Studies forecast new restrictions could save lives, reduce hospitalizations; Beshear warns hospitals at 'tipping point'

University of Louisville graph, relabeled by Ky. Health News; for a larger version, click on it.

By Melissa Patrick

Kentucky Health News

A new study shows that compliance with Kentucky's new emergency orders to thwart the coronavirus could save up to 1,000 lives in the Louisville region, and presumably have similar results across Kentucky.

Department for Public Health map,
adapted by Kentucky Health News

As he made perhaps his strongest plea yet for compliance, Health Commissioner Steven Stack went over two University of Louisville studies that forecast deaths and hospitalization trends in Jefferson County and the 14 other counties in the Louisville hospital region, based on differing levels of compliance.

One study projects that by mid-January, a high level of compliance would prevent about 1,000 deaths in the 15 counties and low compliance would still prevent more than 500 deaths. 

The study also forecasts 1,689 active hospitalizations in mid-January with little to no compliance, up from about 350 now. High compliance would limit the increase about 100 hospitalizations, the study predicts.

"This is substantial," Stack said. "Those measures, if they're followed, could have a profound impact and could really change the trajectory of this, and completely avert the crisis of health-care staffing and the harm that is caused to other people without covid who aren't able to get care because covid fills the hospitals, consumes all the resources and also causes health-care workers to go out sick. " 

Stack noted that for three weeks, the state had recommendations in place that public-health officials said would have brought down Kentucky's infection rates if they had been followed. Stack said Kentucky health officials were "asking, urging, begging, pleading, trying to persuade with facts and figures, and also appeals to people's better angels" to try to get people to comply, but it didn't work.  

"And as a result, because we can't stand by idling and let Kentuckians who can't otherwise protect themselves who are vulnerable, pay with their lives, literally. . . . The additional measures became necessary," he said. "And if we were just to comply fully with the mask mandate, that alone probably would help to contain this virus and get us back to reopening all these different things that are now shuttered. So ultimately, it's the public's choice, how we're going to respond." 

Stack called on local leaders and individuals to step up and do their part to improve compliance  in their communities. He also urged Kentuckians to not celebrate Thanksgiving with anyone who is not in their households, calling it an "assured recipe for disaster."

"This is really important. This is a defining moment. And we're gonna have a dark winter if we don't pull it together," he said. "And we want to lift as many of these restrictions as fast as we can, as soon as we can feel more confident that it won't be paid for with large-scale loss of human life and harm to other people who need medical and hospital care who don't have covid." 

Last week, Beshear banned in-person schooling and indoor service in bars and restaurants, limited indoor gyms and recreation facilities to one-third capacity, with no group classes; placed a limit of 25 people in all venues, event spaces and theatres; limited professional spaces to one-third capacity along with a call for them to allow people to work at home or to close altogether if at all possible; and limited sizes of gatherings to eight people from a maximum of two families. Beshear also asked churches to stop in-person worship. In addition, the mask mandate remains in effect. 

The second study Stack discussed looked at compliance with the mask mandate in Jefferson County. It found that men aged 19 to 44 were the least likely to wear a mask. Researchers who observed 191 public areas found that men made up 82% of unmasked staff and 75% of unmasked visitors, and more than half of the incorrectly masked visitors.  

The study also compared mask compliance in small, medium and large public areas and found that compliance was worst in small areas; 35% of such areas had at least one unmasked visitor, compared to 23% in medium-sized areas and 14% in large areas. Large areas had the highest rate of at least one visitor wearing their mask incorrectly, 61%. 

Daily data, threat to hospitals: Beshear announced 2,135 new cases of the coronavirus, another record for a Monday, a day that is typically low because of limited laboratory work on weekends. This follows the highest week for cases yet, up 22 percent from the week before.

"With what we're going to see happening over Thanksgiving, we're headed to an even darker place than we are right now," Beshear said. "That's why we're taking the steps that we're taking, to put up a fight against a virus that wants to take those we love. And it's our job to fight for those individuals. " 

The share of Kentuckians testing positive for the virus in the past seven days dropped a bit, to 8.97%. It had been above 9% since Tuesday, Nov. 17.

The state reported another day of highs for covid-19 hospitalizations and intensive-care-unit beds: 1,573 and 391, respectively. Of the ICU patients, 203 were on ventilators.

Beshear was asked if Kentucky hospitals have enough specialists to operate the ventilators around the clock for an extended period of time if they reach or extend beyond capacity, a worry in some other states.

"We talk about running out of staff before we run out of beds," he said. "We think it’s the same with ventilators." He said that if ventilator staff go out sick, hospitals "have to start bringing in people who don’t do it on a daily basis and our outcomes aren’t as good."

Beshear again warned that if cases continue to escalate, the state's health-care system will become overwhelmed, and said it is at "a tipping point." He asked Kentuckians whether they were willing to make sacrifices to ensure everyone has access to care when and if they need it, and said:

"We're taking action before we hit the point of no return, because that point is close, folks. If we don't take action now, what we're talking about will happen. Taking action before Thanksgiving is critical to make sure that the surge that we all expect to see afterwards, [to] make sure that we're as ready for it as we can [be]."

Beshear pointed to examples in other states as cases surge across the nation. He said New York has had to reopen a field hospital, the Mayo Clinic's Wisconsin hospitals have been forced to put beds in lobbies and a parking garage because they have exceeded capacity, and 22% of hospitals nationwide say they will face a critical staff shortage in the next week.

