Officials warn Kentuckians to follow rules, to keep economy open; Beshear says spike could bring a mask order or 'surgical' moves

Kentucky Health News chart; hospitalizations are not reported on weekends.

By Melissa Patrick
Kentucky Health News

With every business in Kentucky reopened this week at some capacity, Gov. Andy Beshear warned Tuesday that the onus is on every Kentuckian to follow the rules for the coronavirus if they want to keep the economy open and not wind up like other states with outbreaks that are causing reversals.

"We have a responsibility, all of us individually, to do what it takes to be reopened at this level and not cause a spike in cases," Beshear said at his now-weekly covid-19 news conference. "If we have to roll things back, it will be because we individual Kentuckians did not take the responsibility to make sure we followed the rules to do it safely. It will be on us."

Until there is a vaccine, the rules are to keep your hands washed, stay six feet away from anyone who doesn't live in your home, get tested regularly and, most important, wear a mask when in public.

"The single most powerful thing you can do and the cheapest is to wear these mask," said state Health Commissioner Steven Stack, a physician.

Beshear was asked why he didn't mandate the wearing of masks in public, as some states and localities have. "It's because of where our numbers are," he said. "If we have significant increases, we will look at mandating masks." He said such an order would require a mask only when a person is unable to keep six feet away from others, as in indoor shopping spaces.

Beshear said he could approach surges of new cases "surgically," by location.

"If we see a spike like we've seen in other places, we are going to pause the reopening stuff that we are doing," he said. "We are going to look at what are the highest-spreading areas. . . . address the issue that is there, and then look at whatever else we have to do."

Stack pointed to several states that have seen spikes in the past two weeks and warned that it would be easy for Kentucky to follow in their path if Kentuckians don't follow the rules as the state moves to the next phase of reopening.

He said Arizona's number of cases has more than doubled in the past two weeks, increasing from 180 per million residents to 400 per million; in Florida, from 80 to 300 per million; and in South Carolina, from 125 to 250.

He said that for the last two weeks, Kentucky has stayed at 50 cases per million. "That is not an accident," he said. "That is because you have made sacrifices."

Beshear announced 282 new cases Tuesday, bringing the state's total to 15,624. He said the state continues to be in a plateau, between 150 and 300 new cases daily, and "It's something we've got to watch very carefully."

One metric that state officials watch to determine future actions is hospitalizations. Tuesday's number was hit 408, the first time it has exceeded 400 since June 17; it has trended up in the last week. Beshear said hospitals are using less than 60% of their hospital beds, 73% of their intensive care beds and 27% of their ventilators. Click here for the daily report.

Since last Wednesday, 189 more residents of long-term-care facilities and 100 more staff have tested positive for the virus, for totals of 1,887 and 912, respectively. He said 18 more residents had died from covid-19, bringing that total up to 358, plus three employees. Click here for details on each facility.

In other covid-19 news Tuesday:

• Five more Kentuckians have died from the virus, increasing the death toll to 565. The fatalities were a 70-year-old man from Campbell County; a 71-year-old man from Hardin County; and two women, ages 77 and 86, and a 92-year-old man from Jefferson County.
• Jefferson County again had the most new cases, with 49, but Fayette County continued to run a close second, with 46. Warren County had 25 and Laurel County had 12. Others were Hardin, 9; Pike, 8; Campbell, Kenton and Franklin, 7 each; and Clay, Graves and Shelby, 6 each.
• U.S. Sen. Rand Paul of Kentucky once again took on the nation's top infectious-disease specialist, telling Dr. Anthony Fauci, "We just need more optimism. There is good news out there." Testifying before a Senate committee, Fauci made national headlines by saying he would not be surprised if recent "out of control" surges led to the country having 100,000 new coronavirus cases per day: “I'm very concerned, because it could get very bad. . . . What was thought to be unimaginable turns out to be the reality we’re facing right now.” The Courier Journal has details.
• Some people have begun to choose face shields over masks, "especially as summer temperatures make it hard to wear a mask for long periods of time," reports Dawson White of the McClatchy Co. newspapers. "Experts say that both options have their pros and cons and that you could wear both, but it’s probably not necessary."
• "Growing evidence shows most infected people aren’t spreading the virus," but a few of them become "superspreaders," The New York Times reports. "But whether you become a superspreader probably depends more on circumstance than biology."
• Kentucky has hired Ernst & Young to help process 56,000 outstanding unemployment insurance claims that were filed in March, April and May. Beshear said the one-month contract that starts on July 1 will be paid for with $7.4 million of federal CARES Act money.
• Kentucky has extended the deadline to sign up for the Pandemic Electronic Benefits Transfer funding, or P-EBT, from June 30 to the end of August. This program provides money to families of children who are eligible for free or reduced lunches. Health Secretary Eric Friedlander said over 516,000 individuals have signed up for the benefit, and that there is another 100,000 eligible who have not yet signed up. If you have questions about this program, go to chfs.ky.gov and search for “PEBT,” email PEBT.info@ky.gov or call 855-306-8959.
• Kentucky has also extended its short-term Medicaid coverage for Kentuckians who qualified under the Presumptive Eligibility Medicaid program. This coverage was set to end on June 30, but has now been extended for three months "unless you contact us and ask us not to extend," said Friedlander. Families can apply online at chfs.ky.gov or benefind.ky.gov, by contacting an application assister at healthbenefitexchange.ky.gov or by calling 855-459-6328.
• Beshear said state government faces a budget shortfall of $1.1 billion in 2021, which will result in a 16 to 29 percent reduction of services, unless the federal government sends more relief money. "It would be like letting Kentucky go bankrupt," he said.
• The tax-filing deadline won’t be extended past July 15. After the pandemic hit, the federal government pushed the original April 15 deadline back three months. The Internal Revenue Service has offers options for taxpayers unable to pay in full.
  

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For breakfast, give me 2 observational studies and an anti-irritant

This is the way many of my days begin.

I check for messages – across all media – and I see this on Twitter from Adam Cifu, MD, one of our former editorial contributors:

I think this article was published just to irritate ⁦@VPrasadMDMPH⁩ and ⁦@garyschwitzer⁩ https://t.co/KWVqMEk3K8

— Adam Cifu (@adamcifu) June 30, 2020

Once again, it’s the New York Times making causal statements about an observational study, confusing a study that shows a statistical association with one that shows cause-and-effect – which this one did not. And once again, it’s in the Times’ Well column. 

In this case, the Times acknowledges the study can’t prove cause and effect – as early as the second sentence.  However, by then the story had already used wording suggesting causation twice:

• Headline: “Sitting All Day May Increase Your Risk of Dying From Cancer.”  Adding ‘may’ to ‘increase your risk’ doesn’t provide absolution. 
• First sentence:  “Sitting for hours on end could heighten someone’s risk of later dying from cancer.” Again, adding the qualifying ‘could’ isn’t sufficient.  The story still made a causal link – ‘heighten someone’s risk.’  You can’t prove that kind of effect if you haven’t proven cause-and-effect.  Pretty simple.

So readers heads were spinning like Linda Blair’s in The Exorcist – just in the first two sentences.

But I’ve often felt that the way you end a story is the most important because it leaves the reader with a take-home message. And in this case, the Times turned over the take-home message to one of the researchers:

“The tangible takeaway is that we can tell people they do not have to go out and run a marathon” to potentially reduce their risk of dying from cancer, she says.

