As health departments face crippling pension costs, unless lawmakers intervene, health boss promotes a new model for them

Without a reprieve from pension-contribution rules, 42 county health departments will close in the next year, and 22 more will the following year, says the Department of Public Health, which made this map.

By Melissa Patrick
Kentucky Health News

Under the gun of new pension rules, Kentucky's health commissioner wants local health departments to drastically cut services, but he says the departments need the legislature to give them one more reprieve from big pension bills that would put dozens of them out of business in the next 12 months.

Dr. Jeffrey Howard, the health commissioner, says his plan calls for a system that would assure the survival of public health in the state, and would ultimately improve the state's health outcomes.

Dr. Jeffrey Howard, health commissioner

Howard created this new model largely in response to the state's pension crisis, which on July 1 will require health departments to increase their pension obligation from 49.47 percent to 83.43 percent of payroll -- unless a special session of the General Assembly changes that.

In the regular session that ended in April, Gov. Matt Bevin vetoed a bill that would have offered some temporary relief to health departments. He has said he will call a special session to deal with the issue, but he and legislators have yet to secure the agreement and votes needed to pass a bill into law.

Without any relief from this added pension contribution and everything remaining the same, Howard's Department of Public Health says 42 health departments would close in the next 12 months, and 22 more would run out of reserves and be forced to close in the the next 24 months.

A taxing situation?

One of the departments most in danger, in Anderson County, recently raised its local property tax from 30 cents per $1,000 in assessed valuation to 52.5, cents to pay for its possible extra pension obligation, Ben Carlson reports for The Anderson News. Without relief from the added pension liability, the agency is slated to pay an extra $140,470 a year.

However, raising local taxes doesn't seem to be a popular option among the 113 counties that have a health tax.

Of the 23 counties that have reported their tax rates for the coming year, only five have proposed an increase, and minutes of the local health board meetings do not indicate that the increases are being driven by the need to cover higher pension costs, said Mike Tuggle, the state health department's assistant director for administration and financial management. He said in an email that the department will continue to receive tax resolutions through early October.

Using local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties.

"Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard said. He added that when he was the health director in relatively wealthy Clark County, his tax base was about the same as it is for all seven counties in his district, which has about three times as many people.

"In Eastern Kentucky, we cannot raise enough local tax revenue to address this problem. And shifting the burden from the state to the locality is just not going to work for these poor communities," he said. He added that Howard's new plan is designed to address some of these inequities.

Crisis = Opportunity?

Howard says the crisis has created an opportunity.

He told a statewide board of health meeting in January that the state can take the opportunity to move away from a public-health system that is "an inch deep and a mile wide" and transform it in a way that will improve health outcomes across the state. "This is truly an opportunity to transform a system that has needed transforming for many decades," he said at the meeting, shown on YouTube.

Howard's plan calls for departments to scale back their services, and only be required to provide four "core public health" areas. He said it doesn't matter if the department implements these programs or if a community partner does, only that the department is committed to making sure they are in place.

The core areas include: foundational public health services, five areas that are required by law or regulation; the Women's, Infants and Children nutrition program; the HANDS program, which stands for Health Access Nurturing Development Services for child rearing; and harm reduction and substance-use disorder programs, including syringe exchanges.

The plan also requires health departments to perform community health assessments, which many of them already do, to determine their local public health priorities beyond those core requirements.

However, under Howard's new plan, before a department could implement a program to address a local need, such as diabetes management, it must first see if the need is already being addressed elsewhere, and if it is, they would be asked to work with that agency to either support or complement its program instead of creating a new one.

If the need is not being met in their community, a department would then have to present its proposed program to a newly formed advisory board, which would review the request to make sure it meets a list of five criteria, including whether it is data-driven, offers an evidence-based solution, is adequately funded, includes a performance and quality management plan; and has an exit strategy.

At the January meeting, Howard said the plan has the support of the Kentucky Health Departments Association, the Kentucky Association of Local Boards of Health, the Kentucky Public Health Association and the University of Kentucky's Center of Excellence in Rural Health. The health-department association has long promoted a similar model called "Public Health 3.0," on which Howard's plan is based.

Howard said the plan also has the support of his colleagues at the health department and Gov. Matt Bevin. He said it will be introduced to lawmakers during the 2020 session, noting that it will require "some overwhelming legislative buy-in." He also said he needs lawmakers to hold the pension rate at 49.47% for one more year to give him time to get this plan in place.

Scott Lockard

The new model has already been embraced at the Kentucky River department, which covers Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe counties.

Why? "We are one of the most financially fragile health departments in the state," Lockard said. "We are redirecting our resources just to our foundational services, and basically we're going to be focusing on what we are statutorily mandated to do."

Under the higher pension rates, the Kentucky River department's extra pension obligation is about $1.3 million each year, and it has less than one year of unrestricted resources available before it would be forced to close, according to a spreadsheet provided by Tuggle. That makes it the fourth-worst-off department in the state.

Lockard said he has been working for the last year toward this "public health transformation" model. He said his agency has cut its payroll costs by $900,000, renegotiated contracts with pediatric therapists, is working toward referring all cancer screenings out of the department, and will be discontinuing all maternity services.

Bottom line, he said, if a program is not financially viable or is not statutorily mandated, it must go. And if somebody else can meet the need in the private sector, we need to let them do it.

He ended his interview with a warning: "I feel like we are facing truly a tipping point in public health, that if we do not make the right choices now and put a sustainable public-health funding model in place, the health outcomes for the people of this state are going to be impacted for generations."

Republicans call for de-funding Planned Parenthood in state; health secretary says that would lead to more teen pregnancies

By Melissa Patrick
Kentucky Health News

Republican gubernatorial candidate Matt Bevin and the state House GOP caucus are calling for de-funding of Planned Parenthood in Kentucky, but Democratic Gov. Steve Beshear and his health secretary say the Republicans don't understand how federally funded family planning and women's health services work.

Planned Parenthood has come under attack because of edited, undercover videos published by the anti-abortion group Center for Medical Progress that show officials of Planned Parenthood afifliates in other states discussing sale of fetal body parts after abortions. Planned Parenthood, which does not do abortions in Kentucky, says it facilitates transfer of fetal parts for medical research, and any fees it charges are to cover its costs of handling and shipping.

Matt Bevin (Lexington Herald-Leader)

After Republicans in Congress moved to stop funding of Planned Parenthood, Bevin issued this statement: "As governor, I will direct my secretary of the Cabinet for Health and Family Services not to distribute federal taxpayer dollars from that department to Planned Parenthood clinics. Federal taxpayer dollars appropriated to Planned Parenthood flow through the governor’s administration. As governor, I will prevent those dollars from being distributed, and order them returned to the federal government."

