Almost half of Kentucky's counties are in federal report's danger zones, reflected in the state's slowly rising daily virus case count

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Somerset-area legislators decry Beshear's restrictions at Chamber meeting with little use of masks or social distancing

L-R: Sen. Rick Gidler, Reps. David Meade and Ken Upchurch, unopposed House nominees Josh Branscum and Shane Baker (Photos by Chris Harris, Commonwealth Journal)

By Al Cross
Kentucky Health News

Chafing under Democratic Gov. Andy Beshear's executive orders, several Republican legislators said Thursday evening that the General Assembly will rein in the emergency powers that the Democratic governor has used to fight the covid-19 pandemic.

The Somerset-area lawmakers spoke to "a packed house" that included "a whole host of the community’s business and political leaders," reported the Somerset Commonwealth Journal, whose editor told Kentucky Health News that "There wasn’t a whole lot of social distancing, and since they were eating, there were not a lot of masks being used." 

Most "who took the microphone asked the legislators questions about how the Kentucky House and Senate could address or repeal Beshear’s numerous executive orders," the newspaper reported.

“I’ve heard from all of you,” said Sen. Rick Girdler of Somerset. “A ‘state of emergency’ was not put in to have somebody in charge for six months. It was put in for an earthquake or a tornado or something where there were no communications for four or five days. We don’t need, Republican or Democrat, somebody up at the office deciding for six months or a year that that’s what we’re going to do. We are three branches of government, and we need to use all of our three branches of government."

Leaders of the legislature's Republican majorities have said Beshear should have consulted with them before making major moves, such as his July 9 order to wear masks in indoor public spaces and outdoors when six feet of distance can't be maintained. The governor has said Republicans dislike the highly public role he is playing and are politically motivated.

Girdler said of his leaders' request, “Some people say that’s political. No, that ain’t political. The political part is coming from the other side. We’ve meant to be a part of this conversation, and we’ve not been a part of it.”

Girdler was joined by Reps. Ken Upchurch of Monticello and David Meade of Stanford, who is House speaker pro tem, at Lee's Ford Marina on Lake Cumberland for an event sponsored by the Somerset-Pulaski County Chamber of Commerce, the newspaper's Chris Harris reported. Josh Branscum of Russell Springs and Shane Baker of Somerset, Republicans who are unopposed for seats being vacated, also attended.

“We’ve got to do some things that pull back that power of the governor,” Upchurch said. “I’m fairly confident . . . that you’re going to see some pretty powerful legislation that’s passed in both houses that can do that.”

The newspaper reported that Girdler endorsed a pre-filed bill that would limit governors' emergency orders to two weeks and ban them from suspending any laws, and limit to three weeks anti-disease actions of the Cabinet for Health and Family Services -- unless the governor starts a special legislative session.

Girdler said he also favors a constitutional amendment that would let the legislature call itself into session.

“I get calls all the time, I get text messages asking me, ‘Why are you all staying at home? Why don’t you go up there and do something?’ I wish I could,” Girdler said, adding later, “We’ve got to have the legislators involved in making the decisions based upon economic development, tourism. . . . I really believe we have to take our state back.”

Meade said, “I didn’t feel like the shutdowns were necessary because I truly believe that the people of Kentucky are smart enough and intelligent enough to make the decisions for themselves in order to protect themselves.”

The legislators and would-be legislators sat together, without masks. "All the Chamber workers and Harbor Restaurant workers were masked," newspaper editor Neal said, adding later, "You have to remember that in this neck of the woods, no one pays much attention to the virus. People here are rabid anti-maskers. And our numbers are rising. Go figure."

The event concerned Dr. Kevin Kavanagh, a retired Somerset physician who heads Health Watch USA, which focuses on infection control in health care.

"Events like this are very problematic," Kavanagh told Kentucky Health News. "They usually have many cases or none. With the number of individuals present and the prevalence of the virus in Pulaski County, the odds are nothing will happen, but if the virus was present at the event it can be catastrophic. . . . This could be a super-spreader event."

Bobby Clue, the chamber's executive director, did not return a call from Kentucky Health News. He told the Commonwealth Journal, “We’ve said for months now that it was time to get back to business. I believe people are starting to agree with us on that philosophy. We think that people can come out to events, that we can do that in a safe and responsible way, and we have to live our lives at some point. This is a tremendous turnout with over 100 people here tonight, and I’m very confident that we’re going to see more and more people start coming out to events.”

He added, “If people aren’t comfortable, that’s why we still have virtual options: the Facebook Lives, the Zoom.” He added, “The virtual component for us is important and we’re going to keep that in place indefinitely moving forward at all Chamber events.”

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How to help your child get the sleep they need

This year, back-to-school plans are still a work in progress, and some (perhaps many) children will be learning from home because of the pandemic. As tempting as it might be to let the summer sleep schedules stay in place, it’s important that children have a regular routine — and that they are sleeping during the dark hours and awake during the light ones, as our bodies do best that way. So while a child whose trip to school is just a walk to the kitchen table might be able to sleep a bit later than one who has to catch an early bus, no child should be spending all morning in bed.

Sleep is crucial for all of us, and this is particularly true for children. Without enough quality sleep, children are more likely to have health and behavioral problems — and difficulty learning.

Here are a few simple things you can do to help your child get the sleep they need.

Have a regular schedule

Our bodies do best when we go to bed and wake up at roughly the same time every day.

• Children and teens need eight to 10 hours of sleep. Count back 10 hours from when your child needs to get up in the morning. That’s roughly the time they need to be getting ready for bed (for younger children, count back 11 hours).
• For example, if your teen needs to be up at 7, then they should be getting ready for bed by 9, and in bed by 10 (since most of us don’t fall asleep the moment our head hits the pillow). A younger child should start getting ready (bathing, etc.) by around 8.
• Understand that teens are biologically wired to fall asleep later and wake up later and will naturally have later bedtimes. Unfortunately, most school districts don’t accommodate to this, so you are often working against biology.
• While it’s okay to stay up a bit later on weekends, don’t let the bedtime vary by more than an hour or so.

Turn off the screens before bed

The blue light emitted by screens can keep us awake.

• It’s best if the screens can be off two hours before you want your child asleep. Use that time when they start getting ready for bed as the time that the screens go off.
• The only real way to achieve this is to get all devices out of the bedroom. (So true!)
• Teens will fight you on this. If you can, hold firm (and buy them an alarm clock if they say they need their phone for this). At the very least, be sure that the phone is on Do Not Disturb mode overnight.

Have an environment that encourages sleep

• Quiet things down. If you are watching TV, turn the volume down, and in general try to not make much noise after children go to bed.
• Consider a white noise machine, or a fan (or air conditioner if you live somewhere warm). There are also white noise apps for those teens who won’t give up their phones.
• Room-darkening curtains can make a difference for children who tend to wake up at the first light of dawn — or who can’t fall asleep if it’s not fully dark outside.

Know how other factors influence sleep

• Busy teens often have difficulty getting everything done in time to get enough sleep. Talk with your teen about their daily schedule and look for ways to help them get more shut-eye, such as getting homework done during the school day, or limiting video games or other activities that eat into homework time. Sleep needs to be the priority.
• Limit caffeine. It’s best not to have any, but certainly nothing from mid-afternoon on.
• Limit naps! For a tired older child naps may seem like a good idea, but they can interfere with nighttime sleep. Naptime is okay through preschool.
• Make sure your child gets exercise. It’s not only important for their health, it helps their sleep.
• Have calming routines before bed (not exercise!).

If your child is having trouble falling asleep, or is waking up at night, talk to your doctor. It’s also important to talk to your doctor if your child is snoring or having other breathing problems at night. Don’t ever ignore a sleep problem; always ask for help.

The post How to help your child get the sleep they need appeared first on Harvard Health Blog.

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Sunday's new-case report gives state largest one-week total; health commissioner again urges safe behavior next weekend

Plantings in the Floral Clock, to the west of the State Capitol and the Capitol Annex (at left) reflect
Gov. Andy Beshear's "Team Kentucky" slogan for fighting the novel coronavirus. (Photo by Al Cross)

By Al Cross
Kentucky Health News

The state reported 462 new cases of infection by the novel coronavirus Sunday, making its Monday-to-Sunday weekly total the largest ever: 4,503. The previous high was 4,333, two weeks ago.

“That means we have to do better,” Gov. Andy Beshear said in a press release. “With this number of cases we see more people hospitalized, we see sadly more people being lost. So please wear your mask, please make good decisions. This is a time when this virus is spreading aggressively.”