I argue that there are no proven grounds to deliver that ‘tangible takeaway.’  It’s an interesting study, blown way beyond the boundaries of evidence with this story and with that quote.

As always, smart readers weigh in with criticism of the Times’ continued Un-Well coverage.  One wrote:

With these correlational studies, you can’t control for every single variable that may be contributing to the picture and I do not agree with the stark message of “Don’t sit too long or you’ll die from cancer.” That’s too simple and terrifying a picture to be useful to anyone.

-0-

Even earlier today, I saw this on Twitter:

I can’t wait for the popular press to go with this (clearly spurious) association. Is this the same or worse than epidemiological studies of diet? @VPrasadMDMPH @adamcifu
Association of Low to Moderate Alcohol Drinking With Cognitive Functions in US Adults https://t.co/vnKrzb2NEt

— Michael Ostacher, MD, MPH (@RecoveryDoctor) June 29, 2020

Well, he didn’t need to wait long to see a headline like this in The Telegraph from the UK:  Alcohol is good for you, study finds. 

No, that’s not what the study found.  It found a statistical association. Not proof of cause-and-effect.

CNN’s story – “ Moderate drinking may improve cognitive health for older adults, study says” –  used a qualifying term  – ‘may improve’ – which still implies that cause-and-effect ‘may’ have been established when it hasn’t.  Overall, though, the CNN story provided context and caveats in the body text.

As I’ve done dozens of times through the years, I refer readers and journalists to the primer that’s been on this website for more than a dozen years: Observational studies: Does the language fit the evidence? Association vs. causation.

Now it’s time to sit down and have a drink. I’m worn out already today and I’m barely beyond breakfast.

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McConnell: 'We cannot go back to April, and we cannot go right back to normal,' so wear a mask (no stigma!) to protect others

Senate Majority Leader Mitch McConnell delivered these remarks on the Senate floor today.

“Each time I’ve returned home over the last several weeks, I’ve had the honor of traveling to different Kentucky hospitals to safely meet with healthcare professionals, thank them for their incredible work, and listen to what’s on their minds.

“For more than three months now, our nation’s doctors, nurses, and health professionals have been fighting day and night to heal strangers and protect our nation. I said in mid-March that our country was about to meet a lot of new heroes, and that among them would be many people “who wear scrubs…who rush toward the sick, and wash their hands until they bleed.”

“Well, Americans and families from coast to the coast have met just such heroes.

“The front-line professionals I’m meeting are proud to do their work. And you’d better believe they are appreciative that the sacrifices and the smart precautions taken by the American people stopped health systems from being overrun in the springtime; allowed them to continue giving each patient the care they deserve; and bought our country time to plan a smart, safe, and gradual re-opening.

“Until we have a safe and effective vaccine, it will remain all of our jobs as American citizens to help our nation settle into a middle ground between unsustainable emergency lock-downs and our ordinary life from before all this.

“In short: We cannot go back to April, and we cannot go right back to normal. We need new routines, new rhythms, and new strategies for this new middle ground in between.

“It’s the task of each family, each small business, each employer, and all levels of government to apply common sense and make this happen.

“To name just one example: We must have no stigma, none, about wearing masks when we leave our homes and come near other people. Wearing simple face coverings is not about protecting ourselves, it is about protecting everyone we encounter.

“In fact, the more we hate the pain and suffering that accompanied the strict stay-home guidelines a few months ago, the happier we should be to take reasonable small steps every day to ensure our country can stay on offense against the virus.

“Now, the Senate should take pride in the degree to which our historic response has helped the country get where we are. All of the health leaders and professionals I meet continue to be glad for the CARES Act, the historic, bipartisan legislation that Senate Republicans wrote and then negotiated across the aisle.

“We sent historic resources to hospitals and health providers to help them do their healing work and fight this new invader. That was in addition to the historic relief we provided to households and small businesses, which economists across the political spectrum say saved millions of jobs and prevented an economic free-fall.

“In May and June, while the Democratic-led House has been mostly absent, the Senate has kept right on leading. In addition to legislating on other important subjects, we have continued to work all angles of the pandemic. By the end of this week, I believe our committees will have held more than 40 hearings on key aspects of this crisis, so this institution can continue to learn and inform any future work.

“As I’ve been saying for weeks, a number of us are putting together strong legal protections for healthcare professionals, K-12 schools, colleges and universities, and employers so our recovery is not promptly swamped by a second epidemic of frivolous lawsuits.

“While the Democratic House slapped together an absurd multi-trillion-dollar wish list that even the mainstream media panned immediately, the Senate has continued with our substantive, serious, facts-first approach. That is the winning formula that built the historically successful CARES Act, and that is the formula we will replicate in any future recovery legislation down the road.”

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Six months in, here are 3 takes on the pandemic from those who cover the politics of health: optimistic, realistic and pessimistic

By Dan Diamond and Adan Cancryn
Politico Pulse

It’s been nearly six months since the Centers for Disease Control and Prevention first announced that a mystery pneumonia had spread in a Chinese market, and the nation has been transformed.

Lockdowns have been applied and lifted. Millions are out of work. More than 125,000 Americans are already dead, and weeks of declining cases have abruptly reversed, including record surges in Southern states.

The optimistic take: We’re far better prepared to handle this upswing. There are many more supplies and tests than when covid-19 first walloped America in March; hospital staff increasingly have the protective equipment that they initially lacked; and researchers are beginning to identify medications to treat coronavirus.

Those are also the messages amplified by the White House, including in its first coronavirus task force briefing since the end of April, Politico’s Alice Miranda Ollstein and David Lim report.

“We have made truly remarkable progress in moving our nation forward,” Vice President Mike Pence said Friday. “We slowed the spread. We flattened the curve. We saved lives.”

Meanwhile, the fatality rate has fallen, and the surge of new cases is being driven by young Americans, who appear at far less risk of complications or death.

The realistic take: We’re in serious trouble. The soaring number of cases can’t be explained solely by more testing, and health officials like infectious-disease expert Tony Fauci have warned that young Americans are bound to spread the virus to more vulnerable populations.

"The window is closing," Health and Human Services Secretary Alex Azar said on NBC's "Meet the Press:" "We have to act, and people as individuals have to act responsibly. We need to social-distance. We need to wear our face-coverings if we're in settings where we can't social-distance, particularly in these hot zones."

Even once-confident Republican governors have changed their tune. The outbreak “has taken a very swift and very dangerous turn in Texas over just the past few weeks,” Texas Gov. Greg Abbott said on Sunday. He has also acknowledged his regrets about re-opening bars, given that they became hotbeds of infection.

The pessimistic take: This is setting up to be a reprise of February and March, with cases soaring now, hospitalizations and deaths likely to soon follow and President Donald Trump again dismissing basic realities about the virus, such as the protective power of masks, while instead stoking a culture war over their use.

Even senior Republicans are beginning to plead with Trump: Set an example for your skeptical followers. “There are times when he could wear a mask or the vice president could wear a mask,” Sen. Lamar Alexander said on CNN on Sunday. “I think it would be a sign of strength.”

On the other side of the aisle, House Speaker Nancy Pelosi and other progressives have escalated their criticism of the White House’s recent lack of action. Prominent MSNBC host Chris Hayes on Friday, for the first time, called on Trump to resign for his handling of the outbreak.

How Scott Gottleib sees it: The former Trump appointee and Food and Drug Administration commissioner sounded a serious note on CBS's “Face the Nation” on Sunday.

