isn’t accurate. And the juxtaposition of the numbers implies a kind of superiority of natural infection over vaccination — a dangerous notion, given that contracting the virus poses a serious risk.

As University of Florida biostatistician Natalie Dean pointed out in response to Paul’s tweet, “The key distinction is that vaccines are a safe way to achieve immunity. Getting sick with covid-19 is inherently unsafe. We would never ever tolerate a vaccine that carried even a fraction of the risks of natural infection.”

Bogus ‘efficacy’ figure

While Paul purports to offer a precise percentage for how “effective” natural infection is relative to vaccines, experts told us that the comparison is premature and faulty.

The efficacy figures for the vaccines come from interim results released in press releases by the two companies, Pfizer and Moderna, and refer to the ability of the vaccines to prevent symptomatic covid-19 infection in phase 3 trials. (The day after Paul’s tweet, Pfizer announced additional data reflective of the full trial, which showed 95% efficacy.) But the number for natural infection is a broad-strokes calculation Paul made based on reinfections.

“We don’t really know how many reinfections there have been,” virologist Angela Rasmussen said in a phone interview, adding that many reinfections have not been confirmed and that efficacy of naturally-acquired immunity “isn’t a thing.”

“It’s just really ridiculous to try to use the way that efficacy is calculated in clinical trials for vaccines and apply that to epi[demiologic] data across the entire population,” she said.

Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a member of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee, agreed.

“Clearly, there are people who can be reinfected. As a general rule, it’s usually more mild reinfection,” he told us. But, he added, “most people aren’t tested, so you don’t really know who’s getting reinfected and who isn’t.”

It’s true that reinfections so far appear to be rare, which bodes well both for a vaccine and for people who may have immunity as a result of infection. But no one knows yet how the immunity from each will compare.

Most vaccines do not offer quite as good protection from a pathogen as a natural infection will — but of course, a person has to survive or suffer through the infection to get that future protection, sidestepping the entire function of a vaccine. It’s therefore largely irrelevant whether or not vaccine immunity is superior to that from natural infection.

There are some instances in which a vaccine does elicit a better immune response. That’s the case for vaccines against human papillomavirus, or HPV; tetanus; Haemophilus influenzae type b; and pneumococcus.

Whether covid-19 will be one of them remains to be seen. Rasmussen said it was possible, but still hypothetical at this point. “We don’t really know. We only know that these vaccines typically induce levels of neutralizing antibody that are comparable to the higher levels of neutralizing antibody that’s been observed in convalescent patients,” she said, referring to the type of antibody that can prevent cells from becoming infected with the virus.

Based on the performance of the shingles vaccine, Offit speculated that some of the later-arriving vaccine candidates that include powerful adjuvants, or chemicals that are added to vaccines to boost the immune response, such as those from Sanofi-GSK or Novavax, might be better than natural infection.

Immunity unknowns

For both the vaccine and natural infection, important questions about covid-19 immunity remain.

“We do know that most people who get covid-19 do develop some kind of measurable antibody response, but we don’t know what that really means in terms of protection against either reinfection or whether you will mount protective immune responses upon a re-exposure,” said Rasmussen.

As a result, public health officials have cautioned that for now, even if people have previously contracted covid-19, individuals should still follow the standard recommendations.

The Centers for Disease Control and Prevention, for example, advises all people, including those who have recovered from covid-19, to continue to physically distance, wear masks, wash their hands and avoid crowds.

Similarly, the CDC notes that it doesn’t yet know “if or when” it will stop recommending masks or physical distancing after vaccination.

This is in contrast to Paul’s assertion that people “can celebrate immunity.” In a Nov. 12 interview on Fox News, Paul used similar language and advocated that people drop these precautions.

“We have 11 million people in our country who’ve already had covid. We should tell them to celebrate,” he said. “We should tell them to throw away their masks, go to restaurants, live again, because these people are now immune.”

A huge question is how durable immunity will be. Although the study Paul highlighted suggests that most people will be protected for at least six months — and might mean they are protected against severe disease for many years — it’s still not definitive, and doesn’t mean that those timeframes will apply to everyone.

Shane Crotty, an immunologist at the La Jolla Institute for Immunology and one of the senior authors of the paper, noted on Twitter that the team observed a wide range of immune responses in people, including a lack of a measurable response in some people.

“That led us to speculate,” he said, quoting his manuscript, that “‘it may be expected that at least a fraction of the SARS-CoV-2-infected population with particularly low immune memory would be susceptible to re-infection relatively quickly.’”

The CDC, notably, has said that people who have had covid-19 may still benefit from a coronavirus vaccine. And some experts envision a future in which multiple vaccines are on the table for everyone.

“It strikes me as not unlikely that we will learn what the duration of protection is and people will need — whether naturally infected or vaccinated — to have booster shots over some period of time, once a year, once every two years, once every five years,” Barry Bloom, an immunologist and global health expert at Harvard’s T.H. Chan School of Public Health, said in a press call.

Why naturally acquired herd immunity is a bad idea

In his tweet about the new immunity study, Paul also suggested that Democrats were somehow denying realities about immunity from natural infection.

“Why does the left accept immune theory when it comes to vaccines, but not when discussing naturally acquired immunity?” he asked.

Scientists, however, objected to Paul’s characterization.

“I don’t think anybody’s dismissing [immunity following natural infection]. I think what people are saying is, it’s a bad idea as a strategy for dealing with infection,” said Offit, who noted that 30% to 40% of the population could be considered at high risk for covid-19.

Both Offit and Rasmussen also pointed out that historically, there isn’t a lot of precedent for building herd immunity through natural infection.

“People were getting smallpox for millennia,” Rasmussen said, and “the herd immunity threshold was never really reached.”

The much safer way of getting to herd immunity is to use a vaccine instead, especially when multiple candidates are on the horizon.

“Trying to achieve herd immunity [without a vaccine] would result in hundreds of thousands more — if not millions — of unnecessary deaths and debilitating illness for millions more,” Rasmussen said. “So I think it’s not really right to talk about vaccine-induced herd immunity versus naturally-acquired herd immunity without mentioning the fact that one of them has a very, very large price tag in human lives and quality of life attached to it.”

Kentucky sets new records for coronavirus cases, covid-19 hospitalizations and patients in intensive care for the disease

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

By Al Cross
Kentucky Health News

New cases of the novel coronavirus, hospitalizations for its disease and the number of covid-19 patients in intensive care all hit new highs Friday.