Then all the Republicans in the state House, except Jim Stewart of Flat Lick and Tommy Turner of Somerset, signed a statement saying in part, "Recent highly publicized videos have, in astounding detail, demonstrated the appalling and cold-hearted willingness of top employees of Planned Parenthood to violate federal law and human conscience by profiteering from the flesh and organs of aborted babies. Kentuckians will not tolerate the distribution of their tax dollars to this organization, and call upon the governor and attorney general to immediately and forever terminate all funding to Planned Parenthood."

The attorney general is Bevin's Democratic opponent, Jack Conway. Asked to comment on Bevin's call, Conway's campaign did not directly address the issue, saying in an email, "Attorney General Conway does not support public money being used for abortion services and supports Kentucky's ban in place on government funding being used for abortion services."

Conway supports women's right to abortion. CN|2's "Pure Politics" reports that Conway's 2002 congressional campaign received $5,000 in contributions from the Planned Parenthood Action Fund political action committee.

The State Journal in Frankfort reported Beshear's response to Bevin: “No state money goes to Planned Parenthood. The only federal money that goes to Planned Parenthood that we know of goes to our public health departments on a local level. And one or two of them contract with Planned Parenthood to do some of the clinical work that public health departments do. It has nothing to do with abortions, it has to do with family planning. So I don’t really see any issue to get all riled up about. Matt Bevin has proven over and over again he doesn’t understand any of these issues.”

The House Republicans said that once the money comes to Kentucky, it becomes state money and they don't want it going to Planned Parenthood, even through intermediaries.

Bevin told Terry Meiners of WHAS Radio in Louisville that Planned Parenthood plays a "shell game" with its funding.

Audrey Haynes (image from cn|2)

Audrey Haynes, secretary of the Cabinet for Health and Family Services, said many people mistakenly believe federal funds authorized by Title X of the federal Public Health Service Act that wind up with Planned Parenthood go for abortions, which some Planned Parenthood affiliates in other states perform.

"No! It is illegal to pay for abortion," Haynes said in an interview with Kentucky Health News. "Title X is not about abortion, it is about women's health."

Haynes, who was President Clinton's director of women's initiatives and outreach, said Title X money and Kentucky's recent expansion of Medicaid under federal health reform ensure all women access to women's health services, and reductions would have "compounding effects," such as increasing teen pregnancies.

The Guttmacher Institute, a research organization that supports abortion rights, says more teen pregnancies lead to more abortions: "Services provided by clinics that receive some Title X funding helped women avert 1.2 million unintended pregnancies in 2010, preventing 590,000 unplanned births and 400,000 abortions. Without the services provided by Title X–funded clinics, the U.S. unintended pregnancy rate would be 35 percent higher and the rate among teens would be 42 percent higher," the institute says. "Overall, 50 percent of unintended pregnancies result in an unplanned birth, 34 percent in an abortion and 16 percent in a miscarriage; these percentages vary slightly for poor and low-income women and for teenagers."

Haynes said that of the more than 400,000 Kentuckians recently made eligible for Medicaid, about 214,000 are adult women, and 70,000 women on Medicaid used Title X services in 2014. The services are also available to the 9.5 percent of Kentuckians who still don't have health coverage.

For the 2015-16 fiscal year, Kentucky received $5.4 million for Title X family planning and women's health services, and Planned Parenthood gets about 6 percent of it.

The money is divided between local health departments, which then decide if they want to provide these services directly or subcontract them out, or both. Two departments, in Louisville and Lexington, sub-contract a portion of these services to Planned Parenthood, which receives a total of $331,300 of Kentucky's federal Title X funding, according to the Cabinet for Health and Family Services.

Both departments have other family-planning subcontractors; Family Health Centers of Louisville gets $374,653 and Bluegrass Community Health Center in Lexington gets $23,532.

Asked why the Planned Parenthood money couldn't be shifted to the other contractors, Haynes said that is a decision for the health departments, but said she suspects that those decisions "have something to do with the locations of those local health clinics," and denying funding to Planned Parenthood would mean that some women needing services would not be served.

Combined, the Louisville and Lexington Planned Parenthood offices saw more than 4,700 patients last year.

“Banning federal funding for Planned Parenthood would have a devastating impact on women, men and families, especially those in medically underserved communities and with low incomes," Betty Cockrum, President and CEO of Planned Parenthood of Indiana and Kentucky, said in a statement.

Contraceptive services are some of the most utilized services provided by Title X funding and by Planned Parenthood.

"How many unwanted pregnancies that we would certainly have and what that would do to the social and human services equation in our state?" Haynes asked, saying such services have helped greatly reduce the teen-pregnancy rate in Kentucky and other poor states.

Kentucky's teen birth rate dropped to 39 per 1,000 teens in 2013, less than half the rate recorded in 2003, according to the latest Kids Count report. And fewer teens in Kentucky are having sex, though almost half of them (44.7 percent) report they are sexually active, and more of them are using some form of birth control when they do, according to the Kentucky Youth Risk Behavioral Survey.

More than half of the women in the U.S. who received clinical services provided through Title X are in their 20s, while 21 percent are under age 19, according to the cabinet.

Most women who use federally funded family planning are young and poor. At Planned Parenthood in Lexington, 19 percent of its patients are 19 or under and 56 percent of them are in their 20s. In Louisville, 17 percent are 19 or under and 59 percent are in their 20s. Both locations serve a poor population, with 59-60 percent at or below 100 percent poverty and 74-73 percent at or below 150 percent poverty, respectively.

Legislation or executive action to de-fund Planned Parenthood would likely face a legal battle.

Three states, Alabama, Louisiana and New Hampshire, have recently said that they are cutting off Medicaid payments to Planned Parenthood, but "the laws governing Medicaid don't allow exclusion of certain providers solely because of other medical services they provide, such as abortions," CBS News writes, and will "likely face a court challenge," Susan Fogel, director of reproductive health for the National Health Law Program, told CBS News.

The U.S. Senate blocked Republican legislation to cut off federal funding to Planned Parenthood Aug. 3. Senate Majority Leader Mitch McConnell voted against the measure, saying he did so not because he doesn't want to de-fund Planned Parenthood, but because of a procedural rule that will now allow him to bring the issue back for another vote.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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

Diagram illustrates possible misconceptions about vulnerability during gatherings.

By Al Cross
Kentucky Health News

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

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

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

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

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

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

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

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

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

Staley said the guidance was sent to all health departments.

