Flu cases in Kentucky have ticked up a bit in the last few weeks, and it's not too late to get a flu shot; season can go through May

Kentucky Department for Public Health graph

By Melissa Patrick
Kentucky Health News

Following nine weeks of decline, influenza cases in Kentucky ticked back up.

The state Department for Public Health reports that in the week ended March 12, Kentucky had 170 new confirmed cases of influenza, up from 140 the previous week. The week before that, 174 cases were reported, after a month with fewer than 100 cases per week. The state has recorded 3,228 cases this season and one flu-related death.

Dept. for Public Health map, adapted by Ky. Health News; click to enlarge

The health department raised Kentucky's flu level to "widespread" from "regional" because increases in cases were seen in more than half of the state's 16 health regions. Nine showed increases and two showed decreases.

The recent uptick follows a national trend. The Centers for Disease Control and Prevention reports that in the week ending March 12, "influenza activity is increasing in most of the country," with most of the increases seen in central and south-central regions of the nation. 

Flu season usually peaks between December and March, but can run through May. "An annual flu vaccine is the best way to protect against flu," the CDC says. "Vaccination can prevent serious outcomes in people who get vaccinated but still get sick."

The flu shot is recommend for everyone ages 6 months and older as long as flu activity continues.

Registration is open for April 14 conference in Bowling Green on youth vaccine that prevents certain types of cancer

Screenshot of flyer; for registration information, click here.

By Melissa Patrick
Ky. Health News

The Kentucky Rural Health Association is devoting a one-day conference to discuss a vaccine that can protect against infections and cancers caused by the human papillomavirus.

The HPV Vaccine Conference will be held at the Knicely Conference Center on Nashville Road in Bowling Green from 8 a.m. to 3 p.m. CST on April 14. Click here for registration. 

The conference agenda has not been released, but a draft agenda says it will include, among other topics, speakers who will talk about strategies to improve HPV immunization rates, rural HPV data, HPV vaccine resources and inter professional collaborations to increase HPV vaccination.

HPV, or human papillomavirus, is the most common sexually transmitted infection in the U.S. and can cause cancers of the cervix, vagina, vulva, penis, anus, rectum, throat and the back of the tongue. More than 90% could be prevented by the vaccine, according to the Centers for Disease Control and Prevention. 

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, although the series can be started at age 9. It is also recommended for those 13 to 26 if not vaccinated already. A three-dose schedule is recommended for people who get their first dose on or after their 15th birthday and for people with certain immunocompromised conditions. 

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated. 

In 2020, only 55.7% of Kentucky teens aged 13 through 17 had received all recommended doses of the HPV vaccine, slightly below the national rate of 58.6%, according to the America's Health Rankings. Kentucky ranks 29th among the states. 

Those rates are even lower in rural Kentucky. Research published in the Journal of Rural Health found that HPV vaccination rates are 11% lower than urban rates. 

America's Health Rankings reports that among Kentucky's 13-to-17-year-olds, 65.5% of the HPV vaccines were given to girls and 46.4% were given to boys.

Bill to reform public-assistance programs, including Medicaid, is approved by a committee and the House in the same day

By Melissa Patrick

Kentucky Health News

Legislation aimed at tightening Kentucky's rules for public-assistance programs passed out of committee and the full House just hours later on Thursday, with strong opposition from advocates and many Democrats and cries of "fear-mongering" from the prime sponsor. 

House Speaker David Osborne and Speaker Pro Tem David
Meade presented House Bill 7 in committee. (LRC photo)

“The only way that you would lose benefits in this bill is that you were either doing something that is illegal, or you are an able-bodied adult with no dependents that is not willing to participate in the work programs," House Speaker Pro Tem David Meade of Stanford said multiple times on the floor while presenting the bill.

Meade and other supporters of House Bill 7 said it aims to ensure that Kentuckians who are receiving safety-net services such as health and food assistance qualify for them, and to move more able-bodied Kentuckians into jobs, especially as extensions provided because of the pandemic phase out. 

A similar bill passed the House in 2020, but stalled in the Senate. Like last time, this bill is sponsored by Meade and  House Speaker David Osborne of Prospect. Rep. Melinda Gibbons Prunty of Belton in Muhlenberg County recently added her co-sponsorship to this bill. All are Republicans. 

The 27-page bill moved to the Senate on a 71-26 vote. Norma Kirk-McCormick, R-Inez, was the only Republican voting against the measure. 

The bill would require the Cabinet for Health and Family Services to apply for a federal waiver so Kentucky could require able-bodied adults without dependents to participate in at least 80 hours a month of qualifying "community engagement" activities to get Medicaid coverage if they have been enrolled in the program for more than 12 months.

"At this point, there's not a chance really that the Biden administration is going to approve" the application, said Dustin Pugel, senior policy analyst at the left-leaning Kentucky Center for Economic Policy. "There's Supreme Court precedent now against it. But that says nothing about what perhaps a future administration or future Supreme Court might decide." 

Anticipating rejection of the application, the bill would require the state to keep applying annually.

KCEP estimates nearly 200,000 people could lose Medicaid coverage, and tens of thousands of Kentuckians could lose Supplemental Nutrition Assistance Program (SNAP) benefits should HB7 pass.

 "If 200,000 Kentuckians lose Medicaid coverage because of HB7, fewer people will be able to go to the doctor for care. That could result in lost jobs at provider offices and more patients seeking uncompensated care in high-cost emergency departments," the Foundation for a Healthy Kentucky said in a statement opposing the bill.

"For the reasons outlined above, the foundation opposes HB7 as it is currently written and we urge legislators to oppose any new policies that would prevent Kentuckians from accessing care and food assistance," said the foundation.

HB 7 would also establish a Benefits Cliff Task Force to find ways to bridge the "benefits cliff" that results when a small change in income can cause a big loss of benefits. There is also language directing work on child-care assistance programs for people as their incomes increase above the current limits.

"The goal is to get those folks who are able-bodied adults with no dependents back out into the workforce and to assist them in that when we develop the bridge insurance program and the child-care assistance programs as well," said Meade. 

