Almost 2,000 new coronavirus cases, another new record

Kentucky Health News chart, based on initial, unadjusted reports

By Al Cross
Kentucky Health News

The escalation of novel-coronavirus cases in Kentucky accelerated again Saturday, with another record: 1,986 new infections. That brought the seven-day rolling average to 1,688, more than double what it was at the start of October.

“This is now the single largest week . . . by almost a thousand, and we still have one day to go. We need your help,” Gov. Andy Beshear said in a press release. “Make sure you are following the red zone recommendations so the entire community can come together to better protect those around you.”

The state reported more than 2,300 cases on Oct. 7, but more than 1,400 of those were from a backlog of cases in Fayette County.

Other measures of the pandemic slacked a bit. Hospitalizations for covid-19 in Kentucky were 964, 10 lower than Friday; there were 236 intensive-care-unit cases, down by five; and 117 ICU patients on ventilators, down by four.

The share of Kentuckians testing positive for the coronavirus in the last seven days is 6.1 percent, down slightly from Friday's 6.19%.

The state reported nine more covid-19 deaths, raising its toll to 1,485. The fatalities were a 77-year-old man from Pike County; a 76-year-old man from Jefferson County; a 61-year-old man from Lee County; a 71-year-old woman from Montgomery County; a 76-year-old woman from Fayette County; a 90-year-old man from Henderson County; a 95-year-old man from Jessamine County; a 54-year-old woman from Daviess County; and a 69-year-old man from Lewis County.

The list of counties with more than 10 new cases was longer than ever: Jefferson, 331; Fayette, 248; Kenton, 63; Bell, 55; Warren, 48; Nelson, 47; Laurel, 46; Hardin, 45; McCracken, 40; Boone, 37; Bullitt, 36; Campbell, 32; Calloway, 31; Daviess, 30; Madison, 29; Christian, 28; Hopkins, 28; Clay, 27; Pike, 27; Boyd, 25; Whitley, 25; Barren, 24; Johnson, 24; Floyd, Jessamine and Oldham, 20 each; Grayson and Knox, 18 each; Carter and Graves, 17 each; Lewis, 16; Henderson, Marion and Scott, 15 each; Jackson and Shelby, 14 each; Monroe, Montgomery and Perry, 13; Hart, Marshall, Martin and Spencer, 12; and Caldwell, Clark, Greenup, Logan and Pulaski, 11 each.

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Kentucky sets more records for new coronavirus cases, covid-19 hospitalizations; Beshear urges care on Halloween and next week

Ky. Health News chart; case numbers are from initial, unadjusted daily reports; click image to enlarge 

By Al Cross
Kentucky Health News

Kentucky set yet another record for cases of the novel coronavirus Friday, continuing a steady escalation, and set a record for covid-19 hospitalizations.

The state reported 1,941 new cases of the virus, raising the seven-day rolling average to another record, 1,652.

It said 974 people were hospitalized in Kentucky for covid-19, with 241 of them in intensive care and 121 of those on ventilators.

The share of Kentuckians testing positive for the virus in the last seven days was 6.19 percent, the highest since testing became readily available in May.

Despite another day with multiple records, or maybe because it was, Gov. Andy Beshear's news release didn't note the higher-than-ever numbers.

The release focused on safety this weekend and next week, when Beshear and state health officials hope schools, businesses and individuals in "red zone" counties, those with more than 25 cases per 100,000 people in the last seven days, will take a cue from the state's color-coded map and take more care.

"Beshear asked Kentuckians to make a plan now for a safe Halloween, as covid-19 cases rise across the commonwealth and the nation," the release said, and quoted him: “Remember, the more cases, the more people in the hospital, the more people in the ICU and the more people who die. It’s time for a coordinated community effort with everybody on board. Now is the time for leadership, not for excuses.”

The state's focus is on the 68 "red zone" counties. Its recommendations for them are:

• Employers should let employees work from home when possible
• Government offices that do not provide critical services need to operate virtually
• Reduce in-person shopping; order online or pickup curbside as much as possible
• Order take-out; avoid dining in restaurants or bars
• Prioritize businesses that follow and enforce the mask mandate and other guidelines;
• Reschedule, postpone or cancel public events
• Do not host or attend gatherings of any size
• Avoid non-essential activities outside your home
• Reduce overall activity and contacts

“We absolutely must double down in terms of applying caution,” Health Commissioner Steven Stack said in the release. “With nearly 70 counties now in the red zone, I am pleading with you to observe both Halloween and Red Zone Reduction Recommendations. Lives and livelihoods literally depend on all of us doing our part.”

The state reported 15 more covid-19 deaths: an 88-year-old woman from Clark County; an 83-year-old man from Daviess County; two men, 39 and 89, from Fayette County; an 82-year-old man from Greenup County; a 68-year-old man from Hancock County; two men, 66 and 67, from Jefferson County; a 75-year-old woman and a 71-year-old man from Knott County; an 84-year-old man from Laurel County; a 91-year-old man from Lee County; an 86-year-old woman from Montgomery County; a 69-year-old man from Pike County; and a 67-year-old woman from Washington County.

Counties with more than 10 new cases were Jefferson, 406; Fayette, 186; Kenton, 87; Hardin, 81; Warren, 72; Campbell, 45; Boone, 42; Pike, 41; Barren, 36; Bullitt, 35; Laurel, 34; Christian, 32; Daviess, 30; Oldham, 30; McCracken, 26; Montgomery, 26; Larue, 25; Logan, 24; Shelby, 24; Nelson, 23; Henderson, 21; Monroe, 21; Jessamine, 20; Scott, 19; Madison, 18; Calloway, 17; Hopkins, 17; Whitley, 16; Bell, 15; Floyd, 15; Clay, 14; Greenup, 14; Boyle, Hart, Johnson, Washington and Woodford, 13 each; and Graves, Knott and Perry, 11 each.

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Colorectal cancer screening should begin at age 45, says federal panel, following American Cancer Society's advice of 2 years ago

By Melissa Patrick

Kentucky Health News

A federal task force now recommends that adults with a normal risk for colorectal cancer get their first screening at age 45, instead of 50, as the American Cancer Society has recommended since 2018. 

Kentucky already requires health insurance plans to start screening for colorectal cancer at 45, and pay for it without any patient cost sharing, under legislation passed by the 2019 General Assembly.

But many other states still follow the U.S. Preventive Services Task Force guidelines, making this new guidance a welcome change in policy, Dr. Whitney F. Jones, founder of the Colon Cancer Prevention Project, said in a news release. 

“This long-anticipated and overdue course correction proposed by USPSTF is welcome in our state and nationally by patients and advocates,” said Jones. “In Kentucky, the potential to prevent colorectal cancers and reduce colorectal deaths for the 225,000 people between age 45 and 49 will further advance our nation-leading improvements in colorectal cancer screening rates.”

Kentucky leads the nation in colon cancer, but is nationally recognized for getting its citizens screened for it, with about 70% of Kentuckians who are 50 and older reporting  they have been screened for it. In the last 10 years, Kentucky colon cancer screenings have resulted in a 25% reduction in incidence and a 28% reduction in death, according to the prevention project website.

The state law on screening, sponsored by Sen. Ralph Alvarado, R-Winchester, also requires health plans to cover genetic tests for cancer, including those for colon cancer.  It took effect Jan. 1.  

The federal task force's proposal is still a draft open for public comment until Nov. 23. The task force is an independent group of experts appointed by the Department of Health and Human Services.

Once finalized,  private insurance plans that are subject to the Patient Protection and Affordable Care Act and Medicare plans would be required to cover colorectal-cancer screening with no co-pay or out-of-pocket cost, according to a group of colorectal-cancer organizations.

Like the Cancer Society's advice two years ago, the task force's decision is largely driven by increases in colorectal cancer in younger adults. The society says 12% of colorectal cancers will be diagnosed in people under 50. 