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

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

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

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

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

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

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

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

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

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

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

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

In other coronavirus news:

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

Beshear signs more than 35 bills amid pandemic, many related to health care; physician assistants get limited prescribing power

By Melissa Patrick
Kentucky Health News

The Kentucky legislature continues to pass bills despite Gov. Andy Beshear's plea that it just pass a budget and anything related to the coronavirus, due to the social distancing needed to thwart it. He announced Saturday that he had signed more than 35 bills into law, many of them related to health.

“While all of us should be focused on responding to the coronavirus as the number of cases grows in Kentucky, I will continue to evaluate the dozens of bills lawmakers are passing and sign those I believe will benefit the people of the commonwealth,” he said in a news release. “While all of these issues could be addressed after we defeat the coronavirus, my staff and I will continue to look out for the best interests of all Kentuckians in deciding which bills should become law.”

Beshear, a Democrat, earlier rebuffed the request of Republican legislative leaders to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. They plan to pass the budget and other bills April 1, and return April 14 to reconsider vetoed bills; he has vetoed two.

Here are some of the health-related bills Beshear signed:

Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, requires the state to hire a single pharmacy benefit manager to manage Kentucky Medicaid's $1.7 billion-a-year prescription drug business. This bill is designed to address many of the billing practices between pharmacy benefit managers and pharmacists, which pharmacists have long said are so unfair that they are putting some of them out of business.

House Bill 135, sponsored by Rep. Steve Sheldon, R-Bowling Green, gives physician assistants "modified prescriptive authority" for controlled substances in Schedules III, IV and V after they've practiced a year. Sheldon said all other states allow prescriptive authority for PAs and Kentucky will become the sixth state to place restrictions on them for Schedule II drugs, which includes a long list of narcotics used for pain management as well as several psycho-stimulants that are used treat attention deficit hyperactivity disorder, or ADHD.

SB 56, sponsored by Sen. Ralph Alvarado, R-Winchester, brings Kentucky law in line with the new federal law raising the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21. It also removes status offenses for youth who "purchase, use or possess" tobacco products, which are often called PUP laws. The bill allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications. The bill had an emergency clause so it became law upon Beshear's signature.

SB 42, sponsored by Sen. Denise Harper Angel, D-Louisville, requires any student identification badge issued to a public middle- or high-school student to contain the contact information for national crisis hotlines specializing in domestic violence, sexual assault and suicide. This contact information must also be on all IDs issued by public or private postsecondary education establishments. This information must be included on the IDs beginning Aug. 1.

SB 60, sponsored by Sen. Jimmy Higdon, R-Lebanon, adds spinal muscular atrophy, also referred to as SMA, to the list of  required tests run on infants for heritable disorders. Early diagnosis of this genetic disease helps babies receive treatment when it is most effective. Including SMA, Kentucky will now do 60 newborn screenings. Alvarado said at the bill's Jan. 29 committee hearing that this condition affects five or six Kentucky babies each year. 

SB 82, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes the Kentucky Eating Disorder Council to oversee development and implementation of eating-disorder awareness, education and prevention programs. It will also identify strategies for improving access to adequate diagnosis and treatment services. and make recommendations on legislative and regulatory changes. Adams said 900,000 Kentuckians, including nearly 30,000 children, have been diagnosed with an eating disorder but the state has no residential, partial-hospitalization or acute-care programs.

SB 134, sponsored by Sen. David Givens, R-Greensburg, establishes the Optometry Scholarship Program with a trust fund supplied by state appropriations (determined with each biennial budget) gifts, grants, and federal funds. A minimum of one-third of the amount appropriated for scholarships must go to eligible students at an in-state institution -- a boon to the University of Pikeville's Kentucky College of Optometry, the state's only optometry school.

SB 125, sponsored by Sen. Tom Buford, R-Nicholasville, allows the Kentucky Board of Medical Licensure to determine the allowable scope of practice for athletic trainers in Kentucky, particularly related to their training. This bill has been in the works for about 10 years.

HB 153, sponsored by Rep. Kim Moser, R-Taylor-Mill, establishes a mental-health first-aid training program to show people how to best meet the needs of someone in a mental-health or substance-use crisis. Funding will come through a trust supplied by state and federal appropriations, grants and private donations. Advocates' hope is that this training will become as common as CPR.

Beshear had already signed several other health-related bills into law, including:

HB 129, sponsored by Moser, will overhaul the state public-health system, including how health departments are funded and how they prioritize their resources.  It is called the public health transformation bill. It was fully funded in the House budget but falls about $9.4 million short in the Senate's proposal, according to Randy Gooch, director of the Jessamine County Public Health Department. HB 129 is part of a three-phase approach submitted in the state House to create a sustainable solution to local health departments' pension-driven financial crisis.

SB 122, sponsored by Adams, modifies Tim's Law of 2017, which allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized at least twice in the previous year. SB 122 would make that two years. The goal of Tim's Law is to stop the revolving door of these individuals in and out of jails and state psychiatric hospitals, allowing more participants. The law is named for Tim Morton of Lexington, who was hospitalized involuntarily 37 times by his mother because it was the only way she could get him the psychatric treatment he needed. He died in 2014.

HB 99, sponsored by House Speaker David Osborne, R-Prospect, authorizing a $35 million state loan to the University of Louisville to support its recent acquisition of Jewish Hospital and other Louisville health-care facilities.

House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. A House-passed bill to make marijuana legal medicine in Kentucky has gotten nowhere in the Senate. 

Republicans say Beshear's plan to deal with church violators of gatherings order goes too far; he notes some caused outbreaks

A graphic demonstration of social distancing's effect on spread of disease

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

By Al Cross
Kentucky Health News

Republican officials took issue Saturday with Democratic Gov. Andy Beshear's decision to track down people who attend Easter services and order them to self-quarantine, but Beshear said he was trying to avoid a repeat of a deadly covid-19 outbreak that has been traced to a church revival.

Beshear caught flak from U.S. Sen. Rand Paul, 4th District U.S. Rep. Thomas Massie, Agriculture Commissioner Ryan Quarles and Attorney General Daniel Cameron for having state police get license-plate numbers at the "handful" of services that he says are planned. Health departments are to deliver quarantine orders to violators of Beshear's order against mass gatherings.

Cameron said on Twitter, "I encourage all Kentuckians to social distance and celebrate Easter in their homes, as I’ll be doing. I am, however, deeply concerned that our law enforcement officers are being asked to single out religious services. Directing a uniformed presence at church services to record the identity of worshippers and to force a quarantine, while doing no such thing for the people gathered at retail stores or obtaining an abortion, is the definition of arbitrary."