Rep. Lisa Willner, D-Louisville, told the House that she worries that the consequences of the bill will be different than the stated intentions and will result in people getting kicked off their benefits.

At the earlier Health and Family Services Committee meeting, Health Secretary Eric Friedlander estimated that the original bill would probably require the health cabinet to double its current workforce and would cost tens of millions of dollars to simply be able to answer the phones.

"I just think we have the potential for a real disaster situation," Friedlander said.

On the floor, Meade called this estimate "puzzling" because they had removed the most costly part of the bill and some of the work required of the cabinet would also be required by the federal government. He said that the rest of the bill is the same as the 2020 bill, which carried a cost estimate of $20 million, with $15 million of that to be funded by the federal government. 

Asked in committee what problems the bill is trying to solve, Meade said his goal is to reduce the number of ineligible people who are on Medicaid; to put both Medicaid and SNAP benefits on the same EBT card to eliminate any possibility of selling them; and to create a task force to develop a "bridge program" for people who make too much money for Medicaid, but not enough to purchase insurance and to work on the child-care gap to help people work.

Asked on the floor how many people are on the Medicaid rolls who shouldn't be, Meade said discussions with researchers at the University of Kentucky suggest that it could be upwards of 200,000 of the 1.6 million Kentuckians on Medicaid. 

Rep. Kim Moser of Taylor Mill, chair of the health committee, said "We're really trying to streamline and make sure that this is creating efficiencies and not creating barriers." 

Rep. Tom Burch, D-Louisville, scoffed at that: "It is not a bill to streamline our system. It's an evil bill. It's a bill that's going to hurt people."

In support of the bill in committee, Rep. Ryan Dotson, R-Winchester, said, "I think this commonwealth is long overdue with welfare reform and purging those out of the system that really don't need to be there. . . . I do believe this is a good first step." 

Speaking against the bill in committee, several advocates painted a picture of the challenges faced by people on public assistance. 

"I'm here to ask that we don't punish Kentucky's hardworking people who are in transition or trouble," said Mike Wynn of Grace Health in Eastern Kentucky. "Don't punish them for the few bad actors that abuse the system." Wynn said he had been a Kynector for seven years, helping people get health coverage. 

"This bill would make a very complex process even harder and nearly impossible for some," said Celine Mutuyemariya, a community policy strategist with the Louisville Urban League. "I urge the members of this committee to think about the very real consequences of this bill." She added that she has worked as a community health worker and Kynector in the past. 

Christina Libby, a certified community health worker and Kynector with the Homeless and Housing Coalition of Kentucky, said it's important to dispel the myth that everyone who is eligible for benefits are getting them or can get them easily. Further, she said it is an "unnecessarily complicated" process. 

"Getting help is already hard, very hard," she said. "It's a demoralizing and discouraging process." 

Kentucky Voices for Health provided lawmakers with a letter signed by 60 organizations and 64 constituents across the state stating their concerns about the bill.

Here are some key provisions related in HB 7 related to Medicaid: 

• After the federal government lifts the pandemic-era limit of the state's ability to disenroll individuals from Medicaid, the health cabinet would have 12 months to do a full audit of Medicaid rolls. 
• Medicaid coverage for treatment of substance-use disorder in prisoners, included in the 2020 budget, would be put into law. 
• The cabinet could not accept self-attestation of income, residency, age, household composition, caretaker or relative status or coverage for the purpose of determining Medicaid eligibility, except for residents of assisted-living and long-term care facilities. 
• The cabinet would have to use only the most recent income verification data available when determining eligibility.
• The cabinet could not make presumptive eligibility determinations, to approve someone for Medicaid before their qualifying paperwork is completed. 
• New rules would be established for for presumptive eligibility determinations by hospitals. 
• The attorney general, currently Republican Daniel Cameron, could bring action against the cabinet if he thinks provisions of the bill are not appropriately implemented.

Ky. is mostly green on CDC map but partly in big cluster where masks still advised; Fauci says mutated virus may cause uptick

CDC map; click on it to enlarge. The state's version of the map will be posted Friday.

By Al Cross
Kentucky Health News

Almost half of Kentucky's counties are in the low-risk category in the latest federal map of the pandemic, but the state is part of the nation's largest cluster of high-risk counties.

The map by the Centers for Disease Control and Prevention has 24 of Kentucky's 120 counties in orange, meaning that the agency still advises wearing a mask in indoor public spaces. Almost all are in Appalachia.

Largely surrounding that cluster are 37 counties in yellow, where the CDC says residents who are immunocompromised or at high risk for severe illness should talk to a health-care provider about "additional precautions, such as wearing masks or respirators indoors in public. If you live with or have social contact with someone at high risk for severe illness, consider testing yourself for infection before you get together and wearing a mask when indoors with them."

The remaining 59 counties are in green, indicating low risk. The weekly rankings are based on new coronavirus cases, Covid-19 hospitalizations and the percentage of staffed inpatient beds occupied by Covid patients.

Hospitalizations are the key metric to watch as the Omicron BA.2 sub-variant of the virus threatens to increase case numbers, Dr. Anthony Fauci said on the PBS "NewsHour" Thursday evening.

Cases are rising in the United Kingdom and some other European countries, and "We generally follow the European Union, particularly the UK, by about three weeks," Fauci said. (The U.K. is no longer in the Union.)

"I wouldn't be surprised in the next few weeks if we see an uptick in cases," because preventive measures have been relaxed and immunity is waning, said Fauci, President Biden's top medical adviser and director of the National Institute of Allergy and Infectious Diseases.

He said the BA.2 mutation "has a slight to moderate transmission advantage" over the original Omicron variant, but "It doesn't appear to be any more severe and it doesn't seem to evade immune responses."

Asked about Pfizer's request for emergency use of an additional booster shot for seniors, Fauci said he "wouldn't be surprised that at least some set of people" will need a second booster "within some set of time."

UK begins world's first clinical trial to slow a form of dementia recently discovered by a team co-chaired by a UK faculty member

Drs. Pete Nelson and Gregory Jicha discuss their research.
(University of Kentucky photo by Mark Cornelison)

By Hilary Smith
University of Kentucky

The motivation driving the work of Pete Nelson, M.D., Ph.D., is personal. His grandmother, Sylvia Becker, died with Alzheimer's disease, and he says his mother then grew terrified of developing the disease.