"Rates have been increasing since the mid-1980s in adults ages 20-39 years and since the mid-1990s in adults ages 40-54 years, with younger age groups experiencing the steepest increase," the society says. It also reports that in African Americans, colorectal-cancer rates are about 20% higher than whites, and death rates are almost 40% higher. 

Timely screening is important because colorectal cancer usually starts from polyps in the colon or rectum that can only be found during a screening so that they can be removed before they ever turn into cancer. Further, there are no symptoms for polyps or early colon cancer. 

"It is estimated that six out of 10 deaths from colon cancer could be prevented if everyone were screened at 45," says the prevention project.

The draft recommendations cover two types of screenings for colorectal cancer, including a direct visualization tests, such as a colonoscopy, or tests that can detect signs of cancer from a stool sample. 

Stool-based tests are noninvasive and can be done at home, but must be done more frequently. Colonoscopies are generally recommended every 10 years after the first one is done, as long as the patient is considered low risk. 

For people aged 76 to 85, the task force continues to recommend that the decision to be screened be made on an individual basis. 

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Over 1/3 of Ky. nursing homes have reported nurse shortages during pandemic; 1/6 have been short during 4 weeks or more

More than a third of Kentucky's nursing homes have reported nursing-staff shortages at least once during the pandemic that has killed hundreds of their residents, one out of six have reported shortages for at least four weeks, and "Some reported nurse shortages for up to 18 weeks," reports John Cheves of the Lexington Herald-Leader.

"In most instances, the same nursing homes that disclosed a shortage of registered nurses and licensed practical nurses also reported a shortage of nurse aides, the workers who give basic care to residents, such as feeding and bathing, usually for less than $14 an hour," Cheves reports. Then he quotes Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, a national nonprofit that lobbies for better treatment of the elderly and disabled.

“The most important thing that determines the quality of any nursing home is its staffing, whether it has enough staff,” Edelman said, adding that in poorly staffed homes, residents can lie in bed all day and get pressure sores, or fall and hurt themselves; and rushed employees make careless medication errors and fail to prevent infections from spreading.

Nursing homes' state lobby, the Kentucky Association of Health Care Facilities, told Cheves many nurses and aides have quit this year, citing child-care demands when day-care centers closed and schools went to remote instruction; fear of getting sick; and worry about bringing the virus to relatives they care for.

KAHCF President Betsy Johnson told Cheves that nursing homes need to offer higher pay, which would require more reimbursement from the federal-state Medicaid program. Cheves notes, "A national study released in August found that the lower a nursing home’s quality of care rating going into the pandemic, the more likely it was to report a nurse shortage during the pandemic."

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Intermittent fasting: Does a new study show downsides — or not?

Intermittent fasting (IF) is an approach to eating based on timing. The idea is that fasting for long enough allows insulin levels to fall low enough that our body will use fat for fuel. Growing evidence in animals and humans shows that this approach leads to significant weight loss. When combined with a nutritious, plant-based diet and regular physical activity, IF can be part of a healthy weight loss or maintenance plan, as I described in an earlier blog post.

Now, a randomized controlled trial published in JAMA claims that IF has no significant weight loss benefit and a substantial negative effect on muscle mass. News outlets picked up the story and ran headlines like A Potential Downside of Intermittent Fasting and An Unintended Side Effect of Intermittent Fasting.

But what did this study actually look at and find?

In the study, 141 patients were randomly assigned to 12 weeks of either a time-restricted eating plan (TRE) that involved fasting for 16 hours and eating only during an eight-hour window of the day, or a consistent meal timing (CMT) eating plan, with three structured meals a day plus snacks.

Neither group received any nutrition education or behavioral counseling, nor was physical activity recommended. There was no true control group (meaning a group that did not receive any instructions about meal timing).

Interestingly, both groups lost weight. Given the headlines, I had to read and reread the results several times, because they show that the IF group lost a statistically significant amount of weight from beginning to end — which wasn’t true in the CMT group. The researchers reported: “There was a significant decrease in weight in the TRE group (−0.94 kg; 95% CI, −1.68 kg to −0.20 kg; P = .01) and a nonsignificant decrease in weight in the CMT group (−0.68 kg; 95% CI, −1.41 kg to 0.05 kg; P = .07).”

Translated into plain English, the IF group lost more weight than could be due to chance: between half a pound and 4 pounds, or an average of 2 pounds. The structured meals group also lost some weight, although the amounts lost could have been due to chance: between 0.1 and 3 pounds, or an average of 1.5 pounds. The upshot was that there wasn’t a significant difference in weight change between the two groups. And the researchers saw a loss of muscle mass in the IF group that didn’t occur in the CMT group.

Diving deeper into the study

By the way, all of these folks may have been eating fried or fast foods, and sugary sodas and candy — we don’t know. The study doesn’t mention quality of diet or physical activity. This isn’t how IF is supposed to be done! And yet the IF folks still lost between half a pound and 4 pounds.

Importantly, the structured meals group also lost weight. While not significant enough to prove it was due to this intervention, for some participants it was enough to make structured meal weight loss differ little from IF weight loss. But think about it: structured meals are an intervention. After all, some people eat more than three times a day, consuming multiple small meals throughout the day. Telling people to limit their eating to three mealtimes plus snacks may actually be helping some to eat less.

The authors very well could have concluded that IF was indeed successful. They might also call for a follow-up study with a true no-intervention control group, as well as behavioral counseling, guidance on a healthy diet, and recommended activity levels for IF and CMT groups.

Does additional support make a difference?

Prior studies of IF that have provided behavioral counseling, and guidance on nutrition and activity, have definitely shown positive results. For example, in a previous blog post I described a 2020 American Journal of Clinical Nutrition study in which 250 overweight or obese adults followed one of three diets for 12 months:

• IF on the 5:2 protocol, which means drastically reducing food intake for any two of five days of the week (down to 500 calories for women and 700 calories for men)
• Mediterranean, which emphasized fruits and vegetables, legumes, nuts, seeds, whole grains, and olive oil with moderate fish, chicken, eggs, and dairy, and with an allowance of one glass of wine per day for women and two per day for men
• Paleo, which emphasized fruits and vegetables, animal proteins, coconut products, butter, and olive oil, along with some nuts, seeds, and legumes.
• And this is key: all participants were provided education on behavioral strategies for weight loss, stress management, sleep, and exercise.

Everyone lost weight. The IF group lost more than anyone with an average of 8.8 pounds, Mediterranean next at 6.2 pounds, and Paleo last at 4 pounds. Adherence was better with the Mediterranean diet (57%) and IF (54%) than with the Paleo diet (35%), and better adherence resulted in one to three pounds more weight loss. The Mediterranean and IF groups also saw significant drops in blood pressure, another good result.

What about the loss in muscle mass that occurred in the IF group in the JAMA study? While this needs to be studied further, it’s important to note that other research on IF that included guidance on physical activity did not show any loss of muscle mass.

The bottom line

What’s the takeaway here? A high-quality diet and plenty of physical activity — including resistance training — are critical for our good health, and nothing replaces these recommendations. IF is merely a tool, an approach that can be quite effective for weight loss for some folks. While this one negative study adds to the body of literature on IF, it doesn’t reverse it. We simply need more high-quality studies in order to have a better understanding of how to most effectively incorporate IF into a healthy lifestyle.

The post Intermittent fasting: Does a new study show downsides — or not? appeared first on Harvard Health Blog.

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Nov. 9 webinar will focus on youth nutrition and physical activity; part of health foundation's annual policy forum

The third of five free webinars about efforts to reduce disease and unhealthy behaviors that often begin in childhood will focus on policies and programs to improve nutrition and physical activity among Kentucky's children, with a focus on improving health equity and the impact of covid-19.

The webinar, "Promoting Healthy Lifestyles Through Nutrition & Physical Activity," will be presented  from 2 to 3 p.m. ET Monday, Nov. 9. It is free, but registration is required. Click here to register.  

The webinar is part of the monthly "Moving Kids Toward Natural Highs" series that is serving as the Foundation for a Healthy Kentucky's annual policy forum, due to the pandemic. The foundation is partnering with Kentucky Youth Advocates on this year's Howard L. Bost Memorial Health Policy Forum. 