Asked to reply at his daily briefing, Beshear said, "To our knowledge, 99.89 percent of all churches and all synagogues and all mosques in Kentucky have chosen to do the right thing. They are making the sacrifice, as are all of their congregants, knowing that the coronavirus will spread in any mass gathering in Kentucky." Many people with the virus don't know they have it.

“When I make tough decisions part of it is to honor your sacrifices,” Beshear told his Facebook Live audience at the end of his briefing. “I’m making 'em with my heart; I’m making 'em based on my faith.”

Beshear cited cases in other states of deadly outbreaks from churches, and said close to 50 cases of covid-19 and six deaths have been traced to a mid-March revival in Hopkins County. Saying he believes that only seven churches are planning traditional services, he said, “That’d be 42 deaths, just if the same thing happened like happened in Hopkins County, so I’m willing to make unpopular decisions, no matter what it means for me in the future, if I can save 42 people.”

But Paul tweeted Friday night, "Taking license plates at church? Quarantining someone for being Christian on Easter Sunday? Someone needs to take a step back here." Shortly afterward, Massie tweeted the same news story and asked, "What the actual hell?"

Quarles, a possible Republican opponent for Beshear in 2023, tweeted, "Most reasonable people, like me, agree with many decisions he has made so far. But this latest step – using police to follow churchgoers – is a step too far." Beshear has said police will get license-plate numbers in parking lots and give the identifying information to health departments.

Beshear said Saturday, “I’m just doing my best to save lives and there aren’t easy answers. . . . You could do nothing and let people die. Number two, you could arrest a pastor; they did that in Louisiana; I don’t want to do that.” He said padlocking a church would also be wrong.

“All I’m trying to do is to say, if you’re making a decision to go to a mass gathering, it shouldn’t impact other people,” he said. “Your decision should stay with you … just self-quarantine for 14 days so you can’t spread it to other people.”

He added, “I get, in people’s mind, if they say ‘I’m just making a decision for me,’ but you’re not.  . . . It’s not just people who choose go to a mass gathering, but people they come into contact with, and people they come into contact with, and people they come into contact with.”

Beshear has encouraged drive-in services, as long as they follow social-distancing rules, but Louisville Mayor Greg Fischer and Hopkins County Judge-Executive Jack Whitaker have banned even drive-in services.

U.S. District Judge Justin Walker granted Louisville's On Fire Christian Center a temporary restraining order Saturday, prohibiting enforcement of Fischer's order there, and wrote a 20-page opinion that began, "On Holy Thursday, an American mayor criminalized the communal celebration of Easter. That sentence is one that this Court never expected to see outside the pages of a dystopian novel, or perhaps the pages on The Onion," a satirical publication.

Fischer told the Courier Journal that he had "no enforcement mechanism" for his order and said he wished Walker had heard evidence to that effect. Walker said in his 2 p..m. order that there wasn't time to hear the city's side. One of his footnotes quoted Cameron as noting that drive-through restaurants and liquor stores were still open.

Walker's chief patron, Senate Majority Leader Mitch McConnell, said on Twitter that he was "grateful for this strong, eloquent ruling defending Kentuckians’ religious liberty." McConnell had written to Fischer Thursday, urging him to allow drive-in services. Cameron issued a statement Friday saying drive-in services should be allowed as long as they follow social-distancing guidelines.

In other covid-19 news Saturday:

• Cautioning that numbers could be low because of less weekend reporting, Beshear reported 185 new cases of covid-19, for a corrected total of 1,840, and four more deaths, for a total of 94: an 87-year-old man in Boone County, a 79-year-old man in Daviess County, a 79-year-old woman in Pulaski County and a 55-year-old man in Jefferson County.
• He reported 12 new cases at long-term-care facilities, six patients and six staff, for a total of 153 residents and 92 staff; and three more resident deaths, for a total of 21. Five additional facilities reported cases, for a total of 29.
• Asked about inspections of nursing homes, Beshear said they have been limited "because that inspector could have the coronavirus" but the state can still do inspections upon request “if there is good reason.”
• The Green River Correctional Complex in Central City reported three new cases (one inmate, two staff), and Western State Hospital in Hopkinsville reported seven new cases (two patients and five 5 staff). 
• Beshear said the Kentucky National Guard will be available to transfer patients between hospitals starting Sunday.
• Asked about factories where workers have tested positive for the virus, Beshear said "I think there is a duty to communicate with co-workers who come in contact" with those people, who should be "tested, monitored or potentially self-quarantine," and "There has to be significant cleaning" of the workplace.
• Told that a second UPS Worldport employee had died of covid-19, and employees say they not getting adequate protection, Beshear said he hopes they have "an ongoing conversation with management about that," but cautioned that employees shouldn't question workplace safety but gather around the table in a break room.
• "A day after Democratic leaders said the Trump administration would begin bipartisan talks over the interim relief bill" McConnell wants for small businesses, whose pool of federal funds is being quickly depleted, McConnell and House Minority Leader Kevin McCarthy rejected Democratic demands for money for hospitals and local governments, Politico reports, adding that the Republican leaders' remarks "suggest an end to the deadlock remains far off."

Kentucky to get 6% more vaccine doses next week; meanwhile, case numbers and positive-test rate continue to trend down

Ky. Health News graph; new-case numbers are initial, unadjusted reports; click it to enlarge.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear praised Kentuckians for their efforts in thwarting the spread of the novel coronavirus, announcing that case numbers and the positive-test rate keep trending down, and the federal government is sending more vaccine. 

"We are seeing really good compliance out there. Keep it up," Beshear said. "Right now you're showing that we can win. We can decrease cases just through our behavior, and this is at the same time that we're vaccinating, so all that's good."

Beshear announced 2,339 new cases of the virus, bringing the state's seven-day rolling average to 2,032, which is 15 less than Monday.

The share of Kentuckians testing positive for the virus in the past seven days dropped again, to 7.66 percent. "This is a good thing," he said. 

Asked if the state's case numbers are lower because fewer people are getting tested, Beshear said testing numbers are in a "generally good place." In addition, he said the decline in the positivity rate supports the low case numbers. He said it's too early for vaccines to have had an impact on case numbers.

While Kentucky's case numbers have generally declined for a month, so have other states', so the state ranks seventh in new cases in the last seven days.   

Beshear said he had not heard of any more variants of the virus being reported, beyond the one today in Jefferson County. 

He cautioned that the existence of these highly contagious variants doesn't necessarily mean case numbers will go up because wearing a mask and social distancing and the other public health strategies are "still pretty effective." 