New cases totaled 3,825, beating the previous record, set the day before, by 176. The seven-day rolling average of new cases is 2,775. The share of Kentuckians testing positive for the virus in the last seven days is 9.15 percent.

Kentucky hospitals reported 1,554 covid-19 patients, 366 of them in intensive care, both records, and 188 of those on ventilators.

"It is shattering records over and over until we stop it," Gov. Andy Beshear said in a press release. "That’s why we are taking action – we have to. We’ve got more than 10,000 students quarantined right now just based on the last two weeks alone. We’ve got to do so much better."

Beshear has ordered public and private schools to end in-person instruction until at last Dec. 7, and at 5 p.m. Friday a set of new restrictions took effect, including a ban on in-person dining. 

“We’ve got new restrictions in place to help us slow down this speeding train and prevent avoidable death,” Beshear said. “Remember, your decisions are going to be what determines how many people live or die. Do your part.” 

Beshear's executive orders also affect bars, social gatherings, indoor fitness and recreation centers, theaters, other venues and professional services.

The governor reported 20 more covid-19 deaths, raising the state's toll to 1,762: A 74-year-old woman and a 68-year-old man from Boone County; a 54-year-old Boyd County man; an 88-year-old Campbell County woman; two 85-year-old Fayette County men; two women, 74 and 90, and an 82-year-old man from Hardin County; four women, 69, 86, 87 and 91, and two men, 80 and 92, from Jefferson County; a 77-year-old woman from Johnson County; a 93-year-old Marshall County woman; a 93-year-old Nelson County man; a 71-year-old Pike County man; and a 72-year-old Washington County woman.

Bean's Cafe and Bakery, one of three to sue

Coronavirus infection rates; for a larger map, click on it.

Lee County, with only 7,000 people, reported 98 new cases, making its average daily case rate over the last seven days by far the state's highest. The county has been the scene of outbreaks at a nursing home and a privately operated state prison, and there are signs that the outbreak is spreading to adjoining counties of Owsley and Powell; they also have very high infection rates.

 

Counties with more than 10 new cases Friday were: Jefferson, 668; Fayette, 297; Boyd, 185; Boone, 123; Kenton, 119; Lee, 98; Daviess, 88; Hardin, 85; Warren, 84; Oldham, 81; McCracken, 76; Campbell, 62; Franklin, 60; Bullitt, 55; Madison, 54; Jessamine, 52; Pike, 52; Hopkins, 50; Graves, Laurel and Powell, 46 each; Nelson, 45; Clay, 44; Logan, 40; Greenup, 39; Pulaski, 38; Knox, 36; Clark, 34; Boyle and Whitley, 33 each; Floyd, 32; Shelby, 31; Caldwell and Scott, 26 each; Elliott, 25; Bell and Henderson, 24 each; Adair and Christian, 23 each; Anderson, Lincoln and Marion, 22 each; Barren and Muhlenberg, 21 each; Woodford, 20; Knott, Letcher, Russell, Taylor and Washington, 19 each; Lawrence and Spencer, 18 each; LaRue and Simpson, 17 each; Carter. Harlan and Perry, 16 each; Garrard and Grayson, 15; Casey, Fleming, Grant and Rowan, 14 each; Hart, Henry, Marshall, Mercer, Montgomery and Wayne, 13; Allen, Harrison, Monroe, Morgan, Ohio and Union, 12 each.

In other covid-19 news Friday:

• Danville Christian Academy filed a federal lawsuit to continue in-person schooling, alleging that Beshear's order to stop it violates its religious freedom and a state law. Attorney General Daniel Cameron joined as a plaintiff.
• Bean's Bakery and Cafe in Dry Ridge said it would defy Beshear's order and keep its dining room open. It was one of the three businesses that challenged the governor's earlier orders and lost at the state Supreme Court. Beshear's office did not respond to a question about enforcement, but Wednesday he said he would rely on county governments for that.
• Later, Popi's, a recently remodeled restaurant in Marshall County, posted on Facebook that it would remain open. Later it reposted an announcement of a special county health board meeting for 10 a.m. Saturday and asked people to join in. One item on the agenda is Beshear's executive order banning inside dining in restaurants. WKMS in Murray is on the story.
• The Commonwealth Policy Center, which advocates faith-based conservative policies, said it was disappointed that Beshear is allowing gambling halls to stay open and asking churches to stop in-person services. "The governor loses moral authority when he suggests that churches should close and casinos remain open," CPC Director Richard Nelson said.

Kentucky kids improve on some health measures, but many counties lag far behind; pandemic reveals a wealth of disparities

By Melissa Patrick
Kentucky Health News

When it comes to the health of Kentucky's children, who make up about one-fourth of the state's population, the good news is that most have health insurance, fewer teens are getting pregnant, and fewer of the state's women are smoking during pregnancy. The bad news is that the percentage of babies born at a low birth weight has inched up, and many chronic problems pose obstacles to children's well-being.

That's the upshot of the annual Kentucky Kids Count County Data Book, released Nov. 17 by Kentucky Youth Advocates and the Kentucky State Data Center at the University of Louisville. It's part of the 30th annual release of Kids Count, a nationwide initiative of the Annie E. Casey Foundation to track the status of children in the United States. The Data Book provides information on the overall well-being of children in each county, through 17 measures in four areas: economic security, education, community strengths, and health and family.

The report says Kentucky showed improvement in 11 of the 17 measures of child health, made no progress on three and declined on three. 

It shows fewer pregnant women in Kentucky are smoking during pregnancy, dropping from 20.4% in 2011 to 17.8% in 2016-18. But that's still nearly triple the national rate of 6.5%, according to America's Health Rankings.

In some counties, though, this problem is much worse, and got more so between 2016 and 2018. Eighteen counties had rates of 30% or more, led by Owsley County, with 45.3%, the only one with a rate over 40%. Also, 23 counties reported higher rates in 2018 than 2016. This problem correlates closely with income; Owsley is one of the nation's poorest counties; Oldham County, one of Kentucky's wealthiest, had the lowest rate, 9%.

Smoking during pregnancy increases the risk of health problems for developing babies, including birth before full term, low birthweight, and birth defects of the mouth and lip. Smoking during and after pregnancy also increases the risk of sudden infant death syndrome, according to the Centers for Disease Control and Prevention. 

Kids Count map; for a larger version, click on it.