Reports on Sundays, unlike other days, do not give hospitalizations or the percentage of Kentuckians who have tested positive for the virus in the past seven days. Saturday's number was 4.59%, concluding a week in which only one day saw a number larger than 5%, the level that prompts public-health officials to recommend restrictions on activity.

“Do your best,” Beshear said. “We can’t be tired, we can’t give up. We have to bring it every week, because this virus is going to continue to take people we love. So, mask up, Kentucky. Let’s beat covid-19.”

Beshear's press release said 79 of the new cases were in Kentuckians 18 and younger. “That’s a lot of school-age kids, so please be careful,” said the governor, who has recommended that schools delay in-person instruction until Sept. 28. About 30 of the state's 171 school districts have started in-person classes, and some of the remainder have authorization from their local school boards to start before Sept. 28, depending on local conditions. 

Thirteen of Sunday's new cases are in children 5 and under, down to two months old, the release said. Case reports on Sundays and Mondays are usually the lowest of a week due to limited weekend work at testing laboratories.

Beshear reported nine more covid-19 deaths, raising the state's total to 930. The fatalities were a 75-year-old man and an 87-year-old woman from Casey County; an 82-year-old man and a 90-year-old woman from Fayette County; an 82-year-old man from Lincoln County; a 66-year-old woman from Russell County; a 71-year-old man from Green County; an 80-year-old woman from Calloway County; and an 83-year-old man from Harlan County. 

Health Commissioner Steven Stack doubled down on his warning for next weekend, noting that the state's two biggest horse races will coincide with the last holiday weekend of the summer.

“What might be considered in Kentucky a ‘trifecta of holidays’ begins this coming Friday,” said Stack, a physician. “Enjoy watching the fillies on Oaks Day this Friday. Watch the Kentucky Derby, the 146th Run for the Roses, on Saturday. And, enjoy the entire Labor Day weekend. Just do it in ways that keep you and others safe. Stay healthy at home as much as you can. When you go out in public, please practice social distancing, wear a mask whenever you are near others, and wash your hands often. If we all do these things, we have a much better chance for safer, healthier fall and winter holidays with family and friends. These changes to our routines make an immense difference and save lives. Together, Team Kentucky can get through this.”

Counties with five or more new cases are Jefferson, 131; Fayette, 77; Madison, 35; Boone, 10; Bullitt, 10; Clay and Warren, 9 each; Campbell, 8; Caldwell, Green, Jackson and McCracken, 7 each; Boyle, Franklin, Jessamine, Kenton Pulaski and Scott, 6 each; and Boyd, Calloway and Graves, 5 each.

In other covid-19 news Sunday:

• The CovidActNow website estimates high virus-transmission rates for several Kentucky counties: Todd, 1.73; Rowan, 1.47; Jackson, 1.34; Green, 1.28; Warren, 1.21; and Madison, 1.13. A rate of 1.13 means that every 100 infected people will inflect 113 other people, and those 113 will infect 128 (1.13 x 1.13), and so on. McCreary and Monroe counties also appear in red on the CAN map but the site says their transmission rates are unknown. The site estimates Jefferson County's rate to be 0.90 and Fayette County's to be 1.01.
• Getting kids to wear a mask is hard," writes Rachel Buchholz, kids-and-family editor at National Geographic. "Getting kids to keep their shirts and shoes on is hard enough—how do you convince them to wear a restrictive covering for hours, especially when you’re not there to enforce the rules? One idea is to appeal to a child’s natural sense of kindness and fairness, says psychotherapist and parenting coach Alyson Schafer . . . 'Say things like, "We wear masks and stay six feet apart because we don’t want to spread our germs to others who may not be as healthy. We wear our masks because we want to help everyone, not just ourselves." (Superhero-style masks help reinforce that thinking.) Other ideas: outings for treats like ice cream where they have to follow the safety rules in order to get their frozen reward, and rehearsed retorts when confronted with non-mask-wearing peers. ... And of course, figuring out which mask looks best on them. After all, you might as well look cool while you’re saving the world."

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Nursing homes say they need more help from the state; their residents account for 58.6% of covid-19 deaths, down from 63%

By Melissa Patrick
Kentucky Health News

As they remain the main sites for deadly infections of the coronavirus, Kentucky's nursing homes are asking for more help from the state, which says much of the help they seek has already been provided or can't be rendered.

At a legislative committee meeting Aug. 26, the head of Kentucky's main nursing-home association said nursing homes are grateful for the federal dollars and state testing programs they have received during the pandemic, but it's not enough.

Betsy Johnson
Kentucky Assn. of Health Care Facilities

"We still need help," Betsy Johnson, president of the Kentucky Association of Health Care Facilities, told the Interim Joint Committee on Health, Welfare and Family Services.

"We need a lot of help, mainly funding to retain our workforce, which has been decimated, funding to require additional PPE and to support ongoing covid testing," she said. PPE, personal protective equipment, includes masks, gloves and gowns.

Johnson also pointed to research that found quality ratings of facilities was not a factor in outbreaks of covid-19. The Centers for Medicare and Medicaid Services five-star quality rating system gives 69 of the state's nursing homes a two-star or below average rating and 61 of them a one-star or much below average rating. 

"The experts agree covid-19 cases and the community are top factor in whether there is a covid outbreak in a facility," she said. "Covid deaths and long-term-care setting have nothing to do with the quality of that facility."

WKYT-TV image

The day before the hearing, the Georgetown News-Graphic reported that the death toll at Dover Manor, a long-term care facility in Georgetown, had reached four, and all the deaths had occurred within four days of each other. On Aug. 26, WKYT-TV reported the long-term care facility's fifth death. 

On Aug. 29, the state's daily long-term care report showed 26 residents and 12 employees at Dover Manor had active cases of the virus. Since March, 59 residents and 26 staff have tested positive.

“You don’t have this many positive cases in a facility without a breach in your infectious-disease protocols, so we're very concerned," Crystal Miller, public health director at the WEDCO District Health Department, told WKYT. She said some employees have quit and the department is educating the remaining employees about PPE and how to isolate residents who test positive.

At the committee meeting, Johnson said a July survey of nursing homes showed that their labor and benefit costs had risen 8 percent since the pandemic hit in March; nearly 51% of homes had less staff; nearly 21% saw an increase in use of employment agencies; and such agencies had increased their costs between 10% and 75%.

Johnson reminded the lawmakers that her association has warned them for some time that there is a "workforce crisis" in long-term care, and "Covid-19 has only made this worse." 

She also pointed to the state's use of federal relief money to pay for its "strike teams," which help with staffing issues in nursing homes hit hard by the virus but put them in direct competition with the state for much-needed employees.

An advertisement in Madisonville showed the state is paying registered nurses $65 an hour, licensed practical nurses $50 an hour and nursing assistants $32.50 an hour, "significantly higher than the average nursing facility can pay," Johnson said, while still expressing thanks for the help the teams give.

Asked about the strike teams at the governor's daily press conference later that day, Cabinet for Health and Family Services Secretary Eric Friedlander said they have been used, but not recently. "That has obviously been a very controversial piece, " he said.

Johnson said an April survey of her association's members found 87% were in need of some form of personal protective equipment; 9% said they didn't have a week's supply of surgical masks; 10% didn't have a week's supply of N95 respirator masks; and 10% didn't have a week's supply of gowns.

The survey also found PPE costs had increased by 10% or more. Sen. Danny Carroll, a Paducah Republican who owns a non-profit agency that provides therapy and medical-based child care, said he had been told the cost of a case of gloves had increased from $49.70 to $108. 

Johnson added that nursing home are also squeezed financially by an 8% drop in their patient numbers, caused not only by deaths, but by a decrease in elective surgeries because these patients often rehabilitate in nursing homes. 

Association offers solution, state explains why it won't work

Johnson said the best way to help nursing homes would be increasing the amount the state pays for residents covered by Medicaid by $12.55 per resident per day, instead of the additional $270 per day it is paying for positive covid-19 residents only.

“We were grateful for this funding, but we found it a little problematic,” Johnson said. “Not everybody in a facility is Medicaid eligible; a lot of them are Medicare or private pay. A lot of people went immediately out to the hospital, so it really wasn’t providing the necessary funding to arm ourselves in fighting off covid-19.”

She said the association has asked twice for the change, has been denied once and expects that the second request will also be denied, based on an Aug. 13 letter from Friedlander. 

She suggested that the payment boost could come from the 6.2% increase in Medicaid contribution that the federal government is paying states during the pandemic, since it "was intended to assist providers in fighting covid-19."

Secretary Eric Friedlander

However, Friedlander told Kentucky Health News in an interview that states got the increase to cover the cost of expanding their Medicaid populations during covid-19, not to pay providers.