"The variants make everybody nervous," he said, "but they don't change the game plan and what it's going to take to protect ourselves until we're out of this and what we do to get out of it in terms of vaccinations."

Kentucky Health News graph; click on it to enlarge.
Daily listings of deaths are made after cases are reviewed.

Beshear said the number of Covid-19 deaths is still "stubbornly high" after he announced 35 more, 16 from Louisville. That took the state's death toll to 4,126. The 14-day death average is the same as yesterday, 45.1 per day. 

Also, all of the hospital numbers are up, with 1,204 Covid-19 patients in Kentucky hospitals (up 41 from yesterday); 282 in intensive care (up eight) and 148 of those on ventilators (up six). Beshear said these increases are within normal variations. 

For the first time since the state started reporting hospital capacity on a regular basis, none of the hospital readiness regions reported ventilator use, ICU use or overall patient numbers above 80% capacity.

Schools: The state's K-12 school dashboard shows that 182 schools have never reported their case or quarantine numbers, and last week 401 of them did not. Schools have been asked to self-report daily.

Asked about that, Beshear first commended schools that regularly report, saying they are "living their values of being transparent." He voiced disappointment in the rest, "because what they do is they remove the real information . . . that they need" in deciding whether to send a child to school or not, especially as the state works toward getting every school open to in-person learning in some capacity.

"It's highly disappointing that schools would not be reporting, and I would not feel safe with my children going to the ones that do not," he said. "That would not give me confidence that those schools are doing everything it takes to battle Covid because they're not doing everything it takes for public health and local health departments and others to know the situation in their schools."

Asked what he is doing about it, he said the state is encouraging them to participate, and "that's probably where it's going to be." He added, "I think we should all be disappointed that there are schools that claim they can keep our children safe, but won't show us the data that backs it up."

Last week, 1,295 students and 523 staff tested positive for the virus, resulting in 5,197 students and 738 staff being quarantined, according to the dashboard.

The Centers for Disease Control and Prevention is expected to issue guidance on school reopenings this week, CNN reports.

Click here for the Kentucky Department of Education's considerations for reopening Kentucky schools after vaccination. 

Vaccines: Beshear announced that the federal government is increasing Kentucky's vaccine supply for the third time in three weeks, this time by 6 percent. He said that means the state will get 71,675 doses next week, up 28% from the 56,175 three weeks ago. This week, the state received 68,475 doses. 

"It's not enough, but it's great," the governor said. 

At least 452,532 Kentuckians have received at least one dose of the vaccine, according to the state's daily vaccination report.

Beshear said the state's larger vaccine sites will likely move to phase 1C, which includes people 60 and older, people with high-risk conditions and all essential workers, when they find that slots are not being filled up by those in the higher priority groups, which means that some of the regional centers may move to that phase earlier than others. 

In anticipation of severe winter weather expected through Thursday night, Beshear said the regional vaccination sites at the Kentucky Horse Park, Bowling Green and Covington will be closed Thursday to ensure the safety of all staff, volunteers and vaccine recipients.

“If you have waited a long time to get this appointment, I am really sorry,” Beshear said. “But I also don’t want to put you out on the roads with thick amounts of ice. . . . We will get you vaccinated.” He said the appointments will be automatically rescheduled no later than the following week. 

The University of Kentucky said it would keep close its vaccination site inside Kroger Field open, despite due to the weather, and encouraged people to keep their appointments if possible. UK also encouraged them to dress warmly since they may stand outside for a few minutes before checking in. (Updated 2/10)

Adam Mather, inspector general of the Cabinet for Health and Family Services, gave an update on vaccinations in long-term-care facilities. Under a federal contract, CVS Health and Walgreens manage that for all states but West Virginia, and are scheduled to offer three vaccine clinics in each facility. 

Mather said CVS has completed its second clinics in 88% of long-term-care facilities and 79% of assisted-living facilities. He said Walgreens is 28% into its third clinics in long-term care and 90% through second clinics in assisted living. 

He added that the state is also vaccinating Supports for Community Living residents, a program that helps 3,524 people with intellectual or developmental disabilities. He said more than 1,110 have received a shot from Walgreens, local health departments or other providers. 

Mather said the state is working on a program for health departments to vaccine seniors who live in lower-income congregate housing.

On Feb. 5, the Lexington Herald Leader reported that an estimated 45% of long-term-care employees have received the vaccine, compared to an estimated 73% of residents.

Marianne Lee Snowden was 29.

Memorial: Beshear honored Marianne Lee Snowden of Walton who died at age 29 on Jan. 14 at St. Elizabeth Medical Center in Florence from Covid-19 complications. Beshear said she was actively involved in NorthKey Community Care in Williamstown and also in the Special Olympics, where she loved cheerleading, running track, bowling and playing softball. 

“Marianne was sick for 11 days before she passed, begging to go home every day," Beshear said, quoting her mother: "If you don’t think Covid is bad, it’s worse than you think. My daughter passed away from it. Gone almost four weeks and I don’t know what to do with myself. Send prayers, wear your masks and keep your distance." Beshear said, "To the Snowdens, we are so sorry for your loss." 

In other coronavirus news Tuesday: 