This month's panelists will be: Amanda Goldman, health-care industry strategist, Gordon Food Service and the former system director for the Catholic Health Initiatives Food and Nutrition Services national program; Paula Little, assistant superintendent and instructional supervisor, Clinton County Schools; Jamie Sparks, school health program manager for ETR, a national non-profit working to advance health equity, and former coordinated school health director for the state education department; and Nellie Ellis, freshman at Centre College and graduate of Whitley County High School. The moderator will be Marianne Smith Edge, founder, The AgriNutrition Edge, a food-and-agriculture communications consultancy based in Owensboro.

The last two webinars on the schedule will be "Understanding Youth and Building Good Mental Health" (Dec. 14) and "Stopping Vaping and Substance Use" (Jan. 11). 

The webinar recordings for the first two in the series can be viewed on the foundation's website. Click here to view "State of Child Health in Kentucky" and here for "Intervening Early." 

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With 68 counties in red zone, another Top 3 day for new cases, and record hospitalizations, Beshear calls it a frightening time

State Department for Public Health list; red-zone counties have 25 or more new cases per 100,000 people.

By Melissa Patrick
Kentucky Health News

With more than half of Kentucky's counties in the most dangerous zone for new coronavirus cases and the state having three of its top days for new cases this week, Gov. Andy Beshear called it a "frightening time."

"This is a type of outbreak where we can't deny our way out of it," Beshear said at his daily briefing. "We can't rationalize our way out of it. We can't try to find excuses for not following the guidance. It is that present."

The state reported the second-highest single day of new coronavirus cases on Thursday, 1,821, after reporting 1,864 on Wednesday, the record, and 1,786 on Tuesday, the third-highest. (The state announced 2,398 cases Oct. 7, but 1,472 of them were from a Fayette County backlog.)

The share of Kentuckians who have tested positive for the virus in past seven days is above 6 percent for the second day in a row, at 6.04%. Anything above 5% is a concern to public-health experts.

Hospitalizations for covid-19 in Kentucky set a new record, at 969, including 234 in intensive care and 120 of those on ventilators. 

Beshear said 68 Kentucky counties are in the "red zone," meaning they have at least 25 new cases per 100,000 people in that county. Click here for the list. 

Today marks the first day that these red-zone counties are not only asked to follow already-in-place guidelines for schools and nursing homes, but to also follow a set of nine red-zone reduction recommendations, which, among other things, call on businesses and government offices to allow people to work from home if possible and for individuals to cancel all gatherings of any size and to stay home as much as possible. 

"If you are in one of those 68 counties, and most Kentuckians are, we need you to reduce your contacts as much as possible. Really starting now, but certainly Monday through Sunday of next week," Beshear said. "Don't go out unless you have to, don't have gatherings, try to do curbside shopping." 

Again, Beshear said if Kentuckians would just follow the mandates and recommendations already in place, fewer counties will find themselves in the red zone. 

"We know that compliance is our biggest problem right now," he said, adding that if individuals and smaller communities will come together to take ownership of this problem, "We know if that happens, that'll increase compliance." 

Beshear announced 19 new deaths from covid-19 on Thursday, bringing the state's death toll to 1,461. 

He again encouraged Kentuckians to follow the state's guidance, noting that by doing so they are saving lives.  

"Pease help us save lives. Every day you get up and put on a mask, you save lives. Every day you follow the guidance, you save lives. If you are a red county, when you follow what we need you to do in the recommendation, you are going to save lives," he said. 

Halloween: Beshear offered a final pitch to get Kentuckians to follow the state's Halloween guidelines, with several pleas for anyone hosting Halloween parties to cancel them. 

"If families follow this guidance, we think that trick or treating can be safe," he said.. "If you don't, it is not."

The guidance calls on people to only provide individually wrapped candy that is placed on the porch, driveway or table instead of a communal bowl; to maintain social distancing, to wear a face mask, that is not a Halloween mask; to only trick or treat with your family, to sanitize hands often and to not travel to other neighborhoods, among other things. 

He added, "We cannot be having adult Halloween parties right now. . . . So if you're a facility that's out there and you're advertising for it right now, cancel it," later asking them to recognize that we've had three of our four highest days this week and to please not put their communities at risk. "It is dangerous for individuals to go to large gatherings right now," he said. 

Unemployment insurance update: Amy Cubbage, the governor's general counsel, said the state will now sort the claims by the date of the filing, instead of the day the claim is back-filed for to better serve those who have been waiting the longest. She added that the state has requested a federal waiver of the obligation to obtain repayment from those who were mistakenly paid benefits that they didn't qualify for after the federal government changed their eligibility guidance. She also announced several dates that the computer system would be shut down for upgrades. They are: Friday, Nov. 6, and Saturday, Nov. 7; Thursday, Nov. 26, through Saturday, Nov. 28; and briefly after business hours on Dec. 15.

Cubbage also warned Kentuckians to be on the lookout for email scammers using this fake account: PUA@unemployment.usdol.gov. She said scammers are trying to obtain personal information and shared tips to avoid the scam: Never respond to an email unless it is from a ky.gov domain and is clearly marked as coming from a Kentucky Office of Unemployment Insurance employee; you will never be asked to click on a link in an email from  the OUI; unless you initiate contact with U.S. DOL you should not receive any emails from them about your claim.

In other covid-19 news Thursday:

• Today's fatalities from covid-19 were a 68-year-old man from Adair County; a 75-year-old man from Calloway County; a 93-year-old man from Casey County; an 81-year-old man from Daviess County; a 65-year-old man from Fayette County; two women, 83 and 88, and two men, 88 and 90, from Jefferson County; a 73-year-old man from Jessamine County; a 72-year-old man from Lee County; a 61-year-old woman from McLean County; an 80-year-old woman from Meade County; a 71-year-old man from Muhlenberg County; a 68-year-old woman from Rowan County; a 58-year-old man from Russell County; a 68-year-old woman from Shelby County; an 87-year-old woman from Warren County; and an 89-year-old woman from Whitley County.
• Beshear said  227 of today's new cases are children and that in the last seven days, 1,322 of them have been children under 18. 
• In long-term care, Beshear announced there 71 more residents and 42 more staff have tested positive for the virus, with 993 active resident cases and 578 active staff cases.
• The K-12 dashboard shows another 89 students and 32 staff have tested positive for the virus, with a total of  3,136 students and 451 staff in quarantine this week.  
• The college and university report shows 212 new students have tested positive for the virus, with 503 testing positive in the past 14 days. 
• Counties with 10 or more new cases are: Jefferson, 331; Fayette, 127;  Hardin, 65;  Kenton, 52;  Warren, 47;  Christian, 44;  Nelson, 42;  Campbell, 41;  Barren, 40;  Clay, 38;  McCracken, 37;  Pike, 36;  Boone, 33;  Hopkins, 33;  Calloway and  Montgomery, 26 each; Madison, 25; Marion, 24;  Floyd and Whitley, 23 each;  Bullitt and Daviess, 22 each;  Bell, Lee and Marshall, 21 each;  Scott, 19; Caldwell, 18;  Henderson, Knox, Laurel and Oldham, 17 each; Garrard and Hart, 16 each; Boyd, Carter  and Jackson, 15 each;  Harlan and Monroe, 14 each; Logan, 13; Shelby, 12;  Anderson, Franklin, Graves, McLean, Perry and Taylor, 11 each; and Jessamine and Webster, 10 each.
• The Lake Cumberland District Health Department said it would no longer review plans for controlling the virus at public events because people who hold the events don't follow the plans. "Without fail, these groups share with us plans that align with the governor’s guidance. Almost equally without fail these events fail to unfold as planned, and consistent social distancing and masking does not take place," said the department, which serves 10 counties. "It will be the health department’s standing policy that we advise against any such social gathering. While we do not have the authority to prevent these types of events, we can no longer spend our time reviewing plans that consistently fail during execution. We will simply direct such 'event planners' to the state’s guidance."
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Keeping your family safe this Thanksgiving

So much is different and hard during this pandemic — including planning for the holidays.