Many people who have lost their jobs have become Medicaid beneficiaries, and Kentucky has led the nation in the percentage of people gaining Medicaid coverage during the pandemic, according to a July 24 report by the Kaiser Family Foundation. It found that Kentucky Medicaid, which now covers more than 1.5 million people, grew 7% from March to April.

Friedlander had another reason to oppose Johnson's request: "When you give a provider group a raise, you can't ever take it back. And then it becomes a matter of, 'Do you have the budget to support that, ongoing?' And I think we know, Kentucky's got a lot of budget challenges and so it's pretty clear that we wouldn't have that ongoing." 

In an email, Johnson offered an alternative, that the state use federal relief money to help nursing homes "acquire (and/or maintain) these important things to continue to fight covid-19," including "needed PPE, testing beyond what the state or the federal governments are willing to pay for, and to continue to pay 'heroes pay' to staff." 

That doesn't seem to be an immediate option. Some have criticized Gov. Andy Beshear for spending only about 6% of the state's relief money, but he has held firm that Kentucky and other states are stuck between a "rock and a hard place" not knowing whether Congress will provide more money to stabilize state budgets, or allow states to do that with money they already have. The way it is right now, "it doesn't allow for an informed decision," Beshear said Aug. 19. 

Money from the Coronavirus Aid, Relief and Economic Security Act can be spent only on programs that directly respond to effects of the virus. In addition to the strike teams, the state has used it to finance testing and surveillance at long-term-care facilities. States are also waiting on the details around another $5 billion in federal funding that has been promised to skilled nursing facilities.

Friedlander said the state has also done other things to help nursing homes, like allowing them to hold beds longer for patients who leave temporarily, making Medicaid enrollment easier, and increasing their Medicaid payments. The inspector general's written presentation to the committee, which wasn't presented for lack of time, says this increase was 8.5%. 

The impasse in committee

Greensburg Republican David Givens, president pro tem of the Senate, said Johnson's request for state funding of PPE, testing and personnel "sounds like it is a very critical ask for them, and a very appropriate ask in use of CARES money," and asked Adam Mather, the cabinet's inspector general, to respond. 

Inspector General Adam Mather

Mather said he could not speak about Medicaid, but said "large swaths" of federal money have been provided to nursing homes and that a "significant amount" of PPE has been distributed. Johnson's slides showed the federal government has provided $33.6 million to skilled nursing facilities in Kentucky, an average of $169,000 each.

Mather said the state used CARES Act money to test every long-term care facility resident and employee and is using it for testing through the end of the year. 

He said the state's universal testing was "one of the more robust programs in the country" and that its current testing is happening "at a much quicker swath and more appropriate swath than many other states." 

Givens asked, "So then why would she make the ask if the need has already been met?"

Mather said he didn't know, adding that he recognized that while there is always a need for more PPE, "I don't know what to say about the ongoing testing; it is there, and available." 

"We seem to be at an impasse," Givens said.

Sen. Ralph Alvarado

Sen. Ralph Alvarado, R-Winchester, said an unnamed Lexington nursing home didn't follow the local health department's covid-19 guidelines, but did what it had found to be successful in the past to control infectious diseases, and got a much better outcome than another Lexington facility that followed the health department's guidelines.

Alvarado would not share the names of the two nursing homes with Kentucky Health News, but said he was the medical director of one and had patients in the other.

Friedlander said in the interview that many factors influence covid-19 outcomes in a facility, such as employees carpooling or socializing in the break room without PPE. "Sometimes even the best intentions, if they're not implemented fully, don't always yield the perfect results or the optimal results," he said, adding later, "We know . . . we're making sub-optimal decisions sometimes, but it's the best decision we can make." 

Alvarado asked Johnson and Mather if the state requires a "one size fits all approach" for every facility. 

Johnson said, "It's not a one-size-fits-all kind of solution. So it would be nice to have more of a listen to what we need and you all provide support rather than dictating what should happen inside that building." 

Mather, a former nursing-home executive, told a different story. He said long-term-care facilities work with state and local health departments to make an action plan to address a case of covid-19, and with a team that fights infections associated with health care and includes Dr. Kevin Spicer of the federal Centers for Disease Control and Prevention. Mather noted his experience in the industry and that of Keith Knapp, coordinator of the state's nursing-home task force.

He said the Centers for Medicare and Medicaid Services recently commended Kentucky on what a good job it's done with long-term care facilities. "It's a very robust program," he said. "It's a best-in-class, through-all-the-states program," he said.

Most covid-19 deaths are in long-term care

During her presentation, Johnson displayed a map that showed Kentucky has one of the highest covid-19 death rates in long-term care. She was using mid-July data that showed such facilities accounted for 63% of the state's covid-19 deaths. By Aug. 29, that had declined to 58.6%.

Mather said Johnson's data was outdated, and now "We're doing much better than many states around us." The most recent CMS covid-19 nursing home data webpage, using data from the week ending Aug. 16, shows Kentucky with 107.3 cases per 1,000 residents and 23.8 deaths per 1,000 residents, ranking 21st for both measures. Friedlander said the state has been ranked about 20th for several weeks.

Beshear, asked about the topic on the day of the meeting, said "I believe the amount of assistance, the amount of expertise, the amount of resources we provided to our long-term care facilities here in Kentucky battling covid rivals if not exceeds what any other state has done, and they continue to work on that."

At least 3,415 residents and 2,029 employees at 303 nursing homes have tested positive for the coronavirus, and 535 residents and five employees have died from it.

A seat at the table

Johnson said several times that the association should have been included in state decision-making about long-term care in the early days of the coronavirus, adding that she would like a dementia expert and a long-term-care expert on staff at the state health department. "There's been a serious lack of understanding of how skilled nursing facilities operate during the covid-19 pandemic," she said. 

Friedlander said in the interview that he intentionally did not include a lobbyist on the long-term-care task force, but his cabinet has been in regular communication with Johnson's association and Leadingage Kentucky, a lobby for nursing homes and assisted-living centers. 

Friedlander said the task force includes medical personnel, a member from the association that includes medical directors for long-term care, a provider, an owner, an operator, a person from the University of Kentucky and cabinet personnel.

"We think we have a really strong representations of folks who know, one, how to operate; and then, two, on the medical side," he said. "This is a medical group, it isn't a political group. So those are the representatives that we have. So we don't have any associations on there." 

Johnson replied in an e-mail, "We want to have a true collaboration – where they ask what we need, and work with us to achieve a compromise on the “asks.”

She concluded her presentation at the meeting by saying, "I believe the toughest days are actually ahead of us."

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State records 825 new cases, 4th highest of pandemic; positive-test rate still below 5%; health chief warns about Derby Week

Kentucky Health News chart, based on initial reports of daily case numbers, not later adjustments.

By Al Cross
Kentucky Health News

The spread of the coronavirus continued to accelerate slowly in Kentucky Saturday, with 825 new cases, the fourth largest daily number of the pandemic, and creating its third highest seven-day total. The number of cases has increased every day since Monday, a day when numbers are usually low.

The seven-day rolling average of new cases is 659. It has increased nine days of the last 10, and the only decrease was 1.

“Thankfully, our positivity rate is still below five at 4.59%,” Gov. Andy Beshear said in a press release, referring to the share of Kentuckians testing positive for the virus in the last seven days. For all but one day of the last week, it has been below 5%, a key threshold in suppressing the virus.

Beshear said, “Please do your part, live for your fellow human being, and understand that we are all connected and that your decisions truly matter.”

The release reported 145 new cases in among Kentuckians 18 and younger, 15 of them age 5 or younger, including two eight months old.

Lincoln County (Wikipedia map)

Three more deaths were reported, all from Lincoln County: an 86-year-old woman and men 81 and 94. “That’s one county grieving three losses of its own,” Beshear said. “That’s three more families who are suffering during this time.”

Health Commissioner Steven Stack looked ahead to an unusual Kentucky Derby Week. “Now is the time to consider how you will celebrate Oaks, Derby and Labor Day in a way that allows you to share time with others while respecting the required masking and social distancing protocols,” he said.

“As you may recall, as the number of new cases was leveling off months ago, Memorial Day and the Fourth of July resulted in celebrations and mingling. A noticeable spike in the number of positive covid-19 cases followed. Then, the mask mandate went into effect and Kentuckians took extra care in social distancing and avoiding visits to other states known as ‘hot spots.’ This successfully plateaued our new weekly cases.”

Stack, a physician, warned, “If the running of the Oaks, the Kentucky Derby and Labor Day activities reflect other summer holidays, though, cases will spike again and Kentucky will have a setback to the progress we have made by working together. Please, let’s show we can learn from the other holidays. Let’s not slip and lose progress against our fight against the coronavirus.”

