Most Kentuckians with Alzheimer's are over 65 and have chronic illness, putting them at greater risk of covid-19; tips for caretakers

UKNow photo

People with Alzheimer's disease are considered at high risk for covid-19, the disease caused by the new coronavirus, not only because they have Alzheimer's, but also because most of the 272,000 Kentuckians with the disease are over 65 and most of them have at least one other chronic illness, Hillary Smith reports in a University of Kentucky news release.

The increased risk of covid-19 for people with Alzheimer's presents yet another challenge for caretakers. To help them, UK's Sanders-Brown Center on Aging offers some best practices during this outbreak.

Guidance for Caregivers:

• Wash your hands when you leave the home and when you return to the home, and frequently throughout the day. 
• Clean high-use surfaces, like doorknobs, sink handles and refrigerator doors, with a solution of four teaspoons bleach to four cups of water. 
• Manage your underlying chronic health conditions.
• Have both your and your care-recipient's prescriptions called into a pharmacy that can either deliver them or has a drive-through pickup window. 
• Monitor yourself and your person for covid-19 symptoms, which are fever, cough and sore throat, says the release. Shortness of breath is also a symptom. Call your doctor if you have any symptoms. 
• Have an alternative plan of care for your person if you would not be able to provide it. 
• Make sure anyone coming into your home to help with care is adhering to all hand-washing rules and monitoring themselves for covid-19 symptoms.
• Practice social distancing and make sure you and your person are not in close contact with groups of people. 

Social distancing suggestions:

• Work from home if possible, especially if your job allows telecommuting.
• Attend your worship service online or call a member of your religious organization to worship together over the phone.  
• If you must take your person shopping, seek times to shop that are set aside only for seniors. Better yet, have friends, family or neighbors pick up the items you need.
• Order takeout from restaurants that can deliver or offers curbside service and allows you to pay over the phone.
• Limit family visits, including visits with grandchildren. Connect via social media or visit outside standing six feet apart. 
• Going to the park and taking walks or a drive present minimal risk.

Home Engagement: 

• Stick to a routine to help keep things feel normal.
• Keep the curtains open and lights on during the day. 
• Try new activities within the home, like listening to music, looking at or organizing photos, folding washcloths or putting socks together, talking about historical events, playing cards, gardening or crafting.

Other tips for caring for a person with Alzheimer's: 

•  Be flexible and patient. 
• Avoid correcting the person. 
• Help the person remain as independent as possible. 
• Offer opportunities to make choices, two at the most. 
• Simplify instructions. 
• Establish a familiar routine. 
• Provide encouragement and support. 
• Help get your person started in the activity if they don’t start themselves.

Behaviors: If you see an increase in disruptive behavior like agitation, aggression, anxiety or resistance to care, remember that your person can pick up on your stress and anxiety. Sanders-Brown says to first make sure that the general needs of your person are being met and if they are, then to redirect and distract. It is also suggested that you keep a log of when these behaviors occur and what is happening at that time. And if the behaviors persist, call your medical provider.

Beshear says next two or three weeks are 'absolutely critical;' drive-through tests to begin on 'very limited' basis next week

As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

• “The next two to possibly three weeks is gonna be absolutely critical in our battle against the coronavirus,” Gov. Andy Beshear said at his daily press conference, repeating the point several times. “I can’t tell you that after the next two or three weeks, we're gonna be able to stop. We probably won't.”
• Beshear said, “Your work is paying dividends but now is the time do do everything we possibly can . . . so please follow the guidance more than you ever have." He added, I need you to ratchet it up multiple notches . . . I need you to be as diligent as you possibly can." Speaking of groceries and Walmarts, he said, "That can't be a place you go because you’re bored and you just be around people.”
• He concluded the press conference by saying, “Let’s try to be a model for the country, but even more, let’s be a model for humanity. For many people it is a  matter of life and death as we go through this. We are showing the absolute best of humanity but we’ve got to do even more.”
• Health Commissioner Steven Stack said "The early signs are really good," but "We are in crunch time and the next two to three weeks are pivotal." He said people who had been on spring break to Florida should "self-isolate and stay away from others until you get past the two-week period" of incubation for the virus. "Group play dates should not be happening . . . get outside and spread around." He said "social pressure" should be applied to people who don't comply, but people should be patient and avoid misunderstandings: “Never before has it been more important to be a good neighbor.”