It’s understandable to want to gather with friends and family. We are all so worn out by the COVID-19 pandemic, and need some cheering up. And most of us have friends and family that we haven’t been able to really spend time with — or haven’t seen at all — for months.

But gathering with friends and family can bring real risks during the pandemic, especially with cases rising all over the country. All it takes is one sick person — who may not even realize that they are sick — to infect others and spread the virus even more.

The best thing to do, honestly, is to celebrate the holiday with just the people you live with, and to skip in-person sporting (or other) events, or in-person Black Friday shopping. That’s truly the best way to keep everyone safe. Just hunker down, check in virtually, and make plans for next year, when things will hopefully be much better.

Still planning to gather for Thanksgiving?

While experts advise skipping gatherings this Thanksgiving, here are some recommendations to help limit risks for people who plan to celebrate the holiday with others.

Plans to make beforehand

• Travel safely if you are traveling. The safest way is by car with just the people you live with, but if that requires an overnight stay somewhere, a direct flight is likely safer. If you do fly, look for flights that space people apart, wear a mask, and bring hand sanitizer and wipes.
• Keep the numbers low. This is just not the year for a big family gathering.
• Keep the party short. This is not the year for a long family gathering either.
• Agree on “no symptoms” and “no exposure.” Make sure that everyone understands that anyone who has any symptoms of COVID-19, or has been exposed to someone with the virus, cannot come. That needs to be non-negotiable.
• Agree to socialize outside if possible. If you have to be inside, do everything you can to improve ventilation, like opening windows (but understand that this is not as safe as being outside).

Seating and food

• Arrange seating so that there is at least six feet between family members who don’t live together.
• Be mindful of risks as you plan the meal:
  • Ideally, everyone should bring their own food and not share.
  • If some people will be cooking, ask them to wear gloves and masks. And limit the people involved in preparing shared food.
  • No buffets this year. Think pre-served plates of food that people can grab and bring to their seat.
  • If you are serving food, have one person wearing a mask and gloves do all the serving.
  • Try to use single servings of condiments (like packets of salt and pepper) so that people are not all touching the same container.
• Use disposable plates, cutlery, and cooking ware, when possible.
• Use touchless garbage cans or pails.

Masks, physical contact, and sanitizing hands and surfaces

• Wear masks when you aren’t eating and when you cannot be six feet apart. I know this feels weird and hard at a family gathering, but it’s crucial.
• No hugs or other physical contact between people who don’t live together. Even elbow bumps are not a good idea. Not this year.
• Everyone should wash their hands often. Have hand sanitizer available.
• Wipe down surfaces regularly (keep wipes in the bathroom, for example).

Finally, don’t go to any crowded sporting events or shopping venues. Again: not the year for that. It’s just not worth the risk.

For more information on keeping your family safe this holiday season, visit the website of the Centers for Disease Control and Prevention or the Harvard Health Publishing Coronavirus Resource Center.

Follow me on Twitter @drClaire

The post Keeping your family safe this Thanksgiving appeared first on Harvard Health Blog.

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White House report: 78% of Ky. counties had moderate or high level of virus spread; says spread is linked to home gatherings

White House Coronavirus Task Force chart; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

For a month, Kentucky has been in the White House Coronavirus Task Force's worst danger zone for case numbers, and with several days of the highest one-day totals yet being reported this week, it doesn't appear that will change any time soon.  

Kentucky is in the red zone for cases, indicating 101 or more new cases per 100,000 population last week, with the 21st highest rate in the country," says the latest task-force report, which covers Oct. 17-23. "Kentucky had 185 new cases per 100,000 in the last week, compared to a national average of 133." 

As cases surge across the nation, it should be no surprise that both the state and national case rates are up from the previous week, when there were 158 new cases per 100,000 in Kentucky and 117 per 100,000 nationwide. 

The report says the state needs a different strategy for reducing transmission than it used in the summer. 

Kentucky was largely able to stay in the  yellow zone for both its positive-test rate and cases from mid-July to late August, meaning it had 10 to 50 new cases per 100,000 and a positivity rate between 5 and 7.9% for most of that time.  

"What worked in the summer is not working in the fall, with cooler weather and considering covid fatigue," says the White House report, which advises: "Keep mask requirements in place and ensure physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and flu immunizations." 

The report puts 93 of the state's 120 counties into one of the danger zones, up from 84 the previous week. Seven more counties, a total of 69, were in the top two danger zones in this week's report. 

The number of counties in the red zone increased from 43 to 47; the orange zone number rose from 19 to 22; and the yellow zone grew from 22 to 24. 

The report says 78% of Kentucky's counties had a moderate or high level of community transmission, with 39% of them having high levels of transmission. 

Gov. Andy Beshear noted at his Oct. 28 briefing that the report calls on the state to work with communities to limit both large and small social gatherings. 

The report says, "Current transmissions are linked to home gatherings. People must remember that seemingly uninfected family members and friends may be infected but asymptomatic. When meeting people who are not a part of one’s household, masking and physical distancing must be observed at all times, especially when indoors." 

Beshear agreed: "If you're having a Halloween party, the state believes you are spreading the virus; the federal government believes you're spreading the virus; don't spread the virus. We need your help." 

The report places the state in the orange zone for the percentage of residents testing positive for the virus, representing a rate of 8% to 10%, with the 18th highest ranking in the country. 

Beshear has said that the White House report uses a different data stream than the state uses, which means the state's positive-test numbers are lower. Wednesday, he said the rate was 6.07%. 

White House Coronavirus Task force maps; for larger versions, click on the image.

Communities in the red zone had positive-test rates higher than 10% and more than 1 new case per 1,000 residents. Those in the orange zone had 0.51 to 1 new cases per 1,000, and a weekly positive-test rate of 8% to 10%, or one of those two conditions and one condition qualifying for the red zone. Yellow-zone communities have new cases between 0.1 and 0.5 cases per 1,000 and a positive-test rate of 5% to 8% -- or one of those, with the other in a higher zone.

White House task force's national map puts Kentucky's positive-test rate into context.

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97% of school districts have tobacco-free policies, including e-cigs

By Melissa Patrick

Kentucky Health News

Only five of Kentucky's 172 school districts have not passed a tobacco-free policy to line up with a state law that went into effect July 2020, according to the Foundation for a Healthy Kentucky. 

The law, for which the foundation campaigned, bans use of all tobacco products, including electronic cigarettes, on school-owned property and school-sponsored events in all public schools. It includes an opt-out provision that allows school boards three years to opt out of the ban, which is why five school districts don't have it. 

"Our goal was not only to encourage more school districts to adopt tobacco-free campus policies, but to help change the culture of Kentucky's school environment to a place where tobacco use is simply not the norm, no matter what time, what day of the week, or what event is happening on campus," Ben Chandler, president and CEO of the foundation, said in a news release. 

The districts that have opted out are in Union, Clay, Leslie, Knott and Bell counties. The two independent districts in Bell County, Pineville and Middlesboro, adopted the tobacco-free policy after the law was passed. 

When the bill became law on April 9, 2019, only 74 of the 172 districts, or 42%, were fully tobacco-free. Now 97% are.

Bonnie Hackbarth, the foundation's vice-president for external affairs, told Kentucky Health News that the foundation is trying to work with the five holdouts and encourage them to pass tobacco-free policies. "Our hope is that they will do so soon," she said. "Going from 42% to 97% is a huge victory, but we definitely don't want to leave out those students in those five counties that remain and so we just encourage them to look at the benefits of making tobacco use not the norm on campus." 

Hackbarth said the most common reason they get for not yet passing the policy is that school districts say they need to give the adults in their communities time to get used to the idea of not being able to smoke at events where they've always smoked, like football games. 

"But it's what's right for our kids," she said. "And it improves the health of everyone by reducing exposure to tobacco. The research shows these policies work." 