"It gives me purpose in life to attack that," Nelson said. As an experimental neuropathologist at the University of Kentucky's Sanders-Brown Center on Aging, he is guided by that motivation. "It is most every researcher's dream to help identify and classify a disease, and then to go on and help beat it."

Nelson, who is the R.C. Durr Foundation Chair in Alzheimer's Disease at UK, accomplished the first part of that dream back in 2019, when a group of international researchers he co-chaired discovered a new form of dementia named limbic-predominant age-related TDP-43 encephalopathy, more commonly known as LATE.

Symptoms of LATE mimic Alzheimer's disease by causing memory loss and problems with thinking and reasoning in old age. But researchers found the LATE-affected brain looks very different from the Alzheimer's brain.

Now, a couple of years after this discovery, Nelson is working towards the second part of the dream, with the world's first clinical trial for LATE officially underway by his colleagues at UK.

Greg Jicha, M.D., Ph.D., is director of clinical trials at Sanders-Brown and leader of one of the best clinical dementia teams in the country.

"Our collaboration with the basic scientists as always is key. We couldn't have done this without Dr. Nelson's discoveries," said Jicha. "For the first time ever, we are looking at folks participating in our research who we think are heading down the path of Alzheimer's, but now by checking simple blood tests and sometimes spinal fluid, we may be able to say while it looks like Alzheimer's symptomatically … it is actually LATE."

Research Subject No. 1: Ned and Lu-Ann Farrar were married in 1984. They've done many things in their nearly 40 years as a team, including raising two children while both pursuing meaningful careers. Most recently, their teamwork has been focused on Ned's health.

In 2018, after retiring from teaching orchestra in Fayette County Public Schools, Ned was diagnosed with Alzheimer's disease. He took part in an earlier study at Sanders-Brown and was in the evaluation process for another when they refined his diagnosis to LATE, which Nelson and his team had just discovered.

Lu-Ann said, "I asked Dr. Jicha if this was good news or bad news and he told us that anytime someone tells you your brain is not full of beta-amyloid, that is a good thing."

Jicha then told the Farrars that there were plans in the works for a trial regarding LATE and that he would keep them updated. About three months ago, they got the call.

"Ned is research subject number one, which is pretty exciting," said Lu-Ann.

The Farrars have called Lexington home for decades now, and they say it is truly a blessing that the place making these groundbreaking discoveries and then advancing them towards a potential treatment is right in their backyard. Sanders-Brown not only helps evaluate and treat Ned, but they also give LuAnn guidance by providing honest, knowledgeable and compassionate answers.

"I'm not a researcher, but I am pretty sure you can't fix something if you don't know what it is," said LuAnn. "Research and clinical trials may seem like the long road, but it is so foundational to real, effective treatments. Their commitment to curing these diseases is profound, evidenced by the work they do every day, including thoughtful consideration of Ned and his diagnosis and his treatment options."

The disease: LATE is a disease estimated to affect 40% of people over the age of 85. Jicha says the medication in this research study may slow or perhaps even stop LATE in its tracks as a disease-modifying therapy.

The discovery of LATE, which has led to this trial, is crucial to their overall fight to help people with their memory.

"The issues of end-stage dementia, memory loss and mild cognitive impairment are largely incurable, and it is not just all about Alzheimer's disease," said Jicha, who holds the Robert T. & Nyle Y. McCowan Chair in Alzheimer's at UK. "It is about many different diseases and understanding that complexity helps us to move forward with medicines that don't just put a band-aid on memory, but instead actually begin to target the root of the problem."

As with many diseases related to aging, people often ask, "Why did I come down with this? Why me?" In most cases, Jicha says, it is a combination of things. There can be genetic factors that predispose the individual to developing dementia, so some diseases can be seen running in families.

There can also be environmental factors. Identifying those risk factors can help doctors understand what is happening in the brain at the cellular level and maybe find an existing medication that influences the disease course — which is exactly what is happening with the research on LATE.

"The genetic discoveries by Dr. Nelson in his lab have shown us that there is a key element of potassium channel that allows nerve cells to either be healthy or diseased," said Jicha.

The treatment: Based on that knowledge, they identified a drug already used around the world, except in the United States, where it is not yet approved. The medicine has been used for quite some time for heart conditions and researchers at UK believe it could slow or even stop LATE dementia.

"The folks that have been taking this medicine have reduced cardiovascular and cerebrovascular disease," said Jicha. "They are healthier, they have reduced rate of death and longer lifespans. For us, what's really amazing is that modulating the potassium channel with this medicine doesn't just make the heart healthier, but may make the brain healthier, too."

It has been a complex process to bring a drug not yet approved in the United States into the country. Jicha and Nelson are both gratified to say that the medication is finally at UK for their participants who appear to be at high risk for LATE.

Advances in science and treatments are not possible without research volunteers like Ned Farrar. Through the years, researchers at Sanders-Brown have been blessed with thousands of such volunteers, and hope to continue bringing in new participants who are interested in knowing if they are at risk.

"This is the best place to do clinical trials in the country," said Nelson, who is thrilled to know this stage of his LATE discovery is in the very capable hands of Jicha's team at UK. "Some research volunteers are going to be at risk for Alzheimer's disease and they have options, there are also other people who are going to be at risk for other diseases, and they have very few resources in the whole world, but here they have an option. That is extraordinary."

For those who are believed to be at risk for LATE, UK is now the only place in the world where providers can do something about it thanks to this trial. Participants in the 2-year study are required to do a clinic visit about every three months. During those visits, clinical trial participants go through memory and thinking tests and receive their study drug dose. As with all studies, there is a placebo.

Volunteers sought: While the Sanders-Brown volunteer cohort is among the most robust in the country, more research volunteers are needed.

"We need to get more people in line, especially people beyond age 75," said Jicha. "We are looking for the person who might have scratched their head every now and then and said, 'Am I developing a memory problem?' People even with mild memory problems that remain engaged in their daily activities; people who use their GPS a little bit more or are having to write everything on their calendar. These are the kind of people we want to get to because that is where we can make the most impact."