Another measures that worsened in the latest report was the number of low-birthweight babies. The March of Dimes says babies born with low birthweight are more likely to have certain health conditions later in life, including diabetes, heart disease, high blood pressure, intellectual and developmental disabilities, metabolic syndrome and obesity.  

In 2016-18, 8.9% of Kentucky babies were born with a low birthweight, defined as less than 5.5 pounds. That was up very slightly from 8.8% in 2011-13. Again, those rates varied across the state with 58 of the 120 counties showing an increase, and 30 counties with rates higher than 10%. Carlisle County had the lowest rate, 5.6%, and Martin and Union counties had the highest, 12.7%. 

Kids Count map; for a larger version, click on it.

Kentucky continues to make improvements when it comes to teen births. It declined to 28.2 teen births per 1,000 females age 15-19 in 2016-18. That was 30% less than the 40.4 rate recorded five years ago. That said, it's still about two-thirds higher than the national rate of 17 births per 1,000. 

This measure also shows great differences among counties, ranging from a low of 7.5 teen births per 1,000 in Oldham County to a high of 67.3 in Powell County.

Seven counties had higher teen pregnancy rates in 2016-18 than in 2011-13: Lincoln (52.1 teen births per 1,000 females 15-19 in 2016-18); Nicholas (46.9); Edmonson (35.1); Elliott (57.3); Harrison (44.2); Hickman (29.1); and Breckinridge (36.1). 

Other key findings about Kentucky's children in the report include:

• Fewer children were living in poverty before the pandemic began, an improvement of 25.5% in 2013 to 22.3% in 2018; 107 of the state's 120 counties improved.
• 96.3% of Kentucky children have health insurance, and all 120 counties showed improvements in that. The report notes that disparities still exist when it comes to coverage, with only 91% of Latinx youth covered. 
• The number of children in foster care increased from 37.2 per 1,000 children ages 0-17 to 51.1 per 1,000; the number of children exiting foster care to reunite with their families dropped from 41% in 2012-14 to 37% in 2017-19. 
• The percentage of public-school kindergarteners who meet readiness-to-learn standards worsened in 78 of the state's 120 counties from the 2014-15 school year to 2019-20. Statewide, only about half of kindergarteners enter school ready to learn. 
• Because the K-PREP tests were not administered in Kentucky public schools during Spring 2020 due to the pandemic, this year's Data Book did not include the reading and math proficiency indicators. Instead it provided information on the proportion of students with an Individualized Education Plan due to having a disability and the percentage of students experiencing homelessness, which was 15% and 3% respectively.
• In a measure made more important by the pandemic, Kentucky ranks 40th in broadband access with 30% of students, and 35% of students of color, lacking adequate technology at home. 

This year's report also examines the impacts of what it calls "the dual pandemics" of covid-19 and systemic racial injustice on children and families. 

The report points to the disparities around case and death rates among Latinx and Black Kentuckians; the challenges that children with special needs face with remote learning; the challenges for children who are being raised by grandparents, who are at higher risk for the virus because of their age;  and the fact that children in low-income families are more likely to have parents with low-wage jobs that put their families at higher risk of contracting the virus, while being much less likely to have paid sick leave if they get ill. 

"The covid-19 pandemic reminds us once again that opportunities differ based on where you live, your family’s earnings, and the color of your skin," says the report. 

It lays out a plan of action to create "strong, equitable recovery" for all Kentuckians that includes responding to the impacts of trauma, prioritizing mental health supports, addressing the issues of low-wage workers, especially among families of color; strengthening access to health coverage and care for communities of color, bridging the digital divide for employment, education and health, prioritizing closing the gaps in educational achievement that has been exacerbated by the pandemic; and ensuring that families can meet their basic needs until the economy recovers. 

“The dual pandemics have shown us that the status quo was not working for many Kentucky kids and their families," Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. "We must use this opportunity to rethink and rebuild our systems in a way that achieves the vision of Kentucky being the best place in American to be young, regardless of the color of your skin, your zip code, or income level.”

The Louisville Courier Journal published five op-eds this week from people whose work is directly affected by the issues addressed in the Data Book. Click here for one that offers an overview of the data; click here for one that addresses child care; click here for one that addresses parental incarceration; click here for one that addresses health inequity, especially among Latinx populations; and click here for one that addresses the digital divide. 

The 2020 Kentucky County Data Book was made possible with support from the Casey Foundation and other sponsors, including Passport Health Plan by Molina Healthcare; Kosair Charities; Avesis Essential Benefits; and Mountain Comprehensive Care Center. 

The Kids Count Data Center provides easy access to county and school district data for about 100 indicators and allows the user to rank states, counties and school districts; to create customized profiles of the data; to generate customized maps; and to embed maps and graphs in websites or blogs. Click here to see your county's profile. 

Beshear calls new daily record of coronavirus cases 'staggeringly high' as he defends new rules and asks churches to go remote

Dept. for Public Health map, relabeled by Ky. Health News; for a larger version, click on it.

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear reported what he called a "staggeringly high" number of coronavirus cases on Thursday, 3,649, setting the record for a single day. Five of the top five days for new cases have been in the last week. 

“This is exponential growth,” Beshear said. “It’s continuing to grow and it will continue to grow. Our job is to stop it and that's why we have put these new steps into place.”

Those new steps include, among other things, shutting down in-person schooling on Monday, stopping indoor service in bars and restaurants at 5 p.m. Friday, and placing further limits on at-home social gatherings -- which Beshear acknowledged can't be easily enforced but said should be followed. 

In defending his actions, Beshear said the numbers will get worse before they get better. 

"If you're upset that schools [have] got to be virtual, you can be upset with me, but it's the virus. If you're upset about what we're having to do with restaurants and bars, the virus has chosen that area, because people take their masks off and congregate," he said.

"Upset about group classes at gyms or the pause on winter sports? Again, that's what this virus does. And so really, you've got two choices: You can just do nothing but be upset at me or those that are making these choices. Or we can do our part and put on the mask, tamp down the numbers. And then we can all do these things. It's really that simple."

Beshear also announced 30 more deaths from covid-19, the second-highest daily toll from the disease, bringing the state's total to 1,742.

The share of Kentuckians testing positive for the virus in the past seven days hit another new high since widespread testing began in May, 9.18 percent. The news release says the state has experienced a 400% increase in positive cases over the past nine weeks. 

Beshear confirmed that he had asked religious leaders across the state to immediately suspend all in-person services for the next three to four weeks, at his bi-weekly call with the Kentucky Council of Churches. 