Eighty of the state's 120 counties had a new case Saturday. Counties reporting more than five were Jefferson, 263; Warren, 65; Fayette, 49; Todd, 29; Madison, 26; Boone, 14; Hardin, 14; Pike, 14; McCracken, 13; Lewis, 12; Pulaski, 12; Jessamine, 11; Bath, Daviess, Kenton and Monroe, 9 each; Bell, Boyd, Campbell, Hopkins, Logan and Montgomery, 8 each; Christian, Harlan, Jackson, Laurel and Oldham, 7 each; Barren, Green, Hart, Nelson, Rowan and Shelby, 6 each.

In other covid-19 news Saturday:

• Hospitalizations for covid-19 in Kentucky remained steady, at 570, with 149 of the patients in intensive care, the state's daily report said.
• The state's highest court now has all the written arguments in a case challenging the constitutionality of Beshear's emergency orders, reports the Lexington Herald-Leader. The court will hear oral arguments Sept, 17 "and then will decide what is certain to be a historic case," Jack Brammer writes. "It is not known how long it will take the Supreme Court to make a decision. At stake are dozens of emergency orders ranging from a requirement for most Kentuckians to wear a mask in public to class size in child care centers." The Courier Journal highlights the opposing arguments of Beshear and Attorney General Daniel Cameron.
• Two Louisville bars have filed suit challenging Beshear's limits on bars, asking that they be awarded "just compensation" if the orders are judged constitutional.
• Lexington Christian Academy told WTVQ that it started in-person classes Aug. 19, against Beshear's recommendation, because "a very deliberate communication plan" made sure students knew what was expected of them and in-person classes are better for their mental health.
• "Experts across the U.S. say the country can mount a comeback if it embraces reality and taps into its ingenuity," National Geographic headlines a story by Craig Welch, who writes, "First, we must knuckle down and accomplish the obvious: Continue social distancing and strive for universal mask use. Close high-risk spaces, such as churches, bars, and casinos. Spend time outdoors. Limit crowds. Wash our hands. Build up contact tracing. . . . But given national failures thus far, many experts are also pushing for a new way forward based on innovation—specifically, cheaper, faster tests that millions could take at home every day. We’re still just beginning that process."

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State's positive-test rate stays below 5% for the fourth day this week, while daily new-case numbers remain on a slow uptick

Kentucky School Boards Association map shows compliance with the governor's request to delay school opening to Sept 28. For a larger version, click on it.

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear announced Friday that Kentucky has 792 new coronavirus cases, continuing this week's slow uptick in daily case numbers, but a lower positive test rate of 4.5 percent. 

“We still have a whole lot of cases in Kentucky which means a number of people get sick and we lose a number of people, too,” Beshear said in a news release. “The good news is our positivity rate continues to decline. If we keep wearing these masks and we keep doing the work, we can get this to a manageable level to get our kids back in school and get back to more of our old lives.”

This is the fourth day this week the share of Kentuckians testing positive for the virus in the last seven days has been under 5%, the level that puts states in the White House Coronavirus Task Force "yellow zone."

The rolling seven-day average for daily new cases is 658, the fourth highest total of the pandemic. Unadjusted case totals for the Saturday-to-Friday week, which are used by the White House task force, were 4,605, well above the 1 per 1,000 residents that puts states in the task force's "red zone" for cases. 

People 18 and younger accounted for 114 of the new cases; 27 of those were 5 or younger. The youngest was a 1-month-old from Green County. 

Beshear started regularly announcing children's case numbers after getting resistance to his limits on child-care-center capacity, and his recommendation that schools delay in-person classes until Sept. 28 to help get the virus under control. He is expected to announce new child-care rules Monday. 

The state's daily K-12 school report shows 14 more students and nine more employees have tested positive, with active cases in 99 students and 40 staff.  

The universities and colleges report shows 175 new student and five new staff have tested positive for the virus; active cases involve 481 students and 15 employees. The University of Kentucky had the highest number of new cases, 118, followed by Union College at Barbourville with 26. 

Beshear reported eight more covid-19 deaths Friday, raising the state's total to 918. They were of an 85-year-old woman and an 86-year-old man from Christian County; a 69-year-old woman from Barren County; a 94-year-old woman from Carroll County; a 78-year-old woman from Scott County; a 58-year-old woman from Taylor County; a 73-year-old man from Union County; and a 92-year-old man from Warren County. 

“Again, it’s been a hard month. It’s going to probably be an even harder September,” said Beshear.  “Make sure that you’re praying for these families.”

Beshear reminded Kentuckians on Monday that with a 2% death rate from the virus, weeks with more than 4,000 cases, as the state has now seen for three weeks running, will result in the loss of 80 people  to the virus, most of them weeks after the cases are reported. 

Counties with more than 10 new cases Friday were Jefferson, 193; Fayette, 91; Madison, 56; Warren, 34; Christian and Rowan, 28 each; Daviess, 18; Kenton and Pulaski, 17 each; Green, 15; Hardin, 13; and Bullitt, 12. 

In other covid-19 news Friday:

• The state's daily report said 572 people are hospitalized in Kentucky with covid-19 and 158 are in intensive care.
• Lexington, which follows a different reporting schedule than the state, reported 100-plus cases of the virus on the second straight day for the second time, reports the Lexington Herald-Leader.  
• Tina Ryan, school nurse at East Calloway Elementary, part of Calloway County Schools, one of the 30 Kentucky districts that have opened to in-person learning, voiced mixed feelings to Liam Niemeyer of Ohio Valley Resource. Not only are children are asymptomatic carriers of the virus, "She worries about parents and families not following covid-19 guidelines and then sending their kids to her school," Niemeyer reports. "She worries about her students with chronic illnesses who could be more vulnerable, across the hundreds of students she cares for in multiple schools." But despite those worries, Ryan said "I just feel like that kids, physically, mentally, socially, they need to be back in school. It’s time to be back. They want to be back. And again, if they don’t, if the parents choose not to, that’s their option.”
• The Kentucky Board of Education discussed high-school sports for almost three and a half hours, then voted unanimously to send the Kentucky High School Athletic Association a letter expressing concern about high-contact sports such as football and suggesting alternatives to the KHSAA's plan.

• 

  WDRB graph for July 9, July 29, Aug. 27;
  for a larger version, click on it.

  The state has made little progress eliminating its backlog of unemployment claims, despite "an expensive, no-bid contract" with a national accounting firm that provided employees to do the work, Chris Otts reports for WDRB: "Kentucky has about the same amount of backlogged unemployment claims today – 73,642 – as in early July when Ernst & Young was beginning its short-term contract work."
• The Supreme Court of Kentucky gave tenants and landlords an extra 14 days between an initial eviction filing and when a trial can be set, saying that would give "landlords and tenants sufficient time to access available rental assistance through the Healthy at Home Eviction Prevention Fund," which Beshear is creating with federal relief money.

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McConnell announces grants of $125,000 each to 14 counties by federal Drug-Free Communities program

Federal grants of $125,000 each are going to 14 Kentucky counties, school boards and other organizations to help them educate and raise awareness about the dangers of substance abuse in their communities, U.S. Sen. Mitch McConnell announced Friday. The grants are part of the $1.75 million coming to Kentucky through the Drug-Free Communities program.

The grant recipients are: Trimble County Board of Education, Pendleton County Board of Education, Grant County Schools, WestCare Kentucky Inc., Bullitt County Board of Education, Save Our Kids Coalition of Bowling Green, Scottsville-Allen County Faith Coalition, Gallatin County Board of Education, Lyon County School District, Hope’s Hands (Owenton), Webster County Board of Education, Scott Countians Against Drugs, Madison County Health Department and Wolfe County Fiscal Court. 

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Blown up in smoke: Young adults who vape at greater risk of COVID symptoms

COVID-19 has swept across the globe, infecting millions and resulting in hundreds of thousands of deaths. Substantial resources have been invested into understanding individual vulnerability in order to protect those at greatest risk. Age is the most often cited risk factor; 75% of US deaths have been in people over the age of 65, while younger people generally have milder symptoms. In addition to age, the Centers for Disease Control has delineated a list of health factors that increase vulnerability, most of which are chronic disorders that generally alter health status. The single most modifiable risk factor for severe COVID-19 infection is inhaled substance use through smoking or vaping.

Vaping and smoking increase young adults’ risk of COVID symptoms

A new study published in the Journal of Adolescent Health used national data to estimate the toll of smoking and vaping on COVID-19 risk for young adults. The team found that overall, nearly one in three young adults ages 18 to 25 in the US are at heightened risk, though that number falls to one in six among those who do not smoke or vape. In other words, smoking and vaping double the number of young adults in the at-risk category.