Both Jicha and Nelson note how crucial it is to be proactive once you notice changes, even if it seems very minimal.

"Let us help figure out why, because once we know why, it doesn't really matter what the cause is … We have things to offer you that can help," said Jicha. "The earliest we can get to folks to stop the process the more of the brain we can save and that is just critically important."

Nelson believes even those at risk for LATE who receive the placebo during the trial will be better off for participating because of the care of Dr. Jicha, who Nelson jokingly refers to as "Dr. Vitamin J."

"He has an eight-month waitlist outside of clinical trials – there is a reason for that," Nelson said. "He is one of the best neurologists in the world. Everybody in this trial – whether they get a placebo or the drug – they get Dr. Jicha."

This new clinical trial for LATE is a hallmark of the collaboration that goes on at UK, how Sanders-Brown is a worldwide leader in Alzheimer's and dementia research, and how the researchers share a common link as teammates.

"We are all fighting these horrible diseases, and they are a great enemy to have because they are so bad," said Nelson. "For me, it is a spiritual thing. This passion is shared by others here at this center. We really care. This is our common ambition. If we could just start beating these diseases one after another … what a life well-spent that would be."

That goal is also shared by those volunteering to participate in research.

"How awesome would it be if a patient at Sanders-Brown would be the first person to be rid of dementia?" Lu-Ann Farrar asked. "That is almost beyond belief. Ned and I are very clear about clinical trials – he may not get the medicine, but we know that someone will."

For more information on how to get involved with research at Sanders-Brown, call (859) 323-5550 or fill out the research interest form.

Beshear vetoes resolution that would end state of emergency and apparently reduce $243 monthly SNAP food benefit by $100

Beshear signing veto (Still image from Facebook video)

By Al Cross and Melissa Patrick
Kentucky Health News 

Gov. Andy Beshear has vetoed legislation that would end the state's Covid-19 state of emergency if the General Assembly overrides his veto. Beshear says the resolution would end the $100-a-month pandemic boost in federal food aid, but legislators say that isn't their intent and that he's off base.

“Given that we have zero statewide restrictions, and we haven’t for six months, all this does is hurt these folks by cutting off this extra food aid while doing absolutely nothing else,” Beshear said in a Facebook video in which he signed the veto and asked the legislature not to override it, which it could easily do.

The Kentucky Center for Economic Policy says the average monthly benefit of $243 in the Supplemental Nutrition Assistance Program, once called food stamps, would drop by about $100. The state Cabinet for Health and Family Services said that would affect 544,000 Kentuckians.

Senate Joint Resolution 150 says "It is not the intention of the General Assembly that this resolution should impair or delay the ability of the Commonwealth to receive any federal stimulus or pandemic-related funds or services."

The federal law at issue, highlighted by the Beshear administration

The Beshear administration says that won't work around a federal law that requires "an emergency or disaster declaration by a state based on an outbreak of Covid-19" for the extra benefits.

The legislature has barred Beshear from declaring another Covid-19 emergency without its permission. It is unclear whether he could declare a disaster. Senate President Robert Stivers said late Wednesday that he believes Beshear could meet the requirements by issuing an emergency administrative regulation.

“We have yet to be shown the language that they can't draw down that with an emergency reg. We have asked for specific language to send to us,” Stivers said. “I believe somebody said he made a comment there were two emails. We do not have any record of any emails being sent to us with this.”

Cabinet spokeswoman Susan Dunlap said the agency advised the chairs of the House and Senate health committee the week of Feb. 28. “COVID continues to impact many families and it is indefensible to take food benefits away from Kentuckians — especially our most vulnerable seniors and children — who already go hungry at a rate higher than the national average,” Dunlap told Austin Horn of the Lexington Herald-Leader.

Kentucky Health News asked Dunlap if the administration believes that the new law prohibiting another Covid-19 emergency declaration without the legislature’s approval means that the legislature would have to expressly authorize the declaration of an emergency that would meet the federal requirement.

Dunlap said Beshear asked the legislature to extend his original emergency order "until at least the April 16, 2022, expiration of the HHS public health emergency declaration and until the later date that HHS may extend its declaration. During this legislative session, the governor requested the General Assembly extend the state of emergency until Jan. 15, 2023, and the General Assembly responded by extending it to April 14, 2022."

Stivers, told that the federal law requires the state to declare an emergency, "Well, we would like to have that discussion with him to see if there aren't any other avenues. We've been able to work on the Ford deal and several other things, but it seems he wants to talk to you all. We're right here. He knows where we are every day."

The House passed SJR 150 overwhelmingly on March 10 despite warnings from Democratic legislators about SNAP benefits. “I'm not really interested in continuing to draw federal funds if they're not deserved or needed,” said Rep. Thomas Huff, R-Shepherdsville, who managed the bill in the House.

Stivers noted Wednesday that Beshear signed the bill ending the emergency in mid-April and said, "If there is no emergency, and he apparently doesn't believe there is one either, is it appropriate to be requesting emergency funds when there is no emergency? Take all our arguments off the table. When there's no emergency, why do you request emergency funds? It's almost fraudulent to do that. The emergency is over."

Beshear, a Democrat battling with a Republican legislature, said Wednesday, “It comes down to this simple question: do you want our struggling seniors and kids to be able to afford enough food as we navigate out of this pandemic.” He called SJR 150 “a callous act.” Earlier, he called it “politics at its worst.”

The resolution was filed by newly elected Sen. Donald Douglas, R-Nicholasville, who is opposed in the May 17 primary election by Andrew Cooperrider, a leader of protests against pandemic restrictions. He has said the resolution is intended to help Douglas, who was elected in a special election for which party officials chose the nominees and which was held before the legislature redrew its districts.

Stivers said the resolution was intended to tell Beshear, "Show us what you need. We have said file emergency regs if needed. Let us look at them. Tell us what you need in budget language, you know, what are the things [you] need not to discuss through the press? . . . We are here."