"This is a request from the governor, not a mandate, and it seems perfectly reasonable given the situation we are in with covid-19,” Kent Gilbert, the president of the council and the pastor of the historic Union Church in downtown Berea, told Jack Brammer of the Lexington Herald-Leader. The state's largest religious group, the Kentucky Baptist Convention, is not part of the council.

John K. Carter

Beshear received fresh pushback from Republicans, including Oldham County Attorney John K. Carter, who said on Facebook that his office would not prosecute anyone charged with violating the home-gathering order and added, "Have a happy Thanksgiving with as many of your family members as you want to celebrate this national holiday, as you desire."

"My God," Beshear exclaimed after reading Carter's words in response to a question about them. "That is horrible advice that could mean that families that follow it don't have the same people for Christmas that they do for Thanksgiving."

Beshear also said, "I wasn't asking him to prosecute anything. . . . This is advice that could be absolutely deadly. You're a public servant, don't be irresponsible. . . . You are putting yourself at risk if you follow his advice." Later, he called it "crazy."

Asked how he expects new rules to be successful without the support of state and local leaders, Beshear said he does because they are based on science, have worked in other states and are enforceable.  

He added, "Nobody else has given a plan of action, right? They just criticize the action we're taking. Our two choices are action, which is difficult, or inaction, which is deadly." 

Asked to address the concerns that these new rules are being applied inconsistently, he said they all were made on the advice of public-health officials. 

“It is different going into a restaurant, taking off your mask and eating while congregating around other people than going to Walmart to buy toilet paper and wearing your mask,” he said. “It’s entirely different. It’s different to have 10 people over to your house, where people are going to relax and take their masks off, than if you are at a venue that has people working there that are constantly reminding you to keep your mask on.”

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said public-health officials around the country are telling him they are seeing increasing numbers of infections from small gatherings. "Each family unit should do a risk-benefit determination about the holidays," he said on CNN. "Maybe the prudent thing to do now is just pull it back and do it with the family unit you live in."

Beshear, asked more than once whether the state's contact tracers had data on infection hotspots, said they were gathering that from local health departments. Case numbers are so high that contact tracers are only being asked to contact individuals who have tested positive for the virus and instructing them to be the one to contact their close contacts and to ask them to quarantine.

Beshear said 1,550 people were hospitalized with covid-19 in Kentucky on Thursday, with 358 of them in intensive care and 199 of those on a ventilator. The number of ventilators in use was the highest yet, he said. 

The number of counties in the state's "red zone," indicating they have 25 or more new cases per 100,000 people over the past seven days, is up to 112 out of 120. It was 107 yesterday, and 94 a week ago. 

Alexa Rose Veit

The governor highlighted the lost life of Alexa Rose Veit, a 15-year-old from Ballard Memorial High School, who died of covid-19 complications. He noted that while Alexa was born with Down syndrome, she never let that stop her from accomplishing whatever she set her mind to. He said Alexa was in remission from leukemia, but tested positive for the virus the week after Halloween. 

"Those who knew Alexa asked we help raise awareness of how deadly this virus is and how important it is to follow the guidelines put in place," said Beshear.

In other covid-19 news Thursday:

• Today's deaths include a 93-year-old man from Boone County; a 75-year-old Breckinridge County man; a 73-year-old Calloway County woman; a 79-year-old Campbell County man; a 94-year-old woman and a 79-year-old man from Daviess County; two men, 67 and 77, from Fayette County; a 67-year-old man from Gallatin County; a 70-year-old Graves County woman; an 80-year-old Hopkins County woman; three women, 53, 69 and 96, and two men, 70 and 95, from Jefferson County; five women, 75, 86, 90, 95 and 96, and three men, 64, 77 and 96, from Kenton County; a 73-year-old woman and a 58-year-old man from Lee County; a 69-year-old McCracken County woman; two women, 92 and 96, from Monroe County; and an 89-year-old Rockcastle County woman.
• Counties with 10 or more cases were Jefferson, 724; Kenton, 179; Fayette, 178; Boone, 165; Warren, 115; Hardin, 108; Campbell, 104; McCracken, 90; Lee, 69; Bullitt, 64; Graves, 63; Madison, 62; Nelson, 59; Daviess, 56; Calloway, 51; Pulaski, 43; Pike, 41; Hopkins and Shelby, 39 each; Oldham, 38; Clay and Laurel, 37 each; Marion, 34; Woodford, 33; Barren, Christian, Montgomery and Muhlenberg, 31 each; Floyd, 30; Scott and Taylor, 29 each; Boyd, 28; Greenup, 27; Boyle, Henderson, Jessamine and Whitley, 26 each; Logan, Mercer and  Rowan, 24 each; Meade, 22; Adair, 21; Washington, 20; Marshall, 19; Clark, Johnson, Lincoln, Mason and Perry, 18 each; Anderson, Casey, Grant, Grayson, Harrison and Webster, 17 each; Bell, Carter and Harlan, 16 each; Bourbon, Edmonson, Franklin, Hart and LaRue, 15 each; Lawrence and Russell, 14 each; Knox, Pendleton and Spencer, 13 each; Garrard, Morgan and Ohio, 12 each; Livingston, Owsley and Powell, 11 each; and Martin, Monroe and Wayne, 10 each.
• Beshear said 437 of today's new cases were 18 and younger.
• In long-term care, 1,656 residents and 1,077 staff have active cases, with 130 new resident and 104 new staff cases reported today. There have been 1,119 covid-related resident deaths and six covid-related staff deaths, with 17 new resident deaths confirmed today. 
• The college and university report shows 716 students and eight staff have tested positive for the virus in the past 14 days, with 78 students reported today.
• Beshear said another veteran from the Thomson-Hood Veteran Center in Wilmore died of covid-19, bringing its total covid-related deaths to 26. He said the center has gone six days without any new cases and that the state's other three veteran centers had no positive cases. 
• The governor said that over the last two weeks, about 1,359 health care workers have tested positive for the virus and that 8,300 have since the first Kentucky case was found in March. 
• Beshear encouraged Kentuckians to donate blood, noting that it is safe to do so. For more information visit RedCross.org/giveblood or KYBloodCenter.org. On Nov. 10, the Kentucky Blood Center told the Herald-Leader that for several weeks, it has had less than a half-day's supply available. Bill Reed, president and CEO of the center, said in a news release, “The ongoing effects of the pandemic have our blood supply at a critical level and our partner blood centers across the country are experiencing the same issues.”
• The Centers for Disease Control and Prevention now recommends Americans avoid Thanksgiving travel altogether. The guidance says, "Travel may increase your chance of getting and spreading covid-19. Postponing travel and staying home is the best way to protect yourself and others this year."
• The Herald-Leader explores why experts say getting a test before Thanksgiving with family isn't enough. Health professionals continue to suggest only celebrating the holiday with members of your immediate household.
• Dr. Sarah Moyer, the head of the Louisville health department, pointed out places where infected people were reported visiting the two days before they noticed symptoms: "They were traveling, attending parties or gatherings, going to the grocery store, restaurants, schools, churches, workplaces, healthcare settings," she said. "If we want to stop the spread of the virus, we really need to stop moving." 