Some conservative talkers, including a leading one heard in Ky., downplayed the covid-19 threat and criticized efforts to blunt it

President Trump and Mark Levin in the Oval Office on Oct. 8
(Photo by Leah Millis, Reuters)

Several conservative radio talk-show hosts, including one who is heard most nights on leading stations in Louisville and Lexington, "have downplayed the threat of the coronavirus and criticized efforts to blunt its spread," Jack Gillum and Derek Willis report for ProPublica.

The reporters did their research in archives of TVEyes.com and Cortico, a noprofit that says it works with the MIT Media Lab "to foster constructive public conversation in communities and the media that improves our understanding of one another."

Even after President Trump declared March 13 that the coronavirus and its covid-19 disease constituted a national emergency, "Some hosts groused that aggressive measures to contain the disease were a political ploy to undercut the president or ram through unpopular Democratic legislation," ProPublica reports. Polling before Trump's declaration showed considerably less concern among Republicans about the virus than among Democrats; that gap has since narrowed.

ProPublica said the subjects of its story included "at least four of the 12 most listened to as measured by Talkers," an industry magazine, including the nationally syndicated Mark Levin, who is heard weeknights on WHAS in Louisville and WVLK in Lexington.

Several hosts, including Levin, compared covid-19 to seasonal flu, even though it has a higher mortality rate, a much higher hospitalization rate, and a much longer incubation period, allowing people who don't have symptoms to spread the virus unwittingly. "Also, unlike the flu, covid-19 has no vaccine or approved treatment," the reporters note. "Although the hosts conceded that some level of concern about covid-19 is justified, their skepticism could deter their audiences from self-quarantining, social distancing and other behavioral changes that health officials say are necessary."

Video and audio spots to help prevent spread of coronavirus are free for all to use; themes are prepare, protect and disinfect

Prepare, protect, and disinfect are the themes of new public-service announcements aimed at preventing the spread in Kentucky of covid-19, the disease caused by the coronavirus. This one combines all three:

The 30-second PSAs from the Foundation for a Healthy Kentucky and the Kentucky Medical Association, are available free of charge, and focus on three measures: PREPARE: Prepare to stay at home as much as possible by purchasing only the essentials we need for a week at a time; PROTECT: Protect others from the virus by keeping at least six feet of distance between ourselves and others outside our homes; and DISINFECT: Use disinfectant often on the things we touch regularly, such as door knobs, cell phones, keyboards and counters.

Foundation President and CEO Ben Chandler urged Kentuckians to follow advice of public-health experts and stay home: "Covid-19 poses a serious health risk, and one of the greatest threats is overwhelming our health care system if too many people get sick at the same time. We can prevent many, many deaths if we just take the steps to prevent the spread, or 'flatten the curve.' That means everyone needs to stay home as much as they possibly can."

Dr. Brent Wright, KMA president and chair of the foundation's board of directors, encouraged Kentuckians who have symptoms to call their health care provider first, before coming in, to minimize the spread of the virus: "While your individual risk of serious complication from covid-19 may be low, you could contract the disease without knowing it and contribute to the spread to individuals who are advanced in age or have a chronic disease."

After a University of Kentucky public-health professor and a UK surgery professor said over the weekend that PSAs were needed, Gov. Andy Beshear encouraged broadcasters Monday to create them to get social-distancing and covid-19 prevention messaging out to their local communities, saying it is important for communities to hear the guidance from local leaders, not just him. "Do this and do it quickly," he urged at his March 23 news conference. "The more messages we can get out there the better."

The three PSA spots are titled "Stay Home," "Mental Health" and "Call First." Click here to download the videos from the foundation's website. The audio spots are here. Up-to-date, reliable information can be found on the state's regularly updated website, kycovid19.ky.gov. The state's covid-19 hotline is 1-800-722-5725.