“Deaths are actually coming down, but that's not likely to stay that way,” Gottlieb said. “This spread is likely to seep into more vulnerable communities and we're likely to see total daily deaths start to go back up again.”

He added, “We have a hard six months ahead of us.”

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Coronavirus update: Hospitals will get drug than can shorten covid-19 stays by a third; Kentucky's positive-test rate is stable

The federal government has secured half a million treatment courses of the experimental covid-19 drug remdesivir, and hospitals will pay no more than $3,200 per average treatment course, the government and Gilead Sciences announced. Preliminary research shows the drug may reduce the length of covid-19 hospital stays as much as one-third.

Evans Orchard in Scott County has sued Gov. Andy Beshear over his restrictions on outdoor activities.

Buffalo Trace Distillery in Frankfort, not on the official Kentucky Bourbon Trail but very popular, said it would resume tours Wednesday, with advance registration required. "Guests will also be asked to wear a face mask. For anyone who forgets theirs, one will be provided," the distillery says. "Tours and events will be kept to small, comfortable groups to allow for social distancing."

The percentage of positive tests for the virus in Kentucky has remained stable for the past month, tweets Daniel Desrochers of the Lexington Herald-Leader, with this chart (adapted by Kentucky Health News):

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Can controlling blood pressure later in life reduce risk of dementia?

Everyone talks about the importance of treating high blood pressure, the “silent killer.” And everybody knows that untreated high blood pressure can lead to heart attacks and strokes. But can treating high blood pressure reduce your risk of cognitive impairment and dementia?

High blood pressure is a risk factor for cognitive impairment and dementia

Cognition encompasses thinking, memory, language, attention, and other mental abilities. Researchers have known for many years that if you have high blood pressure, you have a higher risk of developing cognitive impairment and dementia. However, just because high blood pressure is a risk factor, it does not necessarily mean that lowering high blood pressure will lower your risk. Many things in health and science correlate without one causing the other (my favorite is the correlation between the drop in birth rate and the decline in the stork population). Thus, randomized, double-blind, controlled studies are needed to answer this question.

Prior studies have not provided clear answers

There have, in fact, been a lot of these studies. The most recent relevant study is the SPRINT-MIND study, designed to measure the effects of lowering high blood pressure on dementia and/or mild cognitive impairment. This study was so successful at reducing the risk of mild cognitive impairment by lowering high blood pressure that it ended early, because the data and safety monitoring board felt that it was unethical to continue the control group. However, the dementia endpoint had not yet reached statistical significance — likely because of this early termination. Thus, while the study succeeded in one sense, it ultimately concluded that treating systolic blood pressure to below 120 mmHg (versus lower than 140 mmHg) did not reduce risk of dementia.

A new analysis of many studies

Because SPRINT-MIND and many other prior studies have not clearly shown whether lowering our high blood pressure can reduce our risk of cognitive impairment and dementia, meta-analyses are needed to answer this question. Researchers in Ireland looked at data from 14 studies comprising almost 100,000 participants, followed over an average of more than four years. They found that older individuals (average age 69) who lowered their blood pressure are slightly less likely to develop dementia or cognitive impairment (7.0% versus 7.5%). Thus, the answer is: Yes! Lowering high blood pressure will lower our risk of dementia and cognitive impairment.

The relationship between high blood pressure and dementia

So, how does lowering high blood pressure reduce our risk of cognitive impairment and dementia? Most people who have dementia don’t have just a single cause. Two or even three different problems in the brain cause their cognitive impairment and lead to their decline in function. One study estimates that the fraction of dementia risk attributable to cerebrovascular disease — that is, strokes — was nearly 25% in people who developed significant memory loss late in life. These researchers also found that the dementia risk attributable to Alzheimer’s disease was considerably higher, nearly 40%.

My reading of the literature is that lowering blood pressure reduces dementia risk because it reduces the risk of stroke. It’s the strokes — not high blood pressure by itself — that cause cognitive impairment. Note, however, that the strokes may be so tiny that one doesn’t even know that they have them. But developing a lot of these tiny strokes (or a few big ones) will greatly increase our risk of dementia.

Optimal blood pressure for optimal brain health

Okay, but what’s considered a healthy blood pressure from the perspective of the brain? The SPRINT-MIND study answers that question: people are less likely to develop mild cognitive impairment if their systolic blood pressure is lower than 120 mm Hg compared to the control condition of between 120 and 140 mm Hg. Thus, for optimal brain health, it’s best to keep your systolic blood pressure below 120 mm Hg — at least according to the SPRINT-MIND study.

The bottom line

The take-home message is clear: You can reduce your risk of cognitive impairment and dementia by lowering your systolic blood pressure to less than 120 mm Hg, preferably with aerobic exercise, a Mediterranean diet, and a healthy weight, and by adding medications if those lifestyle changes alone are not sufficient.

The post Can controlling blood pressure later in life reduce risk of dementia? appeared first on Harvard Health Blog.

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Hospitals say they need more federal money to offset pandemic losses; worry people still afraid to come in for care

Kentucky Hospital Association and Kentucky Medical Association public-service announcement

By Melissa Patrick
Kentucky Health News

The coronavirus pandemic cost Kentucky hospitals $1.6 billion from March to June, and more federal relief is needed to ensure their long-term sustainability, the association's leader says.
    
"Only 53 of the 118 Kentucky hospitals have received enough federal relief to cover their losses to date, and again, we only have quantified losses through the end of this month," Nancy Galvagni, president of the Kentucky Hospital Association, said at the June 25 meeting of the legislature's Interim Health,Welfare and Family Services Committee.

Galvagni said that after figuring in all of the cost-cutting hospitals have done to stanch their losses, "There still remains $750 million in losses in 65 hospitals, just through the end of June, that are still uncovered."

She said KHA was working closely with Senate Majority Leader Mitch McConnell and the entire congressional delegation to get the Department for Health and Human Services to send more federal relief funding to Kentucky's hospitals.

"Getting these losses covered is critical. I can't emphasize that enough," she said. "If we don't get these losses covered, it really is going to be very damaging to the long-term sustainability of our hospitals."

Pressed, Galvagni wouldn't say any Kentucky hospitals were at risk of closing, but said about 20 are considered financially "vulnerable" and fit many of the criteria for other hospitals that have closed across the country. "If those hospital losses are not covered from the shutdowns," she said, "that's just going to speed up the process."

Most recently, McConnell announced that 11 Kentucky hospitals had received $151.8 million to respond to the pandemic, but Galvagni painted a broader picture.

"Some people might have thought that hospitals were going to benefit from additional reimbursement, or what have you, from the spread of the virus, and that we would be overrun with patients, and of course that is very far from actuality," said Galvagni.

She warned that hospitals could continue to lose money because many Kentuckians are still afraid to seek medical care, even when it is a matter of life and death. She said those receiving care now are largely those who deferred it after hospitals were told to cease all elective procedures on March 18.

"We don't really know, once we get those people through the system, really what it's going to be going forward, if people are going to feel comfortable coming back to the hospital," she said.

Elective procedures were halted to make sure the state had enough hospital capacity and personal protective gear to handle a surge of covid-19 patients, which the models were predicting at the time. Hospitals were allowed to resume non-emergency care in mid-May.

Galvagni reflected, "To be clear, neither KHA or our hospitals are criticizing the government for following the best evidence they had at the time to make their decisions." But she noted that elective procedures, which include medically necessary operations like hip replacements, "are the lifeblood of hospitals" because they provide a significant source of revenue that makes up for losses they incur on many of the services they perform.