Slide from Louisville Mayor Greg Fischer's Nov. 17 coronavirus briefing

Beshear stops in-person schooling as of Mon., indoor food service as of Fri., imposes other restrictions; legislative leaders object

One of the slides Gov. Andy Beshear used during his news briefing Wednesday.

By Melissa Patrick
Kentucky Health News

As coronavirus cases surge across Kentucky and the number of counties in the most dangerous level continue to increase -- despite three weeks of targeted recommendations to slow the virus's spread -- Gov. Andy Beshear issued new restrictions on Wednesday.

“Action is unpopular, but inaction is deadly,” Beshear said at his daily briefing. 

The actions include shutting down in-person schooling on Monday, stopping indoor service in bars and restaurants at 5 p.m. Friday, and placing further limits on at-home social gatherings. 

The Democratic governor's new rules were met with criticism from Republican legislative leaders, who have already said they will consider limiting the governor's emergency powers during the upcoming 2021 session. They criticized Beshear for not including them in any pandemic planning, and asked for Kentucky-specific data to support his actions.

Senate President Robert Stivers said: “This is the first time in eight months that the governor has briefed us, and make no mistake, it was a briefing, not a collaboration. The decisions today, made solely by the governor, were to limit and restrict many businesses that may not survive based on what was proposed. We have not been shown any data that would draw a rational basis to limit Thanksgiving in your home to eight people when you can go to a private venue with twenty-five people. Nor were we presented any data that justifies a blanket policy to close public and private schools, especially when we are seeing the loss of a year of educational opportunities and destructive effects to the mental health of our youth. Kentucky is in a crisis, this is real, and the governor needs to start consulting with us for the sake of the commonwealth."

House Speaker David Osborne said Health Commissioner Steven Stack gave them an informative, 20-minute presentation, but “The governor answered questions for less than 10 minutes and failed to provide any contact-tracing-based data on where cases are spreading in Kentucky. He must be prepared to directly answer the same questions we face from our constituents every single day. While we take this virus seriously, we will not be cover for his unilateral decision-making. Working with the legislature means more than calling us an hour before making his pre-determined edicts public. This kind of move is not leadership; it’s misleading.”

Beshear pointed to studies from the Centers for Disease Control and Prevention, Johns Hopkins University and Stanford University to show that the virus is spreading in restaurants and bars, and said the Barren River District Health Department has reported 46 clusters involving 189 virus cases in restaurants and bars in the district, headquartered in Bowling Green.

Beshear at briefing

“This virus spreads where people congregate and take off their masks,” Beshear said. “It’s really unfair but it’s not me being unfair, it’s the virus.”

He declined to comment on his meeting with the legislators, saying he had agreed to not discuss it until after the briefing in exchange for them keeping the information embargoed. 

Beshear's executive order says that starting Monday, Nov. 23, all public and private K-12 schools are to cease in-person instruction, with middle and high schools to remain in remote or virtual instruction until at least Jan. 4. Elementaries will be allowed to resume in-person instruction Dec. 7 if they follow all "Healthy at School" guidance and the county is not in the red zone, which signifies the highest range of infection.

Other new restrictions include: 

• Restaurants and bars – No indoor food or beverage consumption; carryout and delivery encouraged; socially distanced outdoor seating allowed.
• Private social gatherings – Up to eight people from a maximum of two households
• Gyms, fitness centers, pools and other indoor recreation facilities – 33% capacity limit, maintained at six feet apart; no group classes, team practices or competitions; masks must be worn while exercising. This does not include college or professional athletics. 
• Venues, event spaces and theaters – Each room will be limited to 25 people. This applies to indoor weddings and funerals, but excludes worship services, for which Beshear said he would provide recommendations Thursday.
• Professional services – Office-based businesses limited to 33% of employees; all employees who are able to work from home must do so; all businesses that can close to the public must do so.

Most of the new requirements go into effect at 5 p.m. Friday, Nov. 20 and last through 11:59 p.m. Sunday, Dec. 13. 

To help offset the impact on restaurants and bars, Beshear is allocating $40 million in federal relief funds to provide qualifying businesses $10,000 for various expenses, with a maximum award of $20,000 to those with more than one location.  Publicly traded companies and businesses that make at least half their sales via drive-thru will not be eligible. (A typical McDonald's restaurant got about 75 percent of its revenue from drive-thru before the pandemic.)

Applications for relief money are scheduled to open Nov. 30, will be processed in the order they're received, and will close Dec. 18. Funds will be awarded until they run out. Businesses that receive the awards are required to remain in compliance with all public health orders, Beshear's office said.

The release noted that earlier this month, Beshear waived for a year renewal fees for alcoholic-beverage licenses of Kentucky restaurants, bars and temporary venues to help during the pandemic.

Beshear said today's new rules do not further restrict retailers, "but that is based on a commitment to re-up the mask mandate and the enforcement of it."

Stack (April 19 photo)

Stack said, "Folks, none of these decisions are easy; we ran out of easy choices and decisions a long time ago. Every one of these weighs heavily, certainly on me as I recommend interventions to the governor, as I work to lead the public health department – "

At that point, he choked up and said, "It's been months since I got a little emotional over this. But folks, we've got to do this. And we can overcome it. And we know we can overcome it because we've done it two other times."

Beshear said he has no plans to shut down the economy. 

"This is not and there will not be a shutdown. Our economy is open and there will be no categorizing businesses as essential or non-essential and asking them to close," as was the case in the spring, he said.

"Today we're announcing significant but surgical and targeted steps designed to slow the virus and protect our people. These steps range from three to six weeks in duration and are designed to have the maximum impact. with as little disruption, although there will certainly be disruption, as possible."