The at-risk categorization is more than a theoretical concern. Smoking and vaping both cause lung injury that threatens pulmonary reserve. Substance use can also weaken the immune system, resulting in reduced capacity to fight off infection. A recent study found that adolescents and young adults who smoke and vape were five times more likely to report COVID-19 symptoms and seven times more likely to have a diagnosis, compared to their peers. A combined analysis using data from multiple studies found that among people infected with COVID-19, those with history of smoking were twice as likely to have disease progression.

Risk-taking during adolescence could mean greater risk for COVID

During adolescence and young adulthood, developing brains are wired to seek large neurological rewards, resulting in the risk-taking that is associated with this stage of life. Most young adults enjoy good health and hearty physiologic reserve, allowing them to tolerate the insults of substance use without noticeable impact, until the cumulative effects accrue in middle adulthood — or at least that was generally assumed to be the case prior to the COVID-19 pandemic.

Unlike other risk factors for severe COVID-19 disease, smoking and vaping also inherently increase the risk of respiratory virus transmission. Smoking and vaping are often social activities for young adults. Both involve exhaling forcibly, which may propel droplets that carry viral particles further than at-rest breathing. The Canadian government recommends that people remain six feet apart and avoid sharing products, though people who get together to smoke or vape may not adhere to government guidelines. It goes without saying that both smoking and vaping are incompatible with wearing a mask. These factors combine to pose a real threat in places where young people gather — including colleges and universities. Schools would be smart to institute strict no-smoking and no-vaping rules and enforce them vigorously as part of a COVID-19 containment plan.

Younger people may be overconfident about health risks

Young people tend to overestimate their own ability to control a situation, and think of themselves as invincible; many are inclined to think that they will be able to quit smoking whenever they want to. A little extra confidence may be useful during the transition to adulthood, even if based on a faulty assessment of one’s own capabilities. But the same tendency can cause real problems in this pandemic. The idea that younger people are safe from COVID-19 is inaccurate; according to an early report from the CDC, one in five people ages 20 to 44 who become infected are hospitalized, and 2% to 4% require treatment in an intensive care unit. The best thing we can do for young people is to promote accurate information about their true risks. More than any other group, young adults who are able to quit smoking and vaping have the power to flatten their own personal risk curves.

Supporting young people who want to quit vaping and smoking

Parents and healthcare professionals have a role to play here, too. Many youth who use vaping products have seriously considered quitting, but quit attempts don’t always stick. Vaping is so new that specific treatments have not yet been rigorously tested, but there are effective treatments for nicotine use disorders. Healthcare professionals can prescribe medications that help relieve withdrawal symptoms and prevent cravings, and counselors can provide support during the process. Parents can help by encouraging their children to get help. For people who are trying to quit using nicotine, a little help can go a long way.

The post Blown up in smoke: Young adults who vape at greater risk of COVID symptoms appeared first on Harvard Health Blog.

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Virus has spread too much for contact tracing to contain it, but tracing can still help, especially if more people would cooperate

By Lisa Gillespie
Kentucky Health News

In wide swaths of Kentucky, tracing the contacts of people with the coronavirus is no longer preventing its spread, because the spread has become too wide. Nor is it proving to be an effective response to the pandemic. Instead, it is, at best, slowing the disease rate. And many people don't cooperate with it.

That’s according to several local health department officials, including Roanya Rice. She’s the public health director at the North Central District Health Department, which includes Spencer County, where over 10% of residents have tested positive for the virus, as of last week.

“It’s not a situation now that we can contact-trace our way out of,” Rice said. “The window of opportunity to contact-trace to eliminate the spread has come and gone.”

Some people don't welcome contact tracing, which can lead to an official request that they isolate for 10 days in case they have the virus. Gov. Andy Beshear said this week that there has been an increase in a lack of cooperation by infected people those whom they have identified as recent contacts.

Lincoln Trail District Health Department Director Sara Jo Best said she and her staff get the feeling that some people who have tested positive don’t want to provide a list of their recent contacts.

“I feel like there are cases that are not being 100 percent truthful in their contacts,” said Best, who is based in Elizabethtown. “I think they're intentionally leaving some of those off, because people don't want to be quarantined.”

Beshear said some people reached by contact tracers are unresponsive or don’t self-isolate as requested.

"They could lead to another spike,” he said. “This is a war. Whether we win or lose, how many Kentuckians we lose, it's all based on the number of battles that we win, or lose. So please, don't get tired. Let's pick it up. Lives, lives depend on it."

Local health officials say most people cooperate when a contact tracer reaches out. They say they have only rough and unscientific estimates on the percentage of people who are not cooperative, because the state only recently provided a uniform platform for health departments to track cases. Department directors, when pressed, estimated noncompliance between 2% and 40%. 

Barren River District Health Department Director Matt Hunt said the people who are not cooperative in his eight-county region are mainly those without symptoms. His district includes Barren County, where more than 10% of residents tested positive for the virus Aug. 15-21, the most recent week of the White House Coronavirus Task Force report.

“We do have some that deny the test results, [say] that it can't be, [they] don't have symptoms,” Hunt said. “Those are typically asymptomatic individuals. Those are difficult conversations to have.”

Others have used a “critical worker exemption” to refuse quarantine after a high-risk exposure. State Health Commissioner Steven Stack announced Wednesday, Aug. 26, that he had eliminated the exemption for workers in food, health care, energy and other critical industries, saying it had become “fairly distorted . . . Health departments are finding all sorts of people are claiming they’re critical infrastructure workers.”

Meanwhile, health department directors across the state say the virus has spread so much within communities that contact tracing is not containing the spread of the virus. Lexington-Fayette County Health Commissioner Kraig Humbaugh said that’s partly because of how the virus works; the key time to get folks to quarantine is when they start to show symptoms. But many never have symptoms.

“Normally [the contacts] are infectious a couple of days before they even start to show symptoms, if they show symptoms, and then 25 percent of them don't,” Humbaugh said. “So you've got all those people that are also potentially infecting others in the community. It just kind of builds on itself. It is so much easier for this strategy to work when we're in the containment phase.”

Department for Public Health graphic; for a larger version, click on it.

Kentucky has funds to hire 700 contact tracers and has hired 550, with at least one in every county. That leaves room for 150 spots. Mark Carter, the state official leading contact-tracing efforts, estimates those new hires will be made by or around mid-October, depending on the spread of the virus.

“The Department for Public Health assessment of tracing state-wide is that we have sufficient tracers,” Carter said. “The primary issues have been in masking and social distancing; that places a burden on tracing. So, I think it would be fair to say tracing is helpful, but by itself it cannot stop the spread. I do agree that certain districts are in a mitigation phase,” not a containment phase.

With many Kentuckians ignoring the mask mandate and social-distancing guidance, which is difficult to enforce, health officials say contact tracing is the actionable thing health departments can do to fight the virus without a vaccine.

But the funding for tracers runs only through December, and it’s unclear whether Congress will provide more. Hunt, with the Barren River health department in Bowling Green, is hoping the money doesn’t run out before he needs the help the most.

“I want to try to stay two to three steps ahead,” Hunt said. “If I see a spike, like instead of having 25 or 30 to investigate a day, it jumps up to 75, then I’ll start to think about, okay, we need to bring more people in.”

Contact tracing does play a role in fighting the virus, even if it’s not containing spread. Public Health Director Clayton Horton of the Green River District Health Department in Owensboro said at the very least, tracers provide important education about the virus. And it can be critical for Kentuckians who were already living in relative isolation.

“We have people that are in isolation that don't have friends and family that can help support them,” Horton said. “We have people that have real needs in terms of food and medicine, and we're able to help with that, and if we weren't there, they certainly would break their isolation and put others at risk of becoming infected.”

Another issue that may add to noncompliance is the changing guidance from the federal Centers for Disease Control and Prevention.

In its latest shift, the CDC eliminated advice that anyone who’s had close contact with someone who has the virus get tested, regardless of whether they have symptoms. It now says, “You do not necessarily need a test unless you are a vulnerable individual, or your health-care provider or state or local public-health officials recommend you take one.”

Horton said the change has already created confusion and resistance to the department’s guidance.

“So someone had heard that, and we had contacted them to say, you've had contact with someone that was infected,” and advised them to quarantine, Horton said. “And they said, ‘Well, I just saw on the CDC website this morning that I don’t need to do these things,’ and it was just kind of a misinterpretation.”

Kentucky is still recommending people get tested, even if they don’t have symptoms, because asymptomatic carriers can still spread the disease.

Non-existent numbers

By the start of September, the majority of state health departments should be using new technology to track covid-19 data, called the Contact Tracing and Tracking system. Data on the virus now, other than the raw numbers of who has tested positive, is almost nonexistent.