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Sunday cases low, as usual; 7-day average still high; 30-year-old dies; those in 20s are plurality of Ky. cases; media influence seen

State map of all cases, labeled by Kentucky Health News; click on it for a larger version.

Kentucky officials reported 97 new coronavirus cases Sunday, following the trend of Sundays having lower numbers because of limited reporting from laboratories that process tests looking for the virus. The report lowered the state's rolling seven-day average to 222 from 229, where it had jumped after a near-record number of cases on Saturday.

“We see states in the South like Florida and Texas with rising cases, and know it could happen here in Kentucky,” Gov. Andy Beshear said in a press release. “It wasn’t anything magic that led us to our early success. It was us truly coming together as a people and showing that the lives of other Kentuckians is more important to us than anything.”

The second wave of cases this fall is likely to be "substantially larger than the first wave," Dr. William Schaffner, a Vanderbilt University infectious-disease specialist, told CNN. Beshear said in the release, “In the coming weeks and months, we’re going to be tested again about whether we truly can be Together Kentucky and Team Kentucky once again. I know we’re up for it.”

Beshear reported four more deaths Sunday, raising the state's covid-19 death total 558. The fatalities included a 30-year-old woman from Fayette County, who appears to have been the youngest covid-19 death in the state. Others were an 84-year-old woman from Fayette County, an 81-year-old man from Franklin County and a 93-year-old man from Shelby County.

Sunday's update did not include hospitalization data, which have become more important to watch as the virus spread among younger people, who are generally less vulnerable to the virus. When sorted by decades of age, people in their 20s now account for more Kentucky cases than any other decade. Counties reporting five or more new cases Sunday were Jefferson, 10; Fayette, 9; Warren, 7; and Pike, 5.

In other covid-19 news Sunday:

People who get their news from Google or Yahoo, watch Fox News or listen to Rush Limbaugh are more likely to be misinformed about the coronavirus and covid-19, three studies have found. A Harvard University study found that was true even when discounting for ideology and party preference. It found that readers of The Associated Press, The New York Times, The Washington Post and The Wall Street Journal were better informed. It also found, "Exposure to sources such as Facebook, Twitter or YouTube was positively correlated with belief in the efficacy of vitamin C, the belief that the CDC was exaggerating the threat to harm President Trump, and the belief that the virus was created by the U.S. government." Another study found that "Infection and mortality rates are higher in places where one pundit who initially downplayed the severity of the pandemic — Fox News’s Sean Hannity — reaches the largest audiences," the Post reports. 

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Pastor says the pandemic is like driving: Distancing and masking are analogous to wearing a seat belt and watching your speed

Paul Prather

Paul Prather of Mount Sterling, a Pentecostal minister and former Lexington Herald-Leader religion reporter who still writes a column for the paper, has a Facebook page with a diverse set of friends and followers. Recently, he asked them, "Are my wife and I alone in still taking precautions against covid-19? I'm beginning to feel as if we are. Are you wearing masks and practicing strict social distancing or have you returned to your pre-pandemic lifestyle? Either way, what's your rationale? . . . I've ever experienced what I feel now—that those around me could not care less whether they kill me. That the lives of those who are older or have chronic illnesses apparently mean nothing."

Prather reports in the newspaper, "The responses weren’t what I’d anticipated, in volume or content. What I learned from my Facebook friends (mostly) lifted my soul." He estimates that 98 percent those who responded said they wear a mask, but suspects that "way more than 2 percent of my friends aren’t wearing masks or social-distancing now, if they ever did. Apparently, for whatever reasons, these folks didn’t feel comfortable declaring themselves."

That's what Kentucky Health News reporter Melissa Patrick found this month when she interviewed shoppers in the parking lot of Walmart on Nicholasville Road in Lexington. "Most who weren't wearing a mask also didn't want to be interviewed, and of the few who did, most didn't want to share their name," she reported. "But every person who had a mask on and was asked for an interview agreed to it and all but one gave their name."

Prather writes that he has the impression that "hardly anybody was taking precautions," but "After my post, I realized far more people are acting cautiously than I’d imagined. . .. The reason it seemed they weren’t there was that—duh!—they weren’t there. That is, they weren’t the folks cramming into Walmart or Lowe’s or massing on Florida beaches. They were home."

As for his own attitude, Prather says he approaches the pandemic much like driving -- an inherently risky proposition but one that can be managed safely.

"Any 4,000-pound machine hurtling down a road is a lethal threat. People die or are maimed in crashes every day. So I wear my seatbelt. I obey the speed limit (kind of, more or less). I don’t drink and drive. I don’t text while driving. I maintain a comfortable distance between my vehicle and the one ahead of me. If it’s raining, snowing or icy, I slow down. I hope to decrease my odds of having—or causing—a wreck. I want to protect you and me alike," he writes.

"This is how I approach wearing a mask, social distancing and hand washing. I do what I can. I don’t quake with fear. I see it as using good sense and being a good citizen. If you want to risk your life by getting drunk and driving 90, or by failing to take reasonable precautions against covid-19, yes, theoretically that’s your right. Until you start endangering others’ lives. That’s not your right."

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Covid-19 update: Long-term-care visits will come with restrictions

Video from Health and Family Services Secretary Eric Friedlander runs 5 minutes and 35 seconds.

If you plan to visit a long-term-care facility in Kentucky as visitation reopens, be prepared to follow some tight restrictions. Visitation opens Monday, June 29 for personal-care homes, assisted-living communities and family-care homes, and July 15 for skilled nursing facilities.

Visitors will have to schedule in advance, no more than two people can visit a time, they must be socially distanced, and they won't be in patients' rooms. Facilities must have a designated visitation room near the main entrance or outdoors so the area can be sanitized between visits. Inside visitors must be masked, and will be screened for possible signs of covid-19.

“This is done balancing needs of individuals, needs of families, needs of folks in these facilities themselves to start seeing each other again,” Health and Family Services Secretary Eric Friedlander said in an online message.

Visitation is resuming after "three months of forced isolation," notes the Lexington Herald-Leader. "Residents who mostly have been confined to their rooms since March will be able to resume some group activities and communal dining in their facilities.:

Most of Kentucky's deaths from covid-19 have been among residents of long-term-care facilities, and a few nursing homes have lost "close to a quarter of their populations," the Herald-Leader notes. "A spike in cases announced Friday at a nursing home in Corbin shows the facilities remain potentially vulnerable."

There are other restrictions. Before they can allow visitors and resume group activities, the facilities that can start Monday must have gone two weeks without a new coronavirus infection, and those starting July 15 start date must have gone four weeks.

In other covid-19 news Saturday:

• The Herald-Leader's Liz Moomey reports on the reopening of the free Red Bird Clinic in northern Bell County, closed for three months due to the pandemic. Renovations allow it to see as many as before, and accommodate University of Louisville dental students in the fall.
• People needing help with unemployment claims can make appointments for next week in Frankfort from 8 a.m. to 4 p.m.; and for Monday or Tuesday from 9 a.m. to 6 p.m. local time at community colleges in Owensboro and Grayson. Appointments can be made at kcc.ky.gov and going to the In-Person UI Services "View Services" button. Assistance is also available at through the website's "Chat Now" button or by calling 502-564-2900.