The law also requires schools to post signs, but provided no money for the signage. To help with this, the health foundation, the Kentucky Medical Association and the Kentucky Foundation for Medical Care created signs in consultation with the Kentucky School Boards Association and gave them away for free.

As a result of this effort, schools in 101 districts and 51 state operated technology centers across Kentucky are now displaying a total of nearly 12,000 metal signs and window or door stickers announcing that their campuses are tobacco-free, according to the release. 

The schools and centers were also provided with more than 20,000 small cards with a reminder of the new tobacco-free campus policy that districts could hand out in car pool lines and at school events. 

"We know that tobacco-free laws work by reducing not only the number of users, but by reducing the effects of secondhand smoke as well," said KMA President Dr. Dale Toney. "These new signs will help improve compliance with the new policy and prevent thousands of Kentucky youth from becoming addicted to tobacco products. We’re excited that our communities will become healthier as a result of this initiative." 

KFMC President Shawn Jones noted that while fewer teens are smoking traditional cigarettes, there has been a sharp uptick in new users of e-cigarettes. Jones said he hopes the increase in schools with tobacco-free policies and the signage will help curb this uptick. 

According to the 2019 Youth Risk Behavior Surveillance System, which has the latest Kentucky data available, 26.1% of high schoolers in the state said they currently used e-cigarettes, meaning they vaped at least one day in the month prior to the survey; 11.1% vaped on 20 or more days prior to the survey; and 8.7% of them vaped daily. As for cigarettes, the survey found that 8.9% of high school students currently smoke cigarettes; 3% smoked cigarettes on 20 or more days in the month prior to the survey; and 2.2% of them said they smoked daily. 

The 2019 survey found that 17.3% of Kentucky's middle-school students used e-cigarettes or similar products; 2% of them vaped on 20 or more days prior to the survey; and 1.2% of them vaped daily. As for cigarettes, 4.3% currently smoke them; .6% smoked cigarettes on 20 or more days in the month prior to the survey; and .6% of them smoked cigarettes daily. 

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Talking to your doctor about an abusive relationship

When Jayden called our clinic to talk about worsening migraines, a medication change was one potential outcome. But moments into our telehealth visit, it was clear that a cure for her problems couldn’t be found in a pill. “He’s out of control again,” she whispered, lips pressed to the phone speaker, “What can I do?”

Unfortunately, abusive relationships like Jayden’s are incredibly common. Intimate partner violence (IPV) harms one in four women and one in 10 men in the United States. People sometimes think that abusive relationships only happen between men and women. But this type of violence can occur between people of any gender and sexual orientation.

Experiencing abuse can be extremely isolating, and can make you feel hopeless. But it is possible to live a life free from violence. Support and resources are available to guide you toward safety — and your doctor or health professional may be able to help in ways described below.

What is intimate partner violence?

Intimate partner violence (IPV) isn’t just physical abuse like kicking or choking, though it can include physical harm. IPV is any emotional, psychological, sexual, or physical way your partner may hurt and/or control you. This can include sexual harassment, threats to harm you, stalking, or controlling behaviors such as restricting access to bank accounts, children, friends, or family.

If this sounds like your relationship, consider talking to your doctor or health care professional, or contact the National Domestic Violence Hotline at 800-799-SAFE.

What does a healthy relationship look like?

Media images show us uniformly blissful relationships, but perfect relationships are a myth. This culture can make it difficult for us to recognize unhealthy characteristics in our own relationships. Respect, trust, open communication, and shared decisions are part of a healthy relationship. You should be able to freely participate in leisure activities or see friends without fear of your partner’s reaction. You should be able to share your opinions or make decisions without fear of retaliation or abuse. Sexual and physical intimacy should include consent — meaning that no one uses force or guilt to compel you to do things that hurt you or make you feel uncomfortable.

How can a health professional help me?

Health professionals like doctors or nurses can take a history and assess how the abuse may be affecting your health, well-being, and safety. Trauma from IPV can cause visible symptoms, like bruises or scars, as well as more subtle symptoms, like abdominal pain, headaches, trouble sleeping, or symptoms of traumatic brain injury. Health professionals can also provide referrals to see specialists, if needed.

With your consent, health professionals can take a detailed history, examine you, and document the exam findings in your confidential medical record. Let them know if you are concerned that your partner will view your medical record, so measures can be taken to keep it confidential. This documentation can help to strengthen a court case if you decide to pursue legal action in the future.

Additionally, you may be at risk for pregnancy or certain sexually transmitted infections (STIs). A health professional can perform tests for STIs or pregnancy and offer birth control options. Some forms of birth control are less easily detected by your partner, like an IUD, or a contraceptive implant or injection.

Health professionals can help you develop a safety plan if you feel unsafe. They can also help connect you with social services, legal services, and specially trained advocates. If you would like, health professionals can also connect you with law enforcement to file a report.

What is a sexual assault exam?

If you have experienced sexual assault within 120 hours (five days), you may be offered a sexual assault medical examination. This exam is voluntary. It is performed by a trained health professional and may include a full body exam, including your vagina, penis, or anus. It may also include taking blood, urine, or body surface samples and/or photographs that could be used during an investigation or legal action. You may be prescribed medication that could prevent infections or a pregnancy. You can click here to learn more about the sexual assault exam.

What can I expect if I talk to a health care professional about IPV?

Health professionals should listen to you supportively and without judgement. While not all health professionals are trained in trauma-informed care, it is your right to be treated with respect and empathy to help you feel safe and empowered. You should not be pressured to do anything you don’t want to do. And this shouldn’t change the care you receive. You have the right to decline any care you are not comfortable with. You get to decide how you want to proceed after you share information with your healthcare professional, whether that means seeking out legal support, making a safety plan to leave the relationship, or choosing to stay in the relationship and be connected to ongoing support. And you can choose not to share information about abuse at all.

Will the conversation be private and confidential?

These discussions should occur with you and your health professional in a private space. If your abusive partner accompanies you to your appointment, your health professional may ask them to leave the examination room for a period of time so that you have the privacy to talk openly. You can also ask to speak with the health professional alone.

In most cases, discussing your experiences with your health professional is confidential under HIPAA. All states have laws that protect children, elders and people with disabilities from abuse of any kind. Your health professional is obligated in certain circumstances to report abuse, such as violence against a minor or vulnerable adult. However, only a few states require health professionals to report intimate partner abuse.

Where can I find more resources on IPV?

Want to learn more about IPV and how to seek help?

If you or someone you know you is at risk, call the National Domestic Violence Hotline at 800-799-SAFE (7233) or 800-787-3224. This hotline is for anyone, regardless of race, sex, ethnicity, gender identity, sexual orientation, religion, or ability.

If you are unable to speak safely, you can visit thehotline.org or text LOVEIS to 22522. They are available 24/7 by phone or with a live chat, and can work with you to find help in your area.

• RAINN (national resource for sexual assault and violence)
• Love Is Respect (national resource for dating violence)
• WomensLaw.org (legal information for women experiencing domestic violence)
• LGBT National Help Center (LGBTQ+ resources, including chat and peer counseling).

The post Talking to your doctor about an abusive relationship appeared first on Harvard Health Blog.

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On another record day for virus and hospital cases, Beshear says people should wear masks to protect themselves, not just others

Kentucky Health News graph; case numbers are based on initial, unadjusted reports

By Melissa Patrick

Kentucky Health News

After announcing yet another record for the highest number of new coronavirus cases in a single day, Gov. Andy Beshear's messaging shifted to put more of the onus on community members to protect each other from the virus -- and for individuals to protect themselves. 

When counties have at least 25 cases per 100,000 people in the last seven days, which puts them in the "red zone," Beshear said "a coordinated effort" is needed from long-term care facilities, schools and communities to follow the guidelines to thwart the spread of the virus.

"If we can do that, if we can come together, we can make a difference in our local communities, not just protecting nameless, faceless people somewhere in Kentucky, but protecting the people you see every day," Beshear said at his daily briefing. 

The state reported 1,864 new cases Wednesday. The previous high was yesterday, 1,786. It announced 2,398 cases on Oct. 7, but 1,472 of them were from a backlog in Fayette County. 