“As of next Monday (8/31), all but one local health department will be CTT; at that point we will be in a much better position to be able to report this data,” Carter said. I would say that by the end of September or mid-October, we will have some usable data from the system.”

At the start of the pandemic and even now, many departments were using paper charts to log cases; others were using internal systems.

Most health department directors said they’ve just been trying to keep on top of new cases and contacts. There hasn’t been time for analysis.

That's a real disadvantage, said Best, with the Lincoln Trail district. She wants know the number of contacts who test positive for the virus. She wants to know the percent of people who never respond to their calls, and those who initially are cooperative but then no longer answer calls or emails. She wants to know not just her district's own numbers, but also the state-wide average.

“If I know that of one thousand contacts, 20 percent of those are probably going to convert to a positive, that helps me plan,” Best said. “Or if the state's average is 20 percent, and my average is 40 percent, maybe I need to re-look at how we're educating people on isolation and quarantine. I might need to evaluate what I'm doing because it's not it's not effective. It gives you kind of benchmarks like that when you're looking at data.”

And this information might just make contact tracing a stronger tool.

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Legislative committee holds hearing on bipartisan bill to ban 'conversion therapy' for changing sexual orientation of minors

A bill to ban the "conversion therapy" for changing sexual orientation got a hearing before an interim legislative committee Tuesday, perhaps improving its chance for passage in the General Assembly session that is scheduled to begin in January.

"Resuming their bipartisan alliance, Republican Sen. Alice Forgy Kerr and Democratic Rep. Lisa Willner referred to conversion therapy as a discredited practice with potentially dangerous consequences," Louisville's WDRB-TV reports.

Kerr, one of whose children is gay, called the procedure “conversion torture.”

The bill would prohibit licensed mental health professionals from using conversion therapy on minors, or on adults deemed to lack capacity for responsible decision-making. "The bill’s supporters also want to block public money from going to any agency in Kentucky involved in conversion therapy," WDRB reports.

The bill is opposed by the Family Foundation of Kentucky, which said it would impede freedom of speech and religion and parental rights. The foundation's Daniel Mingo said the bill discriminates because it would block a form of counseling for unwanted same-sex attractions, but not counseling for those who “want to be gay."

Kerr told the Interim Joint Committee on Licensing, Occupations and Administrative Regulations that parents want to “pray the gay away in their child,” and cited studies indicating that youngsters undergoing conversion therapy are more likely to commit suicide.

Zach Meiners of Louisville, who underwent conversion therapy as a teenager, called it a “shame-based” practice and said it taught him to inflict physical pain on himself anytime he had “a gay thought.” He said he became suicidal.

The Foundation for a Healthy Kentucky endorsed the bill, saying it "joins a long list of major medical and mental-health organizations in supporting legislation to protect LGBTQ youth from the discredited and harmful practice." It said at least 20 states and 700 cities and counties "have taken action to protect youth from these practices, according to the Movement Advancement Project."

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Amid flurry over high-school football, state records fourth highest seven-day rolling average of daily new coronavirus cases

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Beshear slams CDC's change in guidance for testing, keeps noting kids' cases in counties that have started in-person classes

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Is it safe to reduce blood pressure medications for older adults?

“Doctor, can you take away any of my medications? I am taking too many pills.”

As physicians, we hear this request frequently. The population most affected by the issue of being prescribed multiple medications, known as polypharmacy, is the elderly. Trying to organize long lists of medications, and remembering to take them exactly as prescribed, can become a full-time job. In addition to the physical and emotional burden of organizing medications, older adults are at increased risk for certain types of side effects and potential worse outcomes due to polypharmacy.

A common source of prescriptions is high blood pressure, with older adults often finding themselves on multiple medications to lower their blood pressure. Data from the Framingham Heart Study show that over 90% of middle-aged people will eventually develop high blood pressure, and at least 60% will go on to take medications to lower blood pressure.

The OPTIMISE trial, recently published in JAMA, studied the effect of reducing the number of blood pressure medications, also known as deprescribing, in the elderly.

How low should blood pressure be in older adults?

Previous large studies, including the HYVET trial and the more recent SPRINT trial, have shown that treatment of high blood pressure in older adults remains important, and may reduce the risk of heart attack, heart failure, stroke, and cardiovascular death. Black adults made up 31% of the SPRINT trial study population; therefore, study results could be used to make recommendations for this population, which is at increased risk for high blood pressure. However, many groups of older people were excluded, including nursing home residents, those with dementia, diabetes, and other conditions common in more frail older adults.

The most recent guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA), published in 2017, define optimal blood pressure as less than 120/80 for most people, including older adults age 65 or above. They recommend a target of 130/80 for blood pressure that is treated with medication. The 2018 guidelines from the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) recommend a more relaxed goal of less than 140/90.

The US and European populations differ in their risk for cardiovascular disease, with the US population generally considered at higher risk for strokes, heart failure, and heart attacks, so it might be appropriate to have different blood pressure goals for these two groups. Regardless, both groups acknowledge that factors such as frailty, limited life expectancy, dementia, and other medical issues should be considered when developing individualized goals for patients.

What happened to older patients whose blood pressure medications were reduced?

 The OPTIMISE trial provided preliminary evidence that some older adults may be able to reduce the number of blood pressure medications they take, without causing a large increase in blood pressure. For the trial, researchers randomized 569 patients age 80 or older, with systolic blood pressure lower than 150 mm Hg, to either remain on their current blood pressure medications, or to remove at least one blood pressure medication according to a prespecified protocol. The study subjects were followed for 12 weeks to assess blood pressure response.

Researchers found that both the people who remained on their previous blood pressure medications and those who reduced the number of medications had similar control of blood pressure at the end of the study. While the mean increase in systolic blood pressure for the group that reduced medications was 3.4 mm Hg higher than the control group, the number of patients who had systolic blood pressure below the goal of 150 mm Hg at the end of the study was not significantly different between groups. Approximately two-thirds of patients were able to remain off the medication at the end of the study.

It is important to note that OPTIMISE is relatively a small study, and the investigators did not examine long-term outcomes such as heart attack, heart failure, or stroke for this study (as the HYVET and SPRINT trials did), so we don’t know what the long-term effect of deprescribing would be.

More research needed to examine long-term effects of deprescribing

While the OPTIMISE trial was promising, larger and longer-duration trials looking at outcomes beyond blood pressures alone are necessary to really know whether deprescribing is safe in the long term. Additionally, these researchers used a target systolic blood pressure of less than 150 mm Hg, which is higher than the most recent ACC/AHA and ESC/ESH recommendations.

An interesting aspect of this study design is that the primary care physician had to feel that the patient would be a good candidate for deprescribing. This left room for physicians, who may know patients well, to individualize their decisions regarding deprescribing.

The bottom line

This trial gives doctors and other prescribers some support when considering a trial of deprescribing a blood pressure medication for select older patients, with a goal to improve quality of life. These patients must be closely followed to monitor their responses.

The post Is it safe to reduce blood pressure medications for older adults? appeared first on Harvard Health Blog.

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Beshear says fewer Ky. counties on covid-19 danger list because mask mandate works; funds internet for 32K school kids without it

Lt. Gov. Jacqueline Coleman used this slide to make an announcement at the briefing.

By Mary Meehan and Melissa Patrick

Kentucky Health News 

As the share of Kentuckians testing positive for the coronavirus again rose above the danger level of 5 percent, Gov. Andy Beshear pointed to a federal report that shows fewer Kentucky counties are in covid-19 danger zones, and said that can be attributed to his order to wear masks in public.

“What they say in that report is masks are working,” Beshear said at his daily briefing, adding later, “Federal government says it's working, state government says it's working, all of the public-health officials all the way up and down say it's working.

"So it's easy, just wear a mask. If you refuse to, just know that [you’ll] be spreading it to someone else. Regardless of how you feel about it, everybody else is willing to go through the discomfort. Why won’t you?”

Beshear announced 688 new coronavirus cases in Kentucky, lifting the state’s seven-day rolling average to 644, the seventh highest of the pandemic. The percentage of Kentuckians testing positive for the virus in the last seven days increased to 5.07%, up from 4.77% on Monday. 

“We like being below 5. We really want to get below 4,” Beshear said. “A lot of states that are doing things we really want to do are below 3 or even lower. So . . . let's get competitive with other states and let's get competitive about something that saves lives.” 

Warren County again: Beshear said 96 of Tuesday’s new cases were children, and noted that Warren County had six of them, and “14 school-aged kids in the last three days. That is really concerning.”