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New cases drive up Ky. seven-day average for fifth straight day; Republican senators want Trump to get in the fight, wear a mask

Kentucky Health News chart shows daily cases for last two weeks and 7-day average for each day.

By Al Cross and Melissa Patrick
Kentucky Health News

The state reported 256 new coronavirus cases Friday, moving Kentucky's seven-day rolling average upward for the fifth day in a row. Hospitalizations rose slightly, to 387 from 377, but intensive-care cases declined, to 74 from 79.

Counties with more than five new cases Friday were Jefferson, 53; Fayette, 33; Warren, 29; Kenton, 17; Shelby, 9; Laurel, 8; Daviess, 7; and Mercer, 6.

Gov. Andy Beshear reported in a press release, announcing seven more deaths, raising the state's total to 553. The fatalities were a 90-year-old woman from Clark County; 85- and 88-year-old women and an 83-year-old man from Jefferson County; a 47-year-old man from Monroe County; and 92- and 97-year-old women from Warren County.

In other covid-19 news Friday:

• Republican senators, fearing loss of their majority in the Nov. 3 election, urged President Trump's administration to step up its response to the coronavirus "and pushed Trump to start wearing a mask, at least sometimes," Politico reports. "Trump is still downplaying the virus’ impact, questioning the value of testing and ridiculing the idea of wearing a mask despite holding large-scale campaign rallies. . . . but mask-wearing has become virtually ubiquitous among GOP senators," led by Kentucky's Mitch McConnell.
• "Trump and Republican governors are pointing to fewer coronavirus deaths to suggest that the worst of the coronavirus pandemic has passed — and to blunt criticism that a surge of new infections in more than half the states is proof the country reopened too soon," Politico reports in another story. "But that’s a dangerous gamble. Death rates tell nothing about the current spread of the virus and only offer a snapshot of where the country was roughly three weeks ago."
• As the number of coronavirus cases continues to spread among Lexington's Hispanic community at an alarming rate, Alex Acquisto reports for the Lexington Herald-Leader on how that affects contact tracing. Health department officials told her that right now, there are nearly 300 people the department must call each day. Of those, close to 80 are Hispanic and 50 prefer to speak in Spanish. Fayette County led the state in new cases Thursday, and officials said the Hispanic community and Keeneland Race Course, where many Hispanics work, were the main sources.
• Planning to fly soon? WLEX-TV reports on which airlines are booking at full capacity, and which ones aren't. Forbes reports on four essential websites to help you plan a safer road trip. 
• The Centers for Disease Control and Prevention has expanded its list of people at risk of severe covid-19 illness. These additions include asthma, high blood pressure, neurologic conditions such as dementia, cerebrovascular disease such as stroke, and pregnancy. They are in addition to kidney disease, obesity, heart conditions, COPD, sickle-cell disease, diabetes and those who are immuno-compromised. The CDC estimates that 60 percent of adults in the U.S. suffer from at least one of these conditions.

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Dust from Sahara could pose a health threat through weekend

Video from CNN shows forecast for Saharan dust cloud through Sunday evening.

Dust from the Sahara Desert has made sunsets west of Louisville spectacular in the last few days, but we're about to get too much of a good thing.

Kentucky Health Commissioner Steven Stack "warned Kentuckians that air quality in the state may be poor this weekend and into next week" as the "enormous cloud of dry and dusty air" moves across the South, a state press release said.

The Weather Channel said air quality in the Louisville and Henderson-Owensboro areas on Saturday would be a problem for sensitive people.

Gov. Andy Beshear said in the release, “We absolutely need to be cautious this weekend and next week, monitor the air quality index in our area, and if needed, limit our time outside. We’ve already shown that we can come together to fight a global pandemic for months, so I know we can take the steps needed to protect ourselves and our loved ones over one week.”

Saharan dust "is an annual phenomenon in the late spring, summer and early fall," the release said, but this one "is unusually large. It is one of the thickest on record and nearly 5,000 miles long. That means it could have a significant negative impact on air quality when it moves over Kentucky. Poor air quality can aggravate those suffering from respiratory conditions such as asthma and COPD. It can also pose health risks for seniors and young children."

Stack said, “Fortunately, unlike covid-19, this is a short-term issue, and the masks most Kentuckians are already wearing will also help protect them from inhaling dust. But this is still a serious risk for our youngest and oldest residents, as well as those with any respiratory issues. We need to be especially careful this weekend about spending extended time outdoors. Kentuckians should consistently check the air quality in their ZIP code at airnow.gov and watch for any changes in the sky’s color and visibility.”

The dust may irritate the eyes, lungs and throat and inhibit breathing. The state offered these tips for protection:

• Pay attention to local air quality reports at https://www.airnow.gov/ and watch for news or health warnings about dust particles in your area. Pay attention to public health messages and take extra safety measures such as avoiding spending time outdoors.
• Continue to wear the protective mask you are using to help prevent the spread of covid-19. The mask will also help prevent exposure to dust particles if worn correctly.
• Keep windows and doors closed unless it is very hot outside. Run an air conditioner if you have one, but keep the fresh-air intake closed and the filter clean to prevent dust from getting inside. Seek shelter elsewhere if you do not have an air conditioner and it is too warm to stay inside with the windows closed.
• Follow your doctor's advice about medicines and about your respiratory management plan if you have asthma or another lung disease. Call your doctor if your symptoms worsen.

The release said the state will "monitor the Saharan dust plume and if required, disseminate additional public health advisories and guidance to protect our fellow Kentuckians."

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New focus on obesity makes Ky. kids' health ranking plummet in annual report; 38% of them are either overweight or obese

By Melissa Patrick
Kentucky Health News

The 31st annual Kids Count Data Book on children's well being, released June 22 by the Annie E. Casey Foundation and Kentucky Youth Advocates, ranks Kentucky 37th in the nation for the overall well-being of its children, a drop from 34th in last year's report.

The state improved in most measurements, but dropped apparently because of a switch in measurement: replacing alcohol or drug abuse with obesity, a problem area in which Kentucky kids rank higher.

Nearly one in four Kentuckians are children, the report notes.

It points out that it does not reflect current conditions for families in the covid-19 pandemic, "which has overwhelmed states and communities and has decimated the health and economic stability of families, with a profoundly disparate effect on people of color."

Still, the report can be used "as a guidepost as we work to safely and thoughtfully move forward from the immense impacts of the pandemic," KYA Executive Director Terry Brooks said in a news release.

The latest data are for 2018, and are largely compared with data from 2010. The report rates children's overall well-being through 16 indicators in four major domains: health, economic security, education, and family and community.

Overall, Kentucky saw improvement in 11 of the 16 indicators. KYA called the improvements "measurable, but still inadequate," largely because it says Kentucky is not making progress as quickly as other states.

Kids Count charts; for a larger version of any chart, click on it.

Health: Kentucky's health ranking plummeted to No. 42 this year, largely because the report used the percentage of kids who are overweight or obese, instead of how many of them abused alcohol or drugs in past years. With the original indicator, Kentucky ranked 25th last year.

The report found 38 percent of Kentucky's children were either overweight or obese in 2017-18, up from 37% in 2016-17. The national rate is 31%, and Kentucky kids are the second most obese in the  nation.

"Being overweight or obese during childhood can have harmful effects on a child’s overall health and well-being into adulthood," says the report. "Children who struggle with their weight are at higher risk for a range of health problems, including asthma, heart disease, diabetes and cancer. They are also more likely to experience social and emotional difficulties."