Beshear said the new restrictions should be easier to enforce than his earlier ones since they largely involve establishments that require a license to be open. He said he is also authorizing counties to enforce the order.

Daily data: The restrictions were announced on the state's fourth highest day for new cases, all of which have happened in the last week. Today's 2,753 cases took the seven-day rolling average to a new high of 2,495. 

The share of Kentuckians testing positive for the virus in the past seven days also inched up a bit, to 9.13%, another record high since testing became widely available in May. 

Beshear announced that 1,553 people were hospitalized in Kentucky with covid-19, an increase of 32 since yesterday, that 359 of them are in intensive care and 176 of those are on a ventilator. 

The number of counties in the red zone, indicating they have at least 25 new cases per 100,000 people in the last seven days, is up to 107.  

Beshear said 15 more Kentuckians have died from covid-19, bringing the state's death toll to 1,712. He said one of the deaths was a 15-year-old girl from Ballard County, the state's first student to die from the virus. He said she had some significant pre-existing conditions. Another unusually young victim was reported: a 32-year-old woman from Louisville.

The other fatalities were a 60-year-old man from Barren County; a 75-year-old man from Caldwell County; a 90-year-old man from Calloway County; two women, 78 and 91, from Christian County; an 87-year-old man from Clay County; a 43-year-old man from Fayette County; a 78-year-old man from Hancock County; a 73-year-old woman from Jefferson County; a 78-year-old man from Marshall County; a 68-year-old woman from McCracken County; an 86-year-old woman from Nelson County; and a 79-year-old woman from Pike County.

In other covid-19 news Wednesday: 

• Counties with 10 or more new cases were Jefferson, 530; Fayette, 196; Boone, 99; Kenton, 94; Warren, 86; Christian, 85; Madison, 78; Campbell, 70; Bullitt, 67; Hardin, 66; Daviess, 59; McCracken, 52; Henderson, 48; Laurel, 45; Hopkins, 44; Boyd, 37; Lee and Muhlenberg, 34 each; Jessamine, Oldham and Pulaski, 33; Nelson, 32; Barren, 27; Shelby, 25; Whitley, 24; Greenup, Marshall and Union, 22 each; Grant, 20; Knox, Pike and Woodford, 18; Casey and Marion, 17; Floyd, Graves and Monroe, 16; Bourbon, Carter, Edmonson, Perry and Trigg, 15; Clay, Logan, Ohio, Pendleton, Scott and Taylor, 14; Bell, Breathitt, Calloway, Larue, Lawrence, Lincoln and Montgomery, 13; Grayson, Jackson and Simpson, 12; Magoffin, Powell and Webster, 11; and Breckinridge, 10.
• Beshear said 292 of today's new cases are 18 and younger.
• In long-term care, there are 1,675 active resident cases and 987 active staff cases, with 105 resident cases and 120 staff cases reported Wednesday. There have been 1,102 resident deaths and six staff deaths attributed to covid-19, with 13 of the resident deaths reported today. 
• The K-12 public health report, which includes confirmed cases, shows 1,031 students and 518 staff tested positive for the virus in the past 14 days, with 128 students and 69 staff reported today. The report now shows one student death, along with the two staff deaths that have been previously reported. 
• The colleges and universities report shows 710 residents and nine staff tested positive for the virus in the past 14 days, with 93 of the students reported today. 
• A new study shows why cigarette smoke worsens covid-19 infection in the lungs, Katie Camero reports for the Lexington Herald-Leader. Using human airway stem cells, researchers at UCLA the recreated what happens when the airways of a smoker are infected with the virus. "If you think of the airways like the high walls that protect a castle, smoking cigarettes is like creating holes in these walls," Dr. Brigitte Gomperts, co-senior author, said in a news release. "Smoking reduces the natural defenses and that allows the virus to set in."
• Some covid-19 patients will be able to receive an antibody infusion at U of L Health starting on Thursday, WDRB reports. The monoclonal antibody, Bamlanivimab, is a single-dose infusion targeted toward early treatment of the disease in select high-risk patients. 
• Pfizer and BioNTech announced Wednesday that new test results show its vaccine is 95% effective, reports Stat. The companies said they plan to submit their application for emergency use authorization to the Food and Drug Administration "within days." Damian Garde and Matthew Herper report, "Of the 170 cases of Covid-19 Pfizer observed in its trial, 162 occurred in the placebo group and just eight among the group that got its two-dose vaccine. Of the 10 cases of severe Covid-19, nine were in the placebo group, an important finding, which suggests the vaccine prevents not only mild cases, but the type of serious disease that leads patients to die or be hospitalized."
• On Nov. 17 the FDA issued emergency-use authorization for the first at-home test for the virus. The Lucira Covid-19 All-In-One Test Kit is a single-use test that produces results within 30 minutes. A prescription is required to get it.
• University of Kentucky researchers are testing a new technology to evaluate wastewater to track community spread of the virus, UKNow reports. The news release says that the pilot project has kickstarted related research, including a recent $1.2 million CDC grant for wastewater research that can find early warning signs for covid-19 outbreaks in nursing homes.

White House report puts Ky. in most dangerous zones for cases and infection rates, lauds Beshear's actions but asks for more

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

By Melissa Patrick
Kentucky Health News

Kentucky is now in the worst danger zone for both its coronavirus case numbers and the share of Kentuckians who have tested positive for the virus in the past seven days, according to this week's White House Coronavirus Task Force report. 

"Current mitigation efforts are inadequate and must be increased to flatten the curve to sustain the health system for both covid and non-covid emergencies," says the report. "We share the strong concern of Kentucky leaders that the current situation is worsening and that all Kentuckians need to do their part to stop the spread. The governor’s active measures are commended."

Gov. Andy Beshear noted at his Nov. 18 news briefing that the White House and his administration "are all in agreement about how dangerous of a spot we're in" and said this report should "stop the goofiness." 

"The White House supports the things we have done and hopefully the things that we're gonna have to do," he said. "This isn't a red state, blue state, Democrat, Republican, liberal, conservative, any of that. It's a virus that's coming for everybody it can." 

Kentucky has been in the red zone for case numbers, indicating 101 or more new cases per 100,000 people, every week since the Sept. 27 report, but this is the first time the White House has put Kentucky in the most dangerous zone for positivity, meaning it now has a rate at or above 10.1%. 