Rand Paul's resolution to end the federal mask mandate in public transit passes Senate, but not by enough to overcome a veto

The federal rule applies to transport hubs and conveyances. (Photo by Brandon Bell, Getty Images)

By Al Cross

Kentucky Health News

The U.S. Senate passed Kentucky Sen. Rand Paul's legislation to end the mask mandate in public transportation, but not by a margin large enough to overcome a threatened veto by President Biden.

Paul's resolution passed 57-40 Tuesday but it takes a two-thirds vote (67 in the Senate) to override a veto, and the Democrat-controlled House could bottle up the resolution, relieving Biden of the burden of vetoing it. The rule had been set to expire Friday, March 18, but the administration extended it to April 18.

Biden's Office of Management and Budget said requiring masks in public conveyances and in transportation hubs had prevented the spread of Covid, "saving lives." It called them "places where people across communities congregate, often for extended periods and in close quarters. The determination of the timeline and circumstances under which masks should be required in these settings should be guided by science, not politics."

Paul, in a press release, called the rule an "anti-science, nanny state requirement" that is ineffective. "As the entire world is learning to live with Covid, the federal government still uses fear mongering to stubbornly perpetuate its mandates, rather than giving clear-eyed, rational advice on how to best protect yourself from illness."

The rule was issued by the Centers for Disease Control and Prevention in January 2021. On Feb. 25, 2022, it exempted school buses, in conjunction with relaxed guidance for mask wearing in schools. "Travel contributes to interstate and international spread of Covid-19," the CDC says. "Wearing masks that completely cover the mouth and nose reduces the spread of Covid-19."

Tuesday's vote was largely along party lines. Minority Leader Mitch McConnell of Kentucky and all other Republicans except Mitt Romney of Utah voted for the resolution, as did Democrats Mark Kelly and Krysten Sinema of Arizona, Michael Bennet of Colorado, Jon Tester of Montana, Jacky Rosen of Nevada, Maggie Hassan of New Hampshire and Joe Manchin of West Virginia.

Paul and 16 other Republicans in Congress, led by Rep. Thomas Massie of Kentucky's Fourth District, are taking another tack to end the mask mandate: a lawsuit against the CDC, alleging that it lacks the authority to impose such a rule.

Beshear says bill to end state of emergency would cut food benefits, and Covid-19 mitigation funds are needed in budget

Senate President Robert Stivers signs resolution, sending it to
the governor, as Douglas watches. (Photo: Douglas's Twitter)

By Melissa Patrick

Kentucky Health News

Much of what could have been Gov. Andy Beshear's last Covid-19 briefing centered on taxpayer money related to the pandemic.

Beshear said over half a million Kentuckians will lose extra food stamp benefits if the legislature ends the pandemic state of emergency early, and he urged legislators to put money for Covid-19 mitigation in the budget for the fiscal year that begins July 1.

The legislature sent Beshear a joint resolution March 10 to end the state of emergency as soon as it becomes law, rather than April 15, as it directed in January.

The Democratic governor indicated that he will veto it, saying "You'll likely see some action on that a little bit later this week," but it only takes a majority of each legislative chamber to override a governor's veto, and Republicans have huge majorities in the House and Senate. 

"Senate Joint Resolution 150 is politics at its worst," Beshear said. "It will take food off the tables of more than a half a million Kentuckians, most of them struggling seniors and struggling children."

The sponsor of SJR 150 is newly elected Sen. Donald Douglas of Nicholasville, who is in a Republican primary race with Andrew Cooperrider of Lexington, a fervent opponent of anti-pandemic measures who has said the bill is designed to boost the candidacy of Douglas, a more mainstream candidate. 

Beshear's concern is that by ending the state of emergency, Kentucky will lose extra money the federal government is providing for the Supplemental Nutrition Assistance Program, once known as food stamps. He said, "Cutting $50 million worth of food to our people is wrong, and for what? There are no restrictions, no Covid restrictions in Kentucky. None. And there haven’t been for six months."

Deborah Yetter reports for the Louisville Courier Journal, "The average benefit of $243 a month will drop by about $100 for the 544,000 low-income Kentuckians who qualify" for SNAP.

"During the pandemic, the federal government has allowed people to get the maximum amount of monthly benefits rather than have them based on individual income," Yetter explains. "Extra SNAP benefits are expected to continue to be available until the federal emergency ends, probably around September. But without a designated state public-health emergency, Kentucky will not be eligible for them after April."

The legislative resolution says it is not the General Assembly's intent "to impair or delay the ability of the Commonwealth to receive any federal stimulus or pandemic-related funds or services.”

Senate President Robert Stivers reiterated that in a statement Monday, and said there is another way to keep the added food benefits: an emergency regulation from the administration.

"We note that a Statement of Emergency is provided through the emergency administrative regulation process," Stivers said. "If the governor needs something from the legislature, he still has time to come to us and we have time to respond."

Asked to respond, Beshear said the administration has made clear to the legislators that ending his executive order for the pandemic state of emergency would end the extended SNAP benefits.

"It's certainly like someone saying they wouldn't have robbed the bank if the security guard had stopped them," he said. "That's pretty silly. . . . There is no way to our knowledge, and we've had all our lawyers look at it, that we can get that additional $50 million of food assistance to struggling seniors and struggling kids without the executive order I sign being extended." 

When SJR 150 was debated on the House floor, several Republicans said it would not affect SNAP benefits. "From my research, this bill will not impact the SNAP program whatsoever," said Rep. Norma Kirk-McCormick of Inez. "This bill is to set the people free." 

Rep. Kim Moser of Taylor Mill, chair of the House Health and Family Services Committee, said "A state of emergency does not change the eligibility for SNAP benefits. There is no reason to be concerned that the eligibility standards will be changing there."

Yetter reports, "SJR 150 won a hurried passage in the House Thursday on a vote of 75-20 just a few hours after it cleared the House State Government Committee, despite questions of some lawmakers. . . . At the committee meeting, Chairman Jerry Miller, R-Louisville, told members with questions that they still had time to get answers." 

"I'm sure this won't be on the floor today," Miller said. He was wrong.

The resolution also would require Beshear to get the legislature's approval before declaring another Covid-19 state of emergency "based upon the same or substantially similar facts and circumstances."