Because this surge is happening all across the nation, Beshear warned,  "There's nobody coming to help us. When our Kentucky providers run out, there's no one coming to our aid. We have to protect ourselves and the threat is so very real." 

In an open letter, hospitals and health departments in the Paducah area pleaded with the public to wear masks, wash hands frequently, and practice social distancing. “We’re under some pretty significant stress right now,” Murray-Calloway County Hospital CEO Jerry Penner told Murray's WKMS. “Our resources are getting tight and our beds are filling. . .. We’re getting ready to go into a significant holiday when people normally get together. Now all of a sudden we’re asking people to wear masks and in some cases, the governor is asking them not to have large groups at home. We can only imagine the two weeks after Thanksgiving, we’re gonna have another potential blossom of a number of cases. We just need everyone’s help to think about what they’re doing.

Beshear shared a video of health-care workers asking Americans to wear a mask, and his news release noted a recent study in Kansas from the U.S. Centers for Disease Control and Prevention that shows on average, counties that mandated mask-wearing saw a 6% reduction in cases; in contrast, the counties that opted out saw a 100% increase in cases.

The governor announced five new deaths from covid-19, bringing the state's death toll to 1,792: a 73-year-old Fayette County woman, a 73-year-old Harlan County man, a 77-year-old Webster County man and two McCracken County men, 85 and 88.

Beshear honored the life of LaTasha Benton of Lexington, who died of complications from covid-19 at only 43. Beshear said Benton was a key member of the Lexington community, who worked on issues such as tenants’ rights, affordable housing and criminal justice reform.

Benton was featured in a New York Times series about people who have died of covid-19. In the article, her mother, Stephanie Pace, said that even after two kidney transplants, two strokes and two hip replacements, she never complained, saying, "She was my little bionic girl." Beshear said she tested positive for the virus at the end of October and died on Nov. 6. She is survived by her son, Daniel, her two brothers and her mother. 

"LaTasha, we are so sorry, and we grieve with your family," Beshear said. "I will wear my mask for you and I hope everybody else does, too." 

In other coronavirus news Monday:

• Counties with 10 or more new cases were Jefferson, 435; Fayette, 260; Madison, 110; Boone, 85; Kenton, 77; McCracken, 68; Warren, 54; Campbell, 39; Oldham, 38; Greenup, 32; Jessamine, 30; Daviess, 28; Graves, 26; Calloway, 25; Franklin, 24; Whitley, 23; Bullitt, 22; Montgomery, 22; Boyd, Logan and Powell, 21 each; Barren, Floyd and Shelby, 20 each; Henderson, 19; Pulaski, 18; Magoffin and Scott, 17; Caldwell 16 Grayson, 15; Breathitt, Muhlenberg, Owsley, Simpson and Spencer, 14 each; Boyle, 13; Bell, Carter, Hardin, Laurel and Mercer, 12 each; Garrard, Hopkins, McCreary and Russell, 11 each; Harlan, Letcher, Morgan and Taylor, 10 each.
• In long-term care, there were 6,065 active cases in residents and 5,437 among staff, with 138 new resident and 135 new staff cases reported Monday. Beshear said 37 more new resident deaths and one new staff death had been confirmed, bringing the toll attributed to covid in these facilities to 1,155 residents and seven staff.
• Beshear said 15 inmates have died from complications from covid-19, including two from the Kentucky State Reformatory who died this weekend. Two corrections employees have died from covid-19. 
• The college and university report shows 813 students and nine staff tested positive for the virus in the past 14 days. 
• More than 1,000 Kentucky parents, nine religious schools filed a brief supporting a lawsuit by Danville Christian Academy and Attorney General Daniel Cameron against Beshear's order to stop all schools from holding in-person classes. At a Monday hearing, "The judge said both sides made good arguments," WKYT reported. 
• Kentucky funeral homes are divided about Beshear's limit of 25 people in a room, Kristen Shanahan reports for Louisville's WDRB.
• Drugmaker AstraZeneca  announced in a news release that clinical trials show its coronavirus vaccine is 90% effective in preventing covid-19 in one of the dosing regimens tested and less effective in another, the Associated Press reports. The vaccine is also reported to be cheaper and easier to store since it does not require ultra-cold storage, so it may become the vaccine of choice for the developing world. Earlier this month, Pfizer and Moderna reported that their late-stage trials showed their vaccines were almost 95% effective. Both of these vaccines require special storage. The Lexington Herald-Leader explores what it means for a vaccine to be over 90% effective. 
• The first two vaccines for the virus have been developed with a revolutionary kind of genetic technology, report Grace Schneider and Deborah Yetter of the Courier Journal after interviewing University of Louisville physician and researcher Jon Klein, who participated in one of the clinical trials. "He said if the Pfizer and Moderna vaccines win approval and prove successful, it would be a stunning turnaround time for development of a vaccine. Prior to that, the mumps vaccine held the record as the fastest developed — and it took several years. Still, Klein warned the vaccines won't be available in time to prevent what he sees as a pending covid-19 catastrophe, with rates soaring across the United States, as well as many parts of the world."
• Yetter also takes a deep dive into the struggles facing the state's nursing homes and senior living sites as they continue to get slammed with the virus, and no end in site as long as rampant community spread continues.