Living with covid-19: Here's the story of one New York couple still with it, perhaps 'visitors from the future'

What's it like to have a bad case of covid-19, or to care for someone with it? Pretty horrible, Jessica Lustig writes for The New York Times Magazine, where she is a deputy editor. It introduces her story this way: "Our world became one of isolation, round-the-clock care, panic and uncertainty -- even as society carried on around us with all too few changes."

Lustig's 56-year-old husband, "T," who was in excellent health except for asthma, had his first symptoms -- chills, followed by aches and fever -- 12 days before her story was published. "Now we live in a world in which I have planned with his doctor which emergency room we should head to if T suddenly gets worse, a world in which I am suddenly afraid we won’t have enough of the few things tempering the raging fever and soaking sweats and severe aches wracking him — the Advil and Tylenol that the doctors advise us to layer, one after the other, and that I scroll through websites searching for, seeing 'out of stock' again and again."

Lustig has become a health-care worker: "I am consumed with trying to keep us safe. I wipe down the doorknobs, the light switches, the faucets, the handles, the counters with disinfectant. I swab my phone with alcohol. I throw the day’s hoodie into the laundry at night as if it were my scrubs. I wash all our towels, again and again. . . . Anything my husband touches has to stay in his room or be carefully taken from his room to the kitchen, where I stand holding dishes while our 16-year-old daughter, CK, opens the dishwasher and pulls out the racks so I don’t have to touch anything before she closes it again. She turns on the faucet for me, and I hit the soap dispenser with my elbow to wash my hands."

The story ends with T being found to have pneumonia. "At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him."

As Trump envisions Easter reopening, Beshear clamps down, says country must 'defeat the coronavirus on the very first try'

At his daily press conference, Gov. Andy Beshear
addressed remarks by President Donald J. Trump.

By Al Cross

Kentucky Health News

As President Trump openly hoped for “packed churches” on Easter Sunday, April 12, as a signal of a re-opened economy, Gov. Andy Beshear announced further restrictions on Kentucky businesses to stop the spread of the coronavirus.

Beshear said Tuesday that he would order all non-life-sustaining business to close to in-person traffic on Thursday, and even for those that sustain life, “We are going to mandate the type of social distance that we have to see out there to protect our people.”

Beshear’s order, and those of most other governors, runs against a line of thought among some business executives and economists that social distancing and the restrictions it requires will cause irreparable economic damage, and that restrictions need to be relaxed, perhaps by geography.

Health experts say it’s too early to change course, but Trump adopted the line of thought in an interview Tuesday with Fox News, saying he “would love to have the country opened up, and just raring to go, by Easter. . . . You’ll have packed churches all over our country. I think it would be a beautiful time. And it’s just about the timeline that I think is right.”

He added, “Now, people are gonna have to practice all of the social distancing . . . but we have to get our country back to work.”

Governors have more public-health powers than presidents to fight pandemics, but there has been tension and finger-pointing between some states and the Trump administration about their roles and performance. Beshear has steered clear of remarks about Trump, who is popular in Kentucky, but no more.

Asked at his daily press conference about Trump’s remarks, Beshear shook his head as he recounted Trump’s mention of large crowds, and alluded to health experts’ fear that easing up too early could lead to a resurgence of the covid-19 disease caused by the virus.

“We’ve got to be ready to do what it takes to defeat the coronavirus on the very first try,” Beshear said. “My son Will was supposed to be baptized in his church this Easter . . . He said, ‘Dad if it helps other people I can wait.’ All of us have to be ready to wait however long it takes, if it helps other people.”

Earlier in the press conference, Beshear noted that Monday had seen 100 deaths from covid-19 in the U.S., a record, and that Tuesday saw a record number of new cases in Kentucky, 39, for a total of 163.

 “We are just seeing the escalation of this virus,” he said, “and to suggest that there is a short duration we can almost promise people is not something we should be doing.”

As Beshear spoke, Trump was holding his own daily press conference, and taking a softer line than he had earlier in the day. It followed a meeting with experts including Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases.

“Our decision will be based on hard data and facts,” he said. Asked what metrics he would apply, he said, “I will be guided very much by Doctor Fauci” and other professionals.