The day's total pushed Kentucky above 100,000 cases, and even above 101,000 cases, Beshear noted, adding that many of those cases were added recently. 

Hospitalizations for covid-19 continue to increase, with 927 people hospitalized for it in Kentucky, another record, including 235 in intensive care and 110 of those on ventilators. 

The share of people testing positive for the virus in Kentucky in the last seven days is 6.07%. 

Beshear noted that the state's guidance to schools calls for more caution when the positive-test rate is below 6%, but he said schools should continue to follow the current guidelines next week, largely because the figure is barely over 6% and there will be a widespread call next week for all red-zone counties to follow his new recommendations, which includes things like not hosting gatherings of any size and allowing employees to work at home when possible. 

Beshear has asked nursing homes, schools and communities to look at the state's color-coded case incidence map on Thursdays to make decisions around what guidelines they need to follow in the week to come. The map is updated daily. Today, it showed 64 red counties, 47 orange, nine yellow and none in green. 

"We need our communities again, everybody doing their part in each of these areas, to bring those levels down," he said. 

With all metrics headed in the wrong direction, Beshear stressed that it's time for people who may not be concerned about wearing a mask to protect others, to consider wearing one to protect themselves.  

"If you're not wearing a mask, you're putting yourself at risk.. . . People now need to not just do what it takes to protect each other, but to protect themselves," said Beshear." If you're not wearing a mask now, when we passed 101,000 cases, when we have a positivity rate of 6%, when we have 64 red counties -- you're putting yourself at risk. So if you don't want to care for other people, you want to look out for number one, wear a mask." 

The White House Coronavirus Task Force report was not posted on the state's website, but Beshear said it came with several suggestions, including: keep mask requirements in place, ensure physical distancing, avoid public crowds and private social gatherings and to ensure retail establishments are complying with the guidelines. It also said, "Current transmissions are linked to home gatherings." 

Beshear said, "If you're having a Halloween party, the state believes you are spreading the virus; the federal government believes you're spreading the virus; don't spread the virus. We need your help."

Health Commissioner Steven Stack said the incidence-rate map looks the worst ever and by all indications will get worse before it gets better. 

"But we know what works. We know that the tools we have now, as frustrating as they are, are the ones that help keep us safe," he said, noting that those things include wearing masks, social distancing, washing your hands, staying home when sick and getting tested if you have been exposed or have symptoms. 

He also encouraged counties to follow the new guidelines "by aligning what we do in schools, what we do in nursing homes and what we do for all of the communities. If we were to do these things, I have absolute confidence that I could stand here two or three weeks later, and show you a map with green counties and yellow counties and orange counties and a fraction of the red counties we currently have," he said. "But if we ignore it, that whole map's gonna turn largely red and then unfortunately, we'll reach the same conclusion but at a much higher cost."

Eric Friedlander

Earlier in the briefing, Health Secretary Eric Friedlander commended the efforts of those working in long-term care facilities, saying it is due to their efforts that Kentucky is ranked 26th among states for cases and 22nd for deaths. 

Nevertheless, he said we can and should do better, and that includes individuals in a community doing what they can to decrease community spread. 

"All of you can help," Friedlander said. "All of you need to wear a mask. All of you need to practice social distancing. What is important now, in terms of what's happening in our long-term care facilities, has to do with our community spread. If you are in a red county, please . . . follow our guidelines."

Friedlander gave an update on the outbreak at Thomson-Hood Center in Wilmore, the largest nursing home operated by the state Department of Veterans Affairs, with 285 beds. He said there 54 active virus cases among veterans, and 23 active staff cases; and 11 veterans there have died of covid-19. 

“We have to follow the guidelines. That’s the best way we can give back to our veterans and protect them,” said Friedlander.

One more speaker at the briefing asked for compliance.

Virginia Moore, one of the state's American Sign Language interpreters, said in a video post that she is now cancer-free after treatment for uterine cancer. She reminded Kentuckians to not put off cancer screenings, and asked them to be as kind to those suffering from covid-19 as they have been to her. 

"Please use your mask," she said. "Let's show kindness and understanding. Let's do that one thing that we can do, and that's wearing the mask, social distance. Let's pull together as a community. Let's show everyone else the support that you showed me." 

Beshear announced 14 new deaths Wednesday from covid-19, bringing the state's death toll to 1,442. The fatalities were an 83-year-old man from Boyd County; an 80-year-old man from Breathitt County; a 61-year-old woman from Christian County; a 95-year-old woman from Fayette County; a 93-year-old woman and a 91-year-old man from Henderson County; an 87-year-old woman and three men, 70, 80 and 81 from Jefferson County; two women, 80 and 82, from Kenton County; a 64-year-old woman from Knox County; and an 85-year-old woman from Lee County.

In other covid-19 news Wednesday: 

• Counties with 10 or more new cases were Jefferson, 352; Fayette, 102; Hardin, 78; Nelson, 67; Pike, 60; Kenton, 59; Warren, 49; Christian, 37; Bullitt, 35; Barren, 33; Boone and Daviess, 32 each; Madison,  Montgomery and Scott, 28 each; Campbell and Knox, 26 each; Jessamine and Marion, 24 each;  Hart, 23; Henderson, Laurel  and McCracken, 21 each; Clay and Lee, 20 each; Franklin and Taylor, 19 each; Boyd and Oldham, 18 each; Rockcastle and Shelby, 15 each; Bell and Calloway, 14 each; Caldwell, Marshall and Rowan, 13 each; Hopkins, Larue, Lincoln and Magoffin, 12 each; Martin, Monroe and Whitley, 11 each; Floyd, Greenup and Logan, 10 each. 
• Fayette County saw its third-highest day of new cases Tuesday, 135, with Sept. 10 and 11 having more new infections, according to its health department. Spokesman Kevin Hall told the Lexington Herald-Leader that the jump in cases is not tied to any one location. He said hospitalizations are also increasing in the county; in the summer, they were seeing upwards of 40 a day, but now that is moving closer to 60. “With colder weather coming, the concern is more people will stay indoors and have gatherings inside, which could lead to more cases,” said Hall. “We also need to remind people to stay home if they’re symptomatic.”
• Beshear announced that the state, in partnership with the federal government, is offering some new testing sites to address the surge in cases. The new sites will be in Louisville and Lexington. Each person who gets a test will get a pack of five cloth masks.  Click here to check for dates, locations and to register. 
• In long-term care, the daily report shows 105 new resident cases and 60 new staff cases, with 928 active resident cases and 511 active staff cases. There have been 861 resident deaths and six staff deaths attributed to covid-19. 
• The K-12 dashboard says during the current week, 292 students and 149 staff have tested positive for the virus and 2,379 students and 354 staff are quarantined. 
• The college and university report says 463 students and eight staff have tested positive for the virus in the past 14 days. 
• Kroger Co. said it will offer rapid antibody testing for the virus, with most results coming in 15 minutes, at all its pharmacies by the end of November. It said the $25 tests would be conducted by a health professional using a finger stick, and are already being offered in California and Michigan. Antibody testing determines whether someone has had the virus and might have developed some immunity.
• The national seven-day rolling average of new cases topped 70,000 for the first time, "a disturbing record that comes as the number of hospitalizations climbs toward its midsummer peak, and the death rate creeps upward," The Washington Post reports.
• President Trump is saying in campaign speeches that the national surge of cases is caused by increased testing, and has suggested that the numbers are part of a conspiracy against him. The White House's testing czar, Admiral Brett Giroir, said otherwise Wednesday. “It’s not just a function of testing,” he said on NBC’s “Today” show. “The cases are actually going up. And we know that, too, because hospitalizations are going up.”
• Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, gave a 30-minute coronavirus update on JAMA Network's YouTube channel. "We're going into a precarious situation," he said, because cold weather has arrived and the holiday season is approaching. Asked for recommendations about the holidays, he said "You have to take a look at what the risk is to your particular situation," depending on ages, underlying conditions and other factors and ask: "Is it worth it for this year to being these people together when you don't know . . . the status of everybody?" He noted that a person can have the virus without symptoms and still pass it on.
• Fauci said a national mask mandate is needed to get mask wearing to 90-95% of the population. "It makes a difference," he said. "It really, really does." Failing that, he said, "We have to sort of shake each other by the collar and say, 'Look at what's going on'."
• The Centers for Disease Control and Prevention sent a letter to governors this week pushing the deadline for states to be ready to receive and distribute a coronavirus vaccine between Nov. 1 to Nov. 15, the Herald-Leader reports. Such early delivery appears unlikely.