Beshear has noted several times that the state uses a different data stream than the White House, which results in a lower positivity rate. But the bottom line is that the rate keeps going up in both the state and federal report -- and that's reason for concern. 

The White House reports a 12.5 percent positivity rate in Kentucky. On Nov. 18, the state reported that rate to be 9.1%, the highest it's been since testing became widely available in the state. 

"Remember when we had it under 4 and we were concerned when it went up to 5?" Beshear asked at his daily briefing. "This is a very dangerous territory." 

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

The White House report, which covers Saturday, Nov. 7 to Friday, Nov. 13, says Kentucky ranks 24th highest in the country for cases and 20th for positivity. 

The report says 89% of Kentucky's counties had a moderate or high level of community transmission, with 55% of them having high levels. 

It shows Kentucky with 344 new cases per 100,000 people. A jump from 274 per 100,000 in the prior week and 257 per 100,000 the week before. The national average is 294 per 100,000. 

The number of counties in the red zone increased by a whopping 27 counties, from 39 to 66; the orange zone increased by one county, to 24. Many if not most of those came from the yellow zone, which decreased by 17 counties, from 32 to 17. 

The report stresses that "mitigation efforts need to be increased" and suggest "limiting restaurant indoor capacity to less than 25% and limiting bar hours until cases and test positivity decrease to the yellow zone."

Beshear is expected to place additional restrictions on bars and restaurants today at his daily briefing. They are currently allowed to operate at 50% capacity. 

The report calls on the state to recruit "local influencers" to message the importance of wearing a mask in pubic, to stop all gatherings beyond immediate households until both cases and positivity rates are in the yellow zone, and to get a flu shot. 

It calls for active testing in K-12 schools, calls on teachers and students to wear masks, and for schools to  "consider pausing extracurricular school activities, even though athletics are not transmission risks, as the surrounding activities are where transmission is occurring."

The report also asks colleges and universities to encourage their students to not let their guards down as Thanksgiving break approaches, and to follow the Centers for Disease Control and Prevention holiday guidelines if they are going home.

The CDC guidance says, "People who do not currently live in your housing unit, such as college students who are returning home from school for the holidays, should be considered part of different households. In-person gatherings that bring together family members or friends from different households, including college students returning home, pose varying levels of risk."

Kentucky's recent surge is part of a national one.

New coronavirus restrictions will include bars and restaurants; Tuesday is deadliest day for confirmed covid-19 deaths, with 33

State animation shows infection-rate growth from green to red zones.

By Lisa Gillespie

Kentucky Health News

Gov. Andy Beshear said he will impose new pandemic restrictions Wednesday, including limits on restaurants and bars. Meanwhile, coronavirus cases are running so high that health departments are asking Kentuckians who have tested positive for it to do their own contact tracing: notify people they may have exposed to the virus.

Beshear said at his daily briefing, "We will be announcing new steps that we're going to take in this commonwealth. It is time to get control of this beast. I refuse to stand by and watch avoidable loss around us. And we're at war, and there are some right now who want to surrender and accept the fatalities. I'm not that type of governor." 

Beshear announced 2,931 new cases of the virus on Tuesday, the third highest day yet, bringing the seven-day rolling average to 2,487, based on initial, unadjusted daily reports. The highest days were Friday and Saturday, with 3,173 and 3,303, respectively.

The governor also announced 33 more deaths from covid-19, ranging in age from 36 to 99, which he noted was "the deadliest day that we’ve had in our fight against this virus." 

The share of Kentuckians testing positive for the virus in the past seven days also continues to rise. It was 9.1% today, the highest its been since testing became widely available in May. Beshear called this range "dangerous territory," noting that anything above 5% is cause for worry. 

He announced that 1,521 people are hospitalized in Kentucky with covid-19, an increase of 79 from yesterday; 354 of them in intensive care and 178 of those are on a ventilator. 

Beshear reiterated that his new restrictions will be more focused than they were in the spring, partly because testing and personal protective equipment are more available.

“It is not going to look like March, when we had to do 'Healthy at Home’,” he said. when all non-life sustaining businesses closed to in-person services. “So this will be more targeted. But, we've got to stop this. So we’re going to do enough to stop it.”

The Democratic governor said he would talk Wednesday with leaders of the Republican-controlled legislature and industries that will be affected by the new restrictions, before announcing them at his 4 p.m. briefing. It will be his first such briefing for legislators, who have complained about his lack of consultation.

“When these steps come out, we want them to work, and so we'll need leadership on all levels to help us to make that happen,” Beshear said. “And we think taking this extra time to get additional buy-in, can hopefully get us more effective results, and also to communicate especially to those that that may feel the brunt of some new steps.”

Beshear again offered few details on what he said would be mandates and not restrictions, but when asked, he said a statewide 10 p.m. curfew like Ohio's would not be among them. He added that the state would provide assistance for those who would be affected most by the new rules, such as restaurants and bars.

He added that the latest White House Coronavirus Task Force report supports more restrictions, commended his "active measures" and called the spread of the virus "aggressive" and "unrelenting."

“The house is on fire at this point,” Beshear said. “And we need everybody not to close their eyes, close their ears and sit in the house while it burns down on them. We need everybody to join the bucket brigade and to do what it takes to address the crisis.”

State Department for Public Health chart

In a major change, the state will no longer attempt to notify Kentuckians if they’ve been in contact with someone who’s tested positive for the virus. 

“At this point, it is becoming impossible for our local health departments to call each and every one of these contacts in a timely fashion, which is necessary for contact tracing to be effective,” Franklin County Health Department Director Judy Mattingly said in a short video. 

The state is asking people who test positive to reach out to their own contacts if they were within six feet of them for at least 15 minutes in the 48 hours before the test or before their symptoms began.

Health Commissioner Steven Stack said health departments will now focus on identifying new positive cases and enlisting their support to notify their contacts, because the case numbers are so high that the more than 900 people hired by the state to trace contacts can't keep up with the demand. 

“I think that should be no small sign of the situation we find ourselves in,” said Stack, who is a physician.

Stack showed several graphs and charts that showed the number of deaths and cases in Kentucky since March. He showed how the first surge was shut down by the state's Healthy at Home program and the second by the mask mandate. Then he pointed to the current escalation, noting it has a significantly steeper rate of increase than the first two.

“This is where we find ourselves now. This is terrifying. This is now growth from a much higher starting place. The numbers show no signs of relenting,” he said. “There has to be a third intervention.”