One of the state's bright spots continues to be that it has so few children without health insurance, 4%. The national average is 5%.

That said, a report released in December by Georgetown University Health Policy Institute found that insurance rates for Kentucky's children under 6 have dropped, with 4% under 6 lacking insurance in 2018, compared to 2.7% in 2016. In percentage points, Kentucky's increase in uninsured kids was the nation's fifth largest.

Another indicator of children's health is the number of babies that are born at at less than 5.5 pounds. That rate is 8.9% in Kentucky, where it has hovered for years.

This matters because babies born with low birthweight may be more likely to have certain health conditions later in life, including obesity, diabetes, heart disease, high blood pressure, intellectual and developmental disabilities, metabolic syndrome (high blood pressure, diabetes and heart disease combined), says the March of Dimes.

KYA notes that socioeconomic characteristics and environmental exposures, such as secondhand smoke, air pollution, lead and pesticides, can increase the risk of low-weight births. "These are likely contributing factors for a cluster of high rates of low-weight births in Eastern Kentucky," it says.

Education: Kentucky found itself in the bottom one-fourth of states for all domains but one, education, where it ranked 27th for the second year in a row. The good news is that 90% of Kentucky high-school students graduate on time, ranking the state third in the nation.

The bad news, KYA says, is that there has been little change in the past 10 years when it comes to the percentage of Kentucky children who are proficient in reading and math.

The report found that in 2019, 65% of the state's fourth-graders were not proficient in reading, compared to 64% in 2009. Also, 71% of the state's eighth-graders were not proficient in math in 2019, compared to 73% in 2009. Said another way, only 35% of the state's fourth-graders are proficient in reading and only 29% of its eighth-graders are proficient in math.

These gaps are even greater among the state's Black and Latino children. Among Black children, 86% of fourth graders are not proficient in reading, and 89% of eight graders are not proficient in math. Among Latino kids, 75% of fourth-graders are not proficient in reading and 80% of eighth-graders are not proficient in math.

In addition, 57% of the state's young children are not attending pre-school, a figure that has not changed since 2009-11.

The report says establishing conditions that promote educational achievements for children is critical because it helps them remain in school, graduate on time, pursue higher education or training, and "successfully transition to adulthood."

Family and Community: Kentucky dropped two slots in the Family and Community domain, to 41, apparently because other states improved.

The number of teen births continues to drop in Kentucky. This year's report shows that in 2018, there were 27 births per 1,000 females ages 15 to 19. That is a 41% drop from 46 per 1,000 in 2010. But it still remains 59% above the national average of 17 per 1,000.

Several of the family and community indicators have changed little since 2010, such as: 35% of the state's children live in single-parent families and 15% of the state's children live in high-poverty areas, defined as neighborhoods where more than 30% of the households are in poverty.

Economic Well-Being: Kentucky ranks 41st in economic well-being, with all four indicators showing improvement when compared to 2010, but again, KYA says other states are improving more.

This year's report shows that the percentage of Kentucky children in poverty dropped to 23% in 2018, from 26% in 2010; children whose parents lack secure employment dropped to 32% from 37%; and teens who are not in school and not working dropped to 8%, from 11%.

As with many such indicators, racial and ethnic disparities exist. For example, while the percentage of children living in households with a high housing-cost burden dropped to 25% in 2018 from 32% in 2010, there continues to be a huge difference in this indicator between the state's Black and white children: 42% and 20% respectively. A high housing-cost household is defined as one where more than 30% of monthly household pre-tax income is spent on housing-related expenses, including rent, mortgage payments, taxes and insurance.

"High housing costs weigh more heavily on low-income families," says the report. "Paying too much for housing limits the resources families have for other necessities, as well as their ability to save."

In the overall measure of poverty, 42% of Black and 33% of Hispanic children in Kentucky live in poverty, while 20% of white children do.

“While this data is important, it doesn’t tell the whole story about how all Kentucky kids are doing," said Brooks. "The discomforting truth is that the ZIP code in which our children live, the amount of money their family earns, and the color of their skin are pervasive and powerful influences on their childhood and the future they are able to embrace. Systemic inequities continue to limit opportunities to thrive for children of color, and it is our obligation to not only track and understand those, but also to transform systems so every Kentucky kid can grow up healthy, safe, and hopeful for the future."

KYA's recommendations call for a strong state budget as part of covid-19 pandemic recovery efforts; strong investments in the state's safety net and child abuse and neglect prevention programs; continued federal investments in childcare; and for all state agencies to systematically collect, analyze and report data disaggregated by race and ethnicity for those they serve.

The Kids Count Data Center provides current and trend data for child well-being indicators related to each of the four domains in the report, at both a state and county level. It also offers a feature to create customized tables, maps, bar charts and graphs.

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Brain plasticity in drug addiction: Burden and benefit

The human brain is the most complex organ in our body, and is characterized by a unique ability called neuroplasticity. Neuroplasticity refers to our brain’s ability to change and adapt in its structural and functional levels in response to experience. Neuroplasticity makes it possible for us to learn new languages, solve complex mathematical problems, acquire technical skills, and perform challenging athletic skills, which are all positive and advantageous for us. However, neuroplasticity is not beneficial if we develop non-advantageous learned behaviors. One example of non-advantageous learning is habitual drug misuse that can lead to addiction.

Our brain learns to respond to drugs of abuse

Our first decision to use a drug may be triggered by curiosity, circumstances, personality, and stressful life events. This first drug exposure increases the release of a molecule (neurotransmitter) called dopamine, which conveys the feeling of reward. The increased changes in dopamine levels in the brain reward system can lead to further neuroplasticity following repeated exposure to drugs of abuse; these neuroplasticity changes are also fundamental characteristics of learning. Experience-dependent learning, including repeated drug use, might increase or decrease the transmission of signals between neurons. Neuroplasticity in the brain’s reward system following repeated drug use leads to more habitual and (in vulnerable people) more compulsive drug use, where people ignore the negative consequences. Thus, repeated exposure to drugs of abuse creates experience-dependent learning and related brain changes, which can lead to maladaptive patterns of drug use.

Views on addiction: Learning and disease

A recent learning model proposed by Dr. Marc Lewis in New England Journal of Medicine highlights the evidence of brain changes in drug addiction, and explains those changes as normal, habitual learning without referring to pathology or disease. This learning model accepts that drug addiction is disadvantageous, but believes it is a natural and context-sensitive response to challenging environmental circumstances. Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), and many addiction researchers and clinicians, view addiction as a brain disease triggered by many genetic, environmental, and social factors. NIDA uses the term “addiction” to describe the most severe and chronic form of substance use disorder that is characterized by changes in the brain’s reward, stress, and self-control systems. Importantly, both learning and brain disease models accept that addiction is treatable, as our brain is plastic.

We can adapt to new learned behaviors

Our brain’s plastic nature suggests that we can change our behaviors throughout our lives by learning new skills and habits. Learning models support that overcoming addiction can be facilitated by adopting new cognitive modifications. Learning models suggest pursing counseling or psychotherapy, including approaches such as cognitive behavioral therapy (CBT), which can help a person modify their habits. NIDA suggests that, for some people, medications (also called medication-assisted treatment or MAT) can help people manage symptoms to a level that helps them pursue recovery via strategies such as counseling and behavioral therapies, including CBT. Many people use a combination approach of medications, behavioral therapies, and support groups to maintain recovery from addition.