               Fauci said, “You could look at a date but you want to be very flexible. . . . The country is a big country, and there are areas of the country … that we really need to know more about.”

               One of those is Kentucky, where testing for covid-19 is not widespread because the state is short of the personal protective equipment that is needed by people who administer the tests.

               Alluding to an earlier Trump remark, that states should work to find such supplies, Beshear said Kentucky was outbid for one order by the Federal Emergency Management Agency.

“An order that we had the other day, FEMA came in and bought it, all, out from under us,” Beshear said. “It is a challenge that the federal governments says, ‘States, you need to go out and find your supply chain,’ and then the federal government ends up buying from that supply chain.”

               FEMA Administrator Pete Gaynor said Tuesday morning that the agency was invoking the Defense Production Act to allocate testing kits and masks, but at his press conference, Trump said the use of the law wasn’t needed. He has been wary of using the law, which some see as a nationalization of private industry.

               Later, FEMA spokeswoman Lizzie Litzow said, “At the last minute we were able to procure the test kits from the private market without evoking the DPA.” But she said use of it for masks was “still being worked through.”

               Personal protective equipment is also needed at hospitals, which fear being overwhelmed by covid-19 cases. Governors and health experts say social distancing and other restrictions are need to “flatten the curve” of the outbreak so the health-care system can handle it.

               “We’ve got to be ready,” Beshear said. “These are the lives of our parents and our grandparents. This is a significant outbreak that we’re having, and we’re all sacrificing so much.” He noted the job and business losses being suffered by the restrictions he and other governors have imposed.

“We’re putting the lives of people ahead of our economy,” Beshear said. “We’re putting the lives of our people first. We’re putting the lives of people ahead of our financial security . . . After what we’ve asked you to do, let’s make sure we defeat this virus, and we don’t just set a random number of days, and then stop what we’re doing, and it results in a threat to the life of so many Kentuckians.”
Dr. Steven Stack, the state health commissioner, said on KET Monday night, "The states have to solve this, and we are gonna try to solve it. Kentuckians need to anticipate that it would be longer than those two weeks but I wouldn’t speculate how long."

Beshear: Businesses that don't sustain life must end in-person traffic, and hotline to report violators of his orders got 2,000 calls

As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

• Gov. Andy Beshear said Tuesday that he would order all non-life-sustaining business to close to in-person traffic on Thursday, and even for those that sustain life, “We are going to mandate the type of social distance that we have to see out there to protect our people.”
• Businesses remaining open to in-person traffic include groceries, pharmacies, banks, "manufacturing key to our national interest or life-sustaining goods," Beshear said, as well as "all of those under the federal critical infrastructure sector; food, beverage, agriculture, media, gas stations and businesses needed for transportation; financial services, housing, building and construction; mail and delivery services, laundry services."
• Also exempt are businesses "that supply life-sustaining businesses," such as home-based care and services and professional services, but "You can do almost all of it from home," Beshear said. “If regulations need to be eased to allow you to do it we will do it.” He said the detailed order would be issued Wednesday.
• Asked about caregivers, Beshear said that if they spend most of the day with someone, “You have to reduce your outside contacts with other people to a bare minimum.”
• Beshear said takeout restaurants should limit the number of people coming in for food. The Franklin County Health Department stopped takeout entirely because so many people were congregating in restaurants, Director Judy Mattingly told WKYT-TV.

UK HealthCare has launched a new telemedicine program to treat people at home and to slow down the spread of covid-19

UK HealthCare photo

UK HealthCare has launched a new telemedicine program to make it easier for patients to get care without leaving home.

“To help slow down the spread of covid-19, our leaders are asking everyone to stay home as much as possible,” Dr. Mark Newman, University of Kentucky executive vice president for health affairs, said in a news release. “We know that doesn’t mean people will stop getting sick. We launched UK HealthCare Telecare so that people still have access to treatment for everyday illnesses without needing to leave their home.”

The program will function similarly to an urgent-care clinic, caring for patients with symptoms like sore throat, fever, cough, congestion, and respiratory problems, says the release.

The health-care visit will take place through Zoom, a web-based videoconferencing platform that is compliant with patient privacy regulations. Patients will need access to a device with a camera, like a smartphone, tablet or computer, as well as access to the internet and an active e-mail account to use the service.