Covid-19 mitigation money: Beshear objected to the Senate version of the state budget having "zero dollars" for mitigation of Covid-19, even though he asked that those efforts get upwards of $170 million in funds from the American Rescue Plan Act, the latest federal relief bill.

Beshear said he did not know if the House budget allocated any ARPA money toward the efforts. but a cursory search of the House budget shows that it only includes money to support Covid-19 testing of residents and staff at facilities that house people with mental illness or intellectual disabilities. 

Without money for Covid-19 mitigation, Beshear said, several programs will end on June 30: the test-to-stay program in public schools; regional community antibody administration centers; community-based testing through Gravity Diagnostics and the University of Kentucky. He also said it would make uncertain the ability to support a 90-day emergency supply of personal protective equipment and necessary warehouse space. 

"Remember, we're learning to live with it," he said of the coronavirus. "It's not disappearing. . . . This is about us being able to support things like testing, PPE and actual treatment if you get it given that the pandemic in some form is still going to be around."

As most Covid-19 numbers in Kentucky continue to fall, Beshear 'pauses' weekly pandemic press conferences for second time

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

By Melissa Patrick
Kentucky Health News

With almost every metric to measure the pandemic in Kentucky keeping on a steady decline, Gov. Andy Beshear announced that he was putting his weekly Covid-19 press conferences on a "pause." 

"While we still have some struggles, while this pandemic is still with us, things continue to move in the right direction and they are continuing to move at a regular pace," Beshear said. "That means cases, positivity rates [are] all declining, as well as hospitalizations, those in the ICU and those on ventilators. Every metric is moving the right direction."

Beshear stopped regular pandemic briefings last June, but resumed them after the highly contagious Omicron variant arrived. It caused the biggest surge of the pandemic.

"If I can go back in time and change a decision or a way to talk about things," Beshear said, "I really would have talked about how this was going to be a war. None of us have lived through this before so we didn't know. But I would have talked about how you don't win a war in two weeks. That a war may take two years and that's what it's been. And this war will end when we beat the virus or it becomes fully endemic," like influenza and cold viruses.

"We know so much more about the virus and how to fight it. In many ways, it has become a part of our daily lives,” he said. “If today is the last update we give, living with Covid is not ignoring Covid. It is having the information to be empowered to make the right decisions to protect ourselves.”

Beshear pointed to the largely green and yellow Centers for Disease Control and Prevention map, updated last Thursday and Friday, that uses new coronavirus cases and Covid-19 hospitalizations and intensive-care cases to determine the risk that the virus poses in each U.S. county. 

 

The map shows 32 Kentucky counties are red, signifying a high risk of infection and hospitalization, which the CDC says calls for wearing masks in indoor public spaces; 38 are yellow, signifying a medium risk; and 51 are green, indicating a low risk.

"This map is just one way to show how we are moving to a better place," Beshear said, adding that he expects to see many more yellow and green counties in Kentucky next week.

The bad news is that Kentucky's Covid-19 deaths, the pandemic's lagging indicator, keep rising. The state attributed 283 more deaths to Covid-19 in the reporting week ended Sunday, up from 275 the previous week. Beshear said 13 of the deaths were of people under 49, and one was 25. Kentucky's pandemic death toll is now 14,380. 

The governor encouraged Kentuckians to  pray for families of Covid-19 victims, and encouraged them to get vaccinated to prevent more deaths. He said that even with more vaccinations given in the last week, this is the only metric going in the wrong direction.

Actually, Kentucky's vaccination rate more than doubled in the last 10 days. The state averaged 3,662 doses per day last week, more than twice what the average was 10 days ago, when it bottomed out at 1,772 per day, according to CDC data presented by The Washington Post. 

Beshear noted that some people continue to get their first dose. Of the 25,000-plus vaccinations last week, 6,459 were first shots, 8,045 were the second shot; and 10,809 were boosters. 

Kentucky's Covid-19 vaccination rates remain below national averages, with 65% of the state's population having received at least one dose of a vaccine, 56% "fully vaccinated" and 43% of that eligible population with a booster shot.

The percentage of Kentuckians testing positive for the coronavirus in the past seven days is now 4.17%, the lowest this rate has been since July 2021. 

In the week ended March 13, Kentucky reported 9,532 new coronavirus cases, down from 12,010 the week before. It was the seventh straight week this number has fallen. 

Kentucky's new-case rate has finally dropped out of the leaders in the The New York Times rankings; it is now 20th among the states. It had a 78% decline in the last 14 days, the second fastest decline among states. 

However, the state still has many hot spots. The Times reports that Pike County has the highest rate of any county in the nation, with 175 cases per 100,000; the Nome Census Area in Alaska is first among counties and county equivalents, at 239/100K.

Many Kentucky counties are in top 50: Trigg, McCreary, Perry (6th, 7th and 8th); Wayne, Morgan, Taylor (12,13,14); Bath (21), Clinton (24), Pulaski, Adair, Green (28,29,30); Whitley (36), Breathitt (39), Montgomery (42) and Caldwell (48).

Kentucky hospitals reported 470 Covid-19 patients on Monday, with 95 in intensive care and 56 on mechanical ventilation. The Times ranks Kentucky's hospitalization rate fifth in the nation, even though that rate has dropped 49% in the last 14 days.

House passes bill to allow APRNs to prescribe controlled substances after a four-year collaborative agreement with doctor

American Association of Nurse Practitioners map, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

A bill to create a path for Kentucky's advanced practice registered nurses to prescribe controlled substances independently has passed the state House with only eight members voting against it. 

“We are always talking about encouraging folks to enter the health-care field; we hear discussion about a shortage of nurses that we have,” Rep. Russell Webber said while presenting the bill on the House floor. “This bill will help with that.”

House Bill 354, sponsored by Webber, would allow an APRN to prescribe controlled substances without a collaborative agreement with a physician, after practicing under such an agreement for four years and getting approval from the Kentucky Board of Nursing.

If the board decides an APRN is abusing this authority, it can require them to go back under a collaborative agreement, or it can take further action.

The latest version of the bill would hold independently prescribing APRNs to the same standard of care as other prescribers, and create a Controlled Substance Prescribing Review Panel to monitor them.