• Today's fatalities were two men from Barren County, 89 and 91; two men from Boone County, 88 and 92; a Boyle County woman, 97; a Breckinridge County man, 84; a Fayette County man, 57; a Graves County man, 72; two Hardin County women, 75 and 89; two Hardin County men, 67 and 70; a Hopkins County woman, 68; a Hopkins County man, 75; 10 Jefferson County women, 58, 65, 70, 74, 75, 76, 77, 87, 92 and 94; six Jefferson County men, 74, 75, 76, 77, 86 and 93; a Kenton County woman, 95; a Larue County woman, 76; a Nelson County man, 68; a Washington County woman, 102; and a Washington County man, 61.
• Counties with 10 or more new cases were Jefferson, 396; Fayette, 116; Kenton, 115; Boone, 92; Madison, 82; Laurel and Warren, 66; Pulaski, 64; Hardin, 61; Daviess, 58; Campbell, 53; Nelson, 46; Pike, 45; Oldham, 42; Taylor, 38; McCreary, 33; Barren, 30; Bullitt, Russell and Scott, 28; Allen, 27; Grant and Knox, 25; Christian, 24; Henderson, 21; Caldwell, Hopkins, Jackson and Whitley, 20; Marshall and Shelby, 19; Clinton, Franklin and Marion, 18; Lawrence, 17; Mason, 16; Bell, 15; Boyd, Green and McCracken, 14; Clay and Grayson, 13; Jessamine, Livingston, Logan, Owen, Perry and Trigg, 12; Anderson, Graves and Wayne, 11; Floyd, Magoffin, Meade, Pendleton and Simpson, 10.
• In long-term care, there are 14 new cases among residents and 15 among staff; 303 active resident cases, and 204 active staff cases. The state attributed 12 more long-term-care residents' deaths to Covid-19, bringing that death toll to 2,205. 
• The British B117 variant of the virus has been identified in Jefferson County, WDRB reports. "Between that and Super Bowl and people tired of staying home, these numbers can change direction at any minute," Dr. Sarah Moyer, Louisville's chief health strategist, said at a news conference. She said the variant does not produce more severe outcomes, but is much more contagious, "so if before, if you would have infected one or two people if you had Covid, now it's a greater number, like four or six."
• Five weeks into the high-school basketball season and five to go before playoffs, WKYT reports that 16% of games were cancelled in the first week, increasing to 24%, 35% and 37% in subsequent weeks. In week 5, it was back down to 29%. KHSAA Commissioner Julian Tackett told WKYT  that "It's gone about as we expected" and that most cancellations were the result of quarantines following a positive test.
• As teachers' vaccinations begin to wrap up, new state guidance says Kentucky schools don't have to offer virtual work if teachers refuse a shot, Valarie Honeycutt Spears reports for the Lexington Herald-Leader. The requirement to offer accommodations extends until the eligible employee is at least seven calendar days past getting their final vaccine dose, and will be offered to those who refuse the vaccine for medical reasons, Honeycutt reports. A spokeswoman for the Kentucky Department of Education told her that some schools may decide to let staff without medical exemptions who don't get vaccinated continue to work remotely.  
• UK is looking for 200 adult volunteers for a trial to test the efficacy of getting two shots of the Johnson & Johnson vaccine, instead of the currently recommended single dose.  Click here if you are interested in participating in the study. 
• Matt Mencarini reports for the Louisville Courier Journal on the challenges in Kentucky's prisons and jails that have been hit hard by the coronavirus. Medical experts told the paper that the best tools for them would be to provide vaccinations and to reduce their populations. Early in the pandemic, Kentucky reduced its inmate population, but at this time, inmates are not included in any priority list for vaccines. 
• Corinne Boyer of Ohio Valley ReSource reports on the challenges of staying in addiction treatment while staying safe from Covid-19.

Most Ky. Covid-19 metrics remain stable, but deaths are up

Ky. Health News graph; does not include deaths found by death-certificate audit; click it to enlarge.

By Melissa Patrick

Kentucky Health News

Most of the metrics used to measure the coronavirus remain on a plateau in Kentucky, but with 23 deaths reported on Tuesday, it is clear that the virus remains deadly for some.

Health Commissioner Steven Stack emphasized that point at Gov. Andy Beshear's news briefing Monday, saying several times that "Covid is a bad disease" and begging Kentuckians to get vaccinated.

So far, 1,882,396 people have gotten at least one shot of a vaccine in Kentucky, amounting to 53% of Kentuckians 18 and older and 42% of the state's population. 

“No matter where you are in the state, you can sign up for a Covid-19 vaccine near where you live or work,” Beshear said in a news release. “Now, when you get a shot of hope at many Kroger or Walmart locations, you can even earn a free shot at winning the lottery. It’s easier than ever.”

Soon, children between the ages of 12 and 15 can also get the vaccine. The Pfizer-BioNTech vaccine has been approved by the U.S. Food and Drug Administration for this age group, and awaits final approval from a federal advisory committee Wednesday. Go to vaccines.gov/search/ to find a Covid-19 vaccination site. 

Cassie Prather, director of the Woodford County Health Department, told WKYT that adolescent cases are 20 percent of their total now, up from 3 percent, and she worries that youth are Petri dishes for more contagious variants. Statewide, nearly 18% of Tuesday's cases, 136, were in people 18 and younger.

Daily numbers: Beshear reported 758 new cases of the virus Tuesday, bringing the seven-day rolling average to 524, down two from Monday. 

The share of Kentuckians testing positive for the virus in the past seven days is 3.15%. This average has been under 4% for two months.

The state's daily rate of new cases over the last seven days is 9.89 per 100,000 residents, falling below 10 for the first time since April 9. This rate has dropped 13.6% in the last week, from 11.47 on May 4. 

Counties with rates more than double the statewide rate are Powell, 50.9; Montgomery, 45.2; Rockcastle, 31.7; Webster, 27.6; Owen, 27.5; Lewis, 26.9; Bath, 26.3; Estill, 23.3; Mason, 22.6; Fleming, 20.6; Taylor, 20.5; Union, 19.9; and Menifee, 19.8.

The New York Times ranks Kentucky's rate 24th among the states, with a 1% increase in cases over the last 14 days. Only six other states, including Indiana at 3%, have seen increases over that period. Louisiana and Arkansas lead at 15% and 13%, respectively.

The state reported 23 more deaths from the virus, all of them from regularly reported health department reports. This is the most deaths reported in one day since March 28, when 27 were reported. These numbers vary widely because of how health departments report them. The 14-day death average is 9.29 deaths per day; on April 30, it hit a recent low of seven per day. Kentucky's death toll from the disease is now 6,620.

Kentucky hospitals reported 415 Covid-19 patients, 109 of them in intensive care and 51 of those on a ventilator. The latter numbers were the same as Monday; Covid-19 hospitalizations were up by 11.

Among the state's 10 hospital-readiness regions, the only one using at least 80% of its intensive-care-unit capacity is the easternmost region, from Lee to Pike counties, at 81.6%. 

Starting Wednesday, May 12, the daily Covid-19 report will be posted daily on Beshear's social media channels around 5 p.m., instead of being posted in a news release. A full release will be sent on days that the governor holds a Covid-19 press conference. Recently he has done those two days a week. 