Warren County and Bowling Green schools started in-person classes this week, despite Beshear's recommendation to wait until Sept. 28. He has repeatedly called out the county, and did it twice Tuesday.

He noted that the county remains in the federal report’s “red zone,” for places where new weekly cases of the virus numbered more than 1 per 1,000 residents and the share of residents who tested positive for the virus during the week was more than 10%.

Beshear said decisions about when, and how, to return to school matter, as he announced that 57 students and 25 staff have active cases of the coronavirus, an increase of seven and four, respectively, from yesterday. 

“So this is a highly contagious, aggressively spreading virus. We need to be very, very careful,” he said. “And this is one of the reasons that I still don't believe it's safe for schools to open before September 28.” 

The state reported 236 active cases at Kentucky universities and colleges.  

Kentucky has 588 covid-19 hospital cases, 151 of them in the ICU and 81 of those on ventilators. There were 13 new cases of residents in long-term care and 16 new staff members testing positive. Three more residents have died. 

While most of Kentucky’s deaths continue to be older people, Beshear in recent weeks has highlighted the increasing number of children who are testing positive, and emphasized that the long-term health consequences for young people who recover are still unknown.

Child care: Beshear fielded several questions about his limits on the number of children at child-care facilities, the topic of a Republican-led news conference before his briefing. He indicated that a new plan for child-care centers is coming soon. 

Asked about Sen. Danny Carroll's argument that since no children have died, child-care centers should be allowed to expand, Beshear noted that Carroll, a Paducah Republican, is a frequent critic, and expressed frustration that covid-19 has become politically charged.

“Are we really going to base information, decisions that we make for the overall health, just on how many people have died? Is that it? I mean, that's just . . . like consulting not with Dr. Stack or Dr. [Deborah] Birx but with the Dr. Pepper,” he said, repeating a jibe from last week.

He paraphrased Carroll as saying “Kids don't die, so let kids do everything,” and added, “Well, who's watching them? Adults. Adults die, and adults have died.” 

Internet for students: As schools return to class, many of them online, Kentucky announced plans to provide broadband service to the roughly 32,000 students who still don’t have access to the internet. 

“One of those old challenges that Kentucky continues to face is the digital divide,” Lt. Gov. Jacqueline Coleman said at the briefing. “That impacts our kids often in low-income communities in places that are hard to reach in rural Kentucky, as well as low-income families in urban areas of Kentucky.” 

To help them, she said the state is investing $8 million to reduce the monthly internet cost for low-income parents of K-12 students. The “Last Mile” internet service plan will provide eligible families access to high-speed internet at no more than $10 per month for the next two to three school years. She said internet providers should be chosen by Sept. 15.

Knott County schools have put their virtual re-opening on hold after a delay in a shipment of laptops, pushing the start date to Sept. 8 , Liz Moomey reports for the Lexington Herald-Leader. “I cannot with a clear conscience begin school next Monday, Aug. 24 knowing that many households will not have the needed devices to complete their virtual assignments,” Supt. Kim King said in a video posted on Facebook Wednesday.

In other covid-19 news Tuesday:

• Beshear reported 10 new covid-19 deaths Tuesday, bringing Kentucky’s total to 895. Today’s deaths include three women, 80, 84 and 85, from Lewis County, which had an outbreak at a nursing home; an 84-year-old man and a 92-year-old woman from Scott County; an 81-year-old Bell County man; a 59-year-old Daviess County man; an 89-year-old Jefferson County man; an 87-year-old Logan County woman; and a 79-year-old Webster County man. 
• Counties with 10 or more new cases were Jefferson, 203; Warren, 78; Fayette, 45; Madison, 22; Christian, 18; Hardin, 14; Logan and Rowan, 14 each; Greenup, Kenton and McCracken, 12 each; and Laurel, Oldham and Pulaski, 10 each. 
• J. Michael Brown, secretary of Beshear’s executive cabinet, announced that 646 inmates will have their sentences commuted due to covid-19; 121 are considered medically vulnerable to the disease, and 525 have committed non-violent and non-sexual crimes and have less than six months left to serve. The state previously released 1,200 inmates using the same criteria.
• UPS is building a massive vaccine-storage facility that could serve as a national and international distribution hub. The Courier Journal reports that UPS confirmed recently that it's building a "freezer farm" at a South Louisville facility with 300 ultra-low temperature refrigeration units. Each would hold 48,000 vials of vaccines, or 14.4 million units in total across the farm. Grace Schneider writes that the project is part of a larger partnership taking shape between the White House, key agencies and several companies to prepare for the release of a vaccine as early as Nov. 1. President Trump has said a vaccine could be ready by around Election Day, Nov. 3, but health experts have said 2021 is a more likely date.

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CDC publishes article about Ky. monitoring system to guide decisions about reopening, which says it could help other states

Kentucky's daily covid-19 status, as calculated with tool developed by state health department.

By Melissa Patrick
Kentucky Health News

As health departments across the nation help states safely reopen their economies and schools, the monitoring system Kentucky officials use to guide their decisions has been lauded in a recent federal report as an example for other states to follow.

The report, published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, comes at a time when many Republicans and some commentators have said they need to know more about how Gov. Andy Beshear and his public-health chief are making their decisions around reopening, mitigation and response.

Health Commissioner Steven Stack has said he uses a variety of sources to guide his recommendations, but this report reveals the nitty-gritty of how one tool created by Kentucky's epidemiologists helps guide the state's decision-making on covid-19.

The lead author and six of the other 11 listed authors work for the CDC. Five work for the state Department for Public Health, which developed the tool, called the "indicator monitoring report."

The IMR combines multiple data elements that measure the prevalence and severity of the coronavirus, along with the state's readiness to respond to it. The report says this information is use to generate a daily covid-19 status score that can be used to asses the state's ability to safely reopen. 

The report says state epidemiologists "developed the IMR after recognizing the need for a plain-language assessment that could facilitate reopening and ongoing response decision-making addressing multiple stakeholders." 

The assessment is compiled Monday through Saturday and distributed to about 90 stakeholders in and out of state government, including the governor's office and local health-department directors. 

The system monitors five primary indicators: new coronavirus cases, deaths from covid-19, health-care capacity, contact-tracing capacity and syndromic surveillance, which allows the state to track symptoms before a covid-19 diagnosis is confirmed. It was implemented on May 19. 

The indicators are scored on a three-point scale, from excellent to poor, and are given equal weight in producing the composite status score, and the analysis is "combined with publicly available data into a user-friendly composite status that KDPH and local policy makers use to assess state-level covid-19 hazard status," the report says.

The composite status score, which assesses the ability of the state to safely reopen and remain open, is reported at five levels: 5 = excellent (reopen/remain open); 4 = good (monitor); 3 = moderate (caution); 2 = fair (increase mitigation); 1 = poor (reopening risky, slow reopening or close); 0 = poor (reopening risky, slow reopening or close).

The report shows how the state's score worsened between May 19 and July 15, dropping to "fair" between June 17 and July 15, indicating the need for increased mitigation. Beshear issued an executive order for a mask mandate in certain settings on July 9.

The report says this user-friendly system could help other states "guide decision-making for covid-19 mitigation, response, and reopening," and is easily adoptable because its data sources "are publicly available, data are analyzed with familiar software, and a standardized method is used to compile the report."

Click here to see a table of each of the indicators and how they are scored.

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Beshear OKs fall sports, says he can't make all the calls; issues and funds executive order to resolve disputes over evictions

State graph, adapted by Kentucky Health News; weekly numbers reflect adjustments made after initial daily reports, including elimination of duplicate cases

By Melissa Patrick and Al Cross
Kentucky Health News

Gov. Andy Beshear said the state will not overturn the decision by the Kentucky High School Athletic Association to allow fall sports in the midst of the highest coronavirus case numbers the state has seen. 

"It's not because I think that it is a good decision or a wise decision," Beshear said at his daily news conference. "But if we're going to defeat this virus, we need people, other than me up here, all over Kentucky taking responsibility to make good and wise decisions."

He continued, "I have concerns . . . that by starting with some of the most high-contact sports we risk shortened season, we risk what I think can be successful plans to get our kids back in school, that we risk every other sport that's going to follow. But we can't be making every decision for what's best for folks out of the governor's office and it's gonna be incumbent on our superintendents, on coaches, on the different groups to make the wisest decisions that they can." 

On Aug. 20, the KHSAA Board of Control voted 16-2 to keep its schedule for fall sports, starting football practice today and games Sept. 11. Cross-country, field hockey, soccer and volleyball will begin Sept. 7. The KHSAA had said its plan was subject to approval by the state Department of Education, the Department of Public Health and Beshear himself. 