Neuroplasticity can help us modify behaviors relevant to addiction

CBT is an example of a learning-based therapeutic intervention; thus, it utilizes neuroplasticity. Scientific evidence suggests that CBT, alone or in combination with other treatment strategies, can be effective intervention for substance use disorders. CBT teaches a person to recognize, avoid, and learn to handle situations when they would be likely to use drugs. Another example of evidence-based behavioral therapy that has been shown to be effective for substance use disorders is contingency management. Contingency management provides a reward (such as vouchers redeemable for goods or movie passes) to individuals undergoing addiction treatment, to reinforce positive behaviors such as abstinence. This approach is based on operant conditioning theory, a form of learning, where a behavior that is positively reinforced tends to be repeated. Overall, multiple evidence-based approaches are used for the treatment of substance use disorders that require learning and utilize neuroplasticity.

The bottom line

Our brain is plastic, and this trait helps us learn new skills and retrain our brain. As the brain can change in a negative way as observed in drug addiction, the brain can also change in a positive way when we adopt skills learned in therapy and form new, healthier habits.

References

Targeting Behavioral Therapies to Enhance Naltrexone Treatment of Opioid Dependence: Efficacy of Contingency Management and Significant Other Involvement. Archives of General Psychiatry, August 2001.

Efficacy of Disulfiram and Cognitive Behavior Therapy in Cocaine-Dependent Outpatients: A Randomized Placebo-Controlled Trial. Archives of General Psychiatry, March 2004.

Cognitive Behavioral Therapy and the Nicotine Transdermal Patch for Dual Nicotine and Cannabis Dependence: A Pilot Study. American Journal on Addictions, May-June 2013.

Brain Change in Addiction as Learning, Not Disease. New England Journal of Medicine, October 18, 2018.

Cognitive Behavioral Therapy for Substance Use Disorders. The Psychiatric Clinics of North America, September 2010.

Neurobiologic Advances from the Brain Disease Model of Addiction. New England Journal of Medicine, January 28, 2016.

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Anthem and Passport appeal Beshear administration's decision kicking them out of state's Medicaid business as of Jan. 1

By Lisa Gillespie
Kentucky Health News

Passport Health Plan and Anthem Kentucky, twice denied by different governors the chance to keep managing Medicaid coverage for many Kentuckians, are appealing again.

Enrollees with coverage from either plan – close to half a million people – will have to switch insurers at the end of the year unless Passport and Anthem are successful in their appeals.

They had lost prior bids under Republican Gov. Matt Bevin, amid charges of political motivation that he denied. The insurers had hoped that under Democratic Gov. Andy Beshear, the outcome would be different.

But it wasn’t. Giant United Healthcare and California-based Molina are the new winners, while WellCare, Aetna and Humana had their contracts renewed. A month ago Beshear’s administration tapped the five companies to run Medicaid benefits to over a million enrollees, for payments of at least $8 billion a year, with about 80 percent of the money coming from the federal government.

Anthem and Passport allege that the state violated the law by failing to follow all the rules of the selection process. Those violations included not holding oral presentations at which the insurers could have answered questions and gained points from state scorers. The state, according to the appeals, also didn’t score parts of their applications where they might have racked up points.

The Cabinet for Health and Family Services used the same people to score the applications under Bevin and Beshear, according to an email obtained by Kentucky Health News. Passport’s appeal mentions this possibility, and says that this led to unfair scoring.

“Bias from Bevin-administration holdovers improperly favored bidders with a national, rather than local, presence, including comments giving competitors praise for the length of their entire corporate existence, without regard to their history in Medicaid … with no acknowledgement of Passport’s decades of Kentucky-based experience,” Passport’s appeal says.

Passport was a nonprofit formed in 1997 to help transition Kentucky into letting outside health insurers manage Medicaid care. The goal was to save taxpayers money. It no longer holds that nonprofit status; last year publicly traded firm Evolent Health bought Passport. But it is still headquartered in Louisville, and Evolent planned on relocating many employees to a new office building in western Louisville. Molina has pledged to take it over.

According to Louisville Business First, Anthem’s protest includes a focus on how close it was to beating out Molina. Here are the scores for all bidders:

• WellCare Health Insurance of Kentucky: 1,662
• Aetna Better Health of Kentucky: 1,653
• Humana Health Plan Inc: 1,605
• UnitedHealthcare Community Plan of Kentucky: 1,520.5
• Molina Healthcare of Kentucky: 1,507
• Anthem: 1,491
• Passport: 1,409.5

The appeals by Passport and Anthem were expected. Such appeals aren’t out of the ordinary when insurers lose contracts; it’s common for losing companies to appeal decisions, eventually ending up with lawsuits in court that can take years to settle.

A spokeswoman for the state Finance and Administration Cabinet didn’t reply to Kentucky Health News Thursday but earlier told Business First that the agency couldn’t comment on the process because it is “preliminary and ongoing.”

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Covid-19 update: State tells Kentuckians who have been to Myrtle Beach to self-quarantine, notes rises in cases in other states too

The state Department for Public Health issued an advisory Thursday afternoon to Kentuckians who had traveled in the last two weeks to Myrtle Beach, S.C., which has turned into a coronavirus 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."

In other covid-19 news Thursday:

• 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 has ruled Kentucky Gov. Andy 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.
• 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.
• 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.
• 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.

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How risky is a hug right now?

“Can I get a hug?”

It’s a simple question for a simple act that’s been especially missed because of COVID-19 distancing. “Human beings need social contact,” says Dr. Eugene Beresin, executive director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, and professor of psychiatry at Harvard Medical School. “We are not hermits. We are not solo pilots. We are pack animals.” Not that it needs more promotion, but along with feeling connected, a hug has been shown to help fight off a cold and help your mood when dealing with conflict.

But even as restrictions have started to loosen, there are no clear-cut answers on personal interactions between adults. Dr. Todd Ellerin is director of infectious diseases and vice chairman of the department of medicine at South Shore Hospital in Weymouth, Massachusetts, and an instructor in medicine at Harvard Medical School. He doesn’t recommend against giving a hug, but he’s also not giving it the green light.

The reality, he says, is there are no safety guarantees, just as it’s not, “You hug, you get the virus — it’s not that simple.” Like with all coronavirus issues, it’s about individuals making their own assessments about risk.

With a hug, it’s not the act itself that’s worrisome, but everything that comes with it. “It’s where you are and how close you’ll be standing. It’s what you’ll be doing before and after. The hug is not an isolated event.” Ellerin offers three factors to consider in order to determine whether it’s a safe choice for you.

People. Who’s involved? The more people who you’re going to hug, the higher the risk. The health of you and the others involved also matters. It’s not only whether someone has coronavirus symptoms, but anything that would compromise the immune system, like cancer, obesity, heart disease. And age is still a factor. People over 60 years old, even if healthy, are more vulnerable.

Place. Where would it happen? Outside is preferable, and lower risk than indoors.

Space. How close will you be after the hug? The six-foot zone — the approximate distance a droplet travels before it falls — is still a good prescription. And proximity can be an overlooked factor, since there’s the tendency to remain close and talk, and hugs often come with kissing. You’re certainly able to exchange words when you have a mask on. You just shouldn’t. Masks work, but they’re not perfect, so, in order to minimize the risk if you choose to hug, when you’re in close, you shouldn’t talk.

So what’s the ideal hug?