In other pandemic news Tuesday:

• Counties with 10 or more new cases were Jefferson, 93; Fayette, 51; Boone, 45; Campbell, 28; Taylor, 24; Pulaski, 23; Kenton, 21; Bullitt, 20; Warren, 19; Pike, 16; Shelby, 15; McCracken, Mercer and Oldham, 14; Christian and Madison, 13; Rockcastle and Webster, 12; Breathitt, Hopkins, Jessamine and Lewis, 11; and Hardin, 10.
• Tuesday's fatalities were an Anderson County man, 64; a Barren County woman, 42; a Bullitt County man, 68; a Carter County man, 101; a Daviess County man, 94; a Fayette County man, 59; a Grant County woman, 92; a Graves County woman, 84; a Henderson County woman, 90; two Jefferson County women, 95, 97; a Lawrence County woman, 87; a Letcher County man, 79; a McCracken County woman, 92; a McCracken County man, 55; a Menifee County woman, 90; a Monroe County woman, 70; a Muhlenberg County woman, 96; a Rockcastle County man, 62; a Simpson County woman, 59; a Taylor County woman, 74; a Wayne County woman, 71; and a Whitley County woman, 57.
• States will get no Johnson & Johnson vaccine next week because of production problems, federal officials told governors in a private call, Politico reports.
• Some people have found they prefer to wear masks, for a variety of reasons, Julia Carrie Wong writes for The Guardian. They include anonymity, hiding their ethnicity, avoiding unwelcome attention, simpler dealing with customers, and just feeling free to not smile. 
• Katie Camero of McClatchy News answers two questions about the Pfizer-BioNTech vaccine and children, including: Is the shot for teens different than those given to adults?  And how well does the Pfizer vaccine protect children? The article also provides a video that walks through how the FDA and CDC authorize vaccines for children. 
• "In The Associated Press-NORC Center for Public Affairs Research poll released Tuesday, 64% of respondents said they have gotten a Covid-19 vaccine and 35% said they haven’t. Of the respondents who haven’t gotten a shot, 61% said they wouldn’t get a Covid vaccine, with 34% saying they would “definitely” not get a shot and 27% said they “probably” wouldn’t," Summer Lin reports for McClatchy. The poll also found fewer of the respondents in this poll were willing to get a vaccine than in the last one, taken in March, 61% and 43% respectively

Ky. study shows syringe exchange programs decrease infections associated with IV drug use, could result in 'big money saved'

By Melissa Patrick
Kentucky Health News

A new analysis of Medicaid claims data suggests that Kentucky counties with syringe-service programs have slightly lower rates of diseases associated with intravenous drug use, such as HIV and hepatitis C.

The analysis estimated a progressive reduction of 0.5 percent per month, adding up to a 6% increase over a year. That can add up to savings, not only in lives, but money. So said Dr. Connie White, deputy commissioner of clinical affairs for the Kentucky Department for Public Health, at the Kentucky Harm Reduction Summit Aug. 20. 

White said, "As a public-health person, I think of all the emotional tragedy for the patient and for the family with one of these co-morbidities," diseases and conditions that occur together. "But if you're trying to sell this program to a bunch of politicians and legislators, you're talking about money saved, we're talking big money saved."

Kentucky has more syringe-service programs than any other state in the nation, but 56 of the state's 120 counties still don't have one -- and 20 of those are considered highly vulnerable to an HIV or hepatitis C outbreak among IV drug users, according to the Centers for Disease Control and Prevention. Thirty-four of the state's most vulnerable counties have operational syringe exchanges. 

The vulnerable counties without an exchange include Bell and Clinton, which rank sixth and 11th on the national list of 220; Cumberland, Casey, Edmonson, Harlan, Johnson, Lawrence, Lewis, Menifee, Monroe, Rockcastle and Wayne, also in Appalachian Kentucky; and eight in the rest of the state: Carroll, Gallatin, Green, Breckinridge, Grayson, Green, Allen and Hickman. 

Kentucky has 74 operational syringe-service programs in 63 counties, with one more in Christian County approved but not operational. Bracken County's exchange is marked on the state's map as not yet operational, but it started operating July 8. 

Syringe-service programs are more broadly referred to as harm-reduction programs and are designed to prevent outbreaks of HIV and hepatitis C, which are commonly spread by needle sharing among IV drug users. They also provide health screenings and vaccines, and connect drug users to treatment. 

They are allowed by a 2015 state law that requires approval by the county health board, the fiscal court and the city where the exchange is to be located.

Syringe exchanges reduce disease

The Kentucky Office of Health Data and Analytics did the analysis at the request of the Department for Public Health.

One reason the study is so important is that it helps to root the debate about such programs in empirical data, said Mathew Walton, a researcher with the office. 

Walton pointed to a national study that shows a person's political affiliation, income, and amount of stigma they feel about addiction and syringe-service programs are significant predictors of whether or not someone supports these programs -- not the facts.

The study looked at Medicaid claims from January 2015 through June 2019 in any county that had implemented a syringe-service program during that time.

It looked for six infections largely connected to IV drug use and minimally associated with other activities: HIV, hepatitis C, endocarditis, osteomyelitis, and, in people diagnosed with opioid-use disorder, skin and soft-tissue infections. The researchers only included new infections in their analysis. 

The study looked at infection rates before and after the syringe exchange was established in 42 counties. Recognizing that results might not be seen immediately, included lag times of one month, three months and six months. It also adjusted for a list of variables, many related to demographics.

Cameron Bushling, a statistician with the office, said each of the lag-time scenarios showed a decrease in infections after the syringe exchange was established. 

"The infection rate in your county will go down by roughly half a percent each month after you implement a syringe service program," he said. "So some, some may think this is a small number, but it's important to keep in mind that our infection rates were very low. . . . So half a percent is still a pretty big find."

In conclusion, Walton pointed out that most of the counties in the study were rural, outside metro areas. 

"There's an evidence of an association that they were successful in reducing infection, new infections," Walton said. "These do seem to be an effective use of resources for preventing costly and harmful infectious disease." 

He said the savings would come with even small reductions in infections caused by IV drug use.

"While this analysis revealed that this set of infectious-disease diagnoses was rare, even preventing a small percentage of them can have a significant effect on the Medicaid program," he said. "A single course of treatment for hepatitis C can be as much as $85,000 or more, so even a small outbreak prevention can be both a sort of economic benefit as well as a humanitarian and medical population health benefit."

Advice for resistant counties

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, after a separate presentation, was asked what advice he would give counties that have been resistant to syringe exchanges. 

"I realize these can be controversial in some communities," said Ingram, who was Maysville's police chief before taking the drug-control job, and back then opposed syringe exchanges. Many law-enforcement officers do, believing, that they encourage drug use, despite research to the contrary.

"Well, first, just don't give up," he said. "Second, do everything you can to get the public on your side, the voters on your side. . . . and continue to keep raising this issue."  

He also suggested identifying the thought leaders in a community, those who have influence, and then educating them on why it's important to have one. His last bit of advice was to reach out to public health departments that have already fought this fight successfully and learn from their strategies.

Asked the same advice question, Frankie Haynes, the harm reduction coordinator for the Barren River District Health Department, stressed that educating the public is the key. 

"I can't tell you how many times we went into different entities and just explained to people what harm reduction was, or what needle-exchange services are, what are we doing," she said during a panel discussion about exchanges, "And once you give them a whole rundown on what it looks like to be a part of our program, what to expect within the program, you really start seeing eyes opening to the need for these programs across the state." 