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Are there medical exceptions for mask wearing? Very few.

The Washington Post

A so-called “mask loophole” has been circulating on social media. It suggests that people who don't want to wear masks should tell store workers that they have a medical condition, and if challenged they should cite the privacy section of HIPAA, the Health Insurance Portability and Accountability Act.

To be clear, the Americans with Disabilities Act doesn't apply to people without disabilities, and HIPAA only applies to the flow of medical information through health-care providers and insurers.

“This social-media post doesn’t relay a ‘mask loophole’ so much as it encourages people to exploit a law designed to provide protections to disabled people,” the fact-checking website Snopes wrote.

There are very few conditions that would prevent someone from being able to wear a mask. The Centers for Disease Control and Prevention says people who should not wear a mask are: 1) children younger than 2 years old; 2) anyone who has trouble breathing; 3) anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

“Anyone who has trouble breathing” is ambiguous, and this seems to be where people like to point if they don't want to wear a mask.  In an article in the medical journal JAMA, a legal expert and a medical expert wrote that “few medical conditions are truly incompatible with all forms of mask wearing.”

People with facial deformities that are incompatible with masks is one example the authors raised. People with sensory or processing disorders was another. But less clear were the cases of people with chronic lung illnesses who weren't experiencing an acute attack. There is some evidence that masks protect the wearer to a certain extent, which would be beneficial to those with underlying lung disease. Having a chronic cough is also a really good reason to wear a mask.

For asthma, it depends on the severity. For people with mild or well-controlled asthma, masks shouldn't be a problem, according to the Asthma and Allergy Foundation of America. For those with severe asthma that involves many hospital visits and medications, wearing a mask for long periods might not be best.

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Mind-body medicine in addiction recovery

As someone who struggled with a miserable opiate addiction for 10 years, and who has treated hundreds of people for various addictions, I am increasingly impressed with the ways in which mind-body medicine can be a critical component of recovery from addiction. Mind-body medicine is the use of behavioral and lifestyle interventions, such as meditation, relaxation, yoga, acupuncture, and mindfulness, to holistically address medical problems. Mind-body treatments can be integrated with traditional medical treatments, or used as standalone treatments for certain conditions. Mind-body medicine is now being studied by the National Institutes of Health and effectively used in the treatment of addiction, and it will likely play a role in addiction recovery programs in the future.

Mind-body principles are not new to the recovery movement

Mind-body principles have been around since the start of the recovery movement in 1937, and they are a big part of Alcoholics Anonymous. The 12 Steps of AA feature concepts such as surrender, meditation, gratitude, and letting go — all critical components of mind-body medicine. Most 12-step meetings end with the Serenity Prayer: “God, grand me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Mutual help groups play a role in recovery for many people, and the principles of mindfulness that are part of these programs — in addition to the social support — shouldn’t be overlooked.

My experience with mind-body therapies for addiction

When I was sent to rehab for 90 days by the medical board due to my addiction, we participated in a lot of activities that seemed to be meant to approximate mind-body medicine, but they were haphazard and not particularly scientific, and I don’t believe they had the intended effect or were at all therapeutic. For example, we did shrubbery mazes (I’d get lost); we sat meditatively in silence (everyone around me chain-smoked, triggering my asthma); we had repeated lectures about “letting go and letting God” (I still have no idea what this means); we’d spend 30 minutes staring at a red square projected onto a screen (this gave me a migraine); and we went to a local acupuncture place where they hooked up extra electric current to the needles to give us extra “chi” (I felt like I was being cooked for dinner). Given that rehab is a $50 billion industry, I felt this was a lost opportunity to utilize mind-body medicine in a way that wasn’t superficial or trivial.

Formal mind-body therapies for addiction are being rigorously studied

Fortunately, there are now several scientifically-based mind-body medicine options for people in recovery. Mindfulness-Based Relapse Prevention (MBRP) is a technique that uses meditation as well as cognitive approaches to prevent relapse. It aims to cultivate awareness of cues and triggers so that one doesn’t instinctively turn to using drugs. It also helps people get comfortable sitting with unpleasant emotions and thoughts —their distress tolerance, a person’s ability to tolerate emotional discomfort — without automatically escaping by taking a drug. Improving distress tolerance is a common theme to many, if not all, approaches to addiction recovery, as a large part of the appeal of drug use is replacing a bad emotion with a good emotion — for example, by using a drug.

Mindfulness-Oriented Recovery Enhancement (MORE) is another technique to address addiction in recovery. MORE attempts to use both mindfulness and positive psychology to address the underlying distress that caused the addiction in the first place. There are three main pillars of MORE: it has been proven to help with distress tolerance; cue reactivity (the way people with addiction respond to cues, such as seeing a bottle of prescription drugs, which often trigger cravings); and attentional bias (the way an addicted brain will pay extra, selective attention to certain things, such as a pack of cigarettes when one is quitting smoking).

Mindfulness-Based Addiction Therapy (MBAT) is a technique that uses mindfulness to teach clients how to notice current emotions and sensations, and how to detach themselves from the urge to use drugs. This is called “urge surfing,” and we practiced it extensively in rehab. The aim is to break the automatic link between feeling uncomfortable, craving drugs, and, without thought or reflection, taking a drug to alleviate that discomfort.

Is there good evidence for mind-body medicine approaches to recovery?

While there is promising research that mind-body treatments for addiction are effective, some of the research is contradictory. According to a meta-analysis in the Journal of Substance Abuse Treatment, mindfulness is a positive intervention for substance use disorders, it has a significant but small effect on reducing substance misuse, a substantial effect on reducing cravings, and, importantly, it is a treatment that has a large effect on reducing levels of stress.

However, not all studies of mind-body medicine for addiction have shown overwhelmingly positive results. Some studies showed that the treatment gains diminish over time. Some randomized controlled trials did not show that mind-body medicine was better than cognitive behavioral therapy in decreasing alcohol and cocaine use, or in abstaining from cigarette use.

The National Center for Complementary and Integrative Health did a thorough review of much of the current literature surrounding mind-body medicine as it applies to addiction treatment, and summarized the impact of certain mind-body treatments as follows:

• Acupuncture is generally safe, and may help with withdrawal, cravings, and anxiety, but there is little evidence that it directly impacts actual substance use.
• There was some evidence that hypnotherapy my improve smoking cessation.
• Mindfulness-based interventions can reduce the use of substances including alcohol, cocaine, marijuana, cigarettes, opiates, and amphetamines greater than control therapies do, and are also associated with a reduction in cravings and risk of relapse. But the data in several studies are not strong.

At this time, we need more and better evidence, and more definitive conclusions, about how helpful, ultimately, mind-body medicine will be in helping to treat addiction in different treatment settings. But a takeaway message is that mindfulness-based treatments are certainly quite effective as adjunct treatments for addiction, in that they can help people with their anxiety, distress tolerance, and cravings, and quite plausibly will turn out to help people put down the drink or the drug, and to avoid relapsing, once they have managed to get themselves into recovery.

Mind-body interventions to prevent addiction

If mind-body medicine can significantly reduce stress, then one must ask if it can also help us prevent addiction by helping our society deal with the chronic, overwhelming stress that it is facing. Addiction is in large part considered to be a “disease of despair.” Important contributors to addiction are untreated anxiety and depression, unresolved childhood trauma, social isolation, and poor distress tolerance. If all of us can learn, or be trained, to be more mindful, grateful, present, and connected, perhaps the need, and eventually the habit, of fulfilling our most basic needs with the false promise of a chemical that merely wears off — and leaves us worse off — will become less of a problem in our society.