"This component adds teeth to this bill. It adds strength," said Webber, a Shepherdsville Republican. "It  may very well help us get to the bottom of some problems that are existing out there, if they are existing, but the data will certainly be worthwhile for us to have. Problems that may surface will be worthwhile for us to know."

Rep. Russell Webber

Webber was alluding to the implicit contention of the doctors' lobby, the Kentucky Medical Association, that APRNs haven't been responsible enough with their prescribing of Schedule II drugs, those with high potential for abuse, to prescribe them independently.

In Kentucky, APRNs have been able to prescribe controlled substances since 2006 under a "collaborative agreement for prescriptive authority-controlled substances," or CAPA-CS. They are allowed to prescribe a 72-hour supply of a Schedule II drug; HB 354 wouldn't change that.

The bill's primary co-sponsor, Rep. Patti Minter, a Democrat from Bowling Green, told the House that it is needed to increase health-care access in a state that has only 57 percent of the primary-care practitioners it needs and 25% of needed mental-health personnel. 

"Nurse practitioners are for many people the primary-care providers," Minter said. "They're the family doctors of the community."

Rep. Jerry Miller, R-Eastwood, said the bill would improve access to health care. "This is a good bill for the people," he said. "It may not be a good bill for the doctors, but it's a good bill for the people of Kentucky." 

House health committee Chair Kim Moser, R-Taylor Mill, a former nurse and a doctor's wife, voted no. Moser said she liked the amendments because "It's critical that all prescribers play by the same rules" but cautioned, "The only thing that we are doing by passing this bill is increasing controlled substances."

The House voted against suspending its rules to let Moser offer a floor amendment to reinstate the requirement that an APRN be licensed to practice for a year before being prescribing controlled substances, to obtain a registration certificate from the Drug Enforcement Administration and pass each component of the federal licensing exam in three attempts, just as physicians must do before prescribing controlled substances. 

Rep. Mary Lou Marzian, D-Louisville, a nurse, said the bill is needed because APRNs need a DEA number to order some diabetic and psychiatric medication, durable medical equipment, and flu and antibiotic shots.

APRNs were allowed to prescribe controlled substances without a collaborative agreement in the pandemic through an executive order that the General Assembly approved, but that ended in January when lawmakers extended the state of emergency but did not extend the APRNs' expanded authority.

Dueling numbers

A before-and-after comparison by the Kentucky Association of Nurse Practitioners & Nurse-Midwives, said there were "no significant differences in the average number of opioid prescriptions by APRNs without the CAPA-CS in place" before the emergency order was implemented and the seven quarters it was in place. Similar findings were also noted for dentists and physicians. 

The data came from the state's Kentucky All Schedule Prescription Electronic Reporting system. Other KASPER data provided by the APRN association shows that the average number of Schedule II prescriptions per APRN prescriber dropped 34.9% between 2015 and 2021. 

Webber said, "Nurse practitioners were not writing prescriptions hand over fist for controlled substances and flooding the state with opioids." 

The KMA disputed those figures before the House Licensing, Occupations and Administrative Regulations Committee on March 9.

Cory Meadows, KMA's deputy executive vice president and director of advocacy, said "We have KASPER numbers that show that they are consistently up, way up over the course of a lot of years."

KASPER data provided by the KMA, comparing the total number of prescriptions for Schedule II opioids prescribed by APRNs shows an increase in all but one year since since 2011, the year before lawmakers passed what is called the "pill-mill bill" that placed restrictions on opioid prescribing.

There are some discrepancies, many of them slight, in the year-to-year numbers provided to Kentucky Health News by the two organizations, and they measure different things. 

For example, the APRN group provided the average number of Schedule II opioid prescriptions per the number of prescribers since 2015 and for seven recent quarters, while the KMA provided year-to-year percentage changes for the total number of such prescriptions. 

KMA data shows that Schedule II opioid prescribing by APRNs went up 8.2% between 2020 and 2021, years that the CAPA-CS were no longer required, under the executive order.

The APRN data shows that the average number of Schedule II opioid prescriptions per APRN dropped from 100.68 in 2020 to 99.28 in 2021 and that their quarterly average in 2021 was 25 prescriptions. The average was 50 for physicians and 22 for dentists.

The bill passed the House 84-8 and moves to the Senate, where it will be carried by Sen. Julie Raque Adams, R-Louisville. 

The "no" votes were all Republican: Moser, Joe Fischer of Fort Thomas, Kim King of Harrodsburg, Mathew Koch of Paris, Adam Koenig of Erlanger, Sal Santoro of Union, Nancy Tate of Brandenburg and Killian Timoney of Lexington.

Vaccine bills elevating individual rights are moving in legislature

By Melissa Patrick

Kentucky Health News

Bills are moving in both chambers of the General Assembly to loosen immunization rules in Kentucky.

One would ban public entities from asking employees and applicants if they have received a Covid-19 vaccination, and would also ban colleges and universities from requiring students, staff or faculty members to disclose their immunization status. The other would would give a religious exception if any employer requires workers to be immunized against any disease.

Rep. Savannah Maddox (LRC photo)

House Bill 28, sponsored by libertarian Republican Rep. Savannah Maddox of Dry Ridge, defines a public entity as the state, a local government, or any of their agencies or departments. 

It would also ban public entities from mandating or issuing vaccine passports, passes or other standardized documentations to certify immunization status to a third party for a purpose other than health care, and says such information cannot be published or shared for a purpose other than health care. 

The bill originally applied to all employers. Maddox told the House that she was "personally aggrieved" that she had to take that out of the bill to get it moving. 

"Its initial iteration was designed to ensure that every Kentuckian had the ability to decide for themselves whether or not to receive a vaccine without any type of undue force or coercion from the government, from their employer or from anyone," Maddox said. She added later, "I believe that Kentuckians can make good decisions for themselves when it comes to their health care." 

HB 28 also allows parents or guardians of children in schools to opt them out of any Covid-19 vaccination requirements on the basis of a conscientiously held belief. Kentucky's public schools do not require Covid-19 vaccinations.

Rep. Lisa Willner, D-Louisville, asked why that part of the bill is needed since existing law allows parents to exempt their child from any vaccine required during an epidemic based on conscientiously held beliefs. Maddox said that law pertains to executive mandates related to a state of emergency and applies to everyone, but her bill only pertains to school policies. 