"When patients call to arrange an appointment, staff will go through what equipment they need, gather information, and send an email with a link and applicable forms for the visit. Once patients click the link, they’ll be taken to a 'virtual waiting room' to be seen by a health-care provider," says the release.

Visits are first-come, first-serve, and wait times will vary depending on demand. The program is staffed by an integrated team of board-certified providers throughout the departments of Family and Community Medicine, Internal Medicine and Pediatrics, says the release.

Telecare appointments are available Monday-Friday, 8 a.m.-9 p.m. and Saturday 9 a.m.-3 p.m. And though it is not required, if you have access to a thermometer, blood-pressure cuff, most recent blood glucose reading if you have diabetes, and the most recent weight for a child being treated, UK HealthCare asks that you please have those available. To make an appointment call 1-833-739-0225.

UK HealthCare and Baptist Health hospitals have stopped allowing visitors, with some exceptions

Kentucky's two largest hospital enterprises have implemented no-visitor policies due to the outbreak of covid-19: the University of Kentucky and the eight Baptist Health hospitals across the state.

UK HealthCare's policy went into effect March 24 in both its hospitals and clinics and will stay in place until the threat of covid-19 transmission has "decreased significantly," says the news release. The policy makes several exceptions.

Exceptions for women in labor, children and babies include: obstetric patients may have one partner or one birth support person over the age of 16 with them; pediatric patients may have parents or guardians, no more than two, with them for as long as has been cleared by an attending physician; and nursery and neonatal intensive care unit patients can have one birth parent, accompanied by one significant other visitor, if cleared by an attending physician.

Exceptions for end-of-life patients, patients who need extra care, and those who are having surgery or a procedure include: patients who are at the end-of-life may have up to two visitors for the length of time cleared by the attending physician; patients with altered mental status, cognitive impairment, developmental delays or disruptive behavior, where a family member is key to their care, may have one visitor; patients requiring a trained home caregiver may have one visitor; and patients undergoing surgery or a procedure may have one visitor, and that visitor must leave the medical center soon after the procedure or surgery.

In addition, emergency department patients may be accompanied by one person; adult patients who need assistance with clinic, laboratory or radiology appointments  may have one person with them and children with similar appointments may be accompanied by one parent or guardian.

Once a visitor leaves a patient's room, they must immediately leave the hospital. And any visitor who is ill or fails to pass a screening will not be able to enter a UK hospital, says UK;s news release.

No visitors will be allowed with patients under investigation for covid-19, or those who test positive for it, unless the patient is at the end of their life.

“These are extraordinary times and we ask for your cooperation and assistance in complying with these restrictions,” Dr. Mark Newman, University of Kentucky executive vice president for health affairs, said in the release. “The safety and well-being of our patients, employees and our community is our greatest concern and priority in making these decisions.”

Baptist Health's policy, which took effect March 24, also includes its physician offices and outpatient facilities. Its news release says it is "suspending visitation at all of its hospitals, and allowing only essential caregivers to accompany patients for medical appointments or tests."

Baptist Health hospitals will allow one healthy visitor or companion at a time for certain patients, including one parent or a guardian for patients under age 18; the birthing partner for women in labor; clergy for patients in the end-of-life; a visitor for hospice or end-of-life patients; and a caregiver for dependent patients who require assistance. All those who are allowed to visit at Baptist Health will  be screened prior to the visit.

Baptist Health medical groups or outpatient facilities will allow a single caregiver for certain patients, including a parent for a child under age 18 and a caregiver for a dependent adult who requires assistance. Visitors for end-of-life patients will be determined on a case-by-case basis.

"Those with fever (above 100 degrees), runny nose, body aches or respiratory symptoms are asked to refrain from visiting in our facilities," says the release.

“This is a difficult but necessary step to help deal with this ever-changing situation,” Baptist Health CEO Gerard Colman said in the release. “We apologize for the inconvenience to our patients and their loved ones, but we must keep patient and staff safety our top priority. With Baptist Health’s long-standing reputation of providing ‘treat-you-like-family’ care, you know your family members and friends are in good hands.”