Ellerin says that it needs to be mutual, discussed, and pretty much planned. This is not the time for surprise or spontaneous shows of affection. You need to start at six feet away; if you’ve already been talking close to each other, you’ve increased the risk. You need to be masked and looking in opposite directions, so there’s no breathing or chance of coughing or sneezing on each other. Once the hug is over, you both back away to at least six feet without saying anything. If the hug makes someone cry, you don’t wipe away another person’s tears. And even though you should not have hand-to-hand contact, you want to wash your hands afterwards in order to maintain the habit. If you want to add an extra layer of protection, you can also wear a face shield.

The easier decision might be to say it’s not worth chancing, but in extreme cases, such as when a person is dying, the benefits might outweigh the consequences, Beresin says. These kinds of considerations reflect how COVID-19 has turned instinctive acts into calculations. “You need to be scientific about this, but it’s hard to be scientific about people you love. We’re not robots,” Ellerin says.

Maybe there’s another option

Beresin adds that rather than attempt to script a quick hug and still worry about the dangers, this is an opportunity to be creative, while being masked and at least six feet apart. You can listen to music. You can meditate with guided imagery. You can sit, maybe by a fire, and talk, maybe sharing a reminiscence about a great family vacation or a disastrous Thanksgiving that ended in laughs.

Recollecting, along with making eye contact and saying kind words, are ways to feel close and to be a reminder of how you got through something together. None of these alternatives are as immediate or physical as a hug, “but it does the same kinds of things. We can touch and embrace each other in many different ways,” Beresin says. “And in some respects, it could be better, because it lasts longer than 10 seconds.”

But with the hug, it goes back to the fact that the decision is up to each person. Ellerin says that until a widespread vaccine and treatments are available, “as individuals, we have to learn how to manage risks. It’s not an exact formula.”

For more information about the coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.

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Health departments getting temporary workers to trace contacts of people who have the coronavirus; start of school will be big test

Centers for Disease Control and Prevention chart, via CFCF

By Lisa Gillespie

Kentucky Health News

As restaurants have reopened and people are gathering more after three months of social isolation, Kentucky’s health departments are finally getting extra help to help track down people who may have been exposed to the coronavirus and ask them to self-isolate.

The “contact tracers” will allow health-department employees who have been reassigned to covid-19 work to get back to their normal work in public health. But most of the new workers haven’t been hired yet, because officials expect a surge of cases when school begins.

Congress gave states money to hire temporary contract tracers. Sara Jo Best, public-health director at the Lincoln Trail District Health Department in Elizabethtown, said contract tracing has been done for decades, but it might be a new term people haven’t heard of.

“If you’ve ever seen in a newspaper, ‘If you ate this food product between this date and this date, you need to call us,’ that’s contract tracing,” Best said. “No one ever thought anything about that; it was almost expected. It would be unethical for public health to know that you’re at higher risk of a disease or injury and withhold that information from you.”

But some legislators at the June 24 meeting of the Interim Joint Committee on State Government expressed privacy concerns.

"I know we've been doing contact tracing at local health departments for a long time, but at the level that we're doing it here . . . it could very much infringe on people's freedom and liberty," said Senate Majority Leader Damon Thayer, R-Georgetown.

Mark Carter, the state official leading Kentucky's contact-tracing efforts, said "We are not going to be tracking people's movements. The purpose for this contact tracing effort is simply to help people protect their family, friends, loved ones from the spread of covid."

The state covid-19 website says contract tracing is completely confidential. When someone is contacted, they’re only informed that they may have been exposed to someone who has the virus, and aren’t told the identity of that patient.

Rep. Patti Minter, D-Bowling Green, spoke up for contact tracing: "We have been a hotspot in Warren County, so one of the reasons we're not a hotspot anymore has been the heroic work that has been done in the eight-county area by Barren River health department, and contact tracing has been a very big part of that.”

Some job slots wait for start of school

So far, the state Department for Public Health has hired 180 contract tracers and investigators to work in health departments across the state but is waiting to fill another 520 jobs, Carter said.

“The staffing is ahead of the disease,” he said. “We kind of want to see what the virus is going to do, because it wouldn't make sense if they had 500 people right now, because most of them would be sitting around with nothing to do. But they’re probably going to be busy in September and October with schools back.”

Robert Redfield, director of the federal Centers for Disease Control and Prevention, told a congressional committee June 23 that tracing the contacts of infected people and getting them to self-isolate will be “critical” as schools open.

For the Barren River District Health Department, the new help will mean the staff reassigned to covid-19 work can go back to their original work in public health; things like health education or work to reduce infant mortality rates.

About 80 of the Bowling Green-based agency’s approximately 100 employees were reassigned in March, Director Matt Hunt said. Before the pandemic, he said, only seven full-time staff notified members of the public if there was a possibility of contracting a communicable disease.

“We had to move very, very quickly to repurpose nearly 80 percent of our staff to work on covid,” Hunt said.

At the Lincoln Trail department, Best said her staff were moved to contact tracing and other covid-19 tasks. Night and weekend work became the norm, with many hours of overtime or comp time. Meanwhile, unemployment from the pandemic restrictions brought more clients into the department’s Women, Infants and Children food program.

“It’s nice to have the ability to bring in the additional staff to be able to relieve our staff so they don’t burn out,” Best said.

Asked if permanent staff would now give more attention to enforcing covid-19 preventive measures like limits on business’ space capacity, Best said her environmentalists working with restaurants try education first.

“You're treating it as a partnership,” she said. “Because we're good at educating people on risks, most people comply and do all right. Also, with restaurants, there is a liability issue; they want to know how to operate so they can successfully follow the rules."

State-local dispute caused delay

Each state handled the federal money for contract tracing differently. Health departments said the money should go directly to them. They have years of experience tracing diseases, from food-borne illnesses caused by bad grocery food to wide outbreaks of diseases such as hepatitis.

“We do this all the time for things like pertussis [whooping cough], hepatitis, tuberculosis, and we’re actually still doing that right now while we’re doing covid-19; other diseases didn’t take a vacation when covid-19 came to town.”

Kentucky decided to use staffing agencies to hire tracers. But these agencies only conduct initial resume screenings, interviews and background checks. Health departments do the final hiring and supervision of contact tracers and investigators.

Best and Hunt said their district health departments could have used extra dollars for contract tracers much earlier, but they made do with the employees they had.

Most of Barren River District’s eight counties have relatively high per-capita infection rates. Hunt said he doesn’t think the delay led to more infection or negative health outcomes, mostly because his district didn’t wait for federal funds to arrive. He said he has hired 26 people, with five slots left to fill.

Carter said he and other state officials decided to use temp agencies for several reasons. While most health departments will hire local contract tracers, the state is also hiring regional tracers who can work anywhere within a broad region.

“If you had an outbreak in Bowling Green, for example, and it was quiet in Somerset, what that [our model] allows us to do very easily is to redirect some of those resources in Somerset to focus on the problem in Bowling Green,” he said.

Though the strategy might work best for state control of the contract tracing project, Best hopes the legislature will help increase staffing levels to help health departments prepare better.

“Local health departments have been carrying the bulk of the load of this since March; that’s a long time,” Best said. “I hope this is enough to highlight the necessity to invest in our infrastructure, like our staffing levels, so that we’re nimble and able to respond quickly to the next thing, because there will be a next thing … that would reduce negative health impacts.”

Information for this story was also gathered by Melissa Patrick of Kentucky Health News.

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