Sentate Bill 8, passed in 2020 without Gov. Andy Beshear's signature, allows several exemptions for "any child or adult" who doesn't want to receive a vaccine that the state mandates during an epidemic, including religious grounds, medical reasons or a "conscientiously held belief." 

Responding to a question from Rep. Pamela Stevenson, D-Louisville, about governments' responsibility to protect the common good and their need for information to do that, Maddox said that while governments need to provide accurate information, it is not their responsibility to mandate vaccines.

She called words and phrases like "protection" or "the government's role to keep people safe . . . euphemisms for forcing a needle into someone's arm against their will. That's what mandatory vaccination is."

Rep. Jennifer Decker, R-Waddy, one of the bill's 26 co-sponsors, said government employers who require employers to disclose their immunization status against their will are practicing government overreach and it is policymakers' responsibility to "protect freedom in our society." 

"After a period of years now that all levels of government have exercised control over people who have longed to be free," Decker said, "this bill is needed."

Minority Caucus Chair Derrick Graham, D-Frankfort, disagreed, saying, "I voted no for the good of the Commonwealth and for local government, the boards of education and the boards in our universities because they need to make those decisions for their students, their community." 

The Kentucky League of Cities opposed the bill, saying it violates home rule of local governments. 

HB 28 passed the House on a 71-22 vote and awaits committee assignment in the Senate. 

Sen. Rick Girdler (LRC photo)

The religious-exception bill for employees is Senate Bill 93, sponsored by Sen. Rick Girdler, R-Somerset.

"This bill just says on my behalf that we have the right to reject a vaccination based upon our own freedom of religion," he told the Senate Judiciary Committee. "Don't need the church or anybody else. . . . I announced my faith in Jesus Christ wholly on my behalf, and so we will take your word, based upon this bill, that it's against your religion."

The original bill also had an exception for conscientious belief. The committee approved a substitute bill removing that portion. Also, it would put the religious exception in a different section of law to keep it from forming a newly protected class of religious protection, said Sen. Stephen West, R-Paris. 

West noted that Kentucky already allows for medical and religious exceptions to government-required vaccinations, "so this just kind of follows what we already do there." 

The bill also provides that if an employer requires a vaccine, they must provide employees with a one-page sign-off sheet to inform employees of the allowable exceptions.

West noted that the U.S. Supreme Court upheld a federal law that requires health-care workers to be vaccinated for Covid-19 but also allows religious exemptions. He said health-care employers must provide notice to their employees that this exemption exists and have them employees sign off on this notice. 

"In my opinion, this is about personal, individual medical freedom," West said. "The right to choose for yourself if you want to be vaccinated or not vaccinated. And it protects the rights of the individual. But it also provides a framework and some clear guidelines for employers if they want to do the mandate." 

The bill includes a list of health-care providers who would be allowed to provide a written opinion to allow a medical exception for employees, including advanced practice registered nurses, physicians, osteopaths, chiropractors, podiatrists, physician assistants, pharmacists and optometrists.

Sen. Karen Berg, D-Louisville, a physician, objected to including some of those providers: "I just want to make sure that we do limit this to the health-care people who actually would have the knowledge to be able to make this decision."

The bill cleared the Senate Judiciary Committee on an 8-1-1 vote on March 10 and is ready for floor action.

Medical marijuana appears to have more traction than ever in Ky.

UPDATE: The House sent the bill to the Senate March 17 by a vote of 59-35.

Rep. Jason Nemes (CJ photo by Joe Sonka)

Kentucky looks closer than ever to joining the 37 states that allow prescriptions for marijuana, or cannabis.

Thursday evening a state House committee approved a bill that would allow doctors to prescribe cannabis to people who have certain ailments, "along with a new bureaucracy to strictly regulate it from plant to processor to dispensaries," which sponsor Jason Nemes, a Louisville Republican, says will be the strictest medical program in the country," Joe Sonka reports for the Courier Journal.

The ailments are cancer, "chronic, severe, intractable, or debilitating pain; epilepsy or any other intractable seizure disorder; multiple sclerosis, muscle spasms, or spasticity; and nausea or vomiting." Nemes said he will support a floor amendment by Rep. Rachel Roberts, D-Newport, to add post-traumatic stress syndrome.

"A similar medical cannabis bill led by Nemes easily cleared the House chamber for the first time in 2020 with 65 votes, but stalled in the Senate because of the Covid-shortened session" and lack of support by Republican leaders, Sonka notes. "However, medical marijuana advocates are now optimistic," due to new support from Senate Judiciary Committee Chairman Whitney Westerfield, "who met many times with Nemes over the past year to amend it into legislation he could back."

Sen. Whitney Westerfield
(Legislative staff photo)

"You can't overestimate how important he is," Nemes said after the House Judiciary Committee approved House Bill 136 15-1. Voting no was Rep. Kim Moser, R-Taylor Mill, who cited opposition from doctors, including concerns about the lack of guidelines for prescribing and dosing cannabis.

Westerfield, a Republican from Crofton in Christian County, said he still has concerns about youth access to cannabis, but “I’ve heard too many stories in my district, and out, from those long suffering, and their loved ones left behind, that marijuana brought comfort and relief when nothing else worked.”

Nemes said "I feel good about where we are in the Senate," but Sonka reports that to pass, the bill would need a majority of the 30 Republicans in that chamber, and the top two Republicans, "Senate President Robert Stivers and Majority Floor Leader Damon Thayer, have both expressed skepticism about medical marijuana in the past and said more research was needed, though the legislation has never received a thorough debate within the chamber's GOP caucus room." Those debates are private.

The bill would allow county governments to impose fees on cannabis businesses "to compensate for any additional public safety impact" and prohibit medicinal cannabis sales by voter referendum, but if a county's voters did so, city governments could exempt themselves from the prohibition.

The bill also includes a 12 percent tax on cannabis sold to dispensers, mainly to cover the costs of regulating it; 13.75% of the revenue would be returned to dispensaries to subsidize purchases of cannabis by those who can't afford it.