Pikeville Medical Center CEO Donovan Blackburn also spoke in a video in the briefing, and said his hospital, like others in the state and region, is nearly full. 

“It is becoming increasingly difficult to accept additional covid patients, especially in our ICU,” Blackburn said. “Transferring patients outside of the region would be our next option; we also are at risk of shutting down other vital services. . . . I urge all Kentuckians to please take this seriously. ”

Blackburn urged Kentuckians to get a flu shot, wear a mask and social distance.

Beshear also made his first public hint that he may seek re-election in 2023, as he said Kentuckians need to wear a mask not for him, but for other Kentuckians.

Holding a hand to his chest, he said, “I hope something touches your heart in a way that it says, ‘Okay, even with all the questions I have or concerns or anger over other things, I'm going to do this, I'm going to put on a mask, I'm going to do what it takes,’ Stay angry with me, vote against me the next time around. At the moment, all I care about is that we get through this, we get through it together and we save as many lives along the line.”

In other coronavirus news Tuesday:

• The 33 fatalities were an 85-year-old man from Barren County; a 69-year-old man from Breathitt County; a 60-year-old man from Calloway County; a 36-year-old woman from Christian County; four women, 83, 90, 91 and 91, from Daviess County; an 89-year-old man from Floyd County; a 51-year-old man from Grayson County; a 78-year-old woman from Green County; an 85-year-old man from Hancock County; a 93-year-old woman from Henderson County; three women, ages 75, 78 and 93, and five men, 49, 79, 87, 88 and 94, from Jefferson County; two men, ages 68 and 72, from Jessamine County; a 94-year-old woman and an 89-year-old man from Madison County; two women, 92 and 94, from McLean County; an 86-year-old woman from Monroe County; a 68-year-old woman and a 74-year-old man from Ohio County; a 65-year-old man from Oldham County; a 99-year-old woman from Rockcastle County; and a 58-year-old woman from Trigg County.
• Counties with 10 or more cases were Jefferson, 330; Fayette, 233; Madison, 156; Daviess, 93; Boone and Hardin, 84 each ; Kenton, 83; Warren, 63; Bullitt, 61; Pike, 58; Laurel, 55; Graves, 52; Campbell and McCracken, 51 each; Barren, 48; Christian, 47; Lee and Nelson, 44 each; Floyd, 43; Calloway, 38; Jessamine, 36; Greenup, 35; Pulaski and Scott, 33 each; Breckinridge, Hopkins and Rowan, 32 each; Henderson, 22; Lincoln, Logan and Muhlenberg, 21 each; Adair, Bell, Boyd, Edmonson and Johnson, 20 each; Marion and Whitley, 19 each; Elliott, Garrard, Grayson, Magoffin, Ohio, Perry, Powell and Wayne, 18 each; Anderson, Boyle, Monroe and Oldham, 17 each; Franklin, Marshall, Mercer and Webster, 16 each; Grant, Hancock and Martin, 15 each; Knox, 14; Green, Lawrence, Shelby and Taylor, 13 each; Casey, Estill, McLean, Meade, Pendleton and Woodford, 12 each; Breathitt, Morgan and Union, 11 each; Clark, Clay, Clinton, Jackson and Mason, 10 each.
• Of today's new cases, Beshear said 325 were age 18 or younger. 
• The state's long-term care facilities have 1,667 active resident cases and 1,015 active staff cases, with 58 new resident and 78 new staff cases reported today. There have been 1,089 resident deaths and six staff deaths attributed to covid-19, with 40 confirmed today.
• The K-12 dashboard shows that last week, 1,063 more students and 567 more staff tested positive for the virus, and 6,557 students and 1,148 staff were in quarantine.
• The college and university report shows 733 students and 10 staff tested positive in the past 14 days, with 66 of the students reported today.  
• Other states are imposing restrictions as the virus surges. California Gov. Gavin Newsom said he was pulling an “emergency brake” and putting almost all counties in the state's most restrictive level. Newsom is a Democrat. Republican Gov. Kim Reynolds of Iowa announced, after months of resisting the idea, that everyone age 2 and older must wear a face covering in indoor spaces open to the public. In Oklahoma, Republican Gov. Kevin Stitt said bars and restaurants must close by 11 p.m., except for to-go and drive-thru orders, and required state employees to wear masks at work.
• Governors of Kentucky, Indiana, Ohio, Michigan, Illinois, Minnesota and Wisconsin sent out a message of unity in the hopes of thwarting the spread of the surging virus, with a shared concern about the stress this surge is placing on their hospitals and staff, Travis Ragsdale reports for WDRB. 
• Friendship Health and Rehab in Pewee Valley asked for help from the state's nursing strike team after 63 residents and 20 staff tested positive for the virus, WDRB reports. Six residents of the 142-bed facility have died from covid-19 since the pandemic began.  
• At a weekly news conference, three of the largest hospital systems in Louisville said they are able to handle the increase in covid-19 patients right now," Lexie Ratterman reports for WDRB. But Dr. Jason Smith with U of L Health warned, "There will always be a breaking point. I think we are doing a good job across the three healthcare systems in managing this right now, but sooner or later if the numbers continue to rise, it's a simple matter of numbers, in that you will eventually overwhelm the healthcare system no matter how well prepared and how much they're working."
• A father-son team of infectious-disease doctors add their voices to others who are asking Kentuckians to scale back or to cancel their Thanksgiving plans, Jeremy Chisenhall reports for the Lexington Herald-Leader. Dr. Mark Dougherty and his son, Dr. David Dougherty, told Chisenhall that "it’s vital that older and at-risk populations remain aware of covid dangers and stay safe – even if it means declining an invitation to the family dinner this year." Mark Dougherty said, "If younger people are not going to protect the vulnerable and elderly, then the vulnerable and elderly need to protect themselves." 
• Health departments across Eastern Kentucky released new coronavirus numbers, including one new death, on Tuesday and WYMT reports on them. 
• WYMT reports about the outbreak of coronavirus cases at the Lee Adjustment Center in Beattyville, which has seen more than 430 inmates and nearly 30 staff test positive in the 866-bed facility. 
• The Centers for Disease Control and Prevention has removed from its website a statement that stressed "the importance of reopening America's schools" in the pandemic. "The now-withdrawn statement, which took a stronger tone in favor of reopening than the agency's other guidance documents, was reportedly influenced by White House discussions over the subject," Education Week reports. "It appears to have been removed on Oct. 28, according to cached versions of the website kept by the Internet Archive.