The Bowling Green-based Barren River department is working to expand syringe services into Logan County, which has received approval from its Board of Health, but still needs the approval of the Russellville City Council and the county Fiscal Court. Two of the district's eight counties (Warren and Barren) have exchanges. 

Jennifer Twyman, health-education specialist with the Louisville Metro Public Health and Wellness syringe exchange program, agreed with Haynes. She said discussions with the public put a face on the program: "Talking to people in the community, so that they know what we're doing, makes just a huge difference."

State health chief tells Kentuckians who've been to Myrtle Beach to self-quarantine; some long-term-care visitation to resume Mon.

By Al Cross and Melissa Patrick
Kentucky Health News

As it reported 280 more coronavirus cases in Kentucky, the state Department for Public Health issued an advisory to Kentuckians who had traveled in the last two weeks to Myrtle Beach, S.C., which has turned into a hotspot.

“DPH advises Kentucky residents who have traveled to Myrtle Beach in the past two weeks to self-quarantine for 14 days and monitor themselves for covid-19 symptoms,” the advisory says, then adds a message from Dr. Steven Stack, commissioner of the agency:

“If you or someone to whom you are close has been to Myrtle Beach in the past two weeks, please be aware that you have a good probability of having been exposed to the novel coronavirus. Please avoid contact with those who are vulnerable, such as the elderly and anyone with significant medical conditions, including diabetes, obesity and heart disease.”

Some other South Carolina beach counties are also hotspots, and the advisory warned, “Exposure to covid-19 is not limited to Myrtle Beach. Multiple states have reported a rise in covid-19 cases, and the guidance should be applied more broadly, including social situations where people gathered in numbers of 10 or greater and in situations where people are not observing recommended precautions, including practicing social distancing and wearing a cloth mask when in public or in groups. Kentuckians should also practice thorough and frequent hand-washing."

Kentucky Health News chart

Gov. Andy Beshear announced the 280 new cases in a press release, bringing the state's total to 14,617. That pushed the seven-day rolling average to 211, from 204 the day before. The average has risen for five days in a row. Fayette County again led the new-case list with 57; Jefferson had 42, Warren 32, Kenton 18, Shelby 15 and Boone 10.

Beshear also reported eight additional deaths, making the state's toll 546. The fatalities were an 81-year-old woman from Warren County, a 69-year-old man from Christian County; a 63-year-old man from Fayette County; an 89-year-old woman and an 86-year-old man from Jefferson County; and three women from Shelby County, 84, 90 and 93.

The state's daily report said 377 Kentuckians were hospitalized with covid-19, and 79 of them were in intensive care.

Cabinet for Health and Family Services Secretary Eric Friedlander announced in the release that on Monday, June 29, the state allow visitation at assisted-living and personal-care homes, group activities with 10 or fewer people in facilities, communal dining, and off-site appointments. Visitation in nursing homes and intermediate-care facilities for individuals with intellectual disabilities will resume July 15.

In other covid-19 news Thursday:

• Deborah Yetter of the Courier Journal tells the story of 106-year-old Sherman Guthrie Price, who had covid-19 but really died of complications from pneumonia, which he had before he tested positive for the virus, his family says. A grandson said that "profoundly affected his final days by keeping him isolated from family and friends except for video visits."
• Churchill Downs said the Sept. 5 Kentucky Derby will be run with fans in the stands and still-to-be-specified capacity reductions. "The plan approved by Gov. Andy Beshear’s office will restrict holders of general admission tickets to the track’s 26-acre infield and impose density limits on reserved seating and suites," the CJ reports.
• Beshear's office said he would hold one coronavirus briefing a week, on Tuesdays.
• "State health departments reported 38,115 new infections on Wednesday," the most ever, and “Our best estimate right now is that for every case that’s reported, there actually are 10 other infections,” The Washington Post reports. "The new spike was caused by a rush to reopen without proper safety measures in place, infectious-disease experts say, and the push to do so, even as cases climb, sends a dangerous and inaccurate message."
• The University of Kentucky is adding extract from the medicinal plant Artemisia annua, also known as sweet wormwood, to its innovative clinical trial of covid-19 therapies to test its effectiveness against the coronavirus, following studies in Germany that showed it to be effective, the university reports. The trial will also test artesunate, "a derivative of the plant that is a standard treatment for malaria in many parts of the world," UK's Elizabeth Chapin writes.
  
• UK President Eli Capilouto has made a public service announcement to encourage everyone to follow the suggested guidelines to decrease the spread of the coronavirus, with a focus on why it is important to wear masks. 
• A federal judge ruled that Beshear went “too far” in limiting in-person protests at the Capitol during the pandemic, Jack Brammer reports for the Lexington Herald-Leader. District Judge Greg Van Tatenhove said Wednesday that Beshear must amend his mass-gatherings order to allow for in-person protests. Despite the order, several large gatherings have been held outside the Capitol in recent months, at least one of which Beshear attended himself, Brammer notes.
• The annual political speaking will not be held at the Aug. 1 Fancy Farm Picnic in far Western Kentucky due to the pandemic. The priest at St. Jerome Catholic Church overruled the picnic committee, which had announced the event would be held with a limited audience in a school gym, the Mayfield Messenger and the Herald-Leader report.
• An updated model by the University of Washington's Institute for Health Metrics and Evaluation released Wednesday projects that 33,000 American lives would be saved between now and Oct. 1 by near-universal wearing of masks.
• Eleven Kentucky hospitals received $151.8 million to respond to the coronavirus pandemic "because of their focus on providing medical care to all patients regardless of ability to pay," Senate Majority Leader Mitch McConnell said. They are UofL Health (Jewish Hospital and Shelbyville Hospital), St. Claire HealthCare in Morehead, Pikeville Medical Center, CHI St. Joseph (Mount Sterling and London), Methodist Health in Henderson, St. Elizabeth Healthcare in Northern Kentucky, Hardin Memorial Health in Elizabethtown, Murray-Calloway County Hospital and Baptist Health Richmond.
• West Virginia Gov. Jim Justice forced out his top public-health official "hours after he publicly questioned the accuracy of the state’s coronavirus data and detailed growing outbreaks in about a dozen counties" and "vented during a news conference," The Associated Press reports. Dr. Cathy Slemp "was a regular feature of the governor’s daily virus news conferences, at which he "showered Slemp with praise." West Virginia's estimated virus transmission rate has been rising slowly and was at 1.06 Thursday morning, meaning that every 100 infected people in the state would infect 106 others, and so on. Kentucky's was 0.99.