The post Mind-body medicine in addiction recovery appeared first on Harvard Health Blog.

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Virus cases and hospitalizations accelerate, setting new records

Gov. Beshear recognized Bobby Rorer of Lawrenceburg, who died of covid-19. He enlisted at age 16.

By Lisa Gillespie
Kentucky Health News

Kentucky's coronavirus increase accelerated Tuesday, as the state reported 1,786 new cases, the state’s highest one-day total yet. 

“We are seeing this very serious escalation of cases,” Gov. Andy Beshear said at his daily briefing. ”Just look at last week, 9,335 cases, look at how quickly it grew and by how much. I'm here to tell you that we expect this week's cases to exceed last week's cases,” which was the highest week yet.

The previous high for the number of cases found in a single day was 1,738, on Saturday. The state announced 2,398 cases on Oct. 7, but 1,472 of them were from a backlog in Fayette County. The total for the pandemic is almost 100,000.

Hospitalizations for covid-19 are also accelerating, with 913 people hospitalized Tuesday, a new record, with 233 of them in intensive care and 115 of those on a ventilator.

Also increasing is the share of Kentuckians testing positive for the virus in the last seven days. That is 5.97 percent, continuing a steady rise over the period.   

Beshear reiterated his new “red-zone reduction recommendations” that call for counties in with at least 25 cases per 100,000 people in the last seven days to take more steps to thwart the spread of the virus.

The governor said Kentuckians should look at the state's color-coded case-incidence map on Thursdays to make decisions for business operations the following Monday, just as the state’s schools are doing.

“Schools are going to do their part, government should be doing their part, our employers should be doing their part,” Beshear said. “It brings all of it together in a way that where we can have the most effective response. . . . It also lets us know, week to week, how safe it is or is not in our community.” 

He added later, “It’s about everybody having to pitch in when a community is in the red, and that school system not shouldering the burden of all of it.” 

Among other things, the recommendations ask people in red zone counties to not eat in restaurants, to allow employees to work from home when possible, and to not host gatherings of any size.

Asked again why these are recommendations and not mandates, Beshear said that the recommendations put “the right type of pressure on a community to come together to do what it takes” to bring their cases down, while also following the existing mandates such as mask wearing and limited restaurant capacity. 

But he added, “If increases continue, if communities can't get things under control, we're not ruling out additional steps.” 

Prison report: J. Michael Brown, Beshear’s executive cabinet secretary, said there are 263 active inmate cases and 20 active staff cases in state correctional facilities, most of them at the Little Sandy Correctional Complex in Elliott County, where at least 239 inmates and nine staff have contracted the virus.

Beshear asked that residents and businesses in Elliott County, which currently has the highest incidence rate in the state, follow the red-zone recommendations because employees and vendors regularly move between the facility and the community. 

“There’s 300 plus employees that go in and out on a daily basis,” he said. “It means that the community is at risk based on that level of transmission.” 

The governor announced 18 more deaths from covid-19, bringing the state’s death toll to 1,428. The Lexington Herald-Leader reports that with four days left, October is already the deadliest month of the pandemic, with 254 deaths.

Victims' stories: Beshear recognized the late Bobby Rorer of Lawrenceburg, who died Oct. 16 of covid-19. Rorer, a familiar figure at Democratic Party events, was a veteran who “never met a stranger” and was the father and step-father of two sons and two daughters, and had nine grandchildren. 

Rorer was a resident of the Thomson-Hood Veterans Center in Wilmore, where he passed away separated from his family and called for his wife Dana in his final days. 

“That’s what this virus does to our people, makes the hardest moments more unbearable,” Beshear said. 

Kelly Alexander, chief of staff at the Department for Public Health, told the story of her 40-year-old husband, Josh, who contracted the virus in his work as a Louisville firefighter. She said he had been “extremely healthy and loved hiking and the outdoors” and had no pre-existing conditions, “couldn't even talk without being short of breath, or suffering from a coughing attack.” 

She said he had acute respiratory failure, pneumonia in both lungs and liver inflammation. and is now home, but still fighting pneumonia. 

“I do not want to see any more Kentuckians hospitalized with covid-19, or in the ICU; we must come together and act with compassion for our families, friends and communities,” Alexander said. “Please stay home, if you are sick, seek medical care when and if you need it, stay physically distant from others who are not within your immediate household, wear a mask and practice proper hand hygiene.”

Here's a video of Alexander's presentation, via the Herald-Leader:

In other covid-19 news Tuesday:

• While UK HealthCare is again preparing for an "expected increase" in covid-19 patients, it will not likely need an overflow facility, like the unused $7 million field hospital that was deconstructed month ago, Alex Acquisto reports for the Herald-Leader.nbsp At a nbspvirtual news conference Monday, Dr. Mark Newman, UK's health vice president, said the current models "are peaking much lower, within the range of [hospital] capacity" currently across the state. 
• WDRB reports that the three largest health-care providers in Louisville, Baptist Health, Norton Healthcare and the University of Louisville, are seeing an increase in covid-19 patients, but not intensive-care patients. However, hospital officials told WDRB that they worried about capacity during cold weather and flu season. 
• Pfizer Inc. will likely say whether its coronavirus vaccine works after the election, with hopes to be able to apply for emergency use authorization by the end of November, CEO Albert Bourla said Tuesday, Inside Health Policy reports.
• Becker's Hospital Review reports, "The number of people with covid-19 antibodies decreased by 26.5% between June 20 and Sept. 28, suggesting that contracting the virus might not mean gaining long-lasting immunity, according to a study conducted by Imperial College London and Ipsos Mori, a London-based polling organization . . . If the study's findings are confirmed, the prospect of widespread long-term herd immunity may be difficult to achieve."
• The latest Children and Covid-19: State Data Report, by the American Academy of Pediatrics and the Children's Hospital Association, says almost 800,000 U.S. children have been infected by the coronavirus, making up 11% of the 8.4 million cases in the U.S. -- about 1,053 cases per 100,000. From Oct. 8 to 22, 94,555 new youth cases were reported, a 14% increase. Hospitalizations and deaths remain very low. As of Oct. 22, the reports says 15.4% of Kentucky's cases have been in people under age 20, with a rate of 1,251 cases per 100,000. 
• The 18 deaths reported Tuesday were a 99-year-old woman from Christian County; a 79-year-old woman from Henderson County; a 70-year-old woman from Hopkins County; three women, 79, 82 and 86, and five men, 62, 62, 70, 88 and 93, from Jefferson County; two men, 96 and 97, from Jessamine County; a 76-year-old man from Nicholas County; a 72-year-old man from Ohio County; two women, 77 and 91, from Scott County; and a 72-year-old woman from Wayne County.  
• Counties with 10 or more new cases were: Jefferson, 379; Fayette, 118; Warren, 68; Kenton, 60; Hardin, 49; Pike, 45; Barren, Laurel and Madison, 42; Boone, 41; Bullitt, 40; Campbell and Nelson, 36; Clay and LaRue, 25; Hart, 23; Daviess, 22; Lee, 21; Calloway and Logan, 20; Floyd, 19; Christian and Whitley, 18; Jessamine, Johnson, Knox, Marion and McCracken, 16; Garrard, Henderson, Montgomery and Todd, 14; Clark, Hancock, Martin and Rockcastle, 13; Boyd, Grant, Perry and Shelby, 12; Estill, Lincoln, Monroe and Scott, 11; and Carter, Franklin, Graves and Ohio, 10. 
• In long-term care, 57 new residents and 33 new staff have tested positive for the virus, with 906 active resident cases and 500 active staff cases. There have been 852 resident deaths and six staff deaths from covid-19. 
• The college and university report shows 30 new student cases and three new staff and faculty cases, with 518 new student cases and eight new staff and faculty cases in the last 14 days.
• The K-12 public health report, which includes verified case numbers, shows 563 students and 260 staff tested positive for the virus in the last 14 days.

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