As surgeon general says this week will be bad, Beshear says 'It's game time' and pushes social distancing; starts toll-free hotline for Kentuckians to report violators of his emergency orders

As news develops in Kentucky about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at https://kycovid19.ky.gov.

• Reflecting the surgeon general's warning that "It's going to get bad" this week, Gov. Andy Beshear stressed the importance of social distancing and good hygiene. "This is game time," he said. "This is the time where we've all got to step up and prove we can do this and the stakes are the health and the lives of those that we care about."
• Health Commissioner Steven Stack painted a verbal picture of how someone can end up infecting 1,000 others. He said Kentuckians should ask themselves before choosing to engage without social distancing: "Was it worth what you did if someone else ends up on a ventilator in an intensive care unit?"

UK public-health, surgery professors urge quick hospital and government action to limit deaths from covid-19 in rural Ky.

A public-health professor and a surgeon at the University of Kentucky are sounding the alarm that the covid-19 disease caused by the new coronavirus could devastate rural Kentucky, and they say rural citizens and hospitals need to be more careful.

Tyrone Borders, Ph.D.

Ty Borders, the Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy, and Sam C. Tyagi, an assistant professor of surgery, wrote a letter to Kentucky newspapers, prompted in part when one of them saw a lack of distancing and testing at a rural hospital.

Sam Tyagi, M.D.

"Anecdotal evidence shows that too many rural citizens and hospital personnel are not heeding federal and state recommendations to reduce coronavirus transmission," they wrote. "It has been observed multiple times that health-care workers who have been exposed are not being quarantined and tested appropriately by these rural and community hospitals, despite requests from the health-care employees."

Rural Kentucky is especially at risk, Borders and Tyagi say: "The first known case of coronavirus in Kentucky was in Cynthiana, a town with a population of only 6,400 persons, and cases of coronavirus have been identified in several other rural communities. The older age compositions and inadequate hospital infrastructures of rural communities place them at extremely high risk for serious cases of coronavirus and mortality."

Very few rural hospitals have the facilities and equipment needed to treat serious cases of covid-19, they wrote: "An inadequate supply of health-care personnel in rural areas severely limits the abilities of critical-access and other rural hospitals to deliver intensive care and respiratory services for patients with coronavirus. Transferring patients from rural to urban hospitals is not a realistic option because many urban hospitals are already facing short supplies." The Lexington Herald-Leader did a story in which Borders and others voiced concerns about rural hospitals.

Borders and Tyagi recommended three immediate steps to limit the spread of the virus and keep rural hospitals from being overwhelmed:

1. Public-service announcements "to better communicate the risk of coronavirus and rationale for social distancing to rural citizens," perhaps adapting one being used in Alabama, including short instructions on social distancing, making hand sanitizer and masks, and handling  mail and other home deliveries.
2. Coordinated coronavirus testing, centralized at hospitals, clinics, health departments, or drive-through testing areas, to "reduce coronavirus exposure among health-care personnel."
3. Expansion of hospital facilities and equipment, especially intensive care units and ventilators. "State government and the hospital industry must carefully coordinate the expansion of hospital capacity," they wrote. "The supply of ICUs and ventilators must be accurately and continually assessed and then reported in a transparent fashion to hospital administrators, clinicians, and the general public."

Urging quick action, Borders and Tyagi concluded, "Government and hospital leaders must act faster than the rate of coronavirus transmission."

Beshear ends non-essential retail, elective medical procedures; calls out violators, including a church; Sen. Paul has the virus

As news develops in Kentucky about the coronavirus and its covid-19 disease, this page will be updated. Official state guidance is at https://kycovid19.ky.gov.