Players, coaches and parents rallied Monday on the steps of the Capitol in an effort to get the governor's green light for fall sports with the message: "Let them play," Lexie Ratterman reports for WDRB.  WKYT reports that Republicans in the state House issued a statement calling on Beshear to let the schools play. 

Asked later if he reserves the right to intervene if things are out of control in October, Beshear said, "Heck, yeah, I do." 

Beshear stressed that it will be important for schools to be transparent and do the right thing if and when team members test positive, even if it's the biggest game of the season and the star player is quarantined.

He and Health Commissioner Steven Stack pointed out some of the differences between high-school sports and the Southeastern Conference, which is proceeding with its fall season. The SEC is testing its players three times a week and has stringent requirements that have to be met before a player who has tested positive is allowed to return to the game. 

"If you're in a public school in the state or you're in a private school, do you have the money and the resources and the ability to secure three tests a week for the students to play sports?" Stack asked. "I think you all know the answer to that."

Stack said there is still much unknown about the long-term effects of the coronavirus, pointing to several studies that show it can affect the heart, including one by a sports cardiologist at Ohio State who says the university's doctors have found that up to 13 percent of college athletes who test positive for the virus develop inflammation of their heart muscles, called myocarditis, which Stack said can result in a range of outcomes from complete recovery to death.  

"You can have sudden cardiac death because you have an irritable heart muscle," he said. "I hope this doesn't happen, but it's just going to take one 16- or 17-year-old to drop dead on on the sporting field before someone notices that it's not fictional, it's real."

Evictions and covid-19

Beshear issued a new executive order on evictions that dedicates $15 million of federal coronavirus relief funds to create a Healthy at Home Eviction Relief Fund. He said funding is also available from several other sources.  

The order says landlords must give tenants 30 days' notice of their intent to evict for nonpayment of rent and during that 30 days, the landlord and tenant must meet and try to work out an agreement. The order also says there will be no penalties, late fees or interest charged relating to nonpayment of rent between March 6, when the pandemic arrived in Kentucky, and Dec. 31. 

This stems from three Northern Kentucky landlords' lawsuit challenging the governor's ban on evictions. He said mediation efforts have failed, but the lawsuit is now moot because the executive order it was based is no longer in effect. 

Beshear said his new order is designed to meet three challenges: making sure Kentuckians don't end up on the street, making sure landlords are being treated fairly, and making sure Kentuckians don't end up with so much debt that they can't dig out of it. 

"Kentuckians cannot be healthy at home without a home," he said, directing Kentuckians who need help with an eviction issue to visit kycovidlegalhelp.org or call 833-540-0242. 

Don't let your guard down

Beshear voiced concern that Kentuckians might get complacent about following preventive measures as schools start to reopen and sports rev up, as they did around July 4 when a surge in cases "almost sent us spiraling out of control." 

He said his worry is compounded because the state is seeing more people trying to get out of quarantine and more people not wanting to help health departments, which are trying to trace and quarantine people who have been in contact with infected Kentuckians.

"Those feelings are natural, but they're harmful," he said. "They could lead to another spike and it would be a spike from where we are right now. This is a war. Whether we win or lose, how many Kentuckians we lose, it's all based on the number of battles that we win, or lose. So please, don't get tired. Let's pick it up. Lives, lives depend on it."

Kentucky has seen more 4,000 new cases in each of the past two weeks. Beshear pointed out that for each of those weeks, with a 2% mortality rate, the state will lose 80 people a week to the virus. 

"They trail the weeks in which we see those cases, meaning it's gonna be a tough month, and next month is going to be a tough month," he said.

Beshear reported four more covid-19 deaths Monday, bringing the state's death toll to 885. The fatalities were a 71-year-old woman from Marion County, a 74-year-old man from Harlan County and an 82-year-old man and a 94-year-old woman from Jefferson County. 

The governor added that while today's death toll was lower than it's been, "We had more deaths announced last week than in any week in which we've been battling this virus," and there are 19 deaths pending in front of the committee that determines if a death is related to covid-19.

The state recorded 373 new coronavirus cases on Monday, bringing its seven-day rolling average to 635. The percentage of Kentuckians testing positive for the virus in the last seven days was 4.77%, a slight drop from Saturday, the last day the figure was reported. Reporting is typically limited on Sundays, and labs are still catching up on Mondays, reducing case figures for both days. 

Reporting to increase

Beshear said the state is working on a dashboard that will be regularly update coronavirus information for schools and universities. Beshear cautioned that because of processes involved, the state's reporting may lag behind local reporting. The state will ask schools to submit data daily "because parents deserve to know," he said. 

The governor reported that 31 school districts had at least one positive coronavirus test and they believe that at least 50 cases are active. He said there are 223 active cases in the state's universities.  

Stack said that in response to a demand for county-level data, he will work with the state Department of Education to create a simple metric with county-level data that counties can use to inform their decisions, cautioning that such localized data will have severe limitations. 

Stack reiterated that the virus does not respect lines on a map. "If you are next to a county with very active disease, your county could be very active very quickly; when you get hot red, it takes longer to cool off than it does to accelerate up," he said. 

In other covid-19 news Monday:

• Jefferson County again accounted for almost a third of the new cases, 152, Other counties with five or more cases were Fayette, 76; Madison, 29; Kenton, 20; Calloway, 11; Marion, 10; Bullitt, 9; Daviess and Warren, 8 each; Knox, 6; and Boone, Casey, Hardin, Simpson, Trigg and Woodford, 5 each.  
• Kentucky hospitals have 564 covid-19 patients, 149 of them in intensive care and 82 of those on ventilators, Beshear said. 
• In long-term care facilities, active cases numbered 513 among residents and 310 among staff, after four more in each category were added Monday. 
• Beshear reported nine veterans and one staff member have tested positive for the Eastern Kentucky Veterans Center in Hazard, the first veterans' nursing home with an extensive outbreak. He said it has been confined to one hallway of one unit, and all of the cases trace to an aide who is recovering at home. He said all the veterans who tested positive have been moved to the local Appalachian Regional Healthcare hospital, allowing everyone left on the hall to have a single room. He said veterans in facility will be tested by Wednesday. 
• In child-care centers, 10 more employees and three children tested positive, for totals of 128 staff and 99 kids; 158 facilities have had at least one case. 
• After five students and one staff member tested positive for the coronavirus at Lexington Catholic High School, it switched to virtual learning Monday for two weeks. It opened last week to in-person learning despite Beshear's recommendation to delay until Sept. 28, Valarie Honeycutt Spears reports for the Lexington Herald-Leader.  The local health department also reported one student at Lexington Christian Academy and two students at Sayre School had tested positive.
• Beshear's travel advisory, asking people to avoid traveling to state's with positive-test rates of 15% and to self-quarantine if they do, now applies to fewer states: Mississippi, South Carolina, Texas, Nevada and Idaho. 
• KFC announced suspension of its “Finger lickin’ good” slogan, calling it “a bit off” during a pandemic when people are advised not to touch their faces with unwashed hands. in a YouTube video, the Louisville-based chain blurred "finger lickin’" from some of its old ads and advised, “That thing we always say? Ignore it. For now."
• Senate Majority Leader Mitch McConnell is urging Americans to wear hemp face masks to prevent the spread of coronavirus, Kyle Jaeger reports for Marijuana Moment. He was speaking at the Kentucky-based hemp company Ecofibre on Monday. 
• Kentuckians with children eligible for free or reduced-price school meals have until Aug. 31 to apply to get help with their home purchased groceries, Jack Brammer reports for the Herald-Leader. Jessica Klein, policy associate for the Kentucky Center for Economic Policy, said at a news conference that parents or guardians of roughly 117,000 Kentucky students who qualify have not applied. Brammer reports there is no income limit to participate and persons can apply regardless of their immigration status.  The benefits are called P-EBT, for Pandemic Electronic Benefit Transfer. Click here for more information about requirements and qualifications. 
• Researchers from McGill University in Montreal set out to find out what makes one person more likely than another to believe fake news and conspiracy theories about covid-19. The study, published in Misinformation Review, found that "even after adjusting for demographics such as scientific literacy and socioeconomic differences, those who regularly consume social media rather than traditional media were less likely to observe social distancing and to perceive covid-19 as a threat," Quentin Fottrell reports for Market Watch. The paper concluded that "those that consume more traditional news media have fewer misperceptions and are more likely to follow public-health recommendations like social distancing," Fottrell reports. 
• In their weekly "Covid Watch" article, Deborah Yetter and Grace Schneider of the Courier-Journal reports on how the state determines the covid-19 death count; the reliability of the state's data; death rates for the flu and covid-19 in Kentucky; and issues of immunity and recovery from the virus.

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