Sunday, March 22, 2020

• Gov. Andy Beshear said he would order all non-essential retail businesses to close by 8 p.m. Monday, March 23. His order applies to "all in-person retail businesses that are not life-sustaining." It includes auto-dealer showrooms; clothing, furniture, electronics and sporting-goods stores; opticians and bookstores. It does not include banks; pharmacies; grocery, drug, pet, liquor, building-supply, lawn-and-garden and auto-parts stores; gas stations, vehicle rental and "the lawful sale of firearms and ammunition." Businesses can still do online and phone orders, and curbside and delivery service. Beshear warned Kentuckians to sanitize hands after using gas pumps: "This virus can live on just about any surface."
• The order continues Beshear's approach of gradually escalating restrictions. "We have already done a whole lot of things that a lot of other states have done maybe in one scary order," he said. He encouraged Kentuckians to use the social media hashtag #HealthyAtHome, saying that this would be the term he uses instead of "shelter-in-place," which he has said doesn't fit. 
• Beshear said that starting Monday, all medical facilities must cease elective procedures, because not all have complied with the request he made a week ago, in an effort to keep hospital beds available. "A group of chiropractors have been exceedingly difficult," he said.
• Some churches violated Beshear's order against mass gatherings. He called out one in Lewis County, saying "You can't do that. Bringing together some of the most vulnerable in a small room -- when we know that this virus has been passed around in churches -- means that you are harming your congregation and it undermines the sacrifice of every other church, every other church that is doing the tough thing and canceling their in-person services." 
• "God makes a way," pastor Paul Prather wrote in his faith column for the Lexington Herald-Leader. "This past Sunday I preached to the biggest congregation I’ve ever spoken to. Without leaving my house." Prather canceled services at his church and went online.
• Responding to a question the day before, Beshear said Jen Harris of the Todd County Health Department is working with Amish and Mennonite populations there to make sure they are informed about covid-19, and is willing to work with other such communities. 
• U.S. Sen. Rand Paul announced that he had tested positive for the virus. His Twitter account said, "He is feeling fine and is in quarantine. He is asymptomatic and was tested out of an abundance of caution due to his extensive travel and events. He was not aware of any direct contact with any infected person." Paul was criticized for going to the Senate gym Sunday between getting the test and the results; Sens. Mitt Romney and Mike Lee of Utah said they would self-quarantine because they had contact with him.
• Paul may have caught the virus at the March 7 fundraiser at the Speed Art Museum in Louisville. Joe Sonka of the Courier Journal writes, "Kentucky's governor, Louisville's mayor and a high-ranking member of Congress, all clad in tuxedos, made their way to the dinner table at the glitzy ball inside the art museum — but little did they know that the bourbon heiress and prominent philanthropist sitting next to them were unknowingly infected with the virus that was well on its way to becoming a global pandemic. The opening to a bad novel? No, it unfolded two weeks ago in Louisville, as the emergence of the coronavirus continues to be as strange as dystopian fiction."
• Two University of Kentucky professors wrote a letter to Kentucky newspapers warning rural Kentuckians and their hospitals to get more serious about the threat, recommending public-service announcements about social distancing, handwashing and so on; coordinated local testing; and state coordination to make sure hospitals have what they need.
• Beshear noted the shortage of personal protective equipment, such as masks, respirators and gowns, and said "We are doing everything we can" to secure them for medical facilities in the state. He said the shortage is the most limiting factor for mass testing, and such equipment must be saved for those who are the sickest. 
• He said two more laboratories can test for the virus: the University of Kentucky and Diatherix.
• The governor said he misspoke a few days ago when he said the state had eight times the number of applications for unemployment assistance compared to last year, and it was actually 30 times that amount. He encouraged anyone who needs unemployment benefits, Medicaid or food stamps (now called the Supplemental Nutrition Assistance Program) should apply. "There is no stigma on public assistance," he said. "We want to make sure that everybody gets the help they need coming through this." 
• Beshear said Kentucky now has 103 confirmed cases of covid-19. He said there have been more than 2,000 tests and that the average age of someone identified with the virus is 53.3 years old. He said the hospitalization rate for those with it was "somewhat high" but the share of cases in intensive care is down to 6 percent, which he said was encouraging.
• He said the covid-19 hotline (800)-722-5725 was getting about 2,400 calls a day. He said it should be called by Kentuckians who are ill but would a have not otherwise sought care, and not by those who are well but nervous.  
• Repeating an earlier assurance about the food supply, he said, "These are not the times to hoard. These are not the times to react in fear. These are the times to understand that how we treat each other is what gets us through this."